The effectiveness of stand-alone cognitive-behavioural therapy for body image: a meta-analysis

This meta-analysis examined the effectiveness of stand-alone body image (BI) cognitive-behavioural therapy (CBT). Nineteen studies met inclusion criteria. The behavioural dimension of BI improves most after BI CBT while the investment dimension improves the least. Individuals with clinical BI disturbances improve more than do college student samples. Treatments addressing the attitudinal, behavioural, and perceptual components of BI are more effective than treatments addressing attitude and behaviour only. Therapist-assisted therapy is more effective than is self-directed therapy. BI variables improve somewhat more than do general psychological variables, while the latter show equivalent improvement. Finally, treatment gains are maintained at follow-up. More research is needed to better understand and treat the investment dimension of BI.     

The (mis)measurement of body image: ten strategies to improve assessment for applied and research purposes

Body image is a multifaceted construct consisting of a variety of measured dimensions. Research in the area has mushroomed in recent years, a phenomenon paralleled by an explosion in the assessments developed to measure some aspect of the construct. Unfortunately, these developments have not always been guided by a clear-cut attention to measurement issues. Assessment errors specific to the field of body image and also germane to basic psychological measurement strategies have characterized much of the work in the area. This article outlines 10 such issues with accompanying examples and suggestions for avoiding such pitfalls. Attention to these seemingly minor methodological details should result in a more consistent conceptualization of body image, utilization of appropriate measures in specific contexts, and engender more valid comparisons of findings across disparate studies.     

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.     

Measuring "negative body image": validation of the Body Image Disturbance Questionnaire in a nonclinical population

Despite numerous measures of facets of the body image construct, no single assessment broadly measures a continuum of body image disturbance. Accordingly, this study developed the Body Image Disturbance Questionnaire (BIDQ), derived from the Body Dysmorphic Disorder Questionnaire. Participants were 220 college women and 75 college men who completed an online survey containing this new assessment and established measures of body image and psychosocial functioning. Results confirmed that the Body Image Disturbance Questionnaire was internally consistent and free of impression-management response bias. For both sexes, the measure converged appropriately with other body image indices (evaluation, affect, investment, and impact), was positively correlated with depression, social anxiety, and eating disturbance. Scores on this assessment also predicted psychosocial functioning above and beyond body dissatisfaction as a predictor. Greater body image disturbance was observed among women than men, among heavier than lighter women, and among White than African American women. Limitations and future research implications 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.     

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.     

Beyond differences between the body schema and the body image: insights from body hallucinations

The distinction between the body schema and the body image has become the stock in trade of much recent work in cognitive neuroscience and philosophy. Yet little is known about the interactions between these two types of body representations. We need to account not only for their dissociations in rare cases, but also for their convergence most of the time. Indeed in our everyday life the body we perceive does not conflict with the body we act with. Are the body image and the body schema then somehow reshaping each other or are they relatively independent and do they only happen to be congruent? On the basis of the study of bodily hallucinations, we consider which model can best account for the body schema/body image interactions.     

Body image and cosmetic medical treatments

Cosmetic medical treatments have become increasingly popular over the past decade. The explosion in popularity can be attributed to several factors—the evolution of safer, minimally invasive procedures, increased mass media attention, and the greater willingness of individuals to undergo cosmetic procedures as a means to enhance physical appearance. Medical and mental health professionals have long been interested in understanding both the motivations for seeking a change in physical appearance as well as the psychological outcomes of these treatments. Body image has been thought to play a key role in the decision to seek cosmetic procedures, however, only recently have studies investigated the pre- and postoperative body image concerns of patients. While body image dissatisfaction may motivate the pursuit of cosmetic medical treatments, psychiatric disorders characterized by body image disturbances, such as body dysmorphic disorder and eating disorders, may be relatively common among these patients. Subsequent research on persons who alter their physical appearance through cosmetic medical treatments are likely provide important information on the nature of body image.     

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.     

Obesity and body image

Modern western culture emphasizes thinness, denigrates excess weight, and stigmatizes obese individuals, making it likely that obese people internalize these messages and feel badly about the physical presence that brands them. There is clear evidence that obesity is linked with poor body image, but not all obese persons suffer from this problem or are equally vulnerable. Risk factors identified thus far are degree of overweight, being female, and binge eating, with some evidence of risk increasing with early age of onset of obesity, race, and several additional factors. Treatments do exist for improving body image in overweight individuals. Key questions are how to identify those in need of body image intervention, how such programs can be integrated with weight loss treatments, and ultimately, how body image distress can be prevented.     

Assessing body image in patients with systemic sclerosis (scleroderma): validation of the adapted Satisfaction with Appearance Scale

People with scleroderma often experience disfiguring appearance-related changes in socially visible and interpersonally salient areas. Although disfigurement can lead to body image dissatisfaction, this phenomenon has not been well investigated due to the lack of a disfigurement-specific measure. The Satisfaction With Appearance (SWAP) scale, previously developed in burn survivors, was adapted and administered to 254 participants with scleroderma to evaluate its psychometric integrity and its validity for use in a different medical population that experiences changes in appearance. Principal component analysis revealed two factors – Subjective Dissatisfaction and Perceived Social Impact – rather than the four found in burn victims. Excellent estimates of internal consistency and temporal stability and strong evidence for the reliability of the two-factor solution were found. The resulting factor structure in a scleroderma population suggests that differing medical conditions may create alternate constellations of BID, reflects the need for body image researchers to assess psychometrics across medical populations and may have clinical implications for BID interventions.     

A preliminary examination of the effect of massage on state body image

Evidence suggests positive effects of massage on psychological health; however, little is known about the effects of massage on body image. This research examined the effect of massage on state body image as well as relations between trait body image and attitudes toward massage. Forty-nine female university students were randomly assigned to either a massage condition or a control condition. It was hypothesized that participants in the massage condition would report improved state body image following the intervention when compared to participants in the control condition. As predicted, participants in the massage condition reported a more favorable state body image than participants in the control condition post-manipulation. Certain body image evaluations were moderately associated with views that massage is pleasurable, with the link between Body Areas Satisfaction and viewing massage as pleasurable reaching significance. Research is needed to determine the mechanism/s through which massage improves body image.     

Body image importance and body dissatisfaction among indigenous Australian adolescents

Despite their elevated risk of health problems and a propensity to be more overweight or underweight relative to the other members of the Australian population, there has been no previous investigation of body image concerns among Indigenous Australians. In this study we investigated the level of body image importance and body image dissatisfaction among 19 rural Indigenous adolescents (7 males, 12 females) and 28 urban Indigenous adolescents (15 males and 13 females). Our hypotheses that there would be gender differences in body image importance and body image satisfaction were not generally supported. However, males placed more importance on muscle size and strength than females, and rural participants placed more importance on weight than urban participants. Comparison to existing data obtained from Caucasian adolescents suggested that Indigenous youth may be less concerned and dissatisfied with body weight and shape. These results are discussed in relation to findings from studies of non-Indigenous adolescents, and Indigenous health issues. The limitations of the current study and the need for further studies are also discussed.     

Perfectionistic self-presentation, body image, and eating disorder symptoms

A specific model for eating disorder symptoms involving perfectionistic self-presentation and two different moderators (i.e., body image evaluation and body image investment) was tested. Participants completed measures of perfectionistic self-presentation, body image dysfunction, and eating disorder symptoms. Findings indicated that all three dimensions of perfectionistic self-presentation were associated with eating disorder symptoms. Results also showed that perfectionistic self-presentation predicted eating disorder symptoms in women who were dissatisfied with their bodies, but that it did not predict eating problems in women who liked their bodies and felt there was little or no discrepancy between their actual and ideal appearances. Body image investment did not moderate the relationship between perfectionistic self-presentation and eating disorder symptoms, suggesting that ego-involvement alone is insufficient to promote eating disturbance in the context of perfectionism. The importance of self-presentation components of perfectionism and specific body image difficulties in predicting eating disorder symptoms are discussed.     

Sociocultural influences on adolescent boys' body image and body change strategies

Society provides messages about how people should ideally look and previous research has indicated these messages, both the actual messages provided and the perception of the message, influence body image. Research into male body image has shown males are concerned with having a lean and muscular body and as such, may want to decrease fat and increase their muscles. This paper explored the influence of a range of messages from parents, peers, and the media on a number of different measures of 362 adolescent boys’ body image and body change strategies. Specifically, messages about shape, food, exercise, losing weight and increasing muscles were explored in relation to satisfaction with weight and muscles, and the use of strategies to decrease weight and increase muscles. The findings indicated that parental messages were the strongest influence on body image and that parents, the media, and to a lesser extent messages from male friends were the strongest predictors of body change strategies.     

Mental body distance comparison: A tool for assessing clinical disturbances in visual body image

Despite numerous body size estimation studies, it cannot be concluded that the disturbance of body image in anorexia nervosa (AN) is specifically one of the visual body images.We adopted a visual imagery method, the Distance Comparison task, to enable across-population testing of differences in visual body image with respect to shape. Participants were asked to mentally scan across two body widths (e.g. hips and shoulders) and to decide as quickly as possible which one was longer or shorter. If the mental representation accessed to make such comparisons is visual, an inverse relation would be expected between RT and distance difference on the body to be judged (i.e. actual difference in size between the two body widths), with accuracy increasing with increasing distance difference. Females with high body shape concern (scoring high on the Body Shape Questionnaire: BSQ, n = 23) were compared to females with low body shape concern (scoring low on the BSQ, n = 19).RT and distance differences on the body demonstrated standard distance differences effects: RT increased and accuracy decreased with decreasing distance differences on the body. Groups differed with respect to accuracy, in that females high on body shape concern were significantly less accurate than females low on body shape concern when making evaluations involving small (?9 cm) differences, which implies a less appropriate visual image of the own body in the former group. With respect to the relation between RT and body distance difference, on the other hand, there were no differences between groups. We concluded that evaluations of own body size employ visual imagery and that the distance comparison task holds promise for the assessment of visual disturbances in body image in clinical populations.     

Body representations and cognitive ontology: Drawing the boundaries of the body image

The distinction between body image and body schema has been incredibly influential in cognitive neuroscience. Recently, researchers have begun to speculate about the relationship between these representations (Gadsby, 2017, 2018; Pitron & de Vignemont, 2017; Pitron et al., 2018). Within this emerging literature, Pitron et al. (2018) proposed that the long-term body image and long-term body schema co-construct one another, through a process of reciprocal interaction. In proposing this model, they make two assumptions: that the long-term body image incorporates the spatial characteristics of tools, and that it is distorted in the case of Alice in wonderland syndrome. Here, I challenge these assumptions, with a closer examination of what the term “long-term body image” refers to. In doing so, I draw out some important taxonomic principles for research into body representation.     

More than just body weight: The role of body image in psychological and physical functioning

The current study examined BMI and body image dissatisfaction as predictors of physical and mental health-related quality of life (HRQL) and psychosocial functioning in a sample of 414 undergraduate students (mean age = 21.5, SD = 4.9; mean BMI = 23.6, SD = 5.2). In men and women, higher BMI was correlated with body image dissatisfaction and physical HRQL, but not with any measures of psychosocial functioning, whereas higher body image dissatisfaction was associated with poorer physical HRQL and psychosocial functioning. Furthermore, body image dissatisfaction was observed to mediate the relationship between BMI and physical HRQL in men and women. Interestingly, in this model, higher BMI predicted increased self-esteem. These findings suggest that body image dissatisfaction may be an important target for health interventions.     

The swimsuit issue: Correlates of body image in a sample of 52,677 heterosexual adults

Past research on adults’ body image has typically used small convenience samples, limiting the ability to examine associations of personal characteristics to body satisfaction. This study of 52,677 heterosexual adults ages 18–65 examined associations of body satisfaction to age, height, gender, and body mass index (BMI). Age and height were mostly unrelated to body satisfaction. Consistent with an Objectification Theory perspective, fewer men than women reported being too heavy (41% versus 61%), rated their body as unattractive (11% versus 21%), or avoided wearing a swimsuit in public (16% versus 31%). Men felt better about their bodies than women across most of the weight span, although among underweight individuals, women felt better than men. Slender women (BMIs 14.5–22.49) were more satisfied than most other women (BMIs 22.5–40.5). Among men, underweight and obese men were least satisfied. These findings highlight gender differences in the association of weight to body satisfaction.     

Raising the bar on the body beautiful: An analysis of the body image concerns of homosexual men

Research suggests that gay men are at particular risk for body image dissatisfaction. This study seeks to extend research on gay men's body image concerns. A survey assessed the nature and correlates of body image dissatisfaction among 64 gay men. The survey included assessments related to involvement in and perceived acceptance within the gay community, social comparison tendencies, body image satisfaction, self-esteem, and depression. The results indicate that most participants were concerned with muscularity rather than weight. Greater social comparison tendencies and higher body mass index (BMI) were associated with greater body dissatisfaction. Although involvement and perceived acceptance in the gay community did not independently predict general body image dissatisfaction, there is evidence to suggest that the association between body image and self-esteem may be moderated by integration into the gay community, defined as involvement and perceived acceptance. Implications for the further study of gay men's body image are discussed.