Body image and nonsuicidal self-injury: Validation of the Body Investment Scale in participants with eating disorders

Predictors of non-suicidal self-injury in adolescents with depressive disorder: the role of alexithymia, childhood trauma, and body investment

Purpose

This study analyzes the relationship of alexithymia, childhood trauma, and body investment to non-suicidal self-injury (NSSI) behaviors in adolescents with depressive disorder and whether they have predictive and diagnostic value for non-suicidal self-injury (NSSI) behaviors in adolescents with depressive disorder.

Patients and methods

A total of 225 patients with a diagnosis of adolescent depressive disorder were included in the study and were divided into two groups according to the DSM-5 criteria: 98 cases without NSSI and 127 cases with NSSI. Compare the demographic data, 24-item Hamilton Depression Scale (HAMD-24), 20-item Toronto Alexithymia Scale (TAS-20), Childhood Trauma Questionnaire-Short Form (CTQ-SF), and Body Investment Scale (BIS) scores between two groups. Binary logistic regression was used to analyze the independent risk factors contributing to NSSI behaviors in adolescents with depression, and establish four predictive models. Based on the models' predictive probability, the ROC curves were plotted to calculate the value of the predictive diagnostic effect.

Results

The group without NSSI had lower scores than the group with NSSI on HAMD-24 total score, TAS-20 total score, difficulty identifying feelings, difficulty describing feelings, and externally focused thinking, as well as lower scores on CTQ-SF total score, physical neglect, emotional neglect, physical abuse, and emotional abuse. In contrast, the BIS total score, body image feelings and attitudes, body care, and body protection factor scores were higher for the group without NSSI. The BIS body care factor score and the CTQ-SF emotional abuse factor score were significantly linked with adolescents diagnosed with depressive disorder who exhibited NSSI behaviors. These results provide a good diagnostic model for adolescents with depressive disorder.

Conclusion

Low levels of body care and childhood emotional abuse may independently contribute to the implementation of NSSI in adolescents with depressive disorder. Body investment and childhood trauma are valuable in diagnosing and predicting NSSI behaviors and should be considered as potentially important factors in clinical treatment.

Non-suicidal self-injury among individuals with an eating disorder: A systematic review and prevalence meta-analysis

OBJECTIVE

This study aimed to quantify the prevalence of non-suicidal self-injury across eating disorders (EDs) and within diagnostic categories through systematic review and proportional, or so-called prevalence, meta-analysis.

METHOD

Included studies had to contain individuals with a verified diagnosis of an ED. The last literature search was conducted on September 11, 2023, for studies published on or before September 2023 without a restriction on earliest publication year. Results were synthesized and analyzed using the "metaprop" package in R and presented using forest plots. Bias was assessed by a Peters' regression test and funnel plot.

RESULTS

79 studies published between 1985 and 2023 were included encompassing 32,334 individuals with an ED. Importantly, 42 studies were not included in any other meta-analyses on self-injury in EDs to date. Overall prevalence of non-suicidal self-injury was 34.59% (95%CI = 30.49-38.81). Prevalence in anorexia nervosa restrictive type, binge/purge type, bulimia nervosa, binge eating disorder and other specified feeding/eating disorder were 23.19% (95%CI = 16.96-30.03%), 41.98% (95%CI = 32.35-51.91%), 36.97% (95%CI = 30.69-43.46%), 21.21% (95%CI = 14.93-28.12%) and 37.65% (95%CI = 28.59-47.09%), respectively. Prevalence estimations could not be estimated for other ED categories due to lack of a sufficient number of studies.

DISCUSSION

Non-suicidal self-injury is prevalent across both binge/purge and restrictive EDs. Considering the transdiagnostic nature of self-injurious behaviors in ED, the results highlight the importance of assessment and monitoring of self-injury in people with ED, irrespective of specific diagnoses. The method of determining self-injury varied across studies and may limit this study.

PUBLIC SIGNIFICANCE

This study highlights the prevalence of self-injury across eating disorders irrespective of diagnosis and within specific EDs. While diagnoses known to exhibit self-injurious behaviors (e.g., bulimia nervosa, anorexia nervosa binge/purge subtype) demonstrated the highest prevalence of self-injury, all diagnoses were found to have a prevalence greater than 20%. These findings suggest the importance of assessing and monitoring all individuals with an eating disorder for the presence of self-injury.

Eating disorder risk in adolescent and adult female athletes: the role of body satisfaction, sport type, BMI, level of competition, and training background

BACKGROUND

Eating disorders negatively influence athletes' health and performance. To achieve a high level of performance and conform to cultural expectations regarding an athletic body type, female athletes often restrict their diets, which can lead to eating disorders. In addition to factors related to the sports environment, adolescent athletes are subject to changes caused by the maturation process. Therefore, the same factors may have different effects on eating disorder risk among adolescent and adult athletes. This study examined the relationship between eating disorder risk, specific aspects of the sports environment (sport type, level of competition [national and international], and training background), and individual aspects (body satisfaction and body mass index) in two groups of athletes: adolescents and adults.

METHODS

The sample included 241 highly trained female athletes aged 12-30 years (M = 20.68, SD = 4.45) recruited from different sports clubs in Poland. The subgroup of adolescents consisted of 82 athletes, while the number of adult athletes was 159. The Eating Attitudes Test questionnaire was used to assess the eating disorder risk among the athletes. Body satisfaction was measured using the Feelings and Attitudes Toward Body Scale incorporated into the Body Investment Scale.

RESULTS

Eating disorder risk was prevalent among 14.6% of the adolescent and 6.9% of the adult athletes. Significant associations between eating disorder risk and the studied variables were noted only among adolescent athletes. Univariate logistic regression analysis revealed that the occurrence of eating disorder risk was associated with participation in lean non-aesthetic sports (OR = 11.50, 95% CI: 3.58-37.09). Moreover, eating disorder risk was associated with athletes' lower body satisfaction (OR = 0.80, 95% CI: 0.70-0.92). Body mass index was not included in the final regression model.

CONCLUSIONS

The study indicated that eating disorder risk in adolescent female athletes was related to sport type and body satisfaction. The findings showed that, in adolescent athletes, eating disorder risk was the most associated with practicing lean non-aesthetic sports. Coaches and athletes should be aware that eating disorder risk increases among individuals with a lower body image.

Randomized control trial of a single-session intervention targeting sociocultural pressures of body image in college sorority women

Objective: To assess the effectiveness of a peer-led single-session intervention targeting the sociocultural pressures of body image. Participants: New members of 13 sororities at one university. Methods: Participants were randomized by sorority into the intervention (n = 207) or wait list control (n = 264). Online surveys were administered at baseline and one month to assess social determinants of body image, body image dissatisfaction (BID), and body appreciation. Multiple logistic and linear regression analyses compared changes over time between groups. Results: We observed significant improvements in overall sociocultural pressures of body image (p = .001) and the subscales of Norms (p < .001) and Perceived Norms (p = .009) of eating and exercise behaviors. Change in BID and body appreciation did not differ between groups. Conclusion: A one-hour peer-led community-level intervention can lead to positive changes in sociocultural pressures in new initiates to a sorority.

Body Investment as a Protective Factor in the Relationship Between Acquired Capability for Suicide and Suicide Attempts

Acquired capability for suicide is associated with increased suicide risk and behaviors, but little research has examined factors that may qualify this relationship. Body investment is proposed as one such factor, as it may engage self-preservation instincts and serve as a buffer to capability for suicide. It was expected that facets of body investment (body feelings, body care, comfort with touch, and body protection) would moderate the relationship between acquired capability for suicide and suicide attempts. The current study included a sample of 1,150 undergraduate students with a mean age of 19.74 (3.44). The majority of the sample identified as female (71%) and White/Caucasian (78%). Participants completed self-report measures of body investment (Body Investment Scale [BIS]), acquired capability (Acquired Capability for Suicide Scale [ACSS]), suicide thoughts and attempt history (Self-Harm Behavior Questionnaire [SHBQ]), and demographic information. Four moderation analyses were run using the PROCESS macro; one for each body investment subscale. All facets of body investment showed significant moderation except for body care. Acquired capability was significantly associated with suicide attempts when body feelings, comfort with touch, and body protection were low, but not when they were high. Results indicate that fostering aspects of body investment may be important for suicide prevention.

Post-hospitalization Daycare Treatment for Adolescents With Eating Disorders

Background: There are several possible facilities for the treatment of eating disorders (EDs). Specifically, there is the issue of the use of specialized daycare and ambulatory services over inpatient settings and the place of daycare programs following inpatient treatment. Aim: We sought to examine the contribution of post-hospitalization daycare program to the treatment of adolescents hospitalized with an ED. Methods: We assessed 61 female adolescents hospitalized with an ED. All but three were diagnosed with clinical or subthreshold anorexia nervosa (AN). Three were diagnosed with bulimia nervosa. Thirty-seven patients continued with a post-hospitalization daycare program for at least 5 months, whereas 24 did not enter or were enrolled in the program for <5 months. Patients completed on admission to, and discharge from, inpatient treatment self-rating questionnaires assessing ED-related symptoms, body-related attitudes and behaviors, and depression and anxiety. Social functioning was assessed 1 year from discharge using open-ended questions. One-year ED outcome was evaluated according to the patients' body mass index (BMI) and according to composite remission criteria, assessed with a standardized semistructured interview. To be remitted from an ED, patients were required to maintain a stable weight, to have regular menstrual cycles, and not to engage in binging, purging, and restricting behaviors for at least eight consecutive weeks before their assessment. Results: BMI was within normal range at follow-up, whether completing or not completing daycare treatment, and around 75% of the patients had menstrual cycles. By contrast, when using comprehensive composite remission criteria, less than a quarter of former inpatients not entering/not completing daycare program achieved remission vs. almost a half of the completers. In addition, a greater percentage of completers continued with psychotherapy following discharge. Fifty percent of both groups showed good post-discharge social functioning. No between-group differences were found in the BMI and the scores of the self-rating questionnaires at admission to, and discharge from, inpatient treatment. Conclusion: Adolescent females with EDs can maintain a normal-range BMI from discharge to 1-year follow-up, even if not completing daycare treatment. By contrast, completion of a post-hospitalization daycare program may improve the 1-year follow-up ED-related outcome of former ED inpatients.

The Portuguese version of the body investment scale: psychometric properties and relationships with disordered eating and emotion dysregulation

BACKGROUND

This study aimed to examine the psychometric properties of the Portuguese version of the Body Investment Scale (BIS) in a nonclinical sample of students and a clinical sample of outpatients with eating disorders, to analyse the differences in the BIS factors between the samples and to explore the relationships among body investment, eating disorder symptoms and difficulties in emotion regulation.

METHODS

The clinical (n = 93) and nonclinical (n = 448) samples completed self-report measures.

RESULTS

In contrast to the nonclinical sample, confirmatory factor analysis showed an acceptable fit for the original four-factor solution of the BIS in the clinical sample. This scale also demonstrated adequate internal consistency in both samples. Significant differences in BIS factors were found between the samples; outpatients with eating disorders presented more negative feelings about the body, less comfort with touch and lower levels of body protection than those of the students. In the clinical sample, significant relationships were found between these factors and a higher severity of disordered eating, as well as between these factors and higher difficulties in emotion regulation.

CONCLUSIONS

The Portuguese version of the BIS is a psychometrically sound measure for the assessment of body investment, and it is especially appropriate in a clinical setting of outpatients with eating disorders.

Body Image of Highly Trained Female Athletes Engaged in Different Types of Sport

Background

The aim of the study was to evaluate differences in body image across different types of sports in highly trained female athletes.

Methods

242 female individuals, aged 13–30 years (M = 20.0, SD = 4.5), representing aesthetic sports (n = 56) and nonaesthetic sports (n = 186), were recruited from different sports clubs in Poland. Body image, BMI, age, the level of competition attained, and the training background of participants were recorded.

Results

One-way ANOVA showed differences in the body image of athletes engaged in different types of sport (F(11,230) = 4.10, p < 0.001, and η² = 0.16). The model predicting the body image of female athletes was significant (F(5,236) = 10.40, p < 0.001); the adjusted R² = 0.163. Type of sport explained 7.1% (β = –0.263, p < 0.001), age explained 4.5% (β = 0.341, p < 0.001), BMI explained 3.6% (β = –0.230, p < 0.001), and level of competition explained 0.9% (β = 0.153, p < 0.05) of variance in body image.

Conclusions

The findings provide vital new knowledge which can be used by researchers and practitioners in designing educational programs on weight-related behaviors in female athletes. Such programs should be implemented especially in young female athletes participating in high-level sporting activities at an early stage.