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

Visual body size estimation in adolescent anorexia nervosa: Behavioural and neurophysiological data suggest intact visual perception and biased emotional attention

Body image disturbance is a key symptom of anorexia nervosa (AN). AN patients report body dissatisfaction and overestimate their own body size in several tasks. This study aimed to clarify whether this overestimation arises from deficits in visual perception. To this end, 36 adolescent restrictive-type AN patients and 42 matched healthy controls performed metric and depictive body size estimation (BSE) tasks. Magneto- and electroencephalography were measured during the size estimation of 66 computer-generated body pictures varying in size from underweight to overweight. AN patients versus controls showed overestimation across self-referential metric and depictive BSE tasks, but similar performance in a depictive BSE task without self-reference and similar early neurophysiological responses. Starting mid-latency (200 ms), AN patients showed relatively more neural activity in response to underweight body pictures and less neural activity in response to higher-weight body pictures in distributed brain regions. A secondary comparison of AN patients with slight vs. distinct overestimation during self-referential BSE uncovered relatively stronger neural responses to body pictures corresponding to the estimated body mass index. These results suggest that body image disturbances in adolescent restrictive-type AN patients depend on self-reference and do not represent a deficit of visual perception, but rather biased emotional attention.

Body image at the trunk: An investigation into externally referenced width perception and picture mapping

Body image is a conscious representation of the body, encompassing how our body feels to us. Body image can be measured in a variety of ways, including metric and depictive measures. This study sought to assess body image at the trunk by investigating, and comparing, a metric and depictive measure. Sixty-nine healthy participants estimated their thorax, waist, and hip width by externally referencing mechanical calipers. Participants were also asked to select the true image of their trunk from a random display of nine images containing the true image and incrementally shrunken or enlarged images. Participants demonstrated evidence of thorax and waist width overestimation in the width perception task, with no evidence for hip misestimation. For the picture mapping task, the majority of participants were inaccurate. In participants who were inaccurate, approximately equal proportions underestimated and overestimated their trunk width. The two tasks were found to be independent of each other. Distortions, or inaccuracies, were apparent in a metric measure, and inaccuracies also present in a depictive measure, of body image at the trunk for healthy participants. An overestimation bias was apparent in the metric, but not depictive, task. No relationship was found between tasks..

Representations of the relative proportions of body part width

Despite our wealth of experience with our bodies, our perceptions of our body size are far from veridical. For example, when estimating the relative proportions of their body part lengths, using the hand as a metric, individuals tend to exhibit systematic distortions which vary across body parts. Whilst extensive research with healthy populations has focused on perceptions of body part length, less is known about perceptions of the width of individual body parts and the various components comprising these representations. Across four experiments, representations of the relative proportions of body part width were investigated for both the self and other, and when using both the hand, or a hand-sized stick as the metric. Overall, we found distortions in the perceived width of body parts; however, different patterns of distortions were observed across all experiments. Moreover, the variability across experiments appears not to be moderated by the type of metric used or individuals' posture at the time of estimation. Consequently, findings suggest that, unlike perceptions of body part length, assessed using an identical methodology, our representations of the width of the body parts measured in this task are not fixed and vary across individuals and context. We propose that, as stored width representations of these parts are not necessarily required for navigating our environments, these may not be maintained by our perceptual systems, and thus variable task performance reflects the engagement of idiosyncratic guessing strategies.

Visual system structural and functional connections during face viewing in body dysmorphic disorder

Background

Individuals with body dysmorphic disorder (BDD) perceive distortions in their appearance, which could be due to imbalances in global and local visual processing. The vertical occipital fasciculus connects dorsal and ventral visual stream regions, integrating global and local information, yet the role of this structural connection in BDD has not been explored. Here, we investigated the vertical occipital fasciculus's white matter microstructure in those with BDD and healthy controls and tested associations with psychometric measures and effective connectivity while viewing their face during fMRI.

Methods

We analyzed diffusion MRI and fMRI data in 17 unmedicated adults with BDD and 21 healthy controls. For diffusion MRI, bundle-specific analysis was performed, enabling quantitative estimation of neurite density and orientation dispersion of the vertical occipital fasciculus. For task fMRI, participants naturalistically viewed photos of their own face, from which we computed effective connectivity from dorsal to ventral visual regions.

Results

In BDD, neurite density was negatively correlated with appearance dissatisfaction and negatively correlated with effective connectivity. Further, those with weaker effective connectivity while viewing their face had worse BDD symptoms and worse insight. In controls, no significant relationships were found between any of the measures. There were no significant group differences in neurite density or orientation dispersion.

Conclusion

Those with BDD with worse appearance dissatisfaction have a lower fraction of tissue having axons or dendrites along the vertical occipital fasciculus bundle, possibly reflecting impacting the degree of integration of global and local visual information between the dorsal and ventral visual streams. These results provide early insights into how the vertical occipital fasciculus's microstructure relates to the subjective experience of one's appearance, as well as the possibility of distinct functional-structural relationships in BDD.

The effect of an odd-one-out visual search task on attentional bias, body size adaptation, and body dissatisfaction

Body image disturbance is a both a risk factor for, and a symptom of, many eating disorders and refers to the misperception of and dissatisfaction with one's own body. Women with high body dissatisfaction have been shown to direct more attention to low body mass index (BMI) bodies, which results in the overestimation of body size via body size adaptation. Therefore, attention may have a causal role in body image disturbance. We conducted a novel training visual search task with 142 young adult women who we trained to attend to either high or low BMI bodies. We assessed the effects of this training on attention to bodies of different sizes, body size adaptation, and body dissatisfaction. Women trained to attend to low BMI bodies decreased their perceptions of a 'normal' body size via adaptation from pre- to post-training (p < 0.001); however, women trained to attend to high BMI bodies showed no change in their perception of a 'normal' body size. We found no lasting effects of the training on attention to body size or body dissatisfaction; however, our visual search task showed poor internal consistency as a measure of attention. These findings indicate that attention to low BMI bodies may exacerbate body image disturbance in women. However, more reliable measures of attentional are required to confirm this finding.

Embodiment of underweight and normal-weight avatars affects bodily self-representations in anorexia nervosa

Body image distortion (BID) is a crucial aspect of anorexia nervosa (AN), leading to body overestimation, dissatisfaction, and low self-esteem. BID significantly influences the onset, maintenance, and relapse of the pathology. We assessed whether a Full Body Illusion (FBI) using under and normal-weight avatars' bodies affects perceptual body image and body schema estimations in both individuals with anorexia nervosa (AN) and healthy controls (HC). After each embodiment procedure, we asked participants to estimate the width of their hips (Perceptual Body Image Task) and the minimum aperture width of a virtual door necessary to pass through it (Body Schema Task). Additionally, we asked participants to rate the avatars in terms of self-similarity, attractiveness, and implicit disgust (i.e., pleasant/unpleasant body odour). Whereas participants with AN (N = 26) showed changes in body schema estimations after embodying the normal-weight avatar, no changes were found in HC (N = 25), highlighting increased bodily self-plasticity in AN. Notably, individuals with AN rated the normal weight avatar as the most similar to their real body, which was also considered the least attractive and the most repulsive. These ratings correlated with BID severity. Furthermore, at the explicit level, all participants reported feeling thinner than usual after embodying the underweight avatar. Overall, our findings suggest that BID in AN engages multiple sensory channels (from visual to olfactory) and components (from perceptual to affective), offering potential targets for innovative non-invasive treatments aimed at modifying flexible aspects of body representation.

The body interior in anorexia nervosa: from interoception to conceptual representation of body interior

Background

Body image disorders are well documented in anorexia nervosa (AN); however, knowledge of interoceptive awareness (IA) in this population remains poor. This descriptive study investigated whether and how the representation of the interior of the body may have an impact on IA.

Methods

The representations and knowledge of the body interior were evaluated with a drawing task in 34 women with AN and 34 healthy controls (HCs). A lexicometric analysis was performed on the vocabulary used to describe the drawn body parts in a structured interview. It was assumed that the conceptual representation of the body interior could be affected by or influence IA. Thus, the relationship between IA, measured with the heartbeat task and the ischemia-induction test, and the drawings was explored. Other scales, such as those of body shape, awareness or satisfaction, were used to assess affective representations of the body.

Results

The drawing, lexicometric and IA results were similar in the two groups. No correlations were found among IA, body representation scores and representation level of body interior. Only the representation of bones by the AN group was significantly different.

Discussion

Increased visual attention to the skeleton or greater awareness of bone health could explain the stronger representation of bones in the AN group. The psychophysical therapy received by some AN participants (73%) did not seem to have influenced IA. Our results do not support a relationship between IA and the representation of the body interior.Clinical trial registration:https://clinicaltrials.gov/, identifier NCT03988218.

Testing the validity of online psychophysical measurement of body image perception

This body image study tests the viability of transferring a complex psychophysical paradigm from a controlled in-person laboratory task to an online environment. 172 female participants made online judgements about their own body size when viewing images of computer-generated female bodies presented in either in front-view or at 45-degrees in a method of adjustment (MOA) paradigm. The results of these judgements were then compared to the results of two laboratory-based studies (with 96 and 40 female participants respectively) to establish three key findings. Firstly, the results show that the accuracy of online and in-lab estimates of body size are comparable, secondly that the same patterns of visual biases in judgements are shown both in-lab and online, and thirdly online data shows the same view-orientation advantage in accuracy in body size judgements as the laboratory studies. Thus, this study suggests that that online sampling potentially represents a rapid and accurate way of collecting reliable complex behavioural and perceptual data from a more diverse range of participants than is normally sampled in laboratory-based studies. It also offers the potential for designing stratified sampling strategies to construct a truly representative sample of a target population.

The impact of weight and negative body image on the body schema in undergraduate women

BACKGROUND AND OBJECTIVES

Alterations of the sensory-motor body schema question the origins of such distortions. For example, in anorexia nervosa where patients think they are broader than they really are (body image) but act as if it was really the case (body schema). To date, the results of studies about what hinders the updating of the body schema so much (weight, body image) have been contradictory.

METHODS

We therefore conducted two studies that aimed to assess the impact of weight and body image problems on body schema in 92 young women without anorexia nervosa. For this purpose, we used a new body schema assessment tool (SKIN) that is sensitive enough to detect fine alterations of body schema in seven different body parts.

RESULTS

In Study 1, the thinness or overweight of the young women had a major impact on their tactile perception, especially because the assessed body part was a sensitive area for body dissatisfaction in young women (e.g., belly, thigh). In Study 2, the level of body dissatisfaction of the participants in its attitudinal and perceptual dimension also had a negative impact on their body schema, again in interaction with weight and body part.

CONCLUSIONS

These results imply that body dissatisfaction and thinness are predictors of massive body schema distortions. An oversized body schema could maintain various weight-control behaviors, thus risking the development, maintenance, or relapse of an eating disorder.

Corpus callosum morphology and relationships to illness phenotypes in individuals with anorexia nervosa

Anorexia nervosa is an often-severe psychiatric illness characterized by significantly low body weight, fear of gaining weight, and distorted body image. Multiple neuroimaging studies have shown abnormalities in cortical morphology, mostly associated with the starvation state. Investigations of white matter, while more limited in number, have suggested global and regional volume reductions, as well as abnormal diffusivity in multiple regions including the corpus callosum. Yet, no study has specifically examined thickness of the corpus callosum, a large white matter tract instrumental in the inter-hemispheric integration of sensory, motor, and cognitive information. We analyzed MRI data from 48 adolescents and adults with anorexia nervosa and 50 healthy controls, all girls/women, to compare corpus callosum thickness and examined relationships with body mass index (BMI), illness duration, and eating disorder symptoms (controlling for BMI). There were no significant group differences in corpus callosum thickness. In the anorexia nervosa group, severity of body shape concerns was significantly, positively correlated with callosal thickness in the rostrum, genu, rostral body, isthmus, and splenium. In addition, there were significant positive correlations between eating disorder-related obsessions and compulsions and thickness of the anterior midbody, rostral body, and splenium. There were no significant associations between callosal thickness and BMI or illness duration. In sum, those with AN with worse concerns about bodily appearance and worse eating disorder-related obsessive thought patterns and compulsive behaviours have regionally thicker corpus callosum, independent of current weight status. These findings provide important neurobiological links to key, specific eating disorder behavioural phenotypes.

Perceptual Dysfunction in Eating Disorders

Eating disorders (EDs) are characterized by abnormal responses to food and weight-related stimuli and are associated with significant distress, impairment, and poor outcomes. Because many of the cardinal symptoms of EDs involve disturbances in perception of one's body or abnormal affective or cognitive reactions to food intake and how that affects one's size, there has been longstanding interest in characterizing alterations in sensory perception among differing ED diagnostic groups. Within the current review, we aimed to critically assess the existing research on exteroceptive and interoceptive perception and how sensory perception may influence ED behavior. Overall, existing research is most consistent regarding alterations in taste, visual, tactile, and gastric-specific interoceptive processing in EDs, with emerging work indicating elevated respiratory and cardiovascular sensitivity. However, this work is far from conclusive, with most studies unable to speak to the precise etiology of observed perceptual differences in these domains and disentangle these effects from affective and cognitive processes observed within EDs. Further, existing knowledge regarding perceptual disturbances in EDs is limited by heterogeneity in methodology, lack of multimodal assessment protocols, and inconsistent attention to different ED diagnoses. We propose several new avenues for improving neurobiology-informed research on sensory processing to generate actionable knowledge that can inform the development of innovative interventions for these serious disorders.

The Body Image Virtual Reality Assessment (BIVRA): Measuring the body representation through virtual reality

Our physical and psychological well-being is significantly influenced by how we perceive our body, in addition to our thoughts and emotions associated with it. Dysfunctional body perceptions and attitudes play a key role in the development and maintenance of severe conditions such as eating disorders in both males and females. Given its relevance, some attempts have been made to improve body image assessment methods in terms of perceptual accuracy and body satisfaction taking advantage of technological advances such as virtual reality. However, existing applications have mainly focused on women and clinical conditions. In this study, we presented the Body Image Virtual Reality Assessment (BIVRA), a virtual reality figure rating scale to assess body image in both male and female subjects. We tested BIVRA's ability to measure perceptual accuracy and compared its results with a standardized body satisfaction questionnaire. Additionally, we investigated gender differences. BIVRA was found to be effective in assessing body image. We observed that a perceptually based task successfully captured both low and high levels of body representations, shedding light on the significant gender differences. The association between BIVRA and the body satisfaction questionnaires was moderated by gender, with a stronger association for women. While further validation of BIVRA is needed to fully exploit its potential, our results suggest that the integration of virtual reality into the assessment of body image and related disorders may significantly enhance our understanding of individuals struggling with body image issues and has the potential to advance current methods and techniques.

Understanding and treating body image disturbances in eating disorders through body illusion interventions: a scoping review protocol

BACKGROUND

We plan a scoping review aimed to synthesize what is known about the use of sensory-driven body illusion (BI) interventions for understanding and treating body image disturbance (BID) in people diagnosed with clinical eating disorders (EDs) and people with subclinical ED symptomatology. Our study will provide an outline of the current literature, identify gaps within the literature, and suggest novel directions for future research.

METHODS/DESIGN

The scoping review process will be guided by the methodological framework of Arksey and O'Malley, subsequent recommendations by Levac et al., and the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols Extension for Scoping Reviews guidelines. The following electronic databases will be systematically searched: MEDLINE (via PubMed), Web of Science, PsycINFO, and Scopus. Furthermore, to identify additional studies, we will use a search engine such as Google Scholar, and for grey literature, we will include Proquest for Dissertations and Theses. A search strategy has been identified and agreed upon by the research team in conjunction with a research librarian. Two researchers will screen the titles and abstracts independently and then assess the full text of the selected citations for the inclusion criteria. A third reviewer will be involved in cases of disagreement. Data will be extracted, collated, and charted to summarize all the relevant methods, outcomes, and key findings in the articles.

DISCUSSION

A better understanding of this topic will aid in the development and refinement of current treatments aimed at treating BID in people with EDs. Implications and recommendations for research, policy, and practice in the context of the ED community will be discussed.

SYSTEMATIC REVIEW REGISTRATION

https://osf.io/3bcm6/?view_only=83b2e8a2445d4266909992e3dfb51929.

Accuracy of estimating self and other body size among adolescent girls with anorexia nervosa

This study aimed to analyze body size estimates of others by patients with anorexia nervosa (AN) and to identify any differences with the perception of their own body size. Adolescent females (age, 13-17 years) were enrolled into AN (n = 30) and control(n = 23) groups. The Subjective Body Dimensions Apparatus (SBDA) was used to evaluate body size estimates for oneself (self-estimation) and others (other-estimation). Participants also completed questionnaires assessing eating disorders and depressive symptoms. The AN and control groups scored significantly higher in self-estimation than in other-estimation. However, the AN group showed higher self-estimation scores than the control group for all the body parts and for the global silhouette (p < .001). Patients with more severe eating disorder symptomatology showed more distorted self-estimation (p < .05). No statistically significant differences were found in the other-estimation scores between the groups (p = .714), indicating that AN and control patients estimate the body sizes of others similarly. Eating disorder symptomatology correlates with self-estimation scores but not with other-estimation scores in adolescents with AN. No correlations existed between clinical symptomatology and other-estimation.

Development of implicit and explicit attentional modulation of the processing of social cues conveyed by faces and bodies in children and adolescents

Emotions and sex of other people shape the way we interact in social environments. The influence of these dimensions on cognitive processing is recognized as a highly conditional phenomenon. While much of researches on the topic focused on adults, less evidence is available for the pediatric population. This study aimed at examining the development of the modulation of attention control on emotion and sex processing using facial and body expressions in children and adolescents (8–16 years old). In Experiment 1a, participants performed a Flanker task (probing space-based attention) in which they had to indicate either the emotion (happy/fearful) or the sex of the target stimulus while ignoring the distracting stimuli at the side. We found evidence for intrusion of the sex, but not emotion, of the stimuli during both sex and emotion recognition tasks, thus both at an explicit (i.e., task relevant) and implicit (i.e., task irrelevant) level. A control experiment consisting of an emotional Flanker task confirmed that, in contrast with previous findings in adults, emotion did not modulate attention control in children and adolescents even when task relevant (Experiment 1b). In Experiment 2 participants performed a same-or-different judgment task (probing feature-based attention) in which they indicated whether the central stimulus matched the lateral ones for emotion or sex. Results showed that emotional features exerted an implicit influence during sex judgements; likewise, sex features intruded on the processing of both faces and bodies during emotion judgments. Finally, Experiment 3 explored the development of the explicit attention modulation exerted by the sex dimension on the processing of faces and bodies. To this aim, participants performed a Flanker task in which they were asked to recognize the sex of faces and bodies. The results indicated that, while younger participants showed a task-relevant influence of sexual features when processing faces, older participants showed such influence when processing bodies. These findings point to a greater attentional modulation exerted by sex, as compared to emotion, during social processing in children and adolescents and suggest a developmental trend of the saliency of facial and bodily cues for the perception of others’ sex.

Exploring the thalamus: a crucial hub for brain function and communication in patients with bulimia nervosa

BACKGROUND

Bulimia nervosa (BN) is an eating disorder characterized by recurrent binge eating and compensatory behaviors. The thalamus plays a crucial role in the neural circuitry related to eating behavior and needs to be further explored in BN.

METHODS

In this study, 49 BN patients and 44 healthy controls (HCs) were recruited. We applied the fractional amplitude of low-frequency fluctuation to investigate regional brain activity in the thalamus and functional connectivity (FC) to examine the synchronization of activity between thalamic subregions and other brain regions in both groups. All results underwent false discovery rate (p < 0.05, FDR correction) correction. Pearson correlation analysis was performed to assess the relationship between the patients' abnormal clinical performance and the thalamic alterations (p < 0.05, FDR correction).

RESULTS

We found no significant differences in neural activity between BN patients and HCs in the sixteen thalamic subregions. However, compared to the HCs, the individuals with BN showed decreased FC between the thalamic subregions and several regions, including the bilateral prefrontal cortex, right inferior parietal lobule, right supplementary motor area, right insula, cingulate gyrus and vermis. Additionally, BN patients showed increased FC between the thalamic subregions and visual association regions, primary sensorimotor cortex, and left cerebellum. These altered FC patterns in the thalamus were found to be correlated with clinical variables (the frequency of binge eating/purging per week and external eating behavior scale scores) in the BN group. All results have passed FDR correction.

CONCLUSIONS

Our study provides evidence that there is disrupted FC between thalamic subregions and other brain regions in BN patients during resting state. These regions are primarily located within the frontoparietal network, default mode network, somatosensory, and visual network. These findings elucidate the neural activity characteristics underlying BN and suggest that thalamic subregions have potential as targets for future neuromodulation interventions.

Measuring implicit associations between food and body stimuli in anorexia nervosa: a Go/No-Go Association Task

PURPOSE

The present study aimed to explore the implicit associations between food and bodily stimuli in patients with anorexia nervosa (AN) and control subjects (HC).

METHODS

A Go/No-Go Association Task was administrated to 55 participants (28 AN and 27 HC), using food stimuli (low-calorie food vs. high-calorie food) and body stimuli (underweight vs. overweight bodies).

RESULTS

We evidenced an implicit association between food and body stimuli in the AN group, whereas the HC group only showed a tendency. AN and HC groups also exhibited different categorization strategies: the AN group tended to categorize stimuli as low-calorie foods and underweight bodies less than the HC group, and they tended to categorize stimuli as high-calorie foods and overweight bodies more than the HC group.

CONCLUSION

The present study revealed for the first time specificities of the AN population's implicit association between food and body stimuli in terms of association strength and categorization strategy. Furthermore, the results suggest that combining implicit methodologies with other methods could contribute to a better characterization of the physiopathology of AN.

LEVEL OF EVIDENCE

Level I, experimental study.

Testing visual self-misperception in anorexia nervosa using a symmetrical body size estimation paradigm

OBJECTIVE

Individuals diagnosed with anorexia nervosa (AN) often report seeing themselves as overweight. While body size estimation tasks suggest that such individuals overestimate their body size, these tasks have failed to establish whether this misestimation stems from visual misperception. Misestimation might, instead, be due to response bias. We designed a paradigm to distinguish between visual and response bias contributions to body size misestimation: the symmetrical body size estimation (s-BSE) paradigm.

METHOD

The s-BSE paradigm involves two tasks. In the conventional task, participants estimate the width of their photographed body by adjusting the size of a rectangle to match. In the transposed task, participants adjust the size of a photograph of their body to match the rectangle. If overestimation stems exclusively from visual misperception, then errors in each task would be equal and opposite. Using this paradigm, we compared the performance of women diagnosed with AN (n = 14) against women without any eating disorder (n = 40).

RESULTS

In the conventional task, we replicated previous findings indicating that both women with AN and women without any eating disorder overestimate their body size. In the transposed task, neither group adjusted the bodies to be narrower than the rectangle. Participants with AN set their photographs to be significantly wider.

DISCUSSION

While we replicated previous findings of body size overestimation amongst women with AN and those without any eating disorder, our results are inconsistent with the hypothesis that such overestimation stems exclusively from visual misperception and instead suggest a substantial response bias effect.

PUBLIC SIGNIFICANCE

Women with anorexia nervosa overestimate their own body size. Research has not yet determined whether this overestimation stems from them seeing themselves as larger or other, non-visual factors. We employ a new method for distinguishing these possibilities and find that non-visual factors influence size estimates for women with and without anorexia nervosa. This method can help future research control for non-perceptual influences on participant responses.

The impact of floatation therapy on body image and anxiety in anorexia nervosa: a randomised clinical efficacy trial

Background

Body image disturbance and anxiety are core features of anorexia nervosa (AN), a psychiatric disorder with one of the highest mortality rates. This study examined the efficacy of a novel non-pharmacological treatment, floatation-REST (Reduced Environmental Stimulation Therapy) on body image disturbance and anxiety in inpatients with AN.

Methods

This parallel group randomised controlled trial compared floatation-REST vs. care as usual in women and girls hospitalised for treatment of AN in Tulsa, Oklahoma, USA. Participants were randomised on a 2:1 ratio to receive eight, twice-weekly, 60-min floatation-REST sessions for 4 weeks, in addition to care as usual, or to receive care as usual. The primary outcome was the average change in body dissatisfaction from pre- to post-float as measured by the Photographic Figure Rating Scale. The secondary outcome was the average change in anxiety from pre- to post-float as measured by the state version of the State Trait Anxiety Inventory. Longitudinal effects of floatation-REST on body dissatisfaction were also examined. All analyses were conducted using the intention-to-treat principle. Planned linear mixed models tested the effect of floatation-REST vs. care as usual. The trial was preregistered (clinicaltrials.govNCT03610451).

Findings

Between March 16, 2018 and February 25, 2021, 133 participants were screened for eligibility, and 86 were consented. Eighteen were excluded after consent, for a final randomisation sample of 68 participants (45 floatation-REST; 23 care as usual). There were two session by condition interactions on body dissatisfaction (p = 0.00026) and state anxiety (p < 0.0001), such that the floatation-REST group exhibited acute (i.e., pre- to post-session) reductions in body dissatisfaction (floatation-REST group mean change (Δm) = -0.43; 95% CI -0.56 to -0.30, p < 0.0001, Cohen's d = 0.23), and acute reductions in anxiety (floatation-REST group Δm = -15.75; 95% CI -17.95 to -13.56, p < 0.0001, Cohen's d = 1.52); however, the care as usual group exhibited no significant changes. With regard to longitudinal results, there was a significant time by treatment interaction between baseline and immediately post intervention (p = 0.012) and baseline and six-month follow up (p = 0.0019). At immediately post intervention, there was a trending reduction in body dissatisfaction for the floatation-REST group (Δm = -0.41, 95% CI -0.86 to 0.03, p = 0.068) and care as usual group (Δm = 0.61; 95% CI -0.04 to 1.27, p = 0.070). At six-months post-intervention, the floatation-REST group exhibited lower body dissatisfaction (Δm = -0.91; 95% CI -1.37 to -0.45, p = 0.0020, Cohen's d = 0.53) whereas the care as usual group reported no change in body dissatisfaction (Δm = 0.35; 95% CI -0.28 to 0.98, p = 0.96) relative to baseline. There were no adverse events related to the trial during the study.

Interpretation

Our findings suggest that Floatation-REST decreased body dissatisfaction compared to care as usual acutely after each float session and at six-month follow-up. Floatation-REST has potential utility for the treatment of body image disturbance and anxiety in AN. These results may be limited by some generalisability concerns given the recruitment of a modest sample receiving inpatient treatment at a single site.

Funding

The William K. Warren Foundation.

Virtual reality in managing Complex Regional Pain Syndrome (CRPS): a scoping review

Background

Complex Regional Pain Syndrome (CRPS) is a severe pain disorder that does not yet have a specific treatment. Patients with CRPS not only suffer from a wide range of symptoms that affect their quality of life but also present psychological affections to the way they see their body and specifically their affected limb. Virtual Reality (VR) modalities have become a targeted treatment for chronic pain and in the case of CRPS, may be a valuable approach to the mechanisms that affect these patients.

Objectives

Using the PRISMA Scoping Review guidelines, we intend to uncover the key information from the studies available about VR modalities in the treatment of CRPS. We focus on the improvement of pain levels, body perception disturbances (BPD), and limb movement/daily function.

Results

Our search strategy resulted in 217 articles from PubMed. Twenty were assessed for eligibility and seven were included in the final qualitative synthesis. Of these seven articles, we included a clinical trial, three pilot studies, a blinded randomized controlled trial, a crossover double-blind trial, and a randomized controlled trial. These studies provide important subjective patient findings, along with some statistically significant results in the experiences of VR therapies modulating pain, BPD, and improving limb movement/daily function. However, not all the studies included statistical analysis, and there are contradicting data found from some patients that did not perceive any improvement from VR therapies.

Conclusions

We describe the results found in 7 articles that focus on the treatment of CRPS with VR modalities. Overall, the articles have various limitations, but the strategies related to immersive virtual reality, cardiac signaling, body switching and limb modulation have shown the most promising results for pain reduction and BPD improvement. These strategies reflect on pathophysiological mechanisms that are hypothesized to be affected in CRPS patients leading to the chronic pain and BPD that they experience. Not much evidence was found for improvement in limb movement and daily function. This review is a pathway for future studies on this topic and a more extensive data synthesis when more information is available.

Relating different Dimensions of Bodily Experiences: Review and proposition of an integrative model relying on phenomenology, predictive brain and neuroscience of the self

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.

The flubbed body: Pathological body size representation in personal neglect

Personal Neglect (PN) is a disorder in which patients fail to attend or explore the contralateral side of their body. An increasing number of studies have considered PN as a form of body representation disorder frequently observed following damage to parietal areas. The extent and the direction of the body misrepresentation is still unclear with recent studies suggesting a general reduction of contralesional hand size. However, little is known about the specificity of this representation and whether the misrepresentation also generalises to other body parts. We explored the features of the representation of the hands and face in a group of 9 right brain damaged patients with (PN+) and without PN (PN-), when compared to a healthy control group. For this, we used a body size estimation task with pictures, in which patients were required to choose the one that most closely matched the perceived size of their body part. We found that PN + patients showed a labile body representation for both hands and face, having a larger distorted representational range. Interestingly, in comparison with PN + patients and healthy controls, PN- patients also showed misrepresentation of the left contralesional hand which could be related to impaired motor performance of their upper limb. Our findings are discussed within a theoretical framework suggesting a reliance on multisensory integration (body representation, ownership, and motor influences) for an ordered representation of the size of the body.

Exploring multisensory integration of non-naturalistic sounds on body perception in young females with eating disorders symptomatology: a study protocol

BACKGROUND

Bodily illusions can be used to investigate the experience of being in a body by manipulating the underlying processes of multisensory integration. Research suggests that people with eating disorders (EDs) may have impairments in visual, interoceptive, proprioceptive, and tactile bodily perception. Furthermore, people with EDs also show abnormalities in integrating multisensory visuo-tactile and visual-auditory signals related to the body, which may contribute to the development of body image disturbances. Visuo-auditory integration abnormalities have been observed also in people with subthreshold ED symptomatology. However, it remains unclear whether these impairments are specific to bodily signals or if they extend to any auditory signals.

METHODS

We will recruit 50 participants (aged 18-24; females assigned at birth) with ED symptomatology (subthreshold group) and 50 control participants. The Eating Disorder Examination Questionnaire will be administered to screen for ED symptomatology and divide the sample into two groups accordingly (control and subthreshold group using a clinical cut-off score of 2.8). The strength of both illusions will be measured implicitly with estimations of body part position and size, and explicitly with self-report questionnaires. As a secondary aim, regression analysis will be run to test the predictive role of susceptibility for both illusions on interoceptive body awareness (measured by the Multidimensional Assessment of Interoceptive Awareness Scale) and sensory-processing sensitivity (measured by the Highly Sensitive Person Scale).

DISCUSSION

Our study may contribute to our understanding of the mechanisms underlying body image disturbances. The results may pave the way for novel clinical interventions targeting early symptoms prior to the development of the disorder in young females.

Beyond body image: what body schema and motor imagery can tell us about the way patients with anorexia nervosa experience their body

AIM

Recent evidence suggests that the body image disturbance often observed in patients with anorexia nervosa also extends to the body schema. According to the embodiment approach, the body schema is not only involved in motor execution, but also in tasks that only require a mental simulation of a movement such as motor imagery, mental rotation of bodies, and visuospatial perspective-taking. The aim of the present study was to assess the ability of patients with anorexia to mentally simulate movements.

METHODS

The sample included 52 patients with acute anorexia and 62 healthy controls. All participants completed three tests of explicit motor imagery, a mental rotation test and a test of visuospatial perspective-taking.

RESULTS

Patients with anorexia nervosa, with respect to controls, reported greater difficulties in imagining movements according to a first-person perspective, lower accuracy in motor imagery, selective impairment in the mental rotation of human figures, and reduced ability in assuming a different egocentric visuospatial perspective.

CONCLUSION

These results are indicative of a specific alteration in motor imagery in patients with anorexia nervosa. Interestingly, patients' difficulties appear to be limited to those tasks which specifically rely on the body schema, while patients and controls performed similarly in the 3D objects mental rotation task.

The Somatomorphic Matrix-Female: More evidence for the validity of bidimensional figural rating scales for women

Our study aimed to develop and provide a preliminary psychometric validation of the Somatomorphic Matrix-Female (SM-F), a new bidimensional female figural rating scale which can be used to gauge actual and desired levels of both body fat and muscularity in a consolidated measure, as well as providing an index of actual-desired body discrepancy based on these measures. Across two studies undergraduate women (n Study 1 = 481; n Study 2 = 391) completed the Eating Disorder Examination-Questionnaire, the Body Shape Questionnaire-34, and the Depression Anxiety Stress Scales-21 (Study 1) and the Drive for Thinness Scale and the Drive for Muscularity Scale (Study 2), as well as the SM-F. Overall, the SM-F demonstrated sound content, concurrent, and convergent validity for actual and desired body fat, actual and desired muscularity, and their respective discrepancy scores.

Sizing up the crowd: Assessing spatial integration difficulties in body size judgements across eating disorder symptomatology

Introduction

Body size judgements are frequently biased, or inaccurate, and these errors are further exaggerated for individuals with eating disorders. Within the eating disorder literature, it has been suggested that exaggerated errors in body size judgements are due to difficulties with integration. Across two experiments, we developed a novel integration task, named the Ebbinghaus Illusion for Bodies in Virtual Reality (VR), to assess whether nearby bodies influence the perceived size of a single body. VR was used to simulate the appearance of a small crowd around a central target body.

Method and Results

In Experiment 1 (N = 412), participants were required to judge the size of a central female target within a crowd. Experiment 1 revealed an Ebbinghaus Illusion, in which a central female appeared larger when surrounded by small distractors, but comparatively smaller when surrounded by large distractors. In other words, the findings of Experiment 1 demonstrate that surrounding crowd information is integrated when judging an individual's body size; a novel measure of spatial integration (i.e., an Ebbinghaus Illusion for Bodies in VR). In Experiment 2 (N = 96), female participants were selected based on high (n = 43) and low (n = 53) eating disorder symptomatology. We examined whether the magnitude of this illusion would differ amongst those with elevated versus low eating disorder symptomatology, in accordance with weak central coherence theory, with the high symptomatology group displaying less spatial integration relative to the low group. The results of Experiment 2 similarly found an Ebbinghaus Illusion for Bodies in VR. However, illusion magnitude did not vary across high and low symptomatology groups.

Discussion

Overall, these findings demonstrate that surrounding crowd information is integrated when judging individual body size; however, those with elevated eating disorder symptomatology did not show any integration deficit on this broader measure of spatial integration.

Psychometric properties of the Italian body shape questionnaire: an investigation of its reliability, factorial, concurrent, and criterion validity

PURPOSE

This study was set up to investigate the reliability, factorial, concurrent, and criterion validity of the Italian version of the 34-item Body Shape Questionnaire (BSQ) and its shorter versions.

METHODS

The study included 231 patients diagnosed with an eating disorder and 58 putatively healthy people (comparison sample). The Italian BSQ-34 was administered to participants together with the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale. Information on body mass index, caloric intake at baseline, and the number of episodes of self-vomiting per week was also acquired.

RESULTS

Cronbach's alpha of BSQ-34 was 0.971 (95% confidence interval [CI] 0.965-0.976) in patients and 0.960 (0.944-0.974) in controls. Test-retest stability in patients (n = 69), measured with intraclass correlation coefficient, was 0.987 (0.983-0.991). Confirmatory factor analysis of the single-factor model yielded acceptable fit for all versions of the BSQ. On all BSQ versions, patients scored higher than controls with a large effect size when calculated as Cliff's delta. BMI and mean caloric intake at baseline had a stronger association with BSQ-34 than levels of anxiety and depression. The analysis with the receiver operating characteristics (ROC) curve showed that the BSQ-34 distinguished patients with an eating disorder from controls with good accuracy (Area Under the Curve = 86.5; 95% CI 82.2-90.7).

CONCLUSION

The Italian version of the BSQ possesses good psychometric properties, in both the long and the shortened versions, and it can be applied to measure body dissatisfaction for both clinical and research purposes.

LEVEL OF EVIDENCE

Level III, Evidence obtained from well-designed cohort or case-control analytic studies.

Body image distortion among Brazilian and Portuguese women with children: A comparative study between the ELSA-Brasil and Generation XXI cohorts

Solid evidence indicates that body image distortion is associated with various physical and mental health problems in women (e.g. Lee and Lee, 2016; Mölbert et al., 2017; Raj and Ploriya, 2020; Sagar, 2005; Shin et al., 2015). Furthermore, body image has been shown to vary according to life context and stage, particularly after a woman has had children. This scenario justifies the comparison between different countries and cultures. The objective of the present study was to evaluate the prevalence and associated factors of body image distortion/accuracy in Brazilian and Portuguese women with children. The study assessed women selected from two epidemiological cohorts: ELSA-Brasil in Brazil (n = 1468) and Generation XXI in Portugal (n = 3380). The data analyzed were based on multidimensional questionnaires from which sociodemographic and family characteristics as well as data associated with lifestyle and health were obtained. The results show that most women in both cohorts had an accurate perception of their own body size. In cases of distorted self-perception, the likelihood of the Brazilian women perceiving themselves as being heavier was greater if they had had cancer, whereas the Portuguese women were less likely to perceive themselves as heavier when they had less schooling. Perceiving themselves as thinner than they actually are, was associated with poorer self-perception of their own state of health in the Brazilian women and with poorer schooling in both the Brazilian and Portuguese women. The present findings contribute towards improving understanding of the influence of body image distortion on the health and wellbeing of Brazilian and Portuguese women, possibly leading to the implementation of health-promoting policies in both countries.

Die Spiegelkonfrontationstherapie zur Behandlung von Körperbildstörungen bei Essstörungen – Evidenz, Wirkmechanismen und Vorgehensweise

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.

Relationships between paranoia and body image concern among community women

Previous research has indicated that lifetime body image concerns are associated with increased odds of paranoid ideation. In this study, we sought to replicate and extend this finding by exploring how paranoia relates to different aspects of body image concern using a comprehensive, cross-sectional design. Women without a mental health diagnosis (n = 119) completed online questionnaires assessing paranoia, shape and weight concerns, and figure ratings for how they "think" their body looks and how they "feel" in their body. Participant's "actual" figure ratings were estimated from height and weight; discrepancy scores were then calculated for "actual-think" and "actual-feel" figure ratings. Correlational analyses, and mediation models testing paranoia as a mediator between "actual-feel" and shape and weight concerns, were conducted. Paranoia was significantly correlated with increased shape and weight concerns, and with "feeling" larger. Paranoia significantly mediated paths from feeling larger to increased shape or weight concerns. There were no significant associations of paranoia with "actual-think" ratings. Limitations include that height and weight data could not be objectively confirmed, and only women were included in the study. Further research is needed to understand mechanisms by which paranoia may influence shape and weight concerns and vice versa, and how "feeling" larger may feed paranoia. Future research should investigate these relationships among clinical eating disorder groups.

What happens in the course of positive mirror exposure? Effects on eating pathology, body satisfaction, affect, and subjective physiological arousal in patients with anorexia and bulimia nervosa

OBJECTIVE

Mirror exposure (ME) is a therapeutic technique to improve body image disturbance. However, evidence on the effectiveness of different forms of ME in clinical populations is lacking. The present study therefore analysed effects of ME on trait-like and state measures of body image in patients with anorexia nervosa (AN) and bulimia nervosa (BN).

METHOD

The present study therefore analysed effects of ME on trait-like and state measures of body image in patients with anorexia nervosa (AN) and bulimia nervosa (BN). In total, 47 inpatients underwent 3 ME sessions guided by a therapist, with instructions to exclusively verbalise positively about their whole body. Participants completed questionnaires on trait-like eating pathology and body image at the start and end of the study, and instruments on state affect and body satisfaction were administered directly before and after each ME session. Subjective physiological arousal and emotional valence relating to each body part were assessed within each session.

RESULTS

The results indicate significant improvements in eating pathology and body image regarding trait-like measures in patients with AN and BN. Concerning state measures, negative affect significantly decreased and body satisfaction increased during ME. Physiological arousal decreased and positively valenced emotions relating to the various body parts increased.

CONCLUSIONS

These findings suggest that positively verbalising about one's body during ME improves eating pathology, body image, affect, and subjective physiological arousal, and thus seems to be an effective form of ME.

Giving a Body a Different Face—How Men and Women Evaluate Their Own Body vs. That of Others

Eating disorders affect women more than men. Women reportedly dislike their body shape more and appreciate it less than do men. One factor influencing body image might be the application of different standards for oneself than for other people when evaluating bodies. To investigate this possibility, we determined whether the application of double standards is different between men and women. We presented 57 women and 54 men (aged 18–30 and of average weight) with pictures of their own bodies and pictures of average weight, overweight, and “ideal” bodies attached to the participants’ own face and to another person’s face. Participants were instructed to evaluate their emotional reaction to the pictures and then rate the various pictures on aspects of attractiveness, body fat, and muscle mass. The degree of the double standard was defined as the difference between ratings of what appeared to be one’s own body and what appeared to be someone else’s according to the presented face. The analyses revealed, firstly, that both genders applied self-deprecating double standards when viewing overweight and average-weight bodies. Women, but not men, also showed self-deprecating double standards when viewing the ideal body and their own body. By contrast, men applied fewer double standards when viewing the ideal body and self-enhancing double standards when viewing their own body. The study suggests that young, average-weight men are more or less satisfied with their own bodies, whereas young, average-weight women tend to apply a stricter standard for themselves than for others, thus devaluing their own bodies. This vulnerability to body image is hypothesized as contributing to the prevalence of eating disorders in women.

The Relationship Between Women’s Negative Body Image and Disordered Eating Behaviors During the COVID-19 Pandemic: A Cross-Sectional Study

Recent studies have shed light on how the COVID-19 pandemic changed our lives, and most of them have documented its detrimental effect on eating habits. Until now, the effects of this global crisis on negative body image and its association with disordered eating behaviors remain largely understudied. This study aimed to investigate changes in frequency of disordered eating behaviors (i.e., restrictive eating, emotional eating, and overeating) and negative body image (i.e., shape and weight concern, and body dissatisfaction) among a community sample of women during the COVID-19 pandemic (October 2020–May 2021). Furthermore, we explored the possible relation between body image-related variables and changes in the frequency of disordered eating behaviors in the context of the pandemic. A total of 161 self-identified female participants enrolled in an online-based survey. Descriptive statistics showed that women did not report clinically significant levels of weight and body shape concerns, but participants reported being dissatisfied with their body. One sample Wilcoxon Signed Rank tests revealed a tendency toward an increasing of the frequency of all disordered eating behaviors during the COVID-19 pandemic. Multinomial logistic regressions showed that weight concerns predicted an overall increase in the frequency of restrictive eating behaviors, whereas higher body dissatisfaction was associated with a moderate self-perceived increase in the frequency of emotional eating. These results shed light on a risk pattern of phenomena in a non-clinical sample of women, as they represent the key risk factors for the development of eating disorders. Findings could have implications for designing and implementing prevention programs.

Distortion of mental body representations

Our body is central to our sense of self, and distorted body representations are found in several serious medical conditions. This paper reviews evidence that distortions of body representations are also common in healthy individuals, and occur in domains including tactile spatial perception, proprioception, and the conscious body image. Across domains, there is a general tendency for body width to be overestimated compared to body length. Intriguingly, distortions in both eating disorders and chronic pain appear to be exaggerations of this baseline pattern of distortions, suggesting that these conditions may relate to dysfunction of mechanisms for body perception. Distortions of body representations provide a revealing window into basic aspects of self-perception.

The effect of attention on body size adaptation and body dissatisfaction

Attentional bias to low-fat bodies is thought to be associated with body dissatisfaction-a symptom and risk factor of eating disorders. However, the causal nature of this relationship is unclear. In three preregistered experiments, we trained 370 women to attend towards either high- or low-fat body stimuli using an attention training dot probe task. For each experiment, we analysed the effect of the attention training on (i) attention to subsequently presented high- versus low-fat body stimuli, (ii) visual adaptation to body size, and (iii) body dissatisfaction. The attention training had no effect on attention towards high- or low-fat bodies in an online setting (Experiment 1), but did increase attention to high-fat bodies in a laboratory setting (Experiment 2). Neither perceptions of a 'normal' body size nor levels of body dissatisfaction changed as a result of the attention training in either setting. The results in the online setting did not change when we reduced the stimulus onset-asynchrony of the dot probe task from 500 to 100 ms (Experiment 3). Our results provide no evidence that the dot probe training task used here has robust effects on attention to body size, body image disturbance or body dissatisfaction.

Visual Self-Misperception in Eating Disorders

Many who suffer from eating disorders claim that they see themselves as "fat". Despite decades of research into the phenomenon, behavioural evidence has failed to confirm that eating disorders involve visual misperception of own-body size. I illustrate the importance of this phenomenon for our understanding of perceptual processing, outline the challenges involved in experimentally confirming it, and provide solutions to those challenges.

The Self in the Mind's Eye: Revealing How We Truly See Ourselves Through Reverse Correlation

Is there a way to visually depict the image people "see" of themselves in their minds' eyes? And if so, what can these mental images tell us about ourselves? We used a computational reverse-correlation technique to explore individuals' mental "self-portraits" of their faces and body shapes in an unbiased, data-driven way (total N = 116 adults). Self-portraits were similar to individuals' real faces but, importantly, also contained clues to each person's self-reported personality traits, which were reliably detected by external observers. Furthermore, people with higher social self-esteem produced more true-to-life self-portraits. Unlike face portraits, body portraits had negligible relationships with individuals' actual body shape, but as with faces, they were influenced by people's beliefs and emotions. We show how psychological beliefs and attitudes about oneself bias the perceptual representation of one's appearance and provide a unique window into the internal mental self-representation-findings that have important implications for mental health and visual culture.

The Association of Muscle Dysmorphia, Social Physique Anxiety, and Body Checking Behavior in Male College Students With Weight Exercise

Objectives: To investigate the association between muscle dysmorphia (MD), social physique anxiety, and body-checking behavior in male college students with weight exercise, and to reveal the association between them.

Methods: A total of 492 male college students with weight exercise from 18 Fitness Clubs or bodybuilding centers in Chengdu, China, participated in this study.

Results: First, the social physique anxiety scores, body checking frequency, and weight exercise behavior (i.e., frequency, time, and intensity) in male college students with MD were significantly higher than those without MD; it indicated that the higher the exercise frequency they had, the longer the exercise time they cost, and the higher exercise intensity carried out, and the higher the social physique anxiety scores tended to be, the higher the frequency of body checking on “global muscles,” “chest and shoulder muscles,” “comparison with others” and “posture measurement” they did. Second, the mediating effect of the social physique anxiety on MD and body checking was established in the “MD → global muscle checking,” “MD → chest and shoulder muscle checking,” “MD → comparison with others,” and “muscle dysmorphia → posture measurement.”

Conclusion: Male college students with MD not only have a higher social physique anxiety, but also a higher frequency of body-checking behavior than the ordinary individuals. Social physique anxiety is one of the important mediating factors to those with MD which affects the body-checking behavior.

Spatial hand representation in anorexia nervosa: a controlled pilot study

Body representation distortion (BRD) is a core criterion of Anorexia Nervosa (AN), and is usually assessed subjectively, focusing on body shape. We aimed to develop a new assessment to evaluate body representation independently from socially-mediated body image, on a body part with low emotional salience (hands). In a monocentric open label pilot study, we measured hand representations based on explicit (verbal) and implicit (tactile) instructions. Participants, with eyes closed, had to point targeted locations (knuckles and nails of each finger) based on verbal instructions and tactile stimulations to evaluate body representations respectively. Ratios between hand width and finger length were compared between AN (n = 31) and controls (n = 31) and correlated with current body mass index, AN subtype and disease duration. To control that hand distortion was specific to body representation, we also assessed object representation. Hand representation’s width/length ratio was significantly increased in patients with AN, whereas no difference was found in object representation. We found no correlation between hand wideness and clinical traits related to eating disorders. Our results propose that BRD is not limited to body parts with high emotional salience, strengthening the hypothesis that anorexia nervosa is associated with profound unspecific BRD.

Body appreciation and appearance evaluation in individuals with obesity compared to individuals with normal-weight: findings from a representative German population sample

PURPOSE

Body image has been identified as an important factor in mental health in individuals with obesity. Previous studies have focused on negative body image and research of positive body image-particularly in obesity-is still in its infancy. The current study explored the positive body image facet body appreciation and the negative facet appearance evaluation in different BMI groups as well as men and women.

METHODS

A total of 1003 participants of the general German public above the age of 18 years completed measures on body appreciation and appearance evaluation.

RESULTS

Significantly lower body appreciation was observed in male participants with obesity compared to normal-weight participants. In women, the BMI groups did not differ significantly in body appreciation. BMI was negatively associated with appearance evaluation in both genders. While men and women did not differ in body appreciation, men reported lower appearance evaluation scores compared to women.

CONCLUSION

The present study is one of few that investigated positive body image in individuals with obesity compared to individuals with normal weight. The findings underscore the potential of body appreciation as a resource in treatment of body image concerns in individuals with obesity. Further implications for future research are discussed.

LEVEL OF EVIDENCE

III, case-control analytic study.

Body exposure, its forms of delivery and potentially associated working mechanisms: How to move the field forward

Background

Body image disturbance (BID) is a hallmark feature of eating disorders (EDs) and has proven to be involved in their etiology and maintenance. Therefore, the targeting of BID in treatment is crucial, and has been incorporated in various treatment manuals. One of the most common techniques in the treatment of BID is body exposure (BE), the confrontation with one’s own body. BE has been found to be effective in individuals with EDs or high body dissatisfaction. However, BE is applied in a multitude of ways, most of which are based on one or a combination of the hypothesized underlying working mechanisms, with no differential effectiveness known so far.

Method

The aim of this paper is to selectively review the main hypothesized working mechanisms of BE and their translation into therapeutic approaches.

Results and Conclusion

Specifically, we underline that studies are needed to pinpoint the proposed mechanisms and to develop an empirically informed theoretical model of BE. We provide a framework for future studies in order to identify working mechanisms and increase effectiveness of BE.

Towards a Comprehensive Understanding of Body Image: Integrating Positive Body Image, Embodiment and Self-Compassion

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).

The role of sexual orientation in the relationships between body perception, body weight dissatisfaction, physical comparison, and eating psychopathology in the cisgender population

PURPOSE

Body weight dissatisfaction (BWD) and visual body perception are specific aspects that can influence the own body image, and that can concur with the development or the maintenance of specific psychopathological dimensions of different psychiatric disorders. The sexual orientation is a fundamental but understudied aspect in this field, and, for this reason, the purpose of this study is to improve knowledge about the relationships among BWD, visual body size-perception, and sexual orientation.

METHODS

A total of 1033 individuals participated in an online survey. Physical comparison, depression, and self-esteem was evaluated, as well as sexual orientation and the presence of an eating disorder. A Figure Rating Scale was used to assess different valences of body weight, and mediation analyses were performed to investigated specific relationships between psychological aspects.

RESULTS

Bisexual women and gay men reported significantly higher BWD than other groups (p < 0.001); instead, higher body misperception was present in gay men (p = 0.001). Physical appearance comparison mediated the effect of sexual orientation in both BWD and perceptual distortion. No difference emerged between women with a history of eating disorders and without, as regards the value of body weight attributed to attractiveness, health, and presence on social media.

CONCLUSION

This study contributes to understanding the relationship between sexual orientations and body image representation and evaluation. Physical appearance comparisons should be considered as critical psychological factors that can improve and affect well-being. The impact on subjects with high levels of eating concerns is also discussed.

LEVEL OF EVIDENCE

Level III: case-control analytic study.

Visual illusions modulate body perception disturbance and pain in Complex Regional Pain Syndrome: A randomized trial

BACKGROUND

Effective treatment of longstanding Complex Regional Pain Syndrome (CRPS) is a challenge, as causal mechanisms remain elusive. People with CRPS frequently report distorted subjective perceptions of their affected limb. Evidence of pain reduction when the affected limb is visually altered in size suggests that visual illusions used to target central processing could restore coherence of this disrupted limb representation. We hypothesized that using virtual reality that alters hand image to match the patient's desired hand appearance would improve body perception disturbance and pain. Also, repeated exposure would maintain any therapeutic effect.

METHODS

A blinded randomized controlled trial of 45 participants with refractory upper-limb CRPS and body perception disturbance (BPD) viewed a digital image of their affected hand for 1 min. The image was digitally altered according to the patient's description of how they desired their hand to look in the experimental group and unaltered in the control group. BPD and pain were measured pre- and post-intervention. A subgroup was followed up 2 weeks after a course of repeated interventions.

RESULTS

BPD (mean-6, ±SD 7.9, p = 0.036, effect size [ES] = 0.6) and pain intensity (mean-0.43, ±SD 1.3, p = 0.047, ES = 0.5) reduced in 23 participants after single exposure compared to controls (n = 22). At follow-up, the subgroup (experimental n = 21; control n = 18) showed sustained pain reduction only (p = 0.037, ±SD 1.9, ES = 0.7), with an overall 1.2 decrease on an 11-point scale.

CONCLUSIONS

Visually changing the CRPS hand to a desired appearance modulates BPD and pain suggesting therapeutic potential for those with refractory CRPS. Further research to optimize this therapeutic effect is required.

SIGNIFICANCE

Visual bodily illusions that change the shape and appearance of the painful CRPS hand to that desired by the patient result in a rapid amelioration of pain and body perception disturbance in people with longstanding CRPS. These findings highlight the future potential of this drug-free approach in the treatment of refractory CRPS.

The relationship between orthorexia nervosa symptomatology and body image attitudes and distortion

Orthorexia Nervosa (ON), a condition characterized by a fixation on healthy eating, still does not conform to any consensus concerning diagnostic criteria, notably in regard to a possible body image component. This study investigated the relationship between ON symptomatology, measured with the Eating Habit Questionnaire, and body image attitudes and body image distortion in a non-clinical sample. Explicit body image attitudes and distortion were measured using the Multidimensional Body-Self Relations Questionnaire. Implicit body image attitudes and distortion were assessed using the reverse correlation technique. Correlational analyses showed that ON is associated with both explicit and implicit attitudes and distortion toward body image. More precisely, multivariate analyses combining various body image components showed that ON is mostly associated with explicit overweight preoccupation, explicit investment in physical health and leading a healthy lifestyle, and implicit muscularity distortion. These findings suggest that ON symptomatology is positively associated with body image attitudes and distortion in a non-clinical sample. However, further studies should be conducted to better understand how ON symptomatology relates to body image, especially among clinical samples.

A Reference-Dependent Computational Model of Anorexia Nervosa

Influential accounts interpret anorexia as arising from perfectionism, dichotomous thinking, and poor control expressed in a variety of life domains, resulting in low self-esteem. In this context, restraining eating would allow patients to re-establish some control and self-esteem. Although this view has offered important insight, one shortcoming is that constructs such as perfectionism, control, and dichotomous thinking, remain poorly specified. To clarify these constructs, we propose a computational model of anorexia. This relies on previous theories of evaluation, which highlight its reference-dependent nature: when attributing a value to an outcome, our brain automatically assesses the outcome relative to its context. Following these theories, the model proposes that a high reference point explains general characteristics such as perfectionism, dichotomous thinking, low self-esteem, and low sense of control. These characteristics would result specifically in anorexia when the sense of control regarding body shape, compared with other life domains, is relatively high. The model raises the possibility that reference effects also might explain why patients pursue extremely low weight; exposure to skinny body images-one product of obsessive dieting-might change the reference point for their own body, hence leading to extremely low body weight, staunch refusal to gain weight, and body misperceptions. The model contributes to clarify key concepts adopted in the literature and their relation. Such computational formulation might help to foster theoretical debate, formulating novel empirical predictions, and integrate psychological and neuroscientific perspectives on anorexia.

Body size overestimation in anorexia nervosa: Contributions of cognitive, affective, tactile and visual information

Body image disturbance (BID) in anorexia nervosa (AN) is poorly understood and the individual contribution of perceptual, cognitive, and affective components remains unclear. This study compared females with AN and matched healthy controls (HC) on a perceptual size estimation task. Participants (AN n=19 M[SD] age=16.97[2.24], HC n=19, age=15.77[2.17]) were blindfolded and estimated the size of neutral objects, safe foods, unsafe foods, and parts of their bodies (hips, waist, knees, ankle) over three blocks using: 1) no sensory information (baseline), 2) tactile information, and 3) added visual information. There were no significant differences between AN and HC on neutral and safe or unsafe food objects. Participants with AN were significantly more likely to overestimate their body size across blocks compared to HC. Both groups made fewer errors on unsafe foods and body parts when using tactile or visual information compared to baseline. Exploratory analyses revealed significant correlations between body size overestimation and drive for thinness and body dissatisfaction in the AN group, with body dissatisfaction being the most robust. Results suggest that both deficits in tactile and visual perception and affective factors play a role in BID for young women with AN.