Body image in eating disorders: the influence of exposure to virtual-reality environments

The aim of this article was to study the effect of virtual-reality exposure to situations that are emotionally significant for patients with eating disorders (ED) on the stability of body-image distortion and body-image dissatisfaction. A total of 85 ED patients and 108 non-ED students were randomly exposed to four experimental virtual environments: a kitchen with low-calorie food, a kitchen with high-calorie food, a restaurant with low-calorie food, and a restaurant with high-calorie food. In the interval between the presentation of each situation, body-image distortion and body-image dissatisfaction were assessed. Several 2?x?2?x?2 repeated measures analyses of variance (high-calorie vs. low-calorie food?x?presence vs. absence of people?x ED group vs. control group) showed that ED participants had significantly higher levels of body-image distortion and body dissatisfaction after eating high-calorie food than after eating low-calorie food, while control participants reported a similar body image in all situations. The results suggest that body-image distortion and body-image dissatisfaction show both trait and state features. On the one hand, ED patients show a general predisposition to overestimate their body size and to feel more dissatisfied with their body image than controls. On the other hand, these body-image disturbances fluctuate when participants are exposed to virtual situations that are emotionally relevant for them.     

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.     

Body image or body images?: Comparative, multidimensional assessment among college students

A major criticism of research on body image concerns the dubious assumptions of the unidimensionality of the construct and the equivalence of body-image measures. Our study of 125 male and female college students compared multiple measurement methods within each of two modalities of body image: (a) perceptual (body-size estimation) and (b) attitudinal (body-image affect and cognition). Clinically relevant indices of psychological adjustment and eating disturbance were included. Results clearly supported the distinction between attitudinal and perceptual modalities of body image and indicated more convergent and discriminant validity for the former than for the latter. Whereas one method of assessing size-estimation accuracy and most body-image attitudes produced relationships with maladjustment, only attitudinal body image and perceptual, self-ideal discrepancy measures were significantly linked to eating disturbance. Relationships were generally more consistent for women than for men. Implications are discussed in the context of extant and future research on body image with clinical and nonclinical populations.     

Body Image or Body Images?: Comparative,Multidimensional Assessment Among College Students

A major criticism of research on body image concerns the dubious assumptions of the unidimensionality of the construct and the equivalence of body-image measures. Our study of 125 male and female college students compared multiple measurement methods within each of two modalities of body image. (a) perceptual (body-size estimation) and (b) attitudinal (body-image affect and cognition). Clinically relevant indices of psychological adjustment and eating disturbance were included. Results clearly supported the distinction between attitudinal and perceptual modalities of body image and indicated more convergent and discriminant validity for the former than for the latter. Whereas one method of assessing size-estimation accuracy and most body-image attitudes produced relationships with maladjustment, only attitudinal body image and perceptual, self-ideal discrepancy measures were significantly linked to eating disturbance. Relationships were generally more consistent for women that for men. Implications are discussed in the context of extant and future research on body image with clinical and nonclinical populations.     

Considering J.Lo and Ugly Betty: a qualitative examination of risk factors and prevention targets for body dissatisfaction, eating disorders, and obesity in young Latina women

Latina women are vulnerable to poor body image, eating disorders, and obesity, particularly during the college years. This study sought to identify common cultural antecedents of these concerns in order to inform the development of prevention programs for this population. Six groups of university students who identified as Latina (N=27) discussed cultural aspects of body image, eating disorders, and obesity. Thematic analysis identified four main themes: (a) cultural disparities in body-ideal, including the influence of the media and acculturation issues; (b) messages about body shape and weight received by family, peers, and society; (c) difficulties making healthy eating and physical activity choices as a function of college life; and (d) the influence of peers and potential male partners on body satisfaction and body-ideals. These results have implications for the development of programs targeting body dissatisfaction and risk for eating disorders and obesity in Latina college women.     

Weight concerns among elementary school children: a review of prevention programs

There is increasing evidence that children display high levels of weight and muscle concerns, which include body dissatisfaction and problem eating. In order to address these issues, researchers have designed and implemented prevention programs for this age group. Thirteen published studies were located and reviewed, with children aged 8-12 years from elementary schools, or equivalent. Overall, the programs were shown to be effective in improving children's knowledge at post-test and at follow-up assessments. However, there is limited evidence to show that the programs reduced or prevented body image concerns and/or problem eating. Too few studies have examined muscle concerns so no conclusions can yet be drawn about this domain. Limitations of the studies and suggestions for future prevention efforts are discussed.     

Effects of Participant’s Choice of Different Digital Interventions on Outcomes for Binge-Spectrum Eating Disorders: A Pilot Doubly Randomized Preference Trial

It is unclear whether offering individuals a choice between different digital intervention programs affects treatment outcomes. To generate initial insights, we conducted a pilot doubly randomized preference trial to test whether offering individuals with binge-spectrum eating disorder a choice between two digital interventions is causally linked with superior outcomes than random assignment to these interventions. Participants with recurrent binge eating were randomized to either a choice (n = 77) or no-choice (n = 78) group. Those in the choice group could choose one of the two digital programs, while those in the no-choice group were assigned a program at random. The two digital interventions (a broad and a focused program) took 4 weeks to complete, were based on cognitive-behavioral principles and have demonstrated comparable efficacy, but differ in scope, content, and targeted change mechanisms. Most participants (79%) allocated to the choice condition chose the broad program. While both groups experienced improvements in primary (Eating Disorder Examination Questionnaire global scores and number of binge eating episodes over the past month) and secondary outcomes (dietary restraint, body image concerns, etc.), no significant between-group differences were observed. The two groups did not differ on dropout rates, nor on most indices of intervention engagement. Findings provide preliminary insights towards the role of client preferences in digital mental health interventions for eating disorders. Client preferences may not determine outcomes when digital interventions are based on similar underlying principles, although larger trials are needed to confirm this.     

Prevention program for disturbed eating and body dissatisfaction in a Spanish university population: a pilot study

A pilot study was carried out in university students to evaluate the effect of a health promotion program for eating disturbances and body dissatisfaction. A subgroup of 135 medical students of both sexes in their second year was selected. There were divided in three groups, high-risk students (EDI > 40) and low-risk students (EDI < 40) who participated in the program and nonparticipants as comparison group. Program had a total of 16 workshops of 90 min. A year later the different assessment measurements were compared, body image, attitudes and eating behaviours, psychopathological levels and self-esteem. Differences by gender were found on the impact of the intervention. The program presented a statistical significant improvement in body-image satisfaction, eating attitudes only in high-risk female students in the intervention group. This pilot program for eating disorder prevention in university populations can be considered effective, mainly in female populations at risk for developing an eating disorder.     

Clarifying body-image disturbance: analysis of a multidimensional model using structural modeling

A multidimensional model of body-image disturbance was tested. The model incorporated the concepts of body-size distortion, preference for thinness, body dissatisfaction, and fear of fatness as predictors of restrictive eating. The LISREL 7 program was used to perform a structural modeling analysis of the theoretical model. A total of 175 women participated in the study (54 eating-disordered patients and 121 undergraduate students). The results supported the hypothesized four-dimensional model relative to alternative one-, two-, and three-dimensional models. Body dissatisfaction appeared to be directly affected by both body-size distortion and preference for thinness. Fear of fatness was found to be the best predictor of restrictive eating. The results appeared consistent across the clinical and nonclinical samples. These data may help resolve many of the current controversies in the body-image literature. The results also suggested the need to develop more sound assessment instruments for fear of fatness.     

New assessments of weight-related body image derived from extant instruments

A study of 79 female college students examined the reliability and validity of two new size/weight-related measures of body image. The Body-size Appraisal Scale and the Overweight Preoccupation Scale were derived from existing instruments. Analyses supported the internal consistency and 2-wk. test-retest reliability of both new scales. Correlations of scores on each scale with measures of anxiety about being fat, negative body-image affect and avoidance, restrained and bulimic eating, and depression support their concurrent and construct validity. Scores on the Overweight Preoccupation Scale were also related to the extent of investment in physical appearance. Regression analyses indicated that each new scale could be predicted from several other conceptually relevant body-image attitudes, even after actual body weight was controlled.     

Confirmatory factor analysis of eating disorder symptoms in college women

Recent studies have found that the eating disorders can best be conceptualized as multidimensional. Four factors have consistently emerged from factor analytic studies of eating disorder symptoms: dietary restraint, bulimic behaviors, neurotic personality characteristics, and body image/body dysphoria. Confirmatory factor analysis was utilized to determine if this four-factor structure of eating disorder symptoms would be found in a sample of college women. Principal components analysis extracted four factors which were supported with a confirmatory factor analysis procedure. These four factors were negative affect and body dysphoria, bulimic behaviors, restrictive eating, and body image. The negative affect and body dysphoria factor was positively correlated with the other factors (i.e., bulimic behaviors, restrictive eating, and body image). This factor structure was similar to the factor structure found in samples of patients with bulimia and anorexia nervosa, except that the factors were more highly intercorrelated in the nonclinical sample. Results suggest that the measures of eating disorder symptoms used in this investigation are measuring the same multidimensional constructs in clinical and nonclinical subjects.This paper is partially based upon the master's thesis of the first author.     

Body image, shape, and volumetric assessments using 3D whole body laser scanning and 2D digital photography in females with a diagnosed eating disorder: preliminary novel findings

We piloted three-dimensional (3D) body scanning in eating disorder (ED) patients. Assessments of 22 ED patients (including nine anorexia nervosa (AN) patients, 12 bulimia nervosa (BN) patients, and one patient with eating disorder not otherwise specified) and 22 matched controls are presented. Volunteers underwent visual screening, two-dimensional (2D) digital photography to assess perception and dissatisfaction (via computerized image distortion), and adjunctive 3D full-body scanning. Patients and controls perceived themselves as bigger than their true shape (except in the chest region for controls and anorexia patients). All participants wished to be smaller across all body regions. Patients had poorer veridical perception and greater dissatisfaction than controls. Perception was generally poorer and dissatisfaction greater in bulimia compared with anorexia patients. 3D-volume:2D-area relationships showed that anorexia cases had least tissue on the torso and most on the arms and legs relative to frontal area. The engagement of patients with the scanning process suggests a validation study is viable. This would enable mental constructs of body image to be aligned with segmental volume of body areas, overcoming limitations, and errors associated with 2D instruments restricted to frontal (coronal) shapes. These novel data could inform the design of clinical trials in adjunctive treatments for eating disorders.     

Use of 3-dimensional body scans for body-image research

This preliminary study explored the use of highly realistic 3-dimensional body-scan images as a potential tool, taking advantage of a much more specific and expanded representation of the entire body. Traditionally, body-image research makes use of various contour drawing scales whose 2-dimensional figures increase proportionately and do not match the shape of many women. The study tested whether body-scanned images (N = 85) could be consistently "matched" to individual figures on a contour drawing scale. Internal consistency and interrater reliability were calculated and high coefficients were observed (alpha = .97, kappa = .80). The potential of utilizing 3-dimensional images either as more realistic somatotypes in contour-rating scales or as a measurement of body-image satisfaction using computer manipulation of a digital image is discussed.     

Les troubles des comportements alimentaires chez des étudiants de première année : une étude prospective multigroupes

There is increasing use of the phrase “campus eating symptoms” to describe regular binge eating (together with frequent exercise, and occasional reliance on vomiting or laxatives), concerns about body image, depressive symptoms, stress, and university adjustment problems among students. Incidence of eating disorders in the early grades of university is increasing, and the period from age 17–19 years (peak of bulimia) which corresponds to the beginning of study at university is critical. Given the stressful environment that is the 1st academic year, it is useful to consider eating disorders risk factors.

Method

Our study is longitudinal. At the beginning, the participants consisted of 1110 freshmen. Data regarding adjustment to university, gender, body image, BMI, transactional variables (perceived stress and coping) and eating disorders (EAT-26) were collected. At T2 (end of academic year), 556 students were recruited to reassess their eating behaviours. The aim of the study was to test gender invariance of a theoretical eating disorders model including all these variables and eating disorders measured a year apart from a mixed population integrating the university for the first times. This model assumes that these variables exert direct effects on eating disorders as measured in time one who in turn will affect the stability of these troubles a year later. Although very little research include boys in the study of eating disorders, the results of our multi-group analysis support the idea of the existence of sex differences in eating disorder predictors: the only common predictor of eating disorders among girls and boys was the use emotion-focused coping. Among boys, the best predictors of eating disorders were problem-focused coping, and seeking social support. Among girls, our results revealed that body mass index, body image, and academic adjustment and stress were the predictors of eating disorders. Finally, we found a temporal stability of eating disorders. This study showed that personal and contextual aspects have a direct impact on students’ eating behaviour. However, among boys, neither body image nor perceived stress affect the eating behaviour but how they cope with stress. The gender gap in the explanation of eating disorders suggest to not exclude the male population in this type of study and to treat the data separately.     

Day-to-day body-image states: prospective predictors of intra-individual level and variability

Most body-image research has focused on the trait level of body-image evaluation, often neglecting the momentary fluctuations many people experience in everyday life. The present prospective study investigated whether theory-relevant body-image measures, perfectionistic self-presentation, and eating attitudes would predict average day-to-day body-image levels and their intra-individual variability. A convenience sample consisted of 121 women from two universities. In Phase 1 of the study, participants completed an online battery of selected body-image and personality questionnaires. In Phase 2, participants went online to complete the dependent measure, the Body Image States Scale, once per evening over 10 days. As hypothesized, more favorable body-image state levels were associated with less investment in appearance for self-worth, less body-image disturbance, fewer body-image cognitive distortions, less disturbed eating attitudes, and lower body mass. Moreover, greater day-to-day body-image variability was predicted by greater psychological investment in appearance, more body-image cognitive distortions, and higher perfectionistic self-presentation. Implications and future directions for research are discussed.     

Body-image and eating disturbances prospectively predict increases in depressive symptoms in adolescent girls: a growth curve analysis

Using data from a longitudinal community study (N = 231), the authors tested whether body-image and eating disturbances might partially explain the increase in depression observed in adolescent girls. Initial pressure to be thin, thin-ideal internalization, body dissatisfaction, dieting, and bulimic symptoms, but not body mass, predicted subsequent increases in depressive symptoms, as did increases in these risk factors over the study. There was also prospective support for each of the hypothesized mediational relations linking these risk factors to increases in depressive symptoms. Effects remained significant when other established gender-nonspecific risk factors for depression (social support and emotionality) were statistically controlled. Results provide support for the assertion that body-image and eating disturbances, operating above and beyond gender-nonspecific risk factors, contribute to the elevated depression in adolescent girls.     

Assessing the Role of Body Image Coping Strategies as Mediators or Moderators of the Links Between Self-Objectification, Body Shame, and Well-Being

We examined self-objectification in relation to well-being, and the potential moderating versus mediating role of body image coping strategies (appearance fixing, avoidance, positive rational acceptance). Undergraduate women from southern Ontario, Canada (Sample 1, n?=?104; Sample 2, n?=?314) completed measures of depression, disordered eating attitudes, subjective well-being, and body-image coping. Self-objectification was related to greater depression, disordered eating attitudes, and lower subjective well-being. A two-stage mediation model was supported: Body shame and body image coping strategies (appearance fixing and avoidance) partially mediated the associations between self-objectification and outcomes; appearance fixing and avoidance partially mediated the associations between body shame and outcomes. Body image coping strategies did not moderate any of the relations between body shame and outcomes.     

A program for assessing body image disturbance using adjustable partial image distortion

Body image disturbance has been one of the most widely studied areas in the literature on eating disorders. Some of the tasks designed to assess it have been used to estimate the sizes of specific parts of the body, whereas others have served to make estimations of overall body size. In recent years, the introduction of innovative computing procedures has allowed the two approaches to be combined and has made their application more straightforward. The program we describe here (Body Image Assessment Software, or BIAS) evaluates body image distortions and body dissatisfaction via the on-screen presentation of a scale image, the different components of which can be modified by the patient. The program was developed using Microsoft Access 2000 and Visual Basic for applications. It can be run on any computer with Windows and Microsoft Access 2000 or Microsoft Access 2000 RunTime, which makes it particularly easy to use and enables direct analysis of the recorded data through the use of applications such as SPSS.     

Psychometric properties of the Situational Inventory of Body-Image Dysphoria-Short form in a Spanish sample

The primary objective of this study was to translate and validate Situational Inventory of Body-Image Dysphoria-Short form (SIBID-S) in a Spanish population. The scale consists of 20 items to assess the frequency of dysphoric body-image emotions in certain situational contexts, using a five-point rating scale. The questionnaire was administered to 214 women between the ages of 14 and 29 years, from primary and secondary schools and a university. Principal components analysis indicated a one-factor structure for the entire sample and both younger (<18) and older (≥18) participants. Internal consistency was high (0.94), and the test–retest reliability over 1 month ranged between 0.89 and 0.93. The SIBID-S showed good convergent validity in relation to other pertinent measures of body image, eating pathology, and self-esteem. Moreover, the SIBID-S was differentiated low-risk, subclinical eating disturbed, and clinical eating disordered patients. Results support the potential utility of the SIBID-S in the Spanish female population, including a younger group than previously studied, as well as its usefulness in the assessment of body image among females varying in degrees of eating pathology.