Psychother Psychosom Med Psychol 2013; 63(05): 193-200
DOI: 10.1055/s-0032-1331171
Aktuelle psychosomatische und psychotherapeutische Behandlungsansätze
© Georg Thieme Verlag KG Stuttgart · New York

Körperexposition bei Essstörungen: Durchführung und Bedeutung für den Therapieerfolg

Body Exposure for Eating Disorders: Technique and Relevance for Therapy Outcome
Anna N. Vossbeck-Elsebusch
1   Klinische Psychologie und Psychotherapie, Universität Osnabrück
,
Silja Vocks
2   Klinische Psychologie und Psychotherapie, Universität Osnabrück
,
Tanja Legenbauer
3   LWL Universitätsklinikum Hamm für Kinder -und Jugendpsychiatrie, ­Ruhr-Universität Bochum
› Author Affiliations
Further Information

Publication History

eingereicht06 April 2012

akzeptiert 28 October 2012

Publication Date:
04 February 2013 (online)

Zusammenfassung

Bei der Behandlung von Essstörungen zielen die Kerninterventionen aufgrund der Bedrohlichkeit des gestörten Essverhaltens als erstes auf dessen Normalisierung. In den letzten Jahren haben darüber hinaus Interventionen zur Verbesserung des Körperbildes Eingang in die Behandlung gefunden. Körperexpositionsübungen stellen dabei eine bedeutsame Technik dar. Im vorliegenden Beitrag wird daher neben einer kurzen Einführung zur Rolle des Körperbildes bei Essstörungen eine Übersicht über aktuelle Forschungsergebnisse zur Wirksamkeit und den Effekten der Interventionen zur Verbesserung des Körperbildes auf die verschiedenen Komponenten des Körperbildes gegeben. Im zweiten Teil wird das therapeutische Vorgehen bei Körperexpositionen beschrieben. Insgesamt stellt Körperexposition eine vielversprechende Technik zur Verbesserung der Therapieerfolge bei Essstörungen dar.

Abstract

The main interventions in the treatment of eating disorders aim at the normalization of the potentially life threatening disordered eating behavior. During the past years, interventions for the improvement of body image have been implemented in the treatment. Body exposure is an important technique in body image therapy. Our article introduces the role of body image in eating disorders and gives an overview of current research regarding effectiveness and effects of therapeutic interventions on the different components of body image. The second part describes the therapeutic technique of body exposure. Taken together, body exposure can be viewed as a promising technique for the improvement of therapy outcomes in eating disorders.

 
  • Literatur

  • 1 Cash TF, Henry PE. Women’s body images. The results of a national survey in the U.S.A. Sex Roles 1995; 33: 19-28
  • 2 Garner DM. Eating Disorders Inventory-2. Professional Manuals. Odessa, FL: Psychological Assessment Ressources; 1991
  • 3 Wood KC, Becker JA, Thompson JK. Body image dissatisfaction in preadolescent children. J Appl Dev Psychol 1996; 17: 85-100
  • 4 Feingold A, Mazzella R. Gender differences in body image are increasing. Psychol Sci 1998; 9: 190-195
  • 5 Wiseman CV, Gray JJ, Mosimann JE et al. Cultural expectations of thinness in women: An update. Int J Eat Disord 1992; 11: 85-89
  • 6 Groesz L, Levine P, Murnen SK. The effect of experimental presentation of thin media images on body satisfaction: A meta-analytic-review. Int J Eat Disord 2002; 31: 1-16
  • 7 Rühl I, Legenbauer T, Hiller W. The impact of exposure to images of ideally thin models in TV commercials on eating behavior: An experimental study with women diagnosed with bulimia nervosa. Body image 2011; 8: 349-356
  • 8 Legenbauer T, Rühl I, Vocks S. Influence of appearance-related TV commercials on body image state. Behav Modif 2008; 32: 252-271
  • 9 Cash TF, Deagle EA. The nature and extent of body-image disturbances in anorexia nervosa and bulimia nervosa: A meta-analysis. Int J Eat Disord 1997; 22: 107-125
  • 10 Post G, Crowther JH. Restricter-purger differences in bulimic adolescent females. Int J Eat Disord 1987; 6: 757-761
  • 11 Ricciardelli LA, Tate D, Williams RJ. Body dissatisfaction as a mediator of the relationship between dietary restraint and bulimic eating patterns. Appetite 1997; 29: 43-54
  • 12 APA – American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders – DSM-IV-TR (4th ed., Text Revision). Washington, DC: American Psychiatric Association; 2001
  • 13 Weltgesundheitsorganisation . Internationale Klassifikation psychischer Störungen. ICD-10 Kapitel V (F). Bern: Huber; 1993
  • 14 Eldredge KL, Agras WS. Weight and shape overconcern and emotional eating in binge eating disorder. Int J Eat Disord 1996; 19: 73-82
  • 15 Telch CF, Stice E. Psychiatric comorbidity in women with binge eating disorder: prevalence rates from a non-treatment-seeking sample. J Consult Psychol 1998; 66: 768-776
  • 16 Ahrberg M, Trojca D, Nasrawi N et al. Body image disturbance in binge eating disorder: A review. Eur Eat Disorders Rev 2011; 19: 375-381
  • 17 Hilbert A, Tuschen-Caffier B, Vögele C. Effects of prolonged and repeated body image exposure in binge-eating disorder. J Psychosom Res 2002; 137-144
  • 18 Slade PD. Body image in anorexia nervosa. Br J Psychiatry 1988; 153 (Suppl. 02) 20-22
  • 19 Cash TF. Body image: Past, Present and future. Body Image 2004; 1: 1-5
  • 20 Tuschen-Caffier B. Körperbildstörungen. In: Herpertz S, de Zwaan M, Zipfel S. Hrsg: Handbuch Essstörungen und Adipositas. Heidelberg: Springer Medizin Verlag; 2008: 82-86
  • 21 Vocks S, Legenbauer T. Körperbildtherapie bei Anorexia und Bulimia nervosa. Ein kognitiv-verhaltenstherapeutisches Behandlungsprogramm (2. überarbeitete Auflage). Göttingen: Hogrefe; 2010
  • 22 Vocks S. Die Behandlung von Körperbildstörungen. In: Herpertz S, de Zwaan M, Zipfel S. Hrsg Handbuch Essstörungen und Adipositas. Heidelberg: Springer Medizin Verlag; 2008: 219-225
  • 23 Gleghorn AA, Penner LA, Powers PS et al. The psychometric properties of several measures of body image. J of Psychopathol and Behav Assess 1987; 9: 203-218
  • 24 Gardner RM, Tockerman YR. Body dissatisfaction as a predictor of body size distortion: A multidimensional analysis of body image. Genet Soc Gen Psychol Monogr 1993; 119: 125-145
  • 25 Skrzypek S, Wehmeier PM, Remschmidt H. Body image assessment using body size estimation in recent studies on anorexia nervosa. A brief review. Eur Child Adolesc Psychiatry 2001; 10: 215-221
  • 26 Farrell C, Lee M, Shafran R. Assessment of body size estimation: A review. Eur Eat Disord Rev 2005; 13: 75-88
  • 27 Schneider N, Frieler K, Pfeiffer E et al. Comparison of body size estimation in adolescents with different types of eating disorders. Eur Eat Disord Rev 2009; 17: 468-475
  • 28 Legenbauer T, Vocks S, Betz S et al. Differences in the nature of body image disturbances between female obese individuals with versus without a comorbid binge eating disorder: An exploratory study including static and dynamic aspects of body image. Behav Modif 2011; 35: 162-186
  • 29 Antony MM, Johnson WG, Carr-Nangle RE et al. Psychopathology correlates of binge eating and binge eating disorder. Compr Psychiatry 1994; 35: 386-392
  • 30 Nicoli MG, Liberatore Junior RR. Binge Eating Disorder and body image perception among university students. Eat Behav 2011; 12: 284-288
  • 31 Vocks S, Legenbauer T, Rüddel H et al. Static and dynamic body image in bulimia nervosa: Mental representation of body dimensions and biological motion patterns. Int J Eat Disord 2007; 40: 59-66
  • 32 Jansen A, Nederkoorn C, Mulkens S. Selective visual attention for ugly and beautiful body parts in eating disorders. Behav Res Ther 2005; 43: 183-196
  • 33 Svaldi J, Caffier D, Tuschen-Caffier B. Attention to ugly body parts is increased in women with binge eating disorder. Psychother Psychosom 2011; 80: 186-188
  • 34 Suchan B, Busch M, Schulte D et al. Reduction of gray matter density in the extrastriate body area in women with anorexia nervosa. Behav Brain Res 2010; 206: 63-67
  • 35 Uher R, Murphy T, Friederich H-C et al. Functional neuroanatomy of body shape perception in healthy and eating-disordered women. Biol Psychiatry 2005; 58: 990-997
  • 36 Urgesi C, Fornasari L, De Faccio S et al. Body schema and self-representation in patients with bulimia nervosa. Int J Eat Disord 2011; 44: 238-248
  • 37 Cash TF, Brown TA. Body image in anorexia nervosa and bulimia nervosa: A review of the literature. Behav Modif 1987; 11: 487-521
  • 38 Pumariega AJ, William S, Black SA et al. Clinical correlates of body-size distortion. Percept Mot Skills 1993; 76: 1311-1319
  • 39 Heilbrun AB, Witt N. Distorted body image as a risk factor in anorexia nervosa: Replication and clarification. Psychol Rep 1990; 66: 407-416
  • 40 Williamson DA, Cubic BA, Gleaves DH. Equivalence of body image disturbances in anorexia and bulimia nervosa. J Abnorm Psychol 1993; 102: 177-180
  • 41 Wilson JMB, Tripp DA, Boland FJ. The relative contributions of subjective and objective measures of body shape and size to body image and disordered eating in women. Body Image 2005; 2: 233-247
  • 42 Goldschmidt AB, Hilbert A, Manwaring JL et al. The significance of overvaluation of shape and weight in binge eating disorder. Behav Res Ther 2010; 48: 187-193
  • 43 Tuschen-Caffier B, Vögele C, Bracht S et al. Psychological responses to body shape exposure in patients with bulimia nervosa. Behav Res Ther 2003; 41: 573-586
  • 44 Vocks S, Legenbauer T, Wächter A et al. What happens in the course of body exposure? Emotional, cognitive, and pysiological reactions to mirror confrontation in eating disorders. J Psychosom Res 2007; 62: 231-239
  • 45 Beck AT. Cognitive therapy and emotional disorders. New York: International Universities Press; 1976
  • 46 Davis C, Claridge G, Fox J. Not just a pretty face: Physical attractiveness and perfectionism in the risk for eating disorders. Int J Eat Disord 2000; 27: 67-73
  • 47 Hilbert A, Tuschen-Caffier B. Body-related cognitions in binge-eating disorder and bulimia nervosa. J Soc Clin Psychol 2005; 24: 561-579
  • 48 Cooper M. Bias in interpretation of ambiguous scenarios in eating disorders. Behav Res Ther 1997; 35: 619-626
  • 49 Cserjési R, Vermeulen N, Luminet O et al. Explicit vs. Implicit body image evaluation in restrictive anorexia nervosa. Psychiatry Res 2010; 175: 148-153
  • 50 Beato-Fernández L, Rodríguez-Cano T, García-Vilches I et al. Changes in regional cerebral blood flow after body image exposure in eating disorders. Psychiatry Res 2009; 171: 129-137
  • 51 Svaldi J, Bender C, Tuschen-Caffier B. Explicit memory bias for positively valenced body-related cues in women with binge eating disorder. J Behav Ther Exp Psychiatry 2010; 41: 251-257
  • 52 Gordon KH, Holm-Denoma JM, Troop-Gordon W et al. Rumination and body dissatisfaction interact to predict concurrent binge eating. Body Image 2012; 9: 352-357
  • 53 Rosen JC. Cognitive-behavioral body-image therapy. In: Garner DM, Garfinkel PE. Hrsg Handbook of Treatment for Eating Disorders. 2nd ed. New York: Guilford; 1998: 188-201
  • 54 Legenbauer T, Vocks S, Schütt-Strömel S. Validierung einer deutschsprachigen Version des Body Image Avoidance Questionnaire (BIAQ). Diagnostica 2007; 53: 218-225
  • 55 Shafran R, Fairburn CG, Robinson P et al. Body checking and its avoidance in eating disorders. Int J Eat Disord 2004; 35: 93-101
  • 56 Rosen JC, Srebnik D, Saltzberg E et al. Development of a body image avoidance questionnaire. J Consult Psychol 1991; 3: 32-37
  • 57 Reas DL, Whisenhunt BL, Netemeyer R et al. Development of the body checking questionnaire: A self-report measure of body checking behaviors. Int J Eat Disord 2002; 31: 324-333
  • 58 Williamson DA, White MA, York-Crowe E et al. Cognitive-behavioural theories of eating disorders. Behav Modif 2004; 28: 711-738
  • 59 Blechert J, Nickert T, Caffier D et al. Social comparison and its relation to body dissatisfaction in bulimia nervosa: Evidence from eye movements. Psychosom Med 2009; 71: 907-912
  • 60 Graber JA, Brooks-Gunn J, Paikoff RL et al. Prediction of eating problems: an 8-year study of adolescent girls. Dev Psychol 1994; 30: 823-834
  • 61 Wertheim EH, Koerner J, Paxton SJ. Longitudinal predictors of restrictive eating and bulimic tendencies in three different age groups of adolescent girls. J Youth Adolesc 2001; 30: 69-81
  • 62 Stice E, Agras WS. Predicting onset and cessation of bulimic behaviors during adolescence: A longitudinal grouping analysis. Behav Ther 1998; 29: 257-276
  • 63 Stice E, Presnell K, Spangler D. Risk factors for binge eating in adolescent girls: A 2-year prospective investigation. Health Psychol 2002; 21: 131-138
  • 64 Killen JD, Taylor CB, Hayward C et al. Pursuit of thinness and onset of eating disorder symptoms in a community sample of adolescent girls: A three-year prospective analysis. Int J Eat Disord 1994; 16: 227-238
  • 65 Cooley E, Toray T. Body image and personality predictors of eating disorder symptoms during the college years. Int J Eat Disord 2001; 30: 28-36
  • 66 Killen JD, Taylor CB, Hayward C et al. Weight concerns influence the development of eating disorders: A 4-year prospective study. J Consult Psychol 1996; 64: 936-940
  • 67 Jacobi C, Thiel A, Paul T. Kognitive Verhaltenstherapie bei Anorexia und Bulimia nervosa. Beltz; PVU. 2004
  • 68 Stice E, Marti CN, Durant S. Risk factors for onset of eating disorders: Evidence of multiple risk pathways from an 8-year prospective study. Behav Res Ther 2011; 49: 622-627
  • 69 Stice E. Risk and maintenance factors for eating pathology: A meta-analytic review. Psychol Bull 2002; 128: 825-848
  • 70 Fairburn CG, Peveler RC, Jones R et al. Predictors of 12-month outcome in bulimia nervosa and the influence of attitudes to shape and weight. J Consult Psychol 1993; 61: 696-698
  • 71 Freeman RJ, Beach B, Davis R et al. The prediction of relapse in bulimia nervosa. J Psychiatr Res 1985; 19: 349-353
  • 72 Fairburn CG, Stice E, Cooper Z et al. Understanding persistence in bulimia nervosa: A 5-year naturalistic study. J Consult Clin Psychol 2003; 71: 103-109
  • 73 Steinhausen HC. The outcome of anorexia nervosa in the 20th century. Am J Psychiatry 2002; 159: 1284-1293
  • 74 Nielsen S. Standardized mortality ratio in bulimia nervosa. Arch Gen Psychiatry 2003; 60: 851
  • 75 Herzpertz-Dahlmann B. Essstörungen und Depressionen. In: Braun-Scharm H. Hrsg Depressionen bei Kindern und Jugendlichen. Stuttgart: Wissenschaftliche Verlagsgesellschaft; 2002: 125-141
  • 76 O’Brien KM, Vincent NK. Psychiatric comorbidity in anorexia and bulimia nervosa: nature, prevalence, and causal relationships. Clin Psychol Rev 2003; 23: 57-74
  • 77 Wilson GT, Fairburn CG, Agras WS. Cognitive-behavioral therapy for bulimia nervosa. In: Garner DM, Garfinkel PE. Hrsg: Handbook of Treatment for Eating Disorders. 2nd ed. New York: Guilford Press; 1997: 67-93
  • 78 Jacobi C, Paul T, Thiel A. Essstörungen. Göttingen: Hogrefe. 2004
  • 79 Wilson GT. Cognitive behavioral therapy for eating disorders: Progress and problems. Behav Res Ther 1999; 37: 79-95
  • 80 Cash TF, Hrabosky JI. Treatment of body image disturbances. In Thompson JK. ed. Handbook of Eating Disorders and Obesity. New Jersey: John Wiley & Sons; 2004: 515-541
  • 81 Borgart E-J, Meermann R. Stationäre Verhaltenstherapie. Behandlungskonzepte und Therapiemanuale. Bern: Hans Huber; 2004
  • 82 Salbach-Andrae H, Jacobi C, Jaite C. Anorexia und Bulimia nervosa im Jugendalter. Weinheim: Beltz; 2010
  • 83 Cash TF. The Body Image Workbook: An 8-step Program for Learning how to like your Looks. Oakland, CA: New Harbinger; 1997
  • 84 Vandereycken W, Depreitere L, Probst M. Body-oriented therapy for anorexia nervosa patients. Am J Psychother 1987; 41: 252-259
  • 85 Böse R. Body-Image Therapie bei Anorexia nervosa. Regensburg: Roderer; 2002
  • 86 Tuschen-Caffier B, Florin I. Teufelskreis Bulimie: Ein Manual zur psychologischen Therapie. Göttingen: Hogrefe. 2002
  • 87 Legenbauer T, Vocks S. Manual der kognitiven Verhaltenstherapie bei Anorexie und Bulimie. Heidelberg: Springer; 2006
  • 88 Thompson RF, Spencer WA. Habituation: A model phenomenon for the study of neuronal substrates of behavior. Psychol Rev 1966; 73: 16-43
  • 89 Tuschen-Caffier B. Konfrontation mit dem eigenen Körperbild. In: Wittchen HU, Neudeck P. Hrsg Konfrontationstherapie bei psychischen Störungen. Theorie und Praxis. Göttingen: Hogrefe; 2005: 227-248
  • 90 Goldsmith D, Thompson JK. The effect of mirror confrontation and size estimation feedback on perceptual inaccuracy in normal females who overestimate body size. Int J Eat Disord 1989; 8: 437-444
  • 91 Fernandez F, Vandereycken W. Influence of video confrontation on the self-evaluation of anorexia nervosa patients: A controlled study. Eat Disord 2004; 2: 135-140
  • 92 Key A, George CL, Beattie D et al. Body image treatment within an inpatient program for anorexia nervosa: The role of mirror exposure on the desenzitation process: A 4-year prospective study. Int J Eat Disord 2002; 31: 185-190
  • 93 Norris DL. The effects of miror confrontation on self-estimation of body dimensions in anorexia nervosa, bulimia and two control groups. Psychol Med 1984; 14: 835-842
  • 94 Gardner RM, Gallegos V, Martinez R et al. Mirror feedback and judgments of body size. J Psychosom Res 1989; 33: 603-607
  • 95 Vocks S, Kosfelder J, Ahrberg M et al. Effects of a cognitive-behavioral exposure-based body image therapy for overweight females with Binge Eating Disorder: A randomized controlled trial. Zur Veröffentlichung eingereicht.
  • 96 Vocks S, Legenbauer T, Troje N et al. Körperbildtherapie bei Essstörungen: Beeinflussung der perzeptiven, kognitiv-affektiven und behavioralen Körperbildkomponente. Z Klin Psychol Psychother 2006; 35: 286-295
  • 97 Vocks S, Busch M, Schulte D et al. Cognitive-behavioral body image therapy enhances extrastriate body area activation among patients with Anorexia Nervosa: An fMRI study. Psychiatry Res 2010; 183: 114-118
  • 98 Vocks S, Schulte D, Busch M et al. Changes in neuronal correlates of body image processing by means of cognitive-behavioural body image therapy for eating disorders: A randomized-controlled fMRI study. Psychol Med 2011; 41: 1651-1664
  • 99 Geissner E, Bauer C, Fichter MM. Videogestützte Konfrontation mit dem eigenen körperlichen Erscheinungsbild als Behandlungselement in der Therapie der Anorexia nervosa. Z Klin Psychol Psychiatr Psychother 1997; 26: 218-226
  • 100 Vocks S, Kosfelder J, Wucherer M et al. Does habitual body avoidance and checking behavior influence the decrease of negative emotions during body exposure in eating disorders?. Psychother Res 2008; 18: 412-419
  • 101 Vocks S, Wächter A, Wucherer M et al. Look at yourself: Can body image therapy affect the cognitive and emotional response to seeing oneself in the mirror in eating disorders?. Eur Eat Disorders Rev 2008; 16: 147-154
  • 102 Hilbert A, Tuschen-Caffier B. Body image interventions in cognitive-behavioural therapy of binge eating disorder: a component analysis. Behav Res Ther 2004; 42: 1325-1339
  • 103 Legenbauer T, Schütt-Strömel S, Hiller W et al. Predictors of improved eating behaviour following body image therapy: A pilot study. Eur Eat Disord Rev 2011; 19: 129-137
  • 104 Delinsky SS, Wilson GT. Mirror exposure for the treatment of body image disturbance. Int J Eat Disord 2006; 39: 108-116
  • 105 Waller G, Katzman MA. Female or male therapists for women with eating disorders? A pilot study of experts’ opinions. Int J Eat Disord 1998; 23: 117-123
  • 106 Kopeining M, El-Giamal N, Bailer U et al. Zur Bedeutung des Geschlechts in der Behandlung von Patientinnen mit Essstörungen. Psychologische Medizin 2001; 12: 22-27
  • 107 Margraf J, Schneider S. Panik. Angstanfälle und ihre Behandlung. (2. Aufl.) Berlin: Springer; 1990
  • 108 Luethcke CA, McDaniel L, Becker C. A comparison of mindfulness, nonjudgmental, and cognitive dissonance-based approaches to mirror exposure. Body Image 2011; 8: 251-258
  • 109 Smeets E, Jansen A, Roefs A. Bias for the (un)attractive self: On the role of attention in causing body (dis)satisfaction. Health Psychology 2011; 30: 360-367
  • 110 Rushford N, Ostermeyer A. Body image disturbance and their change with videofeedback in anorexia nervosa. Behav Res Ther 1997; 35: 389-398