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.

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.

BackgroundAlthough not part of the diagnostic criteria of the DSM-5, body image disturbance seems to be a relevant feature of Binge Eating Disorder (BED) as well as of other eating disorders such as Anorexia Nervosa (AN) or Bulimia Nervosa (BN). Hence, the aim of the present pilot study was to assess the changeability of body image disturbance in a sample of overweight females with BED by a cognitive-behavioral treatment, directly addressing body image disturbance.MethodOverweight females (N = 34) with BED were randomized to a manualized body image therapy or a waiting-list control group. The final sample consisted of n = 15 participants in the intervention group and n = 19 in the control group due to two drop-outs in the control condition. Before and after the intervention or the waiting period, respectively, participants filled out a questionnaire battery assessing several body image and eating disorder related features. To quantify the perceptual component of body image disturbance, a digital photo distortion technique based on a picture of each participant taken in a standardized suit was applied.ResultsIn a two-way ANOVA, significant Time × Group interactions were found for eating and shape concerns, drive for thinness, body dissatisfaction, depressiveness and low self-esteem. Follow-up t-tests indicated a significant symptom reduction of a generally high magnitude in the intervention group. No significant changes concerning body checking and the estimations of one’s own “real”, “felt” and “ideal” body dimensions were found.ConclusionThe strong symptom reduction in the cognitive-affective component of body image disturbance indicates that an exposure-based cognitive-behavioral body image intervention is a promising treatment module for overweight females with BED, but future research with a larger sample size is needed to quantify possible changes in all components of body image.

Die eineiigen Zwillingsschwestern Agnes H. und Hannah H. (Namen verändert) kommen wegen starker Angst vor dem Erbrechen in die psychotherapeutische Ambulanz. Zum Zeitpunkt des Therapiebeginns sind sie 22 Jahre alt. Hannah H. lebt mit ihrem Partner zusammen und befindet sich in einer Ausbildung. Ih re Schwester lebt im Elternhaus und stu diert. Beide berichten, seit 2003 unter der starken Angst, sich erbrechen zu müssen oder zu erleben, wie jemand anderes sich erbricht, zu leiden. Infolge dieser Angst schildert Hannah H., dass sie Krankenhäuser, Imbissbuden oder Freizeitparks vermeide, da dies nach ihrer Einschätzung Orte seien, an denen andere sich erbrechen könnten, man eine Lebensmittelvergiftung erleiden könne bzw. eine Ansteckung mit Magen-Darm-Keimen sehr wahrscheinlich sei. Agnes H. meidet aus den gleichen Gründen Krankenhäuser, Arztpraxen, Menschenmengen und sämt-liche Orte, an denen sie auf alkoholisierte Menschen treffen könnte. Beide geben an, dass sie nur unter intensivem Angsterleben TV-Sendungen schauen können, in denen jemand erbrechen könnte. Des Weiteren vermeidet es Agnes H. aus Angst vor Übelkeitserleben, mit dem Auto zu fahren. Ihre Zwillingsschwester kann sich trotz Kinderwunsch nicht vorstellen, schwanger zu werden. Beide können nur in der eigenen Wohnung essen, da sie besorgt sind, in Restaurants schlechte oder abgelaufene Lebensmittel serviert zu bekommen. Ferner vermeidet Hannah H. bewusst Lebensmittel, wie z. B. Fisch, Sushi, Mett oder Kiwis. Auch achte sie besonders auf das Haltbarkeitsdatum von Lebensmitteln und vermeide es, abgelaufene oder bald ablaufende Speisen zu sich zu nehmen. Medikamente werden von keiner der beiden als Sicherheitssignal verwendet und/ oder missbräuchlich genutzt. Beide Frauen geben Panikattacken an, wenn andere Personen von Übelkeit berichten bzw. sie sel-

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