Body checking in the eating disorders: Associations between cognitions and behaviors

The influence of body image on psychological symptomatology in breast cancer women undergoing intervention: a pre-post study

Introduction

Body image concerns related to breast cancer surgery may challenge patients' quality of life and their treatment outcomes, thus representing a key aspect to be assessed in the psycho-oncological settings. The present longitudinal study is aimed to (1) investigate the association between preoperative body image and postoperative psychological symptoms in breast cancer patients; (2) explore the impact of pre-/post-surgery variation in body image on psychological symptomatology.

Methods

N = 72 women undergoing breast cancer surgery were preoperatively screened (T1) using the Body Uneasiness Test (BUT) and were assessed postoperatively (T2) using the Symptom Checklist-90 Revised (SCL-90-R) and re-administered the BUT. Spearman's correlation was used to investigate the relationship between age, preoperative body image and postoperative psychological symptoms, and variation in body image. To predict post-surgical psychological symptomatology, two separated multiple regression models were used to evaluate preoperative body image and its variation after surgery controlling for covariates (i.e., education; intervention type). P significance was set as 0.05 for all analyses and adjusted for multiple comparisons.

Results

At T1, anxiety in relation to body image scores emerged as the most frequently experienced psychological symptomatology after surgery (all adjusted p < 0.05). Significant correlations were observed between all SCL-90-R scores at T2 and avoidance behaviors and depersonalization scores at T1. The associations were most significantly strong for somatization, depression, anxiety, and hostility (all adjusted p < 0.05). However, change in body image between pre- and post-intervention was not associated with psychological symptomatology at T2 (all adjusted p > 0.05). Pre-surgery body avoidance was significantly associated with post-intervention psychological symptoms (SOMβ = 0.453, p = 0.0001; DEPβ = 0.507, p = 0.0001; AXβ = 0.459, p = 0.0001; HOSβ = 0.410, p=. 0001). However, increased weight phobia between pre- and post-surgery was statistically associated with increased somatization, anxiety, depression and hostility at T2 (βSOM = 0.439, p = 0.0001; βDEP = 0.454, p = 0.0001; βANX = 0.471, p = 0.0001).

Discussion

Overall, pre-/post-intervention body concerns were significantly associated with primary psychological symptoms in breast cancer patients undergoing surgery. Higher levels of body avoidance and weight phobia were significantly associated with the primary psychological dimensions assessed. As body concerns might act as quality-of-life predictors, their evaluation is crucial in fostering patients' well-being and treatment adherence.

Psychometric properties of self-report measures of eating disorder cognitions: a systematic review

BACKGROUND

Although eating disorder (ED) models display some differences in theory and treatment approach, cognitive-behavioural, schema-focused, and disorder-specific models all highlight the fundamental nature of cognitions as key factors in ED development and maintenance processes. As such, it is vital that ED cognitions continue to be assessed and monitored as therapeutic targets and treatment outcomes as well as being examined as constructs in empirical research. This review aimed to systematically identify and evaluate the psychometric properties of existing self-report measures of ED cognitions.

METHODS

A systematic review protocol was registered using the international prospective register of systematic reviews (PROSPERO; CRD42023440840). Included studies described the development, validation and/or the psychometric evaluation of a measure (or subscale) that was specifically developed to solely assess ED cognitions (that is thoughts, expectations, assumptions, or beliefs), in English-speaking, adult populations. The search was conducted using three electronic databases: PsycINFO, MedLine, and Embase. Two independent reviewers conducted screening, selection and evaluation of the psychometric properties of relevant measures using a standardised, well-established quality appraisal tool.

RESULTS

Of the initial search of 7581 potential studies, 59 met inclusion criteria and described the psychometric evaluation of 31 measures (or subscales) of ED cognitions. The findings from the current review indicate that of the included measures, none currently meet all nine criteria of adequate psychometric properties. The Eating Beliefs Questionnaire (EBQ; and EBQ-18), and the Eating Disorder Inventory Body Dissatisfaction subscale (EDI [BD]) currently possess the most evidence supporting their validity, reliability, and clinical utility.

CONCLUSIONS

The findings of the current systematic review provide guidance for future researchers to focus efforts on improving evidence for the validity, reliability and utility of self-report measures of ED cognitions. Overall, the present study has provided a detailed and systematic evaluation to support researchers and clinicians in future selection of measures of ED cognitions dependent on the specific aims of their research and treatment.

Examining the momentary relationships between body checking and eating disorder symptoms in women with anorexia nervosa

Body checking is common among individuals with anorexia nervosa (AN) and increases risk for dietary restriction. However, no study has examined whether body checking increases the immediate risk for engaging in other harmful weight loss behaviors, or whether this relationship is moderated by person-level traits. The current study utilized ecological momentary assessment (EMA) to examine whether (a) body checking predicted rapid use of weight loss behaviors, and (b) whether eating-related obsessionality/compulsivity moderated this relationship. Women with full or subthreshold anorexia nervosa (N = 118) completed a measure of eating-related obsessionality/compulsivity at baseline, followed by a 14-day EMA protocol during which they reported on body checking and weight loss behaviors (i.e., exercise, self-induced vomiting, laxative use, skipping meals, and increasing fluid intake). In a series of generalized linear mixed models, within-person effects indicated that momentary body checking significantly predicted subsequent meal skipping and using fluids to curb appetite. Between-person effects indicated that individuals who engage in more frequent body checking also engage in a higher frequency of self-induced vomiting, meal skipping, and use of fluids to curb appetite. An individual's degree of eating-related obsessionality/compulsivity did not moderate any of these relationships. Findings highlight body checking as an immediate precursor of dangerous weight loss behaviors among individuals with AN, and underscore the need for clinicians to address body checking during treatment.

Transdiagnostic fears and avoidance behaviors in self-reported eating disorders

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.

Understanding relations between intolerance of uncertainty and body checking and body avoiding in anorexia nervosa

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. 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.

Body checking behaviors and eating disorder pathology among nonbinary individuals with androgynous appearance ideals

BACKGROUND

Internalized sociocultural standards of attractiveness are a risk factor repeatedly linked to eating disorders; however, many nonbinary individuals do not conform to these standards.

PURPOSE

This study investigated the body checking behaviors and eating disorder pathology among nonbinary individuals with androgynous appearance ideals.

METHODS

Participants (n = 194) completed an online survey assessing body checking behaviors, body appreciation, gender congruence, and eating disorder pathology RESULTS: Body checking predicted eating disorder pathology, and body image significantly improved the model. Gender congruence did not additional variance in predicting eating pathology CONCLUSION: Though gender congruence was not a significant predictor of eating pathology, content analysis revealed unique body behaviors specific to nonbinary individuals' gender identity and gender expression. Clinical implications include expanding perceptions of eating disorder presentation when working with nonbinary individuals with androgynous appearance ideals.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Consequences of Repeated Critical Versus Neutral Body Checking in Women With High Shape or Weight Concern

Body checking is a repeated behavior conducted in an attempt to gain information about one's shape, weight, size, or body composition. Body checking is associated with negative behavioral, emotional, and cognitive outcomes and may maintain body dissatisfaction and eating disorders. The precise function and consequences of body checking remain less well understood. Specifically, immediate and delayed impacts of repeated critical body checking (CBC) have not been determined. The current study randomly assigned 142 young women with high shape/weight concern to daily 10-min CBC, neutral body checking (NBC), or a non-body critical checking (NBCC) comparison condition, examining their immediate and delayed (one-week follow-up) effects on body satisfaction, self-esteem, and negative affect. Multilevel modeling and follow-up planned comparisons found that compared to NBCC, CBC participants' body satisfaction and self-esteem immediately decreased, but negative affect improved from baseline to follow-up. Compared to CBC, NBC participants' self-esteem and negative affect improved immediately, and their self-esteem improved over time compared to NBCC. Over time, all participants' state body satisfaction improved, regardless of condition. Our findings suggest a 10-min CBC session may function differently than typical (harmful) in vivo body checking. However, reasons for this difference are unclear. Additional research is needed to distinguish (harmful) in vivo body checking from CBC procedures such as this and other mirror exposure interventions. Research is needed to examine the effects of varying CBC duration and instructions during body exposure to further clarify mechanisms of change during body exposures.

The Renfrew Unified Treatment for Eating Disorders and Comorbidity: Long-Term Effects of an Evidence-Based Practice Implementation in Residential Treatment

Background: The Renfrew Unified Treatment for Eating Disorders and Comorbidity (UT) is a transdiagnostic, emotion-focused treatment adapted for use in residential group treatment. This study examined the effect of UT implementation across five years of treatment delivery. Methods: Data were collected by questionnaire at admission, discharge (DC), and 6-month follow-up (6MFU). Patient outcomes were measured by the Eating Disorder Examination-Questionnaire, Center for Epidemiologic Studies-Depression Scale, Brief Experiential Avoidance Questionnaire (BEAQ), Anxiety Sensitivity Index, and Southampton Mindfulness Scale. Data were analyzed for N = 345 patients treated with treatment-as-usual (TAU), and N = 2,763 treated with the UT in subsequent years. Results: Results from multilevel models demonstrated a significant interaction between implementation status (TAU vs. UT) and time, both linear and quadratic, for the depression, experiential avoidance, anxiety sensitivity, and mindfulness variables. Patients treated with the UT showed more improvement in these variables on average, as well as more rebound between DC and 6MFU. Results from multilevel models examining eating disorder outcome showed no significant difference between the TAU and UT for the full sample, but a significant three-way interaction indicated that the UT produced more improvement in the EDE-Q relative to the TAU particularly for patients who entered treatment with high levels of experiential avoidance (BEAQ score). Conclusion: This long-term study of a transdiagnostic, evidence-based treatment in residential care for eating disorders and comorbidity suggests implementation was associated with beneficial effects on depression and emotion function outcomes, as well as eating disorder severity for patients with high levels of baseline emotion regulation problems. These effects did not appear to diminish in the 5 years following initial implementation.

Conceptualizing eating disorder psychopathology using an anxiety disorders framework: Evidence and implications for exposure-based clinical research

Eating disorders (EDs) and anxiety disorders (ADs) evidence shared risk and significant comorbidity. Recent advances in understanding of anxiety-based disorders may have direct application to research and treatment efforts for EDs. The current review presents an up-to-date, behavioral conceptualization of the overlap between anxiety-based disorders and EDs. We identify ways in which anxiety presents in EDs, consider differences between EDs and ADs relevant to treatment adaptions, discuss how exposure-based strategies may be adapted for use in ED treatment, and outline directions for future mechanistic, translational, and clinical ED research from this perspective. Important research directions include: simultaneous examination of the extent to which EDs are characterized by aberrant avoidance-, reward-, and/or habit-based neurobiological and behavioral processes; improvement in understanding of how nutritional status interacts with neurobiological characteristics of EDs; incorporation of a growing knowledge of biobehavioral signatures in ED treatment planning; development of more comprehensive exposure-based treatment approaches for EDs; testing whether certain exposure interventions for AD are appropriate for EDs; and improvement in clinician self-efficacy and ability to use exposure therapy for EDs.

How do you feel when you check your body? Emotional states during a body-checking episode in normal-weight females

PURPOSE

Cognitive-behavioral theories posit that body checking decreases negative emotions, but increases levels of arousal. However, few studies have investigated the effects of body checking on the course of emotional states. Therefore, the current study examined how normal-weight females with higher and lower eating, weight, and shape concerns feel during a checking episode of their most-liked and least-liked body parts.

METHODS

In an online design, levels of negative emotions and arousal were retrospectively assessed before, during, immediately after, and 15 min after an individually remembered body-checking episode. Participants (N = 355) also rated their subjective satisfaction with specific body parts.

RESULTS

Levels of negative emotions were lower 15 min after the checking episode of most-liked and least-liked body parts than before the episode. However, negative emotions increased during the checking episode of least-liked body parts, but subsided thereafter. The levels of arousal increased during the checking episodes of most-liked and least-liked body parts and decreased afterwards, and females with higher concerns reported greater levels of arousal than females with lower concerns. Furthermore, females with higher concerns reported more body checking than those with lower concerns.

CONCLUSIONS

The results support the assumptions of the cognitive-behavioral theories, as body checking led to a decrease in negative emotions in the longer term, and levels of arousal increased during the checking episode. The greater levels of arousal in females with higher concerns, and their pronounced body-checking behavior, might enhance their existing concerns and increase the risk of disordered eating.

LEVEL OF EVIDENCE

Level V, descriptive study.

The Body Image Approach Test (BIAT): A Potential Measure of the Behavioral Components of Body Image Disturbance in Anorexia and Bulimia Nervosa?

A disturbed body image with fluctuating behavioral patterns of body related avoidance (BA) and body checking (BC) characterizes individuals with eating disorders (EDs) such as anorexia (AN) or bulimia nervosa (BN). So far, these behavioral body image components are mostly assessed via self-report instruments thereby neglecting their behavioral and partially automatic characteristics. Therefore, behavioral measures of BA and BC are needed. The present study investigates a behavioral assessment task for BA and BC in a sample of patients with diagnosed EDs and healthy controls. The sample consisted of 40 women diagnosed with either BN (N = 19) or AN (N = 21; ED sample) and 24 non-eating disordered, healthy female controls (HC). Within the Body Image Approach Task (BIAT) participants viewed photos of their own body (self-image) and a matched control body (other-image) by zooming the photos closer toward them (image became more focused) on the screen. The BIAT yields zoom-levels recorded separately for self- relative to other-images. Further measures were attractiveness ratings of these body images as well as questionnaire measures of BA, BC, and general ED symptomatology. Results showed that despite strong body dissatisfaction and clearly negative ratings of self- relative to other-images in both EDs, no group differences were found in approach to self-images on zoom-level as measured with the BIAT. Correlational analysis in each group indicated that zoom-level was positively related to BA scores in the HC group only. Yet, stepwise regression analyses revealed that attractiveness ratings explained most of the variance accounted by BA in predicting zoom-level. In sum, the BIAT seems suitable to assess BA and self-rated body attractiveness, but only in healthy individuals with subclinical levels on these constructs. It does not seem to capture the body image satisfaction or the behavioral components of body image disturbances in AN or BN or it conflates the opposed influences of BA and BC. Further experimentation is needed to adapt measures of behavioral body image components to the processes evoked in patients with ED during confrontation with body images.

Nutritional Recommendations for Physique Athletes

The popularity of physique sports is increasing, yet there are currently few comprehensive nutritional guidelines for these athletes. Physique sport now encompasses more than just a short phase before competition and offseason guidelines have recently been published. Therefore, the goal of this review is to provide an extensive guide for male and female physique athletes in the contest preparation and recovery period. As optimal protein intake is largely related to one’s skeletal muscle mass, current evidence supports a range of 1.8-2.7 g/kg. Furthermore, as a benefit from having adequate carbohydrate to fuel performance and activity, low-end fat intake during contest preparation of 10-25% of calories allows for what calories remain in the “energy budget” to come from carbohydrate to mitigate the negative impact of energy restriction and weight loss on training performance. For nutrient timing, we recommend consuming four or five protein boluses per day with one consumed near training and one prior to sleep. During competition periods, slower rates of weight loss (≤0.5% of body mass per week) are preferable for attenuating the loss of fat-free mass with the use of intermittent energy restriction strategies, such as diet breaks and refeeds, being possibly beneficial. Additionally, physiological and psychological factors are covered, and potential best-practice guidelines are provided for disordered eating and body image concerns since physique athletes present with higher incidences of these issues, which may be potentially exacerbated by certain traditional physique practices. We also review common peaking practices, and the critical transition to the post-competition period.

Evaluating the effectiveness of ecological momentary assessment and intervention targeting body checking behaviors

This study investigated the efficacy of using ecological momentary assessment and intervention (EMA/EMI) to target body checking behaviors. Body checking has been shown to increase body dissatisfaction and play a role in eating disorders, but few treatments specifically targeting body checking have been empirically evaluated. Forty-four female undergraduates who reported engaging in frequent body checking behaviors participated in a five-day study wherein they were assessed five times a day via smart phone. On the final two days of the study, intervention messages were sent containing cognitive-behavioral strategies for decreasing body checking. Body checking behaviors increased within each day, but decreased across the five day intervention period. Pretest to posttest analyses found healthy improvements in a number of body image related constructs. These results highlight that 1) body checking appears to increase throughout the day, and 2) targeting body checking behaviors through brief EMA/EMI may be a useful clinical tool.

Disentangling relations between the desirability of the thin-ideal, body checking, and worry on college women's weight-loss dieting: A self-regulation perspective

The study used self-regulation theory to elucidate the relationships between the desirability of the thin-ideal goal, dispositional worry, body checking and weight-loss dieting (WLD) in college women. We hypothesized that body checking would mediate the relationship between the desirability of the thin-ideal goal and WLD: the desire to be thin would be associated with more WLD through more frequent body checking. We also hypothesized that dispositional worry would moderate this mediation pathway, such that the mediation pathway would be stronger for those higher in worry. Finally, all effects were expected to occur when controlling for self-reported body size. A paper and pencil survey was conducted on a convenience sample of 237 college women who completed measures of: thin-ideal desirability, dispositional worry, body checking, WLD, as well as providing height and weight. A bootstrap analysis using PROCESS (Hayes, 2013) supported the hypothesized moderated mediation model. Findings add to current knowledge by elucidating the nature and function of body checking, and by so doing may provide insight into the prevention and treatment of disordered eating.

Psychometric Properties of the Body Checking Questionnaire (BCQ) and of the Body Checking Cognitions Scale (BCCS): A Bifactor-Exploratory Structural Equation Modeling Approach

This research sought to assess the psychometric properties of the French versions of the Body Checking Questionnaire and the Body Checking Cognitions Scale among community samples. A total sample of 922 adolescents and adults was involved in a series of two studies. The results from the first study supported factor validity and reliability of responses obtained on these two measures, and showed that both measures were best represented by a bifactor-exploratory structural equation modeling representation of the data. The results from the second study replicated these conclusions, while also supporting the measurement invariance of the bifactor-exploratory structural equation modeling solution and the equivalence of the correlations among the two measures (i.e., convergent validity) across samples. This second study also supported the criterion-related validity of ratings on both measures with measures of global self-esteem, physical appearance, social physique anxiety, fear of negative appearance evaluation, and disturbed eating attitudes and behaviors. Finally, the results of this last study also supported the measurement invariance and lack of differential item functioning of both measures in relation to sex, age, diagnosis of eating disorders, and body mass index.

Towards a Sustainable Nutrition Paradigm in Physique Sport: A Narrative Review

Physique athletes strive for low body fat with high lean mass and have higher body image and eating disorder rates than the general population, and even other weightlifting populations. Whether athletes with a background or tendency to develop these issues are drawn to the sport, or whether it drives these higher incidences, is unknown. However, the biological drive of cyclical energy restriction may contribute to binge-eating behavior. Additionally, requisite monitoring, manipulation, comparison, and judgement of one's physique may contribute to body image concerns. Contest preparation necessitates manipulating body composition through energy restriction and increased expenditure, requiring dietary restraint and nutrition, exercise, and physique assessment. Thus, competitors are at mental health risk due to (1) pre-existing or predispositions to develop body image or eating disorders; (2) biological effects of energy restriction on eating psychology; and (3) dietary restraint attitudes and resultant physique, exercise, and nutrition monitoring behavior. In our narrative review we cover each factor, concluding with tentative best-practice recommendations, including dietary flexibility, slower weight loss, structured monitoring, gradual returns to offseason energy intakes, internal eating cues, appropriate offseason body compositions, and support from nutrition and mental health professionals. A mental health focus is a needed paradigm shift in bodybuilding nutrition practice and research.

The Mediating Effect of Specific Social Anxiety Facets on Body Checking and Avoidance

Objective: Body checking (BC) and avoidance (BA) form the behavioral component of body image disturbance. High levels of BC/BA have often been documented to hold a positive and potentially reinforcing relationship with eating pathology. While some researchers hypothesize, that patients engage in BC/BA to prevent or reduce levels of anxiety, little is known about the mediating factors. Considering the great comorbidity between eating disorders (ED) and in particular social anxieties, the present study investigated whether socially relevant types of anxiety mediate the relationship between eating pathology and BC/BA.

Methods: 83 participants reporting an eating disorder and 323 healthy participants (14–25 years) took part in an online survey. Eating pathology was measured with the Eating Disorder Examination Questionnaire and Body Checking and Avoidance Questionnaire. Trait and social anxiety were assessed by means of the State Trait Anxiety Inventory (STAI-T), the Fear of Negative Evaluation (FNE) and the Social Appearance and Anxiety Scale (SAAS). Separate mediation analyses were carried out with eating pathology as independent variable, BC/BA as dependent variable and STAI, FNE, and SAAS as mediating variables.

Results: Anxieties correlated highly positive with eating pathology in both groups. SAAS mediated the relationship between ED pathology and BC/BA in participants with ED and mediated the relationship between ED pathology and BA in healthy participants. FNE mediated the relationship between eating pathology and BA for participants with eating pathology.

Discussion: SAAS mediated the relationship between eating pathology and BC/BA. Being afraid of bodily evaluations may represent a particular relevant fear that triggers safety behaviors.

PREOCUPAÇÕES E COMPORTAMENTOS RELACIONADOS À APARÊNCIA FÍSICA NA INFÂNCIA: UMA ABORDAGEM QUALITATIVA

A criança elabora mecanismos internos para formação de referências do próprio corpo, desde a tenra idade, tornando-se uma fase da vida relevante para estudiosos. Objetivou-se investigar atitudes relacionadas à imagem corporal sob o ponto de vista de crianças. Esta pesquisa qualitativa descritiva foi conduzida em quatro grupos focais. Participaram 19 crianças (10 meninas e 9 meninos), de 6 a 11 anos (M=8,36±1,42 anos), estudantes de escolas públicas da cidade de Juiz de Fora-MG. Os dados obtidos foram tratados mediante análise de conteúdo categórica. Três categorias emergiram a partir das falas das crianças: preocupações com aspectos específicos do corpo; preocupações com aspectos gerais do corpo; e comportamentos relacionados ao corpo. Conclui-se que as crianças avaliadas apresentaram atitudes que indicam preocupação com o corpo em aspectos gerais e específicos, além de comportamentos relacionados com a imagem corporal. Recomendam-se a elaboração e a adoção de estratégias de terapia e intervenção no sentido de promover uma imagem corporal positiva em crianças.

A meta-analysis of the relationships between body checking, body image avoidance, body image dissatisfaction, mood, and disordered eating

OBJECTIVE

Body checking (BC) and body image avoidance (BIA) have been proposed as etiological and maintaining mechanisms for eating disorder (ED) pathology. To date, no comprehensive review summarizes the relationships of BC and BIA with ED pathology, body image dissatisfaction, or mood/affect.

METHOD

Meta-analyses examined the relationships of BC and BIA with ED pathology, body image dissatisfaction, and mood/affect. Gender, publication status, and presence or absence of ED diagnoses were examined as potential moderators.

RESULTS

Results showed strong relationships between BC and ED pathology (ρ = 0.588) and BC and body image dissatisfaction (ρ = 0.631) and a moderate relationship between BC and mood/affect (ρ = 0.385). Similarly, results showed strong relationships between BIA and ED pathology (ρ = 0.553) and BIA and body image dissatisfaction (ρ = 0.543) and a moderate relationship between BIA and mood/affect (ρ = 0.392). Overall, limited evidence supported publication bias; however, publication bias may exist in the relationship between BIA and body image dissatisfaction in the literature. Subgroup moderator analyses suggested that gender moderates the strength of the relationships between BC and ED pathology, body image dissatisfaction, and mood/affect and between BIA and body image dissatisfaction.

DISCUSSION

Results are consistent with cognitive-behavioral models of ED pathology that suggest BC and BIA are behavioral expressions of overvaluation of weight and shape. Notably, more published research has investigated BC than BIA. Future studies, incorporating methods such as meta-analytic structural equation modeling, should examine these variables to further test cognitive-behavioral models of ED development and maintenance.

Body checking in non-clinical women: Experimental evidence of a specific impact on fear of uncontrollable weight gain

Body checking is used widely among clinical and non-clinical individuals. It is suggested to be a safety behavior, reducing anxiety initially but potentially enhancing eating and shape concerns in the longer term. However, there is little causal evidence of those negative effects. This experimental study tests the potential negative impact of body checking. Fifty non-clinical women took part in a study of the effects of body checking in naturalistic settings. Each checked their wrist size every 15 minutes for eight hours on one day, then did not check the next day (order randomized). The impact on eating cognitions and body dissatisfaction was measured at the end of each day, and levels of change in those characteristics were also associated with eating pathology levels. Body checking did not result in more negative general eating attitudes or body dissatisfaction, but did result in a significant increase in a specific cognition that is hypothesised to be relevant to eating pathology - the fear of uncontrollable weight gain following eating. This impact was greater among those women with more negative existing eating attitudes. These findings add to the small experimental evidence base, demonstrating negative causal links between body checking and eating pathology. The findings need to be extended to clinical groups, but support the use of existing cognitive-behavioral methods to reduce body checking behavior.

Body checking and eating cognitions in Brazilian outpatients with eating disorders and non psychiatric controls

OBJECTIVE

Compare inadequate eating behaviors and their relationship to body checking in three groups: patients with anorexia nervosa (AN), patients with bulimia nervosa (BN) and a control group (C).

METHODS

Eighty three outpatients with eating disorders (ED) and 40 controls completed eating attitudes and body checking questionnaires.

RESULTS

The overall relationship between the eating attitude and body checking was statistically significant in all three groups. The worse the eating attitude, the greater the body checking behavior. However, when we look at each group individually, the relationship was only statistically significant in the AN group (r=.354, p=0.020).

DISCUSSION

The lower the desired weight and the worse the eating attitude, the more people check themselves, although in the presence of an ED the relationship between body checking and food restrictions is greater. In patients displaying the AN subgroup, body checking is also related to continued dietary control.

Clinicians' practices regarding blind versus open weighing among patients with eating disorders

BACKGROUND

Empirically supported treatments for eating disorders, such as cognitive-behavioral therapy and family-based treatment, stress the importance of weighing patients during therapy and using this information as part of treatment. However, weighing practices vary widely across eating disorders professionals, including those that purport to provide empirically supported interventions.

OBJECTIVES

To characterize clinicians' practices regarding the decision to share (open weighing) or withhold (blind weighing) weight information with patients, a topic that has received limited prior attention.

METHOD

Clinicians (N = 114; 85% female) who regularly treat individuals with an eating disorder completed an online survey to identify factors that might impact their decision to practice blind or open weighing.

RESULTS

Approximately half of the clinicians reported generally using open weighing procedures (n = 53; 46.49%). Endorsement of cognitive-behavioral or family-based therapeutic orientation was not significantly associated with open weighing. However, clinicians who endorsed therapeutic modalities that do not specifically encourage open weighing were significantly more likely to engage in blind weighing. Clinicians working with clients with anorexia nervosa were significantly more likely to practice blind weighing, compared to clients with other eating disorder diagnoses, and cognitive or emotional impairment from malnutrition emerged as the strongest predictor of clinicians' decisions to practice blind weighing, controlling for all other variables.

DISCUSSION

Development of specific training modules may be useful for improving adherence to empirically supported protocols that recommend open weighing. More importantly, however, our results highlight the need for future treatment studies to identify whether blind or open weighing is beneficial for improving patient outcomes.

Analysis of Attentional Bias towards Attractive and Unattractive Body Regions among Overweight Males and Females: An Eye-Movement Study

Background

Body image distortion is highly prevalent among overweight individuals. Whilst there is evidence that body-dissatisfied women and those suffering from disordered eating show a negative attentional bias towards their own unattractive body parts and others’ attractive body parts, little is known about visual attention patterns in the area of obesity and with respect to males. Since eating disorders and obesity share common features in terms of distorted body image and body dissatisfaction, the aim of this study was to examine whether overweight men and women show a similar attentional bias.

Methods/Design

We analyzed eye movements in 30 overweight individuals (18 females) and 28 normal-weight individuals (16 females) with respect to the participants’ own pictures as well as gender- and BMI-matched control pictures (front and back view). Additionally, we assessed body image and disordered eating using validated questionnaires.

Discussion

The overweight sample rated their own body as less attractive and showed a more disturbed body image. Contrary to our assumptions, they focused significantly longer on attractive compared to unattractive regions of both their own and the control body. For one’s own body, this was more pronounced for women. A higher weight status and more frequent body checking predicted attentional bias towards attractive body parts. We found that overweight adults exhibit an unexpected and stable pattern of selective attention, with a distinctive focus on their own attractive body regions despite higher levels of body dissatisfaction. This positive attentional bias may either be an indicator of a more pronounced pattern of attentional avoidance or a self-enhancing strategy. Further research is warranted to clarify these results.

Weighing patients within cognitive-behavioural therapy for eating disorders: How, when and why

While weight, beliefs about weight and weight changes are key issues in the pathology and treatment of eating disorders, there is substantial variation in whether and how psychological therapists weigh their patients. This review considers the reasons for that variability, highlighting the differences that exist in clinical protocols between therapies, as well as levels of reluctance on the part of some therapists and patients. It is noted that there have been substantial changes over time in the recommendations made within therapies, including cognitive-behavioural therapy (CBT). The review then makes the case for all CBT therapists needing to weigh their patients in session and for the patient to be aware of their weight, in order to give the best chance of cognitive, emotional and behavioural progress. Specific guidance is given as to how to weigh, stressing the importance of preparation of the patient and presentation, timing and execution of the task. Consideration is given to reasons that clinicians commonly report for not weighing patients routinely, and counter-arguments and solutions are presented. Finally, there is consideration of procedures to follow with some special groups of patients.

Psychometric properties of the Body Checking Questionnaire in college women

While the Body Checking Questionnaire (BCQ; Reas et al., 2002) is the most commonly-used measure of body checking behaviors, findings on the factor structure in nonclinical samples are mixed. This study investigated the factor structure and psychometric properties of the BCQ among nonclinical college women. In Study 1 (n=326), an exploratory factor analysis indicated factors corresponding to (a) behavioral and (b) visual checking. In Study 2 (n=1013), a confirmatory factor analysis revealed adequate fit for these factors, better than the original or total score solutions. Scales based upon the two factors demonstrated good internal consistency, convergent validity with measures of eating pathology, and sensitivity for detecting at-risk eating pathology. Results suggest an alternate two-factor solution that differs from the original three-factor solution.

Predictors of improved eating behaviour following body image therapy: a pilot study

Cognitive processes seem to play a vital role in eating disorders and body image. The current study, therefore, examines the impact and change of dysfunctional cognitions during a body image group therapy, which included 41 patients with an eating disorder. Dysfunctional cognitions were assessed with the 'Eating Disorder Cognition Questionnaire' both before and after treatment. Eating disorder psychopathology was also assessed. Results indicate a significant reduction of dysfunctional cognitions relating to 'body and self-esteem', 'dietary restraint', 'eating and loss of control', as well as 'internalisation and social comparison'. Furthermore, the changes in dysfunctional cognitions were associated with a reduction in eating disorder psychopathology. Body image therapy is a worthy complementation to standardised eating disorder treatment programmes as it reduces negative eating related thoughts and changes attitudes towards the body.

Body checking as a behavioral link: a preliminary study assessing inhibition and its association to idiosyncratic body checking in anorexia nervosa

Body checking (BC) is a behavioral feature of anorexia nervosa (AN), which is also present in obsessive-compulsive (OC) disorders. This study assessed whether increased body checking in AN patients correlated with deficits in cognitive inhibition. A battery of neuropsychological tests (the Ravello Profile), OC disorder measures, and the Body Checking Questionnaire (BCQ) were administered to nine adolescent females being treated for AN at an in-patient hospital in Scotland, UK. Neuropsychological measures were assessed using composite variables. Body Checking prevalence was split into high and low category to compare across groups. A negative relationship between cognitive inhibition and idiosyncratic body checking was evident. Clinically, increased body-checking symptoms were related to OC symptoms. These findings provide preliminary evidence that idiosyncratic body checking in AN patients may indicate a similar neuropsychological profile found in those with checking behaviors in OCD patients.

The influence of social anxiety on the body checking behaviors of female college students

Social anxiety and eating pathology frequently co-occur. However, there is limited research examining the relationship between anxiety and body checking, aside from one study in which social physique anxiety partially mediated the relationship between body checking cognitions and body checking behavior (Haase, Mountford, & Waller, 2007). In an independent sample of 567 college women, we tested the fit of Haase and colleagues' foundational model but did not find evidence of mediation. Thus we tested the fit of an expanded path model that included eating pathology and clinical impairment. In the best-fitting path model (CFI=.991; RMSEA=.083) eating pathology and social physique anxiety positively predicted body checking, and body checking positively predicted clinical impairment. Therefore, women who endorse social physique anxiety may be more likely to engage in body checking behaviors and experience impaired psychosocial functioning.

Body checking and obsessive-compulsive symptoms in Brazilian outpatients with eating disorders

OBJECTIVE

Compare obsessive-compulsive symptoms in patients with anorexia nervosa (AN) and bulimia nervosa (BN), and assess the association of these symptoms and body checking in each of these groups of patients.

METHODS

Eighty-five female outpatients with eating disorders (ED) completed body checking and obsessive-compulsive questionnaires.

RESULTS

Body checking was more prevalent in the BN group. Among patients with AN, the highest mean body-checking scores were found in patients with somatic obsessions related to body areas and eating rituals (p = 0.003 and 0.018, respectively).

DISCUSSION

Patients with eating disorders are believed to be included in the obsessive-compulsive spectrum, and may experience intrusive thoughts about behavior. The results of our work suggest that obsessive symptoms and body checking should be further investigated and properly managed in patients with ED.

Body checking and avoidance in low weight and weight restored individuals with anorexia nervosa and non-clinical females

Body dissatisfaction (BD) is central to the development, maintenance and relapse of anorexia nervosa (AN). BD has been conceptualized as a multi-dimensional construct incorporating behaviours, cognitions and affect, yet little is known about the impact of weight and disordered eating on these aspects. 56 'below DSM-IV weight criteria for AN' (<BMI 17.5 kg/m(2)) and 44 'above DSM-IV weight criteria for AN' (>BMI 17.5 kg/m(2)) individuals currently receiving treatment for an eating disorder, and 60 non-eating disordered females completed the Body Checking Scale, Body Image Avoidance Questionnaire and the Body Image Anxiety Questionnaire. As expected, females diagnosed with AN showed significantly more behavioural and affective body dissatisfaction than the control group. Patients at lower weights showed significantly more avoidance behaviours and less body image anxiety than those with anorexia at higher weights. No difference was seen in checking behaviours between these groups. Weight based differences in avoidance behaviours continued to exist even when the effects of anxiety were controlled for. Affective and behavioural aspects of BD should be considered in clinical practice at all stages of treatment.

Functional neuroanatomy of body checking in people with anorexia nervosa

OBJECTIVE

The neural correlates of body checking perceptions in eating disorders have not yet been identified. This functional Magnetic Resonance Imaging study examined the neuroanatomy involved in altered perception and identification with body checking in female with anorexia nervosa (AN).

METHOD

Brain activation while viewing images depicting normal weight individuals involved in either body checking behavior or a neutral (noneating disorder) body action, was compared between 20 females with AN and 15 matched healthy controls (HC).

RESULTS

Females with AN reported higher anxiety compared to HC during the body checking task. The level of anxiety positively correlated with body shape concern scores. People with AN had less activation in the medial prefrontal cortex (PFC) and right fusiform gyrus compared to HC in response to body checking compared to neutral action images. Body shape concern scores correlated negatively with medial PFC activation in AN group.

DISCUSSION

This preliminary study with modest power suggests that AN patients have reduced activation in cortical areas associated with self-reference, body action perception, and social cognition in females with AN.

An initial psychometric evaluation and exploratory cross-sectional study of the body checking questionnaire among Brazilian women

Body checking is considered an expression of an excessive preoccupation with appearance. The first aim of this study was to evaluate the psychometric properties of a Brazilian Portuguese version of the Body Checking Questionnaire (BCQ). Additionally, we wanted to examine the questionnaire’s associations with body avoidance behaviour, body mass index, dietary habits, and the intensity, frequency, and length of physical exercise. Finally, we also examined the differences between the total BCQ score and the individual BCQ factor scores. Differences between active and sedentary persons and between non-dieters and those on weight-loss diets were also analyzed. For the psychometric study, 546 female public university students from four different courses were surveyed. Two minor samples of university students and eating disorders women were also recruited. In the second part of the study, 403 women were recruited from weight-loss programs, gyms, and a university. All participants were verbally invited to participate in the research and voluntarily took part. Confirmatory factor analysis showed a good fit to the original model of the Brazilian BCQ that retained all 23 items. Satisfactory evidence of construct validity and internal consistency were also generated through analysis of factor loadings, t-values, Cronbach’s alpha, and construct reliability tests. The results also showed associations among body checking and body avoidance, body satisfaction, social anxiety, body mass index, and the frequency and intensity of physical exercise. Significant differences were found between non-dieters and weight-loss dieters for all BCQ factors and the total BCQ score. For physically active and sedentary persons, a significant difference was only observed for idiosyncratic checking behaviour. In conclusion, the BCQ appears to be a valid and reliable scale for Brazilian research, and the associations and differences found in this study suggest that women at gyms and especially in weight-loss programs should be targeted for future body checking studies.

Body checking and avoidance in ethnically diverse female college students

Although body checking and avoidance behaviors are common in women with eating disorders, minimal research has examined the nature or correlates of these behaviors in ethnically diverse female college students without eating disorders. Self-identified European American (n=268), Asian American (n=163), Latina (n=146), and African American (n=73) women completed self-report measures of body checking and avoidance, thin-ideal internalization, eating pathology, and clinical impairment. Results indicated that European and Asian American women reported significantly more body checking and avoidance than African American and Latina women. Generally, correlates of body checking and avoidance were consistent across ethnic groups: Regression analyses indicated that type of ethnicity predicted body checking and avoidance; and ethnicity, body checking, and body avoidance predicted eating pathology and clinical impairment. These associations suggest that body checking and avoidance are not benign behaviors in diverse nonclinical women.

The relationship between anorexia nervosa and body dysmorphic disorder

Anorexia nervosa (AN) and body dysmorphic disorder (BDD) are severe body image disorders that highly impair individuals in their daily functioning. They are discrete but overlapping nosological entities. In this review, we examine similarities between AN and BDD with regard to clinical, personality and demographic aspects, such as comorbidity, phenomenology, and treatment outcome. The review suggests that the two disorders are highly comorbid, and show similar ages of onset, illness trajectories, and comparable clinical and personality characteristics. However, important differences emerge in their responsiveness to psychosocial and psychopharmacological treatment, which are discussed. Clinical implications of these findings are summarized and directions for future research are delineated, with a focus on how current treatment components from each disorder may inform new interventions for both disorders.

Psychometric Evaluation of the Body Checking Cognitions Scale (BCCS) Portuguese Version

The aim of this study is evaluate the psychometric results and validity of the Brazilian Portuguese language version of the Body Checking Cognitions Scale (BCCS). Factor analysis and concurrent validity were checked on assessments from participants with and without eating disorders. The scale had good internal consistency. Factor analysis confirmed four components. Control and Eating Disorders groups were discriminated, and results correlated well with the Eating Attitudes Test and Body Shape Questionnaire. The results for the Portuguese version of the BCCS were similar to the original version, and its use is recommended for evaluation of body-checking cognitions in the Brazilian population with or without eating disorders.

Body checking and associated cognitions among Brazilian outpatients with eating disorders and nonpsychiatric controls

This work aims to compare in patients with anorexia nervosa, bulimia nervosa, and control subjects: (a) body checking types, frequency, and parts; (b) prevalence of body avoidance and the most checked body parts; (c) body checking cognitions. Eighty-five outpatients with eating disorders (ED) and 40 controls filled out validated body checking and cognition questionnaires. ED patients, especially bulimia nervosa, check their bodies more than do the control subjects. The most checked area was the belly. The most frequent means of body checking was mirror checking, while the most avoided was weighing. The reasons that participants in the various study groups check their bodies seem to differ. Given the importance of body checking in the etiology and maintenance of EDs, it is important that clinicians consider this behavior, as well as the factors that lead to checking/avoidance in the different eating disorder subtypes, so that treatment may be more specific.

Body-Related Behaviours and Cognitions in the Eating Disorders

Background: Different body-related behaviours and cognitions (checking, avoidance, comparison, display) have been shown to be related to unhealthy eating attitudes in a non-clinical sample. Aims: This study tested whether the use of body-related behaviours is higher in eating-disordered women than in non-clinical women. It also examined whether the use of body-related behaviours is associated with psychological characteristics (particularly anxiety, depression and narcissistic characteristics), controlling for age and eating pathology. Method: Ninety-nine adult women with diagnosed eating disorders (mean age = 30.4 years, SD = 9.44; mean body mass index = 21.9, SD = 6.39) completed standardized measures of eating pathology, anxiety and depression, narcissistic characteristics, and body-related behaviours and cognitions. Results: The Body-Related Behaviours Scale (BRBS) had acceptable levels of internal consistency in this group, and its scales were only weakly to moderately correlated with each other. There were no differences between diagnostic groups, but the clinical group had higher scores that a previous non-clinical sample on three of the scales. The four body-related behaviours had different patterns of association with eating pathology, depression and narcissistic features. However, anxiety was not associated with BRBS scores. Conclusions: The findings support the importance of a wide range of body-related behaviours and cognitions in understanding the eating disorders. However, the lack of an association with anxiety is counter to the suggestion that the various behaviours measured by the BRBS reflect safety behaviours on the part of sufferers. Depression and narcissistic features might be more important in maintaining such behaviours.

Clinical and temperamental correlates of body image disturbance in eating disorders

OBJECTIVE

Although body image disturbance (BID) is considered a core symptom in anorexia nervosa (AN) and bulimia nervosa (BN), little is known about its psychopathological correlates. The present study aimed at analysing the correlation of aspects of BID with psychopathological and temperamental characteristics.

METHOD

A sample of 1288 patients (538 AN and 750 BN) were assessed through a structured diagnostic interview, the Eating Disorders Inventory and Tridimensional Personality Questionnaire. Cognition of body image distortion, weight checking, fear of weight gain and body dissatisfaction were assessed by specific questions during the interview.

RESULTS

Various aspects of BID formed similar, but not identical, dimensions in AN and BN. In both groups, anticipatory anxiety and interoceptive awareness were significantly and independently associated with body image distortion, whereas ineffectiveness was associated with weight checking.

DISCUSSION

Body image disturbance is a multidimensional characteristic linked to psychological features, such as anticipatory anxiety, ineffectiveness and interoceptive awareness. These findings have scientific and treatment implications, and should be considered by clinicians in adopting successful treatment strategies.

Body dissatisfaction is improved but the ideal silhouette is unchanged during weight recovery in anorexia nervosa female inpatients

OBJECTIVE

Few studies have examined the impact of weight gain on body image disturbance (BID) in patients suffering from anorexia nervosa (AN). This study aims to explore the evolution of body distortion and body dissatisfaction following inpatient treatment.

METHOD

Sixty-four women suffering from AN enrolled in our inpatient Cognitive and Behavioural Therapy programme and undertook a body image perception test and completed the Eating Disorder Inventory (EDI). Thirty-four participants completed a total of four evaluations over a three-month period.

RESULTS

Patients' weight gain following treatment was significant. Weight regain was accompanied by significant reductions in both body distortion and body dissatisfaction. These reductions were complemented by improved scores for both EDI Drive for Thinness and Body Dissatisfaction. Perceived body image differed significantly between the onset and the completion of inpatient treatment whereas ideal body image did not.

DISCUSSION

The high severity of the included patients and the significant attrition rate should limit our conclusions for a subgroup of patients. New approaches are needed to facilitate changes in the way patients assess their ideal body image.

Psychometric evaluation of the "Body Checking and Avoidance Questionnaire--BCAQ" adapted to Brazilian Portuguese

OBJECTIVE

Adapt and validate the Brazilian Portuguese version of the Body Checking and Avoidance Questionnaire (BCAQ).

METHODS

The study consisted of: translation and back translation; technical review and assessment of semantic equivalences, factor analysis and discriminant and concurrent validity in a sample of subjects with and without eating disorders.

RESULTS

The instrument was adapted and was found to be easy to understand (mean scores higher than 3.4; maximum score: 5.0) and showed excellent concordance (Cronbach's alpha: 0.94). Factor analysis identified five components with eigenvalues greater than 1. It was able to discriminate the two groups (p<0.001) and correlated with the Eating Attitudes Test (EAT) (r=0.50), body shape questionnaire (BSQ) (r=0.68) and Beck Depression Inventory (BDI) scales (0.51).

DISCUSSION

The Brazilian Language version showed suitable internal consistency and external validation, and was easy to understand. The results were similar to the original version and its use is recommended for evaluation of body checking in the Brazilian population in subjects with or without eating disorders.