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Torres S, Vieira AI, Vieira FM, Miller KM, Guerra MP, Lencastre L, Reis AC, Timóteo S, Nunes P, Barbosa MR. A Comprehensive Study of Positive Body Image as a Predictor of Psychological Well-Being in Anorexia Nervosa. Nutrients 2024; 16:1787. [PMID: 38892718 PMCID: PMC11174434 DOI: 10.3390/nu16111787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 05/31/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
Recent data suggest a close association between positive body image (PBI) and eating disorder recovery. Nevertheless, the specific mechanisms through which PBI may facilitate recovery from anorexia nervosa (AN) remain unknown. To advance understanding of these mechanisms, this study examined core indices of PBI within AN, exploring its association with emotion regulation and well-being outcomes. Data were collected from 159 female participants, 64 with AN diagnosis and 95 healthy controls (HCs), who completed measures of PBI (body appreciation, functionality appreciation, and body responsiveness), emotion regulation, and psychological well-being (depression, anxiety, stress, and psychological quality of life). The AN group reported lower levels of PBI and psychological well-being, along with greater difficulties in regulating emotions, relative to HCs. PBI variables significantly predicted emotion regulation and psychological well-being in AN, accounting for 36% to 72% of the variance, with body appreciation emerging as the strongest predictor. These findings lend credence to the view that PBI can serve as a catalyst for psychological health. We hypothesize that enhancing PBI can improve interoceptive awareness, which is crucial for emotion regulation and reducing maladaptive food-related coping. Emphasizing a mind-body connection in lifestyle could be a relevant element to consider for both treating and preventing AN.
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Affiliation(s)
- Sandra Torres
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal; (F.M.V.); (M.P.G.); (L.L.); (M.R.B.)
- Center for Psychology at the University of Porto (CPUP), University of Porto, 4200-135 Porto, Portugal;
| | - Ana Isabel Vieira
- Center for Psychology at the University of Porto (CPUP), University of Porto, 4200-135 Porto, Portugal;
| | - Filipa Mucha Vieira
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal; (F.M.V.); (M.P.G.); (L.L.); (M.R.B.)
- Center for Psychology at the University of Porto (CPUP), University of Porto, 4200-135 Porto, Portugal;
| | - Kylee M. Miller
- Child Development and Rehabilitation Center (CDRC), Institute on Development & Disability, Oregon Health & Science University, Portland, OR 97403, USA;
| | - Marina Prista Guerra
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal; (F.M.V.); (M.P.G.); (L.L.); (M.R.B.)
- Center for Psychology at the University of Porto (CPUP), University of Porto, 4200-135 Porto, Portugal;
| | - Leonor Lencastre
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal; (F.M.V.); (M.P.G.); (L.L.); (M.R.B.)
- Center for Psychology at the University of Porto (CPUP), University of Porto, 4200-135 Porto, Portugal;
| | - Ana Catarina Reis
- Department of Psychiatry, Centro Hospitalar de São João, 4200-319 Porto, Portugal; (A.C.R.); (S.T.); (P.N.)
| | - Sertório Timóteo
- Department of Psychiatry, Centro Hospitalar de São João, 4200-319 Porto, Portugal; (A.C.R.); (S.T.); (P.N.)
| | - Patrícia Nunes
- Department of Psychiatry, Centro Hospitalar de São João, 4200-319 Porto, Portugal; (A.C.R.); (S.T.); (P.N.)
| | - Maria Raquel Barbosa
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal; (F.M.V.); (M.P.G.); (L.L.); (M.R.B.)
- Center for Psychology at the University of Porto (CPUP), University of Porto, 4200-135 Porto, Portugal;
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2
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Lin JA, Jhe G, Adhikari R, Vitagliano JA, Rose KL, Freizinger M, Richmond TK. Triggers for eating disorder onset in youth with anorexia nervosa across the weight spectrum. Eat Disord 2023; 31:553-572. [PMID: 37039575 DOI: 10.1080/10640266.2023.2201988] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
To aid in more targeted eating disorder (ED) prevention efforts, we sought to identify sociodemographic and weight-related risk factors for identified triggers for the onset of anorexia nervosa (AN) in youth. We conducted a retrospective chart review of youth admitted for medical treatment of AN between January 2015 and February 2020. From multidisciplinary admission notes, we extracted patient-reported reasons for diet/exercise changes. We used qualitative thematic analysis to identify ED triggers, then categorized each trigger as binary variables (presence/absence) for logistic regression analysis of risks associated with each trigger. Of 150 patients, mean (SD) age was 14.1(2.3) years. A total of 129 (86%) were female and 120 (80%) were Non-Hispanic White. Triggers included environmental stressors (reported by 30%), external pressures of the thin/fit ideal (29%), internalized thin/fit ideal (29%), weight-related teasing (19%), and receiving health education (14%). Younger age was associated with higher odds of weight-related teasing (p = .04) and health education (p = .03). Males had greater odds of internalized thin/fit ideal than females (p = .04). Those with premorbid body mass indices ≥85th percentile for age and sex had greater odds of reporting positive reinforcement (p = .03) and weight-related teasing (p = .04) than those with weights <85th percentile. We use these findings to detail potential targets for advancing ED prevention efforts.
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Affiliation(s)
- Jessica A Lin
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Grace Jhe
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Julia A Vitagliano
- Health and Social Behavior, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kelsey L Rose
- Department of Nutrition and Food Sciences, University of Vermont, Burlington, Vermont, USA
| | - Melissa Freizinger
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Tracy K Richmond
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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3
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Federico B, Federica S, Ilaria B, Valentina V, Gianluca C, Emanuela A, Sandra S, Leonardo M. Short-term effects of a multidisciplinary inpatient intensive rehabilitation treatment on body image in anorexia nervosa. J Eat Disord 2023; 11:178. [PMID: 37803403 PMCID: PMC10559592 DOI: 10.1186/s40337-023-00906-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/02/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Positive changes in weight gain and eating pathology were reported after inpatient treatments for anorexia nervosa (AN). However, changes in the physical body do not always mirror changes in the imagined body. Here, the effect of a treatment focused on body image (BI) was described. METHODS This retrospective observational study had a quasi-experimental pre-post design without the control group. During the treatment, participants (N = 72) undertake a variety of activities focused on BI. The main outcome was tested through the Body Uneasiness Test. RESULTS At the end of the treatment, BI uneasiness decreased with a significant increase in weight gain. CONCLUSION This study highlights the positive short-term effect of a multidisciplinary inpatient intensive rehabilitation treatment on BI in AN. We encourage to design of psychological treatments focusing on the cognitive and emotional bodily representation (i.e. the body in the mind) to increase physical well-being.
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Affiliation(s)
- Brusa Federico
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. dei Disturbi del Comportamento Alimentare, Ospedale San Giuseppe, Piancavallo, VCO, Italy.
- I.R.C.C.S. Istituto Auxologico Italiano, Laboratorio di Psicologia, Ospedale San Giuseppe, Piancavallo, VCO, Italy.
| | - Scarpina Federica
- "Rita Levi Montalcini" Department of Neurosciences, University of Turin, Turin, Italy
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, Piancavallo, VCO, Italy
| | - Bastoni Ilaria
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. dei Disturbi del Comportamento Alimentare, Ospedale San Giuseppe, Piancavallo, VCO, Italy
- I.R.C.C.S. Istituto Auxologico Italiano, Laboratorio di Psicologia, Ospedale San Giuseppe, Piancavallo, VCO, Italy
| | - Villa Valentina
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. dei Disturbi del Comportamento Alimentare, Ospedale San Giuseppe, Piancavallo, VCO, Italy
- I.R.C.C.S. Istituto Auxologico Italiano, Laboratorio di Psicologia, Ospedale San Giuseppe, Piancavallo, VCO, Italy
| | - Castelnuovo Gianluca
- I.R.C.C.S. Istituto Auxologico Italiano, Laboratorio di Psicologia, Ospedale San Giuseppe, Piancavallo, VCO, Italy
- Psychology Department, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Apicella Emanuela
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. dei Disturbi del Comportamento Alimentare, Ospedale San Giuseppe, Piancavallo, VCO, Italy
| | - Savino Sandra
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. dei Disturbi del Comportamento Alimentare, Ospedale San Giuseppe, Piancavallo, VCO, Italy
| | - Mendolicchio Leonardo
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. dei Disturbi del Comportamento Alimentare, Ospedale San Giuseppe, Piancavallo, VCO, Italy
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Bianchi D, Schinelli A, Fatta LM, Lonigro A, Lucidi F, Laghi F. Body image impact on quality of life and adolescents' binge eating: the indirect role of body image coping strategies. Eat Weight Disord 2023; 28:75. [PMID: 37707679 PMCID: PMC10501925 DOI: 10.1007/s40519-023-01607-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023] Open
Abstract
PURPOSE The role of body image in adolescent binge eating is widely confirmed, albeit the various facets of this relationship are still mostly unexplored. Within the multidimensional body image framework, this study hypothesized the indirect effects of three body image coping strategies (positive rational acceptance, appearance fixing, avoidance) in the expected relationship between the perceived impact of body image on individuals' quality of life and binge eating symptoms. METHODS Participants were 715 adolescents aged 15-21 years (49.1% girls) recruited in Italian schools. An anonymous self-report online survey was administered. A multiple mediation model was tested. RESULTS A more positive perceived impact of body image on quality of life was a negative predictor of adolescents' binge eating, controlling for individual levels of body satisfaction. Three indirect effects were found in this relationship: on one hand, the positive body image impact reduced binge eating via increasing positive rational acceptance (M1), and via reducing avoidance (M2); on the contrary, the positive body image impact also enhanced binge eating via increasing appearance fixing (M3). CONCLUSIONS The body image impact on quality of life can be alternatively protective-when adaptive coping is solicited, and maladaptive strategies are reduced-or a risk factor, which may increase binge eating by soliciting appearance fixing. LEVEL III Evidence obtained from cohort or case-control analytic studies.
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Affiliation(s)
- Dora Bianchi
- Department of Social and Developmental Psychology, University of Rome Sapienza, Via Dei Marsi 78, 00185, Rome, Italy.
| | - Anthony Schinelli
- University of South Florida, Morsani College of Medicine, Tampa, USA
| | | | - Antonia Lonigro
- Department of Education Science, University of Rome Tre, Rome, Italy
| | - Fabio Lucidi
- Department of Social and Developmental Psychology, University of Rome Sapienza, Via Dei Marsi 78, 00185, Rome, Italy
| | - Fiorenzo Laghi
- Department of Social and Developmental Psychology, University of Rome Sapienza, Via Dei Marsi 78, 00185, Rome, Italy
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5
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Raoul L, Grosbras MH. Relating different Dimensions of Bodily Experiences: Review and proposition of an integrative model relying on phenomenology, predictive brain and neuroscience of the self. Neurosci Biobehav Rev 2023; 148:105141. [PMID: 36965863 DOI: 10.1016/j.neubiorev.2023.105141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 03/27/2023]
Abstract
How we mentally experience our body has been studied in a variety research domains. Each of these domains focuses in its own ways on different aspects of the body, namely the neurophysiological, perceptual, affective or social components, and proposes different conceptual taxonomies. It is therefore difficult to find one's way through this vast literature and to grasp the relationships between the different dimensions of bodily experiences. In this narrative review, we summarize the existing research directions and present their limits. We propose an integrative framework, grounded in studies on phenomenal consciousness, self-consciousness and bodily self-consciousness, that can provide a common basis for evaluating findings on different dimensions of bodily experiences. We review the putative mechanisms, relying on predictive processes, and neural substrates that support this model. We discuss how this model enables a conceptual assessment of the interrelationships between multiple dimensions of bodily experiences and potentiate interdisciplinary approaches.
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Affiliation(s)
- Lisa Raoul
- Aix Marseille Univ, CNRS, LNC, Laboratoire de Neurosciences Cognitives, Marseille, France.
| | - Marie-Hélène Grosbras
- Aix Marseille Univ, CNRS, LNC, Laboratoire de Neurosciences Cognitives, Marseille, France.
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6
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Garcia-Gil M, Ceccarini MR, Stoppini F, Cataldi S, Mazzeschi C, Delvecchio E, Albi E, Gizzi G. Brain and gut microbiota disorders in the psychopathology of anorexia nervosa. Transl Neurosci 2022; 13:516-526. [PMID: 36660007 PMCID: PMC9824428 DOI: 10.1515/tnsci-2022-0267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 01/08/2023] Open
Abstract
Studies of pathophysiological mechanisms involved in eating disorders (EDs) have intensified over the past several years, revealing their unprecedented and unanticipated complexity. Results from many articles highlight critical aspects in each member of ED family. Notably, anorexia nervosa (AN) is a disorder due to undefined etiology, frequently associated with symptoms of depression, anxiety, obsessive-compulsiveness, accompanied by endocrine alterations, altered immune response, increased inflammation, and dysbiosis of the gut microbiota. Hence, an advanced knowledge of how and why a multisystem involvement exists is of paramount importance to understand the pathogenetic mechanisms of AN. In this review, we describe the change in the brain structure/function focusing on hypothalamic endocrine disorders and the disequilibrium of gut microbiota in AN that might be responsible for the psychopathological complication.
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Affiliation(s)
- Mercedes Garcia-Gil
- Department of Biology, University of Pisa, 56127, Pisa, Italy,Department of Biology, Interdepartmental Research Center Nutrafood “Nutraceuticals and Food for Health”, University of Pisa, 56127 Pisa, Italy,Department of Biology, CISUP, Center for Instrument Sharing of the University of Pisa, 56127 Pisa, Italy
| | | | - Fabrizio Stoppini
- Department of Pharmaceutical Science, University of Perugia, 06126 Perugia, Italy
| | - Samuela Cataldi
- Department of Pharmaceutical Science, University of Perugia, 06126 Perugia, Italy
| | - Claudia Mazzeschi
- Department of Philosophy, Social Sciences and Education, University of Perugia, 06126 Perugia, Italy
| | - Elisa Delvecchio
- Department of Philosophy, Social Sciences and Education, University of Perugia, 06126 Perugia, Italy
| | - Elisabetta Albi
- Department of Pharmaceutical Science, University of Perugia, 06126 Perugia, Italy
| | - Giulia Gizzi
- Department of Philosophy, Social Sciences and Education, University of Perugia, 06126 Perugia, Italy
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7
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Ciwoniuk N, Wayda-Zalewska M, Kucharska K. Distorted Body Image and Mental Pain in Anorexia Nervosa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010718. [PMID: 36613039 PMCID: PMC9819498 DOI: 10.3390/ijerph20010718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/25/2022] [Accepted: 12/27/2022] [Indexed: 06/12/2023]
Abstract
(1) Background: Body image is being defined as the picture of our own body in our mind with its size and shape, and with a perceptive and attitudinal evaluation of this body. It appears to be a complex clinical construct predisposing an individual to developing and maintaining anorexia nervosa (AN), as well as having considerable impact on prolonging the duration of this illness and its relapse risk. The aim of the research work was to assess whether the symptomatology of eating disorders, level of depression, and mental pain are associated with body image, and examine the influence of a distorted body image as well as eating disorders and depression symptoms on mental pain in AN; (2) Methods: A total of 36 women diagnosed with AN and 69 healthy controls (HC) participated in this study. All participants completed a battery of the following scales: EAT-26, BSQ-34, BIDQ, BDD-YBOCS, CESDR, and the Mental Pain Scale; (3) Results: Results show statistically significantly greater body image disturbances and higher level of depression and mental pain intensity in the AN compared to the HC group. Regression analysis indicates a greater impact of distorted body image, eating disorders, and depression symptoms on mental pain in AN; (4) Conclusions: As assumed, distorted body image and mental pain are central components of AN that should be especially emphasized in the therapeutical process of treating AN. Future research should focus on the etiopathogenesis of distorted body image in relation to the chronicity of mental pain and depression in AN, and address these outcomes in clinical practice to minimize suicide risk in this high-risk group of patients.
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8
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Naumann E, Werthmann J, Vocks S, Svaldi J, Hartmann AS. Die Spiegelkonfrontationstherapie zur Behandlung von Körperbildstörungen bei Essstörungen – Evidenz, Wirkmechanismen und Vorgehensweise. PSYCHOLOGISCHE RUNDSCHAU 2022. [DOI: 10.1026/0033-3042/a000558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Körperbildprobleme sind ein Kernmerkmal von Essstörungen. Daher gilt eine Verbesserung des Körperbildes bei der Behandlung von Essstörungen als zentrales Therapieziel. Verschiedene empirische Befunde weisen auf die Spiegelkonfrontation als wirksame Methode zur Reduktion von Körperbildstörungen hin. Ziel dieses Übersichtsartikels ist es, den aktuellen Stand der wissenschaftlichen Literatur zum Thema Spiegelkonfrontationstherapie bei Essstörungen darzulegen. Insbesondere sollen die Wirksamkeitsstudien getrennt für nicht-klinische, körperunzufriedene Gruppen mit und ohne Übergewicht sowie die verschiedenen Essstörungsgruppen systematisiert und unterschiedliche Vorgehensweisen beschrieben werden. Der Übersichtsartikel liefert Hinweise dafür, dass die Spiegelkonfrontationstherapie bei Hochrisikogruppen mit erhöhter Körperunzufriedenheit sowie bei Essstörungen zu positiven Veränderungen hinsichtlich der kognitiv-affektiven und behavioralen Komponente des Körperbildes führt. Jedoch mangelt es insgesamt an randomisiert-kontrollierten Studien, die die Wirksamkeit der Spiegelkonfrontationstherapie mit ausreichend großen Stichproben gezielt untersuchen – vor allem bei der Anorexia nervosa. Der Übersichtsartikel schließt mit einer Diskussion über mögliche Wirkmechanismen, (Kontra–)Indikationen und einem Ausblick für zukünftige Forschung ab.
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Affiliation(s)
- Eva Naumann
- Abteilung Klinische Psychologie und Psychologie, Institut für Psychologie, Eberhard Karls Universität Tübingen, Deutschland
| | - Jessica Werthmann
- Abteilung Klinische Psychologie und Psychologie, Institut für Psychologie, Albert-Ludwigs-Universität Freiburg, Deutschland
| | - Silja Vocks
- Fachgebiet Klinische Psychologie und Psychologie, Institut für Psychologie, Universität Osnabrück, Deutschland
| | - Jennifer Svaldi
- Abteilung Klinische Psychologie und Psychologie, Institut für Psychologie, Eberhard Karls Universität Tübingen, Deutschland
| | - Andrea S. Hartmann
- Fachgebiet Klinische Psychologie und Psychologie, Institut für Psychologie, Universität Osnabrück, Deutschland
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9
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Sourlier P, Bozzi S, Kabuth B, Lamourette M, Ligier F. Experiences of parents and patients hospitalised in a child psychiatric unit for anorexia nervosa after reorganisation of care imposed by the COVID-19 Pandemic in France: a qualitative study-The QUALICOVID study. J Eat Disord 2022; 10:57. [PMID: 35468851 PMCID: PMC9035507 DOI: 10.1186/s40337-022-00579-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anorexia nervosa is a serious, albeit common mental illness that generally occurs during adolescence. Although outpatient care is recommended, hospitalisation is sometimes required. There is a dedicated hospitalisation unit caring for children and adolescents presenting with anorexia nervosa in Nancy, France. However, on 16 March 2020, a national lockdown was declared by the French government as the COVID-19 pandemic escalated in France. This resulted in the adjustment of hospital admissions accompanied by premature discharge and an intensive outpatient care programme. In the light of such changes, consideration should be given to the potential impact of changes in the care pattern for anorexic patients and their parents. The purpose of our study was to explore the experiences of anorexia nervosa patients hospitalised in the unit, and their parents, following changes in the care strategy. METHODS The study was conducted between weeks four and eight after lockdown was announced. The study cohort included all the patients treated for anorexia nervosa and hospitalised in the treatment unit before 16 March 2020 and their parents. A qualitative method was used and every subject was offered a semi-structured interview. Data were analysed by means of inductive thematic analysis. RESULTS Seven superordinate themes were identified: positive aspects, concerns, preparation, loss of landmarks and hospital security, gradual return to a "normal" life, relational aspects and the likelihood of disease progression. Moreover, all the parents and patients were satisfied with the intensive outpatient care offered on discharge. CONCLUSION Despite initial ambivalence, all patients and their parents viewed this unexpected hospital discharge positively in these exceptional conditions. This suggests that restructuring the care programme could prove beneficial with increasing use of outpatient management, thereby reducing the length of the hospital stay and adjusting the return to school. TRIAL REGISTRATION ID-RCB 2020-A01101-38-This project was approved by the Comité de Protection des Personnes (CPP) Sud Méditerranée IV [South Mediterranean IV Ethics Committee (EC)] on 5 May 2020.
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Affiliation(s)
- Pauline Sourlier
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Psychothérapique de Nancy, 1 Rue du Docteur Archambault, 54520, Laxou, France. .,EA 4432 PRISME, Université de Lorraine, 54000, Nancy, France.
| | - Sophie Bozzi
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Psychothérapique de Nancy, 1 Rue du Docteur Archambault, 54520, Laxou, France.,EA 4432 PRISME, Université de Lorraine, 54000, Nancy, France
| | - Bernard Kabuth
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Psychothérapique de Nancy, 1 Rue du Docteur Archambault, 54520, Laxou, France.,EA 4432 PRISME, Université de Lorraine, 54000, Nancy, France
| | - Marilou Lamourette
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Psychothérapique de Nancy, 1 Rue du Docteur Archambault, 54520, Laxou, France.,EA 4360 APEMAC, Université de Lorraine, 54000, Nancy, France
| | - Fabienne Ligier
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Psychothérapique de Nancy, 1 Rue du Docteur Archambault, 54520, Laxou, France.,EA 4360 APEMAC, Université de Lorraine, 54000, Nancy, France
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10
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Turnbull G, Alexi J, Mann G, Li Y, Engel M, Bayliss DM, Farrell S, Bell J. EXPRESS: The Influence of Three-Dimensional Cues on Body Size Judgements. Q J Exp Psychol (Hove) 2022; 75:2318-2331. [PMID: 35034530 DOI: 10.1177/17470218221076850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Research has shown that body size judgements are frequently biased, or inaccurate. Critically, judgement biases are further exaggerated for individuals with eating disorders, a finding that has been attributed to difficulties integrating body features into a perceptual whole. However, current understanding of which body features are integrated when judging body size is lacking. In this study, we examine whether individuals integrate three-dimensional (3D) cues to body volume when making body size judgements. Computer-generated body stimuli were presented in a 3D Virtual Reality (VR) environment. Participants (N = 412) were randomly assigned to one of two conditions: in one condition the to-be-judged body was displayed binocularly (containing 3D cues to body volume), in the other, bodies were presented monocularly (2D cues only). Across 150 trials, participants were required to make a body size judgement of a target female body from a third-person point of view using an unmarked visual analogue scale (VAS). It was found that 3D cues significantly influenced body size judgements. Namely, thin 3D bodies were judged smaller, and overweight 3D bodies were judged larger, than their 2D counterpart. Furthermore, to reconcile these effects, we present evidence that the two perceptual biases, regression to the mean and serial dependence, were reduced by the additional 3D feature information. Our findings increase our understanding of how body size is perceptually encoded and creates testable predictions for clinical populations exhibiting integration difficulties.
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Affiliation(s)
- Georgia Turnbull
- School of Psychological Science, University of Western Australia (M304), 35 Stirling Highway, Crawley WA 6009, Australia 2720
| | - Joanna Alexi
- School of Psychological Science, University of Western Australia (M304), 35 Stirling Highway, Crawley WA 6009, Australia 2720
| | - Georgina Mann
- School of Psychological Science, University of Western Australia (M304), 35 Stirling Highway, Crawley WA 6009, Australia 2720
| | - Yanqi Li
- School of Psychological Science, University of Western Australia (M304), 35 Stirling Highway, Crawley WA 6009, Australia 2720
| | - Manja Engel
- Utrecht University, Faculty of Social and Behavioural Sciences, Experimental Psychology/Helmholtz Institute. Heidelberglaan 1, 3584 CS Utrecht, Netherlands 8125
| | - Donna M Bayliss
- School of Psychological Science, University of Western Australia (M304), 35 Stirling Highway, Crawley WA 6009, Australia 2720
| | - Simon Farrell
- School of Psychological Science, University of Western Australia (M304), 35 Stirling Highway, Crawley WA 6009, Australia 2720
| | - Jason Bell
- School of Psychological Science, University of Western Australia (M304), 35 Stirling Highway, Crawley WA 6009, Australia 2720
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11
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Bijsterbosch JM, Keizer A, Boelen PA, van den Brink F, Danner UN, Sternheim LC. How deep is your thought? The relations between intolerance of uncertainty, worry and weight and shape concerns in adolescent girls with anorexia nervosa. J Eat Disord 2021; 9:164. [PMID: 34930469 PMCID: PMC8686596 DOI: 10.1186/s40337-021-00523-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/10/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Inherent to anorexia nervosa are repetitive thoughts about weight and shape. Growing research suggests the relevance of intolerance of uncertainty and worry in maintaining these types of repetitive thoughts. The relation between these cognitive processes and weight and shape concerns in adolescent girls with anorexia nervosa is understudied. This study investigated associations between prospective (desire for predictability) and inhibitory (uncertainty paralysis) intolerance of uncertainty, and weight and shape concerns and the mediating role of worry in these associations. METHODS In a cross-sectional study, 93 adolescent girls with anorexia nervosa completed questionnaires measuring the variables of interest. A mediation model with worry as a mediator between inhibitory and prospective intolerance of uncertainty and weight and shape concerns was tested. RESULTS A total and direct effect of inhibitory intolerance of uncertainty on weight and shape concerns was found. Worry did not mediate this relation. CONCLUSIONS These results confirm the importance of inhibitory intolerance of uncertainty in adolescent girls with anorexia nervosa, more specifically to weight and shape concerns. This group may benefit from intervention strategies targeting intolerance of uncertainty. General worry seems less relevant to weight and shape concerns in adolescent girls with anorexia nervosa. Adolescent girls with anorexia nervosa often experience repetitive thoughts about weight and shape. Growing research suggests the relevance of intolerance of uncertainty and worry in maintaining these types of repetitive thoughts. Intolerance of uncertainty is defined as the incapacity to tolerate uncertainty and is often divided into two components; prospective intolerance of uncertainty (desire for predictability) and inhibitory intolerance of uncertainty (uncertainty paralysis). The relation between intolerance of uncertainty, worry and weight and shape concerns in adolescent girls with anorexia nervosa is understudied. This study aims to investigate study relations between prospective and inhibitory intolerance of uncertainty, worry, and weight and shape concerns. A total of 93 adolescent girls with anorexia nervosa completed three questionnaires, measuring prospective and inhibitory intolerance of uncertainty worry, and weight and shape concerns, respectively. The results of this study confirmed the importance of inhibitory intolerance of uncertainty in adolescent girls with anorexia nervosa, more specifically to weight and shape concerns. This group may benefit from intervention strategies targeting intolerance of uncertainty. General worry seems less relevant to weight and shape concerns in adolescent girls.
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Affiliation(s)
- Jojanneke M Bijsterbosch
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands.
| | - Anouk Keizer
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | - Paul A Boelen
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
- ARQ Centrum'45, Diemen, The Netherlands
| | - Femke van den Brink
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
| | - Unna N Danner
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
- Rintveld Center for Eating Disorders, Altrecht, Zeist, The Netherlands
| | - Lot C Sternheim
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
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12
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Wayda-Zalewska M, Kostecka B, Kucharska K. Body Image in Borderline Personality Disorder: A Systematic Review of the Emerging Empirical Literature. J Clin Med 2021; 10:jcm10184264. [PMID: 34575375 PMCID: PMC8470847 DOI: 10.3390/jcm10184264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 12/02/2022] Open
Abstract
As an element of distorted self-image, body image disturbances may be relevant to borderline personality disorder (BPD). Therefore, this systematic review aims to critically discuss and summarize empirical findings in this matter. Based on the available theoretical models, three body image components were identified: (a) perception, (b) affect and cognition, and (c) general body dissatisfaction. We conducted a systematic search of the empirical literature published in English in the MEDLINE, PsycINFO, and Scopus databases until June 2021 using a priori eligibility criteria (BPD; BPD symptoms or features in nonclinical groups; quasipsychotic or psychotic symptoms were not considered). We included k = 10 records meeting the criteria. Compared with other analyzed groups, individuals diagnosed with BPD obtained higher scores in the three components of body image disturbances. The issue of body image in BPD is relatively understudied, although current research findings clearly indicate disturbances in all of the abovementioned body image components in individuals with BPD or significant relationships of these components with BPD traits or symptoms both in clinical and nonclinical samples. Eventually, possible practical implications and future research directions are also discussed.
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Affiliation(s)
- Magdalena Wayda-Zalewska
- Institute of Psychology, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland; (M.W.-Z.); (K.K.)
| | - Barbara Kostecka
- II Department of Psychiatry, Medical University of Warsaw, 03-242 Warsaw, Poland
- Correspondence:
| | - Katarzyna Kucharska
- Institute of Psychology, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland; (M.W.-Z.); (K.K.)
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13
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Towards a Comprehensive Understanding of Body Image: Integrating Positive Body Image, Embodiment and Self-Compassion. Psychol Belg 2021; 61:248-261. [PMID: 34394951 PMCID: PMC8323527 DOI: 10.5334/pb.1057] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 07/12/2021] [Indexed: 11/25/2022] Open
Abstract
Body image (BI) disturbance is a relevant factor in the etiology and treatment of eating disorders (ED). Although progress has been made in recent decades in understanding BI and its relationship with ED, the efficacy of BI disturbance prevention and intervention programs is still limited. In order to reach deeper understanding of BI disturbance and clarify the interactions between some protective and risk factors related to this construct, we carried out a literature review on some specific BI-related factors that so far have been analyzed independently. We specifically examined positive and negative BI; embodiment and its role in the development of positive and negative BI; and self-compassion as a protective factor that promotes positive embodiment (vs. disembodiment) and protection against body shame. We conclude that integrating the available evidence on these factors into BI models may be used to enhance our understanding of BI and improve the efficacy of prevention and intervention programs to help fight negative BI (by reducing body shame and disembodiment) and promote positive BI (by increasing self-compassion and positive embodiment).
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14
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Stonawski V, Sasse L, Moll G, Kratz O, Horndasch S. Computer Based Body Exposure in Adolescents With Anorexia Nervosa: A Study Protocol. Front Psychiatry 2021; 12:769239. [PMID: 35140637 PMCID: PMC8818868 DOI: 10.3389/fpsyt.2021.769239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/27/2021] [Indexed: 11/25/2022] Open
Abstract
Body dissatisfaction is a core feature of eating disorders (EDs) and plays an essential role in the development and maintenance of anorexia nervosa (AN). In the current study, a computer based body exposure intervention is conducted and evaluated regarding short-term effects on body dissatisfaction, psychopathology, viewing patterns, and stress reactivity. Within a randomized controlled trial (RCT) female adolescents and young women with AN are either receiving the intervention or treatment as usual (TAU). Furthermore, in a transdiagnostic approach, a highly body-dissatisfied group of clinical control participants obtaining the intervention will be surveyed to identify AN-specific processes. The standardized four-session body exposure intervention using photographs of the own body is adapted from a manualized body image treatment program for computer use. Psychopathology (body dissatisfaction, body image avoidance, body checking, depression, anxiety) is assessed via standardized questionnaires before and after the intervention. During each session, attentional biases regarding one's own body are measured via eye tracking, stress levels are measured via subjective ratings, heart rate variability, as well as salivary cortisol and alpha amylase. Between- and within-subject effects will be assessed. The pilot study aims to identify short-term effects of the intervention on body dissatisfaction and attentional bias, as well as to investigate the potential underlying mechanism of physiological habituation.
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Affiliation(s)
- Valeska Stonawski
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Lena Sasse
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Gunther Moll
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Oliver Kratz
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Stefanie Horndasch
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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15
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Preventing Nutritional Disorders in Adolescents by Encouraging a Healthy Relationship With Food. J Adolesc Health 2020; 67:875-879. [PMID: 33220798 DOI: 10.1016/j.jadohealth.2020.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 11/28/2022]
Abstract
Nutritional disorders, including overweight, underweight, and/or nutrient deficiency, are a significant cause of morbidity and mortality. These disorders are frequently related to abnormal patterns of eating and/or physical activity, which commonly begin in adolescence and persist into adulthood. Abnormal eating and exercise behaviors may stem from an unhealthy relationship with food, which often takes root in preadolescence or early adolescence. To prevent eating disorders, overweight, underweight, and nutritional deficiencies in adolescence and beyond, health care providers need to proactively support early adolescents and their caregivers to develop a healthy relationship with food and their bodies. Anticipatory guidance, nutrition and exercise counseling, and encouragement of body positivity and healthy self-image during the vulnerable period of early adolescence can prevent maladaptive behaviors from emerging later on. Advocacy beyond the health care setting is also needed to ensure that adolescents are exposed to consistent and positive nutritional messaging. In this position article, authors from both the Nutrition/Obesity Committee and the Eating Disorder Committee of the Society of Adolescent Health and Medicine provide practical recommendations for health care professionals to guide their young patients and caregivers toward a flexible, balanced, and satisfying approach to nutrition that will lead to physical and emotional wellness throughout their lifetimes.
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16
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Price T, Zebitz M, Giraldi A, Lokind TS, Treasure J, Sjögren JM. Sexual function and dysfunction among women with anorexia nervosa: A systematic scoping review. Int J Eat Disord 2020; 53:1377-1399. [PMID: 32449544 DOI: 10.1002/eat.23299] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Research suggests that a variety of biological and psychosocial factors are associated with the sexual health of women diagnosed with anorexia nervosa (AN). This systematic scoping review, conducted in accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines, synthesizes the current literature concerning sexual function and dysfunction in women with AN. METHOD We searched PubMed, EMBASE, and PsychInfo for literature published until April 2020. All study designs were eligible for inclusion, providing they focused on sexual function and dysfunction in women with AN. Studies that only included outcomes related to gender identity or sexual orientation were excluded. RESULTS N = 28 studies met criteria for inclusion in the review. All studies were conducted in Western countries and the majority employed either a cohort or cross-sectional design. Although measures of sexual function and dysfunction varied markedly across studies, most studies adopted a biopsychosocial framework. Libido may be linked to body mass index (BMI), while other aspects of sexual functioning and behavior might not be specifically associated with weight status. Limited data are available on evidence-based interventions. DISCUSSION Sexual dysfunction in women with AN is common. Although some of the variance is explained by low BMI, associated physiological sequelae and other psychosocial factors are also involved. Sexual dysfunction is a relevant clinical problem and clinicians should sensitively incorporate questions related to sexual function into their eating disorder assessments. Future research, using more robust designs and validated outcome measures, is needed to better understand causal pathways between the biological and psychosocial correlates of AN and sexual dysfunction. Identifying predictors of sexual function and dysfunction in more diverse groups of people with AN will support the development of evidence-based therapies.
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Affiliation(s)
- Tom Price
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Martin Zebitz
- Research Unit Eating Disorders, Psychiatric Center BALLERUP, Ballerup, Denmark
| | - Annamaria Giraldi
- Sexological Clinic, Psychiatric Center Copenhagen, Rigshospitalet Capitol Region of Denmark Psychiatry Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thea Stine Lokind
- Research Unit Eating Disorders, Psychiatric Center BALLERUP, Ballerup, Denmark
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Jan Magnus Sjögren
- Research Unit Eating Disorders, Psychiatric Center BALLERUP, Ballerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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17
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Barkhordari-Sharifabad M, Vaziri-Yazdi S, Barkhordari-Sharifabad M. The effect of teaching puberty health concepts on the basis of a health belief model for improving perceived body image of female adolescents: a quasi-experimental study. BMC Public Health 2020; 20:370. [PMID: 32197594 PMCID: PMC7083033 DOI: 10.1186/s12889-020-08482-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/09/2020] [Indexed: 11/22/2022] Open
Abstract
Background As children approach adolescence, they focus increasingly on their appearance and physical attraction due to teenage body-image. Teaching the concepts of adolescent health changes an individual’s attitudes towards parts of the body. The health belief model (HBM) is one of the significant pedagogic models in health education. According to this model, the individual’s decision and motivation for adopting healthy behaviors depends on three separate categories “personal perception, adaptive behaviors, and probability of performing that action or behavior”. This study investigated the effect of teaching puberty health concepts on the basis of a HBM on perceived body image in female adolescents. Methods A quasi-experimental research design was used in the study. This study was conducted with 60 sixth grade girls in state elementary schools in Yazd, Iran, that were selected with cluster sampling method and assigned randomly into experimental and control groups. The experimental group were educated in the school during eight 45-min sessions based on the HBM, whereas the control group were educated using the traditional lecturing method. The data were collected with demographic and self-body image questionnaires completed before and after intervention. The data were analyzed with SPSS16 using analysis of covariance (ANCOVA). Results The mean age of the participants was 12.16 ± 0.74 years. The findings showed that “perceived body image” and “students’ self-attitude” improved significantly after intervention; yet, no significant difference was found between the subscales “attitudes towards weight” and “satisfaction with various parts of the body”. Conclusion The results of the study confirmed the efficacy and efficiency of teaching puberty health on the basis of the HBM on improving perceived body image in female adolescents.
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Affiliation(s)
- Maasoumeh Barkhordari-Sharifabad
- Department of Nursing, School of Medical Sciences, Yazd Branch, Islamic Azad University, Shohadaye Gomnam Blvd., Safaiyeh, Yazd, Iran.
| | - Saeed Vaziri-Yazdi
- Department of Educational Sciences, Yazd Branch, Islamic Azad University, Yazd, Iran
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