Thoughts about eating, weight and shape in anorexia nervosa and bulimia nervosa

doi:10.1016/0005-7967(92)90034-E

Behaviour Research and Therapy

Volume 30, Issue 5, September 1992, Pages 501-511

https://doi.org/10.1016/0005-7967(92)90034-E Get rights and content

Abstract

Concurrent verbalisation and a self-report questionnaire were used to investigate self-statements in patients with anorexia nervosa, patients with bulimia nervosa, two groups of dieters and non-dieting controls. Thoughts were collected while subjects performed three behavioural tasks, looking at themselves in a full-length mirror, weighing themselves and eating a chocolate covered mint. Both groups of patients had more negative thoughts related to eating, weight and shape than those in the three control groups. In addition, patients with anorexia nervosa showed a greater concern with eating while patients with bulimia nervosa showed a greater concern with weight and appearance. Differences were found between the patients and non-dieting controls using both methods but the self-report questionnaire was less sensitive than concurrent verbalisation to differences between the patients and dieters. Implications of the findings for cognitive-behavioural treatments of the two disorders are discussed.

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Cited by (109)

Mirror exposure therapy for body image disturbances and eating disorders: A review
2018, Clinical Psychology Review
Citation Excerpt :
In summary, women with ED, like individuals with BDD, spend a significant amount of time engaging in body checking and/or avoiding behaviors, often mirror related, that lead to considerable distress. Those with ED tend to experience even more distress and negative emotions than healthy individuals soon after being exposed to their reflection in a mirror, although this effect may be specific to BN and BED and may not apply to those with AN (Cooper & Fairburn, 1992; Naumann, Trentowska, & Svaldi, 2013; Vocks et al., 2007). Additionally, for women with BED a brief mirror exposure increases both salivation and their desire to binge eat (Naumann et al., 2013).
Mirror exposure therapy is a clinical trial validated treatment component that improves body image and body satisfaction. Mirror exposure therapy has been shown to benefit individuals with high body dissatisfaction and patients with eating disorders (ED) in clinical trials. Mirror exposure is an optional component of cognitive behavioral therapy (CBT), an effective treatment for body dysmorphic disorder (BDD). However, most clinical trials of mirror exposure therapy have been small or uncontrolled and have included few male subjects. Adverse events have been reported during mirror exposure clinical trials. We discuss how individuals respond when looking in a mirror and how mirrors can be used therapeutically, and we critically evaluate the evidence in favor of mirror exposure therapy. We discuss clinical indications and technical considerations for the use of mirror exposure therapy.
Does habituation really happen? Investigation of psycho-biological responses to body exposure in bulimia nervosa
2017, Behaviour Research and Therapy
Body exposure is a common and effective treatment for body image disturbance in bulimia nervosa (BN). However, little is known about treatment mechanisms. Based on models of emotional processing and neurovisceral integration, we expected to observe a) initial activation and b) habituation of cognitive-affective and autonomic responding within one and between two standardized body exposure sessions.
A group of 13 women with BN and 13 healthy controls (HC) were repeatedly exposed to their bodies. Prior to and after treatment with three individualized mirror exposure sessions participants received a session of standardized exposure to videographic recordings of their body. Subjective ratings of body-related emotions and thoughts were assessed repeatedly throughout the standardized exposure sessions and autonomic responses were recorded continuously.
Subjective and sympathetic responses were activated initially in both groups. Cognitive-affective responses habituated within the standardized sessions in both groups, whereas between the standardized sessions habituation was only found in women with BN. Increasing sympathetic responses were found within the sessions in both groups.
The results support cognitive-affective habituation during body exposure in BN and to a lesser extent in HC. Autonomic responses however did not show a corresponding pattern and did not distinguish between groups. Implications for body exposure research and practice are discussed.
Thought-shape fusion in young healthy females appears after vivid imagination of thin ideals
2016, Journal of Behavior Therapy and Experimental Psychiatry
Citation Excerpt :
Cognitive distortions, defined as inaccurate tendencies in information processing, play an important role in the maintenance of mental disorders, e.g., in panic or depressive disorders and also in EDs. As such, weight and shape concerns represent core features of ED pathology and a target of evidence-based treatment of EDs (Cooper & Fairburn, 1992; Fairburn, 1981). In the present study, we hypothesize that exposure to thin ideals will trigger specific body-related cognitive distortions.
It has been shown that exposure to female thin ideals in media has minimal to moderate direct effects on body image satisfaction (BIS), mood and dysfunctional eating in healthy young women. Evidence has been found for several intervening variables such as social comparison processes. Accordingly it is assumed, that cognitive processing (rather than mere media exposure) is crucial. Consequently, vivid imagination of thin ideals after exposure to a fashion magazine was induced in order to trigger cognitive processes. Changes in mood, BIS and resulting bodyrelated cognitive distortions (Thought-Shape Fusion Body, TSF-B) were assessed.
A total of 91 healthy women (mean age 21.9 years, SD = 2.0) were exposed to either a fashion magazine (thin-ideal group) or a nature magazine (control group) in a waiting room design. Afterwards they were instructed to vividly imagine either the thin ideals or landscapes.
When exposed to thin ideals, a significant decrease in mood and BIS emerged after vivid imagination, but not after mere magazine exposure. Imagining thin ideals triggered body-related cognitive distortions (TSF-B). A higher degree of eating disorder (ED) symptomatology amplified this effect.
These findings apply to young healthy females and cannot be generalized to samples with obesity, EDs or males. Internal validity is limited since the intensity of the exposure has not been systematically controlled.
Vivid imagination of thin ideals promoted by magazines results in impaired mood and BIS and moreover in body-related cognitive distortions (TSF-B) in healthy women, especially, for those with stronger ED symptomatology.
Efficacy of body exposure as treatment component for patients with eating disorders
2014, Journal of Behavior Therapy and Experimental Psychiatry
Body exposure and cognitive restructuring are well known interventions in cognitive-behavioral therapies for patients with eating disorders. Though promising, little is known about the impact of body exposure on body dissatisfaction, overvaluation of weight and shape and other aspects of eating disorder psychopathology. Thus, the aim of the two studies presented here is to evaluate the efficacy of mirror exposure and video exposure on body dissatisfaction, weight and shape concerns and other aspects of eating disorder psychopathology.
Fourteen women diagnosed with Eating Disorders Not Otherwise Specified (EDNOS; DSM-IV-TR) were treated in repeated mirror exposure sessions. Assessments were carried out before (baseline) and after body exposure.
Measures of body dissatisfaction, shape concerns and eating disorder psychopathology were significantly improved at the post treatment assessment.
Thirteen women with Bulimia Nervosa (BN; DSM-IV-TR) received repeated mirror and video exposure sessions. Measures were assessed before (baseline) and after body exposure.
Body image dissatisfaction was significantly improved at post treatment assessment.
These preliminary results are based on subjective data from two small clinical samples. Comparisons between the studies are limited by design variations.
The studies provide evidence that body exposure is a promising technique for treatment of body dissatisfaction in EDNOS and BN. Moreover, in EDNOS shape concern and aspects of eating disorder psychopathology were improved after body exposure. Reasons for the lack of change in shape and weight concern as well as in eating disorder psychopathology in BN are discussed.
Body-related cognitions, affect and post-event processing in body dysmorphic disorder
2014, Journal of Behavior Therapy and Experimental Psychiatry
Cognitive behavioural models postulate that individuals with BDD engage in negative appearance-related appraisals and affect. External representations of one's appearance are thought to activate a specific mode of processing characterized by increased self-focused attention and an activation of negative appraisals and affect.
The present study used a think-aloud approach including an in vivo body exposure to examine body-related cognitions and affect in individuals with BDD (n = 30), as compared to individuals with major depression (n = 30) and healthy controls (n = 30). Participants were instructed to think aloud during baseline, exposure and follow-up trials.
Individuals with BDD verbalized more body-related and more negative body-related cognitions during all trials and reported higher degrees of negative affect than both control groups. A weaker increase of positive body-related cognitions during exposure, a stronger increase of sadness and anger after exposure and higher levels of post-event processing, were specific processes in individuals with BDD.
Individuals with major depression were not excluded from the BDD group. This is associated with a reduction of internal validity, as the two clinical groups are somewhat interwoven. Key findings need to be replicated.
The findings indicate that outcomes such as negative appearance-related cognitions and affect are specific to individuals with BDD. An external representation of one's appearance activates a specific mode of processing in BDD, manifesting itself in the absence of positive body-related cognitions, increased anger and sadness, and high levels of post-event processing. These specific processes may contribute toward maintenance of BDD psychopathology.
Mirror exposure in women with bulimic symptoms: How do thoughts and emotions change in body image treatment?
2013, Behaviour Research and Therapy
Mirror exposure is an efficient treatment for body image problems in eating disorders. Although habituation processes and cognitive changes are postulated to be underlying mechanisms, evidence is scarce, especially during repeated mirror exposure treatment. Fourteen participants with eating disorders not otherwise specified (EDNOS) and five with bulimia nervosa (BN) composed the bulimic group (BG), and 19 healthy women without any mental disorder composed the healthy controls group (HC). The participants were treated by four standardized mirror exposure sessions. Subjective distress was assessed five times during each session. Both negative and positive emotions and negative thoughts were assessed after each session. The patients in the BG reported significantly higher levels of negative emotions and cognitions than did those in the HC in all measures and across all sessions. In both groups, subjective distress increased significantly within each session and decreased toward the end of each session. Only in the subjects of the BG group did both distress and negative thoughts and emotions decrease significantly from session to session, whereas positive emotions increased. The patterns of change differed between the BG and the HC, suggesting that habituation between sessions occurred only in the BG. Our findings suggest that the additional underlying cognitive–affective processes merit further investigation.

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Thoughts about eating, weight and shape in anorexia nervosa and bulimia nervosa

Abstract

DSM-III-R

Cognitive therapy and the emotional disorders

An inventory for measuring depression

Archives of General Psychiatry

Eating disorders: Obesity, anorexia nervosa and the person within

Dysfunctional thinking in anorexia and bulimia nervosa

Cognitive Therapy and Research

The Eating Disorder Examination: A semi-structured interview for the assessment of the specific psychopathology of eating disorders

International Journal of Eating Disorders

The validity of the Eating Disorder Examination and its subscales

British Journal of Psychiatry

Articulated thoughts during simulated situations: A paradigm for studying cognition in emotion and behaviour

Cognitive Therapy and Research

Reason and emotion in psychotherapy

The definition of bulimia nervosa

Annals of Behavioural Medicine

The diagnosis of bulimia nervosa

International Journal of Eating Disorders