Effects of a cognitive-behavioral exposure-based body image therapy for overweight females with binge eating disorder: a pilot study

Abstract

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.

Body uneasiness is associated with food addiction symptoms: A cross‐sectional study

“…Our study differs from and adds to previous findings by investigating the association between FA and body uneasiness, while controlling for potential confounding variables. Our results suggest that clinicians should carefully investigate the presence of body uneasiness in individuals with FA symptoms in order to use specific treatment approaches, such as cognitive‐behavioural exposure‐based body image therapy (Lewer et al, ), to manage this critical symptom.…”

Different Facets of Body Image Disturbance in Binge Eating Disorder: A Review

“…As the empirical evidence referring to these aspects is still relatively scarce for individuals with BED, it is not yet clear whether individuals with BED are also influenced by cognitive biases, body size misperception, or checking and avoidance behavior. Nevertheless, Williamson et al [ 56 ] propose that a cognitive bias leads to increased negative emotions and dietary restraint, which is both common in individuals with BED [ 62 , 67 , 68 , 87 ] and in turn might lead to binge eating behavior. Furthermore, there are signs that overvaluation of weight/shape triggered by body-related stimuli, such as watching other persons in a fashion store, might further increase the desire to binge in individuals with BED [ 119 ].…”

“…However, as the overall sample size was rather small and the proportion of participants with BED was only about 6%, conclusions regarding the treatment of BED need to be drawn with caution. In a recent study that explicitly addressed body image disturbance in BED, Lewer and colleagues [ 62 ] compared individuals with BED and obesity to a waiting-list control group within a standardized group therapy program consisting of ten sessions. During the program, participants received psychoeducation on the disorder, were guided in cognitive restructuring of negative cognitions towards one’s own body, exposed themselves to their body in the mirror, and received guidance regarding exposure outside of the therapeutic setting (e.g., use personal care products such as body lotion, visit a public pool).…”

“…In view of the prominent role of the different aspects of body image disturbance in AN and BN, it can be hypothesized that body image disturbance might also be a part of the symptomatology of BED [ 61 ], although it is not yet included in the diagnostic criteria [ 3 ]. In addition, it might prove to be a target for treatment [ 61 , 62 ]. Therefore, the goal of this review is to give an overview of the existing findings concerning the question of whether people suffering from BED also display symptoms of a disturbed body image in terms of body dissatisfaction, an overconcern with weight and shape, body-related checking and avoidance behavior, body size misperception, and body-related cognitive biases.…”

A Proposed Approach Treating Gender Dysphoria Through Body Image Therapy

“…The study shows that body image therapy is a worthy complement to the current approaches for BED treatments, as it significantly lowers the dysfunctional cognition related to body and self-esteem (Legenbauer, Schütt-Strömel, Hiller, & Vocks, 2011). The same manualized treatment was used in another research study where 15 overweight female participants with BED showed significant improvement in the cognitive-affective component of body image disturbance (one's mental picture of oneself) compared to the obese women in the control group who did not receive the treatment (Lewer, Kosfelder, Michalak, Schroeder, Nasrawi, & Vocks, 2017).…”