Body image assessment in anorexia nervosa patients and university students by means of video distortion: a reliability study

Depictive and metric body size estimation in anorexia nervosa and bulimia nervosa: A systematic review and meta-analysis

A distorted representation of one's own body is a diagnostic criterion and core psychopathology of both anorexia nervosa (AN) and bulimia nervosa (BN). Despite recent technical advances in research, it is still unknown whether this body image disturbance is characterized by body dissatisfaction and a low ideal weight and/or includes a distorted perception or processing of body size. In this article, we provide an update and meta-analysis of 42 articles summarizing measures and results for body size estimation (BSE) from 926 individuals with AN, 536 individuals with BN and 1920 controls. We replicate findings that individuals with AN and BN overestimate their body size as compared to controls (ES=0.63). Our meta-regression shows that metric methods (BSE by direct or indirect spatial measures) yield larger effect sizes than depictive methods (BSE by evaluating distorted pictures), and that effect sizes are larger for patients with BN than for patients with AN. To interpret these results, we suggest a revised theoretical framework for BSE that accounts for differences between depictive and metric BSE methods regarding the underlying body representations (conceptual vs. perceptual, implicit vs. explicit). We also discuss clinical implications and argue for the importance of multimethod approaches to investigate body image disturbance.

The Perceptual and Affective Components of Body Image Disturbances in Anorexic and Normal Females

The literature is inundated with studies reporting the body image experiences of anorexia nervosa patients and normal weight people. Such studies have not, however, yielded consistent results. The present study reinvestigated the issue bearing in mind the theoretical and methodological limitations of previous research. The perceptual and affective aspects of body image were investigated in 11 white, female anorexic patients and 51 white, female psychology undergraduate university students. A combination of the movable caliper technique and image-marking procedure was used to assess body size perception, that is, the perceptual aspect, and the Body Cathexis scale was used to assess body satisfaction, that is, the affective aspect. It was found that anorexic females overestimate the width of their waist and thighs significantly more than normal females ( p < 0.05) and that they have a significantly lower body satisfaction ( p < 0.001). It was concluded that the DSM IV criterion of a disturbance in body image has specific diagnostic relevance in anorexia nervosa.

Using psychophysical tools to quantify body image perception: a tutorial

ABSTRACT This article presents a tutorial about two protocols that can be used to measure an individual's perception of body image, direct and indirect , and which follow S.S. ( Stevens 1951) methods. Two psychophysical task approaches illustrate the ability of individuals to quantify body image distortions. We selected psychophysical tasks that indirectly assess a participant's behavioral component of body image (i.e., satisfaction tendencies about body image); and second, the cognitive component of body image (i.e., individuals' perceptual accuracy in magnitude estimation tasks, which depend on a familiarity with interval scales and the use of numbers and ratios to represent physical dimensions of stimuli). We determined individuals' perceptual sensitivity (i.e., his or her perceptual style ) to manipulations of the body's size by using Stevens' power function ( Stevens, 1951).

Tactile mental body parts representation in obesity

Obese people׳s distortions in visually-based mental body-parts representations have been reported in previous studies, but other sensory modalities have largely been neglected. In the present study, we investigated possible differences in tactilely-based body-parts representation between an obese and a healthy-weight group; additionally we explore the possible relationship between the tactile- and the visually-based body representation. Participants were asked to estimate the distance between two tactile stimuli that were simultaneously administered on the arm or on the abdomen, in the absence of visual input. The visually-based body-parts representation was investigated by a visual imagery method in which subjects were instructed to compare the horizontal extension of body part pairs. According to the results, the obese participants overestimated the size of the tactilely-perceived distances more than the healthy-weight group when the arm, and not the abdomen, was stimulated. Moreover, they reported a lower level of accuracy than did the healthy-weight group when estimating horizontal distances relative to their bodies, confirming an inappropriate visually-based mental body representation. Our results imply that body representation disturbance in obese people is not limited to the visual mental domain, but it spreads to the tactilely perceived distances. The inaccuracy was not a generalized tendency but was body-part related.

Body image distortions in healthy adults

Distortions of body image have often been investigated in clinical disorders. Much of this literature implicitly assumes healthy adults maintain an accurate body image. We recently developed a novel, implicit, and quantitative measure of body image - the Body Image Task (BIT). Here, we report a large-scale analysis of performance on this task by healthy adults. In both an in-person and an online version of the BIT, participants were presented with an image of a head as an anchoring stimulus on a computer screen, and told to imagine that the head was part of a mirror image of themselves in a standing position. They were then instructed to judge where, relative to the head, each of several parts of their body would be located. The relative positions of each landmark can be used to construct an implicit perceptual map of bodily structure. We could thus measure the internally-stored body image, although we cannot exclude contributions from other representations. Our results show several distortions of body image. First, we found a large and systematic over-estimation of width relative to height. These distortions were similar for both males and females, and did not closely track the idiosyncrasies of individual participant's own bodies. Comparisons of individual body parts showed that participants overestimated the width of their shoulders and the length of their upper arms, relative to their height, while underestimating the lengths of their lower arms and legs. Principal components analysis showed a clear spatial structure to the distortions, suggesting spatial organisation and segmentation of the body image into upper and lower limb components that are bilaterally integrated. These results provide new insight into the body image of healthy adults, and have implications for the study and rehabilitation of clinical populations.

Body Image Assessment Software: psychometric data

The aim of the present study was to analyze the psychometric characteristics of the Body Image Assessment Software (BIAS), an innovative interactive computer program developed to assess body image disturbances. The program was tested on 252 psychology students at the University of Barcelona and 51 patients with an eating disorder (ED). The subjects filled in the Eating Attitudes Test-26, the Body Shape Questionnaire, the body dissatisfaction scale of the Eating Disorders Inventory-2, and the Body Image Assessment-Revised (a test of silhouettes). Results showed good validity and very high reliability. Furthermore, BIAS was able to discriminate between people who were at risk of an ED and those who were not, as well as between people with and without a history of an ED. Those at risk of having an ED and those with a current ED showed more body image distortion (overestimation of body size) and higher levels of body image dissatisfaction.

Assessment of adolescent body perception: development and characterization of a novel tool for morphing images of adolescent bodies

We developed a computer-based method of distorting adolescent body images, which incorporates the covariation between body parts found during growth and sexual maturation. An adolescent body-shape database (AdoBSD) and adolescent body morphing tool (AdoBMT) are described; the AdoBSD comprises real (n=320) and morphed (n approximately 41,000) images (front and side view) of 160 adolescents (9-17 years). We used a point distribution model, based upon principal components analysis, to characterize the covariation between predefined body tag-points manually positioned on the body images and to morph the body images in a realistic manner. Eight principal components (PCs) were found to characterize 96.3% of the covariation between body tag-point. Application of the PCs to the body images resulted in the manipulation of body parts including shoulder width, waist, hip, belly, thigh and calf sizes. The AdoBMT and AdoBSD may be used to investigate changes in body perception during adolescence, and the role of body perception in adolescent obesity and eating disorders. The AdoBSD is available to the research community (www.brainbody.nottingham.ac.uk).

A program for assessing body image disturbance using adjustable partial image distortion

Body image disturbance has been one of the most widely studied areas in the literature on eating disorders. Some of the tasks designed to assess it have been used to estimate the sizes of specific parts of the body, whereas others have served to make estimations of overall body size. In recent years, the introduction of innovative computing procedures has allowed the two approaches to be combined and has made their application more straightforward. The program we describe here (Body Image Assessment Software, or BIAS) evaluates body image distortions and body dissatisfaction via the on-screen presentation of a scale image, the different components of which can be modified by the patient. The program was developed using Microsoft Access 2000 and Visual Basic for applications. It can be run on any computer with Windows and Microsoft Access 2000 or Microsoft Access 2000 RunTime, which makes it particularly easy to use and enables direct analysis of the recorded data through the use of applications such as SPSS.

Multitrait-multimethod investigation of a novel body image measurement technique

A multitrait-multimethod (MTMM) matrix was used to evaluate validity evidence for a digital image manipulation (DIM) body image measurement technique in young women. One hundred one young women completed the DIM procedure and the Thompson and Gray (1995) Contour Drawing Rating Scale to measure self-ideal discrepancy and size perception accuracy components of body image. Seven-day test-retest reliability was acceptable (R = .81-.95). Convergent validity for self-ideal discrepancy was higher (r = .74) than the corresponding heterotrait, monomethod coefficients (r = .46, r = .23) and heterotrait-heteromethod coefficients (r = .18, r = .12). However, the convergent validity coefficient for size perception accuracy was r = .12. The pattern of correlations in the MTMM matrix met the criteria of Campbell and Fiske (1959) for validity of these procedures to measure self-ideal discrepancy but not size perception accuracy. The DIM procedure addresses some of the criticisms associated with figure-rating scales, such as unrepresentativeness of the figures, scale coarseness, and restriction of range in responses. DIM, therefore, represents a realistic, valid alternative to figure-rating scales for measuring self-ideal discrepancy.

The ideal nasal profile: rhinoplasty patients vs the general public

OBJECTIVES

To evaluate whether patients seeking reduction rhinoplasty hold a different concept of the ideal nose than does the general public, and to determine what features characterize the ideal nasal profile.

METHODS

Twenty-seven patients seeking reduction rhinoplasty and 15 randomly selected members of the public evaluated a series of computer-manipulated photographic profiles using a pictorial visual analogue scale to rate their preferences for several variables. Center-scale images were created from mesh-warped ("morphed") computer averaging of 12 white women. Differences between the rhinoplasty group and the public group were then compared, as was each group's deviation from the center of the scale.

RESULTS

Both groups preferred narrowly distributed differences from the "average" profile to a high degree of significance. No statistically significant difference was found between the ideal nasal profiles selected by the rhinoplasty group and the public group.

CONCLUSIONS

Reduction rhinoplasty patients do not appear to have a different concept of the ideal nose than does the public at large. The ideal nose, as it pertains to the ideal white female profile, has characteristics that differ from a mathematically averaged nasal profile.

A computer program for measuring body size distortion and body dissatisfaction

A computer program is described that measures body size distortion and body dissatisfaction. The program is written using Visual Basic development tools and will run on any Windows 98 or more current system. The width of a static digital image of the participant can be manipulated using three separate psychophysical methods. In the method of adjustment, the participant adjusts the image wider or thinner to match his or her perceived size. The participants may also be required to adjust the image to their ideal size, with the discrepancy between perceived and ideal size being used as a measure of body dissatisfaction. In the staircase method, participants see an image that is continuously expanding or contracting. The participants change the direction of the distortion when the image matches their perceived size. In the adaptive probit estimation procedure, participants judge whether a static image is distorted too wide or too thin. Analysis of the responses permits a determination of the point of subjective equality (PSE) and the difference limen (DL) values. The DL reflects the amount of body size distortion necessary for the participant to detect the distortion 50% of the time. The PSE reflects the participant's subjective judgment of his or her body size. These two values are reflective of the sensory and nonsensory components, respectively, that contribute to body size judgments.

Japanese version of the Body Attitude Test: its reliability and validity

The Body Attitude Test (BAT) was developed by Probst et al. (1995) for female patients with eating disorders (ED). This test measures the subjective body experience and attitudes toward one's body. The present authors have developed the Japanese version of the BAT and the purpose of the present paper was to investigate its reliability and validity in control (CON, n = 599) and ED patients (n = 46). The ED patients consisted of 21 anorexia nervosa, restricting type (AN-R) patients and 25 bulimia nervosa (BN) patients. Internal consistency was determined with Cronbach's alpha coefficient in CON. Factor analysis was conducted on BAT ratings given by CON. Factor analysis indicated that BAT was composed of two factors. These were body dissatisfaction (factor 1) and lack of familiarity with one's body (factor 2). A comparison was made among AN-R, BN, and CON. Bulimia nervosa had a significantly higher score than the other two groups. The BAT scores of ED patients correlated significantly with the Self -rating Depression Scale, and State-Trait Anxiety Inventory. These results show that ED patients have negative feelings toward their own body, similar to the findings in the original report. On factor analysis, however, it was not possible to distinguish between negative appreciation of body size and general body dissatisfaction as described in the original report. The authors also examine influences on this difference from a cross-cultural view point.

The Body Attitude Test: validation of the Spanish version

A Spanish version of the Body Attitude Test (BAT) is presented. It was validated with 165 eating disorder patients (79 anorexia nervosa, 86 bulimia nervosa) and 220 schoolgirls from the general population. Factor analysis allowed the extraction of four factors, as in the original questionnaire, but with different item loadings on each. Taken together, these four factors accounted for 67.1% of the variance. The alpha reliability coefficient was 0.92 in both groups. The test-retest reliability with a one-week interval was 0.91 in a subgroup of 34 eating disorder patients and in a subgroup of 43 girls from the general population. The difference between the mean scores of the girls from the general population and the anorexics on one hand and the bulimics on the other was highly significant (p < 0.0001). On the basis of the discriminant validity study, the use of a cut-off point of 41--which gives a sensitivity of 75.1% and a specificity of 72.7%--is recommended.

Development and validation of two new scales for assessment of body-image

This study reports the development and validation of two new and improved tools for assessment of body-image. Two schematic contour scales were created using a frontal view photograph of an adult male and female with height and weight of the median American. A 2-figure analogue scale was created by distorting this drawing by +/- 30%. A 13-card scale was created by generating 13 drawings distorted between +/- 30% by increments of 5%. Evidence is presented for the reliability and validity of both scales. The advantages of these new scales over existing figural and silhouette scales are discussed.

Body image in eating disorders and analysis of its relevance: a preliminary study

The purpose of the present study was to assess body perception in eating disorders and its meaning in therapy. A total of 44 patients, 25 bulimia nervosa and 19 anorexia nervosa, admitted at a specialized in-patient treatment center participated in the present study. Body size estimation procedures (video-distortion and image-marking techniques) and self-report questionnaires were used for the assessment. No significant differences were found in actual body size estimation between the two eating disorder groups, either before or after therapy. It emerged after therapy that the outcome was not related to body size estimation. These findings suggest that there is no evidence for a serious impairment of body perception (size estimation) in eating-disordered patients, but rather for a disturbance in the emotional aspect of body image, as expressed in negative body attitudes. Body size perception does not appear to be a predictor of treatment outcome in eating disorders.

Body-size estimations in children six through fourteen: a longitudinal study

Estimates of perceived and ideal body size were collected in 216 boys and girls ages 6 through 14 years. Video methodology was used to adjust the width of a life-size frontal image of the children. Longitudinal data were collected annually for three years, beginning at ages 6, 9, and 12. Three psychological methods were used, including the method of adjustment, staircase method, and adaptive probit estimation technique which permitted separate measures of the children's point of subjective equality and just noticeable difference values. The point of subjective equality is the body size which is subjectively equal to the child's perception of self. The just noticeable difference is the amount of change in body size necessary to detect the difference 50% of the time. Acceptable size boundaries were also measured, using the method of adjustment. Over-all, children were accurate in estimating their body width, with average overestimation of less than 2%. Overestimation decreased within each age group during the three years of the study. There were no differences between ages or sexes. Both point of subjective equality and just noticeable difference values decreased significantly during the three years of the study. The latter values significantly decreased as children became older. Body dissatisfaction (the discrepancy between perceived and ideal size) remained low for boys in all age groups. Girls' body dissatisfaction significantly increased across ages, beginning at age 9. Test-retest consistency of both perceived and ideal size judgments at intervals of one and two years were low. Acceptable boundaries in body width were similar between sexes and across age cohorts.

Body size estimation in anorexia nervosa patients: the significance of overestimation

Using the video distortion method on a life-size screen, we have studied body size estimation in 100 female restricting anorexia nervosa patients. About half of the patients were accurate in estimating their own body dimensions and only 20% clearly showed overestimation. We then tested whether differences in accuracy of estimation were related to scores on the following questionnaires: Eating Disorder Inventory; Body Attitude Test; and Symptom Checklist (SCL-90). Overestimators reported a more negative body attitude and a more "neurotic profile" on the SCL-90. These differences might have both prognostic and therapeutic implications.

Perception of body size and body satisfaction in recovered anorexic women: comparison with restrained and unrestrained eaters

The perception of body size, measured by three different methods, and body satisfaction were assessed in 23 formerly anorexic inpatients with an "intermediate" (n = 9) or a "good" outcome (n = 14) and compared with the data obtained from 21 restrained and 20 unrestrained eaters. Using the Kinaesthetic Size Estimation Apparatus, overestimation and uncertainty in the perception of body size became apparent in both groups of former patients. The other two methods, Video Distortion Technique and Image Marking Procedure, did not produce comparable results. There was only a trend towards higher scores on body dissatisfaction, as measured by the Body Shape Questionnaire, in the patients' groups in comparison with the group of unrestrained eaters, whereas the patients' scores on body dissatisfaction were quite similar to those of the restrained eaters. None of these measures discriminated between the two outcome categories of "intermediate" and "good.". These findings suggest that restoration of body weight, by itself, obviously does not cause a normalization of body experience in all its components in patients with anorexia nervosa.

Body image disturbances and their change with videofeedback in anorexia nervosa

Disturbance in the way the body is experienced is a diagnostic criterion for anorexia nervosa, and impedes recovery. A method relatively free of external prompts, to reduce the potential for experimentally induced biases, evaluated body image distortions (BID) in 18 patients with anorexia nervosa soon after admission to an inpatient unit, and 18 normal controls, before and after a videofeedback session. The BID were assessed in the affective and self/social domains by visual analogue scales in which the instructional set oriented subjects to (a) the sensation of fatness (Affective Response, AR), and (b) size compared with other young women (Comparative Size Response, CSR). The AR and CSR were significantly greater than normal in anorexia but decreased significantly with videofeedback, while values for controls were stable. The AR and CSR were only partially independent, indicating overlap of the domains. In anorexia only, the responses were related to two DSM-IV diagnostic criteria for anorexia, fear of gaining weight and health-weight concerns, as well as to drive for thinness and body dissatisfaction. Fear of gaining weight occupied a central position in determining the magnitudes of BID and the other measures, including anxiety and depression.

Body image in secondary amenorrhea

Body image and personality traits are described in women suffering from secondary amenorrhea. Data gathered, in 21 consecutive female patients, from the Minnesota Multiphasic Personality Inventory (MMPI), Body Cathexis Scale, Image Marking Method and Distorting Television Image Method, were examined and compared with those collected in a control group. No significant differences were found in terms of body perception and body dissatisfaction. The evaluation of MMPI profiles, on the contrary, suggested differences between amenorrheic subjects and controls for what concerned personality traits, these last being significantly, but differently, related to body dissatisfaction and wish for thinness in both groups.

Social physique anxiety, body esteem, and social anxiety in bodybuilders and self-reported anabolic steroid users

Social physique anxiety, upper body esteem, social anxiety, and body dissatisfaction were examined among self-reported anabolic steroid (AS)-using bodybuilders, non-using bodybuilders, athletically active exercisers, and non-exercising individuals. Results indicate that: (a) the AS-using bodybuilder group had significantly lower levels of social physique anxiety than non-user groups, (b) AS-using bodybuilders have significantly higher upper body strength ratings than do non-users (non-using bodybuilders, athletically active exercisers, and non-exercisers), and (c) no differences among groups on a measure of social anxiety. Implications for further research and intervention are discussed in terms of the differences between anabolic steroids and other substances of abuse.

Body size estimation in eating disorder patients: testing the video distortion method on a life-size screen

The video distortion method on a life-size screen is a new method for studying eating disordered patients' estimations of their own body width. Testing this method in female patients (53 with anorexia nervosa, 38 with bulimia nervosa) and 36 normal females, yielded high to very high reliability scores (consistency and test-retest stability). A careful analysis of the 'just noticeable difference' showed that a 5% deviation from the undistorted image should be considered as within the range of accuracy. Taking this into account, anorectic patients appear to score below, above, as well as within the normal range. Bulimia nervosa patients are either accurate in their body estimations or overestimate their body width. All control Ss are correct in their estimations. With this method no significant differences were found between the anorectic patients and the controls. Bulimics differ significantly from anorectics and controls on their optative responses (i.e. what they wanted to look like) and their affective responses (i.e. what they felt they looked like).

Comparison of three psychophysical techniques for estimating body-size perception

Perception of body size was recorded for 63 university students (M age = 25.3 yr., 41 women) who estimated their own body size using three methods. Using the method of adjustment, subjects over- or underestimated their body size. A signal-detection analysis indicated that subjects were sensitive to detecting a 4% distortion in body size and that there was no systematic bias for reporting distortion as present or absent. Scores on the adaptive probit estimation task were significantly correlated with values for point of subjective equality and the size judgements with the method of adjustment. Over-all, this experiment demonstrated adaptive probit estimation as a reliable indicator of perceived body size, sensitivity in detecting size distortion, and response bias in making body-size judgements.

Body size estimation and body dissatisfaction in eating disorder patients and normal controls

In this study comparing 41 eating disorder patients and 34 female controls, the video distortion technique was used to test the accuracy of body size estimation and to assess the ideal body image. No difference was found in the estimation of actual body sizes, although the accuracy of estimation was quite variable in both bulimics and anorexics. With regard to the ideal body image, significant differences were found: All bulimics and 92.6% of the controls wished to be thinner versus 42.9% of the anorexics (23.8% wished to be larger). Looking at subjective body experience, as measured with a self-report questionnaire (Body Attitudes Test), body dissatisfaction appeared to be negatively correlated with the ideal body image but not with the estimation of actual body sizes.