Perceptual distortion of body image in adolescent girls: distortion of body image in adolescence

Tactile distance anisotropy on the tongue

A large literature has described illusions of tactile distance perception. Across many body parts, there is an anisotropic bias for tactile distances to be perceived as larger when oriented across body part width than when oriented along body part length. This study investigated whether there is a similar bias on the tongue. A forced-choice judgment task was used in which participants judged which of two tactile distances felt larger either on the tongue or on the hand dorsum, a region for which anisotropy is well established. Anisotropy was measured using the method of constant stimuli. Clear anisotropy was found on both body parts, with distances oriented with body part width overestimated compared to those oriented with body part length. These results provide further evidence that tactile distance anisotropy is widespread across the body.

Nasogastric tube feeding under restraint: practical guidance for children's nurses

The number of children and young people admitted to children's wards with an eating disorder has increased significantly since the start of the coronavirus disease 2019 (COVID-19) pandemic. In the most extreme cases, those with severe malnutrition may need to be fed via a nasogastric tube without their consent. Children's nurses working on hospital wards may therefore care for children and young people who need to receive nasogastric tube feeding under physical restraint. This article offers an overview of eating disorders and their detrimental effects as well as practical advice for children's nurses, supporting them to provide safe, compassionate and person-centred care to their patients.

No evidence for sex differences in tactile distance anisotropy

Perceptual illusions of the distance between two touches have been used to study mental representations of the body since E. H. Weber's classic studies in the nineteenth century. For example, on many body parts tactile distance is anisotropic, with distances aligned with body width being perceived as larger than distances aligned with body length on several skin regions. Recent work has demonstrated sex differences in other distortions of mental body representations, such as proprioceptive hand maps. Given such findings, I analysed the results of 24 experiments, conducted by myself and my colleagues, measuring tactile distance anisotropy on the hand dorsum in both women and men. The results showed clear, and highly consistent anisotropy in both women and men, with no evidence for any sex difference.

Tactile distance anisotropy on the feet

Perception of distance between two touches varies with orientation on the hand, with distances aligned with hand width perceived as larger than those aligned with hand length. Similar anisotropies are found on other body parts (e.g., the face), suggesting they may reflect a general feature of tactile organization, but appear absent on other body parts (e.g., the belly). Here, we investigated tactile-distance anisotropy on the foot, a body part structurally and embryologically similar to the hand, but with very different patterns of functional usage in humans. In three experiments, we compared the perceived distance between pairs of touches aligned with the medio-lateral and proximal-distal foot axes. On the hairy skin of the foot dorsum, anisotropy was consistently found, with distances aligned with the medio-lateral foot axis perceived as larger than those in the proximo-distal axis. In contrast, on the glabrous skin of the sole, inconsistent results were found across experiments, with no overall evidence for anisotropy. This shows a pattern of anisotropy on the foot broadly similar to that on the hand, adding to the list of body parts showing tactile-distance anisotropy, and providing further evidence that such biases are a general aspect of tactile spatial organization across the body. Significance: The perception of tactile distance has been widely used to understand the spatial structure of touch. On the hand, anisotropy of tactile distance perception is well established, with distances oriented across hand width perceived larger than those oriented along hand length. We investigated tactile-distance anisotropy on the feet, a body part structurally, genetically, and developmentally homologous to the hands, but with strikingly different patterns of functional usage. We report highly similar patterns of anisotropy on the hairy skin of the hand dorsum and foot dorsum. This suggests that anisotropy arises from the general organization of touch across the body.

Distorted perceptual face maps

Recent research has shown that proprioception relies on distorted representations of body size and shape. By asking participants to localise multiple landmarks in space, perceptual body maps can be constructed. Such maps of the hand and forearm is highly distorted, with large overestimation of limb width compared to length. Here, we investigated perceptual maps of the face, a body part central to our sense of self and personal identity. Participants localised 19 facial landmarks by pointing on a board covering their face. By comparing the relative location of judgments, we constructed perceptual face maps and compared them to actual face structure. These maps were massively distorted, with large overestimation of face width, but not length. This shows that distortions in perceptual body maps are not unique to the hand, but widespread on the body, including parts like the face at the core of our personal identity.

Perceptual Distortions of 3-D Finger Size

Our body is a volumetric, three-dimensional (3-D) object in the world, and we experience it as such. Existing methods for measuring the perceptual body image, however, have been based on judgments of one-dimensional (1-D) length or two-dimensional images. We developed a new approach to the 3-D perceptual body image of the fingers by asking people to judge whether each finger would fit through rings of varying diameter. This task requires participants to conceptualize their finger as a volumetric object entering the ring. In two experiments, we used an adaptive staircase procedure to estimate the perceived size of each finger. There were systematic distortions of perceived 3-D finger size, with the size of index finger and (to a lesser extent) the middle finger underestimated. These distortions were unaffected by changes in hand posture. Notably, the pattern of distortions is qualitatively different from that found in previous research investigating 1-D finger length, suggesting that 3-D judgments of the body may differ in fundamental ways from 1-D judgments of individual body dimensions.

Sex differences in perceptual hand maps: A meta-analysis

A large body of research has suggested that localisation of the hand in external space relies on distorted representations of the hand. We developed a paradigm for measuring implicit perceptual maps of the hand (Longo & Haggard, 2010, Proc Natl Acad Sci USA, 107, 11727-11732), which show systematic deviation from actual hand shape, including overestimation of hand width and underestimation of finger length. Recently, Coelho and Gonzalez (in press, Psychol Res) reported sex differences in these perceptual hand maps, with women showing greater overestimation of hand width, but less underestimation of finger length than men. In the current study, I conducted a meta-analysis of 19 experiments using this paradigm by myself and my colleagues. The results replicated the sex differences reported by Coelho and Gonzalez. Importantly, however, these sex differences were not apparent when actual hand size was included as a covariate in analyses, suggesting that they may, at least in part, be due to women having smaller hands on average than men.

No evidence of tactile distance anisotropy on the belly

The perceived distance between two touches has been found to be larger for pairs of stimuli oriented across the width of the body than along the length of the body, for several body parts. Nevertheless, the magnitude of such biases varies from place to place, suggesting systematically different distortions of tactile space across the body. Several recent studies have investigated perceived tactile distance on the belly as an implicit measure of body perception in clinical conditions including anorexia nervosa and obesity. In this study, we investigated whether there is an anisotropy of perceived tactile distance on the belly in a sample of adult women. Participants made verbal estimates of the perceived distance between pairs of touches oriented either across body width or along body length on the belly and the dorsum of the left hand. Consistent with previous results, a large anisotropy was apparent on the hand, with across stimuli perceived as larger than along stimuli. In contrast, no such bias was apparent on the belly. These results provide further evidence that anisotropies of perceived tactile distance vary systematically across the body and suggest that there is no anisotropy at all on the belly in healthy women.

Reliability Measures in Distorting Body-Image

This study is the first to make a direct comparison between the distorting mirror and the distorting videocamera with the same group of nonclinical subjects. It also establishes the internal consistency, the test-retest reliability and the convergent validity of both techniques. Analysis indicates, as with other studies, that perceived image is consistently over-estimated and ideal image is consistently underestimated by both techniques. With the distorting mirror, the frontal orientation is repeatable over four days and with the video the profile is the more reliable orientation. A comparison between profile and frontal orientations on any single test occasion (internal consistency) indicates that the results correlate well so either orientation is acceptable for experimental purposes. The extent to which both techniques were measuring the same aspect (convergent validity) was more marked for the ideal image. A researcher using the distorting mirror can be confident that the ideal image is reliable over time using either orientation but that the perceived image requires a frontal orientation. The frontal or profile orientation is acceptable for the ideal image using the distorting video, but the profile orientation is advisable if one wishes a reliable perceived image. The researcher should also be cautious in assuming that both techniques are measuring an identical body-image construct.

A Conceptual Model of Tactile Processing across Body Features of Size, Shape, Side, and Spatial Location

The processing of touch depends of multiple factors, such as the properties of the skin and type of receptors stimulated, as well as features related to the actual configuration and shape of the body itself. A large body of research has focused on the effect that the nature of the stimuli has on tactile processing. Less research, however, has focused on features beyond the nature of the touch. In this review, we focus on some features related to the body that have been investigated for less time and in a more fragmented way. These include the symmetrical quality of the two sides of the body, the postural configuration of the body, as well as the size and shape of different body parts. We will describe what we consider three key aspects: (1) how and at which stages tactile information is integrated between different parts and sides of the body; (2) how tactile signals are integrated with online and stored postural configurations of the body, regarded as priors; (3) and how tactile signals are integrated with representations of body size and shape. Here, we describe how these different body dimensions affect integration of tactile information as well as guide motor behavior by integrating them in a single model of tactile processing. We review a wide range of neuropsychological, neuroimaging, and neurophysiological data and suggest a revised model of tactile integration on the basis of the one proposed previously by Longo et al.

Eating and body image: Does food insecurity make us feel thinner?

Body image distortions are common in healthy individuals and a central aspect of serious clinical conditions, such as eating disorders. This commentary explores the potential implications of body image and its distortions for the insurance hypothesis. In particular, we speculate that body image may be an intervening variable mediating the relationship between perceived food scarcity and eating behavior.

Assessment of adolescent body perception: development and characterization of a novel tool for morphing images of adolescent bodies

We developed a computer-based method of distorting adolescent body images, which incorporates the covariation between body parts found during growth and sexual maturation. An adolescent body-shape database (AdoBSD) and adolescent body morphing tool (AdoBMT) are described; the AdoBSD comprises real (n=320) and morphed (n approximately 41,000) images (front and side view) of 160 adolescents (9-17 years). We used a point distribution model, based upon principal components analysis, to characterize the covariation between predefined body tag-points manually positioned on the body images and to morph the body images in a realistic manner. Eight principal components (PCs) were found to characterize 96.3% of the covariation between body tag-point. Application of the PCs to the body images resulted in the manipulation of body parts including shoulder width, waist, hip, belly, thigh and calf sizes. The AdoBMT and AdoBSD may be used to investigate changes in body perception during adolescence, and the role of body perception in adolescent obesity and eating disorders. The AdoBSD is available to the research community (www.brainbody.nottingham.ac.uk).

Body image and self-esteem in adolescent ballet dancers

Body-image disturbances and low self-esteem have been implicated in the pathogenesis of eating disorders. This study investigated self-perception of body and personality among adolescent ballet dancers in a cross-sectional survey. Two questionnaires assessing "my body right now" and "my personality right now," using semantic differentials were completed by 90 ballet school students and 156 controls. Adolescent female dancers (ages 13 to 17 years) scored higher than age-matched controls and 11- to 12-yr. old peers on Undesirability and Sensitivity for personality and Unattractiveness for body. For both subscales of personality, differences were also found between male and female dancers; female ballet students scored higher. Within the control group a difference could be found only for Sensitivity on which girls scored higher than boys. Male dancers did not differ from controls except for a lower score on the Body mass measure. Adolescent female dancers showed a distinct answering profile for 7 of 16 semantic differentials in each questionnaire implicating less favorable body image and self-esteem. Interventions focused particularly on enhancing self-esteem may be useful in the prevention of psychopathology in adolescent ballet dancers.

Influência da percepção do peso e do índice de massa corporal nos comportamentos alimentares anormais

OBJETIVO: Estudar a associação entre a percepção do peso corporal, o índice de massa corporal e os comportamentos alimentares anormais. MÉTODOS: Delineamento transversal, de base populacional, com mulheres de 12 a 29 anos, da zona urbana de Porto Alegre, RS (n=513). Para medir a prevalência de comportamentos alimentares anormais utilizou-se o Teste de Atitudes Alimentares 26 (EAT-26) e o Teste de Investigação Bulímica de Edimburgo (BITE), considerados separadamente e em conjunto, e a percepção do peso corporal por meio de 2 perguntas estruturadas: qual era o peso que a mulher julgava ideal e a auto-avaliação sobre seu peso. O índice de massa corporal (IMC) foi calculado por medida de peso e altura aferidos. RESULTADOS: Considerando os instrumentos conjuntamente, 30,2% das mulheres tinham comportamento alimentar de risco, e 11,3% apresentaram comportamento alimentar anormal. Além disso, 82% das mulheres apresentaram IMC normal, sendo que 2% eram magras, e 16% apresentaram IMC de sobrepeso/obesidade. Das mulheres estudadas, 46% tinham o ideal de pesar menos, e 37,8% consideravam-se gordas. Entre as mulheres com IMC normal, 25,2% das que se achavam normais apresentavam comportamento alimentar de risco, e 5,7 % comportamento alimentar anormal. Das mulheres que se consideravam gordas, 47,2% apresentaram comportamento alimentar de risco, e 19,2% tinham comportamento alimentar anormal. Mulheres que se sentiam gordas apresentaram um risco quatro vezes maior de apresentar comportamentos alimentares anormais (razão de odds 4,50; IC 95% 2,88-7,01; p<0,001). CONCLUSÃO: A percepção do peso corporal - sentir-se gorda - mostrou um papel mais importante na determinação dos comportamentos alimentares anormais do que o índice de massa corporal (IMC sobrepeso/obesidade).

Dieting, binge eating, and some of their correlates among secondary school girls

A total of 440 girls from three private schools in Sydney completed a self-report questionnaire that asked about their body- and weight-related attitudes and practices, and assessed their reactions to the phenomenology of binge eating. The findings emphasize the integral relationship between dieting and disordered eating. Those who wanted to lose at least 7 kg, and were dieting most of the time, were more likely to be categorized as having a "severe" binge eating problem than were those who were happy with their weight and were "never" or "rarely" dieting.

Body-image perception in pre- and postadolescent females

The purpose of this study was to examine both perceived and ideal body-image to establish if the process of adolescence was a contributory factor. A distorting mirror and silhouette pictures were used to examine the image in two groups of 59 pre- and 41 postadolescent girls. The girls' perception of themselves was reasonably accurate yet both groups had a significantly slimmer mean ideal image, irrespective of adolescent status. The differences between the two groups were nonsignificant whether using the distorting mirror or the pictures. The only difference to be observed was when using a body-satisfaction scale. The postadolescents were significantly less satisfied about their nonhead body parts. Scores from the mirror and the pictures question the assumption that body-image dissatisfaction is a postadolescent phenomenon. This should be a cause for concern as eating disorders, which appear to be linked to body-image, are being observed in younger children. The comparability between scores for the pictures and the distorting mirror opens the possibility of home-based therapy in the treatment of perceptual and eating disorders.

Clinical correlates of body-size distortion

Body-size distortion has been considered a central symptom of eating disorders. We studied 35 female eating-disordered patients and 85 controls using a computer-based body-size estimation technique. We have found almost identical linear relationships between body-size distortion and weight:height ratios in both groups. In the clinical group, distortion scores were not correlated with scores on the Eating Attitudes Test or Beck Depression Inventory but were negatively correlated with body dissatisfaction as measured on the Eating Disorder Inventory. These results raise further questions about the role of body-size distortion both as a diagnostic criterion and as a complicating phenomenon in eating disorders.

Abnormal perception of body weight is not solely observed in pubertal girls: incorrect body image in children and its relationship to body weight

Perceived actual body weight and perceived ideal weight were assessed in 255 Japanese children and adolescents (130 boys, 125 girls) aged 6 years through 18 years using the drawing test to clarify whether they wanted to be thinner or to gain weight. More than half (68%) of the girls attending high school and 41% of the elementary school girls perceived their ideal weight to be less than the standard. The mean difference between the perceived actual weight and the ideal weight was positive in the high school girls of normal weight as well as in the overweight girls, meaning that even the normal-weight girls wanted to lose weight. The difference was also slightly positive in the underweight girls. The difference in the high school boys was negative, demonstrating that they wished to gain weight. It is suggested that girls want to lose weight even before adolescence; this tendency becomes more prominent in the high school period and is mostly unrelated to their own weight.

Body-image dissatisfaction among American male and female college students: a computer-based graphical approach

College students (56 women and 43 men) attending state colleges in the southwestern United States were tested for body-image dissatisfaction using a computer-based graphical body-image task. A reliable relationship between desired stature and desired body-image was observed for the women. Women of large stature showed a greater discrepancy between verbally reported desired stature and redrawn images of desired stature than women of average or smaller than average stature. No reliable discrepancy between desired body-image and verbally reported desired stature was shown by the men.

Body-image distortion among male and female college and high school students, and eating-disordered patients

For 179 male and female college and high school students, and 26 female eating-disordered patients body-image distortion was measured using a computer-based image-analysis of redrawn images of standardized human figures. Statistical analysis indicated that body-image distortion was the same for all groups. Body-image distortion was significantly and negatively related to weight:height ratio as a function of a simple polynomial. These results suggest this evaluation of distortion of body-image yields a quantitative measure reliably related to weight status but also suggests the technique, and possibly measurement of body-image distortion in general, may not be a valid discriminator between eating-disordered and normal persons.

Body cathexis and clothed body cathexis: is there a difference?

To investigate the difference between perceptions of the nude body and of the clothed body 29 women were administered the Body Cathexis Scale and a Clothed Body Cathexis Scale. Paired t tests indicated that these working women were significantly more satisfied with their clothed bodies than with their nude bodies.

Reliability measures in distorting body-image

This study is the first to make a direct comparison between the distorting mirror and the distorting videocamera with the same group of nonclinical subjects. It also establishes the internal consistency, the test-retest reliability and the convergent validity of both techniques. Analysis indicates, as with other studies, that perceived image is consistently over-estimated and ideal image is consistently under-estimated by both techniques. With the distorting mirror, the frontal orientation is repeatable over four days and with the video the profile is the more reliable orientation. A comparison between profile and frontal orientations on any single test occasion (internal consistency) indicates that the results correlate well so either orientation is acceptable for experimental purposes. The extent to which both techniques were measuring the same aspect (convergent validity) was more marked for the ideal image. A researcher using the distorting mirror can be confident that the ideal image is reliable over time using either orientation but that the perceived image requires a frontal orientation. The frontal or profile orientation is acceptable for the ideal image using the distorting video, but the profile orientation is advisable if one wishes a reliable perceived image. The researcher should also be cautious in assuming that both techniques are measuring an identical body-image construct.

Body image disturbance in anorexia nervosa: beyond body image

In this paper the literature on body image disturbance in anorexic patients is reviewed. After a decade of experimental investigation of body image in anorexia nervosa, where old and new techniques have been used and where a large number of correlations have been identified, what do we really know? The findings have been conflicting but some regularities exist. It is hypothesized that the conflicting results may be related to the presence of different subgroups among anorexics and different types of body image disturbance. Body size estimation is only one dimension of body image perception. Likewise, body size overestimation is only one aspect of body image perception. Likewise, body size overestimation is only one aspect of body image disturbance. Some, but not all anorexics, overestimate their body size, and those who do, seem to have poor prognosis. Body size overestimation is not confined to anorexics. It is not known whether it is a function of a general perceptual/cognitive disorder, but it does seem to be stable over time. The implications of the presence of other psychiatric conditions in anorexic patients are discussed and suggestions for future research and for practice are made.

Distorting patient or distorting instrument? Body shape disturbance in patients with anorexia nervosa and bulimia

Three current techniques for estimating body size (Image Marking, Visual Size Estimation, and Distorting Video techniques) were compared. Anorexia nervosa and bulimic patients and normal control subjects were required to make size judgments of the way they 'knew' they looked, the way they 'felt' they looked, and of the width of an inanimate control object. Results from the three techniques were not the same, thus implying that research findings can no longer be cross-compared. Moreover, while all subjects were similar in the accuracy of their estimation of a control object, anorexia nervosa and bulimic patients overestimated their own body size significantly more than normal controls. This difference was even more marked when affective instructions were compared.

Eating disorders in a general practice population. Prevalence, characteristics and follow-up at 12 to 18 months

Attenders to four South London group general practices were screened using the Eating Attitudes Test (EAT), after which all high scorers and a random selection of low scorers were approached for interview. General practitioners (GPs) were given details on a random half of high-scoring patients with the aim of assessing intervention for revealed and hidden psychopathology. Twelve to 18 months later all high scorers on the EAT were followed up by post to measure change in behaviour and attitudes. Practice records were examined to determine the doctor's knowledge of the patient and any intervention that had occurred. It was found that 1.1% of women had bulimia nervosa and 2.8% a partial-syndrome eating disorder. No cases of anorexia nervosa were found. Cases of bulimia nervosa and partial syndromes were similar in being: mainly female, of higher social class, in the normal weight range but with considerable weight fluctuation in the past, more likely to have had a history of menstrual irregularity, and frequently psychologically troubled with more past psychiatric contact. Over the follow-up period there was some change along a spectrum of normal dieting to the full syndrome, although only one subject with bulimia nervosa recovered significantly. Although the GPs were unaware of the eating pathology and their intervention was minimal, most had documented their patients' psychological distress.

Body image in anorexia nervosa and bulimia nervosa. A review of the literature

Disturbances in body image are often regarded as a cardinal feature of anorexia nervosa and bulimia nervosa. The various approaches to assessing body-image disturbances in anorexics and bulimics are detailed, including body-part size estimation techniques, distorting image methods, silhouettes, and attitudinal measures. The marked inconsistency of findings across studies comparing anorexics or bulimics with some "control" group on body-image variables is discussed in terms of variations in measurement techniques, subject characteristics, and experimental setting. The reliability and validity of existing measures are discussed. Finally, conclusions and recommendations for future research are provided, in addition to a brief presentation of therapeutic approaches to treating body-image disturbances.

Restraint, body image and food attitudes in children from 12 to 18 years

Body image, dietary restraint, attitudes to food and food intake pattern were assessed in a survey of 348 London schoolchildren from three age groups. The data revealed striking sex differences in body image, restraint and food attitudes, even in the youngest age group (12 to 13 years). The majority of girls felt too fat, attempted to restrict their food intake, and expressed guilt about eating. The boys expressed much less concern in all these areas. No differences were found across the age groups. The results suggested that normal English girls experience significant levels of distress over eating and weight.

The dieting and body shape concerns of adolescent females

This study set out to examine dietary and body shape concerns of four age groups (12-18 yr) of British female adolescents in order to compare current findings with previous results. Although less than 4% were overweight as measured by standard tables, over 10 times this number considered themselves overweight. Approximately half desired to alter their weight and considered various ways of doing so. The subjects' shape related directly to the subjects' desire to alter body shape, particularly in the oldest group. These results are discussed in terms on the literature on the development of an idea of ideal body shape, increasing interest in exercise and previous research in the area.

Body build and the desire for slenderness in young people

The median weight-for-height of young people in Brisbane are below the 'standard' values. In most groups the weight-for-height are symmetrically distributed, suggesting that this is the range of normal variation. Only among girls aged 15-19 years was there an excess of 'obese' subjects. Almost all girls and young women say they want to lose weight, even though many are already well below the 'standard'. This trend is also present, but is less marked, among boys and young men. In these young people the desire for slenderness is causing unhappiness that seems out of proportion to the possible benefits of change. Health professionals should encourage a more balanced attitude to physiological variations in weight-for-height among young people.

Body Image: Anorexia Nervosa Patients and Occupational Therapy Students

The subject of body image is discussed with reference to reported studies on anorexia nervosa patients and ‘normal’ subjects. These results are compared with those of 25 occupational therapy students. Reference is made to the use of occupational therapy activities which explore the area of self-perception.

The effects of mirror confrontation on self-estimation of body dimensions in anorexia nervosa, bulimia and two control groups

Using an apparatus which provides a continuous horizontal slit of light of variable length, self-estimations of 4 body widths were carried out before and after a mirror confrontation procedure on 4 groups of young female subjects--anorexic, bulimic, emotionally disturbed and normal. The results confirm that anorexic subjects overestimate body size, although in this study the hip diameter was frequently underestimated. Bulimic and emotionally disturbed subjects overestimate to much the same degree as anorexics, whereas normal subjects are remarkably accurate with the exception of the head width. Mirror confrontation resulted in reduced estimations in the majority of subjects, but significant differences were found in the degree to which this occurred in the 4 groups; anorexic subjects showed the greatest change and normal subjects the least. This relative instability of the anorexic subject's body image cannot be explained simply on the basis of a self-correcting experience, as many estimations which were initially below actual width were even lower on re-testing. In the anorexic and bulimic groups a significant correlation was found between the degree of overestimation after mirror confrontation and progress in treatment, as measured on a specially devised rating scale. Possible explanations for these findings and their diagnostic and prognostic implications are discussed.

A modified video camera for measuring body image distortion: technical description and reliability

Previously employed techniques for the measurement of body image are briefly described, with a short consideration of methodological or procedural limitations associated with each technique. A new procedure is described which employs a simple modification to a standard video camera to produce an image which appears from 20% thinner to 40% fatter than the actual person, without other distortion of the image. Reliability and preliminary validity data for the new procedure are presented.

Body image in anorexia nervosa

Despite much recent interest in the objective measurement of body image in anorexia nervosa, many questions remain regarding basic mechanisms responsible for the findings as well as their meaning in the disorder. It is unclear if "whole body" measures assess the same underlying phenomena as the "body part" method, and it is unclear if body image disturbances are etiologic or a byproduct of anorexia nervosa. The possible association between self-esteem and body satisfaction and the relationship of the latter variable to actual size estimation supports the hypothesis that size perception may be closely tied to satisfaction with non-physical aspects of self. Finally it must be determined if overestimation is a function of a general psychological disturbance or of a deficit of specific interest in this disorder. Despite these questions, the way in which anorexic patients see themselves as well as the cognitive and affective responses to this perception remains an interesting and potentially fruitful area of study with this disorder.

Some recent observations on the pathogenesis of anorexia nervosa

Studies of diagnostic subtypes within the anorexia nervosa syndrome has given rise to the differentiation of a bulimic subgroup as distinct from the restrictive type of anorexia nervosa. The bulimic subtype is characterized by the use of vomiting and laxatives to induce weight loss; a display of impulse-related behaviours; extraversion and sexual activity in contrast to the isolation of the restrictive group; and a family history of obesity in the mother, all suggesting a subcategory within the primary anorexia nervosa syndrome. Investigation of behaviours and attitudes related to anorexia nervosa in a group of dancers disclosed a significantly elevated attitude toward food and body image characteristic of anorexia nervosa in this group and ten times the expected prevalence of the disorder itself. This is suggestive of the relative importance of cultural pressures towards thinness and anorexia nervosa in certain populations as one factor amongst others in the multi-determined origin of this condition. This cultural pressure is consistent with a disturbance of body image perception in anorexia nervosa. This disturbance seems to be stable in the same individual over a period of one year, is related to a poor prognosis and is correlated with measures of psychopathology including helplessness, depression and anhedonia. It is also correlated with a satiety defect as reflected in a failure to develop an aversion to sucrose when directly tested.

Anorexia nervosa and 'Turner syndrome': cause or coincidence?

We report the eleventh documented case of the concurrence of anorexia nervosa and 'Turner syndrome'. Although some authors have suggested that the 2 syndromes occur together more often than by chance, and 5% of anorexia nervosa patients karyotyped to data have 'Turner syndrome', recent evidence in fact suggests that the 2 conditions do not occur together more often than one would expect by chance.

Body image in obese adults

Data were gathered on 38 obese women and 16 obese men attending a weight-reduction programme and on an equal number of normal weight controls, regarding accuracy of perception of body width in 4 regions, as well as attitudes towards body size. Obese subjects, particularly women, tended to overestimate body width and to dislike their bodies, but neither of these factors predicted success in losing weight. Age of onset of obesity was not related to degree of adult obesity or to accuracy of estimation of body width.

Body image in anorexia nervosa: measurement, theory and clinical implications

Clinical manifestations of body image disturbance in anorexia nervosa are described including size misperceptions and faulty beliefs about shape. The empirical investigations of body image aberrations in anorexia nervosa are critically reviewed. Methodological issues such as reliability, validity subject selection and sources of experimental bias are discussed with recommendations for further research. Theoretical explanations for the mechanisms determining self-overestimation are presented with data indicating a relationship between self-overestimation, body satisfaction and self-esteem. Finally, a therapeutic approach is suggested that is aimed specifically at modifying the patient's faculty beliefs about her body while coping with her refractory self-misperceptions.

[The anorexia nervosa inventory for self-rating (ANIS) (author's transl)]

The Anorexia Nervosa Inventory for Self-Rating (ANIS) was developed as a reliable and valid instrument for diagnostic purposes and for longitudinal assessments in the course of therapy of anorexic patients. Appropriate items, which were selected from a larger pool of items by expert ratings, were subjected to factor analyses. The analyses were based on self-ratings of a sample of 101 patients suffering from anorexia nervosa and a sample of 118 high school students comparable in sex and age. The factor analytic studies based on maximum likelihood procedures resulted in a 31-item self-rating scale consisting of six interpretable factors. The rotated factor structure was stable for the different patient and student samples. The factors identified were labeled: (1) figure consciousness; (2) feeling of insufficiency; (3) anancasm; (4) adverse effect of meals; (5) sexual anxieties and (6) bulimia. The first two factors are discussed in the context of concepts formulated by Bruch (1973) concerning 'disturbances in body image' and an 'all-pervasive feeling of ineffectiveness' in anorexic patients. The usefulness of the ANIS scale to discriminate between healthy and anorexic subjects and for self-assessment of patients during the process of therapy is demonstrated.

Body image disturbance in anorexia nervosa during the acute and recuperative phase

Perception of body size, subjective experience of body image distortions and differentiation of body concept in the human figure drawing were assessed in adolescent anorexia nervosa patients and controls shortly after hospital admission, and again 6 months later during the recuperative phase. Size estimation was not found to be a distinguishing variable, as both groups exhibited overestimation tendencies of comparable magnitude at both time periods. By contrast, experiences denoting estrangement from the body, insensitivity to body sensations, and weakness of body boundaries were more prevalent in anorexics, and persisted at high levels after frank symptoms of weight and eating disorder had subsided. Anorexics were also shown to depict the human figure with less differentiation relative to controls. Within the anorexic sample the presence of vomiting was linked to greater subjective experience of body image distortion, and such phenomena appear to be a more enduring feature in this subgroup. Overall, the results were viewed as lending support to the argument that defects in body image formation render the anorexic vulnerable to their manifest pathology, which is itself activated by maturational conflicts unique to adolescence.

The stability of perceptual disturbances in anorexia nervosa

Patients with anorexia nervosa have previously been shown to display disturbances in visual self-perception and interoception. In the present investigation we wished to determine the stability of these disturbances and the effects of weight gain on them. We studied 29 females, 16 patients with primary anorexia nervosa and 13 controls, who had also been studied one year previously. Each subject took part in investigations of body image, using a distorting photograph technique, and interoception, using a satiety aversion to sucrose test. We found that some anorexic subjects tend to overestimate body size and have an absence of aversion to repeated sucrose tastes. Moreover, these disturbances were stable over the year and were not affected by weight change.

Unique features associated with age of onset of anorexia nervosa

The relationship between age of onset of anorexia nervosa and a variety of personal characteristics was examined in 105 patients. Age of onset of anorexia nervosa had a bimodal distribution, with peaks at 14 1/2 and 18 years. The patients whose onset of illness occurred at the later age tended to have a greater weight loss during their illness, more "underweight problems" before the onset of illness, less of the typical anorectic behaviors and attitudes, greater body disparagement, more symptoms of depression, and a greater number of previous hospitalizations. These associations suggest that an older age of onset of anorexia nervosa might predict a poor outcome.