Functionality appreciation is associated with improvements in positive and negative body image in patients with an eating disorder and following recovery.

BACKGROUND: Research on body image in eating disorders has predominantly focused on negative body image, only recently shifting to positive body image. Findings suggest that enhancing positive body image can, amongst other things, serve as a protective mechanism against (re)developing a negative body image. One suggested way of enhancing positive body image is to focus on enhancing body functionality appreciation. Although studies show promising effects, this research is mainly conducted in non-clinical samples. METHODS: The current study investigated the levels of positive and negative body image in an online community sample of patients with an eating disorder (PAT, n = 227), patients recovered from an eating disorder (REC, n = 102) and controls (HC, n = 175) (self-reported diagnosis, not confirmed). In addition, we tested whether body functionality appreciation was associated with appearance dissatisfaction (negative body image) and body appreciation (positive body image). RESULTS: REC showed similar results to controls to most of the body image measures except for how much importance one places on their appearance (no different between REC and PAT), and how satisfied one is with certain body parts. For this measure, REC scored in-between PAT and HC. We further found functionality appreciation to be significantly associated with of both positive and negative body image, except for appearance evaluation in patients with an eating disorder. CONCLUSIONS: This study showed a positive association between body functionality appreciation and positive body image and a negative association between body functionality appreciation and negative body image. Further research is required to investigate the effectiveness of interventions targeting body functionality appreciation in clinical settings.

People with an eating disorder often suffer from a negative body image. This negative body image has been found to be hard to treat. Recently researchers started to not only look at ways to decrease negative body image but also enhance positive body image. It has been found that it is beneficial for people with a negative body image to learn to focus on appreciating the functions of the body (body functionality appreciation), as this leads to a more positive body image. However, this research was done on people without an eating disorder. In this questionnaire study, we looked at whether there is a relationship between body functionality appreciation and body image in patients with a (self-reported) eating disorder diagnosis and those who are recovered from an eating disorder. We found that functionality appreciation is associated with increased positive body image and decreased negative body image in all groups. Further studies should investigate the effectiveness of clinical interventions that focus on body functionality appreciation to enhance body image.

Sense of agency during and following recovery from anorexia nervosa.

The need to feel in control is central to anorexia nervosa (AN). The sense of control in AN has only been studied through self-report. This study investigated whether implicit sense of control (sense of agency; SoA) differs across AN patients, recovered AN (RAN) patients and healthy controls (HC). Furthermore, we assessed whether state anxiety is influenced by negative emotional states. SoA was measured with the intentional binding task (IB) and state-anxiety levels through a questionnaire. We did not find any evidence of differences in SoA between groups. Furthermore, state anxiety was not a significant predictor of SoA. Further research into SoA in AN should focus on other features of the SoA that are not targeted by the IB task.

Waiting longer, feeling fatter: Effects of response delay on tactile distance estimation and confidence in females with anorexia nervosa.

BACKGROUND: Research suggests that patients with anorexia nervosa (AN) exhibit differences in the perceptual processing of their own bodies. However, some researchers suggest that these differences are better explained with reference to non-perceptual factors, such as demand characteristics or emotional responses to the task. In this study, we investigated whether overestimation of tactile distances in participants with AN results from differences in tactile processing or non-perceptual factors, by measuring the role of allowed response time in an adapted version of the tactile distance estimation task (TDE-D). We further investigated the relationship between allowed response time and participants' confidence in their tactile judgments. METHOD: Our sample consisted of females: participants with AN (n = 30), recovered (REC) participants (n = 29) and healthy controls (HC) (n = 31). Participants were asked to estimate tactile distances presented on the skin of either a salient (abdomen) or non-salient (arm) body part, either directly after stimulus presentation (direct condition) or after a 5 s delay (delayed condition). Confidence of estimation accuracy was measured after each response. RESULTS: Results showed that allowing AN and REC more time to respond caused them to estimate tactile distances as larger. Additionally, participants with AN became less confident when given more time to respond. CONCLUSIONS: These results suggest that non-perceptual influences cause participants with AN to increase their estimates of tactile distances and become less certain of these estimates. We speculate that previous findings-where participants with AN estimate tactile distances as larger than HC-may be due to non-perceptual differences.

Sizing up the crowd: Assessing spatial integration difficulties in body size judgements across eating disorder symptomatology.

Introduction: Body size judgements are frequently biased, or inaccurate, and these errors are further exaggerated for individuals with eating disorders. Within the eating disorder literature, it has been suggested that exaggerated errors in body size judgements are due to difficulties with integration. Across two experiments, we developed a novel integration task, named the Ebbinghaus Illusion for Bodies in Virtual Reality (VR), to assess whether nearby bodies influence the perceived size of a single body. VR was used to simulate the appearance of a small crowd around a central target body. Method and Results: In Experiment 1 (N = 412), participants were required to judge the size of a central female target within a crowd. Experiment 1 revealed an Ebbinghaus Illusion, in which a central female appeared larger when surrounded by small distractors, but comparatively smaller when surrounded by large distractors. In other words, the findings of Experiment 1 demonstrate that surrounding crowd information is integrated when judging an individual's body size; a novel measure of spatial integration (i.e., an Ebbinghaus Illusion for Bodies in VR). In Experiment 2 (N = 96), female participants were selected based on high (n = 43) and low (n = 53) eating disorder symptomatology. We examined whether the magnitude of this illusion would differ amongst those with elevated versus low eating disorder symptomatology, in accordance with weak central coherence theory, with the high symptomatology group displaying less spatial integration relative to the low group. The results of Experiment 2 similarly found an Ebbinghaus Illusion for Bodies in VR. However, illusion magnitude did not vary across high and low symptomatology groups. Discussion: Overall, these findings demonstrate that surrounding crowd information is integrated when judging individual body size; however, those with elevated eating disorder symptomatology did not show any integration deficit on this broader measure of spatial integration.

Lower limb peripersonal space and the desire to amputate a leg.

Body integrity identity disorder (BIID) is a rare condition defined by a persistent desire to amputate or paralyze a healthy limb (usually one or both of the legs). This desire arises from experiencing a mismatch between the internal body model and the actual physical/functional boundaries of the body. People with BIID show an abnormal physiological response to stimuli approaching the affected (unwanted) but not the unaffected leg, which might suggest a retracted peripersonal space (PPS: a multisensory integration zone near the body) around the unwanted limb. Thus, using a visuo-tactile interaction task, we examined leg PPS in a group of healthy men and three men with BIID who desired unilateral leg amputation. PPS size (~ 70 cm) around the unwanted BIID legs did not differ from that of healthy controls. Although the leg feels foreign in BIID, it still seems to maintain a PPS, presumably to protect it and facilitate interactions within the surrounding environment.

Anorexia nervosa and the size-weight illusion: No evidence of impaired visual-haptic object integration.

Body image disorders in anorexia nervosa (AN) patients and recovered AN (RAN) patients have been suggested to stem from aberrant integration of sensory information. Previous research by Case et al. (2012) used the size-weight illusion (SWI) to study multisensory integration in AN. Their results showed a diminished SWI in AN patients, which they interpreted as evidence of decreased integration of visual and proprioceptive information. However, their method did not distinguish between visual and haptic size information, which was presented concurrently while making weight judgements. Therefore, the reported effect might be attributed to integrating visual, haptic size cues, or a combination of both processes with proprioceptive input. Here, we use the SWI to investigate the integration of visual and haptic object-related sensory information in a sample of AN patients (n = 30), RAN patients (n = 29) and healthy controls (HC) (n = 29). We aimed to distinguish the contribution of visual and haptic object size by including separate visual and haptic SWI conditions. In addition to explicit measures, we included grip force measurements to assess implicit expectations about object weight. We further analysed the correlation between the SWI and a visual body size estimation (VSE) task. In contrast to Case et al. (2012), we found no evidence of differential SWI experience between groups. All participants reported a stronger visual SWI compared to haptic SWI. Grip force rate (but not peak) showed evidence of motor adaptation for the larger object in the visual condition. Furthermore, there was no correlation between the VSE and SWI, indicating no relation between perceived object weight and body size estimation. These results do not support the hypothesised impairment of visual-haptic object related integration in AN.

An Investigation of Lower Limb Representations Underlying Vision, Touch, and Proprioception in Body Integrity Identity Disorder.

Individuals with Body Integrity Identity Disorder (BIID) have a (non-psychotic) longstanding desire to amputate or paralyze one or more fully-functioning limbs, often the legs. This desire presumably arises from experiencing a mismatch between one's perceived mental image of the body and the physical structural and/or functional boundaries of the body itself. While neuroimaging studies suggest a disturbed body representation network in individuals with BIID, few behavioral studies have looked at the manifestation of this disrupted lower limb representations in this population. Specifically, people with BIID feel like they are overcomplete in their current body. Perhaps sensory input, processed normally on and about the limb, cannot communicate with a higher-order model of the leg in the brain (which might be underdeveloped). We asked individuals who desire paralysis or amputation of the lower legs (and a group of age- and sex-matched controls) to make explicit and implicit judgments about the size and shape of their legs while relying on vision, touch, and proprioception. We hypothesized that BIID participants would mis-estimate the size of their affected leg(s) more than the same leg of controls. Using a multiple single-case analysis, we found no global differences in lower limb representations between BIID participants and controls. Thus, while people with BIID feel that part of the body is foreign, they can still make normal sensory-guided implicit and explicit judgments about the limb. Moreover, these results suggest that BIID is not a body image disorder, per se, and that an examination of leg representation does not uncover the disturbed bodily experience that individuals with BIID have.

Hoop training: a pilot study assessing the effectiveness of a multisensory approach to treatment of body image disturbance in anorexia nervosa.

PURPOSE: We tested in a pilot study a new intervention for body image disturbance in anorexia nervosa (AN). Unlike common treatment approaches our hoop training targeted not only cognitive-emotional and visual aspects of body image, but also tactile and body-scaled action components. METHODS: We assessed cognitive, visual, tactile and body-scaled action aspects of body image disturbance before and after completion of hoop training. Twelve AN patients completed treatment as usual (TAU) for body image, 14 completed hoop training in addition to TAU. RESULTS: Results show that patients who completed the 8-week individual hoop training in addition to TAU improved more on body image disturbance tasks from baseline to follow-up than patients who completed only TAU. Hoop training specifically seems to affect tactile body image and body-scaled action. CONCLUSIONS: Taken together, a treatment approach in which the full spectrum of body image disturbances in AN is targeted has a unique added effect over treatment as usual. LEVEL OF EVIDENCE: Level II, non-randomized controlled study.

Body representation disturbances in visual perception and affordance perception persist in eating disorder patients after completing treatment.

Body image disturbances (BID) are a key feature of eating disorders (ED). Clinical experience shows that BID exists in patients who Completed their Eating Disorder Treatment (CEDT), however studies concerning BID in CEDT patients are often limited to cognition and affect, measured by interviews and questionnaires. The current study is the first systematic study investigating the full scope of the mental body representation, including bodily attitudes, visual perception of body size, tactile perception, and affordance perception in CEDT patients. ED patients (N = 22), CEDT patients (N = 39) and healthy controls (HC; N = 30) were compared on BID tasks including the Body Attitude Test (BAT), Visual Size Estimation (VSE), Tactile Estimation Task (TET), and Hoop Task (HT). Results on the BAT show higher scores for ED patients compared to CEDT patients and HC but no difference between CEDT patients and HC. Both ED and CEDT patients show larger overestimations on the VSE and HT compared to HC, where ED patients show the largest overestimations. No group differences were found on the TET. The results indicate the existence of disturbances in visual perception and affordance perception in CEDT patients. Research focussing on more effective treatments for ED addressing multiple (sensory) modalities is advised.

Does affective touch influence the virtual reality full body illusion?

The sense of how we experience our physical body as our own represents a fundamental component of human self-awareness. Body ownership can be studied with bodily illusions which are generated by inducing a visuo-tactile conflict where individuals experience illusionary ownership over a fake body or body part, such as a rubber hand. Previous studies showed that different types of touch modulate the strength of experienced ownership over a rubber hand. Specifically, participants experienced more ownership after the rubber hand illusion was induced through affective touch vs non-affective touch. It is, however, unclear whether this effect would also occur for an entire fake body. The aim of this study was, therefore, to investigate whether affective touch modulates the strength of ownership in a virtual reality full body illusion. To elicit this illusion, we used slow (3 cm/s; affective touch) and fast (30 cm/s; non-affective touch) stroking velocities on the participants' abdomen. Both stroking velocities were performed either synchronous or asynchronous (control condition), while participants viewed a virtual body from a first-person-perspective. In our first study, we found that participants experienced more subjective ownership over a virtual body in the affective touch condition, compared to the non-affective touch condition. In our second study, we found higher levels of subjective ownership for synchronous stimulation, compared to asynchronous, for both touch conditions, but failed to replicate the findings from study 1 that show a difference between affective and non-affective touch. We, therefore, cannot conclude unequivocally that affective touch enhances the full-body illusion. Future research is required to study the effects of affective touch on body ownership.