When do anorexic patients perceive their body as too fat? Aggravating and ameliorating factors

Abstract

Objective Our study investigated body image representations in female patients with anorexia nervosa and healthy controls using a size estimation with pictures of their own body. We also explored a method to reduce body image distortions through right hemispheric activation. Method Pictures of participants' own bodies were shown on the left or right visual fields for 130 ms after presentation of neutral, positive, or negative word primes, which could be self-relevant or not, with the task of classifying the picture as “thinner than”, “equal to”, or “fatter than” one’s own body. Subsequently, activation of the left- or right hemispheric through right- or left-hand muscle contractions for 3 min., respectively. Finally, participants completed the size estimation task again. Results The distorted “fatter than” body image was found only in patients and only when a picture of their own body appeared on the right visual field (left hemisphere) and was preceded by negative self-relevant words. This distorted perception of the patients' body image was reduced after left-hand muscle contractions (right hemispheric activation). Discussion To reduce body image distortions it is advisable to find methods that help anorexia nervosa patients to increase their self-esteem. The body image distortions were ameliorated after right hemispheric activation. A related method to prevent distorted body-image representations in these patients may be Eye Movement Desensitization and Reprocessing (EMDR) therapy.

A systematic and methodological review of attentional biases in eating disorders: Food, body, and perfectionism

“…Therefore, it may not be clear what aspects of processing are linked to which areas, and different brain areas may be active in a variety of processes. Many studies support a cognitive theoretical understanding that body‐ and/or food‐related information processing style is an emotion‐activating process that underlies ED, as the presence of stress or negatively valenced stimuli appears to exacerbate differences between ED and HC (e.g., Collins et al, ; Kazén et al, ; Miyake, Okamoto, Onoda, Shirao, et al, ).…”

“…Prior to viewing these images, participants are primed with positive, negative, or neutral words and then are asked to estimate whether the image is thinner than, equal to, or “fatter” than their own body. Findings indicate that in contrast to HC, AN exhibit perceptual body distortions only after being primed with negative words and viewing pictures presented to their right visual field (corresponding to left hemisphere processing) (Kazén et al, ). It may be the case that left hemisphere attentional processing involving cognitive control is ramped up during aversive body‐related thoughts in AN.…”

“…Given that PFC activation is often associated with cognitive control processes, elevated PFC signal to ideal body and food pictures could be related to issues regarding control over diet and thinness. Finally, an additional study does not compare fMRI patterns of brain activation in AN and HC, but instead evaluates contributions of left versus right hemispheric activation to visual processing, presenting images of the participant's body in either the left or right visual field (Kazén, Baumann, Twenhöfel, & Kuhl, ). Prior to viewing these images, participants are primed with positive, negative, or neutral words and then are asked to estimate whether the image is thinner than, equal to, or “fatter” than their own body.…”

“…Fortunately, brain imaging, dot‐probe, and eye‐tracking studies, among others, provide more clues as to whether approach versus avoidance mechanisms are involved in these attentional biases. Taken together, findings from these studies suggest that AN are (a) preoccupied with their own as opposed to others' body‐related stimuli when given the choice (Blechert et al, ), unless these stimuli are specifically associated with thinness or their ideal underweight body type (Castellini et al, ; Mohr et al, ; Van den Eynde et al, ); (b) show aversion and anxiety toward their own bodies (Brockmeyer et al, ; Kazén et al, ; Miyake, Okamoto, Onoda, Kurosaki, et al, ; Miyake, Okamoto, Onoda, Shirao, et al, ) as well as other overweight bodies (Vocks et al, ); and (c) are initially drawn to food stimuli (Blechert et al, ; Brooks et al, ; Gordon et al, ) but may switch to avoidance of food, particularly if the food is high‐calorie (Berry et al, ; Giel et al, ). On the whole, research suggests that BN: (a) focus substantial attention on others' bodies (Blechert et al, , , ; Smeets et al, ; Spangler & Allen, ; Van den Eynde et al, ); (b) appear to be more drawn to than repelled by food stimuli (Berry et al, ; Blechert et al, ; Brooks et al, ; Friederich et al, , Smeets et al, ; but see Uher et al, ); and (c) show difficulty inhibiting behavior in the presence of food cues (Mobbs et al, ) as well as reduced conflict‐related brain signals to desirable foods when stressed (Collins et al, ).…”

Screening four broad categories of eating disorders: suitability of a clinical algorithm adapted from the SCOFF questionnaire

“…AN and BN share common features such as perfectionism, obsessive-compulsiveness, neuroticism, and negative emotionality, which may not be easy to detect by non-specialists [21]. In contrast, a self-perception of being too fat, or fear of gaining weight is present in both AN and BN and both are easily expressed by patients [22]. High impulsivity, sensation seeking, and loss of control are typical of bulimic disorders in, such as BN or BED but BMI is usually normal in BN while it is increased in BED [23].…”