Multiple Perspectives on Body Image Research

Abstract

Free AccessEditorialMultiple Perspectives on Body Image ResearchCosimo UrgesiCosimo Urgesi Department of Human Sciences, University of Udine and Scientific Institute (IRCCS) E. Medea, Udine, Italy School of Psychology, Bangor University, UK Search for more papers by this authorPublished OnlineJanuary 01, 2015https://doi.org/10.1027/1016-9040/a000223PDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInReddit SectionsMoreRepresentation of the body is a nuclear aspect of self-image (Berlucchi & Aglioti 2010; James, 2007). Visual self-recognition seems to be one of the earliest forms of self-awareness in human infants and nonhuman primates (Gallup, 1982) and precedes the use of the personal pronouns “I” and “me.” However, our body is not a personal affair, since it does not only affect how we represent ourselves, but also how we appear to others (Cazzato, Mian, Serino, Mele, & Urgesi, 2014); thus, 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. Research on body image disturbances in mental disorders, however, has mainly focused on the subjective, explicit perception of body image (in particular of body weight). For example, until now, most models and treatments for EDs stem from approaches based on psychodynamics or motivation, personality and social factors. However, recent advances in cognitive neuroscience of visual body representation could offer new insights into the etiopathogenesis of the disorders and have the potential to provide more efficacious treatments. While a purely neuroanatomical view of EDs and other body image disorders is unlikely to explain their development and maintenance, these results point to the need for integrating different approaches into the study of body image representation, including at least psychiatry and clinical psychology, social psychology, cognitive psychology, personality psychology, anthropology, philosophy, and cognitive neuroscience and biological psychiatry.Psychiatry and clinical psychology studies may provide better descriptions of the type of representation disturbances that characterize the different forms of EDs, clarifying which forms of body image are altered in ED patients within and across different diagnostic categories. Social psychology perspectives may highlight how ideals of body beauty are conveyed through the media and social teasing. Although the role played by mass media in determining EDs has not yet been thoroughly analyzed, there is evidence that the constant parade of ultrathin models in the media helps to internalize an ideal of beauty of an extremely lean body, contributing to an increase in the degree of body dissatisfaction in adolescent girls and young women (Benowitz-Fredericks, Garcia, Massey, Vasagar, & Borzekowski, 2012). Cognitive psychology approaches may try to explain the perceptual processes involved in the influence of media exposure on body perception and representation disorders. For example, studies of face (Langlois et al., 2000; Rhodes, Jeffery, Watson, Clifford, & Nakayama, 2003) and body (Glauert, Rhodes, Byrne, Fink, & Grammer, 2009; Mele, Cazzato, & Urgesi, 2013; Winkler & Rhodes, 2005) attractiveness have shown that familiarity is crucial for esthetic appreciation of others and that perceptual experience increases what we find attractive and normal in other individuals’ faces and bodies. The effects of visual familiarity on esthetic perception have been attributed to either perceptual after-effects that occur when exposure to certain features of a stimulus modifies perception in the opposite direction to that of the adapted features (i.e., bodies appear rounder after repeated exposure to extremely thin bodies; Mele et al., 2013), or to the change of the template used for norm-based coding of individual exemplars of bodies that share a very similar structure (Rhodes et al., 2003). The exact consequences of these two mechanisms on body esthetic appreciation, however, are still not clear and need to be clarified (Mele et al., 2013), also taking into account individual differences in the preferred strategies used in processing social stimuli (Urgesi et al., 2012, 2014). In this regard, personality psychology studies may determine the dimensions predicting a greater susceptibility of some individuals to the influence of socially driven body ideals. Anthropology studies may allow us to understand the cultural binding of EDs, which affect young women (Stice, Marti, & Rohde, 2013), rather than men, in Western, industrialized countries more than in those non-Western countries that have been less affected by cultural globalization accompanying the gradually increasing influence of mass media (Makino, Tsuboi, & Dennerstein, 2004). Cognitive neuroscience studies may show the neural underpinning of these processes. In particular, neuroimaging evidence has shown that body representations engage brain regions that are at least partially different from those dedicated to the representation of non-corporeal objects and space (Berlucchi & Aglioti, 2010). Visual perception of the human body activates selected areas in the lateral (extrastriate body area, EBA) and medial (fusiform body area, FBA) occipito-temporal cortex (Peelen & Downing, 2007). These areas respond to visual presentation of whole bodies and single body parts, but not of faces or any other objects, suggesting that the visual appearance of the human body is special in the brain. Although the functional role played by these body-selective areas in social perception is still not clear, there is evidence that they are important in processing body morphology (Moro et al., 2008; Urgesi, Berlucchi, & Aglioti, 2004) and contribute to the esthetic appreciation of human figures (Calvo-Merino, Urgesi, Orgs, Aglioti, & Haggard, 2010; Cazzato, Mele, & Urgesi, 2014). These findings have boosted research into the cognitive neuroscience of visual body representation, which complements research on the representation of body ownership, sense of agency, and self-other distinction in the temporo-parietal cortex (Berlucchi & Aglioti, 1997) and to the understanding of body actions in the fronto-parietal areas (Rizzolatti & Craighero, 2004). Biological psychiatry studies may show what are the neural bases of body image disturbances in ED patients, considering different levels of alterations spanning from the molecular level, which is linked with the psychological description of what makes patients more susceptible to developing body image disturbances, to system level, identifying which brain networks are altered in ED and how. For example, recent studies have documented structural and functional alterations of occipito-temporal (Suchan et al., 2010, 2013) and temporo-parietal (Uher et al., 2005) cortices during body processing in patients with anorexia nervosa (AN), which might be related to their altered body perception (Urgesi et al., 2012, 2014).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. Eight contributions from leading researchers in the field are included in the collection; the contributors work in six different European countries and investigate, from different perspectives, how body image representations and their disturbances are established, maintained, and altered in healthy and patient populations.The first two papers start from the consideration that our body is special because it is always present to us and mediates almost all types of perceptual, motor, cognitive, and emotional processes, thus affecting not only how we represent the self, but also how we interact with the physical and social world. The body representation used during perceptuo-motor and cognitive processes is likely to be implicit and to rely on different neural mechanisms than the explicit representation of our body image.From an experimental psychology approach, Longo (2015) explores how multiple representations of the body emerge from sensory and perceptual processing. He reviews studies showing that basic information processing, in particular in the somatosensory modality, relies on referencing to an implicit model of the body and that investigating abilities such as tactile localization, tactile size perception, and position sense reveals surprisingly large distortions of represented body size and shape that are reliable across different individuals. These large distortions of implicit body representation, as estimated by the pattern of somatosensation performance, markedly contrast with the approximate accuracy of our explicit body image, at least in healthy individuals. How the body image disorders observed in patients with EDs may derive from the alteration of one or more of these body representations is an important issue for future research.The second paper (Candidi & Aglioti, 2015) explores the neural underpinnings of visual and sensorimotor body representations and how these representations may contribute to the esthetic appreciation of body form, motion, and emotion. Their final claim is that the esthetic value we attribute to physical and social objects is strictly dependent on how these objects alter visual, sensorimotor, and affective body representations in our brain. Thus, alteration of self-body representations may affect how we perceive and appreciate what is in and around us. Understanding the neural basis of esthetic body appreciation is helpful when attempting to identify which are the neurocognitive alterations underlying body representation disorders in EDs.Suchan, Vocks, and Waldorf (2015) review studies showing that patients with ED, in particular with AN, present neurofunctional alterations of temporal and parietal areas involved in and specialized for sensory, cognitive, and affective representation of the body. These alterations may underlie the perceptual (e.g., overestimation of one’s own actual body size), cognitive (e.g., negative thoughts and attitudes regarding one’s own body), affective (e.g., fear and disgust toward one’s own body), and behavioral (e.g., body checking or avoidance of body-related situations) components of body image disturbances in EDs. An important claim made in this paper is that, besides alteration of the functional and structural organization of single brain areas, researchers need to take into account that altered connectivity between the areas that form the complex brain network specialized in visual body processing may underpin body image disturbances. This opens new fascinating perspectives in the biological psychiatry study of EDs. Importantly; the tight relation between body image disturbances and neurofunctional alterations of visual body processing is also supported by evidence of normalization of neural activity in the visual body processing network after treatment of EDs (e.g., exposure-based cognitive-behavioral body image therapy; Vocks et al., 2011). However, different subgroups of patients may present different levels of alteration in the different nodes of the network, pointing to a need for more extensive evaluation of patients with regard to both types of body representation tested and sample size. Although the relatively low prevalence of EDs, in particular of AN, does not favor large studies, collaborative efforts are encouraged to deepen our knowledge of how multiple body representations are altered and which are the mechanisms leading to these alterations.The paper by Riva, Gaudio, and Dakanalis (2015) proposes a tentative model of the neurocognitive mechanisms involved in the establishment and maintenance of body image disturbances in EDs. It complements the objectification theory (Fredrickson & Roberts, 1997), which claims that women adopt a self-objectified view of themselves as objects to be evaluated on the basis of their appearance, with the allocentric lock hypothesis (Riva, 2012), which suggests that ED patients have difficulties in updating their body representation on the basis of perceptual input, thus being anchored to the memory of a “virtual body” that derives from outside (e.g., from peers’ or relatives’ teasing about being overweight). In other words, the egocentric representation of body image based on the perceptions and sensations that depart from the body does not integrate with the allocentric body representation that is conveyed by others. Thus, ED patients may be locked to an allocentric negative representation of their body that cannot be updated through perception even after weight loss. Although empirical evidence supporting the model is still scant, the allocentric lock hypothesis may help to provide an explanatory framework for integrating previous behavioral and neural studies in ED patients and to guide future investigations.Swami (2015) directly addresses the issue of whether EDs are culturally bound to Western and industrialized countries or whether they are more specifically linked to socioeconomically developed, urban sites, independent of geographical location. The recent evidence of increased ED prevalence in countries previously considered relatively immune to EDs is here explained in the light of two key processes, namely Westernization and modernization. Westernization refers to the cultural globalization accompanying the gradually increasing influence of mass media, while modernization refers to the effects of socioeconomic development that allows more resource security and less need for physical protection from environmental hazards. Although the role of these broadly-defined processes is still ambiguous, the cultural binding of ED, related to either geographical origin or socioeconomic status, hints at the importance of social influences in the internalization of an extremely thin ideal of the female body.Legrand and Briend (2015) investigate, with a philosophical perspective, how the experience of the body involves relations to others, thus being intersubjective in nature. In this view, the appearance of the body to others may be used by patients with AN as a form of communication to others. Furthermore, this objectified body (see Riva et al., 2015) may be refused by AN patients, who look for a more genuine and subjective body that is not immediately given to others. This philosophical perspective recalls neuropsychiatric models’ (Kaye, 2008) viewing of AN symptoms as an expression of a pathological need to control, which finds in an individual’s body the most available and, apparently, personal object.That social relations are crucial in EDs is also indicated by the empirical evidence reviewed by Martijn, Alleva, and Jansen (2015), which shows that positive social feedback may attenuate dissatisfaction with one’s own body. The paper discusses the features and causes of body dissatisfaction, highlighting, in particular, the cognitive bias toward paying attention to one’s own negative aspects and others’ positive ones, sociocultural pressure through mass media, and direct parental and peer influence through modeling or teasing about being overweight. In keeping with this analysis, the authors review clinical studies showing a reduction of body dissatisfaction after guided mirror interventions, in which patients are trained to look at their body in a neutral fashion, as well as after exposure to a conditioning procedure in which images of one’s body are associated to positive social feedback (e.g., smiling faces or positive vs. negative adjectives). Taken together, these studies suggest the efficacy of treatments aimed at changing implicit representation of one’s body (see also Longo, 2015) as compared to standard cognitive-behavioral therapy interventions, which tackle more conscious and reflective levels of body image.Finally, the paper by Mohr and Messina (2015) puts in relation ED symptomatology with that of other mental disorders that are often associated with EDs (e.g., obsessive-compulsive disorder, impulse control disorder, and addiction). The authors’ analysis shows that all these pathologies share obsessive-compulsive, addictive, and impulsive traits and suggests that they may not be independent, but reflect a common pattern of altered executive functions (see also Calderoni et al., 2013) that derives from neurofunctional alteration of the right frontal lobe. Furthermore, this pattern of alterations may also be shared by other psychiatric conditions, such as muscle dysmorphia (i.e., bigorexia), in which individuals (in particular men) are pathologically worried about their body muscularity, body dysmorphic disorder, characterized by preoccupation with an imagined body part defect, and body integrity identity disorder, in which the affected individual feels that a body part does not belong to his/her body and expresses a strong desire for amputation of the alien body part. Mohr and Messina suggest that all these diagnostic categories are characterized by traits of defective impulse control and/or addictive tendencies that may assume specific symptomatic features in interactions with the environmental situations people face in everyday life. The inevitable consequence of this line of argument is that treatment of these conditions should not focus on the symptoms of each diagnostic category, but on the nuclear vulnerability (i.e., right frontal lobe dysfunction) that is shared by different pathologies. The contribution of cognitive neuroscience studies to determining the behavioral and neural underpinnings of such vulnerability is, thus, crucial for the evaluation and treatment of body image disorders in various mental illnesses.In conclusion, the papers included in this special section highlight a need to cross the boundaries between different disciplines to heighten our understanding of body image disorders in EDs and other related illnesses. Earlier versions of most papers were presented at the international conference on “Body representation and eating disorders: Basic and clinical research approaches” that was held in Udine, Italy, on April 19–20, 2013. The possibility to discuss and integrate different approaches to body image disturbances during live meeting among scholars from different disciplines seems crucial for the emergence of new protocols for the evaluation and treatment of EDs, thus allowing us to go beyond the current limitations of any single approach, which are often exasperated by reciprocal skepticism and apparent incompatibility of specific methodology and level of analysis. This special issue reflects an attempt at such an integrative approach and I hope it is helpful in boosting multidisciplinary research on the multiple and complex aspects of body image disturbances.Cosimo Urgesi is Assistant Professor of Cognitive Neuroscience in the Department of Human Sciences at the University of Udine (Italy) and a Marie Curie Senior Research Fellow in the School of Psychology at Bangor University (Wales, UK). He coordinates the Udine Body Lab Group conducting behavioral, neuropsychological, and transcranial magnetic stimulation studies on body and action representations. He also serves as a senior research collaborator at the Scientific Institute Eugenio Medea (San Vito al Tagliamento, Italy), for research on the neuropsychological evaluation of children and adolescents with developmental disorders. 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First citation in articleCrossref, Google ScholarCosimo Urgesi, Department of Human Sciences, University of Udine, Via Margreth, 3, 33100 Udine, Italy +39 0432 249889+39 0432 556545cosimo.urgesi@uniud.itFiguresReferencesRelatedDetailsCited byTool-use: An open window into body representation and its plasticity17 June 2016 | Cognitive Neuropsychology, Vol. 33, No. 1-2 Special Issue: Body ImageVolume 20Issue 1March 2015ISSN: 1016-9040eISSN: 1878-531X tabs.informationEuropean Psychologist (2015), 20, pp. 1-5 https://doi.org/10.1027/1016-9040/a000223.© 2015Hogrefe PublishingPDF download