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Body Checking and its Avoidance in Eating Disorders
Abstract
One expression of the core psychopathology of eating disorders is the repeated checking and avoidance of shape or weight. Two studies are reported. The primary purpose of the first was to describe the phenomenology of such body checking and avoidance. The aim of the second was to compare body checking and avoidance in women with and without a clinical eating disorder.
In Study 1, 64 female patients with clinical eating disorders participated in a semistructured interview assessing the features of body checking and avoidance. In the second study, a self-report questionnaire was used to compare body checking and avoidance in women with and without a clinical eating disorder (n = 110).
The majority (92%) of the patients in Study 1 checked their bodies to assess their shape or weight and this was associated significantly with eating disorder symptoms. In Study 2, the clinical group had significantly more body checking and avoidance than the comparison group, and there was a strong association between eating disorder psychopathology and body checking and avoidance.
These findings support the view that body checking and avoidance are direct expressions of the overevaluation of shape and weight. Further work is needed to determine whether these expressions contribute to the maintenance of eating disorders.
... According to Stice et al. (2011), individuals dissatisfied with their own bodies, as well as those with body image distortion, may adopt unhealthy behaviors such as changing eating behavior, including disordered eating (i.e., vomiting, use of laxatives and diuretics, restrictive diet and not eating) and maladaptive and/or excessive exercise behavior, which may result in exercise dependence (Alcaraz-Ibáñez et al., 2021). Male physical exercise practitioners have a high frequency of body image disturbances that include dysfunctional beliefs about the body and appearance (e.g., body-ideal or muscular-ideal internalization), constant body checking behaviors (Carvalho et al., 2013;Shafran et al., 2004), and a heightened drive for muscularity (Edwards et al., 2014;McCreary & Sasse, 2000), showing a concern with acquiring a muscular physique, with emphasis on particular body parts, such as shoulders, chest and arms . Being this body, characterized by an ideal with a muscular upper body and low body fat index (Almeida et al., 2019). ...
... Regarding body-checking behaviors we found no effects of time, protocol or interaction between timepoint measurements and protocol. Body-checking behaviors are frequent among male physical exercise practitioners (Carvalho et al., 2013;Shafran et al., 2004), and include behaviors such as frequent weighing, examining specific body parts in the mirror, using the fit of clothes to judge shape or weight change, and body comparison (Shafran, Fairburn, Robinson, & Lask, 2004). This excessive body-monitoring behavior increases the selective attention to disliked body parts, and as a result, individuals become increasingly preoccupied and dissatisfied with their bodies. ...
... Regarding body-checking behaviors we found no effects of time, protocol or interaction between timepoint measurements and protocol. Body-checking behaviors are frequent among male physical exercise practitioners (Carvalho et al., 2013;Shafran et al., 2004), and include behaviors such as frequent weighing, examining specific body parts in the mirror, using the fit of clothes to judge shape or weight change, and body comparison (Shafran, Fairburn, Robinson, & Lask, 2004). This excessive body-monitoring behavior increases the selective attention to disliked body parts, and as a result, individuals become increasingly preoccupied and dissatisfied with their bodies. ...
Introduction: Body image disturbance, encompassing dissatisfaction, behaviors, and perceptions, is often associated with negative body image values. Scientific studies have aimed to identify strategies capable of modulating aspects of body image, with physical activity emerging as a viable intervention. Objective: This study aimed to assess the effects of aerobic exercise sessions at varying intensities on body image components in sedentary men. Twenty-six young adults (mean age 25.4 ± 3.3 years) were randomly assigned to either: a) 30 min at 60-70% of reserve heart rate (HRRes) or b) 70-80% of HRRes. Methods: Validated measures were used to assess body dissatisfaction, drive for muscularity, body checking behaviors, body-ideal internalization and body image perception in the five time-points: Pre-exercise, Post-exercise, 24, 48 and 72-hours post-exercise. Results: The main results indicated increases in muscularity dissatisfaction, with an isolated effect of the measurement time-points (p≤0.001) in which the 48h post-exercise had a higher average compared to the others [Pre (p≤0.001; 95%CI= 0.8-3.9), Post (p=0.001; 95%CI= 0.5-3.7), 24h (p≤0.001; 95%CI= 0.7-3.9) and 72h (p≤0.001; 95%CI= 1.1-4.4)]. For body image perception, an isolated effect of the measurement time (p=0.032) was found, in which the 72h post-exercise scores was significantly higher when compared to the pre-exercise moment (p=0.022; 95%CI=-1.66-0.05). Conclusion: The analysis of the present results allows us to conclude that the acute aerobic exercise results in higher muscularity dissatisfaction, mainly 48 hours after the exercise. In addition, there was also a higher body image distortion 72 hours post-exercise.
... Measurement of the body image is challenging, as it requires instruments capable of capturing body valuation from the individual's perception and/or attitudes [7]. Considering the multidimensionality of body image and the diversity of instruments available to measure it [8][9][10][11][12][13][14][15], future studies aiming to evaluate different body image components simultaneously have become increasingly relevant. ...
... These components can be assessed using psychometric scales, such as the Attention to Body Shape Scale (ABS) [8] and the Social Physique Anxiety Scale (SPAS) [9]. Body checking and avoidance are behavioral aspects of body image [10], which deal with reluctance to expose the body to oneself or others and the resources adopted to control and deprecate one's own body. They can be assessed by the Body Checking and Avoidance Questionnaire (BCAQ) [10]. ...
... Body checking and avoidance are behavioral aspects of body image [10], which deal with reluctance to expose the body to oneself or others and the resources adopted to control and deprecate one's own body. They can be assessed by the Body Checking and Avoidance Questionnaire (BCAQ) [10]. Body Satisfaction Scale (BSS), with separate versions for women and men [12], measures individuals' satisfaction/dissatisfaction towards specific parts of their own body [11]. ...
Aims
1. to elaborate a general model of physical appearance taking into account body image (BI) and orofacial appearance (OA) components; and 2. to evaluate the impact of BI and OA on life satisfaction among Brazilian adults.
Methods
This is a cross-sectional observational study. The cognitive, behavioral, affective, and satisfaction/dissatisfaction aspects of BI, the satisfaction and psychosocial impact of OA, and life satisfaction were evaluated by self-reported psychometric scales. Principal Component Analysis and Parallel Analysis were performed. Structural equation models were elaborated to estimate the impact of BI and OA on life satisfaction. The fit of the models was verified and the significance of the path estimates (β) was evaluated using z-tests (α = 5%).
Results
A total of 1,940 individuals participated in the study (age: mean = 24.8, standard deviation = 5.7 years; females = 70.1%). In the male sample, three physical appearance factors were retained (OA, cognitive and behavioral components of BI, and affective and satisfaction/dissatisfaction components of BI). In the female sample, two factors were retained (OA and all components of BI). All factors had significant impact on life satisfaction (β = |0.26|-|0.48|, p<0.001) in both samples. Individuals dissatisfied with BI and OA had lower levels of life satisfaction. For men, the affective and satisfaction components of BI had a greater impact on life satisfaction (β = 0.48, p<0.001) than the other factors (β =] -0.30;-0.25[, p<0.001). For women, both BI and OA had a similar impact (BI: β = -0.30, p<0.001; OA: β = -0.32, p<0.001).
Conclusion
BI and OA formed distinct clusters in the physical appearance evaluation. Physical appearance was perceived differently by men and women, fostering discussion about the sociocultural construction of the body. BI and OA had a significant impact on life satisfaction and should be considered in assessment and treatment protocols.
... In recent studies it has been suggested that eating disorders show their first symptoms especially in childhood and adolescence and later developmental periods may increase the risk of eating psychopathology (13). In previous studies stating (14,15) eating disorders were defined as a psychopathology that is handled with more than one theoretical framework and has different risk factors (16)(17)(18)(19)(20). ...
... Considering the approaches emphasizing eating behavior and eating psychopathology, it is thought that cognitive behavioral approaches provide important information both in the explanation and effective treatment of eating disorders (9). Cognitive-behavioral approaches have stated that people's attribute on excessive meaning to variables such as body image and weight and determine their own value through these two individual variables may trigger maladaptive eating behaviors (17)(18)(19). ...
... On the other hand, in another study conducted by Brechan and Kvalem (16), it was concluded that depressive symptoms and body dissatisfaction were associated with disordered eating behavior. In another study conducted by Shafran, Fairburn, Robinson, and Lask (17), it was stated that the need for self-control or avoidance of people regarding body image is associated with health eating behavior. It was suggested by Reas and colleagues (18) that avoidance behavior is frequently observed in overweight individuals as a result of the importance they attach to body image, and emotional eating behavior can be observed as a result of the emotional load caused by this situation. ...
Objective: Eating disorders are classified as psychiatric diseases that include deterioration in eating behaviors and attitudes and has negative effects on the physical and mental health of the individual. The main objective of the study is to elaborate the psychosocial and psychopathological factors related to eating disorders among university students. Methods: We have enrolled 199 female and 201 male volunteer students at Balıkesir University Faculty of Medicine. Participants were evaluated with a semi-structured questionnaire prepared by our institution regarding clinical experience and available information sources and according to DSM-V diagnostic criteria. Eating Attitude Scale, Ortho-15 Scale, Maudsley Obsessive Compulsive Question List, Rosenberg Self-Esteem Scale and Body Perception Scale were administered to all participants. Individuals with previously known or concomitant dementia, delirium, mental retardation, psychotic disorder diagnosis, depression with psychotic symptoms, and bipolar depression were not included in the study. Results: The OCD sub-dimension and cleaning sub-dimension differed significantly according to the gender variable (p
... It occurs in several mental disorders such as body dysmorphic disorder [BDD (2)] or illness anxiety disorder (3), but is most commonly known in the context of eating disorders (EDs). Patients with EDs engage in BC to obtain information about their size, shape, and weight (4,5). Etiological models of EDs assume a high relevance of BC, and empirical research has demonstrated that BC is a contributing factor to the development (6) and maintenance (7) of ED symptoms. ...
... While the strategies used to check one's body vary, all have been found to be associated with greater ED pathology (5,9,15) such as body dissatisfaction (16), overvaluation of one's weight and shape (17), dietary restriction (18,19), and negative treatment outcomes (20). Besides its prominence in EDs, studies have also shown that body-related checking is a generally normative behavior (5), which is likewise present in healthy individuals (6) who tend to apply similar BC strategies to those listed above for patients with EDs (7,21). ...
... While the strategies used to check one's body vary, all have been found to be associated with greater ED pathology (5,9,15) such as body dissatisfaction (16), overvaluation of one's weight and shape (17), dietary restriction (18,19), and negative treatment outcomes (20). Besides its prominence in EDs, studies have also shown that body-related checking is a generally normative behavior (5), which is likewise present in healthy individuals (6) who tend to apply similar BC strategies to those listed above for patients with EDs (7,21). However, even among healthy females, participants with higher body dissatisfaction reported more BC of disliked body parts compared to participants with a rather positive attitude toward their body (22), suggesting a clinical significance of assessing one's shape, weight, and size through BC also in the nonclinical population. ...
Body checking (BC) is not only inherent to the maintenance of eating disorders but is also widespread among healthy females. According to etiological models, while BC serves as an affect-regulating behavior in the short term, in the longer term it is assumed to be disorder-maintaining and also produces more negative affect. The present study therefore aimed to empirically examine the proposed longer-term consequences of increased BC. In an online study, N = 167 women tracked their daily amount of BC over a total of 7 days: Following a 1-day baseline assessment of typical BC, participants were asked to check their bodies in an typical manner for 3 days and with a 3-fold increased frequency for 3-days. Before and after each BC episode, the impact of BC on affect, eating disorder symptoms, general pathology and endorsement of different functions of BC was assessed. Participants showed longer-term consequences of increased BC in terms of increased negative affect and general pathology, while eating disorder symptoms remained unaffected. In the case of typical BC, participants showed decreased general pathology and anxiety. Furthermore, the endorsement of a higher number of BC functions led to increased negative affect and an increased amount of typical BC. The findings support the theoretically assumed role of maladaptive BC in maintaining negative emotion in the longer term. However, though requiring replication, our finding of positive effects of typical BC calls into question the overall dysfunctionality of BC among non-clinical women who are not at risk of developing an eating disorder.
... Body checking and avoidance can be seen as manifestations that contribute to the development of psychopathologies, such as eating disorders and obsessive-compulsive disorder (Coelho et al., 2019;Shafran et al., 2004). Body checking is the repetitive and frequent examination of numerous aspects of the body (e.g., weight, size, and shape). ...
... In contrast, body avoidance encompasses avoiding information about one's body that may cause discomfort. Examples of the body avoidance include not weighing oneself, wearing baggy clothes to disguise body shape, avoiding situations in which revealing clothing is worn (e.g., the beach) and looking at the reflection of ones' own body on mirrors or shop windows, and covering mirrors in the house (Shafran et al., 2004;Walker et al., 2018). ...
... On the other hand, body avoidance provides temporary relief from distress regarding body changes, which can lead to social withdrawal (Nikodijevic et al., 2018;Pellizzer et al., 2018). Patients with eating and obsessive-compulsive disorders share numerous cognitive and behavioral features including body checking and avoidance, which can reinforce negative body evaluation (Coelho et al., 2019;Shafran et al., 2004); however, these behaviors can also manifest in non-clinical samples (Mountford et al., 2006;Shafran et al., 2004;Smith et al., 2019). Nikodijevic et al. (2018) performed a systematic review with meta-analysis to quantify the evidence related to body checking and avoidance in clinical and non-clinical populations. ...
Frequent body checking and avoidance are commonly related to psychopathologies; therefore, these behaviors are important to be investigated with appropriate measures. In this study, we investigated the factorial model for Body Checking and Avoidance Questionnaire (BCAQ) and used the structure with the best fit to the data to verify the frequency of body checking and avoidance among adult Brazilian respondents. A total of 1455 individuals completed both the BCAQ and a sociodemographic questionnaire. We evaluated this instrument through factorial, convergent, and discriminant validity, and we determined its reliability. Confirmatory factor analysis revealed that the one-factor model did not fit our data for either female or male samples. Thus, an exploratory factor analysis was conducted, which uncovered the presence of five factors. This model had a good fit to data and was invariant across independent subsamples, but not across sexes. A model with five first-order factors and one second-order factor also had a good fit to data; therefore, its use is recommended to provide a general score for body checking and avoidance behaviors. The general BCAQ score showed a low frequency of body checking and avoidance behaviors among the participants. The BCAQ can gather important data of clinical and epidemiological benefit in the prevention of the psychopathologies, such as eating and obsessive–compulsive disorders.
... For ED patients, in particular, placing attention on one's eating or weight may trigger symptoms, relapses, and even denial of one's condition [87]. Additionally, reviews of mental health apps reveal that a large amount of information provided by these apps was not only clinically unverified or grounded, but also can exacerbate an individual's condition, instead of helping alleviate symptoms [102]. ...
... Users and clinicians alike remain concerned about most apps' privacy and security features [95], their (lack of) transparency [23], and ethics [52]. A prominent takeaway from this research has been that most mental health including ED apps are not clinically grounded, verified, or vetted; therefore not only are their therapeutic effects a suspect, but they can also exacerbate an individual's condition, instead of helping alleviate significant symptoms [102]. Eating disorders make up a subset of mental disorders, and the number of apps targeting people with ED and ED professionals is also rising, including the appropriation of more general-purpose health apps for ED needs [56,58]. ...
... Although most apps were designed for ED patients, we also included apps targeted at comorbid psychological challenges such as depression and anxiety [110]. The coders did a recheck of the final 34 apps to ensure we disregard apps that could exacerbate EDs [102]. We excluded food journaling apps that were not primarily designed for individuals with an ED, as food logging apps have been noted to exacerbate ED behaviors [25,55]. ...
Eating disorders (EDs) constitute a mental illness with the highest mortality. Today, mobile health apps provide promising means to ED patients for managing their condition. Apps enable users to monitor their eating habits, thoughts, and feelings, and offer analytic insights for behavior change. However, not only have scholars critiqued the clinical validity of these apps, their underlying design principles are not well understood. Through a review of 34 ED apps, we uncovered 11 different data types ED apps collect, and 9 strategies they employ to support collection and reflection. Drawing upon personal health informatics and visualization frameworks, we found that most apps did not adhere to best practices on what and how data should be collected from and reflected to users, or how data-driven insights should be communicated. Our review offers suggestions for improving the design of ED apps such that they can be useful and meaningful in ED recovery.
... Body checking entails an increase in negative attention directed at disliked body parts (Nikodijevic et al., 2018;Walker et al., 2021) through behaviors such as weighing oneself repeatedly, frequently looking in the mirror, pinching one's body parts to check for fat deposits, and inspecting one's body for imperfections (Linardon et al., 2019a;Reas et al., 2002). In contrast, body avoidance involves efforts to avoid interacting with, or showing to others, one's body, such as wearing baggy clothing, covering mirrors, avoiding physical intimacy, and refusing to be weighed (Nikodijevic et al., 2018;Shafran et al., 2004). These behaviors make it harder to collect new bodily evidence able to falsify ones' unrealistic body perceptions (Trottier et al., 2015). ...
... Body Checking and Avoidance (Profiles indicators). Participants completed the French version (Maïano et al., 2022) of the Body Checking and Avoidance Questionnaire (BCAQ; Shafran et al., 2004), which includes 22 items and measures five types of behaviors (Kachani et al., 2011;da Silva et al., 2021): (a) pinching (four items; α = .786; e.g., Pinched your thighs); (b) looking (four items; α = .761; ...
... These two psychological aspects reinforce a strong preoccupation with and overvaluation of body shape and size, which are often manifested in compulsive and habitual behaviors like repetitive body checking and body avoidance (e.g., Lavender et al. 2013;Steinglass et al. 2011;Nikodijevic et al. 2018). Body checking, characterized by the repeated visual or physical inspection of particular parts of one's own body (e.g., thighs, waist, or upper arms), can involve pinching body parts to test for fat, monitoring the movement of thighs when sitting down, examining whether thighs touch each other when walking, etc. (Engel et al. 2005;Lavender et al. 2013; for a controlled study, see Calugi et al. 2006; The Body Checking Questionnaire, Reas et al. 2002), whereas body avoidance, characterized by trying to avoid seeing one's body, can include wearing loose-fitting clothes to disguise one's body, hiding or covering mirrors, declining to be weighed, and redirecting gaze when walking past reflective surfaces (Shafran et al. 2004). While some have suggested that over time body checking becomes aversive and is eventually avoided (Fairburn et al. 1999), other studies found that body checking and body avoidance are not mutually exclusive and may alternate (Shafran et al. 2004). ...
... Body checking, characterized by the repeated visual or physical inspection of particular parts of one's own body (e.g., thighs, waist, or upper arms), can involve pinching body parts to test for fat, monitoring the movement of thighs when sitting down, examining whether thighs touch each other when walking, etc. (Engel et al. 2005;Lavender et al. 2013; for a controlled study, see Calugi et al. 2006; The Body Checking Questionnaire, Reas et al. 2002), whereas body avoidance, characterized by trying to avoid seeing one's body, can include wearing loose-fitting clothes to disguise one's body, hiding or covering mirrors, declining to be weighed, and redirecting gaze when walking past reflective surfaces (Shafran et al. 2004). While some have suggested that over time body checking becomes aversive and is eventually avoided (Fairburn et al. 1999), other studies found that body checking and body avoidance are not mutually exclusive and may alternate (Shafran et al. 2004). The association between the severity of the eating disorder and the frequency of body checking/avoidance in part stimulated the view that body checking in AN is closely related to OCD behaviors (e.g., Breithaupt et al. 2014). ...
Body checking, characterized by the repeated visual or physical inspection of particular parts of one’s own body (e.g. thighs, waist, or upper arms) is one of the most prominent behaviors associated with eating disorders, particularly Anorexia Nervosa (AN). In this paper, we explore the explanatory potential of the Recalcitrant Fear Model of AN (RFM) in relation to body checking. We argue that RFM, when combined with certain plausible auxiliary hypotheses about the cognitive and epistemic roles of emotions, is able to explain key characteristics of body checking, including how body checking behavior becomes habitual and compulsive.
... Specifically, body checking behaviours, which are often brief but repeated frequently, may result in amplifying the perceived imperfections in body shape or weight that commonly contribute to body dissatisfaction in AN ( [23], 25. Although levels of body checking might clearly distinguish women with and without AN, findings from studies in nonclinical samples of women suggest that body checking is positively associated with greater eating disorder symptom severity [45,50,65] and thus should be regarded as a risk factor within this group as well [4,11,53]. Regarding women recovered from AN, there is only one study, in which Bamford and colleagues (2014) found no differences in levels of body checking in weight restored women versus low weight women. This suggests that body checking remains high even when individuals restore their weights during recovery, however, these results require further replication. ...
... A concept that is closely related to body checking is body avoiding [53]. Body avoiding is characterized by efforts to avoid seeing one's body weight and shape and includes behaviours such as covering mirrors, wearing oversized clothes and refusing to be weighed [24,51]. ...
Background
A key feature of anorexia nervosa is body image disturbances and is often expressed by dysfunctional body-related behaviours such as body checking and body avoiding. These behaviours are thought to contribute to both the maintenance and relapse of AN, yet empirical evidence is scarce. One variable that may contribute to the need for engaging in these behaviours is intolerance of uncertainty. This study aims to investigate body checking and body avoiding and its relations with intolerance of uncertainty in women with anorexia nervosa (AN-ill; 70), women recovered from AN (AN-rec; 85) and control group (127).
Methods
Three questionnaires were completed, measuring eating pathology, intolerance of uncertainty and body checking and body avoiding. One-way ANOVAS were used to test group differences. Moderation analyses were used to investigate associations between variables.
Results
Levels of intolerance of uncertainty, body checking and body avoiding were highest in AN-ill followed by AN-rec and, lastly, the control group, confirming group differences. Intolerance of uncertainty was associated with body checking in the AN-rec group and the control group but not in the AN-ill group. The association between intolerance of uncertainty and body avoiding was reported in the AN-rec group and only marginally in the control group.
Conclusion
Levels of intolerance of uncertainty, body checking and body avoiding were highest in AN-ill, however still elevated in AN-rec, confirming the presence of body image disturbances, even after recovery. The unique associations between intolerance of uncertainty and body checking and body avoiding within the studied groups may represent different stages of the illness. In the AN-rec group, the relation between intolerance of uncertainty, body checking and body avoiding may be driven by trait anxiety. For AN-ill group, body checking and body avoiding may eventually have grown into habitual patterns, rather than a strategy to ameliorate anxiety and uncertainty.
Plain English summary
Women with anorexia nervosa often experience disturbances in their body image and are expressed in body-related behaviours such as body checking and body avoiding. These behaviours are thought to contribute to both the maintenance and relapse of anorexia nervosa. Intolerance of uncertainty is defined as the incapacity to tolerate uncertainty and may contribute to the need for engaging in these behaviours. This study aims to investigate body checking and body avoiding and its relations with intolerance of uncertainty in women with anorexia nervosa (AN-ill; 70), women recovered from AN (AN-rec; 85) and control group (127). Three questionnaires were completed, measuring eating pathology, intolerance of uncertainty and body checking and body avoiding. Levels of intolerance of uncertainty, body checking and body avoiding were highest in AN-ill and still elevated in AN-rec, even after recovery. The associations between intolerance of uncertainty and body checking and body avoiding within the studied groups may represent different stages of the illness. In the AN-rec group, the relation between intolerance of uncertainty, body checking and body avoiding may be driven by trait anxiety. For AN-ill group, body checking and body avoiding may have grown into habitual patterns, rather than a strategy to ameliorate anxiety and uncertainty.
... For example, Stanford and Mccabe (2002) found that females tend to rate their middle (waist) and lower body (hips and thighs) as less attractive and too large. Also, body checking as been identified to both lead to negative body image (Shafran et al. 2004) and negative affect (Tanck et al. 2019). Shafran et al. (2004) study revealed that individuals with clinical eating disorders (ED) history will alternate intensive body checking with avoidance, much more frequently than those without such ED history. ...
... Also, body checking as been identified to both lead to negative body image (Shafran et al. 2004) and negative affect (Tanck et al. 2019). Shafran et al. (2004) study revealed that individuals with clinical eating disorders (ED) history will alternate intensive body checking with avoidance, much more frequently than those without such ED history. They found that when exposed unintentionally to their body in the mirror or a window, participants with ED would report feeling upset and thinking that they looked too fat. ...
Evidence suggests that dissatisfaction with body image in women can be enhanced by exposure to media’s idealized images. The theory of social comparison and the avoidance hypothesis offer contradictory explanations of this relationship. We compare these two theories using a haptic virtual reality environment. We ask 42 female participants to interact with one of four types of virtual humans (VH) randomly assigned to them. The interaction task involves giving a virtual hug to a normal weight or overweight male or female VH. We verify the hypothesis that participants’ satisfaction with particular body parts and their anti-fat attitudes will determine the choice of the body area of the VH they will virtually touch. Our results show that: (1) touching VH lower torso is predicted by less anti-fat attitude, and avoidance of the upper torso and upper limb areas, and (2) touching VH shoulder and upper limbs areas is predicted by concerns with own stomach area and avoidance of VH lower torso and stomach waist areas. Our results tend to support the avoidance hypothesis as well as other research findings on anti-fat attitudes.
... Nevertheless, the requested increase in BC did enhance their preoccupation with thinness, possibly because it prompted a rather positive approach motivation for eating regulation (i.e., an autonomous focus on health and well-being; [58]), which is less associated with ED development. In women with high body concern, by contrast, drive for thinness might rather have been based on maladaptive avoidance motivation to counteract negative assumptions and fears regarding body weight, shape, or size (i.e., a controlled focus on appearance; [58]), as indicated in previous research (e.g., [3]). ...
Body checking is a common behavior in both the general population and individuals with body image disturbances. Cognitive-behavioral theories postulate that body checking reduces negative emotions in the short term, but over time contributes to the development and maintenance of eating disorder pathology. So far, few experimental studies have assessed these longer-term consequences, mostly under laboratory conditions, yielding inconsistent findings, and without considering individual vulnerability and specific personality traits. In a naturalistic experimental cross-over design, women with low (n = 76) vs. high (n = 103) body concern completed an online survey on trait characteristics (e.g., intolerance of uncertainty). After a two-day baseline to assess the daily amount of habitual body checking, participants underwent two three-day experimental conditions in randomized order, in which they were asked to exhibit typical vs. threefold increased body checking. Before and after conditions, participants completed state measures of eating disorder symptoms, body dissatisfaction, affect, and general pathology online. In women with high body concern, body image-related symptoms (i.e., drive for thinness, body dissatisfaction) and negative affect worsened in the increased body checking condition, whereas in the typical body checking condition, positive affect increased and no negative impact emerged. Conversely, women with low body concern remained unaffected, except for higher drive for thinness following the increased condition. Bulimic and depressive symptoms did not change in either group. The inclusion of intolerance of uncertainty from an exploratory perspective generally did not impact the results. Our findings regarding the high-risk group underscore the potential etiological relevance of body checking for body image disturbances and eating disorders. For individuals at risk and those already affected by eating disorders, it seems important to address individual body checking as early as possible within psychoeducation to prevent a presumably harmful increase in this behavior. Personality factors influencing vulnerability to body checking need to be further examined.
... Repeated body checking is a behavior aiming at gaining information about one's body shape, weight, or size and is considered a transdiagnostic symptom of eating disorders (EDs; American Psychiatric Association 2013). Body checking may include examining one's body in the mirror while focusing on disliked body parts, frequently weighing, and scrutinizing different body parts by touching and pinching (Shafran et al. 2004). Compulsive body checking is associated with various EDs symptoms. ...
Objective
Body checking is considered a behavioral expression of the core psychopathology of eating disorders (EDs), namely, overvaluation of body weight and shape. Compulsive checking is motivated by a desire to increase a sense of certainty regarding feared outcomes. Paradoxically, studies showed that repeated checking acts to reduce certainty, forming a vicious cycle. No previous study examined whether the same principle applies for body checking. This study filled this gap by examining the causal effect of repeated body checking on memory certainty regarding checked body parts.
Method
In a laboratory‐based study, 77 female participants without an ED checked the size and shape of six body parts. Their objective memory regarding which body part was last checked, and subjective certainty about this memory were assessed. Then, one group of participants continued to engage in repeated body checking, and another group repeatedly checked a neutral object. Finally, all participants completed the six body parts checking procedure again, and their objective memory and memory certainty were re‐assessed.
Results
In both checking groups, objective memory regarding the last body part checked was unaffected by the type of checking performed. Importantly, certainty about memory dropped considerably only among those in the repeated body‐checking group.
Discussion
The findings provide the first empirical evidence of a paradoxical effect demonstrating that repeated body checking reduces certainty about checked body parts. The study implies that repeated body checking reduces the quality of information obtained through checking and, as such, could potentially motivate further checking.
... 79 checking one's own body for shape, weight, or body fat percentage (e.g., by weighing oneself, measuring body parts, or constantly staring in the mirror) is a common manifestation of cB in eDs. 80 however research concludes of this eating disorder in the presence of additional symptoms pointing to the numerous comorbidities of anorexia nervosa mentioned above in the review, given the nosological problem in psychiatry, the real question we must undoubtedly ask ourselves is how the diagnostic process can and should be changed in the future so that it is more realistic and does not lead to false results, wrong treatment and deterioration of the patients' condition. in the last years (after publishing the last DsM revision) it is visible that the comorbidities in mental disorders are becoming more and more frequent and the reason behind this is simply the fact that the number of diagnosis between the two revisions has almost doubled. ...
Anorexia nervosa (AN) is one of the most common eating disorders with multiple psychiatric comorbidities. This review aims to bring together the recent data on the most frequently coexisting with AN psychiatric nosologies including: body dysmorphic disorder (BDD), borderline personality disorder, non-suicidal self-injury, anxiety disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), autism spectrum disorders (ASDs), major depressive disorder, bipolar disorder (BD) and checking behavior (CB). For the current review, PubMed was used to conduct an automated search for all studies on anorexia nervosa and its psychiatric comorbidities that were published between 2017 and 2023. The results of this review indicate that for many of these comorbidities there is strong evidence of an association between the conditions. To date there is no clear answer to the question if there is a common cause for these comorbidities, despite the numerous studies for similarities between their pathomorphology, such as similar patterns of activation of brain areas explored by functional magnetic resonance imaging (fMRI). A contributing factor could be that the application of the current criterial approach creates a substantial overlap of symptoms between different diagnostic groups. Based on the current review, it can be concluded that due to the frequent changes in the diagnostic criteria and their subjectivity, the main problems in the diagnosis and treatment of anorexia nervosa and its psychiatric comorbidities are the nosological problem. Further study is needed to explore the reasons behind the high frequency of coexistence of AN with other psychiatric disorders and how this may affect the treatment process.
... Instructing participants to engage in negative body scrutinising also increases body dissatisfaction (McComb & Mills, 2021;Shafran et al., 2007;Smeets et al., 2011). 6 Finally, some who employ this practise report doing so deliberately, "…to induce distress and hence increase their motivation to maintain dietary restraint" (Shafran et al., 2004, p. 100; see also : Opladen et al., 2021). These converging streams of evidence suggest that some cases of negative body scrutinising are undertaken for self-motivation. ...
I introduce and discuss an underappreciated form of motivated cognition: motivational pessimism, which involves the biasing of beliefs for the sake of self-motivation. I illustrate how motivational pessimism avoids explanatory issues that plague other (putative) forms of motivated cognition and discuss distinctions within the category, related to awareness, aetiology, and proximal goals.
... The mere presence of food (CS) is then sufficient to activate fear memories and fear reactions (CR; conditional response [24]). The fear typically elicits avoidance behaviors, such as food restriction, to prevent the expected aversive outcomes [18,20,[25][26][27][28][29][30][31]. The individual may expect the weight gain to be endless and out of control, and may learn to downregulate the anxiety by avoiding certain foods to prevent the expected uncontrollable weight gain [32]. ...
Exposure therapy is known to be an effective intervention in the treatment of anxiety-related disorders. In eating disorders, such as anorexia nervosa, anxiety and avoidance are identified as maintenance factors. Therefore, they may constitute an important treatment target, suitable for the use of exposure therapy. Remarkably, exposure techniques to target fears and avoidance behaviors are not commonly used in the treatment of anorexia nervosa. We present a practical guide for the implementation of exposure therapy in the treatment of anorexia nervosa. We outline how exposure therapy is supposed to work according to the inhibitory learning model and how the exposure intervention can be designed for individuals with anorexia nervosa. Practical examples are provided through the case presentation of a patient with anorexia nervosa who completed 31 exposure sessions that focused on her fears of food, eating, weight, weight gain, their feared social consequences and the associated safety behaviors.
... Individuals with binge eating disorder may apply avoidance behaviors that were not investigated here, and others suggest that the binge eating behavior itself is an avoidance strategy to regulate emotions and negative self-evaluations [46,56,57]. Important other avoidance behaviors in eating disorders are body checking and body avoidance [60,[77][78][79]. A second limitation is the small size of the binge eating disorder sample, which requires careful interpretation of those findings, as well as their replication. ...
Background
Fears and avoidance behaviors are common symptoms of eating disorders. It was investigated whether different eating disorder diagnoses are equally characterized by similar fears and avoidance behaviors.
Methods
Individuals with self-reported eating disorders (n = 250) and healthy controls (n = 95) completed online questionnaires assessing general fears, eating related fears, and avoidance behaviors.
Results
All self-reported eating disorder diagnoses showed more eating related fears, general fears, and avoidance behaviors than healthy controls. Individuals with binge eating disorder showed less specific and general fears on some but by no means all scales, yet they showed less food avoidance behaviors than all other eating disorders and less eating restraint than anorexia nervosa and bulimia nervosa.
Conclusions
Eating related fears, general fears, and food avoidance behaviors were found to be transdiagnostic symptoms in self-reported eating disorders. Individuals with binge eating disorder also exhibit more fears and avoidance behaviors than healthy controls, but to a lesser extent than the other eating disorders. Specialized interventions targeting fears and avoidance may be promising add-on interventions not only in the treatment of anorexia nervosa, but in the treatment of all eating disorders.
... This points out the fact that the persistence of a distorted perception of body schema can become increasingly depressing for patients whose weight gradually increases as therapy progresses. Many studies emphasize increased body checking, avoidance, and anxiety following weight restoration [5,45,46]. Accordingly, future research should focus on finding and exploring body image protective factors related to cultural pressures, personality traits, and life experiences [47] since as far as approximately half of the women population are dissatisfied with their weight and overall appearance. There is also a great challenge in improving existing treatment programs for people with eating disorders as well as to construct new, more effective interventions that enable patients to reduce the symptoms that sustain the disease. ...
(1) Background: Body image is being defined as the picture of our own body in our mind with its size and shape, and with a perceptive and attitudinal evaluation of this body. It appears to be a complex clinical construct predisposing an individual to developing and maintaining anorexia nervosa (AN), as well as having considerable impact on prolonging the duration of this illness and its relapse risk. The aim of the research work was to assess whether the symptomatology of eating disorders, level of depression, and mental pain are associated with body image, and examine the influence of a distorted body image as well as eating disorders and depression symptoms on mental pain in AN; (2) Methods: A total of 36 women diagnosed with AN and 69 healthy controls (HC) participated in this study. All participants completed a battery of the following scales: EAT-26, BSQ-34, BIDQ, BDD-YBOCS, CESDR, and the Mental Pain Scale; (3) Results: Results show statistically significantly greater body image disturbances and higher level of depression and mental pain intensity in the AN compared to the HC group. Regression analysis indicates a greater impact of distorted body image, eating disorders, and depression symptoms on mental pain in AN; (4) Conclusions: As assumed, distorted body image and mental pain are central components of AN that should be especially emphasized in the therapeutical process of treating AN. Future research should focus on the etiopathogenesis of distorted body image in relation to the chronicity of mental pain and depression in AN, and address these outcomes in clinical practice to minimize suicide risk in this high-risk group of patients.
... Obraz ciała jest wielowymiarowym konstruktem, na który składają się komponenty poznawcze, afektywne i behawioralne (Thompson, 2004). Dysfunkcja jednego lub kilku z nich może prowadzić do następujących skutków: przecenianie wymiarów własnego ciała (Farrell, Lee, Shafran, 2005), negatywne uczucia i myśli wobec ciała (Rekkers, Scheffers, van Busschbach, van Elburg, 2021;Troisi, 2020), ale też unikanie ciała i zachowania sprawdzające (Shafran, Fairburn, Robinson, Lask, 2004). Wykazano, że zaburzenia obrazu ciała są dodatnio skorelowane z negatywnym stanem psychicznym -niską samooceną, depresją i lękiem (Cruz-Sáez, Pascual, Wlodarczyk, Echeburúa, 2020; Junne i in., 2019), skłonnością do samobójstw (Naivar Sen, Gurleyik, Psouni, 2020), niższym poziomem szczęścia (Wang i in., 2018) i często utrzymują się nawet po wyzdrowieniu (Bachner-Melman, Zohar, Ebstein, 2006). ...
Cel Pomimo rosnącego znaczenia terapii zorientowanej na ciało i szerokiego stosowania metod wykorzystujących pracę z ciałem brakuje systematycznych przeglądów naukowych, które analizowałyby jej skuteczność w zakresie zaburzeń obrazu ciała u osób chorujących na anoreksję lub zagrożonych jej wystąpieniem. Stanowi to barierę zarówno dla praktyków sięgających po rozwiązania terapeutyczne, jak i teoretyków badających mechanizmy interwencji terapeutycznych czy edukatorów działających na rzecz profilaktyki zdrowia. Celem niniejszych rozważań jest przegląd badań dotyczących wpływu różnego rodzaju interwencji opartych na metodach pracy z ciałem na obraz ciała osób z zaburzeniami odżywiania lub zagrożonych zaburzeniami odżywiania typu anoreksja. Metoda Badanie przeprowadzono zgodnie ze standardem PRISMA. Zeksplorowano elektroniczne bazy danych (ProQuest, PsychINFO, PubMed, ScienceDirect, Scopus, Web of Science) w poszukiwaniu randomizowanych badań kontrolnych (RCT). Łącznie przeanalizowano 425 pozycji, z czego 69 pełnotekstowych artykułów zostało poddanych krytycznej ocenie. Ostatecznie do przeglądu włączono 15 badań, które spełniły wszystkie kryteria włączenia. Wyniki Analizy wskazują, że programy oparte na metodach pracy z ciałem, w porównaniu z grupami kontrolnymi, były bardziej skuteczne w redukowaniu czynników ryzyka i promowaniu czynników ochronnych, a dodanie ich do podstawowej formy terapii może prowadzić do znaczącego zmniejszenia objawów zaburzeń odżywiania. Konkluzje W przyszłości istotne byłoby bezpośrednie porównanie wpływu konkretnych typów interwencji na czynniki ryzyka i czynniki chroniące.
... The body image is a multi-dimensional construct with cognitive, affective, and behavioral components (Thompson, 2004). Dysfunctions involving one or several components can lead to the overestimation of the size of body features (Farrell, Lee, & Shafran, 2005), negative feelings and thoughts about the body (Rekkers, Scheffers, van Busschbach, & van Elburg, 2021;Troisi, 2020), body checking and body avoidance (Shafran, Fairburn, Robinson, & Lask, 2004). Research has demonstrated that BID is positively correlated with negative psychological well-being, including low self-esteem, depression, and anxiety (Cruz-Sáez, Pascual, Wlodarczyk, & Echeburúa, 2020;Junne et al., 2019), higher risk of suicide (Naivar Sen, Gurleyik, & Psouni, 2020), and anhedonia (Wang et al., 2018), which often persist after recovery (Bachner-Melman, Zohar, & Ebstein, 2006). ...
Aim Despite the growing significance of body-oriented therapy and the broad applicability of psychotherapeutic methods that focus on the body, there is a general scarcity of systematic reviews analyzing the effectiveness of this therapeutic approach in addressing body image problems in persons with anorexia or at risk of anorexia. The above constitutes a barrier for practitioners, theoreticians who investigate the mechanisms underpinning therapeutic interventions, as well as educators who implement health promotion programs. The aim of this article was to review research studies analyzing the effects of different body-oriented interventions on body image perception in persons suffering from or at risk of eating disorders such as anorexia. Methods The review was conducted according to the PRISMA guidelines. Digital databases (ProQuest, PsychINFO, PubMed, ScienceDirect, Scopus, Web of Science) were searched for randomized control trials (RCT). A total of 425 records, including 69 full-length research articles, were critically analyzed. Fifteen trials that met all inclusion criteria were ultimately included in the analysis. Results The review revealed that body-oriented therapeutic programs are more effective in reducing risk factors and reinforcing protective factors in comparison with the control groups, and that the inclusion of body-oriented therapy in standard therapeutic practice could substantially minimize the symptoms of eating disorders. Conclusions Further research is needed to directly compare the effects of different types of interventions on risk factors and protective factors.
... Similarly, body-checking has been acknowledged in the literature as a manifestation and maintenance factor in body concerns including body dissatisfaction (Shafran et al., 2004). According to McLean and colleagues (2015), photo-editing behaviour can be conceptualised similarly such that photo-editing is likely to occur in female social media users with higher body dissatisfaction, due to a higher investment in appearance, maintaining existing body concerns. ...
Emerging research has raised concerns about the growing prevalence of photo-editing behaviour and how this may negatively interact with body-related concerns among females. This review aimed to systematically examine the current evidence relating to the associations between photo-editing behaviour and female body concerns, including body image, body dissatisfaction and body modification. Six databases were searched for studies investigating associations between photo-editing and body concerns in female social media users. Empirical studies published in English were included if they quantitatively measured the association between photo-editing and at least one of the body-related outcomes, and included female participants. A narrative synthesis of the 22 studies meeting these specific criteria was completed. This review revealed mixed findings in relation to the associations between photo-editing and body concerns. The findings indicate there may be a more complex relationship between both concepts that is influenced by alternative factors. The findings also revealed considerable heterogeneity in measurement approaches for both photo-editing behaviour and body-related outcomes. Future research should focus on developing a gold-standard approach to the measurement of various body-related concerns and conducting in-depth analyses in order to further understand the complex relationship between photo-editing and female social media users’ body concerns.
... The specificity of the BSQ to measure this construct is helpful in the perspective of assessing changes in the core symptoms of eating disorders. However, it should be considered that body avoidance and checking are important psychological dimensions in eating disorders at both ends as well [25,[67][68][69], and they may contribute to the onset, course, and outcome of these diseases [70,71]. Thus, the use of the BSQ for clinical purposes might be supplemented with likewise specific measures of body checking and avoidance or it might be complemented with multidimensional tools, such as the Body Uneasiness Test (BUT; [72]). ...
Purpose
This study was set up to investigate the reliability, factorial, concurrent, and criterion validity of the Italian version of the 34-item Body Shape Questionnaire (BSQ) and its shorter versions.
Methods
The study included 231 patients diagnosed with an eating disorder and 58 putatively healthy people (comparison sample). The Italian BSQ-34 was administered to participants together with the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale. Information on body mass index, caloric intake at baseline, and the number of episodes of self-vomiting per week was also acquired.
Results
Cronbach’s alpha of BSQ-34 was 0.971 (95% confidence interval [CI] 0.965–0.976) in patients and 0.960 (0.944–0.974) in controls. Test–retest stability in patients (n = 69), measured with intraclass correlation coefficient, was 0.987 (0.983–0.991). Confirmatory factor analysis of the single-factor model yielded acceptable fit for all versions of the BSQ. On all BSQ versions, patients scored higher than controls with a large effect size when calculated as Cliff’s delta. BMI and mean caloric intake at baseline had a stronger association with BSQ-34 than levels of anxiety and depression. The analysis with the receiver operating characteristics (ROC) curve showed that the BSQ-34 distinguished patients with an eating disorder from controls with good accuracy (Area Under the Curve = 86.5; 95% CI 82.2–90.7).
Conclusion
The Italian version of the BSQ possesses good psychometric properties, in both the long and the shortened versions, and it can be applied to measure body dissatisfaction for both clinical and research purposes.
Level of evidence
Level III, Evidence obtained from well-designed cohort or case–control analytic studies.
... The mere act of focusing on one's self can be highly aversive to some individuals, such as those suffering from body dysmorphic or eating disorders (Shafran et al., 2004;Toh et al., 2017;Veale & Riley, 2001), low self-esteem (Brockner & Wallnau, 1981) or borderline personality disorder (Winter et al., 2015). However, self-awareness can be aversive to most individuals in certain unpleasant situations, as for example, after a major failure or setback. ...
Failure increases the motivation to escape self-awareness. To date, however, the role of self-conscious emotions (shame and guilt) in triggering escape responses after failure has not been sufficiently addressed. In this pre-registered study (N = 156 undergraduates), we adapted a classic paradigm (avoidance of one’s image in a mirror) to a modern eye-tracking technology to test the hypothesis that shame proneness moderates the effect of failure on self-awareness avoidance. Individual differences in guilt and shame proneness were assessed before priming thoughts of failure or success. Then, an eye-tracking paradigm was used to monitor gaze avoidance of one’s screen-reflected face during a neutral, unrelated task. Unexpectedly, results showed that guilt but not shame proneness exacerbated self-avoidance after failure. The present findings challenge the dominant view that shame fosters avoidance more so than guilt.
... Increased attention may result in cognitive (e.g., appraisal of internal sensations) and behavioral checks (e.g., moving body parts) reinforcing ED psychopathology, suggesting that overvaluation of weight and shape involves multiple sensory inputs (Preston and Ehrsson, 2014). Future work should consider the function of heightened sensitivity to bodily cues, as they may reflect emotional and experiential avoidance associated with body checking behaviors (Shafran et al., 2004). ...
Individuals with eating disorders (EDs) often present with somatic concerns in treatment, such as bloating, fullness, and feeling tight clothes on skin. However, most research generally focuses on general interoception (e.g., heartbeat) rather than sensations relevant to EDs (e.g., sensations related to the gastrointestinal system or body movement). In the current study (N = 181), we used network analysis to model the structure of ED symptoms and somatic concerns among individuals with anorexia nervosa, bulimia nervosa, and other specified feeding and eating disorder. Results showed that heightened sensitivity to somatic concerns had the highest strength centrality within a symptom network comprising ED and somatic symptoms. Exploratory graph analysis identified four symptom dimensions: cognitive-affective ED symptoms, behavioral ED symptoms, general interoception, and ED-specific proprioception. Findings suggest that heightened sensitivity to somatic concerns may maintain ED symptoms and mutually reinforce other somatic concerns. Implications concerning assessment and treatment of EDs are discussed.
... The Self-Regulatory Executive Function (S-REF) model (Wells & Matthews, 1994 proposes that metacognitions such as excessive worry about food may help to maintain psychological and emotional disorders. For instance, in eating disorders and dietary restraint, cognitive biases maintain a focus on eating, weight and shape issues (Shafran, Fairburn, Robinson, & Lask, 2004) and there is some research to suggest that metacognitive appraisals may be enhanced among anorexic patients, whereby anorexics are more worried by their depressive thoughts and negative self-beliefs than restrained eaters and non-dieters (Turner & Cooper, 2002). The present study suggests that disinhibited restrainers may be less likely to engage in adaptive metacognitive activity than inhibited and low restrainers. ...
p>The thesis commences with a review of thought suppression research and focuses on the effects of suppressing personally relevant material. Limitations of the research are discussed, in addition to the current theoretical understandings of thought suppression phenomenon. Following this, the review focuses on the clinical applications of thought suppression research in relation to dietary restraint. However, results have been inconsistent and further studies are required to differentiate between the effects of dietary restraint and disinhibition and investigate individual differences in thought suppression attempts. In view of this, the empirical paper investigated the effects of thought suppression, dietary restraint and disinhibition on automatic cognitive processes, in addition to individual differences in thought control techniques. Participants classified as low restraint, inhibited restraint and disinhibited restraint were instructed to either suppress or not suppress their thoughts prior to completing a modified Stroop task. It was found that, contrary to predictions, thought suppression decreased reaction time on the Stroop task. Furthermore, disinhibited restrainers were more likely to engage in thought suppression attempts, experienced higher levels of anxiety and were less likely to use adaptive thought control techniques compared to low restrainers and inhibited restrainers. Results are considered in relation to previous research, and methodological limitations as well as clinical implications and suggestions for future research are discussed.</p
... However, despite their phenomenologically opposite characteristics, that is, focussing on disliked body parts while at the same time avoiding them, both body checking and body avoidance behaviours are strongly related to ED pathology such as body dissatisfaction (Walker et al., 2018). Research suggests that patients with EDs engage in both behaviours concurrently (Shafran et al., 2004). ...
Objective:
Mirror exposure (ME) is a therapeutic technique to improve body image disturbance. However, evidence on the effectiveness of different forms of ME in clinical populations is lacking. The present study therefore analysed effects of ME on trait-like and state measures of body image in patients with anorexia nervosa (AN) and bulimia nervosa (BN).
Method:
The present study therefore analysed effects of ME on trait-like and state measures of body image in patients with anorexia nervosa (AN) and bulimia nervosa (BN). In total, 47 inpatients underwent 3 ME sessions guided by a therapist, with instructions to exclusively verbalise positively about their whole body. Participants completed questionnaires on trait-like eating pathology and body image at the start and end of the study, and instruments on state affect and body satisfaction were administered directly before and after each ME session. Subjective physiological arousal and emotional valence relating to each body part were assessed within each session.
Results:
The results indicate significant improvements in eating pathology and body image regarding trait-like measures in patients with AN and BN. Concerning state measures, negative affect significantly decreased and body satisfaction increased during ME. Physiological arousal decreased and positively valenced emotions relating to the various body parts increased.
Conclusions:
These findings suggest that positively verbalising about one's body during ME improves eating pathology, body image, affect, and subjective physiological arousal, and thus seems to be an effective form of ME.
... However, this conclusion is limited by the fact that body image processing data in these studies (Sachdev et al., 2008;Vocks et al., 2010) was derived from free viewing tasks. Thus, one cannot exclude visual avoidance of the stimuli as an alternative explanation of the results , especially as body image avoidance is a central component of body image disturbances both in AN and BN (Shafran et al., 2004). ...
Although body image disturbances play a central role in the development, maintenance and relapse of binge eating disorder (BED), studies investigating the neural basis underlying body processing in BED are still missing. To address this gap, we conducted a preregistered (German Clinical Trials Register [Deutsches Register Klinischer Studien; DRKS], Registration DRKS00008107) combined functional magnetic resonance (fMRI)/eye tracking study in which 38 women with BED and 22 healthy controls weight-matched for overall equivalence processed images of their own bodies, an unfamiliar weight-matched body, and visually matched nonbody control stimuli while performing a one-back task. Women with BED responded with higher left fusiform body area (FBA) activity than controls during body image processing. Despite higher levels of self-reported body dissatisfaction, women with BED did not show overactivation in emotion-processing areas in response to their own body. The eye-tracking results indicated that visual attention toward the presented stimuli was associated with increased activity in the extrastriate body area (EBA) and FBA across groups. Our results thus provide evidence for an aberrant neural processing of body images in BED and highlight the importance of controlling for visual attention in future studies assessing neuronal body processing. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... makes the person more confident that they have not gained weight at the time) but to worsen such pathology in the longer term (e. g., the person fears that the scales might be wrong and that they have actually gained weight, so have to keep checking). The causal impact of body checking and avoidance are well understood (e.g., Bailey & Waller, 2017;Shafran, Fairburn, Robinson & Lask. 2004), with each resulting in a worsening of body and eating concerns. However, the effects of body comparison are less well understood, and require experimental study to demonstrate the impact of this behaviour on body image and eating pathology. ...
Background and objectives
Two experimental studies examined the impact that body comparison has on women's body satisfaction and self-esteem. The two studies differed in the use of a human comparator or an avatar (non-human) comparator. The independent variables were the type of body comparison (upward, downward and neutral) and the perceived personality of the comparator.
Methods
Each study used a within-participant design. Participants compared themselves to images of women or avatars (previously rated as ‘attractive’, ‘neutral’ or ‘unattractive’), with an accompanying ‘positive’ or negative’ personality descriptor. Participants rated their body satisfaction and self-esteem after each image.
Results
Upward comparison resulted in negative effects for the participant compared to downward and neutral conditions, but downward comparison's impact was only found for human images. The described personality of the image had a more complex impact when using human images, but was still relevant for avatars.
Limitations
The sample for this study was lacking in diversity. Compliance within the experimental tasks was not strictly monitored. The use of a within-subject design might have allowed some participants to deduce the nature of the study.
Conclusions
These findings provide causal evidence for the theorised effects of body comparison on body satisfaction self-esteem. Upward comparison has especially problematic outcomes, even causing negative effects when comparing to a non-human avatar. Downward comparison had positive effects, but only for human images. Furthermore, personality played some moderating role in these outcomes. Social comparison theory needs to be reviewed in light of these findings, and practical implications are discussed.
... El aspecto afectivo puede alterarse por la insatisfacción corporal (peso y la forma), pudiendo ocasionar una carga emocional de sentimientos negativos (Crowther y Williams, 2011), involucrados con el control del cuerpo y con la psicopatología alimentaria (Shafran et al., 2004). ...
La Imagen Corporal es un constructo multidimensional complejo que engloba las percepciones, pensamientos, actitudes y sentimientos del ser humano sobre su cuerpo, la manera en que estima su tamaño, evalúa su atractivo, las emociones asociadas con su forma y apariencia, así como las conductas dirigidas a su manejo.
En este libro se describe la psicopatología de la imagen corporal, sus definiciones, alteraciones, teorías y evaluación, permitiendo al lector conocer sobre las preocupaciones exageradas sobre la percepción de la imagen del cuerpo, que pueden incluso llegar a desencadenar serias alteraciones de la imagen corporal.
Además, en sus contenidos se describen indicadores y criterios clínicos de algunas psicoptologías, así como la preocupación por la apariencia. Se estudia diferentes instrumentos para la evaluación de la IC y su relación con aspectos de la salud mental. Se hace un repaso a diferentes teorías y se describen algunas perspectivas desde la psicología clínica.
La investigación empírica, publicada en dos artículos científicos, cuyos resultados concluyen que la presión social ejerce significativamente en la mente de las personas, especialmente por la estética del cuerpo, fenómeno más frecuente en las mujeres que en los hombres y que presentan mayor insatisfacción al valorar su apariencia corporal.
... BI disturbances are diagnostic features and stabilizing factors in eating disorders (EDs): patients overestimate their shape and weight (6). Regarding behavioral aspects of BI disturbances, typical features in AN are body checking (repeated measuring and checking of shape and weight) and body avoidance [e.g., covering up the body shape by wearing baggy clothes or avoiding looking at oneself in the mirror (7)]. Despite much fewer studies on adolescents than on adults, a recent systematic review reported more BI disturbances in adolescents with AN and bulimia nervosa (BN) compared to healthy controls (8), similar to findings in adults. ...
Body dissatisfaction is a core feature of eating disorders (EDs) and plays an essential role in the development and maintenance of anorexia nervosa (AN). In the current study, a computer based body exposure intervention is conducted and evaluated regarding short-term effects on body dissatisfaction, psychopathology, viewing patterns, and stress reactivity. Within a randomized controlled trial (RCT) female adolescents and young women with AN are either receiving the intervention or treatment as usual (TAU). Furthermore, in a transdiagnostic approach, a highly body-dissatisfied group of clinical control participants obtaining the intervention will be surveyed to identify AN-specific processes. The standardized four-session body exposure intervention using photographs of the own body is adapted from a manualized body image treatment program for computer use. Psychopathology (body dissatisfaction, body image avoidance, body checking, depression, anxiety) is assessed via standardized questionnaires before and after the intervention. During each session, attentional biases regarding one's own body are measured via eye tracking, stress levels are measured via subjective ratings, heart rate variability, as well as salivary cortisol and alpha amylase. Between- and within-subject effects will be assessed. The pilot study aims to identify short-term effects of the intervention on body dissatisfaction and attentional bias, as well as to investigate the potential underlying mechanism of physiological habituation.
... For example, it is possible that there are various sub-groups within those with overweight and obesity, such as individuals who engage in body checking versus those who engage in body avoidance. Body checking and avoidance have largely been described in the context of eating disorders (Shafran, Fairburn, Robinson, & Lask, 2003), however it is also possible that these behaviours occur in the context of overweight and obesity. In combining these sub-types in attentional bias research, their unique attentional patterns may be masked. ...
Selective attention to food and body stimuli have been proposed as vulnerability factors for weight gain leading to overweight and obesity, yet research on attentional biases in this population has produced mixed findings. To assist in clarifying the nature of these attentional biases as a function of weight category, the present research examined attentional subcomponents (i.e., speeded detection and increased distraction) using a novel paradigm in this context, namely, the visual-search task. The final sample included women in the healthy-weight (n = 50), overweight (n = 41), and obese (n = 46) weight ranges according to World Health Organization (2000) guidelines. Parts One and Two of this research assessed attentional biases for low- and high-calorie food stimuli in individuals with overweight and obesity. Part One of this research tested the hypothesis that the overweight and obese groups would display speeded detection for low- and high-calorie food versus non-food images (i.e., plants or animals) when compared with the healthy-weight group. When the target images were foods and plants, and the distractor images were animals, results indicated that all weight groups engaged in speeded detection for food versus non-food images. However, relative to the overweight group, the obese group unexpectedly displayed reduced speeded detection for food images, which could represent a degree of avoidance of food in early attentional processing among women with obesity. These findings were not replicated when the target images were foods and animals, and the distractor images were plants. This latter finding may have been due to the visual and/or thematic similarity between foods and plants, rendering it more difficult to discern food targets among plant distractors relative to food targets among animal distractors. Part Two investigated the hypothesis that the overweight and obese groups would display increased distraction by low- and high-calorie food versus non-food images (i.e., plants or animals) when compared with the healthy-weight group. When the distractor images were foods and plants, and the target images were animals, no weight group differences were observed in increased distraction. In contrast, when the distractor images were food and animals, and the target images were plants, the obese group showed increased distraction by low-calorie food images relative to the healthy-weight group. Moreover, all weight groups showed increased distraction by high-calorie food versus non-food images. However, relative to the healthy-weight group, the overweight group surprisingly displayed reduced distraction by high-calorie food images. Overall, the unexpected pattern of results observed across Parts One and Two raises questions about whether attention toward or away from food stimuli is adaptive or maladaptive. Parts Three and Four of this research assessed attentional biases for body shape and weight stimuli in individuals with overweight and obesity. Part Three examined the hypothesis that the overweight and obese groups would display speeded detection for low- and high-weight body versus non-body images (i.e., shoes and cars) when compared with the healthy-weight group. Regardless of whether the shoe or car images performed the role of the target or distractor, no weight group differences were observed in speeded detection. Finally, Part Four investigated the hypothesis that the overweight and obese groups would display increased distraction by low- and high-weight body versus non-body images (i.e., shoes and cars). Again, regardless of the role performed by the non-body images (i.e., target or distractor), no weight group differences were observed in level of distraction. While it is plausible that biased attention for body stimuli does not form part of the core difficulties that contribute to overweight and obesity, it is also possible that the visual-search tasks used in Parts Three and Four were subject to a floor effect.
... feeling for protruding bones or measuring the size of multiple body parts [6,7], and body avoidance behavior [8,9]. Body avoidance behavior strategies manifest in the avoidance of seeing one's body in the mirror [8,10]. Several therapeutic interventions aim at improving dysfunctional aspects of body image in patients with eating disorders (ED) [11][12][13]. ...
Mirror exposure (ME) is an effective technique to improve body image. However, evidence on the underlying mechanisms and the optimal verbalization instruction during ME is lacking. Therefore, this experimental study analyzed mechanisms of ME and therapeutic outcomes by comparing positive (PV) and negative (NV) full-body verbalization. N = 73 healthy females were randomized to a PV or an NV condition. PV participants verbalized positively while NV participants verbalized negatively about their whole body. Each participant underwent three standardized ME sessions. Before and after each ME session, positive affect, negative affect and body satisfaction were assessed. Before the first and after the third ME, participants completed questionnaires on cognitive-affective and behavioral aspects of body image, eating pathology and self-esteem. Regarding within-ME changes, the results indicate that positive affect and body satisfaction decreased while negative affect increased in the NV group but not in the PV group. In contrast, regarding between-ME changes, decreased negative affect as well as positive affect and increased body satisfaction were observed in both groups. However, eating pathology remained stable, whereas body-checking behavior increased and the PV condition was followed by higher levels of self-esteem compared to the NV condition. These findings suggest that both PV and NV improve negative affect and body satisfaction between-ME, and thus seem to be effective ME instructions. Given that NV led to increased negative affect within-ME and did not influence self-esteem, PV might represent the favorable instruction during ME for body-satisfied women.
... The act of viewing oneself in a mirror triggers a complex psychological response, affected greatly by the level of satisfaction/dissatisfaction with one's body (Glashouwer et al., 2016), emotional valence attached to one's body, cognitive selfregulation skills that help manage the elicited negative emotions (Crino et al., 2019), and current mood quality (Svaldi et al., 2016). This response drives individuals with EDs to keep checking their body frequently, engage in body avoidance behavior (e.g., covering mirrors), or switch between these two strategies (Shafran et al., 2004). Variability (flexibility vs. rigidity) in these behavioral responses appears to be significantly influenced by the emotion regulation strategies employed (Brockmeyer et al., 2014), as well as etiological heterogeneity of ED cases (Kaye et al., 2009). ...
Objective: Body image disturbances and the attendant negative emotions are two of the major clinical symptoms of eating disorders. The objective of the present experimental study was to shed more light on the degree of association or dissociation between the physiological and emotional response to mirror exposure in patients with restrictive mental anorexia, and on the relationships between the physiological response and characteristics connected with emotional processing.
Materials and Methods: Thirty adolescent girls with the restrictive type of anorexia and thirty matched healthy controls underwent bilateral measurement of skin conductance (SC) during rest, neutral stimulus exposure, and mirror exposure, and completed a set of measures focused on emotion regulation competencies, affectivity, and eating disorder pathology.
Results: Compared to healthy controls, girls with restrictive anorexia rated mirror exposure as a subjectively more distressful experience. Differences in skin conductance response (SCR) were not significant; however, variance in SCR was substantially greater in the group of anorexia patients as compared to healthy controls. The overall skin conductance level (SCL) was lower in anorexia patients. Increase in SCR during mirror exposure, as opposed to exposure to neutral stimuli, was positively related to the tendency to experience negative emotions, interoceptive sensitivity, body dissatisfaction and suppression, but not to other symptoms of eating pathology or emotional awareness. A post hoc analysis suggested that physiological reactivity might be associated with interoceptive sensitivity to mirror exposure especially in anorectic patients.
Conclusion: The study seems to demonstrate some degree of dissociation between psychophysiological reactivity and subjective response to body exposure in patients with restrictive anorexia. Factors affecting differences in psychophysiological responsiveness to body exposure in anorectic patients require further exploration.
... Nytt är också att ökad uppmärksamhet ges till patientens övervärdering av ätande, vikt och/eller kropppsform och den kontroll man försöker utöva på detta. På senare tid har det alltmer uppmärksammats, att patienter ofta är mycket upptagna med att kontrollera kroppen på olika sätt (Shafran, Fairburn, Robinson & Lask, 2004). Det är viktigt att man arbetar med dessa kontrollbeteenden. ...
CBT Treatment Manual for Anorexia nervosa (In Swedish)
... The attitudinal component involves dissatisfaction with body shape or size (Gardner, 2001). The behavioral component comprises body avoidance, including tendencies to avoid situations that elicit worry about physical appearance (Rosen, Srebnik, Saltzberg, & Wendt, 1991), and body checking, the behavioral manifestation aimed at gaining information on body shape, size, or weight (Shafran, Fairburn, Robinson, & Lask, 2004). According to Stapleton, McIntyre and Bannatyne (2014), body image disturbance "serves as an important risk factor in the development of eating disturbances and other unhealthy behaviors". ...
Objectives. The aim of this study is to assess physical appearance behavior avoidance among a group of Moroccan adolescents and to identify the associated factors.
Material and methods. The data were gathered from a cross-sectional study conducted on 487 adolescents (223 boys and 264 girls), with the average age of 14.6 years. Gender, age, body mass index (BMI), and satisfaction of their body weight and height were considered in this study. Body satisfaction was evaluated by two questions: "Are you satisfied with your body weight?" and "are you satisfied with your body height?". The Body Image Avoidance Questionnaire (BIAQ) test was used to assess the adopted behaviors.
Results. The average score on the BIAQ test was 24.4. According to the different factors of the BIAQ test, the factors "clothing", "grooming and weighing", and "eating restraint", were more noticed among adolescents. The results showed that behavioral avoidance was associated with gender, age, BMI, and body dissatisfaction. It was females, the youngest group of adolescents, overweight, and those dissatisfied with their body weight or height who had the highest scores. This reflects the fact that adolescents resort to physical appearance behavior avoidance or control including practices such as dressing, grooming, and weighing.
Conclusions. It is recommended by health professionals to enhance awareness among adolescents about the risks of adopting such behaviors on their physical and mental health, to correct the narrow and unrealistic standards of physical appearance, and to encourage healthy behaviors.
Regular self-weighing is associated with more effective weight control, yet many individuals avoid weight-related information. Implicit theories about weight, or perceptions of how malleable weight is, predict more effortful weight management and may also influence weight-related information avoidance. Participants (N = 209) were randomly assigned to read an article stressing an incremental theory of weight (i.e., weight is malleable), an article stressing an entity theory (i.e., weight is fixed), or to a control condition. We then examined their self-reported preference to avoid their body composition (i.e., body fat, weight, and muscle composition), their willingness to have their body composition measured during the lab visit, and their eating and exercise intentions. There were no notable differences across conditions, but higher self-reported incremental beliefs predicted less self-reported avoidance of body composition. The findings suggest that implicit theories may influence weight-related information avoidance, but a brief manipulation is not powerful enough to create meaningful change.
Research on suicidality in muscle dysmorphia is limited despite the high rates of suicidal thoughts and behaviors in related disorders. This study employed network analysis to examine the longitudinal relationships between muscle dysmorphia symptoms, as well as the relations between MD symptoms and suicide risk factors. Fifty individuals (Mage = 30.6 years, 63 % male) meeting criteria for muscle dysmorphia received four daily surveys for three weeks. Multi-level vector autoregression analysis was used to estimate associations between muscle dysmorphia- and suicide-related thoughts, emotions, and behaviors. The most central nodes in the muscle dysmorphia networks related to assessing muscle size, dieting, using muscle-building supplements, experiencing body dissatisfaction, seeking reassurance, and avoiding others due to concerns about appearance. In the comorbidity networks, the most central suicide-related factors were feelings of burdensomeness, feeling disgusted, and dwelling on the past. Our findings indicated that various intrusive thoughts (body dissatisfaction, dieting), compulsions (seeking reassurance, body checking, supplement use), and beliefs (burden to others, disgust with oneself) predicted future engagement in muscle dysmorphia and suicide-related symptomology. Targeting intrusive thoughts and compulsions, as well as feelings of disgust and burdensomeness, may reduce the severity of these conditions.
Many people are worried about their social appearance. The fear of negative evaluation and judgment regarding one’s look in social circumstances is referred to as social appearance anxiety. Social appearance anxiety belongs to social anxiety. The aim of the present study was to validate the Social Appearance Anxiety Scale (SAAS) in the Greek language and to examine its psychometric properties. An online survey was conducted in a Greek population sample of adolescents and young adults aged 18 to 35 years. The survey instruments included the Social Appearance Anxiety Scale, the Social Physique Anxiety Scale (SPAS), 2 subscales of Multidimensional Body-Self Relations Questionnaire Appearance Scale (MBSRQ), the Appearance Schemas Inventory-Revised Scale (ASI-R) and the Depression Anxiety Stress Scale (DASS). A total of 429 respondents participated in this research. The statistical analysis showed that the Greek version of the SAAS has good psychometric properties. The internal consistency of questions within the SAAS was 0.942. Positive correlations were found between SAAS and SPAS, the overweight preoccupation subscale of MBSRQ, the ASI-R and the DASS, while negative correlations were observed between SAAS and the appearance evaluation subscale of MBSRQ and age. The results of this study suggest that the Greek version of SAAS can be used as a reliable and valid instrument in the Greek population.
The presence of a physical or mental health issue, such as an eating disorder (ED), impacts daily activities, also known as occupations. For example, an overinvestment in body shape and weight undoubtedly can lead to an underinvestment in other, more meaningful occupations. To address ED-related perceptual disturbances, a detailed log of daily time use can pinpoint food-related occupational imbalances. This study aims to characterize the daily occupations associated with EDs. The first specific objective (SO.1) is to categorize and quantify the temporal organization of a typical day's occupations as self-reported by individuals with an ED. The second specific objective (SO.2) is to compare daily occupational time use among people with different ED types. This retrospective study based on time-use research principles was conducted by analyzing data from an anonymized secondary dataset (LoriCorps's Databank). Data were collected between 2016 and 2020, from 106 participants, with descriptive analysis completed to determine the average daily time use for each occupation. A series of one-way analyses of variance (ANOVAs) were performed to compare perceived time use in each occupation for participants with different types of EDs. The outcomes show a marked underinvestment in leisure categories compared to the general population. In addition, personal care and productivity can represent the blind dysfunctional occupations (SO.1). Moreover, compared to those with binge eating disorder (BED), individuals with anorexia nervosa (AN) are significantly more invested in occupations that focus explicitly on perceptual disturbances, such as personal care (SO.2). The highlight of this study is the distinction between marked versus blind dysfunctional occupation, which offers specific avenues for clinical intervention.
To investigate a model about body image of Iranian’s female students and determining structural relations of physical and psychological factors related to body image, 497 female students from Islamic Azad University Zarand Branch randomly selected. After measuring weight, height and calculating body mass index of participants, they assessed by body image state scale, self- esteem scale of Marsh self-concept test, the appearance schema inventory-revised, personal appearance beliefs test and body checking questionnaire. Evaluation of the proposed model with structural equation modeling (SEM) by using of maximum likelihood estimation of AMOS software and calculation of fit indices indicated that, hypothetical model has the goodness of fit with the data. Results showed that, these model direct and indirect effects of physical and cognitive-behavioral factors respectively, .417 and .33, explain 53% of variation in body image. These findings are consistent with the results of other research, modeling in the area of body image, and furthermore, helping in better knowing complex biological and psychological structure of body image
این پژوهش با هدف بررسی مدلی درباره ی تن انگاره وتعیین روابط ساختاری عوامل جسمی و عوامل شناختی ـ رفتاری دخیل در تن انگاره دانشجویان مونثایرانی انجام شد. به این منظورنمونه ای به حجم 497 نفراز دانشجویان دانشگاه آزاد اسلامی واحد زرند به طورتصادفی انتخاب شدند و پس از اندازه گیری قد، وزن و شاخص توده بدنی با استفاده ازمقیاس حالت تن انگاره، مقیاس عزت نفس آزمون خویشتن پنداره ی مارش، پرسشنامه ی طرحواره ی ظاهر تجدید نظر شده، آزمون باورهای شخصی مربوط به ظاهر و پرسشنامه وارسی بدن مورد ارزیابی قرار گرفتند. ارزشیابی مدل با معادله ساختاری مدل سازی با استفاده از روش حداکثر احتمال برآورد دربرنامه نرم افزاری آموس ومحاسبه ی شاخصهای تناسب مدل حاکی از نیکویی برازش مدل پیشنهادی بود. اثرات مستقیم و غیر مستقیم سازه ی عوامل جسمی و سازه ی عوامل شناختی ـ رفتاری به ترتیب با 0.417 و0.33 دراین مدل، 53٪ از تغییرپذیری تن انگاره دانشجویان مورد مطالعه را تبیین می کند. این یافته ها ضمن همخوانی با نتایج پژوهشهای مربوط به عوامل تاثیر گذار برتن انگاره و برخی از مدلهای آن، به شناخت بهتر ساختار پیچیده ی زیستی و روانشناختی تن انگاره کمک می کنند.
Clinical fear is at the core of anxiety disorders. Considerable research has examined processes through which clinical fears are learned and unlearned (i.e., acquisition, generalization, extinction, return of fear) in anxiety disorders. Empirically supported models of these processes implicate both associative and instrumental learning. Research has also delineated that avoidance (i.e., behaviors intended to prevent aversive experiences) and fear approach (i.e., behaviors that involve exposure to one's fear) modulate fear learning, yet these processes remain under-researched in anxiety-based disorders. The purpose of the current review is to a) review existing research on clinical fear learning, incorporating fear approach, avoidance, and inhibitory learning, and b) extend this model to advance the understanding of fear-based learning in eating disorders. Implications for research and treatment are discussed, including how the anxiety field can inform eating disorder research and the importance of empirically testing fear learning in eating disorders to improve treatment.
Individuals with binge eating disorder (BED) show preferred attention allocation towards their own (vs. another) body, and towards self-disliked (vs. self-liked) body parts. It remains unclear whether these gaze patterns are a consequence of underlying eating pathology or increased weight. In this study, women with BED (N = 73), overweight (N = 38) and healthy weight (N = 42) female control groups (CG) performed two eye-tracking paradigms using pictures of their own and a control body. In task 1 (processing their own vs. a control body), the BED group displayed a stronger preference for the own body during more automatic processing relative to the overweight CG, whereas the healthy weight CG showed a balanced attention distribution between both bodies. In task 2, all groups showed a bias towards the most unattractive relative to the most attractive part of their own body. This was strongest in the BED and overweight groups, but only the BED group showed a negative bias towards the control body. Results indicate a stronger self-focused and deficit-oriented bias in the BED group but also some abnormalities in overweight individuals. Future studies should test whether these biases are modifiable, and whether their modification improves body image.
Maladaptive body size evaluation processes and body dissatisfaction are known as central risk factors for the development and maintenance of anorexia nervosa (AN). This study aimed to experimentally test potential key facets, such as (psycho)physiological, cognitive-verbal and behavioral mechanisms, within the context of these evaluation processes. Twenty-two females with AN (AN-G) and 22 healthy controls (HC-G) looked at pictures of their body gradually increasing in weight using a morphing technique. Implicit emotional arousal was assessed using steady-state visual evoked potentials (SSVEP) in electroencephalography. Additionally, in a forced-choice body size evaluation task, participants were asked to classify pictures of their own body as not big or big while reaction times were captured. A significantly earlier increase in SSVEPs emerged in AN-G compared to HC-G (p <.05), with AN-G evaluating their bodies in the morphing process as big at a significantly thinner body size (p <.05). The AN-G showed faster reaction times in the categorical evaluation of body stimuli (p <.05). Findings from this multimodal paradigm underline the importance of body size evaluation mechanisms and underlying emotional arousal for AN. A differentiated understanding of these processes is essential, since the effectiveness of therapeutic interventions for AN is limited and relapses are frequent.
Background
Despite the severity and high rate of co-occurrence between eating disorders (ED) and obsessive-compulsive disorder (OCD), less is known regarding the longitudinal sequencing of their comorbidity and whether and how their symptoms may influence one another over time. The current study sought to answer these questions by testing if a bidirectional, longitudinal relationship exists between ED symptoms and OCD obsessions and compulsions.
Methods
We examined the relationship between ED symptoms, obsessions and compulsions across five time points, each one week apart using auto-regressive cross-lagged panel modeling. The final sample consisted of 358 individuals from the community with moderate levels of ED and OCD symptoms, the majority of whom identified as White and male.
Results
Bivariate correlations revealed that ED symptoms, obsessions and compulsions were associated with one another across the five weeks. Two cross-lagged panel models indicated that ED symptoms predicted OCD symptoms at numerous time points and vice versa. However, we found this significant longitudinal associations across only certain weeks. Notably, the models found that only ED symptoms and OCD obsessions predicted one another across different time points across the five weeks; ED symptoms and OCD compulsions did not predict one another. Limitations. Due to the non-clinical nature of the sample, there is limited generalizability to clinical populations.
Conclusions
Our results provide preliminary evidence that there is a bidirectional, longitudinal relationship between ED symptoms and OCD symptoms among a community sample, particularly with respect to cognitive as opposed to behavioral symptoms.
Background: It is often advised to ensure a high protein intake during energy-restricted diets. However, it is unclear whether a high protein intake is able to maintain muscle mass and contractility in the absence of resistance training.
Materials and Methods: After 1 week of body mass maintenance (45 kcal/kg), 28 male college students not performing resistance training were randomized to either the energy-restricted (ER, 30 kcal/kg, n = 14) or the eucaloric control group (CG, 45 kcal/kg, n = 14) for 6 weeks. Both groups had their protein intake matched at 2.8 g/kg fat-free-mass and continued their habitual training throughout the study. Body composition was assessed weekly using multifrequency bioelectrical impedance analysis. Contractile properties of the m. rectus femoris were examined with Tensiomyography and MyotonPRO at weeks 1, 3, and 5 along with sleep (PSQI) and mood (POMS).
Results: The ER group revealed greater reductions in body mass (Δ -3.22 kg vs. Δ 1.90 kg , p < .001, partial η² = .360), lean body mass (Δ -1.49 kg vs. Δ .68 kg, p < .001, partial η² = .152), body cell mass (Δ -.85 kg vs. Δ .59 kg, p < .001, partial η² = .181), intracellular water (Δ -.58 l vs. Δ .55 l, p < .001, partial η² = .445) and body fat percentage (Δ -1.74 % vs. Δ 1.22 %, p < .001, partial η² = 433) compared to the CG. Contractile properties, sleep onset, sleep duration as well as depression, fatigue and hostility did not change (p > .05). The PSQI score (Δ -1.43 vs. Δ -.64, p = .006, partial η² = .176) and vigor (Δ -2.79 vs. Δ -4.71, p = .040, partial η² = .116) decreased significantly in the ER group and the CG, respectively.
Discussion: The present data show that a high-protein intake alone was not able to prevent lean mass loss associated with a 6-week moderate energy restriction in college students. Notably, it is unknown whether protein intake at 2.8 g/kg fat-free-mass prevented larger decreases in lean body mass. Muscle contractility was not negatively altered by this form of energy restriction. Sleep quality improved in both groups. Whether these advantages are due to the high-protein intake cannot be clarified and warrants further study. Although vigor was negatively affected in both groups, other mood parameters did not change.
Designed a self-report measure of behavioral tendencies that frequently accompany body-image disturbance. The 19-item questionnaire dealt with avoidance of situations that provoke concern about physical appearance, such as avoidance of tight-fitting clothes, social outings, and physical intimacy. The body image avoidance questionnaire had adequate internal consistency and test–retest reliability. The measure correlated highly with negative attitudes about weight and shape and with perceptual distortion of size. It distinguished women with bulimia nervosa from controls, was sensitive to change following treatment for severe body-image disturbance, and agreed with external raters. Norms for the measure and the factor structure are also provided. Although body-image disturbance is traditionally viewed as perceptual distortion of body size and negative attitudes about weight and shape, it is recommended that a multidimensional assessment also include attention to behavioral tendencies. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
I review and critique restraint theory and develop a 3-factor model of dieting behavior. The factors--frequency of dieting and overeating, current dieting, and weight suppression--are embedded within a 3-dimensional grid that also considers mechanisms mediating the effects of dieting and the influence of weight status. I argue that the eating behavior exhibited by restrained eaters stems from their frequent dieting and overeating in the past rather than from their current state of dietary or cognitive restraint. Evidence is reviewed, indicating that current dieting and weight suppression have different effects on eating than does restraint. The 3-factor model is used to reinterpret findings consistent with restraint theory and to explain findings inconsistent with restraint theory. Finally, clinical and research implications of the 3-factor model are discussed.
Research testing the predictions of cognitive-behavioral theory related to the psychopathology of eating disorders has lagged behind treatment outcome research. Central to cognitive theories of eating disorders is the hypothesis that beliefs and expectancies pertaining to body size and to eating are biased in favor of selectively processing information related to fatness/thinness, dieting, and control of food intake or body weight. In recent years, controlled investigations of the predictions of cognitive theories of eating disorders have yielded empirical support for these theories. This paper reviews research which has tested the predictions of cognitive-behavioral theory and discusses the implications of these findings for the treatment of eating disorders. Understanding of information processing biases may assist the clinician in understanding a range of psychopathological features of anorexia and bulimia nervosa, including denial, resistance to treatment, and misinterpretation of therapeutic interventions.
The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out by a number of authors. Pasamanick12 in a recent article viewed the low interclinician agreement on diagnosis as an indictment of the present state of psychiatry and called for "the development of objective, measurable and verifiable criteria of classification based not on personal or parochial considerations, but on behavioral and other objectively measurable manifestations."Attempts by other investigators to subject clinical observations and judgments to objective measurement have resulted in a wide variety of psychiatric rating scales.4,15 These have been well summarized in a review article by Lorr11 on "Rating Scales and Check Lists for the Evaluation of Psychopathology." In the area of psychological testing, a variety of paper-and-pencil tests have been devised for the purpose of measuring specific
Research addressing the assessment of binge eating and associated eating disorder psychopathology has steadily increased in recent years. Few studies have examined the relationship between the various assessment methods. This study compared an investigator-based interview, the Eating Disorder Examination (EDE), with a self-report version of that interview, the EDE-Q. Fifty-two individuals (six men and 46 women) with binge eating disorder (BED) completed both instruments. Modest-to-good agreement and significant correlations (P < 0.0001) were found between the two methods on all four subscales assessing specific eating disorder psychopathology (i.e., Restraint, Eating Concern, Weight Concern, and Shape Concern subscales). However, higher levels of disturbance were consistently reported on the EDE-Q than the EDE interview. The two methods were not significantly or reliably related to one another when assessing binge eating. This may be due in part to the difficulty inherent in identifying binges in subjects with BED. Examination of individual item scores suggest that it might be possible to improve the performance of the EDE-Q by clarifying the definitions of certain complex features, although this should not be at the expense of compromising the practical utility of its self-report format.
The specific psychopathology of anorexia nervosa and bulimia nervosa is complex in form. Although for many purposes self-report questionnaires are a satisfactory measure of this psychopathology, for detailed psychopathological studies and for investigations into the effects of treatment, more sensitive and flexible assessment measures are required. For this reason a semi-structured interview was developed. This interview, the Eating Disorder Examination, is designed to assess the full range of the specific psychopathology of eating disorders, including these patients' extreme concerns about their shape and weight.
The theoretical and empirical basis of commonly accepted propositions concerning the role of behaviour in the practice of behavioural psychotherapy for anxiety problems is considered. A number of problems are identified, and an alternative, more explicitly cognitive hypothesis is described. According to this cognitive account, there is both a close relationship and specific interactions between “threat cognitions” and “safety seeking behaviour”. For any individual, safety seeking behaviour arises out of, and is logically linked to, the perception of serious threat. Such behaviour may be anticipatory (avoidant) or consequent (escape). Because safety seeking behaviour is perceived to be preventative, and focused on especially negative consequences (e.g. death, illness, humiliation), spontaneous disconfirmation of threat is made particularly unlikely by such safety seeking behaviours. By preventing disconfirmation of threat-related cognitions, safety seeking behaviour may be a crucial factor in the maintenance of anxiety disorders. The implications of this view for the understanding and treatment of anxiety disorders are discussed.
Research addressing the assessment of binge eating and associated eating disorder psychopathology has steadily increased in recent years. Few studies have examined the relationship between the various assessment methods. This study compared an investigator-based interview, the Eating Disorder Examination (EDE), with a self-report version of that interview, the EDE-Q. Fifty-two individuals (six men and 46 women) with binge eating disorder (BED) completed both instruments. Modest-to-good agreement and significant correlations (P < 0.0001) were found between the two methods on all four subscales assessing specific eating disorder psychopathology (i.e., Restraint, Eating Concern, Weight Concern, and Shape Concern subscales). However, higher levels of disturbance were consistently reported on the EDE-Q than the EDE interview. The two methods were not significantly or reliably related to one another when assessing binge eating. This may be due in part to the difficulty inherent in identifying binges in subjects with BED. Examination of individual item scores suggest that it might be possible to improve the performance of the EDE-Q by clarifying the definitions of certain complex features, although this should not be at the expense of compromising the practical utility of its self-report format.
A detailed comparison was made of two methods for assessing the features of eating disorders. An investigator-based interview was compared with a self-report questionnaire based directly on that interview. A number of important discrepancies emerged. Although the two measures performed similarly with respect to the assessment of unambiguous behavioral features such as self-induced vomiting and dieting, the self-report questionnaire generated higher scores than the interview when assessing more complex features such as binge eating and concerns about shape. Both methods underestimated body weight.
Effective planning for medication treatment in patients with bulimia nervosa and anorexia nervosa is based on a comprehensive clinical assessment, including a careful review of comorbid psychiatric disorders and response to treatments for previous episodes of the disorder. Although most patients with bulimia nervosa are offered a trial of psychotherapy, significant results of controlled trials have contributed to an increased role for medications in the treatment of patients with this disorder. Pharmacologic treatment of anorexia nervosa has similarities to that of treatment-resistant depression, with the clinician turning to open trials and clinical reports for clues to rational management. As described in this article, considerations of potential side effects and medical complications are likely to play an important role in guiding the choice of medication used for treatment of patients with eating disorders.
A cognitive behavioural theory of the maintenance of anorexia nervosa is proposed. It is argued that an extreme need to control eating is the central feature of the disorder, and that in Western societies a tendency to judge self-worth in terms of shape and weight is superimposed on this need for self-control. The theory represents a synthesis and extension of existing accounts. It is 'new', not so much because of its content, but because of its exclusive focus on maintenance, its organisational structure and its level of specification. It is suggested that the theory has important implications for treatment.
This research investigated the internal consistency and test-retest reliability of the Eating Disorder Examination-Self-Report Questionnaire Version (EDE-Q), a 41-item measure adapted from the Eating Disorder Examination (EDE). The EDE is a structured clinical interview assessing the key behavioral features and associated psychopathology of eating disorders.
Results indicated excellent internal consistency and 2-week test-retest reliability for the four subscales of the EDE-Q: Restraint, Weight Concern, Shape Concern, and Eating Concern. There was somewhat less stability in the items measuring the occurrence and frequency of the key behavioral features of eating disorders.
Overall, results support the psychometric adequacy of the EDE-Q.
The persistence of dieters' weight loss efforts, despite repeated failures, suggests that there must be some interim reinforcement for dieting that sustains the behavior. We propose that self-change efforts capitalize on a "false hope syndrome," in which the initial commitment to change brings immediate rewards (largely improvements in self-image), regardless of the eventual outcome.
Eighty female students chose whether they would attempt either to reduce their weight or to increase their study time over a 2-week period. A control group did not attempt self-change.
The effects of making a resolution to change differed for novice and veteran self-changers (nondieters and chronic dieters). Nondieters showed an immediate improvement in their mood and self-image after making a resolution, but this subjective improvement dissipated over the course of the study. Veteran dieters showed a mixed response, initially feeling both more depressed, yet more hopeful of success.
These results are discussed in terms of variations on the false hope syndrome for different kinds of individuals (novices and veterans).
The main aim of this study was to assess the level of agreement between the Eating Disorders Examination (EDE) and its self-report version (EDE-Q) on key items in a clinic sample of patients with bulimia nervosa. A second objective was to assess the concordance between self-reported and objective body weight in the sample.
Sixty females who met DSM-IV criteria for bulimia nervosa (purging type) participated. Fifty-seven of them completed both the EDE and the EDE-Q. Self-reported weight was obtained during a telephone screening interview. Objective weight was subsequently measured at an assessment about a week later.
The EDE generated higher scores than the EDE-Q for the frequency of objective binge and vomiting episodes. The two methods produced equivalent results for subjective binge episodes, laxative and diuretic misuse, and concerns about shape and weight. The self-report method underestimated body weight.
These findings suggest that some core features of eating disorders are more accurately assessed using the EDE interview.
The purpose of this study was to develop a brief self-report inventory to assess body checking behaviors.
Using exploratory and confirmatory factor analyses, the 23-item Body Checking Questionnaire (BCQ) was developed. The BCQ measures the global construct of body checking behaviors with three correlated subfactors that assess checking related to overall appearance, checking of specific body parts, and idiosyncratic checking rituals.
The BCQ was found to have good test-retest reliability (.94) and the subfactors had good internal consistency (.88, .92, and .83). The measure correlated highly with other measures of negative body image and eating disorders, demonstrating its concurrent validity. Additionally, the BCQ was found to differentiate normal controls and eating disorder patients, as well as nonclinical participants scoring high and low on a measure of concern with body size and dieting.
Due to the potential role of ritualistic body checking in the maintenance of body dissatisfaction by directing excessive attention to body shape/weight, the BCQ may prove to be a useful clinical tool in the assessment and treatment of eating disorder patients.
This paper is concerned with the psychopathological processes that account for the persistence of severe eating disorders. Two separate but interrelated lines of argument are developed. One is that the leading evidence-based theory of the maintenance of eating disorders, the cognitive behavioural theory of bulimia nervosa, should be extended in its focus to embrace four additional maintaining mechanisms. Specifically, we propose that in certain patients one or more of four additional maintaining processes interact with the core eating disorder maintaining mechanisms and that when this occurs it is an obstacle to change. The additional maintaining processes concern the influence of clinical perfectionism, core low self-esteem, mood intolerance and interpersonal difficulties. The second line of argument is that in the case of eating disorders shared, but distinctive, clinical features tend to be maintained by similar psychopathological processes. Accordingly, we suggest that common mechanisms are involved in the persistence of bulimia nervosa, anorexia nervosa and the atypical eating disorders. Together, these two lines of argument lead us to propose a new transdiagnostic theory of the maintenance of the full range of eating disorders, a theory which embraces a broader range of maintaining mechanisms than the current theory concerning bulimia nervosa. In the final sections of the paper we describe a transdiagnostic treatment derived from the new theory, and we consider in principle the broader relevance of transdiagnostic theories of maintenance.
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