Abstract
A disturbed body image with fluctuating behavioral patterns of body related avoidance (BA) and body checking (BC) characterizes individuals with eating disorders (EDs) such as anorexia (AN) or bulimia nervosa (BN). So far, these behavioral body image components are mostly assessed via self-report instruments thereby neglecting their behavioral and partially automatic characteristics. Therefore, behavioral measures of BA and BC are needed. The present study investigates a behavioral assessment task for BA and BC in a sample of patients with diagnosed EDs and healthy controls. The sample consisted of 40 women diagnosed with either BN (N = 19) or AN (N = 21; ED sample) and 24 non-eating disordered, healthy female controls (HC). Within the Body Image Approach Task (BIAT) participants viewed photos of their own body (self-image) and a matched control body (other-image) by zooming the photos closer toward them (image became more focused) on the screen. The BIAT yields zoom-levels recorded separately for self- relative to other-images. Further measures were attractiveness ratings of these body images as well as questionnaire measures of BA, BC, and general ED symptomatology. Results showed that despite strong body dissatisfaction and clearly negative ratings of self- relative to other-images in both EDs, no group differences were found in approach to self-images on zoom-level as measured with the BIAT. Correlational analysis in each group indicated that zoom-level was positively related to BA scores in the HC group only. Yet, stepwise regression analyses revealed that attractiveness ratings explained most of the variance accounted by BA in predicting zoom-level. In sum, the BIAT seems suitable to assess BA and self-rated body attractiveness, but only in healthy individuals with subclinical levels on these constructs. It does not seem to capture the body image satisfaction or the behavioral components of body image disturbances in AN or BN or it conflates the opposed influences of BA and BC. Further experimentation is needed to adapt measures of behavioral body image components to the processes evoked in patients with ED during confrontation with body images.
Highlights
Eating disorders (ED) are characterized by pervasive body image disturbances (BID)
Only the results of the analysis of variance (ANOVA) with ED vs. healthy female controls (HC) as group factor are reported for reasons of brevity
The present study is the first to apply a behavioral approach task to assess BA and behaviors such as checking (BC) in women with a diagnosed ED in regard to images of their own body. It represents an important step beyond self-report and can enhance our understanding of this neglected behavioral BID component
Summary
Eating disorders (ED) are characterized by pervasive body image disturbances (BID). In Anorexia nervosa (AN), perceptual and attitudinal aspects of BID are classified as necessary diagnostic criteria in the Diagnostic and Statistical Manual for Mental Disorders (DSM-V, American Psychiatric Association [APA], 2013); whereas Bulimia nervosa (BN) criteria require presence of the attitudinal aspects only. Results of studies using these self-report instruments show significant correlations with other aspects of BID and with body weight (e.g., Rosen et al, 1991; Legenbauer et al, 2007; Mountford et al, 2007; Bamford et al, 2014) This former research may be limited as self-report-based assessments can lead to biased results due to self-presentation tendencies and insensitivity to more automatic and implicit behaviors (with possible differences between AN and BN and interferences with severity). To overcome this limitation and to broaden the understanding of behavioral BID in EDs, behavioral assessment should be implemented
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