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There is evidence that gender as well as sexual orientation can affect body image. In particular, heterosexual women and homosexual men seem to be more vulnerable to a negative body image compared to homosexual women and heterosexual men. One reason for this may be derived from the fact that heterosexual women and homosexual men try to attract male romantic partners: As men place more importance on physical attractiveness than do women, the pressure to fulfill the sociocultural beauty ideal is thus increased. The present online study investigated differences in appearance-related partner preferences and their associations with measures of body image and eating pathology in homosexual and heterosexual women and men. The non-representative sample consisted of 893 participants (n = 201 lesbian women,n = 192 gay men,n = 349 heterosexual women, andn = 151 heterosexual men), who completed silhouette measures assessing their perception and expectations regarding body fat and muscularity of their own body and the body of a potential romantic partner, as well as questionnaires on drive for thinness, drive for muscularity, and eating pathology. Overall, few differences in appearance-related partner preferences emerged between the four groups. However, compared to heterosexual women, homosexual men appeared to prefer higher muscularity in potential romantic partners, which was also associated with increased drive for thinness and muscularity and increased eating pathology. The present findings indicate that, irrespective of sexual orientation, women and men tend to share similar standards regarding their own and a potential partner’s physical appearance, potentially suggesting an increased hegemony of heteronormative beauty ideals in women and men in general.

ObjectiveMirror exposure (ME) is a therapeutic technique to improve body image disturbance. However, evidence on the effectiveness of different forms of ME in clinical populations is lacking. The present study therefore analysed effects of ME on trait-like and state measures of body image in patients with anorexia nervosa (AN) and bulimia nervosa (BN).MethodThe present study therefore analysed effects of ME on trait-like and state measures of body image in patients with anorexia nervosa (AN) and bulimia nervosa (BN). In total, 47 inpatients underwent 3 ME sessions guided by a therapist, with instructions to exclusively verbalise positively about their whole body. Participants completed questionnaires on trait-like eating pathology and body image at the start and end of the study, and instruments on state affect and body satisfaction were administered directly before and after each ME session. Subjective physiological arousal and emotional valence relating to each body part were assessed within each session.ResultsThe results indicate significant improvements in eating pathology and body image regarding trait-like measures in patients with AN and BN. Concerning state measures, negative affect significantly decreased and body satisfaction increased during ME. Physiological arousal decreased and positively valenced emotions relating to the various body parts increased.ConclusionsThese findings suggest that positively verbalising about one's body during ME improves eating pathology, body image, affect, and subjective physiological arousal, and thus seems to be an effective form of ME. published

IntroductionChecking behaviour (CB) occurs in various mental health problems. Cognitive-behavioural models for these mental disorders share similar theoretical assumptions. Thus, they postulate a negative reinforcing effect of CB by reducing negative affect (ie, anxiety) and a maintenance of the pathology due to a lack of reality testing of concerns. This paper details methods for a systematic review that will be conducted to synthesise empirical evidence testing these theoretical assumptions across obsessive–compulsive, generalised anxiety, eating, body dysmorphic and illness anxiety disorder. The results are expected to foster our understanding of the mechanisms of action underlying CB, which is of high clinical relevance. Depending on whether or not the findings confirm the model assumptions regarding CB, the focus of treatments would need to be intensified or modified.Methods and analysisWe will search PsycINFO, PubMed, PSYNDEX and Scopus for studies investigating the emotional state in which CB is being used as well as the immediate and longer-term effects of CB on cognitive and emotional measures in clinical and analogue samples. The selection process, data extraction and quality assessment of included studies will be performed by two independent reviewers. In the case of inconsistencies, a third reviewer will be involved. Study results will be reported in a narrative synthesis.Ethics and disseminationEthics approval will not be required as this is a protocol for systematic review. The results are mainly disseminated through peer-reviewed publications.PROSPERO registration numberCRD42021238835.

Negative body-related feedback is associated with increased body dissatisfaction. The English-language version of the Feedback on Physical Appearance Scale (FOPAS) is an instrument to assess verbal and non-verbal body-related feedback, but a German-language version has not been validated yet. The aim of this study was to evaluate the psychometric properties of its German-language version in a sample of adolescents with eating disorders (n=88) and in a sample of adolescents (n=123) and women (n=228) without eating disorders. Confirmatory factor analyses showed a moderate model fit from the English-language original study. All samples showed acceptable internal consistencies. The retest reliability was also mostly acceptable. Significant positive correlations with questionnaires on eating disorder symptoms (criterion validity), teasing (convergent validity) as well as the expected negative correlation with self-esteem indicated good validity. In addition, the FOPAS was able to differentiate between adolescents with and without eating disorders. To sum up, the German-language FOPAS appears to be suitable to assess verbal and non-verbal body-related feedback in research and practice.Negatives körperbezogenes Feedback ist mit einer erhöhten Körperunzufriedenheit assoziiert. Als Instrument zur Erfassung verbalen und nonverbalen körperbezogenen Feedbacks eignet sich die englischsprachige Feedback on Physical Appearance Scale (FOPAS), die jedoch bisher für den deutschsprachigen Raum noch nicht validiert wurde. Ziel dieser Studie ist daher die psychometrische Überprüfung der deutschsprachigen Version der FOPAS an Jugendlichen mit Essstörungen (n=88) sowie Jugendlichen (n=123) und Frauen (n=228) ohne Essstörungen. Konfirmatorische Faktorenanalysen ergaben einen mittelmäßigen Fit des Modells aus der englischsprachigen Originalstudie. Die Reliabilität lag für alle Stichproben im akzeptablen Bereich. Auch die Retest-Reliabilität war größtenteils akzeptabel. Signifikante positive Korrelationen der FOPAS mit Fragebögen zu Essstörungssymptomatik (Kriteriumsvalidität), körperbezogenem Teasing (konvergente Validität) sowie der erwartete negative Zusammenhang der FOPAS mit dem Selbstwert deuteten auf eine gute Validität hin. Zudem wies die FOPAS eine gute Differenzierungsfähigkeit zwischen Jugendlichen mit und ohne Essstörungen auf. Insgesamt erscheint daher der Einsatz der deutschsprachigen FOPAS zur Erfassung verbalen und nonverbalen körperbezogenen Feedbacks in Forschung und Praxis sinnvoll.

Objective This study contributes to the quantitatively large, yet narrow in scope research on body image in gay men by assessing whether gay and heterosexual men systematically differ on various dimensions of body image disturbance and associated pathology, i.e., eating disorder and body dysmorphic disorder symptoms. Moreover, we examined the influence of general everyday discrimination experiences and involvement with the gay community on body image. Method N = 216 men (n = 112 gay men, n = 104 heterosexual men) participated in an online survey measuring the discrepancy between self-rated current and ideal body fat/ muscularity; drive for leanness, muscularity, and thinness; body satisfaction; body-related avoidance and checking; appearance fixing; overall body image disturbance; eating disorder and body dysmorphic disorder pathology; general everyday discrimination experiences; and involvement with the gay community. Results Gay men showed a greater discrepancy between self-rated current and ideal body fat; higher drive for thinness, body-related avoidance, appearance fixing, overall body image disturbance, eating disorder and body dysmorphic disorder pathology; and lower body appreciation than heterosexual men (all p ≤ .05). Contrary to expectation, everyday discrimination experiences were more strongly associated with body image disturbance and eating disorder/ body dysmorphic disorder pathology in heterosexual men than in gay men (all p ≤ .05). Gay community involvement was not associated with any body image disturbance-, ED-, or BDD aspect in gay men (all p ≥ .20). Discussion The results suggest greater body image disturbance in gay men than in heterosexual men regarding cognitions, emotions, behaviors, and perception as well as higher eating disorder and body dysmorphic disorder pathology. The results also suggest the dilemma of a thin, yet muscular body ideal in gay men. Surprisingly, discrimination experiences and involvement with the gay community did not explain differences in body image disturbance. Gay men may have become resilient to discrimination over time, and body ideals might differ across gay sub-communities.

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.

Maladaptive body size evaluation processes and body dissatisfaction are known as central risk factors for the development and maintenance of anorexia nervosa (AN). This study aimed to experimentally test potential key facets, such as (psycho)physiological, cognitive-verbal and behavioral mechanisms, within the context of these evaluation processes. Twenty-two females with AN (AN-G) and 22 healthy controls (HC-G) looked at pictures of their body gradually increasing in weight using a morphing technique. Implicit emotional arousal was assessed using steady-state visual evoked potentials (SSVEP) in electroencephalography. Additionally, in a forced-choice body size evaluation task, participants were asked to classify pictures of their own body as not big or big while reaction times were captured. A significantly earlier increase in SSVEPs emerged in AN-G compared to HC-G (p .05), with AN-G evaluating their bodies in the morphing process as big at a significantly thinner body size (p .05). The AN-G showed faster reaction times in the categorical evaluation of body stimuli (p .05). Findings from this multimodal paradigm underline the importance of body size evaluation mechanisms and underlying emotional arousal for AN. A differentiated understanding of these processes is essential, since the effectiveness of therapeutic interventions for AN is limited and relapses are frequent.

To assess central aspects of muscle dysmorphia, classified as a subtype of body dysmorphic disorder, the Muscle Dysmorphia Inventory (MDI) is available for the English-speaking areas. The aim of the present study was to evaluate the psychometric properties of the German-language version of the MDI. Therefore, male participants from two separate samples (sample 1: n=143; sample 2: n=71; N=214) completed a questionnaire battery, including the MDI. Using confirmatory factor analysis, the factor structure postulated by the authors of the English-language original version could not be replicated. However, the fit indices were broadly adequate when the model was altered based on the modification indices. The MDI subscales showed acceptable to excellent internal consistencies. The test-retest reliability of approximately 14 days was high. Significant positive correlations of the MDI subscales with other body image and psychopathology measures, and the weight-training frequency per week indicated good convergent and criterion validity. Furthermore, the MDI differentiated between subgroups of men with muscle dysmorphia, weight-training, and non-weight-training men. With the exception of the subscale Pharmacological Use (PU), which showed lower reliability and validity, and the insufficient model fit, the German-language version of the MDI generally displayed adequate psychometric properties. Hence, with restrictions concerning the subscale PU, the administration in clinical-psychological research and a psychotherapeutic context seems to be recommendable.Zur Erfassung zentraler Merkmale der Muskeldysmorphie, die als Subtyp der Körperdysmorphen Störung klassifiziert wird, steht für den englischsprachigen Raum das Muscle Dysmorphia Inventory (MDI) zur Verfügung. Gegenstand der vorliegenden Studie war die psychometrische Überprüfung der deutschsprachigen Version des MDI. Hierzu bearbeiteten männliche Teilnehmer zweier separater Stichproben (Stichprobe 1: n=143; Stichprobe 2: n=71; N=214) eine Fragebogenbatterie inklusive des MDI. Anhand einer konfirmatorischen Faktorenanalyse konnte die von den Autoren der englischsprachigen Originalversion postulierte Faktorenstruktur nicht repliziert werden, wobei annähernd adäquate Fit-Indizes für ein auf Basis der Modifikationsindizes verändertes Modell vorlagen. Für die MDI-Subskalen ergaben sich akzeptable bis sehr gute interne Konsistenzen. Die Retest-Reliabilität über ca. 14 Tage war hoch. Signifikant positive Korrelationen der MDI-Subskalen mit weiteren Körperbild- und Psychopathologiemaßen sowie der Kraftsportfrequenz pro Woche legten eine gute konvergente und Kriteriumsvalidität nahe. Zudem differenzierte das MDI zwischen Subgruppen aus Männern mit einer Muskeldysmorphie sowie Kraft- und Nicht-Kraftsportlern. Mit Ausnahme der Subskala Nutzung von Pharmakologischen Mitteln (NP) mit niedrigerer Reliabilität und Validität sowie der ungenügenden Modellpassung wies die deutschsprachige Übersetzung des MDI insgesamt adäquate psychometrische Kennwerte auf. Die Anwendung in klinisch-psychologischer Forschung sowie therapeutischer Praxis scheint daher – mit Einschränkungen hinsichtlich der Subskala NP – empfehlenswert.

Checking behavior (CB) occurs in a variety of disorders such as obsessive-compulsive (OCD), body dysmorphic (BDD), illness anxiety (IA), and panic disorder (PD), as well as anorexia (AN) and bulimia nervosa (BN). Etiological models of these disorders – with the exception of those for PD – postulate that CB mainly occurs in situations characterized by negative affect and serves to regulate it. We aimed to test these assumptions: N = 386 individuals with a self-reported diagnosis of one of the disorders rated their affect at baseline, directly before a remembered CB episode, during, immediately afterwards, and 15 and 60 minutes afterwards, and rated their endorsement of different functions of CB. The results show that transdiagnostically negative affect is significantly higher before CB compared to baseline, and is significantly reduced from before CB to all post-CB assessments. Reduction of negative affect and Attainment of certainty were the sole functions predicting the affective course during CB, and most prominently reported transdiagnostically. Assumptions of the etiological models were confirmed, suggesting that exposure and ritual prevention should be examined across disorders. As attainment of certainty seems to be predictive for the course of CB, this might be targeted in cognitive interventions.

Although muscle dysmorphia (MD) has been added as a specifier for body dysmorphic disorder in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, experimental research on psychopathological mechanisms is lacking. Because models of eating disorders (EDs) suggest parallels between MD and ED, body-oriented attentional biases, which are prominent in ED models, have been identified as potentially important maintaining factors. Specifically, we predicted the existence of biases toward subjectively negative areas of one's own body and positive areas of a bodybuilder in MD. We tracked gaze behaviors of 24 men with MD diagnoses, 24 weight-training controls, and 24 non-weight-training controls during exposure to pictures of their own body, an average male body, a lean-muscular body, and a hypermuscular body. Moreover, state body image and affect were assessed at baseline and after each stimulus. Partially supporting our hypotheses, men with MD diagnoses and non-weight-training controls, but not weight-training controls, displayed significant biases toward subjectively negative areas of their own body. Only men with MD diagnoses displayed biases toward positive areas of the hypermuscular body and reacted with a large, significant deterioration in state body image and affect. Attentional biases possibly contribute to the negative effects of critical examinations of one's body and of upward comparisons. There seems to be a specific positive bias toward subjectively ideal hypermuscular bodies in MD in conjunction with a negative bias toward oneself. Insofar as this pattern might maintain the severe muscularity dissatisfaction, it should be explicitly targeted by cognitive-behavioral interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Cognitive-behavioral theories posit that body checking decreases negative emotions, but increases levels of arousal. However, few studies have investigated the effects of body checking on the course of emotional states. Therefore, the current study examined how normal-weight females with higher and lower eating, weight, and shape concerns feel during a checking episode of their most-liked and least-liked body parts. In an online design, levels of negative emotions and arousal were retrospectively assessed before, during, immediately after, and 15 min after an individually remembered body-checking episode. Participants (N = 355) also rated their subjective satisfaction with specific body parts. Levels of negative emotions were lower 15 min after the checking episode of most-liked and least-liked body parts than before the episode. However, negative emotions increased during the checking episode of least-liked body parts, but subsided thereafter. The levels of arousal increased during the checking episodes of most-liked and least-liked body parts and decreased afterwards, and females with higher concerns reported greater levels of arousal than females with lower concerns. Furthermore, females with higher concerns reported more body checking than those with lower concerns. The results support the assumptions of the cognitive-behavioral theories, as body checking led to a decrease in negative emotions in the longer term, and levels of arousal increased during the checking episode. The greater levels of arousal in females with higher concerns, and their pronounced body-checking behavior, might enhance their existing concerns and increase the risk of disordered eating. Level V, descriptive study.

Although it is well documented that women evaluate their own body differently from other bodies, it remains unclear whether this discrepancy is based on double standards because of identity or on objective differences between these bodies. The aim of this study was therefore to test whether women apply double standards depending on a body’s identity when evaluating the same bodies presented with different faces. Average-weight women (N = 104) rated body attractiveness, body fat, and muscle mass of thin, average-weight, overweight, athletic, and hypermuscular bodies with either another female’s face or their own face. With their own face, subjects rated overweight bodies as more unattractive, higher in body fat and lower in muscle mass than with another female’s face. However, for non-overweight bodies, body ratings did not differ depending on body identity. Based on the self-deprecating double standards for overweight bodies, a body-related identity bias might be considered in theoretical models of body image. Level of evidence Level V, descriptive study.

ObjectiveThe study aimed to validate the Body Image Matrix of Thinness and Muscularity—Male Bodies (BIMTM-MB), a two-dimensional figure rating scale consisting of 64 three-dimensional male bodies, arranged in an 8 × 8 grid, with muscularity increasing stepwise on the vertical axis and body fat on the horizontal axis.MethodThe online sample included 355 men participating in an online survey. Besides the BIMTM-MB, participants completed questionnaires on body-related attitudes, behaviors, and psychopathology. Another 91 men were recruited to examine test–retest reliability of the BIMTM-MB.ResultsThe BIMTM-MB showed good convergent and criterion validity. Men meeting their own body ideal showed higher body satisfaction and lower body-related psychopathology. Test–retest reliability was high.ConclusionsThe BIMTM-MB proved to be a reliable and valid measure and is recommended for use in research and clinical practice to examine central aspects of male body image. published

Objectives Cognitive biases, particularly attentional biases, have been shown to be central to anorexia nervosa (AN). This study looked at attention deployment when consecutively viewing an obese and own body stimulus that both might represent feared stimuli in AN. Methods Individuals with AN (n = 26) and mentally healthy controls (MHCs; n = 16) viewed a picture of themselves and a standardized computer‐generated obese body in random order for 4,000 ms each and then rated the attractiveness of the body parts of both stimuli. We compared dwell times on subjectively unattractive versus attractive body parts, and body parts that show weight status and gain most strongly (stomach, hips, thighs) versus least strongly. Results For both stimuli, participants focused longer on the subjectively unattractive body parts (p, Both women with anorexia nervosa (AN) and healthy controls exhibited an attention bias toward subjectively unattractive body parts when viewing the own and an obese body stimulus. The bias was more pronounced in AN when confronted with the obese stimulus. Both groups also gazed longer at body parts indicative of weight status.

This study aimed to examine self-body recognition in women with high (HWSC) and low weight and shape concerns (LWSC). Thus, the detection rate, the reaction time and the perceptual threshold for recognizing one's own body in a morphed body were measured in n = 25 women with HWSC and n = 26 women with LWSC. Furthermore, by using steady-state visual evoked potentials (SSVEPs), neuronal correlates of body recognition were recorded. The perceptual threshold for recognizing one's own body was higher for women with HWSC in the case of a morph with a thinner body. No group differences emerged for morphs with obese or average-weight bodies. The SSVEP amplitudes did not differentiate between one's own and another body in either group. The results suggest that for women with HWSC, their negative body schemata might hamper recognition of their own body in a thinner morph. Otherwise, self-body recognition is similar in women with LWSC and HWSC.

Body image disturbance is an important feature of Anorexia Nervosa (AN). Some researchers have argued that body image disturbance is not just a symptom of AN, but plays a causal role in the development, persistence, and relapse of AN. Our aim was to systematically review the existing empirical evidence concerning the role of the cognitive-affective, perceptual, and behavioral components of body image disturbance in AN. 46 studies fulfilled eligibility criteria reporting about 4928 participants with AN. There is some evidence suggesting that body image disturbance is related to the course of AN. However, experimental studies were missing and operationalizations of body image constructs and AN outcome measures varied greatly across studies. Therefore, on the basis of the available empirical data, it remained unclear whether body image disturbance is indeed a causal risk factor for AN. For future studies, it is crucial to use more consistent terminology and more specific and precise definitions of body image constructs as well as experimental designs, adequately powered samples, and well-validated measures. Altogether, this would set the stage to generate the high-quality data that are necessary to clarify the role of body image disturbance in the onset, maintenance and relapse of AN.

Long-term effectiveness is a critical aspect of the clinical utility of a treatment; however, a meta-analytic evaluation of psychological and medical treatments for binge-eating disorder (BED), including weight loss treatments, is outstanding. This meta-analysis sought to provide a comprehensive evaluation of the long-term effectiveness in diverse treatments for BED regarding a range of clinically relevant outcomes.Based on a systematic search up to February 2018, 114 published and unpublished randomized-controlled (RCTs), nonrandomized, and uncontrolled treatment studies, totaling 8,862 individuals with BED (DSM-IV, DSM-5), were identified and analyzed using within-group random-effect modeling.Effectiveness (regarding binge-eating episodes and abstinence, eating disorder and general psychopathology) up to 12 months following treatment was demonstrated for psychotherapy, structured self-help treatment, and combined treatment, while the results regarding body weight reduction were inconsistent. These results were confirmed in sensitivity analyses with RCTs on the most common treatments-cognitive-behavioral therapy and self-help treatment based on this approach. Follow-up intervals longer than 12 months were rarely reported, mostly supporting the long-term effectiveness of psychotherapy. Few follow-up data were available for pharmacotherapy, and behavioral and self-help weight loss treatment, while follow-up data were lacking for pharmacological and surgical weight loss treatment. Study quality varied widely.This comprehensive meta-analysis demonstrated the medium-term effectiveness of psychotherapy, structured self-help treatment, and combined treatment for patients with BED, and supported the long-term effectiveness of psychotherapy. The results were derived from uncontrolled comparisons over time. Further long-term high quality research on psychological and medical treatments for BED is required.La efectividad a largo plazo es un aspecto crítico de la utilidad clínica de un tratamiento; sin embargo, una evaluación metaanalítica de los tratamientos psicológicos y médicos para el trastorno por atracón (TpA), incluidos los tratamientos para perder peso, es sobresaliente. Este metaanálisis buscó proporcionar una evaluación integral de la efectividad a largo plazo en diversos tratamientos para TpA con respecto a una gama de resultados clínicamente relevantes. MÉTODO: En base a una búsqueda sistemática hasta febrero de 2018, se identificaron 114 estudios controlados aleatorios (ECA), no aleatorizados y no controlados, publicados y no publicados, de tratamiento, con un total de 8,862 individuos con TpA (DSM-IV, DSM-5), fueron identificados y analizados utilizando modelos de efecto aleatorio dentro del grupo.Se demostró la efectividad para psicoterapia, tratamiento de autoayuda estructurado y tratamiento combinado (con respecto a los episodios de atracones y la abstinencia, el trastorno de la conducta alimentaria y la psicopatología general) hasta 12 meses después del tratamiento, mientras que los resultados con respecto a la reducción del peso corporal fueron inconsistentes. Estos resultados se confirmaron en análisis de sensibilidad con ECAs sobre los tratamientos más comunes - terapia cognitivo conductual y tratamiento de autoayuda basado en este enfoque. Los intervalos de seguimiento de más de 12 meses rara vez se reportaron, la mayoría apoyando la efectividad a largo plazo de la psicoterapia. Había pocos datos de seguimiento disponibles para farmacoterapia y tratamiento de pérdida de peso conductual y de autoayuda, mientras que faltaban datos de seguimiento para el tratamiento farmacológico y quirúrgico de pérdida de peso. La calidad del estudio varió ampliamente. DISCUSIÓN: Este metaanálisis integral demostró la efectividad a medio plazo de la psicoterapia, el tratamiento de autoayuda estructurado y el tratamiento combinado para pacientes con TpA, y apoyó la efectividad a largo plazo de la psicoterapia. Los resultados se derivaron de comparaciones no controladas a lo largo del tiempo. Se requiere más investigación a largo plazo de alta calidad sobre tratamientos psicológicos y médicos para TpA.

Objective The two studies aimed to examine implicit affective evaluations of thin-ideal and normal-weight body shapes in women with anorexia nervosa (AN), taking identification with body shapes into account. Method In study 1, approach-avoidance bias for thin-ideal and normal-weight bodies was assessed in 40 women with AN and 40 healthy women by using an Approach-Avoidance Task and female avatar bodies with a standard face as stimuli. In study 2, 39 women with AN and 38 healthy women underwent a similar task but identification with bodies was manipulated by presenting bodies once with the participant's own face and once with another woman's face. Results In study 1, patients with AN did not differ from healthy participants in their automatic approach-avoidance tendencies towards thin-ideal and normal-weight bodies. In study 2, no definite approach bias for a thin self and no avoidance bias for thin other women or for a normal-weight self were found. However, as compared to healthy women, those with AN showed a less positive implicit evaluation of thin other women, and an implicit preference for thin bodies depicted as themselves over thin bodies depicted as another woman. Conclusions The findings suggest that intra-sexual competition for being slim is increased in AN.

Objective To provide a comprehensive meta-analysis on the efficacy of psychological and medical treatments for binge-eating disorder (BED), including those targeting weight loss. Method Through a systematic search before March 2018, 81 published and unpublished randomized-controlled trials (RCTs), totaling 7,515 individuals with BED (Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition [DSM-IV] and Fifth Edition [DSM-5]), were retrieved and analyzed using random-effect modeling. Results In RCTs with inactive control groups, psychotherapy, mostly consisting of cognitive-behavioral therapy, showed large-size effects for the reduction of binge-eating episodes and abstinence from binge eating, followed by structured self-help treatment with medium-to-large effects when compared with wait-list. Pharmacotherapy and pharmacological weight loss treatment mostly outperformed pill placebo conditions with small effects on binge-eating outcome. These results were confirmed for the most common treatments of cognitive-behavioral therapy, self-help treatment based on cognitive-behavioral therapy, and lisdexamfetamine. In RCTs with active control groups, there was limited evidence for the superiority of one treatment category or treatment. In a few studies, psychotherapy outperformed behavioral weight loss treatment in short- and long-term binge-eating outcome and led to lower longer-term abstinence than self-help treatment, while combined treatment revealed no additive effect on binge-eating outcome over time. Overall study quality was heterogeneous and the quality of evidence for binge-eating outcome was generally very low. Conclusions This comprehensive meta-analysis demonstrated the efficacy of psychotherapy, structured self-help treatment, and pharmacotherapy for patients with BED. More high quality research on treatments for BED is warranted, with a focus on long-term maintenance of therapeutic gains, comparative efficacy, mechanisms through which treatments work, and complex models of care. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Potential long-term associations between repetitive negative thinking and mother-infant interactions have received little attention. The current longitudinal study includingN= 62 mother-infant dyads investigated both maternal and infant behavior in face-to-face interactions as a function of pre- and postnatal maternal repetitive negative thinking when infants were aged around 4 months. We hypothesised that mothers with a strong tendency to engage in repetitive negative thinking would react less contingently to their infants’ behavior compared to mothers with a weak tendency to engage in repetitive negative thinking. Furthermore, we hypothesised that infants of mothers high in repetitive negative thinking would differ from infants of mothers low in repetitive negative thinking in their reactions in the still-face task. Contrary to expectations, there was no difference in maternal contingency between mothers high versus low in repetitive negative thinking. However, infant behavior in the still-face task differed as a function of maternal repetitive negative thinking status. Specifically, infants of mothers high in repetitive negative thinking spent more time with object/environment engagement than infants of mothers who were low in repetitive negative thinking, and they also protested less frequently. These findings are discussed in terms of their relevance for the intergenerational transmission of mental disorders.

Objective Women with eating disorders (ED) evaluate their own body more negatively than do women without ED. However, it is unclear whether this negative rating is due to objective bodily features or different standards for one's own body and others' bodies. Therefore, the purpose of this study was to examine whether women with ED apply double standards when rating bodies by disentangling the objective features of one's own body from the feelings of ownership. Method We presented n = 34 women with anorexia nervosa, n = 31 women with bulimia nervosa, and n = 114 healthy controls with pictures of thin, average-weight, overweight, athletic, and hypermuscular bodies. Identity was manipulated by showing each body once with the participant's own face and once with the face of another woman. Participants were instructed to report their emotional state according to valence and arousal and to rate body attractiveness, body fat, and muscle mass. Results Women with anorexia nervosa and bulimia nervosa displayed greater self-deprecating double standards in body fat rating than did women without ED, as quantified by the difference between the ratings of the same body with one's own versus another woman's face. Double standards reflected in valence, arousal and attractiveness ratings were significantly more pronounced in women with anorexia nervosa than in women without ED. Discussion The double standards found may be due to an activation of dysfunctional self-related body schemata, which distort body evaluation depending on identity. Double standards related to body fat were characteristic for women with ED, but not for women without ED.

Whereas the manifestation of body image disturbance in binge eating disorder (BED) has been intensively investigated concerning the cognitive-affective component, with regard to the behavioral and the perceptual components of body image disturbance in BED, research is limited and results are inconsistent. Therefore, the present study assessed body image disturbance in BED with respect to the different components of body image in a sample of obese females (n = 31) with BED compared to obese females without an eating disorder (n = 28). The Eating Disorder Inventory-2, the Eating Disorder Examination-Questionnaire, the Body Image Avoidance Questionnaire and the Body Checking Questionnaire as well as a Digital Photo Distortion Technique based on a picture of each participant taken under standardized conditions were employed. Using two-sample t tests, we found that the participants with BED displayed significantly greater impairments concerning the cognitive-affective component of body image than the control group. Concerning the behavioral component, participants with BED reported more body checking and avoidance behavior than the controls, but group differences failed to reach significance after the Bonferroni corrections. Regarding the perceptual component, a significant group difference was found for the perceived "ideal" figure, with the individuals suffering from BED displaying a greater wish for a slimmer ideal figure than the control group. These results support the assumption that body image disturbance is a relevant factor in BED, similar to other eating disorders.

Although Islam is the fastest growing religion worldwide, only few studies have investigated body image in Muslim women, and no study has investigated body checking. Therefore, the present study examined whether body image, body checking, and disordered eating differ between veiled and unveiled Muslim women, Christian women, and atheist women. While the groups did not differ regarding body dissatisfaction, unveiled Muslim women reported more checking than veiled Muslim and Christian women, and higher bulimia scores than Christian. Thus, prevention against eating disorders should integrate all women, irrespective of religious affiliation or veiling, with a particular focus on unveiled Muslim women.

The goal of the present review is to give an overview of the current findings on various facets of body image disturbance in Binge Eating Disorder such as body dissatisfaction, overconcern with weight and shape, body-related checking and avoidance behavior, misperception of body size, and body-related cognitive bias. In addition, treatments for a disturbed body image in BED and evidence of body image disturbance in youth with binge eating are reviewed. The results show that a disturbed body image in BED is present in the form of overconcern with weight and shape. Furthermore, there are hints that body dissatisfaction, as well as body-related checking and avoidance behavior, are also impaired. Research concerning misperception of body size in BED has been neglected so far, but first findings show that individuals with BED rate their own body shape rather accurately. Furthermore, there are first hints that body-related cognitive biases are present in individuals with BED. Moreover, in children and adolescents, there are first hints that body dissatisfaction, as well as shape and weight concerns, seem to be associated with loss of control and binge eating. Treatments aimed directly at the convertibility of a disturbed body image in BED have revealed encouraging outcomes. In conclusion, body image disturbance seems to occur in BED, and first studies show that it can be treated effectively. published

The Phase model of psychotherapy outcome assumes a log-linear trajectory of change and allows predictions about the three outcome domains of Well-being, Symptoms, and Interpersonal functioning. Although the model has been partly validated, little is known about the types of trajectories in the specific domains and about the transferability of the model to treatments of longer duration. This study tested whether the domain-specific change trajectories followed a log-linear curve as postulated by the Phase model. Furthermore, it was examined whether the speed of change differed between the domains.Growth curves were modeled using hierarchical linear modeling on an outpatient sample (N = 351), with treatment duration averaging 52 sessions.A log-linear curve best explained the change trajectories of the domains Well-being and Symptoms as well as the Global score of psychopathology, whereas Interpersonal functioning tends to improve in a linear pattern. Estimated slopes were biggest for Well-being and smallest for Interpersonal functioning.In the present study, the predictions of the Phase model concerning multidimensional phases were validated. The finding that trajectories of change are not uniformly log-linear, but either log-linear or linear in a domain-specific manner, is partly inconsistent with the model. Clinical or methodological significance of this article: This article extends previous research in the field of psychotherapeutic change by providing results from the modeling of change trajectories in psychotherapeutic treatments with larger amounts of sessions (i.e., more than 20 sessions). Our findings of domain-specific different shapes (i.e., log-linear for Well-Being and Symptoms and linear for Interpersonal functioning) and speed (i.e., fastest for Well-Being and slowest for Interpersonal function) of trajectories of psychotherapeutic change may be clinically applied by means of guidelines for therapists to plan and adapt their treatments. In addition to content-related aspects of a continuous adjustment of treatment goals (e.g., merely symptom-oriented or focusing on interpersonal change) and interventions, this adaptive planning is also related to health care considerations (e.g., may justify longer treatments if therapy goals target several domains of change).

Background Previous research indicates that body image disturbance is transmitted from mother to daughter via modeling of maternal body-related behaviors and attitudes (indirect transmission) and via maternal body-related feedback (direct transmission). So far, the transmission of body-related attentional biases, which according to cognitive-behavioral theories play a prominent role in the development and maintenance of eating disorders, has not been analyzed. The current eye-tracking study applied the concepts of direct and indirect transmission to body-related attentional biases by examining body-related viewing patterns on self- and other-pictures within mother-daughter dyads. Methods Eye movements of N = 82 participants (n = 41 healthy female adolescents, mean age 15.82 years, SD = 1.80, and their mothers, mean age 47.78 years, SD = 4.52) were recorded while looking at whole-body pictures of themselves and a control peer. Based on fixations on self-defined attractive and unattractive body areas, visual attention bias scores were calculated for mothers and daughters, representing the pattern of body-related attention allocation. Based on mothers’ fixations on their own daughter’s and the adolescent peer’s body, a second visual attention bias score was calculated, reflecting the mothers’ viewing pattern on their own daughter. Results Analysis of variance revealed an attentional bias for self-defined unattractive body areas in adolescents. The girls’ visual attention bias score correlated significantly with their mothers’ bias score, indicating indirect transmission, and with their mothers’ second bias score, indicating direct transmission. Moreover, the girls’ bias score correlated significantly with negative body-related feedback from their mothers. Conclusions Female adolescents show a deficit-oriented attentional bias for one’s own and a peer’s body. The correlated body-related attention patterns imply that attentional biases might be transmitted directly and indirectly from mothers to daughters. Results underline the potential relevance of maternal influences for the development of body image disturbance in girls and suggest specific family-based approaches for the prevention and treatment of eating disorders.

Body image avoidance is conceptualised as a behavioural manifestation of body image disturbance, and describes efforts to avoid confrontation with one's own body. While studies have provided hints that body image avoidance in adulthood contributes to the development and maintenance of eating disorders, so far, there are no corresponding findings for adolescence. The Body Image Avoidance Questionnaire (BIAQ) is the most widely used international questionnaire for measuring body-related avoidance behaviour. As its German version has only been validated in an adult sample, the aim of the present study is to statistically test the questionnaire in adolescents with eating disorders. In total, N=127 female adolescents, including n=57 with Anorexia Nervosa, n=24 with Bulimia Nervosa, and n=46 healthy controls, answered the BIAQ as well as various other instruments for assessing body image disturbance and eating disorder symptoms. The factor structure assumed for the original English version, comprising the higher-order factor "body-related avoidance behaviour" and the 4 subfactors "clothing", "social activities", "eating restraint" and "grooming and weighing", was confirmed by a confirmatory factor analysis. With the exception of the scale "grooming and weighing", all scales showed mostly acceptable internal consistencies, test-retest reliability, differential validity and construct validity. Due to their satisfying psychometric properties, the use of the BIAQ scales "clothing", "social activities" and "eating restraint" can be recommended in research and practice for adolescence.Körperbezogenes Vermeidungsverhalten wird als behaviorale Manifestation einer Körperbildstörung konzeptualisiert und beschreibt Anstrengungen, der Auseinandersetzung mit dem eigenen Körper aus dem Wege zu gehen. Während Studien Hinweise darauf liefern, dass körperbezogenes Vermeidungsverhalten im Erwachsenenalter zur Entstehung und Aufrechterhaltung von Essstörungen beiträgt, existieren bisher keine entsprechenden Befunde für das Jugendalter. Der Body Image Avoidance Questionnaire (BIAQ) ist der international am weitesten verbreitete Fragebogen zur Messung des körperbezogenen Vermeidungsverhaltens. Da seine deutschsprachige Version bisher nur an einer Stichprobe aus Erwachsenen validiert wurde, ist das Ziel der vorliegenden Studie, den Fragebogen an Jugendlichen mit Essstörungen teststatistisch zu überprüfen. Insgesamt N=127 weibliche Jugendliche, davon n=57 mit einer Anorexia Nervosa und n=24 mit einer Bulimia Nervosa (BN) sowie n=46 gesunde weibliche Jugendliche beantworteten den BIAQ und verschiedene Instrumente zur Erfassung der Körperbild- und Essstörungssymptomatik. Die für die englischsprachige Originalversion angenommene Faktorenstruktur von dem Faktor höherer Ordnung „Körperbezogenes Vermeidungsverhalten“ und den 4 Subfaktoren „Kleidung“, „Soziale Aktivitäten“, „Gezügeltes Essverhalten“ sowie „Pflegen und Wiegen“ konnte durch eine konfirmatorische Faktorenanalyse bestätigt werden. Mit Ausnahme der Skala „Pflegen und Wiegen“ weisen alle Skalen eine überwiegend akzeptable interne Konsistenz, Test-Retest-Reliabilität, differenzielle Validität sowie Konstruktvalidität auf. Aufgrund ihrer befriedigenden psychometrischen Kennwerte ist der Einsatz der BIAQ-Skalen „Kleidung“, „Soziale Aktivitäten“ und „Gezügeltes Essverhalten“ auch für das Jugendalter in Forschung und Praxis zu empfehlen.

Introduction Binge-eating disorder (BED) was included as its own diagnostic entity in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). An increasing number of treatment studies have been published, but an up-to-date comprehensive meta-analysis on diverse treatment approaches for BED is lacking. In an updated and extension of a previous meta-analysis, the goals of this study are to assess the short-term and long-term effectiveness of psychological and medical treatments for BED. Methods and analysis We will search bibliographic databases and study registries, including manual searches for studies published before January 2016. The search strategy will include terms relating to binge eating and diverse forms of psychological and medical interventions. Language will be restricted to English. The studies included will be treatment studies, that is, randomised-controlled trials, and non-randomised and non-controlled studies, for individuals with BED (DSM-IV or DSM-5), and studies that provided a pre-treatment and at least one post-treatment or follow-up assessment of binge eating. The primary outcomes will be the number of binge-eating episodes, abstinence from binge eating and diagnosis of BED at post-treatment and/or follow-up(s), and changes from pre-treatment to post-treatment and/or follow-up(s). Likewise, as secondary outcomes, eating disorder and general psychopathology, quality of life, and body weight will be analysed and adverse events and treatment drop-out will be examined. Study search, selection and data extraction, including risk of bias assessment, will be independently performed by 2 reviewers and consensus will be sought. Moderator analyses will be conducted, and equity aspects will be considered. Sensitivity analyses will be conducted to determine the robustness of the results. Ethics and dissemination Ethical approval is not required for this meta-analysis. Published in a peer-reviewed journal and disseminated electronically and in print, this meta-analysis will form the basis of the renewal of the German evidence-based S3 Guidelines of Diagnosis and Treatment of Eating Disorders, specifically BED. Trial registration number CRD42016043604.

Objective The vigilance-avoidance theory postulates a specific threat-related pattern of attention deployment, characterized by initial orientation towards fear-evoking stimuli and subsequent directing of attention away from them. The current eye-tracking study was the first to examine the applicability of the theory for patients with eating disorders, who perceive their own body as a highly aversive, threat-evoking stimulus. Method N = 56 female adolescents with anorexia nervosa (AN) and n = 43 healthy controls (HC) aged 13-18 viewed own-body pictures while their eye movements were recorded. Relative fixation times on self-defined unattractive body areas were compared between the groups by sequencing the overall presentation time of 6,000 ms into six intervals a 1,000 ms. Results Participants with AN showed a significantly stronger attentional bias for unattractive body areas than HC within the time intervals 1, 2, and 3. However, for intervals 4, 5, and 6, no significant group differences occurred. Within the AN group, the bias for unattractive body areas was significantly stronger in interval 1 compared to intervals 4, 5, and 6; whereas within the HC group, a stable pattern of attention deployment emerged. In AN, early attention deployment was positively correlated with the negative affect reported after photo presentation. Discussion The early vigilance in AN and the subsequent decrease in attention to unattractive body parts is in line with our assumptions. However, no indication of attentional avoidance was found. The current findings partially support the vigilance-avoidance theory for the exposure to one's own body in adolescents with AN.

BackgroundPrevious research has demonstrated an association between low motivation to change and an unfavorable treatment outcome in patients with an eating disorder. Consequently, various studies have examined the effects of motivational enhancement therapy (MET) on motivation to change and treatment outcome in eating disorders. In each of these studies, MET was administered in a face-to-face setting. However, because of its anonymity and ease of access, the internet provides several advantages as the format for such an intervention. Therefore, the current study investigated the effects of an internet-based program (‘ESS-KIMO’) to enhance motivation to change in eating disorders.MethodIn total, 212 females were accepted for participation and assigned randomly to the intervention condition (n = 103) or waiting-list control condition (n = 109). The intervention consisted of six online MET sessions. Before and after the intervention or waiting period respectively, participants completed the Eating Disorder Examination Questionnaire (EDE-Q), the Stages of Change Questionnaire for Eating Disorders (SOCQ-ED), the Pros and Cons of Eating Disorders Scale (P-CED), the Self-Efficacy Scale (SES), and the Rosenberg Self-Esteem Scale (RSES). A total of 125 participants completed the assessment post-treatment. Completer analyses and intent-to-treat analyses were performed.ResultsSignificant time × group interactions were found, indicating a stronger increase in motivational aspects and self-esteem, in addition to a stronger symptom reduction on some measures from pre- to post-treatment in the intervention group compared to the control group.ConclusionsInternet-based approaches can be considered as useful for enhancing motivation to change in eating disorders and for yielding initial symptomatic improvement.

Body image disturbances occur in women with borderline personality disorder (BPD). Systematic research on these characteristics in well-defined BPD groups is lacking. It is unknown, if the disturbances are related to eating disorders and childhood sexual abuse (CSA), which frequently co-occur in patients with BPD. In the present study, cognitive-affective and behavioral components of body image for 89 female patients with BPD (49 with lifetime eating disorders) and 41 healthy participants were assessed via Body Image Avoidance Questionnaire (BIAQ) and Multidimensional Body-Self Relations Questionnaire (MBSRQ). Within the BPD group, 43 patients reported a history of CSA. Compared to healthy controls, BPD patients reported significantly more negative scores in the BIAQ and the MBSRQ. Both a history of CSA and a comorbid eating disorder were independently associated with an even more negative body image. Results suggest a disturbance of cognitive-affective and behavioral components of body image in female BPD patients.

Psychotherapy does not always follow a linear path. The present study explores the frequency of sudden gains and losses during the course of outpatient psychotherapy. The sample includes 1500 patients treated at three different outpatient centers. The patients were 57.4% female, and suffered primarily from anxiety and depressive disorders. Progress was measured by session reports. Significant sudden shifts in both directions were prevalent for 28.9% of the patients. Patients with early sudden gains showed the highest effect sizes and patients with sudden losses showed the smallest at the end of treatment. The therapeutic relationship was significantly better after the sudden gain sessions. Results suggest further investigation of the occurrence of sudden gains in relation to early response as well as further exploration of sudden losses during the course of treatment with respect to differential patterns of change and outcome.

Research into correlates of illness anxiety disorder (formerly hypochondriasis) rarely applies comprehensive assessments of health behavior. Moreover, studies on phenomenological varieties of clinical health anxiety are scarce. We examined health behavior, fear, and acceptance of death and dying, and coping with a hypothetical bodily disease in patients with hypochondriasis, panic disorder, depression, and healthy controls (all groups n = 30) using self-rated questionnaires. ANOVA with Dunnett-T3 post hoc tests revealed no group differences in health behavior. The hypochondriasis and panic disorder groups showed more fear and less acceptance of death and dying than patients with depression and controls. Groups did not differ concerning coping strategies. Patients with hypochondriasis ruminated more when confronted with their most feared rather than another disease. Patients apparently overestimate the danger of a specific disease, but without underestimating their coping abilities. A therapeutic focus on fear of death and dying via cognitive interventions and exposure is recommended.

Body-related checking behavior, as a behavioral manifestation of a disturbed body image, fosters the development and maintenance of eating disorders. The Body Checking Questionnaire (BCQ) is the most commonly used questionnaire for measuring body-related checking behavior internationally. To date, validation studies are only available for adult populations. Therefore, the aim of this study was to statistically test the German-language version of the BCQ in adolescents. A total of N=129 female adolescents were examined, comprising n=57 with Anorexia Nervosa, n=24 with Bulimia Nervosa, and n=48 healthy female adolescents. A confirmatory factor analysis supports the subdivision of the BCQ into a general factor and the subfactors "overall appearance", "specific body parts" and "idiosyncratic checking", which was also found in the original version. The internal consistencies are good (α≥0.81), and the BCQ is able to differentiate well between adolescents with and without eating disorders. Significant correlations between the BCQ and other body image questionnaires point to a good convergent validity. The German-language BCQ thus constitutes a valid and reliable instrument for measuring body-related checking behavior among adolescents in clinical research and practice.

Previous body image research suggests that first, exposure to body stimuli can negatively affect men's body satisfaction and second, body concerns are associated with dysfunctional gaze behavior. To date, however, the effects of self- vs. other-referential body stimuli and of gaze behavior on body image in men under exposure conditions have not been investigated. Therefore, 49 weight-trained men were presented with pictures of their own and other bodies of different builds (i.e., normal, muscular, hyper-muscular) while being eye-tracked. Participants completed pre- and post-exposure measures of body image and affect. Results indicated that one's own and the muscular body negatively affected men's body image to a comparable degree. Exposure to one's own body also led to increased negative affect. Increased attention toward disliked own body parts was associated with a more negative post-exposure body image and affect. These results suggest a crucial role of critical self-examination in maintaining body dissatisfaction.

Cognitive processes seem to play a vital role in eating disorders and body image. The current study, therefore, examines the impact and change of dysfunctional cognitions during a body image group therapy, which included 41 patients with an eating disorder. Dysfunctional cognitions were assessed with the 'Eating Disorder Cognition Questionnaire' both before and after treatment. Eating disorder psychopathology was also assessed. Results indicate a significant reduction of dysfunctional cognitions relating to 'body and self-esteem', 'dietary restraint', 'eating and loss of control', as well as 'internalisation and social comparison'. Furthermore, the changes in dysfunctional cognitions were associated with a reduction in eating disorder psychopathology. Body image therapy is a worthy complementation to standardised eating disorder treatment programmes as it reduces negative eating related thoughts and changes attitudes towards the body.

To test effects of body image therapy in anorexia nervosa, functional magnetic resonance imaging was used to assess neuronal responses to viewing photographs of one's own body before and after treatment. Activation decreases emerged in a distributed network and increases were observed in the extrastriate body area, possibly reflecting more intense body image processing.

While sex differences in pain-related coping have been widely reported, little is known on sex differences in changes in coping following multimodal pain treatment and how these changes relate to treatment outcome. The present prospective study therefore aimed to investigate sex differences in coping strategies between boys and girls with chronic pain prior to multimodal inpatient treatment and at 3-month follow-up. Sixty-four boys and 103 girls with various pain disorders were evaluated. Core outcomes (pain intensity and pain-related disability) and coping were assessed via validated questionnaires. At admission, boys and girls used similar coping strategies. Three months following treatment, boys and girls decreased passive pain coping and seeking social support while they maintained the degree of positive self-instruction. Girls displayed higher seeking social support than boys and of importance, only for girls, a reduction in seeking social support was related to decreases in pain intensity. In both groups, the changes in coping were related to positive treatment outcome. Results suggest that both groups may benefit from reductions in passive pain coping and seeking social support. The causal quality of this relationship remains to be determined in future studies. Gender-role expectations and family interactions may account for the sex differences demonstrated for seeking social support. Perspective Boys and girls with chronic pain show profound similarities in pain-related coping strategies prior and after multimodal pain treatment. The changes in coping are related to positive treatment outcomes. Sex-specific treatment strategies for changing seeking social support may need to be developed and tested for their differential efficacy in boys and girls.

Background: In spite of many similarities in the psychopathology of anorexia nervosa (AN) and bulimia nervosa (BN), the 2 groups seem to differ in terms of body image disturbances. Therefore, the aim of the present study was to compare neuronal correlates of viewing pho tographs of one’s own body and another woman’s body in patients with these forms of eating disorders as well as controls. Methods: We performed functional magnetic resonance imaging while women with AN ( n = 13), BN ( n = 15) and healthy controls ( n = 27) viewed 16 standardized pictures of their own body and another woman’s body, taken while the participants were wearing a bikini. Results: When viewing their own body, participants with AN and BN showed reduced activity in the inferior parietal lobule compared with healthy women. In response to looking at another woman’s body, participants with AN had higher amygdala activity than did those in the BN and control groups. Limitations: The generalizability of the results is limited by the small sample size. Conclusion: Our data suggest decreased attentional processes in AN and BN toward one’s own body, possibly reflecting body-related avoidance behaviour. Enhanced limbic activity elicited by looking at another woman’s body in participants with AN might be a neural correlate of stronger emotional activation and en hanced vigilance, possibly resulting from social comparison processes. Our study reveals hints about body image‐associated alterations in brain activity, which seem to be more pronounced among women with AN than among those with BN.

Body processing has been associated functionally to the so called extrastriate body area (EBA) which is located in the lateral occipital cortex. As body image disturbance is one of the main diagnostic criteria in anorexia nervosa (AN) this study aimed at looking for alterations in gray matter density in women with (AN) especially in the EBA. High resolution T1 images from 15 women with AN and 15 age matched healthy controls women were contrasted using voxel based morphometry (VBM). Additionally functional localizer scans were used to determine functionally the EBA of each participant. In general, total gray matter volumes did differ between groups. VBM results yielded evidence for a reduction of gray matter density in the left EBA. This reduction, which resulted from whole brain analysis, was localised within the activation cluster of the EBA localizer scan. The current results provide for the first time evidence for structural alterations in the EBA in patients with AN which might suggest that body image distortion is related at least in part to structural alteration in the EBA.

The effects of a physical exercise session on state body image and mood were examined. In a cross-over design, participants were randomised to two groups starting either with physical exercise (PE; experimental condition) or with reading a newspaper (RN; control condition). Before and after PE and RN, participants (N = 65) rated their body dimensions using a digital photo distortion technique and indicated their attitudinal body image and mood. Participants' judgements of their 'felt' body dimensions and attitudes toward their own body were affected differently by PE and RN, indicating that participants felt slightly slimmer and were more satisfied with their bodies after PE. Exercise-induced changes in body perception were greater, the higher the pre-experimental drive for thinness, body dissatisfaction and weight/shape concerns were. Especially in those participants with higher body image disturbances, physical exercise can have a reinforcing effect on immediate body image and mood improvement.

This study assesses whether characteristics of one's own body image influences preferences of attractiveness in a partner. The role of gender and sexual orientation is also considered. Heterosexual women (n=67), lesbian women (n=73), heterosexual men (n=61) and gay men (n=82) participated in an internet survey assessing attitudes towards the body and preferences of attractiveness in a partner. Men in particular were found to prefer attractive partners, regardless of sexual orientation. Weight/shape dissatisfaction was found to be a negative predictor for heterosexual men and women. For gay men, preferences were better explained by internalization and weight/shape dissatisfaction. No such associations were found in the lesbian group. Levels of weight/shape dissatisfaction and internalization of socio-cultural slenderness ideals influence expectations of thinness and attractiveness in a partner with this effect being modified by gender and sexual orientation.

The aim of the present study was to assess whether habitual body avoidance and body-checking behavior influences the decrease of negative emotions during body exposure. Twenty-one eating-disordered female participants completed the Body Image Avoidance Questionnaire and the Body Checking Questionnaire. On another day, a 40-min body exposure session was conducted under standardized conditions. Every 10 min, negative emotions were assessed. It was shown that the extent of decrease in negative emotions during the body exposure session could be predicted by a lower degree of body checking. Results indicate that habitual checking behavior seems to negatively influence the effect of body exposure. Therefore, an adaptation of body exposure to patients with a higher degree of body-checking behavior might be promising.

Difficulties recognizing emotion have been reported for eating disordered individuals in relation to perception of emotions in others and emotional self-awareness. It remains unclear whether this is a perceptual or cognitive-affective problem. Clarification is sought and the question of a cognitive bias is addressed when interpreting facially expressed emotions. Twenty participants with bulimia nervosa (BN) and 20 normal controls (NC) were assessed for ability to recognize emotional and neutral expressions. Emotional self-awareness was also assessed. Significant differences were found for emotional self-awareness. For emotional faces, only a poorer recognition of the emotion, surprise, for BN was found. Problems with emotional self-awareness suggest a cognitive-affective disturbance in emotion recognition. Implications for therapy are discussed.

The study examined whether the extent of negative body-related thoughts and emotions evoked by looking in a mirror can be changed by cognitive-behavioural body image therapy (BIT) and whether any remaining cognitive and affective responses dropped faster after the treatment. Females with eating disorders (n = 17) looked in a mirror for 40 minutes under standardised conditions before and after BIT. A control group (CG) (n = 24) was also exposed to their own bodies twice. Cognitive and affective reactions were assessed four times during the session. Hierarchical Linear Modelling revealed that among eating-disordered patients, the entrance levels of negative thoughts and feelings were lower at post compared to pre-BIT, whereas they remained stable in the CG. The extent of reduction of the remaining body image distress was not changed after the treatment. BIT seems to be a potent treatment of negative emotions and cognitions in an in vivo situation. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association.

Sufficiently theoretically founded and validated measures in German language to assess psychotherapeutic change are rare. The German Questionnaire for the Evaluation of Psychotherapeutic Change Processes (FEP) was designed on the basis of the Phase model of psychotherapeutic outcome. In the present study, the psychometric properties of the FEP and especially its factorial structure are validated. Psychometric values were calculated and confirmatory factor analyses were performed (outpatient sample, N=427). Itemindices, reliability - with exception of retest-reliability - and validity reached overall good to very good values. The best model-fit indices were obtained for the 3-factor-structure corresponding to the FEP-subscales Well-being, Symptoms and Interpersonal relations which represent the dimensions postulated by the Phase model. The FEP proved to be a psychometrically well-founded transdiagnostic measure of outcome and change which represents multidimensional phases of change. Its application in outcome monitoring is recommended.

Body image disturbances play a significant role in the development of eating disorders. Since body image can vary in diverse contexts, the aim of the present experiment was to investigate whether it is affected by recent food intake. Fifty-seven females without clinically relevant eating disorders were randomly assigned to an experimental group (EG, n=28) that consumed a milkshake while watching a neutral film and a control group (CG, n=29) that only viewed the movie. Before and after the tasks, participants filled in the "Body Image States Scale" and the "Mood Questionnaire" and indicated their own "actual", "felt" and "ideal" body dimensions with a digital distortion technique based on a photograph of themselves. It was shown that after milkshake consumption, state body dissatisfaction as well as the discrepancy between "actual-ideal" and "felt-ideal" body size estimations was higher in the EG than in the CG. Judgements of the "actual", "felt" and "ideal" body dimensions and of mood were not affected. Further analyses revealed that the effect of milkshake consumption on body image and mood was higher the more the participants displayed restrained eating or eating, weight and shape concerns in general. Clinical implications are discussed.

Although enhanced cardiovascular reactivity is extensively discussed as a relevant negative factor in the alteration of vascular structure, only a few controlled studies have been published presenting approaches to alter reactivity. Therefore, we examined whether enhanced reactivity could be reduced by stress management training (SMT). To control for expectation effects, progressive muscular relaxation (PMR) was the control condition. Forty-four patients with a blood pressure response greater than 15 mm Hg to a mental stress test participated in this study. Participants who took part in SMT showed a significantly stronger reduction of diastolic blood pressure reactivity to a mental stress test from pretest to posttest than the controls. Furthermore, patients who took part in SMT showed significantly smaller systolic blood pressure reactions to mental arithmetic and 2 social stress tests than the controls after the trainings. This study indicates that enhanced blood pressure reactivity can be reduced by SMT.

Body image-related interventions become increasingly important in the treatment of anorexia and bulimia nervosa. Previous studies concerning body image disturbance conducted by means of diverse research methods focused on different components of body image - the perceptive, cognitive-emotional and the behavioral component. However, regarding the etiology, maintenance and treatment of body image disturbance in eating disorders, many questions remain unanswered. An integrative perspective on the different body image components within a theoretical framework as well as the development of specific body image-related interventions according to individual indications would be desirable.

Cognitive-behavioural models of eating disorders state that body checking arises in response to negative emotions in order to reduce the aversive emotional state and is therefore negatively reinforced. This study empirically tests this assumption.For a seven-day period, women with eating disorders (n = 26) and healthy controls (n = 29) were provided with a handheld computer for assessing occurring body checking strategies as well as negative and positive emotions. Serving as control condition, randomized computer-emitted acoustic signals prompted reports on body checking and emotions.There was no difference in the intensity of negative emotions before body checking and in control situations across groups. However, from pre- to post-body checking, an increase in negative emotions was found. This effect was more pronounced in women with eating disorders compared with healthy controls.Results are contradictory to the assumptions of the cognitive-behavioural model, as body checking does not seem to reduce negative emotions.