The role of disgust in body image disturbance: Incremental predictive power of self-disgust

Emotional body representations: more pronounced effect of hands at a more explicit level of awareness

To understand conditions such as body dysmorphic disorder, we need to understand healthy individuals' perceptual, conceptual, and emotional representations of their bodies. Not much is known about the differences in these representations across body districts, for example, hands, feet, and whole-body, despite their differences at sensory and functional levels. To understand this, we developed more implicit and explicit measures of body satisfaction for these body districts. Sixty-seven participants (age M = 30.66, SD = 11.19) completed a series of online Implicit Association Tests (IAT) and a Body Image Satisfaction Visual Analogue Scale (BISVAS; explicit) for each body district (hands/feet/whole body). The results show no differences in the more implicit level of awareness in hands, feet and whole body, while differences are apparent at a more explicit level of awareness, with higher scores for body image satisfaction for the hands than the whole body and marginally significant lower scores for feet than hands. Those findings suggest that visual attention, level of concern attributed to a body district, and disgust drivers are possible factors affecting the experience of attitudinal body image satisfaction.

Self-Disgust and Sexual Functioning: A Scenario-Based Study Testing the Ability of Sex-Related Experiences to Elicit Self-Directed Disgust

Increasing evidence indicates that disgust might compromise sexual functioning and can contribute to sexual problems. Although the stimuli and conditions that elicit disgust vary greatly across individuals, they cluster in three categories of disgust elicitors: Stimuli that are associated with an increased risk of the transmission of infectious diseases (pathogen disgust), stimuli that signal poor mating quality and may jeopardize reproductive success (sexual disgust), and behaviors that violate social norms (moral disgust). It has been argued that each of these categories of disgust may interfere with sexual responses. Thus far, research on the role of disgust in sexual contexts focused on external stimuli (e.g., sperm). Yet, recently it has been proposed that disgust can also become directed to features of the self. Such self-directed disgust may also apply to sexual contexts and contribute to sexual problems. As a first step to explore the relevance of self-disgust in sexual functioning, we tested if indeed particular sexual experiences have the ability to elicit self-disgust. Using a within subject design, participants (N = 124; all women) imagined themselves as well as others experiencing a series of sex-related scenarios, each relevant for one of the three categories of disgust, and subsequently rated their self-disgust. For all types of disgust, the scenarios evoked self-disgust, and the "self-perspective" elicited significantly more self-disgust than the "other-perspective." These findings support theoretical models pointing to the relevance of taking self-disgust into consideration as a factor that may compromise sexual functioning. Future research should test whether this also holds for men.

Repeated exposure to body-related memories in women with high body-related self-disgust: Impact on disgust, avoidance, and acceptance

Disgust-based body image concerns can bias autobiographical memory towards the recall and avoidant processing of disgust-related memories of the own body. Repeated exposure to such memories may help breaking avoidance and promote the habituation of disgust, thereby lowering body concerns. Using a pre-post within-participant experimental design, we tested if repeatedly exposing women with high self-disgust (N = 61) to disgust-focused body memories vs. neutral memories led to changes in disgust, body acceptance, and reactive avoidance. Contrary to expectations, state disgust towards the body itself only decreased following exposure to neutral memories. Yet, disgust elicited by body-related memories decreased following both repeated exposure to neutral and body memories. Although acceptance was not found to significantly change in either exposure session, pre-post decreases in state disgust were associated with increases in acceptance following the disgust-focused exposure. In contrast to expectations, reactive avoidance increased from pre to post in the disgust-focused exposure. Overall, the results indicate that repeated exposure to disgust-focused body memories may help reduce disgust elicited by these memories and promote body acceptance. Yet, the effect of this repeated exposure to body memories did not extend to changing state disgust towards the body, possibly due to reactive avoidance.

Negative body image and avoidant retrieval of body-related autobiographical memories

People with a negative body image may be more likely to recall negative memories of their body, but also be motivated to avoid retrieving specific memories to prevent triggering aversive emotions (e.g., disgust). Such inclination to retain at a global level of memory recall may hamper the correction of their negative body image. In previous research using Autobiographical Memory Tests (AMTs) with minimal instructions, we failed to find an overgeneral memory bias specific to individuals with a negative body image but observed low specificity overall in response to body cue words. In the present study (N = 153), we included the traditional AMT next to a minimal instructions AMT and explored the idea that sensory reliving may be relevant to avoidance by assessing sensory reliving ratings next to memory specificity. A negative body image was associated with more negative body memories. In both AMTs, the findings failed to support our prediction that a more negative body image would be associated with lower specificity or sensory reliving. The findings are consistent with the view that autobiographical memories might be an important factor in defining one's body image, yet cast doubt on the relevance of avoidant retrieval of body-related memories in non-clinical samples.

Cognitive-affective reactions to a non-judgmental and judgmental mirror gazing task in individuals with body dysmorphic concerns

BACKGROUND AND OBJECTIVES

The look into the mirror represents a typical trigger situation for people with body dysmorphic concerns. Mirror exposure on the other hand is commonly used in the treatment of Body Dysmorphic Disorder even though little is known about its precise effects. This study aimed to investigate cognitive-affective processes related to mirror gazing.

METHODS

A total of 125 individuals (screening for body dysmorphic concerns: N_BDD+ = 56, negative N_BDD- = 69) participated in a laboratory study using a guided 10-min mirror gazing task. Participants were randomized to one of two experimental conditions, a non-judgmental and judgmental description of the own body during mirror gazing. Distress, self-hostile cognitions and post-event processing were assessed after the task and at follow-up.

RESULTS

Participants with body dysmorphic concerns showed higher values regarding subjective appearance distortion, stress induced by the exposure, distress, self-hostile cognitions and post-event processing compared to the symptom negative group. The two conditions did not yield differential effects.

LIMITATIONS

The short duration of the mirror gazing and the only internal description of the body may have contributed to a missing effect for the approach.

CONCLUSIONS

The results indicate the importance of cognitive and affective processes in reaction to mirror exposure. They support the cognitive model of BDD and suggest post-event processing as a relevant factor requiring further investigation in future research.

Acceptance and Compassion-Based Therapy Targeting Shame in Body Dysmorphic Disorder: A Multiple Baseline Study

Shame is considered central in body dysmorphic disorder (BDD) and empirical accounts highlight the link between shame and BDD symptoms as well as common negative psychosocial effects of the disorder, yet there is a lack of interventions addressing shame in this context. In the past decade, Acceptance and commitment therapy (ACT) and interventions that foster self-compassion have shown promise for reducing the negative effects of shame in a range of clinical problems. The aim of the present study was to develop and evaluate an acceptance and compassion-based treatment specifically targeting shame in BDD. Using a randomized nonconcurrent multiple baseline design, the 12-session intervention, ACT with Compassion (ACTwC), was examined in a psychiatric outpatient sample of five adults diagnosed with BDD. The daily ratings showed marked reductions in BDD-behaviors and self-criticism at posttreatment for four of five participants, while three participants demonstrated decreases in body shame compared to baseline. Improvements were maintained at 6-months follow-up. The intervention also led to reliable long-term improvements in general shame, overall BDD-symptoms, depressive symptoms, and quality of life for four of five participants. All treatment responders showed significant gains in psychological flexibility and self-compassion. Participants reported high credibility and satisfaction with the treatment. These preliminary results suggest that ACTwC may be a promising approach to treating shame in BDD, worthy of further investigation.

Self-disgust as a potential mechanism underlying the association between body image disturbance and suicidal thoughts and behaviours

This study examined whether self-disgust added incremental variance to and mediated the multivariate association between measures of body image disturbance and suicidal thoughts and behaviours. We hypothesized that self-disgust would be associated with suicidal ideation above the effects of body image disturbance, and that self-disgust would mediate the relationship between body image disturbance and suicidal ideation. A total of N=728 participants completed The Body Image Disturbance Questionnaire, The Self-Disgust Scale, and the Suicidal Behaviours Questionnaire-Revised. Suicidality was significantly related to increased levels of self-disgust and body image disturbance, whereas self-disgust was associated with greater body image disturbance. Linear regression analysis showed that self-disgust was associated with suicidal thoughts and behaviours, over and above the effects of body image disturbance. Multiple mediation modelling further showed that self-disgust mediated the relationship between body image disturbance and suicidal thoughts and behaviours. Our findings highlight the role of self-disgust in the context of body image disturbance and support the notion that body image disturbance is associated with aversive self-conscious emotions. Interventions aiming to reduce the risk of suicidality in people with body image disturbance may address self-disgust and negative self-conscious emotions.

Effects of Self-Esteem on Self-Viewing: An Eye-Tracking Investigation on Mirror Gazing

While some people enjoy looking at their faces in the mirror, others experience emotional distress. Despite these individual differences concerning self-viewing in the mirror, systematic investigations on this topic have not been conducted so far. The present eye-tracking study examined whether personality traits (self-esteem, narcissism propensity, self-disgust) are associated with gaze behavior (gaze duration, fixation count) during free mirror viewing of one's face. Sixty-eight adults (mean age = 23.5 years; 39 females, 29 males) viewed their faces in the mirror and watched a video of an unknown person matched for gender and age (control condition) for 90 s each. The computed regression analysis showed that higher self-esteem was associated with a shorter gaze duration for both self-face and other-face. This effect may reflect a less critical evaluation of the faces.

Escaping from revulsion - disgust and escape in response to body-relevant autobiographical memories

The term Repulsive Body Image (RBI) refers to a schematic construct combining body-directed self-disgust and other negative body image features, that is assumed to bias information processing, including autobiographical memory retrieval. When specific memories about the own body are retrieved, intense self-disgust may arise and trigger urges to escape from those memories. We asked 133 women with high (H_RBI; n = 63) and low (L_RBI; n = 70) levels of habitual body-directed self-disgust to recall autobiographical memories in response to 11 concrete body-related cue words in a minimal instructions Autobiographical Memory Test (AMT). Despite an overall low level of memory specificity, we found that RBI levels were associated with stronger disgust reactions and stronger motivations to escape from body-related memories. In addition, disgust reactions to body-related memories accounted for the association between habitual levels of self-disgust and urges to escape from these memories. Thus, the findings indicated that women with body image concerns showed disgust-based urges to escape from body-related memories. This disgust-based urge to avert from body-related autobiographical memories might counteract the correction of an RBI, thereby contributing to the persistence of body image concerns and associated psychopathology.

Self-disgust and urge to be thin in eating disorders: how can self-compassion help?

PURPOSE

This study aimed to examine the moderator role of self-compassion in the relationship between self-disgust and drive for thinness, controlling for external shame, in eating disorder patients and in a community sample.

METHODS

Sixty-two female participants with an eating disorder diagnose and 119 female participants from the community, were asked to fill instruments that assess self-disgust, self-compassion, drive for thinness, and external shame.

RESULTS

We found a moderator effect of self-compassion on the association between self-disgust and drive for thinness in the clinical sample when adjusting for shame. The association between self-disgust and drive for thinness was buffered among those who reported medium and lower levels of self-compassion. Replicating the findings in the community sample we found no moderator effect of self-compassion.

CONCLUSION

These results provide evidence that people with eating disorders who perceive the self as highly disgusting may benefit from promoting a self-compassionate response to diminish drive for thinness.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Body Image in Borderline Personality Disorder: A Systematic Review of the Emerging Empirical Literature

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.

The Role of Disgust in Eating Disorders

PURPOSE OF REVIEW

In current review, we evaluate the current literature examining the role of disgust in eating disorders (EDs), and provide a theoretical model designed to inform the study and treatment of disgust-based symptoms in EDs.

RECENT FINDINGS

Findings from this review suggest that aberrant disgust-conditioning processes represent promising but understudied mechanisms that may contribute to the risk and maintenance of core eating disorder (ED) psychopathology. In addition, preliminary evidence supports the use of interventions designed to target aversive disgust cues and disrupt maladaptive disgust-based conditioning that may maintain eating pathology. However, experimental studies designed to elucidate the role of disgust and aversive learning processes remain limited. Disgust is a promising risk and maintenance factor in EDs. Future systematic investigation is needed to examine disgust-based processes at a mechanistic level in order to better understand the links between disgust, avoidance behaviors, and EDs. Further investigation of the mechanistic role of disgust in EDs is warranted.

The Cash effect: Shaping the research conversation on body image and eating disorders

Cash and Deagle (1997) examined the associations between body image disturbance (BID) and the eating disorders (EDs) of anorexia nervosa (AN) and bulimia nervosa (BN) in a meta-analytic review. They found almost twice as many studies employing perceptual measures of body size evaluation compared to cognitive-evaluative measures of body dissatisfaction, even though effect sizes were larger for studies with cognitive-evaluative measurement. We examined 109 "influential" (i.e., well-cited) studies that cited the Cash and Deagle meta-analysis. We found a slight, continued emphasis on research using body size evaluation measures that implied a biological correlate for perceptual differences (especially for those with AN). We found proportionally more studies using cognitive-evaluative measures than was true in 1997, and more variability in the types of measures used. In these studies researchers emphasized the role of sociocultural factors in the link between BID and EDs. Theory and research that integrate a variety of factors to conceptualize the association between BID and EDs are still needed.

Thomas F. Cash: A multidimensional innovator in the measurement of body image; Some lessons learned and some lessons for the future of the field

Accurate measurement of constructs under investigation is an often-overlooked ingredient of research. However, sound use of strategies to ensure valid and reliable assessment is the building block for any research design, data analysis, and outcome interpretation. In this paper, we note how Thomas F. Cash has pioneered and steered this process in the field of body image for over 30 years-in fact, in the inaugural issue of Body Image, the first article after the editorial introduction focused on measurement (see Thompson, 2004). In the current paper, we detail some of the seminal measures developed by Thomas Cash as well as update the common errors in the (mis)measurement of body image noted in Thompson (2004). The future of body image assessment is bright if we focus on the illumination of past work by Thomas Cash.