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.     

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.     

The Physical Appearance Ambiguous Feedback Scale (PAAFS): a measure for indexing body image related cognitive bias

Recent conceptualizations of body image disturbance have included an information processing model that includes a focus on an interpretive information processing bias. Study 1 involved the development and validation of a measure of appearance-based cognitive bias, the Physical Appearance Ambiguous Feedback Scale (PAAFS). In Studies 2 and 3, two samples of college females (n=313) were tested and the psychometric characteristics of the PAAFS were evaluated. Reliability was acceptable and convergence with measures of body image and eating disturbance was moderate. In Study 4, 313 college females completed the PAAFS in the laboratory based on an instructional content designed to induce processing bias. Preliminary evidence indicates that the PAAFS appears to be sensitive to instructional set manipulations and dispositional level of body dissatisfaction.     

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.     

Body images of patients with anorexia nervosa, bulimia nervosa and female control subjects: a comparison with male ideals of female attractiveness

Body images of female patients with anorexia nervosa and bulimia nervosa were assessed against females without eating disorders and compared with male ideals of female attractiveness. A computer program was applied to examine body images of 62 patients with anorexia nervosa, 45 patients with bulimia nervosa, and 40 female and 39 male control subjects. Body size overestimation was most distinct in the two patient groups. Self-ideal discrepancy was highest in bulimia nervosa. Estimation of the society's ideal female body in all three female groups did not differ from men's perception of the most attractive female body. Congruence of ideals of female attractiveness in patients, female, and male control subjects and described differences between patients and female controls support the theory that body image disturbance is a problem of processing self-referential information regarding body image rather than a problem of processing body image related information per se.     

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.     

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.     

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.     

Three-dimensional coherence of the conscious body image

We experience our body as a coherent object in the three-dimensional (3-D) world. In contrast, the body is represented in somatosensory cortex as a fragmented collection of two-dimensional (2-D) maps. Recent results have suggested that some forms of higher level body representations maintain this fragmentation, for example by showing different patterns of distortion for two surfaces of a single body part, such as the palmar and dorsal hand surfaces. This study investigated the 3-D coherence of the conscious body image of the hand by comparing perceptual biases of perceived hand shape on the dorsal and palmar surfaces. Participants made forced-choice judgements of whether observed hand images were thinner or wider than their own left or right hand, and perceptual distortions of the hand image were assessed by fitting psychometric functions. The results suggested that the hand is consciously represented as a fully coherent, 3-D object. Specifically: (a) Similar overall levels of distortion were found on the palmar and dorsal hand surfaces, (b) comparable laterality effects were found on both surfaces (left hand represented as wider than right hand), and (c) the magnitude of distortions were strongly correlated across the two surfaces. Whereas other recent results have suggested that perceptual abilities such as position sense, tactile size perception, and tactile localization may rely on fragmented, 2-D representations of individual skin surfaces, the present results suggest that, in striking contrast, the conscious body image represents the body (or, at least the hand) as a coherent, 3-D object.     

Cosmetic surgery in inpatients with eating disorders: attitudes and experience

Body image disturbance is frequent among individuals undergoing cosmetic surgery and core to the pathology of eating disorders (ED); however, there is little research examining cosmetic surgery in ED. This study examined body image related measures, ED behaviors, and depression as predictors of attitudes toward cosmetic surgery in 129 women with ED. Patients who had undergone surgery (n = 16, 12%) were compared to those who had not. Having a purging diagnosis, linking success to appearance, and making physical appearance comparisons were predictive of more favorable cosmetic surgery attitudes. All of those who had undergone surgery had purging diagnoses and, on average, were older, had higher BMIs, and were more likely to make physical appearance comparisons and know someone who had undergone surgery. In ED, acceptance and pursuit of cosmetic surgery appears to be related to social group influences more than weight and shape disturbance, media influences, or mood.     

Body talk and body-related co-rumination: Associations with body image,eating attitudes,and psychological adjustment

Talk about physical appearance and body image is common among young women. We investigated how body talk (negative, positive/self-accepting, and co-ruminative) is related to body image, body-related cognitive distortions, disordered eating, psychological adjustment, and friendship quality via hierarchical regression analyses (controlling for social desirability and body mass index). In a sample of young adult women (N = 203), negative body talk was, as predicted, negatively related to body satisfaction and self-esteem and positively related to appearance investment, body-related cognitive distortions, disordered eating, and depression, but not friendship quality. Self-accepting/positive body talk was negatively related to body-related cognitive distortions and positively related to body satisfaction, self-esteem, and friendship quality. Body-related co-rumination demonstrated adjustment trade-offs, being related to body-related cognitive distortions, disordered eating, and higher friendship quality. Results indicated no advantage to negative body talk, both individual and relationship benefits from positive/self-accepting body talk, and mixed outcomes for body-related co-rumination     

Validation and predictive utility of the Sociocultural Attitudes Toward Appearance Questionnaire for Eating Disorders (SATAQ-ED): internalization of sociocultural ideals predicts weight gain

A widely used measure of societal influences on body image and eating disturbances—the Sociocultural Attitudes Toward Appearance Questionnaire (SATAQ) was validated in women with eating disorders. The original SATAQ and measures of convergence and divergence were administered to 165 eating disordered inpatients. Factor analyses were conducted to determine the underlying structure of the SATAQ. Convergent validity, diagnostic category norms and the predictive utility of the revised SATAQ were examined. Factor analyses indicated three factors: Internalization, Awareness, and Success. Internalization significantly predicted treatment success after controlling for admission BMI and drive for thinness. The revised SATAQ-ED measures multiple aspects of societal influence, predicts short-term outcome, and can be a useful tool for evaluating potential outcome and treatment efficacy.     

Understanding the relationships between body esteem,risk for anorexia nervosa,and domain-dependent decision-making impulsivity in a college sample

Impulsivity has been suggested to interact with low body esteem to elevate risk for anorexia nervosa. Discounting tasks are unique tools for examining impulsivity. Female college students (N = 139) at varying levels of body esteem and risk for anorexia nervosa responded to discounting scenarios depicting opportunities to lose/gain weight and to worsen/improve complexion. Multiple regression analyses were used to examine the relationships between impulsivity and risk for anorexia nervosa and body esteem in four disorder-relevant decision-making contexts. Results indicated that lower decision-making impulsivity predicted lower body esteem levels when the outcome of the task was framed as an opportunity to lose weight. It is suggested that greater self-control regarding weight-loss in women with low body esteem may be problematic, placing them at higher risk for eating- and weight-related problems. Results reiterate the need for continued attention to fostering healthy body esteem and weight-control patterns in women on college campuses.     

The effectiveness of enhanced cognitive behavioural therapy for eating disorders: an open trial

The aim of this study was to examine the effectiveness of Enhanced Cognitive Behaviour Therapy (CBT-E) for eating disorders in an open trial for adults with the full range of eating disorders found in the community. The only previously published trial of CBT-E for eating disorders was a randomised controlled trial (RCT) conducted in the U.K. for patients with a BMI ≥ 17.5. The current study represents the first published trial of CBT-E to include patients with a BMI < 17.5. The study involved 125 patients referred to a public outpatient clinic in Perth, Western Australia. Patients attended, on average, 20–40 individual sessions with a clinical psychologist. Of those who entered the trial, 53% completed treatment. Longer waiting time for treatment was significantly associated with drop out. By the end of treatment full remission (cessation of all key eating disorder behaviours, BMI ≥ 18.5 kg/m², not meeting DSM-IV criteria for an eating disorder) or partial remission (meeting at least 2 these criteria) was achieved by two thirds of the patients who completed treatment and 40% of the total sample. The results compared favourably to those reported in the previous RCT of CBT-E, with one exception being the higher drop-out rate in the current study. Overall, the findings indicated that CBT-E results in significant improvements, in both eating and more general psychopathology, in patients with all eating disorders attending an outpatient clinic.     

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 and disfigurement: issues and interventions

Whether present at birth, congenital or acquired later in life, a visible disfigurement can have a profound psychological impact upon the individual concerned. Difficulties include adverse effects on body image, quality of life, and self-esteem. In addition, social encounters can present many challenges, however many individuals adapt to the demands placed upon them and appear relatively unaffected by their visible difference. This article reviews current literature exploring the psychosocial implications of living with a visible difference and considers the complex influence of physical, cultural, and psychosocial factors on adjustment. Attempts that have been made to theorise individual’s experiences, relevant interventions and care provision are then examined and the challenges facing researchers in this area are outlined.     

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.     

Body Poly-texts: Discourses of the Anorexic Body

It is now increasingly acknowledged that anorexia nervosa is a ‘culture-bound syndrome’ which must be understood within the context of an increasing idealization of female thinness and a high prevalence of dieting and body dissatisfaction, particularly amongst women and girls. Whilst this socioculturally-oriented perspective is important, it is also simplistic to conceptualize anorexia simply as a ‘slimmer's disease’. The ways in which contemporary Western culture is imbricated in anorexia are both complex and multiple. This paper uses a discourse-analytic approach, informed by feminist Foucauldian theory, to examine some of the multiple and often conflicting meanings and discursive constructions of the (female) anorexic body. The paper is based on a series of interviews conducted with 23 women (21 diagnosed as anorexic and 2 self-diagnosed). The analysis focuses on the explication of two discourses: a romantic discourse and a discourse of Cartesian dualism evidenced in the interviews. By contrasting the very different ways in which these two discourses constitute the anorexic body, this paper aims to provide thereby a socioculturally contextualized and gender-oriented account of the multiple discursive constructions of ‘anorexia nervosa’ and ‘anorexic’ bodies. Implications for psychotherapeutic interventions are discussed.     

Body image variability: the influence of body-composition information and neuroticism on young women's body dissatisfaction

The current studies consider the effect of body size, body composition feedback, and the moderating influence of neuroticism (N) on three measures of body dissatisfaction (BD) in young women. In Study One, normal-sized subjects who were given false feedback indicating that they were either fatter or leaner than average showed heightened BD compared to groups who received either accurate or no feedback about body size. There was no evidence of a moderating effect of N. In Study Two, thinner-than-average subjects who received accurate body-size feedback showed greater satisfaction than a control group receiving no information. For heavier than average subjects, feedback only increased BD for those low on N. Although these results show mixed support for N as a moderator, they are the first to show an effect of body composition information on BD.     

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.