Body size overestimation and its association with body mass index, body dissatisfaction, and drive for thinness in anorexia nervosa.

BACKGROUND: Body size overestimation is a fundamental feature in anorexia nervosa (AN). There have been inconclusive findings about the extent to which this feature distinguishes psychopathology and some authors have argued that overestimation may be a function of lower body mass index (BMI). METHODS: We examine body size estimation accuracy and body dissatisfaction in 74 females with AN and 11 age-matched female controls using two well-established psychophysical procedures. RESULTS: Participants with AN overestimated their body size more and had greater body dissatisfaction than controls. Size accuracy was found to be independent of BMI and correlated with body dissatisfaction and drive for thinness in participants with AN. CONCLUSIONS: We conclude that overestimation of body size in AN is related to the psychopathology associated with the disorder and is not due to any perceptual tendency for people with lower BMI to overestimate their body size. We discuss the implications of these findings for treatment of AN.

Weight status and the perception of body image in men.

Understanding the role of body size in relation to the accuracy of body image perception in men is an important topic because of the implications for avoiding and treating obesity, and it may serve as a potential diagnostic criterion for eating disorders. The early research on this topic produced mixed findings. About one-half of the early studies showed that obese men overestimated their body size, with the remaining half providing accurate estimates. Later, improvements in research technology and methodology provided a clearer indication of the role of weight status in body image perception. Research in our laboratory has also produced diverse findings, including that obese subjects sometimes overestimate their body size. However, when examining our findings across several studies, obese subjects had about the same level of accuracy in estimating their body size as normal-weight subjects. Studies in our laboratory also permitted the separation of sensory and nonsensory factors in body image perception. In all but one instance, no differences were found overall between the ability of obese and normal-weight subjects to detect overall changes in body size. Importantly, however, obese subjects are better at detecting changes in their body size when the image is distorted to be too thin as compared to too wide. Both obese and normal-weight men require about a 3%-7% change in the width of their body size in order to detect the change reliably. Correlations between a range of body mass index values and body size estimation accuracy indicated no relationship between these variables. Numerous studies in other laboratories asked men to place their body size into discrete categorizes, ranging from thin to obese. Researchers found that overweight and obese men underestimate their weight status, and that men are less accurate in their categorizations than are women. Cultural influences have been found to be important, with body size underestimations occurring in cultures where a larger body is found to be desirable. Methodological issues are reviewed with recommendations for future studies.

Body size estimation in anorexia nervosa: a brief review of findings from 2003 through 2013.

Body size overestimation is a fundamental feature in anorexia nervosa (AN). The extent or even existence of body size overestimation in AN is controversial. The most recent review (Farrell et al., 2005) found that only half the studies reported overestimation of body size in individuals diagnosed with AN. The remaining studies found no overestimation or in some instances underestimation. The discrepancy in these findings has been attributed to the wide variety of assessment techniques that are used, including many with questionable psychometric properties. We review all 9 contemporary studies conducted in this area since the last review in 2005. For each study we describe the number of participants, methodology, reliability/validity data, amount of whole body distortion, effect sizes, and a summary of findings. In all studies that included a healthy control group, individuals with AN overestimated their whole body size more than healthy controls did. The difference was significant in all except two studies. Based on these contemporary findings, we conclude that individuals with AN overestimate their body size and that the greater consistency of findings in the studies conducted over the last decade is attributable to the use of improved methodologies and assessment tools with documented psychometric properties.

Association between different phases of menstrual cycle and body image measures of perceived size, ideal size, and body dissatisfaction.

The association between phases of the menstrual cycle and body image was investigated. 44 university women (M age = 23.3 yr., SD = 4.7) judged their perceived and ideal body size, and body dissatisfaction was calculated at each phase of the menstrual cycle, including premenstrual, menstrual, and intermenstrual. Participants selected one of nine figural drawings ranging from very thin to obese that represented their perceived size and ideal size. Body dissatisfaction was measured as the absolute difference between scores on perceived and ideal figural drawings. During each menstrual phase, anthropometric measures of weight, height, body mass index, circumference of waist and abdomen, and body composition were taken. There were no significant differences in any anthropometric measures between the three menstrual cycle phases. Perceived body size and body dissatisfaction were significantly different between menstrual phases, with the largest perceived body size and highest body dissatisfaction occurring during the menstrual phase. Ideal body size did not differ between menstrual phases, although participants desired a significantly smaller ideal size as compared to the perceived size.

Using Amazon's Mechanical Turk website to measure accuracy of body size estimation and body dissatisfaction.

This study investigated Amazon.com's website Mechanical Turk (MTurk) as a research tool for measuring body size estimation and dissatisfaction. 160 U.S. participants completed the BIAS-BD figural drawing scale and demographic questions posted on the MTurk website. The BIAS-BD consists of 17 drawings of various male and female body sizes based on anthropometric data corresponding to a range of 60% below to 140% above the average U.S. adult. Respondents selected a drawing that best reflected their current size and ideal size. Results revealed that respondents overestimated their body size by 6% and desired an ideal size 9.2% smaller than their perceived size. Findings are compared with three previous studies using the BIAS-BD scale. A general correspondence in findings between the four studies was found. We conclude that the MTurk can serve as a viable method for collecting data on the perceptual and attitudinal aspects of body image quickly and inexpensively.

A double-blind, placebo-controlled study of risperidone for the treatment of adolescents and young adults with anorexia nervosa: a pilot study.

OBJECTIVE: The purpose of this double-blind, placebo-controlled exploratory pilot study was to evaluate the safety and efficacy of risperidone for the treatment of anorexia nervosa. METHOD: Forty female subjects 12 to 21 years of age (mean, 16 years) with primary anorexia nervosa in an eating disorders program were randomized to receive risperidone (n = 18) or placebo (n = 22). Subjects completed the Eating Disorder Inventory 2, Color-A-Person Test, Body Image Software, and Multidimensional Anxiety Scale for Children at baseline and regular intervals. Weight, laboratory values, and electrocardiograms were monitored. Study medication was started at 0.5 mg daily and titrated upward weekly in 0.5-mg increments to a maximum dose of 4 mg until the subject reached a study endpoint. RESULTS: The mean dose for the risperidone group was 2.5 mg and for the placebo group was 3 mg for a mean duration of 9 weeks. Subjects taking risperidone had a significant decrease on the Eating Disorder Inventory 2 Drive for Thinness subscale over the first 7 weeks (effect size, 0.88; p = .002), but this difference was not sustained to the end of the study (p = .13). The Eating Disorder Inventory 2 Interpersonal Distrust subscale decreased significantly more in subjects taking risperidone (effect size, 0.60; p = .03). Subjects taking risperidone had increased prolactin levels (week 7; p = .001). There were no significant differences between groups at baseline or the end of the study for the other rating scales, change in weight, or laboratory measurements. CONCLUSIONS: This study does not demonstrate a benefit for the addition of risperidone in adolescents with anorexia nervosa during the weight-restoration phase of care. Clinical trial registration information-A Double-Blind, Placebo-Controlled Study of Risperidone for the Treatment of Anorexia Nervosa, http://www.clinicaltrials.gov, NCT00140426.

Method of presentation and sex differences when using a revised figural drawing scale to measure body size estimation and dissatisfaction.

The present study examined whether a revision of the Gardner, Jappe, and Gardner (2009) BIAS-BD figural drawing scale gave more accurate estimations of body size estimation and body dissatisfaction than a prior version. It also examined whether the order of figure presentation led to differing values for body size estimation and body dissatisfaction. The revised BIAS-BD scale included a continuous line beneath 17 figural drawings ordered in either ascending or descending size. Results were compared with previous studies using the original scale in which the 17 figural drawings were presented in a random order and, additionally, with a method using an adjustable video image by which the participants estimated their perceived body size by adjusting the width of their static image. The scale was presented to 330 undergraduate university students, including 199 women and 131 men. Overall, compared to BMIs calculated from the participants' reports of their height and weight, men and women participants gave less accurate estimations of body size using the revised scale when compared to the original BIAS-BD scale and video methodology. Participants reported significantly less body dissatisfaction than with the original scale. There was no significant difference in body size estimation when the figures were presented in ascending or descending size. Body dissatisfaction was greater for women than men, and when the figures were presented in descending order. Methodological considerations for using figural drawing scales in body image research are discussed.

Body-image perception and dissatisfaction throughout phases of the female menstrual cycle.

This pilot study investigated the association between the menstrual cycle and participants' body-size perception, judgments of ideal body size, detection of changes in body size, and body dissatisfaction. Thirty participants (M age=23.3 yr., SD=3.9), who did not have eating disorders, viewed digital images of their bodies. Judgments on all tasks were made during premenstrual, intermenstrual, and menstrual phases of the menstrual cycle. Participants expressed a desire for a smaller ideal body size for themselves in all three phases. Body dissatisfaction was significantly greater during the premenstrual and menstrual phases. The menstrual cycle was not associated with significant changes in body-size perception, ideal size judgments, or detection of changes in body size.

Development and validation of a new figural drawing scale for body-image assessment: the BIAS-BD.

This study describes the development and validation of a new and improved body-image assessment tool, the BIAS-BD, based on known body dimensions. The scale's construction consisted of 17 male and 17 female contour-line drawings that used known anthropometric body dimensions of shoulder, chest, waist, hip breadth, thigh breadth, and upper leg breadth. The figural drawings correspond to a series of body weights ranging from 60% below the known average to 140% above average. Differences between figural drawings represented a 5% change in body weight. Participants were 207 undergraduates, including 66 men and 141 women, who selected drawings that reflected their perceived size and their ideal size. Retesting occurred after a 2-week interval and resulted in test-retest reliability values of r=.86 for actual perceived size, r=.72 for ideal size, and r=.76 for body dissatisfaction (p<.005). There were no significant differences in reliability values between genders. Mean differences in perceived size, ideal size, and body dissatisfaction between the two test administrations were small. Concurrent validity, measured as the correspondence between perceived and reported size, was r=.76 (p<.005). Participants slightly overestimated their perceived body size, with women overestimating significantly more. Unlike existing scales, the present scale uses figural drawings based on known body dimensions and has better reliability and validity. It avoids several problems inherent in existing scales, including scale coarseness, the presence of ethnic facial and body features, and the lack of documented reliability and validity values.

Body-size perception, body-esteem, and parenting history in college women reporting a history of child abuse.

This study investigated the relations among physical, emotional, and sexual abuse up to adolescence and subsequent perception of body size, detection of changes in body size, and body-esteem. The role of parenting history in abused participants was also examined. 38 college undergraduate women, half of whom had been abused, reported instances of abuse, childhood parenting history, and current body-esteem. A recently developed software program of Gardner and Boice was used to present a series of distorted frontal profiles of each participant's own body for the women to rate as being too wide or too thin. A psychophysical procedure called adaptive probit estimation was used to measure the amount of over- and underestimation of these ratings and whether these changes were statistically significant. Analysis showed abused participants had distorted perceptions of body size, although the direction of the distortion was not consistent. There was no difference in detection of changes in body size. Abused and nonabused participants differed on measures of body-esteem and on ratings of most parenting experiences, including experiences with both mothers and fathers.

A computer program for measuring body size distortion and body dissatisfaction.

A computer program is described that measures body size distortion and body dissatisfaction. The program is written using Visual Basic development tools and will run on any Windows 98 or more current system. The width of a static digital image of the participant can be manipulated using three separate psychophysical methods. In the method of adjustment, the participant adjusts the image wider or thinner to match his or her perceived size. The participants may also be required to adjust the image to their ideal size, with the discrepancy between perceived and ideal size being used as a measure of body dissatisfaction. In the staircase method, participants see an image that is continuously expanding or contracting. The participants change the direction of the distortion when the image matches their perceived size. In the adaptive probit estimation procedure, participants judge whether a static image is distorted too wide or too thin. Analysis of the responses permits a determination of the point of subjective equality (PSE) and the difference limen (DL) values. The DL reflects the amount of body size distortion necessary for the participant to detect the distortion 50% of the time. The PSE reflects the participant's subjective judgment of his or her body size. These two values are reflective of the sensory and nonsensory components, respectively, that contribute to body size judgments.