The Body Image Quality of Life Inventory: further validation with college men and women

The Body Image Quality of Life Inventory (BIQLI) was recently developed to quantify both the positive and negative effects of body image on one’s psychosocial quality of life. The current study was conducted to further validate the measure with both men and women and to evaluate its psychometric reliability and validity among college students (N=603). Results confirmed that the 19-item measure was an internally consistent and unidimensional measure for both sexes. A significantly more favorable body image quality of life was reported by men than women, by African American than White women, and by women with lower body mass indices. Significant body image correlates included body image evaluation, investment, and situational dysphoria. A better body image quality of life was also related to higher self-esteem, optimism, and social support for both sexes and to less eating disturbance among women. The potential utility of this construct and unique instrument in further research, especially with medical populations, is discussed.     

Development of the body image concern inventory

Development of the Body Image Concern Inventory (BICI), a measure designed to assess dysmorphic concern, is described. A panel of expert raters supported the construct validity of the measure, and four college student samples (Ns=184, 200, 56, 40) supported the internal consistency of the BICI. In addition, in studies 1 and 3, concurrent validity was established through comparison of the BICI to extant self-report and interview measures of dysmorphic symptomatology. Convergent validity patterns were assessed through comparison with measures of obsessive-compulsive and eating disorder symptomatology in studies 2 and 4. Finally, the results of study 4 supported that the BICI discriminated individuals with a diagnosis of Body Dysmorphic Disorder or bulimia (disorders that frequently involve high levels of dysmorphic concern) from those with subclinical symptoms. Results suggest that the BICI is a reliable, valid, and user-friendly tool for assessing dysmorphic concern, with utility in both research and clinical settings.     

Experiential avoidance in body dysmorphic disorder

Experiential avoidance (i.e., the attempt to avoid certain internal experiences including bodily sensations, thoughts, emotions, memories, and urges) has been studied in various psychological disorders. However, research examining experiential avoidance in individuals with body dysmorphic disorder (BDD) is limited and inconsistent. The present study compared experiential avoidance in individuals with primary BDD (n = 23) to healthy controls (n = 22). Standardized measures were used to assess baseline clinical characteristics as well as experiential avoidance. Compared to healthy controls, individuals with BDD presented with significantly greater experiential avoidance (p < .001, d = −2.51). In BDD, experiential avoidance was positively correlated with depressive symptoms (p < .01) and avoidant coping strategies (p < .01). Clinician sensitivity to experiential avoidance may serve to improve the course of treatment for BDD.     

Advances in a cognitive behavioural model of body dysmorphic disorder

Body dysmorphic disorder (BDD) is the most distressing and handicapping of all the body image disorders. A cognitive behavioural model of BDD is discussed which incorporates evidence from recent studies and advances in the author’s 1996 conceptual model. The model aims to understand the maintenance of symptoms in BDD, to assist in the process of engagement of therapy and to guide the strategies to use. At the core of BDD is an excessive self-focussed attention on a distorted body image, the negative appraisal of such images leading to rumination, changes in mood and the use of safety behaviours. Evidence for possible risk factors in the development of BDD is also discussed.     

Perceived teasing experiences in body dysmorphic disorder

Individuals with body dysmorphic disorder (BDD) are excessively concerned about imagined or slight defects in their appearance (e.g., asymmetrical facial features). Cognitive-behavioral models of BDD propose that several factors, including dysfunctional appearance-related beliefs and life experiences, such as teasing, contribute to the avoidance behaviors or rituals (e.g., mirror checking, grooming) characteristic of BDD. Previous research has demonstrated an association between perceived teasing and body dissatisfaction. In the current study, we examined whether individuals with BDD (n = 16) report to have been teased more often than do mentally healthy controls (n = 17). The group comprising individuals with BDD reported more appearance- and competency-related teasing than did control participants. This study provides preliminary evidence for the association between perceived teasing and BDD.     

Body image interventions in cognitive-behavioural therapy of binge-eating disorder: a component analysis

The present study sought to investigate effects of body exposure in the treatment of binge-eating disorder (BED). Cognitive-behavioural therapy with a body exposure component (CBT-E) was compared with CBT with a cognitive restructuring component focused on body image (CBT-C). Twenty-eight patients diagnosed with BED were randomly assigned to CBT-E or CBT-C, both delivered in a group format. Negative automatic thoughts about one's body, dysfunctional assumptions about shape and weight, and body dissatisfaction were assessed using experimental thought-sampling techniques, a clinical interview (Eating Disorder Examination), and self-report questionnaires. At posttreatment and at 4-month follow-up, CBT-E and CBT-C were equally effective in improving body image disturbance on all indicators assessed. Both CBT-E and CBT-C produced substantial and stable improvements in the specific and general eating disorder psychopathology. Results suggest that both treatment components are equally effective in the treatment of BED.     

Mirror gazing in body dysmorphic disorder and healthy controls: effects of duration of gazing

Cognitive-behavioural models of body dysmorphic disorder (BDD) suggest that mirrors can act as a trigger for individuals with BDD, resulting in a specific mode of cognitive processing, characterised by an increase in self-focussed attention and associated distress. The aim of the current study was to investigate these factors experimentally by exposing participants with BDD (n = 25) and without BDD (n = 25) to a mirror in a controlled setting. An additional aim was to ascertain the role of duration of mirror gazing in the maintenance of distress and self-consciousness by manipulating the length of gazing (short check vs. long gazing). Findings demonstrated that contrary to what was predicted, not only participants with BDD, but also those without BDD experienced an increase in distress and self-focused attention upon exposure to the mirror. In addition, people without BDD, unlike those with BDD, experienced more distress when looking in the mirror for a long period of time as opposed to a short period of time. This lends some support to the idea that, for people with BDD, gazing in a mirror, regardless of duration, might act as an immediate trigger for an abnormal mode of processing and associated distress, and that this association has developed from past excessive mirror gazing. Further theoretical implications of these findings, as well as subsidiary research questions relating to additional cognitive factors are discussed.     

The norms and stability of new measures of the multidimensional body image construct

The measurement of the body image construct has become increasingly multidimensional. New assessments are available to measure various facets of body image functioning: The Body Image Disturbance Questionnaire, Appearance Schemas Inventory-Revised, Body Image Coping Strategies Inventory, and Body Image Quality of Life Inventory. The present article reports normative data and acceptable internal reliabilities across seven completed investigations using these measures with female and male college students. Sex differences were examined and found, as expected, for most of the measures. In addition, a study evaluated an undetermined but essential psychometric property of these facets of the construct—their test–retest reliability. In a sample of 107 college students, the 2-week stability of these measures was found to be acceptable. Several directions for future research with these assessments are identified.     

Body Image Testing System: A microcomputer program for assessing body image

An interactive computer program, the Body Image Testing System (BITS), was developed to assess different components of the body image construct. The BITS program displays a frontal and side view of a human body. Subjects can change the size of each of nine body parts independently (face, neck, shoulders, arms, chest, breasts, stomach, hips, and thighs). Subjects interact with the program until satisfied that the image created matches the instructions. Subjects also provide satisfaction ratings for the nine body segments. To validate BITS, a variety of body image and eating disturbance measures was obtained from over 500 subjects. A factor analysis of actual-ideal differences and a perceptual distortion measure, derived using multiple regression, resulted in five orthogonal factors. Factor 1 measured actual-ideal discrepancy for weight-sensitive body parts. Factor 2 measured the perceptual distortion of weight-sensitive body parts. Additional factors measured perception of face and neck, shoulders, and breasts. The five factor scores plus the satisfaction ratings were strongly associated with actual body size, body fat percentage, and circumference of specific body parts. In addition, there were strong associations between the BITS and other measures of body image. Finally, BITS scores accounted for between 15 and 60% of the variance in measures of eating disturbance.     

Rates of abuse in body dysmorphic disorder and obsessive-compulsive disorder

Body dysmorphic disorder (BDD) continues to challenge professionals due to symptom severity, co-morbidity, suicidal ideation, and overvalued ideation. Despite the disorder's severity, little research exists. Clinical observation suggests a noteworthy history of abuse; therefore the present study investigated the reported rate of physical, sexual, and emotional abuse in BDD patients. OCD patients were chosen as a comparison group because BDD is considered to be an obsessive-compulsive spectrum disorder. A group survey design was used (N = 50 for each group). Results show significantly higher levels of emotional and sexual abuse in the BDD sample versus the OCD sample. No significant differences were found in physical abuse. Abuse may be a contributing factor in BDD, but not in OCD.     

Clinical features of muscle dysmorphia among males with body dysmorphic disorder

Muscle dysmorphia – a pathological preoccupation with muscularity – appears to be a form of body dysmorphic disorder (BDD) with a focus on muscularity. However, little is known about muscle dysmorphia in men with BDD, and no study has compared men with BDD who do and do not report muscle dysmorphia. To explore this issue, we reviewed the histories of 63 men with BDD; we compared those rated as having a history of muscle dysmorphia with those who had BDD but not muscle dysmorphia in several domains. The 14 men with muscle dysmorphia resembled the 49 comparison men in demographic features, BDD severity, delusionality, and number of non-muscle-related body parts of concern. However, those with muscle dysmorphia were more likely to have attempted suicide, had poorer quality of life, and had a higher frequency of any substance use disorder and anabolic steroid abuse. Thus, muscle dysmorphia was associated with greater psychopathology.     

Body-image thought processes: The development and initial validation of the Assessment of Body-Image Cognitive Distortions

No measures exist that specifically assess cognitive distortions related to body image per se, despite their theoretical and clinical significance. Most cognitive-distortion scales pertain to depression, anxiety, or eating disorders. Accordingly, the 37-item Assessment of Body-Image Cognitive Distortions (ABCD) was developed and validated in this study with a sample of 263 college women. The ABCD samples eight types of distorted thinking related to how persons process information about their physical appearance. Two 18-item parallel forms of the unidimensional measure were also constructed. All forms were highly internally consistent and relatively free from socially desirable responding. Convergent validity for all ABCD forms was established using several standardized measures of body image and eating attitudes. Multiple regression analysis showed that the ABCD was predictable from body-image evaluation, investment, and overweight preoccupation. The ABCD uniquely predicted body-image quality of life and disturbed eating attitudes above and beyond other body-image predictors. Heavier women and White women were more prone to body-image cognitive distortions than were thinner women and Black women. Finally, limitations of this preliminary study, directions for future research, and clinical implications are discussed.     

The relation between parental influence, body image, and eating behaviors in a nonclinical female sample

The purpose of the current study is to create a comprehensive composite measure of parental influence based on previously developed measures to clarify the underlying dimensions of parental influence and to determine the degree to which parental influence relates to body image and dysfunctional weight concerns. Previously published literature was reviewed for measures of parental influence, and items from 22 measures were condensed and combined into a single questionnaire, which was completed by 367 female undergraduate psychology students. Two dimensions emerged from a principle components analysis: Direct Influence, which includes weight and eating related comments, and Modeling, which includes parental modeling of dieting and related behavior. Direct Influence and Modeling were significantly related to eating disturbance, such as drive for thinness and bulimic symptomatology. Overall, the results integrate the previous literature and clarify the underlying dimensions of parental influence. Further, this study provides directions for future research related to the development and maintenance of body image and eating disturbance.     

The use of virtual reality in the study, assessment, and treatment of body image in eating disorders and nonclinical samples: a review of the literature

This article reviews research into the use of virtual reality in the study, assessment, and treatment of body image disturbances in eating disorders and nonclinical samples. During the last decade, virtual reality has emerged as a technology that is especially suitable not only for the assessment of body image disturbances but also for its treatment. Indeed, several virtual environment-based software systems have been developed for this purpose. Furthermore, virtual reality seems to be a good alternative to guided imagery and in vivo exposure, and is therefore very useful for studies that require exposure to life-like situations but which are difficult to conduct in the real world. Nevertheless, review highlights the lack of published controlled studies and the presence of methodological drawbacks that should be considered in future studies. This article also discusses the implications of the results obtained and proposes directions for future research.     

The interplay of personality and negative comments about appearance in predicting body image

This study investigates how personality traits in combination with frequency of and emotional reaction to negative comments about appearance while growing up are related to appearance evaluation and orientation among adult women. Nine hundred and seven participants from a representative sample of Norwegian women aged 22–55, answered questions measuring body image, personality (Big Five), and history of experiencing negative comments about appearance. Results indicated that only emotional reaction to negative comments about appearance significantly predicted both appearance evaluation and orientation, while frequency of negative comments did not. Being extrovert predicted more positive appearance evaluation and being more appearance oriented than being introvert. Scoring high on neuroticism was related to negative appearance evaluation and high appearance orientation. The findings demonstrate the importance of differentiating between the frequency and the emotional impact of teasing as well as including personality traits when studying body image.     

Body Image: A Study in a Tri-Ethnic Sample of Low Income Women

This study was designed to examine the evaluative, affective, and behavioral components of body image among 1,217 low-income European American, African American, and Latina women. Participants completed a multidimensional body image questionnaire while awaiting an outpatient clinic appointment. Body mass index (BMI) was determined by medical chart review. Nearly all normal weight and a number of overweight and obese African Americans characterized their weight as normal. In contrast, nearly all overweight and obese European Americans and Latinas regarded themselves as overweight as did over 30% of those of normal weight. European Americans and Latinas with higher BMIs reported more appearance shame than their lower BMI peers did; this pattern was not observed among African Americans. Among Latinas, body image was influenced by length of residency in the U.S. Dr. Berenson is supported by Grant Number K24HD043659, a Midcareer Investigator Award in Patient-Oriented Research, from the National Institute of Child Health and Human Development. Heather Littleton is now at Sam Houston State University.     

Treating body dysmorphic disorder with medication: evidence, misconceptions, and a suggested approach

Body dysmorphic disorder (BDD) is a relatively common and often disabling disorder with high morbidity and mortality. Both psychotropic medication and cognitive behavioral therapy (CBT) are considered first-line treatments for BDD, and medication treatment is often essential for more severely ill and suicidal patients. In this practical overview of the pharmacotherapy of BDD, we briefly describe BDD's clinical features, associated morbidity, and how to recognize and diagnose BDD. We describe the importance of forming a therapeutic alliance with the patient, the need for psychoeducation, and other essential groundwork for successful treatment of BDD. We review available pharmacotherapy research, with a focus on serotonin-reuptake inhibitors (SSRIs, or SRIs), which are currently considered the medication of choice for BDD. Many patients have substantial improvement in core BDD symptoms, psychosocial functioning, quality of life, suicidality, and other aspects of BDD when treated with appropriate pharmacotherapy that targets BDD symptoms. We also discuss practical issues such as dosing, length of treatment, and potential side effects associated with the use of SRIs. In addition, we discuss pharmacotherapy approaches that can be tried if SRI treatment alone is not adequately helpful. Finally, some misconceptions about pharmacotherapy, gaps in knowledge about BDD's treatment, and the need for additional research are discussed.     

Culture and body image: Body perception and weight concern in young Asian and Caucasian British women

The comparatively lower prevalence of eating disorders among Asian and Afro-Caribbean than Caucasian women in the UK has often been attributed to cultural differences in pressures for slimness. However, there have been no attempts to evaluate cultural differences in ideals for female physique directly among women in the at risk age groups. In the present study, cultural influences on body image were evaluated by comparing the body size ideals, body image and dieting concerns in a sample of 274 young white and Asian British women. The results indicate that Asian women are less likely to describe themselves as too fat, were less dissatisfied with their body size, less likely to want to lose weight and less restrained. However, Asian women were slimmer than white women and, after controlling for the difference in body size, the effects were reduced. The hypothesis that any body satisfaction differences could be explained by differences in ideal body size between the two groups were not supported; Asian women favoured even slimmer ideal body sizes than white women. Alternative explanations in terms of cultural differences in evaluation of fatness are discussed.     

Body image and cystic fibrosis: a critical review

A slight frame and poor appetite are common among patients with cystic fibrosis (CF) yet healthy body weight has been related to a better prognosis. A review of studies exploring body image (BI) among adults and adolescents with CF was conducted. Seven electronic databases were searched for potential papers. They located 128 references, of which 24 were read in full and 12 included in the review. Accepted papers suggested females with CF had a better BI compared to males, but this could compromise survival, given their preference for a low body weight. Males may be more motivated to adhere to nutritional advice because they favor a larger form. Practitioners should broach the topic of BI at clinic appointments to ensure this does not have a detrimental impact on self-management, although more research is required to guide professionals in this task.