The role of body image in the prevention of eating disorders

This article reviews theory and research pertaining to prevention of negative body image and eating disorders. Research derived from the social cognitive model (SCM) and non-specific vulnerability-stressor (NSVS) model indicates that sustained prevention effects for attitudes and behaviors are possible, but not easy to achieve or explain. These limitations are considered in the context of promising research derived from a third model, critical social perspectives (CSP). We conclude that (1) research on practice should aim beyond the examination of efficacy in order to clarify the active ingredients contributing to prevention; and (2) research informed by each of the divergent perspectives can be used to enrich theory and practice in the field of eating disorders prevention.     

Validation of an interpretation bias assessment for body dissatisfaction

Currently, research on interpretation bias and body dissatisfaction is limited. The few experimental paradigms that have been used to explore this phenomenon utilized a method that may not accurately capture the nature of interpretation bias as explained by cognitive theory. The present study investigated the reliability and validity of a novel computerized assessment of interpretation bias (WSAP) for body dissatisfaction, which may more accurately reflect the cognitive processing involved in such bias by implementing the Word Sentence Association Paradigm (WSAP), a previously established method of measuring interpretation bias in other clinical populations. Undergraduate females (n = 214) completed the WSAP and other measures. Results indicate initial support for the WSAP as a valid, reliable measure of interpretation bias for body dissatisfaction. Although preliminary, this study contributes to the minimal research in this area and serves as the first psychometric investigation of the WSAP to measure such interpretation bias for body dissatisfaction.     

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.     

Implications of accuracy, sensitivity, and variability of body size estimations to disordered eating

The current study was conducted to investigate the relationships between body size estimations and disordered eating symptomatology. The method of constant stimuli was used to derive three measures of self-perceived body size in 93 women: (1) accuracy of body size estimations (body image distortion); (2) sensitivity in discriminating body size within blocks of trials (body image sensitivity); and (3) variability in making body size estimations between blocks of trials (body image variability). Participants also completed measures of disordered eating. Although body image distortion correlated with dietary restraint and eating concern, body image variability accounted for additional variance in these variables, as well as variance in binge eating. The relationships involving body image variability were found to be mediated by body dissatisfaction and internalization of the thin ideal. Together, these results are consistent with the proposition that body image variability is a significant factor in disordered eating.     

Self-compassion moderates the relationship between body mass index and both eating disorder pathology and body image flexibility

The current study examined whether self-compassion, the tendency to treat oneself kindly during distress and disappointments, would attenuate the positive relationship between body mass index (BMI) and eating disorder pathology, and the negative relationship between BMI and body image flexibility. One-hundred and fifty-three female undergraduate students completed measures of self-compassion, self-esteem, eating disorder pathology, and body image flexibility, which refers to one's acceptance of negative body image experiences. Controlling for self-esteem, hierarchical regressions revealed that self-compassion moderated the relationships between BMI and the criteria. Specifically, the positive relationship between BMI and eating disorder pathology and the negative relationship between BMI and body image flexibility were weaker the higher women's levels of self-compassion. Among young women, self-compassion may help to protect against the greater eating disturbances that coincide with a higher BMI, and may facilitate the positive body image experiences that tend to be lower the higher one's BMI.     

Media literacy as a prevention intervention for college women at low- or high-risk for eating disorders

This study examined whether the media literacy program, ARMED, is an effective prevention intervention for college women at low- or high-risk for an eating disorder. Changes in eating disorder risk factors were assessed in low- (n = 26) and high-risk (n = 19) women participating in a two-session media literacy intervention as compared to low- (n = 31) and high-risk (n = 16) controls. Women at high-risk for an eating disorder reported significant decreases in body dissatisfaction, drive for thinness, feelings of ineffectiveness, and internalization of societal standards of beauty after participating in ARMED, whereas control participants did not. No significant decreases in perfectionism, physical appearance comparisons, or awareness of societal standards of beauty were reported among high-risk participants. Changes in eating disorder risk factors were not found among low-risk participants, regardless of treatment condition. Findings suggest that media literacy may be an effective secondary prevention intervention for eating disorders.     

Size of drawings influences body size estimates by women with and without eating concerns

Research has inconsistently shown that women, particularly those with eating concerns, inaccurately estimate their body size. In the present study, drawings of female bodies, ranging from emaciated to obese, were presented to women with and without eating concerns. Drawings approximated the women's actual height or were reduced (15.7 cm). Women selected the drawing that represented how they thought they looked (cognitive rating), felt they looked (affective rating), and would like to look (desired rating). Women tended to select larger drawings when reduced-size drawings were used. Participants with eating concerns overestimated their body size and were more dissatisfied with their body size than participants without eating concerns. Size of drawings and the presence of eating concerns did not affect ratings of the size of a neutral object. Women did not demonstrate a generalized problem in estimating size. Overestimation of body size may be exaggerated in research that used reduced-size drawings.     

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.     

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

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

Body checking and avoidance and the core features of eating disorders among obese men and women seeking bariatric surgery

This study examined two aspects of body checking and avoidance, and their relations to the core psychopathology of eating disorders (EDs), in severely obese men and women seeking bariatric surgery. A consecutive series of 260 (44 male and 216 female) gastric bypass candidates were administered measures to assess body checking and avoidance, binge eating, restraint, and overevaluation of weight and shape. The majority of patients reported regularly pinching areas of their body to check for fatness and avoided wearing clothing that made them particularly aware of their body. Significant associations were observed between checking and restraint, and between avoidance and binge eating. Both checking and avoidance behaviors were significantly associated with overevaluation of weight and shape. The positive associations between each of the two behaviors (body checking and avoidance) with overevaluation of weight/shape remained significant even after controlling for the effects of avoidance on body checking and vice versa. Stepwise multiple regression analyses revealed that binge eating, body checking, and avoidance behaviors made significant unique contributions and jointly accounted for 22-25% of the variance in overevaluation of weight and shape, respectively. This study documents the presence of eating disorder psychopathology among severely obese patients seeking bariatric surgery. The findings support the view that body checking and avoidance behaviors are manifestations of overevaluation of weight and shape and disordered eating.     

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.     

Emotional attention: effects of emotion and gaze direction on overt orienting of visual attention

In the present study we considered the two factors that have been advocated for playing a role in emotional attention: perception of gaze direction and facial expression of emotions. Participants performed an oculomotor task in which they had to make a saccade towards one of the two lateral targets, depending on the colour of the fixation dot which appeared at the centre of the computer screen. At different time intervals (stimulus onset asynchronies, SOAs: 50,100,150 ms) following the onset of the dot, a picture of a human face (gazing either to the right or to the left) was presented at the centre of the screen. The gaze direction of the face could be congruent or incongruent with respect to the location of the target, and the expression could be neutral or angry. In Experiment 1 the facial expressions were presented randomly in a single block, whereas in Experiment 2 they were shown in separate blocks. Latencies for correct saccades and percentage of errors (saccade direction errors) were considered in the analyses. Results showed that incongruent trials determined a significantly higher percentage of saccade direction errors with respect to congruent trials, thus confirming that gaze direction, even when task-irrelevant, interferes with the accuracy of the observer’s oculomotor behaviour. The angry expression was found to hold attention for a longer time with respect to the neutral one, producing delayed saccade latencies. This was particularly evident at 100 ms SOA and for incongruent trials. Emotional faces may then exert a modulatory effect on overt attention mechanisms.     

The effect of leftward bias on visual attention for driving tasks

The leftward bias of driving visual attention has been found to explain the role of driving experience in the visual attention strategy; even though the results reported in the literature are not always consistent. This study aims to explore the driving attention characteristics and the eye movement patterns by using a simulated driving experiment in conjunction with an eye-tracker device. 31 young inexperienced drivers (undergraduate students, average age 21) and 30 old experienced drivers (taxi drivers, average age 36) took part in the experiment. Results show that the eye movement patterns of the drivers have certain similarity in the occurrence of subtle asymmetries of visual attention favouring left space (the direction of the driving in the experiment was right-side) and that they are related to the right hemisphere specialization for spatial attention. However, in the more experienced drivers the leftward eye movement tends to shift toward the centre or even rightward to pay attention to the hazard events on road. These results suggest that inexperienced drivers are initially aroused by natural biological leftward visual attention and likely to develop central and rightward eye movement strategy for safety diving purpose. The implications of this study suggest that, despite the existence of natural visual attention bias, the left asymmetries in visual scan in inexperienced drivers still can be modified by driving trainings that focus on the hazard situation on road.     

Changes in alcohol intake in response to transdiagnostic cognitive behaviour therapy for eating disorders

Objective

The aim of this study was to examine how alcohol intake changes during and after transdiagnostic cognitive behaviour therapy for eating disorders (CBT-E). Additionally, the paper considers the relationship between alcohol consumption, eating disorder diagnosis and current major depressive episode at the time of first assessment.

Method

One hundred and forty nine outpatients with an eating disorder (body mass index over 17.5) were divided into high or low alcohol intake groups (HIG and LIG) according to their intake at pre-treatment assessment. Their alcohol intake and eating disorder psychopathology were examined over the course of treatment and follow-up.

Results

There was no difference between the groups on response of the eating disorder to treatment. The HIG significantly reduced their alcohol intake following treatment whilst the intake of the LIG remained stable over the course of treatment and follow-up. There were no group differences in major depression and overall severity of eating disorder at baseline.

Conclusions

The response to CBT-E was not influenced by baseline level of alcohol use. The mean alcohol intake of the heavy drinking subjects decreased without being specifically addressed by the treatment.     

Gaze bias: Selective encoding and liking effects

People look longer at things that they choose than things they do not choose. How much of this tendency—the gaze bias effect—is due to a liking effect compared to the information encoding aspect of the decision-making process? Do these processes compete under certain conditions? We monitored eye movements during a visual decision-making task with four decision prompts: Like, dislike, older, and newer. The gaze bias effect was present during the first dwell in all conditions except the dislike condition, when the preference to look at the liked item and the goal to identify the disliked item compete. Colour content (whether a photograph was colour or black-and-white), not decision type, influenced the gaze bias effect in the older/newer decisions because colour is a relevant feature for such decisions. These interactions appear early in the eye movement record, indicating that gaze bias is influenced during information encoding.     

Associations Among Selective Attention, Memory Bias, Cognitive Errors and Symptoms of Anxiety in Youth

The purpose of this study was to examine the linkages among selective attention, memory bias, cognitive errors, and anxiety problems by testing a model of the interrelations among these cognitive variables and childhood anxiety disorder symptoms. A community sample of 81 youth (38 females and 43 males) aged 9-17 years and their parents completed measures of the child's anxiety disorder symptoms. Youth completed assessments measuring selective attention, memory bias, and cognitive errors. Results indicated that selective attention, memory bias, and cognitive errors were each correlated with childhood anxiety problems and provide support for a cognitive model of anxiety which posits that these three biases are associated with childhood anxiety problems. Only limited support for significant interrelations among selective attention, memory bias, and cognitive errors was found. Finally, results point towards an effective strategy for moving the assessment of selective attention to younger and community samples of youth.     

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.     

Heuristics and criterion setting during selective encoding in visual decision making: Evidence from eye movements

When making a decision, people spend longer looking at the option they ultimately choose compared to other options—termed the gaze bias effect—even during their first encounter with the options (Glaholt & Reingold, 2009a, 2009b; Schotter, Berry, McKenzie & Rayner, 2010). Schotter et al. (2010) suggested that this is because people selectively encode decision-relevant information about the options, online during the first encounter with them. To extend their findings and test this claim, we recorded subjects' eye movements as they made judgements about pairs of images (i.e., which one was taken more recently or which one was taken longer ago). We manipulated whether both images were presented in the same colour content (e.g., both in colour or both in black-and-white) or whether they differed in colour content and the extent to which colour content was a reliable cue to relative recentness of the images. We found that the magnitude of the gaze bias effect decreased when the colour content cue was not reliable during the first encounter with the images, but no modulation of the gaze bias effect in remaining time on the trial. These data suggest people do selectively encode decision-relevant information online.     

Self-objectification,body image disturbance,and eating disorder symptoms in young Australian children

Self-objectification has been examined extensively in adult populations. Despite theoretical evidence suggesting that children may also be vulnerable to experiencing self-objectification, whether children do self-objectify has not been determined. Accordingly, the present study examined the degree to which children self-objectify. The prevalence of body image and eating disturbances in this population, and the relationship between self-objectification and these disturbances, were also investigated. Results from over 250 boys and girls aged 6–11 years revealed that young girls report levels of self-objectification that are similar to those observed among older girls and women. Self-objectification was also found to be meaningfully related to body image and eating disturbances in children. A significant proportion of children reported body dissatisfaction and a minority engaged in disordered eating behaviours in the four weeks prior to the assessment. These results suggest that children may be at risk of experiencing the negative psychological outcomes associated with self-objectification.     

"I feel fat": an experimental induction of body displacement in disordered eating

Body displacement, the theory that predicts that individuals with eating disorders will displace negative feelings about themselves onto their body, was tested experimentally in this study. Unrestrained eaters (n = 61), restrained eaters (n = 33), and individuals with eating disorders (n = 26) were randomly assigned to a control condition or an ineffectiveness induction. In the ineffectiveness condition participants were asked to recall and reflect on a past experience when they felt useless or incapable (i.e., ineffective). Results showed that individuals with eating disorders who were made to feel ineffective reported more implicit appearance/body concern than those in the control condition. Unrestrained and restrained eaters did not show this effect. This is the first experimental study to support body displacement theory. These data can be used clinically to educate and encourage patients with eating disorders to address thoughts and feelings related to ineffectiveness directly, instead of displacing this distress onto their body and potentially perpetuating their eating disorder.