Body Checking Behaviors Research Articles

Improving Anorexia Nervosa Treatment with Virtual Reality Body Exposure and Attentional Bias Modification: A Single Case Study

This case study explores the potential of integrating attentional bias modification training (ABMT) with mirror exposure therapy (MET), utilizing virtual reality and eye-tracking, for a 14-year-old girl diagnosed with anorexia nervosa (AN). The ABMT-MET intervention was used alongside a standard treatment program called Home Treatment (HoT), which combines cognitive behavioral therapy with family-based therapy. Though the patient began HoT with a 3-week inpatient phase, the ABMT-MET intervention specifically took place during the subsequent Home Treatment sessions. The experimental treatment, comprising five consecutive weekly sessions, was bookended by pre- and post-assessment sessions and included a six-month follow-up. During the sessions, the patient engaged in systematic and hierarchical exposure to a virtual representation of her silhouette, with gradual adjustments made to the avatar’s body mass index (BMI) toward a healthier range. ABMT sessions, conducted before each MET session, aimed to redistribute the patient’s focus evenly across her body, successfully neutralizing her initial attentional bias toward non-weight-related body parts. The patient demonstrated consistent decreases in anxiety and fear of weight gain, effectively progressing through the BMI hierarchy in the virtual setting. Post-treatment assessments indicated significant enhancements in body dissatisfaction, drive for thinness, body-checking behaviors, and body appreciation, with these gains preserved at the six-month follow-up, although the attentional bias returned to pre-treatment levels. Though the single-case design limits definitive conclusions, these findings suggest ABMT-MET may be a promising adjunct therapy for AN, requiring further research for confirmation.

Experiential avoidance, thought suppression, meta-cognition, and body-checking among women during pregnancy and postpartum: Buffering effect of self-compassion.

The present study attempted to explore the psychological experiences of experiential avoidance, thought suppression, meta-cognition, self-compassion and body-checking during two stages of maternity (pregnancy and postpartum) among women embracing maternity for the first time. The study used a cross sectional correlational design and enrolled 306 women participants who were in their third trimester of pregnancy or of postpartum (pregnant = 154 [50.3%]; postpartum = 152 [49.7%]) with ages ranging between 20 and 35 years (M = 26.62; SD = 2.19). The data was collected using the Brief Experiential Avoidance Questionnaire (BEAQ); Thought Control Questionnaire (TCQ); Metacognitions Questionnaire (MCQ); Self-Compassion Scale (SCS), and Body-checking Questionnaire (BCQ). Data was subjected to statistical analysis using SPSS version 21. A significant positive association was observed between experiential avoidance, thought suppression, meta-cognition, and body-checking while self-compassion showed reverse association with these variables. The body-checking outcome was significantly negatively predicted by self-compassionate attitude and positively by thought suppression in both groups (i.e., pregnant and postpartum). The experiential avoidance positively predicted body-checking among women in post-partum group only. Moreover, a mediating association of experiential avoidance and a moderating effect of self-compassion (self-kindness and common humanity) and meta-cognition (positive beliefs about worry and need to control thought) were also observed to moderate between thought suppression and body-checking outcomes. The study concluded that experiential avoidance and thought suppression contribute in developing body-checking behaviors among women who are pregnant or at postpartum stage of maternity. In addition, self-compassion and meta-cognition moderate this association with self-compassion playing potential buffer.

Body Checking in Anorexia Nervosa: from Inquiry to Habit

AbstractBody checking, characterized by the repeated visual or physical inspection of particular parts of one’s own body (e.g. thighs, waist, or upper arms) is one of the most prominent behaviors associated with eating disorders, particularly Anorexia Nervosa (AN). In this paper, we explore the explanatory potential of the Recalcitrant Fear Model of AN (RFM) in relation to body checking. We argue that RFM, when combined with certain plausible auxiliary hypotheses about the cognitive and epistemic roles of emotions, is able to explain key characteristics of body checking, including how body checking behavior becomes habitual and compulsive.

Measuring cognitions during exercise: Associations between thoughts and eating disorder behaviors over a 3-week ecological momentary assessment study.

Previous work has outlined cognitive beliefs about exercise in general, but very little is known about momentary cognitions while engaging in pathological exercise. The primary aim of this study was to explore thought content during exercise and to test whether these thoughts predicted later engagement in eating disorder behaviors. We also tested associations between thoughts and specific exercise activity. We monitored 31 women with clinically significant eating psychopathology for 3 weeks via ecological momentary assessment as they reported on their exercise and eating disorder behaviors, and thoughts about shape, weight, or calories during exercise. Thoughts were self-reported upon cessation of each exercise session. Thinking about weight loss during exercise predicted later engagement in body-checking behaviors. Weight-bearing exercise was associated with a decreased likelihood of thinking about calories but an increased likelihood of thinking about shape during exercise. These findings show that shape and weight thoughts are present during exercise and that their influence on eating disorder behaviors may exist on a much briefer time scale (i.e., within a day) than previous studies show. Clinically, future studies may seek to test interventions aimed at changing or restructuring cognitions during exercise to help shape adaptive exercise behavior during and after treatment. This is the first study measuring thoughts during pathological exercise in real-time among those with eating disorder psychopathology. The results show that thinking about weight loss during exercise might increase the likelihood of engaging in body-checking behaviors. Findings will inform the development of treatment approaches to help those in recovery from eating disorders re-engage with exercise.

Examining the momentary relationships between body checking and eating disorder symptoms in women with anorexia nervosa

Body checking is common among individuals with anorexia nervosa (AN) and increases risk for dietary restriction. However, no study has examined whether body checking increases the immediate risk for engaging in other harmful weight loss behaviors, or whether this relationship is moderated by person-level traits. The current study utilized ecological momentary assessment (EMA) to examine whether (a) body checking predicted rapid use of weight loss behaviors, and (b) whether eating-related obsessionality/compulsivity moderated this relationship. Women with full or subthreshold anorexia nervosa (N = 118) completed a measure of eating-related obsessionality/compulsivity at baseline, followed by a 14-day EMA protocol during which they reported on body checking and weight loss behaviors (i.e., exercise, self-induced vomiting, laxative use, skipping meals, and increasing fluid intake). In a series of generalized linear mixed models, within-person effects indicated that momentary body checking significantly predicted subsequent meal skipping and using fluids to curb appetite. Between-person effects indicated that individuals who engage in more frequent body checking also engage in a higher frequency of self-induced vomiting, meal skipping, and use of fluids to curb appetite. An individual's degree of eating-related obsessionality/compulsivity did not moderate any of these relationships. Findings highlight body checking as an immediate precursor of dangerous weight loss behaviors among individuals with AN, and underscore the need for clinicians to address body checking during treatment.

Inhibitory Learning-Based Exposure Therapy for Patients With Pathological Health Anxiety: Results From a Single Case Series Study

Exposure to illness-related stimuli is a crucial component of CBT for pathological health anxiety. Modern exposure approaches focus on forming inhibitory associations and provide promising results. An implementation in the treatment of pathological health anxiety is still missing. The present single case series study investigated the applicability and effects of an inhibitory learning-based exposure approach (12 sessions) on health anxiety, safety behavior, and tolerance for aversive states in n = 7 outpatients (age: M = 35.14, SD = 8.43) with a DSM-5 Illness Anxiety Disorder or Somatic Symptom Disorder with predominant health worries in multilevel models. A high intervention satisfaction and little adverse effects were reported. A significant(ly) (steepened) reduction of health anxiety (b = −0.10, pbaseline < .001, ppre-intervention = .003), and body checking behavior (b = −0.14, pbaseline/pre-intervention < .001), and a significant increase in distress tolerance (b = 0.07, pbaseline = .02, ppre-intervention = .004), discomfort tolerance (b = 0.11, pbaseline/pre-intervention < .001), and insecurity tolerance (b = 0.13, pbaseline/pre-intervention < .001) were observed during the intervention in comparison to the baseline and pre-intervention phase. The present study provided first evidence that the principles of inhibitory learning can be effectively applied to the exposure-based treatment of pathological health anxiety.

“Muscle Pics”, a new body-checking behavior in muscle dysmorphia?

Background and aimsThe internalization of ideal hypermuscular body and pro-muscularity media's influence have shown their importance in muscle dysmorphia development. The aim of the current study is to have a better understanding of links between specific body checking behaviors and muscle dysmorphia in social network context. MethodsIn total, 342 students practicing weightlifting at the university gym in Bordeaux answered to a survey with sociodemographic information and body checking symptoms including taking specific selfies of muscles and muscularity “Muscle Pics” and the MDDI (Muscle Dysmorphic Disorder Inventory). ResultsMuscle dysmorphia was prevalent in 18.7% of our population (64 students). We observed that muscle dysmorphia was correlated to “Muscle Pics”, “Follow-up”, “Message”, “Selfie”, and gym mirror checking with significant results (P<0.01). Also, « Muscle Pics » were linked to APEDs use, pro-muscularity websites, fitness model comparison and gym mirror checking (P<0.01). For muscle dysmorphia, “Muscle Pics” have strong predictive results (OR=5.10, P=0.000) and (OR=4.08, P=0.000) for adjusted. “Follow up” (OR=4.76, P=0.000) and (OR=3.83, P=0.000) for adjusted, “Muscle Pics Selfie” (OR=11.20, P=0.000) and (OR=11.55, P=0.000) for adjusted, “Muscle Pics Message” (OR=4.49, P=0.001) and (OR=5.78, P=0.001) for adjusted. Conclusion“Muscle Pics” showed several links with muscle dysmorphia for global score “drive for size”, “functional impairment” but not for “appearance intolerance” dimension. Pro-muscularity websites, fitness model comparisons and gym mirror checking are linked to muscle dysmorphia and “Muscle Pics”. Future research on “Muscle Pics” will help to provide a better understanding of muscle dysmorphia and its link with pro-muscularity influence websites.

Familial transmission of attention allocation towards one's own and a peer's body: An eye-tracking study with male adolescents and their fathers.

Previous research provides evidence of maternally transmitted body-related attentional biases in female adolescents. In contrast, it remains unclear whether a familial transmission of body-related attentional biases also exists within father-son dyads. Therefore, the current study examined n = 42 male adolescents and their fathers with respect to direct and indirect paternal influences on body-related attention patterns and specific body-related concerns in sons. Besides completing specific body image questionnaires, participants were shown pictures of their own and a respective peer’s body, while their eye movements were tracked. The fathers additionally viewed the body pictures of their own son and an adolescent peer. Contrary to the assumed direct and indirect paternal transmission processes, the sons’ body-related attention patterns were not significantly associated with the perceived amount of paternal body-related feedback, with the fathers’ attention patterns towards their own son’s and the adolescent peer’s body, or with the fathers’ attention patterns towards their own and the adult peer’s body. Similarly, no significant associations were found between direct or indirect paternal influences and the sons’ drives for muscularity and thinness, body dissatisfaction, and muscularity-related body-checking behavior. Comparing the present findings with previous research indicating a maternal transmission of body-related attentional biases and body-related concerns in female adolescents, alternative (not gender-linked) familial transmission processes, e.g., via one’s own mother, or a comparatively higher relevance of other sociocultural influences, e.g., via peers or the media, might be assumed for male adolescents.

Drawings or 3D models: Do illustration methods matter when assessing perceived body size and body dissatisfaction?

Research has reported that both men and women experience body dissatisfaction. Among other instruments, a widely used method to assess perceived body size and body dissatisfaction are figure rating scales. Although a variety of illustration methods (e.g., three-dimensional, or 3D, models and line-drawing models) have been used to create these figure rating scales, to date, they have not been directly compared to one another. Thus, in the first study, which includes 511 participants at a mean age of 46 years old (range: 20–70), the present research work aims to assess how the line-drawing and 3D model scales, representing different body illustration methods, relate to each other. Furthermore, the first study assesses the validity of the indication of body dissatisfaction measured using these figure rating scales by comparing them to body checking or scrutinizing behavior and body appreciation levels. The project’s second study examines the two figure rating scales using objectively measured anthropometric data. In total, 239 participants at a mean age of 54 years (range: 18–94) were included. The results show that figure rating scales can be considered tools that measure perceptual body image due to their positive correlations with body checking behavior (for women) and their negative correlations with body appreciation. The 3D model and line-drawing scales show good to excellent inter-scale reliability, and both scales agree equally well with body mass index (BMI) measurements. Thus, the 3D model and line-drawing scales both seem well suited for assessing perceived body size and perceptual body dissatisfaction, suggesting that neither illustration method is superior to the other.

The Association of Muscle Dysmorphia, Social Physique Anxiety, and Body Checking Behavior in Male College Students With Weight Exercise.

Objectives: To investigate the association between muscle dysmorphia (MD), social physique anxiety, and body-checking behavior in male college students with weight exercise, and to reveal the association between them.Methods: A total of 492 male college students with weight exercise from 18 Fitness Clubs or bodybuilding centers in Chengdu, China, participated in this study.Results: First, the social physique anxiety scores, body checking frequency, and weight exercise behavior (i.e., frequency, time, and intensity) in male college students with MD were significantly higher than those without MD; it indicated that the higher the exercise frequency they had, the longer the exercise time they cost, and the higher exercise intensity carried out, and the higher the social physique anxiety scores tended to be, the higher the frequency of body checking on “global muscles,” “chest and shoulder muscles,” “comparison with others” and “posture measurement” they did. Second, the mediating effect of the social physique anxiety on MD and body checking was established in the “MD → global muscle checking,” “MD → chest and shoulder muscle checking,” “MD → comparison with others,” and “muscle dysmorphia → posture measurement.”Conclusion: Male college students with MD not only have a higher social physique anxiety, but also a higher frequency of body-checking behavior than the ordinary individuals. Social physique anxiety is one of the important mediating factors to those with MD which affects the body-checking behavior.

Effects of full-body mirror exposure on eating pathology, body image and emotional states: Comparison between positive and negative verbalization.

Mirror exposure (ME) is an effective technique to improve body image. However, evidence on the underlying mechanisms and the optimal verbalization instruction during ME is lacking. Therefore, this experimental study analyzed mechanisms of ME and therapeutic outcomes by comparing positive (PV) and negative (NV) full-body verbalization. N = 73 healthy females were randomized to a PV or an NV condition. PV participants verbalized positively while NV participants verbalized negatively about their whole body. Each participant underwent three standardized ME sessions. Before and after each ME session, positive affect, negative affect and body satisfaction were assessed. Before the first and after the third ME, participants completed questionnaires on cognitive-affective and behavioral aspects of body image, eating pathology and self-esteem. Regarding within-ME changes, the results indicate that positive affect and body satisfaction decreased while negative affect increased in the NV group but not in the PV group. In contrast, regarding between-ME changes, decreased negative affect as well as positive affect and increased body satisfaction were observed in both groups. However, eating pathology remained stable, whereas body-checking behavior increased and the PV condition was followed by higher levels of self-esteem compared to the NV condition. These findings suggest that both PV and NV improve negative affect and body satisfaction between-ME, and thus seem to be effective ME instructions. Given that NV led to increased negative affect within-ME and did not influence self-esteem, PV might represent the favorable instruction during ME for body-satisfied women.

Assessing the Rising Emphasis on Muscularity for Women: Psychometric Properties of the Brazilian Version of the Female Muscularity Scale

The female appearance ideal has undergone considerable changes in recent years, resulting in increases in drive for muscularity among Brazilian women. The Female Muscularity Scale (FMS) was developed to assess muscularity concerns among U.S. women and was shown to be a promising measure of muscularity-related attitudes and behaviors. The present studies aimed to translate and culturally adapt the FMS to Brazilian Portuguese and to explore its factorial structure among Brazilian women (Study 1: n = 202, Mage = 24.40, SD = 5.03) and to confirm the factor structure as well as evaluate convergent and divergent validity and reliability of the FMS for young adult Brazilian women (Study 2: n = 382, Mage = 22.71, SD = 4.32). Exploratory factor analysis revealed a two-factor structure (Attitudes and Behaviors subscales), each comprising five items. Confirmatory factor analysis upheld the original two-factor structure with good fit indices. The full scale and its subscales presented convergent validity through associations with measures of body dissatisfaction, drive for muscularity, body-ideal internalization, body checking and avoidance behaviors, disordered eating, and exercise engagement. Evidence of divergent validity was obtained in relation to self-esteem and depressive symptoms. The Brazilian version of FMS also presented adequate values for internal consistency and 2-week test-retest reliability. These findings support the Brazilian version of the FMS as a useful tool for investigating muscularity-related aspects of body image and body change behaviors that are increasingly a source of concern for women.

Body checking and avoidance behaviors among overweight and obese Brazilians

Rationale: Frequent body checking and avoidance are behaviors related to body image disturbances and eating disorders. The aim of the study was to investigate the prevalence of these behaviors among overweight and obese individuals.

Body checking behaviors and eating disorder pathology among nonbinary individuals with androgynous appearance ideals.

Internalized sociocultural standards of attractiveness are a risk factor repeatedly linked to eating disorders; however, many nonbinary individuals do not conform to these standards. This study investigated the body checking behaviors and eating disorder pathology among nonbinary individuals with androgynous appearance ideals. Participants (n = 194) completed an online survey assessing body checking behaviors, body appreciation, gender congruence, and eating disorder pathology RESULTS: Body checking predicted eating disorder pathology, and body image significantly improved the model. Gender congruence did not additional variance in predicting eating pathology CONCLUSION: Though gender congruence was not a significant predictor of eating pathology, content analysis revealed unique body behaviors specific to nonbinary individuals' gender identity and gender expression. Clinical implications include expanding perceptions of eating disorder presentation when working with nonbinary individuals with androgynous appearance ideals. Level V, cross-sectional descriptive study.

A longitudinal examination of body-checking behaviors and eating disorder pathology in a community sample of adolescent males and females.

Related to the cognitive-behavioral theory of eating disorders, body checking has gained increasing recognition as both a maintaining factor for eating disorders and an important target for treatment. However, it is unclear whether body-checking behaviors contribute to the development of disordered eating, or if these behaviors develop as a response to experiencing eating disorder thoughts and behaviors. This study aims to examine the relationships between body-checking behaviors and eating disordered thoughts and behaviors in adolescent females and males in the community over time. Participants included 238 adolescents (n = 104 males, n = 134 females, Mage = 16.5 years) recruited from high schools in British Columbia, Canada, who completed the Eating Disorder Examination Questionnaire and Body Checking Questionnaire at baseline (T1) and again approximately 4 months later (T2). After controlling for baseline levels of eating pathology and body mass index (BMI), body checking at T1 predicted increases in eating pathology for both males and females. In contrast, after controlling for baseline levels of body checking and BMI, eating pathology at T1 did not predict changes in body checking for females, but it did for males. Findings suggest that, among adolescents, engaging in body-checking behaviors may increase risk for disordered eating. If supported by further research, targeting body-checking behaviors in prevention programs may be warranted.

Self-compassion and Body Checking Among Women: the Mediating Role of Stigmatizing Self-perceptions

The present study examined self-compassion and fear of self-compassion in relation to body checking behavior, an understudied marker of eating disorder risk. Stigmatizing self-perceptions in the form of self-objectification, body shame, and weight bias internalization were also examined as a collective set of factors that may connect self-compassion to body checking behavior. Undergraduate women (N = 177) recruited from a university participation pool completed the Self-Compassion Scale, the Fear of Self-Compassion Scale, the Weight Bias Internalization Scale—Modified, the Self-Objectification Beliefs and Behaviors Scale, the Phenomenological Body Shame Scale, and the Body Checking Scale in counterbalanced order via an online survey hosted on Qualtrics for course credit. Parallel mediation analyses conducted via PROCESS Model 4 demonstrated a significant indirect effect of self-compassion on body checking through weight bias internalization (ab = − .20; 95% percentile bootstrap confidence interval (PB CI): − .31 to − .11), self-objectification (ab = − .15; 95% PB CI: − .25 to − .08), and body shame (ab = − .16; 95% PB CI: − .28 to − .05). Significant indirect effects of fear of self-compassion on body checking were also demonstrated through weight bias internalization (ab = .18; 95% PB CI: .10 to .26), self-objectification (ab = .13; 95% PB CI: .07 to .21), and body shame (ab = .12; 95% PB CI: .03 to .21). No direct effects of self-compassion were observed. The findings support self-stigma as a psychological bridge that links being self-compassionate to body checking behavior. Low self-compassion and fear of self-compassion may allow stigmatizing self-perceptions to take root and drive more body checking behavior.

Racial differences in overeating, loss of control eating, and binge eating: Extending core tenets of the Cognitive Behavioral Theory of Eating Disorders

PurposeThe present study examined racial differences in associations among body dissatisfaction, body checking, and dietary restraint relative to overeating, loss of control eating, and binge eating outcomes among college women. Method: Young adult women (N = 903) at three Mid-Atlantic US institutions completed measures assessing negative body image and eating pathology via an online survey. Structural equation modeling was used to test a model examining associations among body dissatisfaction, body checking, dietary restraint, and disinhibited eating behaviors. Multigroup analyses examined whether these associations differed for women who identified as White (n = 432) versus Black (n = 359). Results: More frequent body checking explained associations between elevated body dissatisfaction and more frequent use of all three disinhibited eating outcomes for White and Black women, whereas restraint solely mediated an association between body dissatisfaction and overeating. The assessed constructs generally operated in a similar manner across racial groups. However, stronger associations among body dissatisfaction, restraint, and overeating, and between body checking and loss of control eating were identified for women who identified as White versus Black. Conclusions: Eating disorder programming efforts targeting body checking behavior may prove useful in decreasing White and Black women's disinhibited eating.

Body checking in pediatric eating and obsessive-compulsive disorders

Background and objectivesEating disorders and obsessive-compulsive disorder (OCD) have high rates of reciprocal comorbidity, and appear to have shared etiological factors. Body checking has been proposed as behavior that is associated with both obsessive-compulsive and eating disorder symptoms. The current study was designed to assess body checking, eating disorder, and OCD symptoms in a combined pediatric sample. MethodsA sample of children and adolescents in treatment for eating disorders (n = 97), OCD (n = 54), and a school-based comparison sample (n = 333) completed measures of obsessive-compulsive symptoms, eating disorder symptoms, and body checking. ResultsCompared to school-based and eating disorder groups, the sample of children and adolescents with OCD reported significantly less body checking and avoidance, as well as eating disorder symptoms. ConclusionsIn contrast to the prediction that those with OCD would exhibit higher levels of body checking and avoidance behaviors than a school-based comparison group, children and adolescents with OCD reported less body checking and other eating disorder symptoms than the school-based sample. The implications for assessment and treatment will be discussed.

Exploring Mechanisms of Action in Exposure-Based Cognitive Behavioral Therapy for Eating Disorders: The Role of Eating-Related Fears and Body-Related Safety Behaviors

Evidence-based cognitive behavioral therapy for eating disorders includes a component of exposure therapy, which involves patients confronting feared eating and body-related stimuli while preventing safety behaviors. With recent research demonstrating that eating-related fears and safety behaviors are central to eating disorder pathology, there is increased emphasis on improving the efficacy of exposure therapy in eating disorders. Doing so will require a better understanding of important mechanisms of action in this treatment. The present study explored how changes during treatment in eating-related fears and avoidance as well as body-related safety behaviors influence overall treatment outcomes. Individuals with eating disorders (N = 71) receiving exposure-based treatment completed measures of global eating disorder severity at admission and discharge. Hypothesized mechanisms of action were also assessed at admission and discharge as well as at a 2-week time point after beginning treatment. Path modeling analyses showed that decreased eating-related cognitions (feared concerns about eating) and emotions (anxiety about eating) at the 2-week time point were prospectively predictive of lowered global eating disorder symptom severity at discharge. Additionally, reduced body checking and avoidance behaviors after 2 weeks of treatment were also associated with lower eating disorder severity at discharge. These findings highlight the importance of exposure-based therapy in eating disorders and the need to uniquely address eating-related fears and safety behaviors.

Evaluating the effectiveness of ecological momentary assessment and intervention targeting body checking behaviors

ABSTRACTThis study investigated the efficacy of using ecological momentary assessment and intervention (EMA/EMI) to target body checking behaviors. Body checking has been shown to increase body dissatisfaction and play a role in eating disorders, but few treatments specifically targeting body checking have been empirically evaluated. Forty-four female undergraduates who reported engaging in frequent body checking behaviors participated in a five-day study wherein they were assessed five times a day via smart phone. On the final two days of the study, intervention messages were sent containing cognitive-behavioral strategies for decreasing body checking. Body checking behaviors increased within each day, but decreased across the five day intervention period. Pretest to posttest analyses found healthy improvements in a number of body image related constructs. These results highlight that 1) body checking appears to increase throughout the day, and 2) targeting body checking behaviors through brief EMA/EMI may be a useful clinical tool.