Are there differences in the attitudinal body image between adolescent anorexia nervosa and bulimia nervosa?

Validation of the Chinese Version of the Body Image Concern Inventory

The Body Image Concern Inventory (BICI) was developed to assess dysmorphic appearance concern and has been found to be a reliable and valid instrument in Western societies. To examine the psychometric properties of a new Chinese BICI, the BICI was administered to 1,231 Chinese young adults (Study 1) and 47 female patients with eating disorders and 56 matched controls (ED; Study 2). In study 1, Cronbach's alpha of .92 and test-retest reliability of .73 over a 6-month interval was observed for the total scale. Confirmatory factor analysis supported a 3-factor model for the BICI: avoidant behaviors (AB), safety behaviors against perceived flaws (SB), and negative appearance evaluation (NE). In study 2, ED patients scored significantly higher on the BICI total and three subscale scores than controls. In addition, AB best differentiated ED patients and matched controls (Cohen's d = 1.52); SB best differentiated between the non-clinical female and male groups (Cohen's d = 0.75); NE was most closely associated with level of negative affect and subjective well-being (inverse relationship) in both clinical and non-clinical groups. In conclusion, the Chinese BICI is a reliable and valid tool for evaluating dysmorphic appearance concern among Chinese speakers.

Eating Pathology Among Patients With Anorexia Nervosa and Bulimia Nervosa: The Role of Narcissism and Self-Esteem

We sought to deepen our understanding of the relationship between pathological narcissism and eating disorders (ED) by examining specific facets that composed grandiose and vulnerable narcissism while taking into account self-esteem, a well-known and consistent risk factor for ED. Twenty-seven women diagnosed with anorexia nervosa (AN) and 23 women diagnosed with bulimia nervosa (BN) completed standardized measures of pathological narcissism, self-esteem, and dysfunctional eating attitudes and behaviors. Different patterns of associations between the facets of pathological narcissism and eating pathology arose between AN and BN diagnoses. Closer examination of the facets of pathological narcissism revealed that hiding the self, a vulnerable narcissistic facet, contributed significantly to dysfunctional eating attitudes and behaviors over and above self-esteem for women with AN. Hiding the self should continue to be explored in regard to treatment of ED.

Body dissatisfaction in adolescents with eating disorders

PURPOSE

This study aims to analyze and compare the level of body dissatisfaction (BD) in different eating disorders (ED) subtypes. Also, the relationship between BD and certain aesthetic body shape model influence and psychological variables was analyzed.

METHODS

The sample consisted of 204 adolescent patients, who were attending in an ED Unit in Zaragoza (Spain). The following instruments were applied: the Spanish Children's Depression Questionnaire (CEDI-II), the Rosenberg Self-Esteem Scale (RSES), the Eating Attitudes Test (EAT-40), the Body Shape Questionnaire (BSQ-34) and the Questionnaire of Influences of Aesthetic Body shape Model (CIMEC-40).

RESULTS

The group of Bulimia Nervosa (BN) showed the greatest BD. Those patients who showed higher levels of BD had lower self-esteem, more depressive symptoms, a greater presence of disordered eating attitudes, and more influence of the aesthetic body shape model.

CONCLUSIONS

This study contributes to highlight the idea of implementing effective prevention programs and specific interventions related to BD in the treatment of ED.

Body image disturbance in children and adolescents with eating disorders. Current evidence and future directions

Body image is multifaceted and incorporates perceptual, affective, and cognitive components as well as behavioral features. Only few studies have examined the character of body-image disturbance in children/adolescents with eating disorders. It is unknown whether body-image disturbances in children/adolescent with eating disturbances are comparable to those of adult patients with eating disorders. Body-image disturbance might differ quantitatively and qualitatively according to the cognitive developmental status and the age of the individual. This paper provides an overview of the current evidence for body-image disturbance in children/adolescents with eating disorders, and how they compare with those adults with eating disorders. Current evidence indicates that older adolescent patients show similar deficits as adult patients with eating disorders, in particular for the attitudinal body-image component. However, evidence for a perceptual body-image disturbance in adolescent patients, in particular anorexia nervosa, is not conclusive. Reliable statements for childhood can hardly be made because clinical studies are not available. Investigations of body-image disturbance in children have focused on the predictive value for eating disorders. Limitations of the current evidence are discussed, and future directions for research and therapy are indicated.

Emotion regulation deficits in eating disorders: a marker of eating pathology or general psychopathology?

Preliminary evidence indicates that individuals with eating disorders (ED) show emotion regulation (ER) difficulties. However, it is yet unclear whether different types of ED differ in their ER profile and whether certain ER difficulties are specific for ED or rather a transdiagnostic factor. Twenty women with anorexia nervosa (AN), 18 with bulimia nervosa (BN), 25 with binge eating disorder (BED), 15 with borderline personality disorder (BPD), 16 with major depressive disorder (MDD) and 42 female healthy controls (HC) were administered the Emotion Regulation Questionnaire, the Inventory of Cognitive Affect Regulation Strategies, the Difficulties in Emotion Regulation Scale and the Affect Intensity Measure. The ED groups reported significantly higher levels of emotion intensity, lower acceptance of emotions, less emotional awareness and clarity, more self-reported ER problems as well as decreased use of functional and increased use of dysfunctional emotion regulation strategies when compared to HC. No significant differences between the ED groups emerged for most ER variables. However, there were indications that the BED group may show a slightly more adaptive pattern of ER than the two other ED groups. As a whole, all clinical groups performed very similar on most ER variables and reported more difficulties regulating their emotions than HC. The findings suggest that ER difficulties are not linked to a particular diagnostic category. Instead, ER difficulties appear to be a transdiagnostic risk and/or maintenance factor rather than being disorder-specific.

Body image distortions in bulimia nervosa: investigating body size overestimation and body size satisfaction by fMRI

BACKGROUND

Body image distortion is a key symptom of eating disorders. In behavioral research two components of body image have been defined: attitudes towards the body and body size estimation. Only few fMRI-studies investigated the neural correlates of body image in bulimia; those are constrained by the lack of a direct distinction between these different body image components.

METHODS

The present study investigates the neural correlates of two aspects of the body image using fMRI: satisfaction rating and size estimation of distorted own body photographs in bulimia nervosa patients (15) and controls (16).

RESULTS

Patients were less satisfied with their current body shape than controls and preferred to be thinner. The amount of insula activity reflects the pattern of the satisfaction rating for patients and controls. Patients also overestimated their own body size. For control subjects, an activated cluster in lateral occipital cortex was sensitive for body size distortions, whereas bulimic patients did not demonstrate such a modulation. Furthermore, bulimic subjects did not recruit the middle frontal gyrus (MFG) in contrast to controls during the body size estimation task, maybe indicating a reduced spatial manipulation capacity. Therefore, this activation pattern of lateral occipital cortex and MFG might be responsible for body size overestimation in bulimia.

CONCLUSIONS

The present results show that bulimic patients exhibit two distinct deficits in body image representations similar to anorectic patients and that specifically associated neuronal correlates can be identified. Concludingly, our study support psychotherapeutic strategies specifically targeting these two aspects of body image distortions.

Attachment insecurity, personality, and body dissatisfaction in eating disorders

The aim of this study is assessing interactions between attachment style and personality in predicting body dissatisfaction (BD). A total of 586 outpatients with eating disorders (EDs) were recruited: 101 with anorexia nervosa, restricting type; 52 with anorexia nervosa, binge-eating/purging type; 184 with bulimia nervosa, purging type; and 249 with an eating disorder not otherwise specified. Participants completed Temperament and Character Inventory, Body Shape Questionnaire, Beck Depression Inventory, and Attachment Style Questionnaire. An insecure attachment was found in all EDs, as well as in eating disorder not otherwise specified. In all diagnostic groups, need for approval, as measured by the Attachment Style Questionnaire and depressive symptomatology, was found to be the best predictor of BD. Personality traits are weaker predictors of BD. This study supports the hypothesis that attachment insecurity is directly correlated with BD, core element in predicting and perpetuating EDs, independently of personality. Implications for treatment are discussed.

Voxel-based morphometry in eating disorders: correlation of psychopathology with grey matter volume

Twenty-nine adult female patients with eating disorders (17 with bulimia nervosa, 12 with restrictive anorexia nervosa) were compared with 18 age-matched female healthy controls, using voxel-based morphometry. Restrictive anorexia nervosa patients showed a decrease of grey matter, particularly affecting the anterior cingulate cortex, frontal operculum, temporoparietal regions and the precuneus. By contrast, patients with bulimia nervosa did not differ from healthy controls. A positive correlation of "drive for thinness" and grey matter volume of the right inferior parietal lobe was found for both eating disorder groups. The strong reduction of grey matter volume in adult patients with restrictive anorexia nervosa is in line with results of adolescent patients. Contrary to other studies, this first voxel-based morphometry report of bulimic patients did not find any structural abnormalities. The inferior parietal cortex is a critical region for sensory integration of body and spatial perception, and the correlation of "drive for thinness" with grey matter volume of this region points to a neural correlate of this core psychopathological feature of eating disorders.

Day hospital programmes for eating disorders: a review of the similarities, differences and goals

Day hospital (DH) treatments for eating disorders (EDs) provide intensive daily care and allow patients to maintain and test their social relations and coping skills at home and outside. Although widespread, their description is lacking. This review compares the different types of DH described in the literature and presents our DH experience in Turin, Italy. We searched Psychinfo and Pubmed with the following keywords: anorexia nervosa, bulimia nervosa, EDs, DH, day treatment and partial hospitalisation. We found and reviewed the DH programmes of eleven specialised centres, which have some shared features but also many differences, suggesting that DH treatments are still largely experimental. Briefly, the shared elements are: biopsychosocial model as reference frame; cognitive-behavioural model or techniques; behavioural contract; patients' selection; body image therapy; involvement of family; weight normalisation/weight gain and modification/normalisation of eating behaviour as objectives. Nonetheless, shared opinions concerning inclusion criteria are lacking; the duration of DH treatment is surprisingly different among centres (from 3 to 39 weeks); the approach to eating and compensation behaviours ranges from control to autonomy; followup and psychometric assessment can be either performed or not; psychological and behavioural objectives can be different. This review suggests the existence of two different DH models: the first has a shorter duration and is mainly symptom-focused; the second is more individual-focused, has a longer duration and is focused on patients' relational skills, psychodynamic understanding of symptoms and more gradual changes in body weight. Further investigation is required to make DH treatment programmes measurable and comparable.

Multidimensional body image comparisons among patients with eating disorders, body dysmorphic disorder, and clinical controls: a multisite study

Body image disturbance is considered a core characteristic of eating disorders and body dysmorphic disorder (BDD), however its definition has been unclear within the literature. This study examined the multidimensional nature of body image functioning among individuals with either anorexia nervosa (AN; n=35), bulimia nervosa (BN; n=26), or BDD (n=56), relative to female (n=34) and male (n=36) psychiatric controls. Participants were recruited from 10 treatment centers in the United States and England and completed psychometrically validated and standardized self-report measures of body image. Overall, the AN, BN, and BDD groups were characterized by significantly elevated disturbances in most body image dimensions relative to their gender-matched clinical controls. There was variability, however, in the comparisons among the three groups of interest, including foci of body dissatisfaction and body image coping patterns. On omnibus indices of body image disturbance and body image quality of life, patients with BDD reported more body image impairment than those with eating disorders. Although AN, BN, and BDD are characterized by body image disturbances, similar and partially distinctive cognitive, behavioral, and emotional elements of body image functioning exist among these groups. The study's empirical and clinical implications are considered.