Body image disturbance in anorexia nervosa during the acute and recuperative phase

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.

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

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

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

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

A Brunswikian Model for Body Image Research in Patients with Eating Disorders

Eating disorders have become a national healthl problem, particularly among adolescent girls. Of particular interest with these patienils is their inability to perceive themselves accurately. While many studies have addressed body image distortion, the cognitive process involved has remained elusive. Rather than study this individual process with a group comparisont ietehodology, Brunswik's lens model was employed. Patienits' individual cognitive models were explored prior to aggregating the data on a group level. Impor tant differ enices emerged between anorexic, bulimic, obese, anrd normal female's utilizatioin of available perceptual cues concerning self and other body sizes. All of the participants in the study demonstrated conzsistenti linear models for use of perceptual cue information. Group differenices emerged in relative emphasis placed on each cue. This luse of Brunswik's lens model represents a uniquie applicationi of the methodology that should prove inivalitable for-future studies of self-per-ceptioni in a wide variety of domains.

Differential hemispheric involvement in anorexia nervosa

Hemispheric function was assessed in 22 restricting anorexia nervosa (AN) female subjects and 22 normal female controls. Two verbal and two visuospatial tasks and a set of psychopathological tests were administered. The failure of the "classic" lateralization tests to reveal the expected left hemisphere dominance or a right hemisphere deficit in AN group, as compared to controls, is counterbalanced by the tendency of the psychopathological tests to prove the neuropsychological hypothesis of the present study. Neuropsychological interpretation of psychopathological data, however, does not constitute direct evidence and so further studies and more sophisticated techniques are needed.

Body image disturbances and their change with videofeedback in anorexia nervosa

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

The self-schema model: a theoretical approach to the self-concept in eating disorders

Over the last several decades, the self-concept has been implicated as a important determinant of eating disorders (ED). Although considerable progress has been made, questions remain unanswered about the properties of self-concept that distinguish women with an ED from other populations, and mechanisms that link the self-concept to the disordered behaviors. Markus's self-schema model is presented as a theoretical approach to explore the role of the self-concept in ED. To show how the schema model can be integrated with existing work on the self-concept in ED, a framework is proposed that addresses the number, content, and accessibility of the self-schemas. More specifically, it is posited that a limited collection of positive self-schemas available in memory, in combination with a chronically and inflexibly accessible body-weight self-schema, lead to the disordered behaviors associated with anorexia nervosa and bulimia nervosa.

Delay of gratification in bulimic and restricting anorexia nervosa patients

This investigation posited that impairment in the delay of gratification is an etiological factor in anorexia nervosa that differentiates between bulimic anorexic and restricting anorexic subgroups. Forty-eight women aged 18-32 served as subjects. Among subjects aged 18-29, restricting anorexics scored significantly higher than bulimic anorexics on delay. Treatment implications indicate that restricting anorexics would benefit from intervention designed to decrease impulse control, while bulimic anorexics would benefit from intervention designed to increase delaying capacity.

Body image disturbance in anorexia nervosa: beyond body image

In this paper the literature on body image disturbance in anorexic patients is reviewed. After a decade of experimental investigation of body image in anorexia nervosa, where old and new techniques have been used and where a large number of correlations have been identified, what do we really know? The findings have been conflicting but some regularities exist. It is hypothesized that the conflicting results may be related to the presence of different subgroups among anorexics and different types of body image disturbance. Body size estimation is only one dimension of body image perception. Likewise, body size overestimation is only one aspect of body image perception. Likewise, body size overestimation is only one aspect of body image disturbance. Some, but not all anorexics, overestimate their body size, and those who do, seem to have poor prognosis. Body size overestimation is not confined to anorexics. It is not known whether it is a function of a general perceptual/cognitive disorder, but it does seem to be stable over time. The implications of the presence of other psychiatric conditions in anorexic patients are discussed and suggestions for future research and for practice are made.

Relationship of body-image distortion to sex-role identifications, irrational cognitions, and body weight in eating-disordered females

Thirty-one eating-disordered (ED) women and 11 normal women completed tests of sex-role identity, dysfunctional cognitions, and body image. Anorexics, not bulimics, exhibited body-image distortion. All EDs (distorters and nondistorters) showed "hyperfeminine" identifications. Maladaptive cognitions were present in all EDs, but more marked in "overestimators." Body weight predicted BID better than other measures of eating pathology, which suggests important effects of weight per se in producing BID.

Body image in anorexia nervosa and bulimia nervosa. A review of the literature

Disturbances in body image are often regarded as a cardinal feature of anorexia nervosa and bulimia nervosa. The various approaches to assessing body-image disturbances in anorexics and bulimics are detailed, including body-part size estimation techniques, distorting image methods, silhouettes, and attitudinal measures. The marked inconsistency of findings across studies comparing anorexics or bulimics with some "control" group on body-image variables is discussed in terms of variations in measurement techniques, subject characteristics, and experimental setting. The reliability and validity of existing measures are discussed. Finally, conclusions and recommendations for future research are provided, in addition to a brief presentation of therapeutic approaches to treating body-image disturbances.

Body image distortion in non-eating disordered women and men

This study of body image perception in 100 non-eating disordered women and men demonstrates that overperception of body widths, whilst accurately perceiving a neutral object, is not restricted to populations with eating disorders, nor is it peculiar to women. Men consistently overestimated body widths to the same extent as female subjects. Overall, 84% of women and 52% of men wished to weigh less. Considering those subjects within the 10% range of Mean Matched Population Weight (MMPW), men wished to be 0.75 kg heavier, whilst women at MMPW wished to weigh 3.25 kg less. For women, the subjects who were most satisfied with their actual weight were those who were well below MMPW. There is a tendancy that the greater the deviation of weight from normal, in either direction, the greater the degree of body width overestimation. These results suggest that the overperception of body width is more related to current weight than to concern about weight and shape, or to the presence or absence of an eating disorder. They question the use of empirical body size estimation measurement in eating disordered populations.

The measurement of body image disturbances in anorexia nervosa. Experimental comparison of different methods

Body image disturbances in anorexia nervosa patients have been assessed in an experimental study which dealt with the following issues: Three different procedures for the assessment of body image disturbances were compared in a discriminant function analysis: a Video Monitor Procedure, the Movable Caliper Procedure and the Image Marking Procedure. The Image Marking Procedure showed the best discrimination between groups. Anorexia nervosa patients showed a statistically significant overestimation as compared to the control group in the variables 'waist', 'upper thigh' and the compound measure 'soft body parts', while they did not overestimate control variables (Kruskal-Wallis-Rank-Analysis of Variance). A standard liquid meal of 240 Kal. had no statistically significant influence on the estimation of body width, irrespective of the amount of calories consumed and instruction given. Possibilities and limitations of various measurement procedures are discussed.

Asymmetric cognitive function in anorexia nervosa

Three anorexics, one at normal weight, were examined, with a neuropsychological battery including the Halstead-Reitan tests. Their data were contrasted with that of 24 psychiatric controls matched for age, sex and IQ. Individually and as a group the anorexics showed above average verbal/academic scores and impaired spatial skills, whereas visual-motor and problem solving skills were equivalent to controls. Somatosensory recognition was impaired bilaterally in all three patients, and motor skills were low in the two emaciated patients. Other sensory tests and intermanual comparisons of sensory and motor skills were not impaired relative to controls. The findings suggest that a spatial reasoning deficit may be a predisposing or maintaining factor in this disorder. High verbal skills, in contrast, may reflect substantial left hemisphere contributions to the anorexic's cognitive style.

A modified video camera for measuring body image distortion: technical description and reliability

Previously employed techniques for the measurement of body image are briefly described, with a short consideration of methodological or procedural limitations associated with each technique. A new procedure is described which employs a simple modification to a standard video camera to produce an image which appears from 20% thinner to 40% fatter than the actual person, without other distortion of the image. Reliability and preliminary validity data for the new procedure are presented.

Body image in anorexia nervosa

Despite much recent interest in the objective measurement of body image in anorexia nervosa, many questions remain regarding basic mechanisms responsible for the findings as well as their meaning in the disorder. It is unclear if "whole body" measures assess the same underlying phenomena as the "body part" method, and it is unclear if body image disturbances are etiologic or a byproduct of anorexia nervosa. The possible association between self-esteem and body satisfaction and the relationship of the latter variable to actual size estimation supports the hypothesis that size perception may be closely tied to satisfaction with non-physical aspects of self. Finally it must be determined if overestimation is a function of a general psychological disturbance or of a deficit of specific interest in this disorder. Despite these questions, the way in which anorexic patients see themselves as well as the cognitive and affective responses to this perception remains an interesting and potentially fruitful area of study with this disorder.

Ego boundary disturbance in juvenile anorexia nervosa

Tested the hypothesis that ego boundary disturbance is present in adolescent females with anorexia nervosa. Twenty anorexics were compared to 20 female depressed controls on Rorschach scales designed to measure theoretically relevant aspects of boundary impairment. Results showed that anorexics scored higher on scales that measure inner-outer and conceptual boundary disturbance and produced significantly more responses that emphasized the solidity of object boundaries. Boundary scores were unrelated to degree of weight loss and global symptom severity, and follow-up testing after normal weight was restored revealed little change from initial levels. These findings are discussed in relation to current theory on the role of developmental ego pathology in the origins and phenomenology of anorexia nervosa.

Body image in obese adults

Data were gathered on 38 obese women and 16 obese men attending a weight-reduction programme and on an equal number of normal weight controls, regarding accuracy of perception of body width in 4 regions, as well as attitudes towards body size. Obese subjects, particularly women, tended to overestimate body width and to dislike their bodies, but neither of these factors predicted success in losing weight. Age of onset of obesity was not related to degree of adult obesity or to accuracy of estimation of body width.

Body image in anorexia nervosa: measurement, theory and clinical implications

Clinical manifestations of body image disturbance in anorexia nervosa are described including size misperceptions and faulty beliefs about shape. The empirical investigations of body image aberrations in anorexia nervosa are critically reviewed. Methodological issues such as reliability, validity subject selection and sources of experimental bias are discussed with recommendations for further research. Theoretical explanations for the mechanisms determining self-overestimation are presented with data indicating a relationship between self-overestimation, body satisfaction and self-esteem. Finally, a therapeutic approach is suggested that is aimed specifically at modifying the patient's faculty beliefs about her body while coping with her refractory self-misperceptions.