Body image disturbance
The onset is mainly attributed to patients with anorexia nervosa who persistently tend to subjectively discern themselves as average or overweight despite adequate, clinical grounds for a classification of being considerably or severely underweight.
[2] The disturbance is associated with significant bodily dissatisfaction and is a source of severe distress, often persisting even after seeking treatment for an eating disorder,[3][4] and is regarded as difficult to treat.
[6] However, there is no hard evidence that current treatments for body image disturbance effectively reduce eating disorder symptoms.
[9] However, to date, research and clinicians are developing new therapies such as virtual reality experiences,[10][11] mirror exposure,[12] or multisensory integration body techniques,[13][14][5] which have shown some extent of efficacy.
German physiologist Hermann Munk was the first to suggest the existence of a cortical representation of the body, supported by his vivisection experiments on the parietal cortex of dogs.
[15] A few years later, Carl Wernicke hypothesized a cortical map capable of collecting and processing sensory inputs from every point of the body.
The German-American psychiatrist Hilde Bruch was the first physician to describe body image disturbance in eating disorders accurately.
[21] In her article "Perceptual and Conceptual Disturbances in Anorexia Nervosa" [6] she wrote: What is pathognomic of anorexia is not the severity of the malnutrition per se—equally severe degrees are seen in other malnourished psychiatric patients—but rather the distortion of body image associated with it: the absence of concern about emaciation, even when advanced, and the vigor and stubbornness with which the often gruesome appearance is defended as normal and right, not too thin, and as the only possible security against the dreaded fate of becoming fat.
A slightly altered perception of the body is a normal part of everyone's life and manifests itself more intensely in more vulnerable individuals (e.g., patients with eating disorders).
[6] However, despite increasing evidence, a review by Glashouwer in 2019 stated that the available empirical data are still insufficient and "provide no basis to answer the question whether body image disturbance is a (causal) risk factor for anorexia nervosa".
[41] On the other hand, few studies have investigated the altered body perception in patients with binge eating disorder[42] and the results are conflicting.
There are numerous challenges with diagnosis, the most relevant of which is the unclear definition of body image disturbance within official diagnostic manuals such as the DSM and the ICD,[44][45] which prevents its identification in the population.
Therefore, the presence of a body image disturbance in other psychiatric diseases remains speculation, not yet supported by sufficient literature data, as suggested by Scheffers.
[46] Different labels are used in research and clinical settings to describe body image disturbance, generating terminological confusion.
[5] In 2021, Artoni et al proposed a clearer definition of body image disturbance as part of a study in Eating and Weight Disorders.
[67] The behavioral component of body image disturbance includes different body-checking behaviors[68] such as repeatedly weighing during the day, spending significant time in front of the mirror or avoiding it, frequently taking selfies, checking parts of the body with hands (e.g. measuring the circumference of the wrists, arms, thighs, belly or hips).
[78] A 2017 study published in a companion journal to Nature[4] highlighted how perceptual disturbance is present in those recovered from anorexia nervosa even without affective-cognitive body concerns.
[25] For example, Grant et al reported that 39% of AN patients in their sample had a comorbid diagnosis of body dysmorphic disorder, with concerns unrelated to weight.
[97] While a 2019 review by Phillipou et al in Psychiatry Research suggested that the two disorders could be taken together as "body image disturbances", plural, more in-depth studies are needed to confirm this new classification hypothesis.
The perception of one's body is a multi-sensory process that integrates information deriving from different sensory cortices, including the visual, proprioceptive, tactile, interoceptive, and auditory-vestibular areas.
[117] The insular cortex is fundamental in the direct perception and integration of bodily signals from different cortical areas[79] and, despite being an area historically delegated to the sole function of perceiving the state of internal organs as proposed by Sherrington in 1911,[118] research advances demonstrate the central role of the insula in several domains, including the recognition that one's body belongs to us.
[119][120] fMRI studies examining brain responses in anorexia nervosa patients to paradigms that include body image tasks have found altered activation across different brain areas, including the prefrontal cortex, precuneus, parietal cortex, insula, amygdala, ventral striatum, extrastriate body area, and fusiform gyrus.
The program provides a forum for high school girls and college-age women to confront unrealistic-looking ideals and develop a healthy body image and self-esteem.
[125] In 2020 a review has shown that CBT-E effectively reduces core symptoms in eating disorders, including concerns about the body.
Compared to the classic cognitive-behavioral therapeutic paradigms, since the early 2000s, new treatments for body image disturbance have been developed focusing on the disorder's perceptual component.
In the International Journal of Eating Disorders, Key et al (2002) conducted a non-randomized trial in a clinical sample and compared a body image group therapy with or without mirror exposure.
Some studies have found that applying this technique to those with anorexia nervosa reduces their misperception of their bodies[56][133] but provides, at the moment, only a short-term effect.
Hoop Training is meant to work on the components cognitive, affective, and perceptive of body image disturbance and the first efficacy data were published in 2019.
BPT is a specific group intervention for body image disturbance focused on tactile, proprioceptive, and interoceptive self-perceptions during a body-focused experience.
[70] Both Hoop Training and Body Perception Treatment showed effective results in pilot studies[13][5] and were designed to work within a multisensory integration framework.
