Women with Anorexia Nervosa do not show altered tactile localization compared to healthy controls

Behavioral, neuronal, and physiological facets of multidimensional body image in anorexia nervosa: a scoping review

Body image is a core identity facet in anorexia nervosa (AN). Current literature outlines body image as a multidimensional construct, characterized by perceptual, cognitive, and emotional components, which explain how individuals perceive, think, and behave in relation to their body. The purpose of this scoping review is to uncover neuropsychological disturbances in AN related to body image by focusing on its different behavioral and neuronal assessments, aiming to provide a broad overview of common findings and limitations. Additionally, we explore the role of somato-sensory/somato-motor components and physiological markers underlying body image disturbances, which have not been extensively examined in previous studies. Literature screening was performed across three databases (PubMed, PsycINFO, Scopus). We classified behavioral, physiological, and neuroimaging studies according to their degree of involvement with body image dimensions and discussed the primary findings for each component. A total of 4015 studies were identified, of which 107 were eligible (84 behavioral and 23 neuroimaging studies) based on eligibility criteria, covering research from 1973 to 2024. Notably, of those which specified the following factors: 16 studies focused on the restrictive subtype (AN-r), two on the binge-eating/purging subtype (AN-b/p), and 19 examined both AN-r and AN-b/p; finally four on the atypical subtype; 11 on the weight-recovered state (WR) and three included also male participants. The mean age across all studies was 20.1 years (SD = 3.79). Our findings reveal that body image disturbances in AN are not limited to the overestimation of body size but also encompass cognitive, emotional, and somato-sensory aspects. A strong drive for thinness emerged as a prominent cognitive factor in maintaining the disturbance, along with altered autobiographical recall, executive function, and attentional biases toward body-related stimuli. Emotional regulation difficulties, altered interoceptive awareness, and distorted somato-sensory aspects-reflected in tactile and motor processes-were highlighted. In addition, increased autonomic reactivity to body image stimuli, indicating a sympathetic/parasympathetic imbalance, is supported by specific cortical-subcortical functional alterations. Our review emphasizes that body image distortion in AN should not be viewed merely as a perceptual deficit but rather as a complex cognitive-emotional and somato-sensory process.

Sensory processing in children and adolescents shortly after the onset of anorexia nervosa: a pilot study

BACKGROUND

Alterations in sensory processing, such as vision, taste, and interoceptive sensation, have been reported in adult anorexia nervosa (AN). Whether these symptoms are traits, states, or "scars" due to chronic starvation has not been fully established. Based on the hypothesis that alterations in sensory processing also occur in adolescent AN in the early stages of the disease, the present study was conducted using both self-administered and parent-administered sensory processing questionnaires.

METHODS

Children and adolescents with anorexia nervosa treated at a single tertiary eating disorder treatment center in Japan (AN group) and female junior high school students attending a public junior high school in Saitama Prefecture, Japan (healthy control group: HC group) were included in the study. The Sensory Profile (SP) and Adult/Adolescent Sensory Profile (AASP) were administered to the participants and their caregivers. In addition, we collected demographic data and administered the Children's Eating Attitude Test and Autism-Spectrum Quotient Children's version.

RESULTS

Seventeen children and adolescents were enrolled in the AN group, and 63 were enrolled in the HC group. There was no statistically significant difference between the AN and HC groups in the quadrant scores of the AASP. In the SP, the Sensory Avoiding score and the Emotional/Social response score were higher in the AN group than in the HC group.

CONCLUSION

From the parents' point of view, the patient avoids unexpected sensory stimuli, but the patients are unaware of their own avoiding behavior in the early stages of the disease. The results suggest that sensory sensitivity in AN may be a "scar" symptom due to chronic starvation and a state symptom. Longitudinal studies from shortly after the onset with larger sample sizes are needed to gain insight into the dynamic relation between sensory processing and eating disorder pathology.

From Virtual Reality to Regenerative Virtual Therapy: Some Insights from a Systematic Review Exploring Inner Body Perception in Anorexia and Bulimia Nervosa

Despite advances in our understanding of the behavioral and molecular factors that underlie the onset and maintenance of Eating Disorders (EDs), it is still necessary to optimize treatment strategies and establish their efficacy. In this context, over the past 25 years, Virtual Reality (VR) has provided creative treatments for a variety of ED symptoms, including body dissatisfaction, craving, and negative emotions. Recently, different researchers suggested that EDs may reflect a broader impairment in multisensory body integration, and a particular VR technique-VR body swapping-has been used to repair it, but with limited clinical results. In this paper, we use the results of a systematic review employing PRISMA guidelines that explore inner body perception in EDs (21 studies included), with the ultimate goal to analyze the features of multisensory impairment associated with this clinical condition and provide possible solutions. Deficits in interoception, proprioception, and vestibular signals were observed across Anorexia and Bulimia Nervosa, suggesting that: (a) alteration of inner body perception might be a crucial feature of EDs, even if further research is needed and; (b) VR, to be effective with these patients, has to simulate/modify both the external and the internal body. Following this outcome, we introduce a new therapeutic approach-Regenerative Virtual Therapy-that integrates VR with different technologies and clinical strategies to regenerate a faulty bodily experience by stimulating the multisensory brain mechanisms and promoting self-regenerative processes within the brain itself.

The Mediating Effect of Negative Appearance Evaluation on the Relationship Between Eating Attitudes and Sociocultural Attitudes Toward Appearance

Objective

Body-image disturbance and eating disorders are significant physical and mental health problems in China. Attitudes toward the body are thought to work in conjunction with other established risk factors for dietary pathology, which include body dissatisfaction, dieting, and negative effects. Negative appearance evaluation may be valuable for extending our understanding of measuring factors and potential causal relationships associated with body image and eating problems. Therefore, this study aimed to determine the association between negative appearance evaluation and a combination of eating attitudes and sociocultural attitudes toward appearance and the mediating effect of negative appearance evaluation on the relationship between eating attitudes and sociocultural attitudes toward appearance.

Methods

We invited 339 Chinese adults to undergo the Eating Attitudes Test (EAT-26), the Fear of Negative Appearance Evaluation Scale (FNAES), and the Sociocultural Attitudes toward Appearance (SATAQ-3) scale, and used AMOS 24.0 for model construction and mediating effects testing.

Results

There was a significant positive correlation between EAT-26 scores and FNAES (p < 0.001) and SATAQ-3 scores (p < 0.001), and all dimensions except internalization general were significantly positively correlated (p < 0.05). There was a significant positive correlation between FNAES and SATAQ-3 scores for all dimensions (p < 0. 01). There was no significant direct effect of eating attitude on sociocultural attitude toward appearance; however, there was a significant mediating effect of fear of negative appearance evaluation.

Conclusion

Our results demonstrate that negative appearance evaluation fully mediates the relationship between eating attitudes and sociocultural attitudes toward appearance. An individual's attitude toward eating affects negative body perceptions and thus their perception of their own body shape. Our exploration of the specific effects of eating attitudes on body perception provides a psychological basis for guidance and developing interventions regarding attitudes toward the body.

Waiting longer, feeling fatter: Effects of response delay on tactile distance estimation and confidence in females with anorexia nervosa

BACKGROUND

Research suggests that patients with anorexia nervosa (AN) exhibit differences in the perceptual processing of their own bodies. However, some researchers suggest that these differences are better explained with reference to non-perceptual factors, such as demand characteristics or emotional responses to the task. In this study, we investigated whether overestimation of tactile distances in participants with AN results from differences in tactile processing or non-perceptual factors, by measuring the role of allowed response time in an adapted version of the tactile distance estimation task (TDE-D). We further investigated the relationship between allowed response time and participants' confidence in their tactile judgments.

METHOD

Our sample consisted of females: participants with AN (n = 30), recovered (REC) participants (n = 29) and healthy controls (HC) (n = 31). Participants were asked to estimate tactile distances presented on the skin of either a salient (abdomen) or non-salient (arm) body part, either directly after stimulus presentation (direct condition) or after a 5 s delay (delayed condition). Confidence of estimation accuracy was measured after each response.

RESULTS

Results showed that allowing AN and REC more time to respond caused them to estimate tactile distances as larger. Additionally, participants with AN became less confident when given more time to respond.

CONCLUSIONS

These results suggest that non-perceptual influences cause participants with AN to increase their estimates of tactile distances and become less certain of these estimates. We speculate that previous findings-where participants with AN estimate tactile distances as larger than HC-may be due to non-perceptual differences.

eLoriCorps Immersive Body Rating Scale and eLoriCorps Mobile Versions: Validation to Assess Body Image Disturbances from Allocentric and Egocentric Perspectives in a Nonclinical Sample of Adolescents

A growing number of studies have used virtual reality (VR) for the assessment and treatment of body image disturbances (BIDs). This study, conducted in a community sample of adolescents, documents the convergent and discriminant validity between (a) the traditional paper-based Figure Rating Scale (paper-based FRS), (b) the VR-based Body Rating Scale (eLoriCorps-IBRS 1.1), and (c) the mobile app-based Body Rating Scale (eLoriCorps-IBRS 1.1-Mobile). A total of 93 adolescents (14 to 18 years old) participated in the study. Body dissatisfaction and body distortion were assessed through the paper-based FRS, the eLoriCorps-IBRS 1.1 and the eLoriCorps-IBRS 1.1-Mobile. Eating disorder symptoms, body image avoidance, and social physique anxiety were also measured. Correlation analyses were performed. Overall, the results showed a good and statistically significant convergence between allocentric perspectives as measured by the paper-based FRS, the eLoriCorps-IBRS 1.1 and the eLoriCorps-IBRS 1.1-Mobile. As expected, the egocentric perspective measured in VR produced different results from the allocentric perspective, and from cognitive–attitudinal–affective dimensions of BIDs, with the exception of body distortion. These differences support the discriminant validity of the egocentric perspective of eLoriCorps-IBRS 1.1 and are consistent with emerging evidence, highlighting a difference between experiencing the body from an egocentric (i.e., the body as a subject) and allocentric (i.e., the body as an object) perspective. The egocentric perspective could reflect a perceptual–sensory–affective construction of BIDs, whereas allocentric measures seem to be more related to a cognitive–affective–attitudinal construction of BIDs. Moreover, the results support the validity of the eLoriCorps-IBRS 1.1-Mobile with promising perspectives of implementation among young populations.

Targeting body image in eating disorders

Eating disorders, such as anorexia nervosa, are challenging to treat successfully and have a very high relapse rate. Body image disturbance (BID) is a core component of these eating disorders. It is a predictor of onset, treatment outcome and future relapse. However, recent studies suggest that BID can be improved by an adaptation of cognitive bias training. This does not target the accuracy of body size judgements, but instead focuses on how a body of a particular size is categorized by a patient. This recalibration of the categorical boundary at which bodies are judged as overweight, which challenges a patient's existing preconceptions about which constitutes an acceptable body size, seems to lead to a more general reassessment of eating disordered attitudes and a significant improvement in their psychological profile. These promising findings need further trials to determine the long-term effectiveness of such a targeted intervention, but it potentially provides an important additional treatment option. In addition, this cognitive bias training may also be an effective augmentation to treatment in other conditions that feature BID, such as bulimia nervosa and body dysmorphia.

Weight bias and linguistic body representation in anorexia nervosa: Findings from the BodyTalk project

OBJECTIVE

This study provides a comprehensive assessment of own body representation and linguistic representation of bodies in general in women with typical and atypical anorexia nervosa (AN).

METHODS

In a series of desktop experiments, participants rated a set of adjectives according to their match with a series of computer generated bodies varying in body mass index, and generated prototypic body shapes for the same set of adjectives. We analysed how body mass index of the bodies was associated with positive or negative valence of the adjectives in the different groups. Further, body image and own body perception were assessed.

RESULTS

In a German-Italian sample comprising 39 women with AN, 20 women with atypical AN and 40 age matched control participants, we observed effects indicative of weight stigmatization, but no significant differences between the groups. Generally, positive adjectives were associated with lean bodies, whereas negative adjectives were associated with obese bodies.

DISCUSSION

Our observations suggest that patients with both typical and atypical AN affectively and visually represent body descriptions not differently from healthy women. We conclude that overvaluation of low body weight and fear of weight gain cannot be explained by generally distorted perception or cognition, but require individual consideration.

Influence of Physical Activity Interventions on Body Representation: A Systematic Review

Distorted representation of one's own body is a diagnostic criterion and corepsychopathology of disorders such as anorexia nervosa and body dysmorphic disorder. Previousliterature has raised the possibility of utilising physical activity intervention (PI) as atreatment option for individuals suffering from poor body satisfaction, which is traditionallyregarded as a systematic distortion in "body image." In this systematic review,conducted according to the PRISMA statement, the evidence on effectiveness of PI on body representation outcomes is synthesised. We provide an update of 34 longitudinal studies evaluating the effectiveness of different types of PIs on body representation. No systematic risk of bias within or across studies were identified. The reviewed studies show that the implementation of structured PIs may be efficacious in increasing individuals' satisfaction of their own body, and thus improving their subjective body image related assessments. However, there is no clear evidence regarding an additional or interactive effect of PI when implemented in conjunction with established treatments for clinical populations. We argue for theoretically sound, mechanism-oriented, multimethod approaches to future investigations on body image disturbance. Specifically, we highlight the need to consider expanding the theoretical framework for the investigation of body representation disturbances to include further body representations besides body image.

Are attitudinal and perceptual body image the same or different? Evidence from high-level adaptation

We used a high-level adaptation paradigm to distinguish between two hypotheses: (1) perceptual and attitudinal body image measurements reflect conceptually different mechanisms which are statistically independent of each other; (2) attitudinal (e.g., questionnaire) and perceptual (e.g., visual yes-no) body image tasks represent two different ways of measuring exactly the same construct. Forty women, with no history of eating disorders, carried out the experiment. Each participant carried out five adaptation blocks, with adapting stimuli representing female bodies at: extreme-low body mass index (BMI), mid-low BMI, actual BMI of the observer, mid-high BMI, and extreme-high BMI. Block order was randomized across participants. The main outcome variable was percentage error in participants' self-estimates of body size, measured post-adaption. In regressions of this percentage error on the strength of the adapting stimuli together with observers' attitudinal body image as a covariate, we found positive regression slopes and no evidence for any interaction between the fixed effects. Therefore, we conclude that perceptual and attitudinal body image mechanisms are indeed independent of each other. In the light of this evidence, we discuss how people with eating disorders, like anorexia nervosa, may come to over-estimate their body size.

A systematic and methodological review of attentional biases in eating disorders: Food, body, and perfectionism

OBJECTIVE

The current systematic and methodological review aimed to critically review existing literature utilizing implicit processing, or automatic approach- and/or avoidance-related attentional biases between eating disorder (ED) and nonclinical samples, which (a) highlights how psychophysiological methods advance knowledge of ED implicit bias; (b) explains how findings fit into transdiagnostic versus disorder-specific ED frameworks; and (c) suggests how research can address perfectionism-related ED biases.

METHOD

Three databases were systematically searched to identify studies: PubMed, Scopus, and PsychInfo electronic databases. Peer-reviewed studies of 18- to 39-year-olds with both clinical ED and healthy samples assessing visual attentional biases using pictorial and/or linguistic stimuli related to food, body, and/or perfectionism were included.

RESULTS

Forty-six studies were included. While behavioral results were often similar across ED diagnoses, studies incorporating psychophysiological measures often revealed disease-specific attentional biases. Specifically, women with bulimia nervosa (BN) tend to approach food and other body types, whereas women with anorexia nervosa (AN) tend to avoid food as well as overweight bodies.

CONCLUSIONS

Further integration of psychophysiological and behavioral methods may identify subtle processing variations in ED, which may guide prevention strategies and interventions, and provide important clinical implications. Few implicit bias studies include male participants, investigate binge-eating disorder, or evaluate perfectionism-relevant stimuli, despite the fact that perfectionism is implicated in models of ED.