Effects of emotional acceptance and rumination on media-induced body dissatisfaction in anorexia and bulimia nervosa

IntroductionBody dissatisfaction is an important risk and maintaining factor for eating disorders. The aim of the present study was to experimentally test the effects of two emotion regulation strategies - acceptance and rumination - on media-induced body dissatisfaction in eating disorders.MethodAfter watching pictures of thin models, women with anorexia nervosa (AN; n = 39) and bulimia nervosa (BN; n = 39) were encouraged to either use emotional acceptance or rumination to cope with their feelings. Body dissatisfaction and mood were repeatedly assessed.ResultsAcceptance significantly improved body dissatisfaction in women with BN. Rumination led to a significant increase of body dissatisfaction in both eating disorder groups. Results were independent from mood changes.DiscussionFindings highlight the importance ruminative thinking may have in the aggravation of dissatisfaction with the own body in AN and BN. Results suggest that emotional acceptance is a useful strategy to regulate body dissatisfaction after exposure to thin-ideal media in BN.     

Looking at my body. Similarities and differences between anorexia nervosa patients and controls in body image visual processing

BackgroundBody image distortion is a core symptom of eating disorders. Functional magnetic resonance imaging (fMRI) studies on body image processing, described different patterns of neural response, mainly involving the inferior and superior parietal lobules, and the dorsolateral prefrontal cortex (DLPFC), with conflicting results.MethodsThe neural response to the view of their own body pictures (normal size and distorted) was evaluated in 18 female anorexia nervosa (AN) restricting type patients, and in 19 healthy female subjects (HC) using fMRI. Clinical assessment was performed by means of the structured clinical interview for DSM-IV and self-reported questionnaires.ResultsIn response to the body image distortion, patients and controls showed an inverse pattern of activation, with the widest extent of activation in the oversize condition in AN, while in the undersize condition in HC. AN and HC showed a similar pattern of neural response to the view of their own body, with an increased activation in the extrastriate body area, superior and inferior parietal lobule and prefrontal areas, although the extent of activation in HC was more limited as compared with AN patients. Increased activity in AN patients, compared with HC, was observed in the DLPFC in response to the oversized body picture and a significant correlation was found in AN patients between DLPFC activation and eating disorder psychopathology.ConclusionsOur findings suggest the existence of a continuum from normalcy to pathology in neural response to body image, and confirm the clinical relevance of body image distortion in AN, reinforcing the key role of attentive, executive and self-evaluation networks in AN visual processing of own distorted body image.     

Neural correlates of body dissatisfaction in anorexia nervosa

Body dissatisfaction is an important precipitating and maintenance factor in anorexia nervosa (AN) and behavioral studies suggest that a cognitive-affective component and a perceptual component (perceptual disturbance of one's own body) are both important in this pathophysiology. However, the functional neuroanatomy of body dissatisfaction in AN is largely unknown. This study has investigated self-other body-shape comparison to establish neural correlates of body dissatisfaction in patients with AN. 17 women with AN and 18 age and sex-matched healthy control (HC) subjects were scanned using functional magnetic resonance imaging while comparing themselves with images of slim idealized female bodies (active condition) or viewing images of interior home designs (control condition). Participants were asked to compare their body shape or room design with those presented.Patients with AN (in comparison to the HC group) showed greater anxiety to the self-other body-shape comparison, and they were less satisfied with their current body shape. In the patient group (in comparison to the HC group) the self-other body-shape comparison induced more activation of the right sensorimotor brain regions (insula, premotor cortex) and less activation of the rostral anterior cingulate cortex (ACC). Insula hyperactivation along with ACC hypoactivation may be critical for altered interoceptive awareness to body self-comparison and/or for altered implicit motivation to thin-idealized body images in AN patients.     

Dopamine and anorexia nervosa

We have suggested that reduced food intake increases the risk for anorexia nervosa by engaging mesolimbic dopamine neurons, thereby initially rewarding dieting. Recent fMRI studies have confirmed that dopamine neurons are activated in anorexia nervosa, but it is not clear whether this response is due to the disorder or to its resulting nutritional deficit. When the body senses the shortage of nutrients, it rapidly shifts behavior toward foraging for food as a normal physiological response and the mesolimbic dopamine neurons may be involved in that process. On the other hand, the altered dopamine status of anorexics has been suggested to result from a brain abnormality that underlies their complex emotional disorder. We suggest that the outcomes of the treatments that emerge from that perspective remain poor because they target the mental symptoms that are actually the consequences of the food deprivation that accompanies anorexia. On the other hand, a method that normalizes the disordered eating behavior of anorexics results in much better physiological, behavioral, and emotional outcomes.     

Psychophysics reveals a right hemispheric contribution to body image distortions in women but not men

We tested the hypothesis that the right cerebral hemisphere contributes to the enhanced body image distortions seen in women when compared to men. Using classical psychophysics, 60 right-handed healthy participants (30 women) were briefly presented with size-distorted pictures of themselves, another person (an experimenter), and a non-corporal, familiar object (a coke bottle) to the central, right, and left visual field. Participants had to decide whether the presented stimulus was fatter or thinner than the real body/object, and thus compare the presented picture with the stored representation of the stimulus from memory. From these data we extracted the amount of image distortion at which participants judged the various stimuli to be veridical. We found that right visual field presentations (initial left hemisphere processing) revealed a general "fatter" bias, which was more evident for bodies than for objects. Crucially, a "fatter" bias with own body presentations in the left visual field (initial right hemisphere processing) was only found for women. Our findings suggest that right visual field presentation results in a general size overestimation, and that this overestimation is more pronounced for bodies than for objects. Moreover, the particular "fatter" bias after own body presentations to the left visual field in women supports the notion of a specific role of the right hemisphere in sex-specific body image distortion.     

Body image disturbance in anorexia nervosa: beyond body image

In this paper the literature on body image disturbance in anorexic patients is reviewed. After a decade of experimental investigation of body image in anorexia nervosa, where old and new techniques have been used and where a large number of correlations have been identified, what do we really know? The findings have been conflicting but some regularities exist. It is hypothesized that the conflicting results may be related to the presence of different subgroups among anorexics and different types of body image disturbance. Body size estimation is only one dimension of body image perception. Likewise, body size overestimation is only one aspect of body image perception. Likewise, body size overestimation is only one aspect of body image disturbance. Some, but not all anorexics, overestimate their body size, and those who do, seem to have poor prognosis. Body size overestimation is not confined to anorexics. It is not known whether it is a function of a general perceptual/cognitive disorder, but it does seem to be stable over time. The implications of the presence of other psychiatric conditions in anorexic patients are discussed and suggestions for future research and for practice are made.     

Enhanced cortical processing of cardio-afferent signals in anorexia nervosa

ObjectiveTo assess cardiac interoception in anorexia nervosa (AN) using a multidimensional approach.MethodsWe assessed the physiological dimensions of cardioception, i.e. the peripheral signal itself (heart rate, HR, and heart rate variability, HRV) and its cortical representation (heartbeat evoked potentials, HEPs), and the psychological dimensions of interoceptive accuracy (heartbeat perception) and interoceptive sensibility (confidence ratings). Electroencephalogram (EEG) and electrocardiogram (ECG) were recorded concurrently during rest and while performing a heartbeat perception task in a sample of 19 female in-patients with AN (DSM-5) and 19 healthy control women (HC).ResultsHEPs, defined as mean EEG amplitude in a time window of 455–595 ms after the R-peak of the ECG, were significantly larger in the AN than in the HC group across conditions (p = .002, d = 1.06). There was a trend toward better heartbeat perception in AN, but no group differences in HR, HRV, and confidence ratings.ConclusionsIndividuals with AN showed an interoceptive profile of heightened cortical processing, a trend toward heightened interoceptive accuracy, and unaltered cardiac autonomic activation and interoceptive sensibility.SignificanceIn terms of neurobiological models of AN, enhanced cortical representations of interoceptive signals might reflect a mechanism, which promotes fasting by alleviating negative body states.     

Body size estimation in anorexia nervosa: A brief review of findings from 2003 through 2013

Body size overestimation is a fundamental feature in anorexia nervosa (AN). The extent or even existence of body size overestimation in AN is controversial. The most recent review (Farrell et al., 2005) found that only half the studies reported overestimation of body size in individuals diagnosed with AN. The remaining studies found no overestimation or in some instances underestimation. The discrepancy in these findings has been attributed to the wide variety of assessment techniques that are used, including many with questionable psychometric properties. We review all 9 contemporary studies conducted in this area since the last review in 2005. For each study we describe the number of participants, methodology, reliability/validity data, amount of whole body distortion, effect sizes, and a summary of findings. In all studies that included a healthy control group, individuals with AN overestimated their whole body size more than healthy controls did. The difference was significant in all except two studies. Based on these contemporary findings, we conclude that individuals with AN overestimate their body size and that the greater consistency of findings in the studies conducted over the last decade is attributable to the use of improved methodologies and assessment tools with documented psychometric properties.     

The intellectual functioning of adolescents with anorexia nervosa and bulimia nervosa

The aim of this study was to investigate the intellectual functioning of a large group of eating disordered adolescents in order to test two hypotheses, viz, that the intellectual functioning of eating disordered adolescents conforms to the normal distribution, and that eating disordered adolescents do not perform better in verbal abilities than in nonverbal abilities. Standard intelligence tests were applied to 190 consecutive out- and inpatients with eating disorder diagnoses. The results were compared with those of a group of patients with other disorders, similar in age, sex, SES, and year of admission. The IQ of the eating disordered patients was significantly higher than that of patients in the comparison group. Patients in the comparison group and bulimic patients, but not anorexic patients, showed better nonverbal than verbal intellectual performance.     

Beyond body image: what body schema and motor imagery can tell us about the way patients with anorexia nervosa experience their body

Aim

Recent evidence suggests that the body image disturbance often observed in patients with anorexia nervosa also extends to the body schema. According to the embodiment approach, the body schema is not only involved in motor execution, but also in tasks that only require a mental simulation of a movement such as motor imagery, mental rotation of bodies, and visuospatial perspective-taking. The aim of the present study was to assess the ability of patients with anorexia to mentally simulate movements.

Methods

The sample included 52 patients with acute anorexia and 62 healthy controls. All participants completed three tests of explicit motor imagery, a mental rotation test and a test of visuospatial perspective-taking.

Results

Patients with anorexia nervosa, with respect to controls, reported greater difficulties in imagining movements according to a first-person perspective, lower accuracy in motor imagery, selective impairment in the mental rotation of human figures, and reduced ability in assuming a different egocentric visuospatial perspective.

Conclusion

These results are indicative of a specific alteration in motor imagery in patients with anorexia nervosa. Interestingly, patients' difficulties appear to be limited to those tasks which specifically rely on the body schema, while patients and controls performed similarly in the 3D objects mental rotation task.     

Efficacy of body exposure as treatment component for patients with eating disorders

Background and objectives

Body exposure and cognitive restructuring are well known interventions in cognitive-behavioral therapies for patients with eating disorders. Though promising, little is known about the impact of body exposure on body dissatisfaction, overvaluation of weight and shape and other aspects of eating disorder psychopathology. Thus, the aim of the two studies presented here is to evaluate the efficacy of mirror exposure and video exposure on body dissatisfaction, weight and shape concerns and other aspects of eating disorder psychopathology.

Method study 1

Fourteen women diagnosed with Eating Disorders Not Otherwise Specified (EDNOS; DSM-IV-TR) were treated in repeated mirror exposure sessions. Assessments were carried out before (baseline) and after body exposure.

Results study 1

Measures of body dissatisfaction, shape concerns and eating disorder psychopathology were significantly improved at the post treatment assessment.

Method study 2

Thirteen women with Bulimia Nervosa (BN; DSM-IV-TR) received repeated mirror and video exposure sessions. Measures were assessed before (baseline) and after body exposure.

Results study 2

Body image dissatisfaction was significantly improved at post treatment assessment.

Limitations

These preliminary results are based on subjective data from two small clinical samples. Comparisons between the studies are limited by design variations.

Conclusions

The studies provide evidence that body exposure is a promising technique for treatment of body dissatisfaction in EDNOS and BN. Moreover, in EDNOS shape concern and aspects of eating disorder psychopathology were improved after body exposure. Reasons for the lack of change in shape and weight concern as well as in eating disorder psychopathology in BN are discussed.     

Gender role, eating disorder symptoms, and body image concern in ballet dancers

OBJECTIVE: Our objective was to evaluate the relationships between gender role, eating behavior, and body image in nonprofessional female ballet dancers. METHODS: One hundred ten female ballet dancers and 59 controls were administered the Bem Sex Role Inventory, the Eating Disorder Examination (EDE), the Body Uneasiness Test (BUT), and the Beck Depression Inventory. RESULTS: Ballet dancers scored higher than controls in most of the items evaluating body image and eating behaviors; a high number of ballet dancers with undifferentiated gender role were also observed. In the dancers group, male-typified subjects showed higher median scores of EDE and BUT scales, while in the control group, the highest median scores of EDE and BUT scales were found in undifferentiated subjects. CONCLUSION: Ballet schools' cultural pressure towards an ideal of leanness could interfere with the process of gender role acquisition. Ballet dancers appear to be overconcerned with performance; this could reinforce the internalization of several constructs that are generally considered as typically male.     

Comprehensive neurocognitive assessment of patients with anorexia nervosa

AIM: To utilise a comprehensive cognitive battery to gain a better understanding of cognitive performance in anorexia nervosa (AN).METHODS: Twenty-six individuals with AN and 27 healthy control participants matched for age, gender and premorbid intelligence, participated in the study. A standard cognitive battery, the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery, was used to investigate performance on seven cognitive domains with the use of 10 different tasks: speed of processing [Brief Assessment Of Cognition In Schizophrenia: Symbol Coding, Category Fluency: Animal Naming (Fluency) and Trail Making Test: Part A], attention/vigilance [Continuous Performance Test - Identical Pairs (CPT-IP)], working memory [Wechsler Memory Scale (WMS^®-III): Spatial Span, and Letter-Number Span (LNS)], verbal learning [Hopkins Verbal Learning Test - Revised], visual learning [Brief Visuospatial Memory Test - Revised], reasoning and problem solving [Neuropsychological Assessment Battery: Mazes], and social cognition [Mayer-Salovey-Caruso Emotional Intelligence Test: Managing Emotions]. Statistical analyses involved the use of multivariate and univariate analyses of variance.RESULTS: Analyses conducted on the cognitive domain scores revealed no overall significant difference between groups nor any interaction between group and domain score [F(1,45) = 0.73, P = 0.649]. Analyses conducted on each of the specific tasks within the cognitive domains revealed significantly slower reaction times for false alarm responses on the CPT-IP task in AN [F(1,51) = 12.80, P < 0.01, Cohen’s d = 0.982] and a trend towards poorer performance in AN on the backward component of the WMS^®-III Spatial Span task [F(1,51) = 5.88, P = 0.02, Cohen’s d = -0.665]. The finding of slower reaction times of false alarm responses is, however, limited due to the small number of false alarm responses for either group.CONCLUSION: The findings are discussed in terms of poorer capacity to manipulate and process visuospatial material in AN.     

Role of body dissatisfaction in the onset and maintenance of eating pathology: a synthesis of research findings

OBJECTIVE: Recent findings implicate body dissatisfaction in the development and maintenance of eating pathology. This paper reviews theory and empirical findings regarding the putative origins and consequences of body dissatisfaction because recent findings have not been synthesized or critically evaluated and because these findings have key etiologic and prevention implications. METHODS: A computer-assisted literature review was conducted to locate relevant prospective and experimental studies. RESULTS: There is evidence that perceived pressure to be thin, thin-ideal internalization and elevated body mass, but not early menarche, increase the risk for subsequent body dissatisfaction. There is also consistent support for the assertion that body dissatisfaction is a risk factor for eating pathology and that this relation is mediated by increases in dieting and negative affect. CONCLUSIONS: This review provides support for the claim that sociocultural processes foster body dissatisfaction, which in turn increase the risk for bulimic pathology, and suggests that prevention and treatment interventions might be enhanced by focusing greater attention on body image disturbances.     

Body image disturbance in 1000 male appearance and performance enhancing drug users

Body image disturbance (BID) among men has only recently become a phenomenon of clinical significance with noted heterogeneity in the behavioral consequences of these disturbances. The degree of heterogeneity among appearance and performance enhancing drug (APED) users is unknown and an empirically derived framework for studying BID is necessary. APED users (N = 1000) were recruited via the Internet and they completed a comprehensive online assessment APED use patterns, motivations, consequences, and BID. Data were evaluated using latent trait, latent class, and factor mixture models. Model results were validated using a range of covariates including cycle characteristics, age, APED history, and APED risk. A 1-Factor, 4-Class model provided the best fit to the data with Class 1 scoring the highest on all measures of BID and Class 4 the lowest on all measures. Class 2 differed in their preference for being lean over muscular and Class 3 preferred adding mass and size. Each class was associated with unique risks, APED history, and training identity. Not all APED users suffer from significant BID and there are unique profiles for those with elevated BID. Future research on male BID should account for this structure in order to better define relevant diagnostic categories and evaluate the clinical significance of BID.     

A supramodal representation of the body surface

The ability to accurately localize both tactile and painful sensations on the body is one of the most important functions of the somatosensory system. Most accounts of localization refer to the systematic spatial relation between skin receptors and cortical neurons. The topographic organization of somatosensory neurons in the brain provides a map of the sensory surface. However, systematic distortions in perceptual localization tasks suggest that localizing a somatosensory stimulus involves more than simply identifying specific active neural populations within a somatotopic map. Thus, perceptual localization may depend on both afferent inputs and other unknown factors. In four experiments, we investigated whether localization biases vary according to the specific skin regions and subset of afferent fibers stimulated. We represented localization errors as a ‘perceptual map’ of skin locations. We compared the perceptual maps of stimuli that activate Aβ (innocuous touch), Aδ (pinprick pain), and C fibers (non-painful heat) on both the hairy and glabrous skin of the left hand. Perceptual maps exhibited systematic distortions that strongly depended on the skin region stimulated. We found systematic distal and radial (i.e., towards the thumb) biases in localization of touch, pain, and heat on the hand dorsum. A less consistent proximal bias was found on the palm. These distortions were independent of the population of afferent fibers stimulated, and also independent of the response modality used to report localization. We argue that these biases are likely to have a central origin, and result from a supramodal representation of the body surface.     

Clinical investigation of set-shifting subtypes in anorexia nervosa

While evidence continues to accumulate on the relevance of cognitive inflexibility in anorexia nervosa (AN), its clinical correlates remain unclear. We aimed at examining the relationship between set-shifting and clinical variables (i.e., eating psychopathology, depression, and personality) in AN. Ninety-four individuals affected by AN and 59 healthy controls (HC) were recruited. All participants were assessed using: Eating Disorders Inventory-2 (EDI-2), Temperament and Character Inventory (TCI), Beck Depression Inventory (BDI), and Wisconsin Card Sorting Test (WCST). The AN group scored worse than HCs on set-shifting. According to their neuropsychological performances, AN patients were split into two groups corresponding to poor (N=30) and intact (N=64) set-shifting subtypes. Interoceptive awareness, impulse regulation, and maturity fears on the EDI-2 and depression on the BDI differed across all groups (HC, intact, and poor set-shifting subtype). Self-directedness on the TCI differed significantly among all groups. Cooperativeness and reward dependence differed instead only between HC and AN poor set-shifting subtype. After controlling for depression, only interoceptive awareness remained significant with reward dependence showing a trend towards statistical significance. These findings suggest that multiple clinical variables may be correlated with set-shifting performances in AN. The factors contributing to impaired cognitive inflexibility could be more complex than heretofore generally considered.     

Body image assessment using body size estimation in recent studies on anorexia nervosa. A brief review.

The concept of body image is thought to consist of two components: body size perception and attitudes towards the body. Correspondingly, two distinct modalities of body image dysfunction seem to be relevant for anorexia nervosa: perceptual body size distortion and cognitive-evaluative dissatisfaction. Consequently, various techniques to assess body image have been developed to assess body image disturbance in eating disorders, particularly anorexia nervosa. This review article compares the numerous methods of assessing body image used in recent studies on anorexia nervosa and discusses the various findings. The findings suggest that body image disturbance is not due to any perceptual deficit, but is based on cognitive-evaluative dissatisfaction. Although overestimation of body size is not a universal symptom in eating disorders, this issue is interesting in terms of prognostic and therapeutic implications. Thus, body size estimation remains a worthwhile approach to assessing body image disturbance in eating disorders. The identification of sensory and non-sensory factors in body image is considered a promising issue for further research. Accepted: 3 April 2001     

Lower body weight is associated with less negative emotions in sad autobiographical memories of patients with anorexia nervosa

Food restriction and weight-loss have been proposed to represent pathogenic mechanisms of emotion regulation in anorexia nervosa (AN). However, there is a lack of studies empirically examining this hypothesis. Therefore, the present study compared 25 women with AN and 25 healthy control women (HC) regarding spontaneous emotional processing of autobiographic memories. Participants' idiographic memories of sad autobiographic events were analyzed using computerized, quantitative text analysis as an unobtrusive approach of nonreactive assessment. Compared to HC, AN patients retrieved more negative but a comparable number of positive emotions. Moreover, the lesser the body weight in AN patients, the lesser negative emotions they retrieved, irrespective of current levels of depressive symptoms and duration of illness. No such association was found in HC. These preliminary findings are in line with models of AN proposing that food restriction and weight-loss may be negatively reinforced by the alleviation of aversive emotional responses.