Body image disturbances and disordered eating during pregnancy: a comparison of pregnant women with low and high risk of eating disorders.

Representation of the body is a nuclear aspect of self-image. Body representation includes both subjective and intersubjective experiences. The importance of visual body representation in our social life is demonstrated by the time we spend to take care of our physical appearance, including use of plastic surgery, as well as by the severe mental disorders associated to its alteration, including eating disorders (EDs) and body dysmorphic disorders. In spite of these issues, (neuro)psychological research on body representation has so far mainly focused on the body as a motor device, devoted to the perception of and interaction with objects. The complexity of factors involved in the development, maintenance, and plasticity of body image representations requires an integrated approach that facilitates the evaluation and treatment of EDs with novel, evidence-based, and more efficacious protocols. This special issue of European Psychologist aims to advance such an integrative approach, with a collection of papers that gather different perspectives on the phenomenological, cognitive, (neuro)psychological, and cultural aspects of body representation disorders.

Body image disturbance (BID) is central to eating disorders (EDs), yet the role of self-face perception has received limited empirical attention despite rising sociocultural pressures emphasizing facial appearance through technologies such as social media. Emerging evidence suggests impairments in self-face recognition accuracy and distorted perceptions of facial appearance among individuals with EDs. Enfacement illusions, involving the experimental induction of perceived ownership over another's face, offer a novel paradigm to comprehensively investigate the perceptual multisensory integration processes underlying self-face perception disturbances in ED populations. Such an approach may hold promise for elucidating core pathological mechanisms contributing to BID and ED psychopathology. We discuss how rigorous investigation of self-face perception through the enfacement illusion paradigm represents an innovative direction of research and/or clinical application that may advance etiological models of EDs and possibly inform interventions targeting the potentially multidimensional nature of body and facial image disturbances characterizing EDs. PUBLIC SIGNIFICANCE STATEMENT: Body image disturbance is central to eating disorders (EDs), yet, the role of face-related disturbances remains critically under-investigated. After summarizing findings on face-related disturbances in EDs we propose how enfacement illusions (i.e., the experimental induction of ownership over another's face) may elucidate self-face perception disturbances in EDs, and their underlying mechanisms. Enfacement illusions may also offer an intervention to potentially address multifaceted face and body image disturbances characterizing EDs.

This study contributes to the quantitatively large, yet narrow in scope research on body image in gay men by assessing whether gay and heterosexual men systematically differ on various dimensions of body image disturbance and associated pathology, i.e., eating disorder and body dysmorphic disorder symptoms. Moreover, we examined the influence of general everyday discrimination experiences and involvement with the gay community on body image. N = 216 men (n = 112 gay men, n = 104 heterosexual men) participated in an online survey measuring the discrepancy between self-rated current and ideal body fat/ muscularity; drive for leanness, muscularity, and thinness; body satisfaction; body-related avoidance and checking; appearance fixing; overall body image disturbance; eating disorder and body dysmorphic disorder pathology; general everyday discrimination experiences; and involvement with the gay community. Gay men showed a greater discrepancy between self-rated current and ideal body fat; higher drive for thinness, body-related avoidance, appearance fixing, overall body image disturbance, eating disorder and body dysmorphic disorder pathology; and lower body appreciation than heterosexual men (all p ≤ .05). Contrary to expectation, everyday discrimination experiences were more strongly associated with body image disturbance and eating disorder/ body dysmorphic disorder pathology in heterosexual men than in gay men (all p ≤ .05). Gay community involvement was not associated with any body image disturbance-, ED-, or BDD aspect in gay men (all p ≥ .20). The results suggest greater body image disturbance in gay men than in heterosexual men regarding cognitions, emotions, behaviors, and perception as well as higher eating disorder and body dysmorphic disorder pathology. The results also suggest the dilemma of a thin, yet muscular body ideal in gay men. Surprisingly, discrimination experiences and involvement with the gay community did not explain differences in body image disturbance. Gay men may have become resilient to discrimination over time, and body ideals might differ across gay sub-communities.

Introduction & Purpose Eating disorders, body image, self-esteem, and emotional issues affect psychological and physical health and often co-occur. Disturbances in body image can trigger and worsen disordered eating behaviours. Emotions and self-esteem are influential factors in both eating disorders and body image issues, impacting their severity and manifestation. The interconnection of eating disorders, body image, emotions, and self-esteem has mostly been studied in adolescents, while there has been less research on the adult population. This systematic review seeks to synthesise existing literature on the comorbidity and coexistence of eating disorders, body image disturbance, emotion, and self-esteem in the adult population. Methods Following the PRISMA guidelines, a systematic search was conducted in scientific databases (PubMed, Scopus, and Web of Science) for articles published between 2010 and 2024 (Figure 1). The selected studies focused on the connections between eating disorders, body image, emotion, and self-esteem in adult populations. Six studies were selected from an initial collection of 1,117 articles, with most female participants representing different racial backgrounds. The study participants were required to be over 18 years old and use standard tools to measure the variables, and only original research with significant results was included. Results Individuals with eating disorders showed higher levels of body dissatisfaction, which was linked with lower self-esteem and emotional dysregulation. Women with bulimia nervosa displayed higher emotion-oriented coping strategies compared to controls, resulting in low self-esteem (Wölfges et al., 2011). Obese patients with binge-eating disorders (BED) had more negative attitudes towards obesity compared to obese individuals without BED, correlating with higher levels of depression and disordered eating behaviours (Barnes et al., 2014). The African American participants reported lower weight bias than white participants (Lewer et al., 2015). Furthermore, body image disturbances were a consistent theme, particularly their role in worsening eating disorders, with findings showing that body dissatisfaction indirectly influenced disordered eating behaviours through its effects on self-esteem and depression (Brechan & Kvalem, 2015). The findings revealed that women are more vulnerable to the negative impacts of body image dissatisfaction and emotional dysregulation on eating disorders (Barnes et al., 2014; Brechan & Kvalem, 2015). Additionally, the impact of weight bias and dissociative experiences during sexual activities, which were linked to binge eating and sexual dissatisfaction, was highlighted (Castellini et al., 2017). Discussion The findings emphasise the connections between self-esteem, body image, emotion, and eating disorders. Professional interventions for eating disorders should consider improving self-esteem and providing adaptive emotion techniques to enhance body image perception. The importance of self-compassion in improving body image and managing eating disorders was also noted (Kelly et al., 2014). More research on adult populations in non-Western countries is needed. Conclusion This review emphasises the relationships between eating disorders, body image, self-esteem, and emotion in adults. Moreover, the combination of strategies that improve emotional regulation, self-esteem, and body image perception within clinical interventions could lead to more practical management of eating disorders in adults. Future research should explore these variables across different cultures with varied research strategies.

Body image disturbance is a core symptom of eating disorders (EDs) and body dysmorphic disorder (BDD). There is first evidence that females’ body image differs depending on sexual orientation, with heterosexual women (HEW) appearing to show more body image disturbance symptoms than homosexual women (HOW). Such disparities might be moderated by everyday discrimination experiences and involvement with the lesbian community. However, to date, there has been no comprehensive assessment of a broad range of body image facets such as drive for thinness, leanness, and muscularity; body avoidance; body checking and body dissatisfaction; and ED and BDD pathology as well as moderating factors. Moreover, studies have often neglected bisexual women (BIW). A total of N = 617 women (n = 180 HOW, n = 322 HEW, n = 115 BIW) completed an online survey assessing the various facets of body image, ED and BDD pathology, discrimination experiences, and involvement with the lesbian community. Significant group differences were found regarding drive for leanness and thinness, body checking, investment behavior, and body ideal (all p<.05). BIW showed significantly more body checking than HOW. Compared to HEW, HOW reported a significantly lower drive for leanness and thinness as well as compared to HEW and BIW less investment behavior. HOW preferred a body ideal with significantly more body fat than did HEW (all p<.05). In contrast, no differences emerged in body dissatisfaction, drive for muscularity, body-related avoidance, ED and BDD pathology, and body image disturbance (all p>.05). In all groups, discrimination experiences were positively related to ED and BDD pathology and to body image disturbance (all p < .05); however, discrimination was significantly correlated with more body image facets in HEW than in HOW or BIW. Involvement with the lesbian community was positively correlated with a larger ideal body size in HOW (p < .05) and negatively correlated with drive for muscularity in BIW (p < .05). Despite the group differences in several body image facets, we found no consistent evidence of increased vulnerability to body image disturbance or associated pathology depending on sexual orientation. However, in HEW, discrimination experience might pose a risk factor for the development of body image–related pathology and single facets of body image disturbance.

Whereas the manifestation of body image disturbance in binge eating disorder (BED) has been intensively investigated concerning the cognitive-affective component, with regard to the behavioral and the perceptual components of body image disturbance in BED, research is limited and results are inconsistent. Therefore, the present study assessed body image disturbance in BED with respect to the different components of body image in a sample of obese females (n=31) with BED compared to obese females without an eating disorder (n=28). The Eating Disorder Inventory-2, the Eating Disorder Examination-Questionnaire, the Body Image Avoidance Questionnaire and the Body Checking Questionnaire as well as a Digital Photo Distortion Technique based on a picture of each participant taken under standardized conditions were employed. Using two-sample t tests, we found that the participants with BED displayed significantly greater impairments concerning the cognitive-affective component of body image than the control group. Concerning the behavioral component, participants with BED reported more body checking and avoidance behavior than the controls, but group differences failed to reach significance after the Bonferroni corrections. Regarding the perceptual component, a significant group difference was found for the perceived "ideal" figure, with the individuals suffering from BED displaying a greater wish for a slimmer ideal figure than the control group. These results support the assumption that body image disturbance is a relevant factor in BED, similar to other eating disorders.

The American Psychiatric Association Practice Guideline for the Treatment of Patients With Eating Disorders.

Body image disturbance (BID) involves negative attitudes towards shape and weight and is associated with lower levels of interoceptive sensibility (IS) (the subjective perceptions of internal bodily states). This association is considered a risk factor for developing eating disorders (EDs) and is linked to altered sensorimotor representations of the body (i.e., body schema). BIDs manifest across genders and are currently understudied in men. This study investigated gender-related differences in BID and its relationship to the body schema and IS. Data were collected from 86 men and 86 women. BID was assessed using questionnaires measuring self-objectification, state, and trait body dissatisfaction. IS was measured via the MAIA-2. The body schema was indexed via an embodied mental rotation task. Results showed that women reported higher BID than men across all scales. Gender differences in sub-components of interoceptive sensibility were found. Overall, both gender and interoceptive sensibility predicted BID. However, interoceptive sensibility exhibited its own unique association with BID beyond the influence of gender. BID, IS and gender were not significant predictors of performance in the body schema task. Therefore, while gender predicts differences in BID and interoceptive sensibility, there was no evidence of gender-related differences in body schema.

J. KEVIN THOMPSON AND LINDA SMOLAK (Eos.): Body Image, Eating Disorders, and Obesity in Youth: Assessment, Prevention, and 'Treatment. American Psychological Association, Washington, DC, 2001, 403 pp., $39.95, ISBN 1-55798-758-0. Body Image, Eating Disorders, and Obesity in Youth is one of the first edited books on children and adolescents that deals with body image, obesity, and eating disorders, and as such, it is a groundbreaker. The editors distill and summarize the findings of examination of risk factors, prevention programs, assessment strategies, and treatment options for 6- to 17-year-olds into a manageable review for beginning clinicians, graduate students, and seasoned researchers. The impetus for the text is that obesity, eating disorders, and body-image disturbances affect a significant number of children today. The volume consists of 14 chapters and an introduction by the editors. The chapters are divided into four sections: Foundations; Risk Factors; Assessment and Prevention; and Treatment. Section I lays the groundwork for the discussion of eating-related problems among children and adolescents. Authors Jennifer O. Fisher and Leann L. Birch lead the section by exploring in utero possibilities of developing a dietary taste. They also discuss formula versus breastfeeding. The view of the etiology of eating problems originating from children's earliest experiences with food and eating is in tune with the more psychodynamic literature. This vantage point marks the scope of the problem. Linda Smolak and Michael P. Levine address the important DSM differential diagnostic question: Are there body image disturbances among children, or body image problems? They examine genetic influences to body-image disturbances. Their studies concede that there are no conclusions, just suppositions. Jennifer Zoler Dounchis, Helen A. Hayden, and Denise E. Wilfrey give an excellent appendix of the summary of body-image and eating-disorder studies within ethnically diverse child and adolescent populations. section II, a strong section, reviews the research of risk factors thought to connect to eating disorders. Catherine M. Shisslak and Marjorie Crago give us a thoughtful and provoking chapter that tries to separate eating disorders from a generalized psychiatric diagnosis. Ari B. Steinberg and Vicky Phares examine parental influences on body-image and weight concerns. They cite a number of studies that conclude that family therapy is an effective treatment strategy since the relationship between parents' attitudes and beliefs concerning weight, eating, and body shape and the development of body-image concerns and eating disturbances has been well established. Mary E. Connors tries to throw light on the connection of the relationship of sexual abuse among children (CSA) to body-image and eating disorders. There is a decent review of the literature. She also raises an interesting question: Does CSA increase psychic distress, which gives rise to tension-reducing activities so that survivors of CSA may use self-mutilation, as well as binge eating, as temporary relief? section III is the best section. Kelley Hill and Claire Pomeroy present a new and different view of body-image disturbances from the other chapters. They clearly state that many adolescents are preoccupied with and critical of their appearance, however, only a small percentage of adolescents go on to develop a true eating disorder. The typical adolescent struggles with control and body image are magnified. They address obesity and offer a warning about total liquid protein diets, medications, and surgery for children and adolescents. …

Treatment of Eating Disorders in Children, Adolescents, and Young Adults

Body image is multifaceted and incorporates perceptual, affective, and cognitive components as well as behavioral features. Only few studies have examined the character of body-image disturbance in children/adolescents with eating disorders. It is unknown whether body-image disturbances in children/adolescent with eating disturbances are comparable to those of adult patients with eating disorders. Body-image disturbance might differ quantitatively and qualitatively according to the cognitive developmental status and the age of the individual. This paper provides an overview of the current evidence for body-image disturbance in children/adolescents with eating disorders, and how they compare with those adults with eating disorders. Current evidence indicates that older adolescent patients show similar deficits as adult patients with eating disorders, in particular for the attitudinal body-image component. However, evidence for a perceptual body-image disturbance in adolescent patients, in particular anorexia nervosa, is not conclusive. Reliable statements for childhood can hardly be made because clinical studies are not available. Investigations of body-image disturbance in children have focused on the predictive value for eating disorders. Limitations of the current evidence are discussed, and future directions for research and therapy are indicated.

This systematic review examines the connections between eating disorders, body image disturbance, self-esteem, and emotion regulation in adults. Following the PRISMA guidelines, a systematic search of PubMed, Scopus, and Web of Science databases was conducted for articles published between 2010 and June 2024. Studies were included if they involved participants aged 18 years and older, employed validated tools for measuring the variables, and presented original research that specifically addressed these psychological factors. Out of 1117 records, six studies met the inclusion criteria, with mostly female samples and a focus on body image, self-esteem, and emotion regulation in relation to eating disorders. The results indicate that body dissatisfaction is closely related to disordered eating behaviors, with a significant link to lower self-esteem and difficulties in emotion regulation. Obese individuals with binge eating disorder (BED) were found to have more negative attitudes toward obesity and greater levels of depression than their non-BED counterparts. Women with bulimia nervosa showed higher emotion-focused coping, which is associated with low self-worth. Differences in gender were evident, with women exhibiting greater vulnerability to body image dissatisfaction and emotion dysregulation. The results show that treatment for adults with eating disorders should focus on the enhancement of self-esteem, the improvement of body image perception, and the development of adaptive emotion regulation strategies. Lastly, practicing self-compassion techniques in psychotherapy could improve the treatment process for patients suffering from eating disorders, low self-esteem, emotion dysregulation, and body image disturbance. Future studies should investigate these variables in various non-Western cultural contexts for better understanding and clinical intervention for the adult population.

The body image disturbance (BID) is a common symptom in eating disorders, often observed and described in anorexia nervosa (AN) and bulimia nervosa (BN). Recently, this symptom has also been observed in binge eating disorder (BED). The research underlines that the BID presents three different altered components: affective, cognitive, and perceptual one. Current treatments for BID have mainly focused on the affective and cognitive components. Nowadays, the need emerges for treatments focused also on the perceptual component of the BID. In this paper, we present the results of an efficacy study on the body perception treatment (BPT), a new treatment for BID focused on the perceptual component of the disorder. We looked for an additional treatment effect on a protocol for ED inpatients to evaluate the efficacy of BPT. We performed the study through statistical analysis of admission and discharge scores. We conducted a case-control study in a hospital ward specialized in eating disorders. Two groups were identified: the control group (TAU; N = 91) and the experimental group (TAU + BPT; N = 91). The experimental group performed BTP activities in addition to the treatment at usual. All patients in both groups had an eating disorder diagnosis (AN, BN, BED and EDNOS/OSFED). Sampling occurred on a time basis and not by randomization. Moreover, all patients admitted in the ED hospital ward in the time frame considered (from end-2009 to mid-2017) were included in the study. BPT activities were introduced in mid-2013 and three psychometric instruments upon entry and discharge were used: Symptom Check List-90 (SCL-90) to measure the general psychopathological state; the Eating Disorder Inventory-3 (EDI-3) to estimate the incidence of personality traits strongly correlated to eating disorders; the body uneasiness test (BUT) to measure the body uneasiness. We performed a pre/post analysis for both groups; we studied the additional effect of the treatment through deltas analysis of the three questionnaires (Δ = assessment at discharge - assessment at the entrance). Data were analyzed using the Student T and the Wilcoxon rank-sum test. The pre/post analysis showed statistically significant improvement in both conditions (TAU and TAU + BPT) in the general psychopathological state (SCL-90) and in the incidence of personality traits (EDI-3). Improvements in body uneasiness (BUT) were observed only in the experimental group (TAU + BPT). Furthermore, the analysis of the deltas shows more significant improvements in TAU + BPT compared to TAU in all the variables considered. We found an additional effect of the BPT on TAU. The usual ED protocol added with BPT activities showed significantly better clinical results. We have interpreted these results in light of recent developments in the neuroscientific field of body image. Level II: controlled trial without randomization.

There is an increasing awareness about body image disturbance and eating disorders which calls for a multidisciplinary approach. The usefulness of new technologies for improving body image distortion has been addressed in the scientific literature, but has not included current strategies such as Metaverse-related technologies. Seemingly, this is the first systematic review which focuses on the efficacy of Metaverse-related technologies in reducing body image disturbance related to eating disorders like Anorexia nervosa and Bulimia nervosa. The main objective of this study was to review the scientific studies published in the last decade to answer the following three questions: (1) Are Metaverse-related technologies useful in mitigating body image disturbance in patients diagnosed with Anorexia nervosa and Bulimia nervosa? (2) What are the advantages and disadvantages? (3) Are the patients satisfied after using this kind of technology? The results obtained were that 80% of the included studies found metaverse-related technologies useful for the improvement in body image disturbance, in addition to various advantages, such as a decrease in eating disorder symptomatology. Whereas patient satisfaction was only evaluated in 20% of the included studies, with the majority of patients evaluating the use of metaverse-related technologies positively. We will conduct a systematic review of the peer-reviewed literature from EBSCO Discovery Service, and Web of Science (WOS), following the PRISMA statements. Only Journal articles published from 2013 to the present, written in the English language, will be reviewed. The findings are expected to offer valuable insights for the development of novel approaches for the improvement in body image disturbance in healthcare settings.

BackgroundDuring pregnancy, body size rapidly modifies over a relatively short period. Literature emphasizes the need to identify the factors that influence body image during peripartum as the extent of women’s adaptation to these changes has significant repercussions on both mother’s and newborn’s health. Emotion regulation strategies (i.e., expressive suppression and cognitive reappraisal) were linked to body image in the general and clinical population, but no studies were conducted in the peripartum. The present study aims to investigate the longitudinal impact of prepartum body image disturbances on postpartum body image disturbances and to evaluate the mediational role of emotional regulation strategies.MethodsA total of 133 pregnant women completed a three-phase longitudinal study. Women answered online questionnaires during the second (T1) and the third (T2) trimesters of pregnancy, and at about 6 months postpartum (T3).ResultsFindings indicated that body image disturbances at T1 were a significant predictor of body image disturbances in the postpartum (1 year after the first assessment). Moreover, cognitive reappraisal measured at T2 partially mediated this relationship: body image disturbances in the second trimester of pregnancy were linked to less use of cognitive reappraisal in the third trimester of pregnancy, and this, in turn, was associated with worse body image disturbances at 6 months after birth.ConclusionFindings of this longitudinal study highlight the importance of assessing body image disturbances during pregnancy to early identify women at risk, and suggest cognitive reappraisal as a possible target intervention.