The role of body image and self‐perception in anorexia nervosa: the neuroimaging perspective

Anorexia nervosa is a severe psychiatric illness characterized by intense fear of gaining weight, relentless pursuit of thinness, deep concerns about food and a pervasive disturbance of body image. Functional magnetic resonance imaging tries to shed light on the neurobiological underpinnings of anorexia nervosa. This review aims to evaluate the empirical neuroimaging literature about self‐perception in anorexia nervosa. This narrative review summarizes a number of task‐based and resting‐state functional magnetic resonance imaging studies in anorexia nervosa about body image and self‐perception. The articles listed in references were searched using electronic databases (PubMed and Google Scholar) from 1990 to February 2016 using specific key words. All studies were reviewed with regard to their quality and eligibility for the review. Differences in brain activity were observed using body image perception and body size estimation tasks showing significant modifications in activity of specific brain areas (extrastriate body area, fusiform body area, inferior parietal lobule). Recent studies highlighted the role of emotions and self‐perception in anorexia nervosa and their neural substrate involving resting‐state networks and particularly frontal and posterior midline cortical structures within default mode network and insula. These findings open new horizons to understand the neural substrate of anorexia nervosa.     

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.     

Cross‐cultural,population‐based study on adolescent body image and eating distress in Japan and Finland

This cross‐sectional population‐based survey compares the prevalence of self‐reported body image and eating distress symptoms among adolescents in Japan and Finland, and associations between emotional/behavioral problems, body image and eating distress from a cross‐cultural perspective. The study included 1,840 Japanese and 1,135 Finnish 8th grade students. The self‐reported questionnaire included the Body Image and Eating Distress Scale and Strengths and Difficulties Questionnaire (SDQ). The female adolescents from both Finland and Japan reported much greater dissatisfaction with, and concern about, their bodies than the males and Japanese females expressed even higher distress than Finnish females. High levels of body image and eating distress were associated with psychiatric problems measured with the SDQ. There was a significant three‐way interaction effect of body image and eating distress, gender and country with SDQ peer problems and prosocial behavior.     

Effects of a physical exercise session on state body image: The influence of pre-experimental body dissatisfaction and concerns about weight and shape

The effects of a physical exercise session on state body image and mood were examined. In a cross-over design, participants were randomised to two groups starting either with physical exercise (PE; experimental condition) or with reading a newspaper (RN; control condition). Before and after PE and RN, participants (N = 65) rated their body dimensions using a digital photo distortion technique and indicated their attitudinal body image and mood. Participants’ judgements of their ‘felt’ body dimensions and attitudes toward their own body were affected differently by PE and RN, indicating that participants felt slightly slimmer and were more satisfied with their bodies after PE. Exercise-induced changes in body perception were greater, the higher the pre-experimental drive for thinness, body dissatisfaction and weight/shape concerns were. Especially in those participants with higher body image disturbances, physical exercise can have a reinforcing effect on immediate body image and mood improvement.     

A review of existing measures of attentional biases in body image and eating disorders research

Cognitive theories emphasise the important role of attentional biases in the development and maintenance of body image issues and eating pathology. A wealth of research has been conducted to examine attentional biases toward body‐related information among individuals with eating pathology. However, there is considerable variability in the methods that have been used to measure attention and, importantly, these methods tap into different attentional processes. Given the multifaceted nature of attention, it is important for researchers to select the right tools to test their hypotheses. This review critically evaluates the attentional measures that have been used in previous research, primarily the modified Stroop task, dot probe task, visual search task, and eyetracking. The strengths and limitations of each measure will be discussed in order to provide a guide for researchers to further investigate the attentional mechanisms underlying body image issues and eating disorders. Overall, we recommend that researchers use a combination of eyetracking technology and specific reaction‐time measures that target the specific attentional mechanism of interest.     

Gendered pathways to romantic attachment in emerging adults: The role of body image and parental support

This study analyses the impact of body image and perceived parental behaviour (support and negativity) as factors that contribute to romantic attachment in emerging adulthood. In a 11-year longitudinal study on 144 females and 114 males, we assessed body image, body mass index, and perceived father's and mother's support and negativity during adolescence (at ages 14 and 17) and in emerging adulthood (age 21). At the age of 25, romantic attachment was assessed. Results of path analyses revealed that females' positive body image was consistently linked with greater parental support over time and contributed to low avoidance in romance at the age of 25, whereas perceived negativity with fathers mediated by body image contributed to more avoidance in females' later romantic relationships. In contrast, parental support and negativity during adolescence and young adulthood had no impact; only a positive body image resulted in males' low avoidance in later romantic attachment at the age of 25. The findings point to gendered socialization for males and females and highlight the importance of body image for an adaptive romantic outcome in emerging adulthood.     

Between a suffering body and a body in a state of need: Aulagnier’s theory of discourses on the body applied to primitive mental states

ABSTRACT

In her theory of discourses on the body, Aulagnier makes the comparison of the concept of ‘a suffering body’ and the concept of ‘a body in a state of need’. The last type is what she thinks is often found in addiction, anorexia and in borderline states, conditions marked by a radical negativity. On the other hand, ‘a suffering body’ is a concept that indicates a relation and two bodies, mother’s and child’s, that communicate. Suffering and infantile sexuality is a first attempt to accept separation by weaving a net of fantasy over the abyss of lack and separation. If pleasure and suffering are lacking as representations, the sensory reactions may exist physiologically but without psychical existence. The concepts of ‘a suffering body’ and 'a body in a state of need' will enable us to think about important structural differences between neurotic-, borderline- and psychotic conditions. As a foundation for her concepts lies a metapsychological elaborations of three kinds of processes for representation: the primal-, the primary- and the secondary process.     

The hijab as a protective factor for body image and disordered eating: a replication in French Muslim women

We examined differences in body image and disordered eating between Muslim women who do and do not wear the hijab in France, a nation marked by religious-based sartorial censorship. In an online survey, 450 French Muslim women completed measures of hijab use, weight discrepancy, disordered eating, body image-related constructs, religiosity, perceived support from Allah, and perceived discrimination. Controlling for religiosity and support from Allah, women who wore the hijab reported significantly lower weight discrepancy, body dissatisfaction, drive for thinness, social physique anxiety, internalisation of the thin and muscular ideals, and pressure to attain ideals from peers and the media, though they also reported significantly higher perceived discrimination than those who did not wear the hijab. Further analyses showed that use of the hijab was significantly associated with weight discrepancy and disordered eating. Our results suggest that use of the hijab may offer a protective element for French Muslim women.     

Understanding body image disturbance in the promotion of mental health: a discourse analytic study

Health care interventions in the area of body image disturbance and eating disorders largely involve individual treatment approaches, while prevention and health promotion are relatively underexplored. A review of health promotion activities in the area of body image in Australia revealed three programmes, the most extensive and longest standing having been established in 1992. The aims of this programme are to reduce body image dissatisfaction and inappropriate eating behaviour, especially among women. Because health promotion is concerned with the social aspects of health, it was hypothesized by the authors that a social understanding of body image and eating disorders might be advanced in a health promotion setting and reflected in the approach to practice. In order to examine approaches to body image in health promotion, 10 health professionals responsible for the design and management of this programme participated in a series of semi‐structured interviews between 1997 and 2000. Three discursive themes were evident in health workers' explanations of body image problems: (1) cognitive‐behavioural themes; (2) gender themes; and (3) socio‐cultural themes. While body image problems were constructed as psychological problems that are particularly experienced by women, their origins were largely conceived to be socio‐cultural. The implications of these constructions are critically discussed in terms of the approach to health promotion used in this programme. Copyright © 2001 John Wiley & Sons, Ltd.     

Changing the body image concern and eating behaviour of chronic dieters: The effects of a psychoeducational intervention

Abstract

A program designed to diminish body image concern and to normalise the eating of chronic dieters was evaluated experimentally and by monitoring outcomes for 12 months. The subjects were 82 females (mean age 44.4 years, mean BMI 31.4). Data from repeated measures of eating style, self-esteem and body shape concern revealed a strong, positive and enduring intervention effect. At 12 months the majority (86%) of the subjects were not dieting and 73% reported “sometimes” or “often” engaging in natural eating, i.e., unrestrained and physiologically cued eating. A positive relationship was found between extent of natural eating and the likelihood of weight loss or weight maintenance. It is concluded that female dieters can derive considerable benefits from programs promoting natural eating.     

Physical activity and body image: Intertwined health priorities identified by transmasculine young people in a non-metropolitan area

Abstract

Background: A dearth of research exists about the health behaviors of transgender young people (TYP). As we seek to learn more about transgender (trans) health, community-based participatory research (CBPR) approaches are crucial for incorporating TYP’s needs into the formulation of research questions and development of health behavior programing.

Aim: Explore body image and exercise as priorities among TYP.

Methods: Trans masculine young adults (N?=?16) in a small city in the Midwest took part in semi-structured interviews about their health behaviors and priorities. Theme analysis was used to capture key patterns in participants’ responses. Specific analysis steps included initial and more specific coding, analytical memos, organizational matrices and reports, and discussion about results with participants.

Results: Participants identified exercise and body image as connected primary health concerns. They discussed these issues in terms of three themes: Body shape as motivation for exercise; Poor body image, stigma and fear as exercise barriers, and; Exercise or lack of, as destructive. Participants wanted to exercise to achieve a certain body shape, not for health or as stress relief. They cited gyms as unwelcoming, however. They also worried about discrimination and did not feel sufficiently comfortable with their bodies to exercise. When they could not exercise, they used harmful behaviors, like restricted eating, to achieve a specific male shape.

Conclusions: Using participatory methods allowed us to understand the priorities of a group of Transmasculine young people. Our findings suggest that it is important to continue to explore TYP’s body-related motivations for exercise and understand the balance between exercise as a positive health behavior, and a potentially harmful one, in light of TYP’s complex body image concerns. Trans friendly gyms and gym policies could promote safe exercise and continued anti trans discrimination work and policy advocacy can promote the safety of TYP in all spaces.     

Optimism and positive body image in women: The mediating role of the feared fat self

We predicted that an expectancy judgment about acquiring a feared fat self and an expectancy judgment about acquiring a hoped-for thin self would mediate dispositional optimism on positive body image. We also predicted that the mediation pathway through the feared self would be significantly stronger than that through the hoped-for self. Participants were 208 female college students who reported their age, height and weight and completed measures of dispositional optimism, the likelihood of acquiring the feared fat and hoped-for thin selves, and positive body image. Statistical analyses revealed that only the perceived likelihood of acquiring the feared fat self mediated dispositional optimism on positive body image. Implications for future research are discussed.     

Dress fit and body image: A thematic analysis of women's accounts during and after trying on dresses

This study was designed to investigate women's experiences of dress fit and body image. Spontaneous speech of 20 women aged 18–45 years was audio-recorded while they tried on a number of dresses. They were also body-scanned and photographed in their chosen dress and discussed both the scan and the photograph in semi-structured interviews. Data were analysed using inductive thematic analysis and four key themes were found: the slim hourglass ideal, functional aspects of clothes fit, body confidence and clothes fit, and clothes dimensions and size coding. All themes and component sub-themes were ratified in follow-up sessions six months after the original interviews. It was concluded that these women had a complicated relationship with clothes fit and sizing and used well-fitting clothes to increase body confidence, cover perceived flaws, and to try to attain a slender hourglass look. Ideas for future directions for research in these areas are discussed.     

Health-related quality of life in transgender adolescents: Associations with body image and emotional and behavioral problems

Background: Transgender adolescents who apply for treatment often experience a marked increase in body-related distress when entering puberty, accompanied by internalizing problems and poor peer relations. Although adolescence is a time of considerable psychosocial and physical change, generally associated with a decline in health-related quality of life (HRQoL), research on HRQoL in transgender youth and possible predictors is sparse. This study thus aims to explore the predictive value of body image factors and emotional and behavioral problems for HRQoL.

Methods: This cross-sectional one-group observational study was carried out at the Child and Adolescent psychiatric department (Gender Identity Service) in Hamburg, Germany. A sample of n = 126 (103 trans male and 23 trans female) adolescents, who were referred for counseling and/or treatment completed different standardized instruments before undergoing any sort of treatment. Firstly, five dimensions of HRQoL were explored in transgender adolescents and secondly, a linear regression model was applied to assess the impact of body image and emotional and behavioral problems on overall HRQoL.

Results: HRQoL was generally impaired in transgender adolescents compared to norm scores, especially with regard to aspects of psychological and physical well-being. Linear regression analysis revealed that greater internalizing problems and less body satisfaction significantly predicted lower HRQoL outcomes.

Conclusions: Impaired HRQoL may be explained by high degrees of internalizing problems and low body satisfaction. Thus, one important aim of mental health professionals working with youth should be to provide appropriate treatment and counseling options that may contribute to overall well-being in the long-term.     

Sex differences in trauma symptoms,body image and intensity of pain in a Polish sample of patients suffering from chronic pain

The main goal of the current study was to investigate sex differences in the relationship between the level of trauma symptoms appearing in posttraumatic stress disorder (PTSD) and intensity of pain in a sample of 300 Polish patients suffering from chronic pain, specifically rheumatoid arthritis and lower back pain. We also focused on participants’ body image with body esteem as a mediator. To assess the intensity of pain among participants, we used the Numerical Rating Scale. The level of trauma symptoms was assessed with the PTSD Factorial Version Inventory. To measure body image among participants, we used the Body Esteem Scale. The results of our study suggest that trauma symptoms and body image dimensions were significant predictors of pain intensity among men suffering from chronic pain. Moreover, trauma symptoms and age were significant predictors of pain intensity among women suffering from chronic pain. Finally, we demonstrated that sex differentiates the reaction to chronic pain.     

Meta-analysis of the effects of third-wave behavioural interventions on disordered eating and body image concerns: implications for eating disorder prevention

Third-wave behavioural interventions are increasingly popular for treating and preventing mental health conditions. Recently, researchers have begun testing whether these interventions can effectively targeting eating disorder risk factors (disordered eating, body image concerns). This meta-analysis examined whether third-wave behavioural interventions (acceptance and commitment therapy; dialectical behaviour therapy; mindfulness-based interventions; compassion-focused therapy) show potential for being effective eating disorder prevention programs, by testing their effects on eating disorder risk factors in samples without an eating disorder. Twenty-four studies (13 randomized trials) were included. Most studies delivered selective prevention programs (i.e. participants who reported elevated risk factor). Third-wave interventions led to significant pre–post (g = 0.59; 95% CI = 0.43, 0.75) and follow-up (g = 0.83; 95% CI = 0.38, 1.28) improvements in disordered eating, and significant pre–post improvements in body image (g = 0.35; 95% CI = 0.13, 0.56). DBT-based interventions were associated with the largest effects. Third-wave interventions were also significantly more efficacious than wait-lists (g = 0.39; 95% CI = 0.09, 0.69) in reducing disordered eating, but did not differ to other interventions (g = 0.25; 95% CI = –0.06, 0.57). Preliminary evidence suggests that third-wave interventions may have a beneficial effect in ameliorating eating disorder risk.     

The development of beliefs and values in early adolescence: a case study through religious education pedagogy

Remarks on current educational language precede discussions of: pupils’ educational development; pupil voice; adolescence and action research. There follows a report of an innovation in religious education pedagogy, designed to address concerns that pupils should be helped to understand the emergence of their own beliefs and values over time. This report then prompts some reflections on religious education’s turn in the direction of hermeneutics. A form of religious education is sketched where pupils’ awareness of changes to their own beliefs and values over time is a key feature. Such awareness marks spiritual, moral, social and cultural development, an issue granted less than adequate coverage in the present UK education agenda.     

Saving graces: Impact of partner support and maternal attachment on partner attachments in an individualistic and a collectivist context

The current study investigated the relationships between current attachment to mother and attachment to romantic partners, and the role of current partner support and culture as moderators of that relationship. University students who were currently in a romantic relationship were recruited from Hong Kong and USA, and completed measures on attachment styles and partner support. Results showed that maternal attachment anxiety was correlated with romantic attachment anxiety; maternal attachment avoidance was correlated with romantic attachment avoidance, but this linkage varied by level of current partner support. Romantic attachment avoidance was also associated with current partner support, but this linkage was stronger for HK Chinese than for Americans. These results are discussed in terms of how interpersonal and personality factors promoted by culture can affect the developmental course of romantic relationships.     

Being authentic is the new image: a qualitative study on the authenticity constructions and self-images of Christian millennials in Africa

The article is a qualitative study that focuses on the authenticity and self-constructions of Christian millennials in Africa. While exploring how 15 respondents manifested their authentic self-behaviours using a case study design, the hallmark of the study was to observe the common coping mechanism of self-regulation, adopted by respondents to deal with their internal crisis. This coping strategy was employed as they remained true to self by creating new “authentic” images of themselves in the forms of the borderline self, the promissory self, the hyphenated self, and the religious self. By implication, looking at the issue of authenticity from an African context has produced an African conceptualisation of authenticity. I argue that African authenticity can be understood by interpreting Africa’s voices of self-expression and images of self-definition, resonating within various African contexts in hope for some kind of cathartic and authentic living experience.