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Body image disturbance

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This is an old revision of this page, as edited by Srobodao84 (talk | contribs) at 20:28, 2 August 2021. The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

  • Comment: Isn't this just a synonym for body dysmorphic disorder? Roger (Dodger67) (talk) 14:17, 2 August 2021 (UTC)
  • Comment: its a common mistake; body dysmorphic disorder is an OCD disturbance with specific features and is NOT body image disturbance. Body image disturbance is a common anorexia symptom (also present in other stress-related disease) with specific brain areas involved and different from OCD disturbances(Srobodao84) (talk) 17:17, 2 August 2021 (UTC)

Body image disturbance (BID) is a frequent symptom in patients with eating disorders. The symptom occurs mainly in patients with anorexia nervosa who, despite being severely underweight, continue to perceive themselves as average weight or even overweight.[1] An altered perception of one's body and a severe state of bodily dissatisfaction characterizing the body image disturbance; the disturbance often persists in eating disorders after completing treatments [2][3] and is considered complex to treat.[4] Finally, effective body image interventions could improve the prognosis in patients with ED, as Hilde Bruch suggested.[5] Unfortunately, there are still no proven effective treatments for body image disturbance, and pharmacotherapy is ineffective.[6][7] However, to date, research and clinicians are developing new therapies for this disturbance. Many of these use virtual reality[8] or multisensory integration body techniques [9][10][11], which are showing promising results .

Characteristics

Hilde Bruch first identified and described body image disturbance in anorexia nervosa. In her famous article "Perceptual and Conceptual Disturbances in Anorexia Nervosa" (Bruch, 1962) she wrote:

What is pathognomic of anorexia is not the severity of the malnutrition per se—equally severe degrees are seen in other malnourished psychiatric patients—but rather the distortion of body image associated with it: the absence of concern about emaciation, even when advanced, and the vigor and stubbornness with which the often gruesome appearance is defended as normal and right, not too thin, and as the only possible security against the dreaded fate of becoming fat"[5]

An altered perception of one's own body is not specific to anorexia nervosa. Indeed, also in bulimia nervosa[12] and binge eating disorder[13], body image disturbance has been more recently observed. Furthermore, recent studies have also shown that even in healthy subjects, it is possible to observe alterations in the perception of one's body. Therefore, suggesting that an altered perception of the body is a normal part of everyone's life manifests itself more intensely in more vulnerable subjects (e.g., patients with anorexia nervosa).[14]

Sign and symptoms

Body image disturbance is a deficit in how one experiences one's body. The DSM-5 includes the disturbance among the diagnostic criteria for anorexia nervosa (criterion C).[15] The disturbance is linked with significant bodily dissatisfaction and is a source of severe distress in patients. Unfortunately, despite its clinical relevance, it is still unknown how one passes to an actual perceptual disorder from an initial dissatisfaction with one's body.[16] Body image disturbance is a multifaceted construct that includes:

  • altered perception of the body and its shapes.
  • mental images of one's distorted and overweight body.
  • frequently third-person view of one's body.
  • negative thoughts like "I'm fat" or "my thighs are huge."
  • frequent body-checking behaviors.
  • frequent comparisons between their bodies and that of others
  • emotions of anxiety, shame, and contempt for one's body

Clinically speaking, a growing body of research suggests that body image disturbance plays a significant role in the onset[17], maintenance[18][19] , and relapse of anorexia nervosa[20], as previously suggested by Hilde Bruch in 1962.[5] However, despite increasing evidence, a recent review stated that the available empirical data are still insufficient and "provide no basis to answer the question whether body image disturbance is a (causal) risk factor for anorexia nervosa[21]". As suggested by the authors, this lack of evidence is partly related to terminology problems used in the body image field.[22]

Definition of body image disturbance

Different labels are used in research and clinical setting to define the body image disturbance generating terminological confusion. Some of the most used terms are body image discrepancy [23], body image self-discrepancy [24], body image distortion [25], disturbed body image[26] , disturbances in body estimations[27] , body image disturbance [28], and negative body image.[29] Sometimes, the term "body dissatisfaction" is also used to refer to body image disturbance indiscriminately.[30] Moreover, the DSM-5 itself defines the disturbance vaguely: "a disturbance in the way one's body weight or shape is experienced"[15] . Thus, the lack of a clear definition is problematic from both a clinical and basic research point of view.

Despite this, the most recent studies define body image disturbance as a multidimensional symptom comprising various components of body image.[12] Specifically, we usually describe body image as a multidimensional concept formed by the interaction of four different body-related components, the cognitive, affective, behavioral, and perceptual ones.

  • Cognitive: thoughts and beliefs about one's body and its shape; it also consists of a conscious mental representation of one's body[31]
  • Affective: feelings and attitudes related to the body (e.g., bodily satisfaction/dissatisfaction).
  • Behavioral: actions that people perform to check on, modify, or hide their one's body parts.
  • Perceptual: how one's body is perceived; it includes proprioceptive, interoceptive, tactile, and visual self-perception .[32]

All these components are altered in body image disturbance and lead to altered body perception and severe body dissatisfaction.[10] Consistent with this, a more clarifying definition of body image disturbance has been proposed by Artoni and colleagues in 2021.[10] The authors suggested using the term "bodily dissatisfaction" when there are alterations in the body image's affective, cognitive, and behavioral components. They also suggest strictly use the term "body image disturbance" only when there is an alteration of all four components, including the perceptual one. In short, they define body image disturbance as when an altered perception of the shape and weight of one's body is present and aggravates body dissatisfaction.

Body dissatisfaction and body image disturbance

Body dissatisfaction and body image disturbance are closely related. Personal, interpersonal, cultural, social, and ethnic variables largely influence bodily dissatisfaction[33], influencing the emergence of painful feelings towards one's body. In addition, social pressure is considered a risk factor for body dissatisfaction. For example, the frequent presence on media of thin female bodies determines, especially in young girls, a daily comparison between their bodies and that of models and actresses favoring bodily dissatisfaction.[34] Comparing an "ideal" and "real" body feeds an intense dissatisfaction with one's own body and increases the feeling of shame, disgust, and anxiety towards the owner's body and appearance.[35] Nevertheless, despite this, body image disturbance is not overlapped by body dissatisfaction but they are closely related.

Dissatisfaction with one's body involves only three of the four components of the body image. Those suffering from bodily dissatisfaction can have negative thoughts about the body (e.g., "I'm ugly" or "I'm too short"). In addition, they may have behaviors related to bodily dissatisfaction (e.g., going on a diet or resorting to cosmetic surgery[36][37]) . They may also have negative feelings of dissatisfaction with their body and be ashamed of showing it in public[38] . However, all these aspects are not enough to define it as a body image disturbance. Nevertheless, body image disturbance is not overlapped by body dissatisfaction despite this, but they are closely related.[39]

Treatments

Historically, research and clinicians have mainly focused on body image disturbance's cognitive, affective, and behavioral components. Consequently, treatments generally target symptoms such as body checking, dysfunctional beliefs, feelings, and emotions relating to the body.Despite recognizing the role of body image disturbance in eating disorders, there are still no proven effective treatments for its treatment [12]

Diagnosis

Body image disturbance is not yet clearly defined by official disease classifications. However, it appears in the DSM-5 as criterion C for anorexia nervosa and vaguely described the symptom as "a disturbance in the way weight and body shapes are experienced" and "the persistent lack of recognition of the severity of the current significantly low body weight." [15]

Numerous psychometric tests measure body image disorder in his cognitive, affective, and behavioral components. Among the most used in the clinical setting we mention:

Eating Disorder Inventory 3

The Eating Disorder Inventory 3 (EDI-3) represents an improvement of the earlier versions of the EDI, a self-report questionnaire widely used both in research and clinical settings. It consists of 91 questions, and items are rated on a six-point Likert-type scale (always, usually, sometimes, rarely, never), with higher scores representing more severe symptoms. Precisely, the BD subscale of EDI-3 measures bodily dissatisfaction.[40]

Body Uneasiness Test

The body uneasiness test (BUT) is a self-administered questionnaire. It explores several areas in clinical and non-clinical populations: weight phobia, body image-related avoidance behavior, compulsive self-monitoring, detachment and estrangement feelings toward one's own body. Besides, explore specific worries about particular body parts, shapes, or functions. Higher scores indicate significant body uneasiness.[41]

The Body Image Disturbance Questionnaire

The body Image Disturbance Questionnaire investigates different areas related to body image disturbance. For example, evaluate the most problematic parts of the body, the psychological effects of worries on the body, and the effects on social life and eating behavior.[42]

The Body Shape Questionnaire

The Body Shape Questionnaire is a 34-item self-assessment questionnaire designed to measure the degree of dissatisfaction with the weight and shape of one's body. It includes questions about the fear of weight gain and the urge/desire to lose weight[43]

References

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