The development of eating disorders is associated with a body-related attentional bias. Although eating disorders are especially prevalent in adolescence, so far, no study has analyzed gaze patterns and state body image in response to viewing one's own body in youth. To fill this gap, the present study aimed to examine a body-related attentional bias and state body satisfaction in adolescents with various forms of eating disorders. Girls with anorexia nervosa, restrictive type (AN-R; n = 30), anorexia nervosa, binge eating/purging type (AN-BP; n = 26), bulimia nervosa (BN; n = 22), clinical controls with anxiety disorders (n = 20) and healthy controls (n = 43) looked at photographs of their own and a peer's body, while their spontaneous eye movements were recorded. After stimulus presentation, state body satisfaction and individual attractiveness ratings for areas of the presented stimuli were assessed. An analysis of variance revealed that participants of all subgroups showed an attentive preference for unattractive areas of one's own body. Girls with AN-R attended significantly longer to unattractive body areas than both control groups and significantly shorter to attractive body areas than healthy controls. State body dissatisfaction was more prominent in all eating disorder subgroups, with significantly lower scores in BN compared to AN-R. In general, the higher the state body dissatisfaction, the stronger was the deficit orientation on one's own body. The attentional bias towards unattractive body areas, which is most pronounced in AN-R, indicates that interventions aiming to modify distorted attention might be promising in the prevention and treatment of eating disorders in adolescence.

The goal of the present review is to give an overview of the current findings on various facets of body image disturbance in Binge Eating Disorder such as body dissatisfaction, overconcern with weight and shape, body-related checking and avoidance behavior, misperception of body size, and body-related cognitive bias. In addition, treatments for a disturbed body image in BED and evidence of body image disturbance in youth with binge eating are reviewed. The results show that a disturbed body image in BED is present in the form of overconcern with weight and shape. Furthermore, there are hints that body dissatisfaction, as well as body-related checking and avoidance behavior, are also impaired. Research concerning misperception of body size in BED has been neglected so far, but first findings show that individuals with BED rate their own body shape rather accurately. Furthermore, there are first hints that body-related cognitive biases are present in individuals with BED. Moreover, in children and adolescents, there are first hints that body dissatisfaction, as well as shape and weight concerns, seem to be associated with loss of control and binge eating. Treatments aimed directly at the convertibility of a disturbed body image in BED have revealed encouraging outcomes. In conclusion, body image disturbance seems to occur in BED, and first studies show that it can be treated effectively.

Whereas for women, body image disturbances have been shown to be associated with a biased, self-deprecating pattern of body-directed visual attention, it has never been directly studied how men look at their own and other bodies and whether gaze behavior is moderated by traits central to male body image (i.e., drive for thinness and muscularity). Therefore, 45 weight-training men were eye-tracked while being presented with photographs of their own body and photographs of 3 other men with various body builds (normal, muscular, hyper-muscular). With regard to one’s own body, men with a high drive for thinness showed a rather dysfunctional pattern of attention allocation, with a decreased focus on body parts with which they were most satisfied and increased attention toward body parts with which they were least satisfied compared with low-scoring men. Unexpectedly, comparing men with a high versus low drive for muscularity, the opposite pattern was observed. Among the 3 other bodies, the attractive body parts of the muscular body drew the most visual attention. Results confirm and extend recent findings on the relevance of muscularity for male body image. At the same time, they indicate a prominent role of drive for thinness for body-related attentional biases assumed to perpetuate body dissatisfaction even in men.

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BackgroundPrevious research indicates that body image disturbance is transmitted from mother to daughter via modeling of maternal body-related behaviors and attitudes (indirect transmission) and via maternal body-related feedback (direct transmission). So far, the transmission of body-related attentional biases, which according to cognitive-behavioral theories play a prominent role in the development and maintenance of eating disorders, has not been analyzed. The current eye-tracking study applied the concepts of direct and indirect transmission to body-related attentional biases by examining body-related viewing patterns on self- and other-pictures within mother-daughter dyads.MethodsEye movements of N = 82 participants (n = 41 healthy female adolescents, mean age 15.82 years, SD = 1.80, and their mothers, mean age 47.78 years, SD = 4.52) were recorded while looking at whole-body pictures of themselves and a control peer. Based on fixations on self-defined attractive and unattractive body areas, visual attention bias scores were calculated for mothers and daughters, representing the pattern of body-related attention allocation. Based on mothers’ fixations on their own daughter’s and the adolescent peer’s body, a second visual attention bias score was calculated, reflecting the mothers’ viewing pattern on their own daughter.ResultsAnalysis of variance revealed an attentional bias for self-defined unattractive body areas in adolescents. The girls’ visual attention bias score correlated significantly with their mothers’ bias score, indicating indirect transmission, and with their mothers’ second bias score, indicating direct transmission. Moreover, the girls’ bias score correlated significantly with negative body-related feedback from their mothers.ConclusionsFemale adolescents show a deficit-oriented attentional bias for one’s own and a peer’s body. The correlated body-related attention patterns imply that attentional biases might be transmitted directly and indirectly from mothers to daughters. Results underline the potential relevance of maternal influences for the development of body image disturbance in girls and suggest specific family-based approaches for the prevention and treatment of eating disorders.

Although muscle dysmorphia (MD) has been added as a specifier for body dysmorphic disorder in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, experimental research on psychopathological mechanisms is lacking. Because models of eating disorders (EDs) suggest parallels between MD and ED, body-oriented attentional biases, which are prominent in ED models, have been identified as potentially important maintaining factors. Specifically, we predicted the existence of biases toward subjectively negative areas of one's own body and positive areas of a bodybuilder in MD. We tracked gaze behaviors of 24 men with MD diagnoses, 24 weight-training controls, and 24 non-weighttraining controls during exposure to pictures of their own body, an average male body, a lean-muscular body, and a hypermuscular body. Moreover, state body image and affect were assessed at baseline and after each stimulus. Partially supporting our hypotheses, men with MD diagnoses and non-weighttraining controls, but not weight-training controls, displayed significant biases toward subjectively negative areas of their own body. Only men with MD diagnoses displayed biases toward positive areas of the hypermuscular body and reacted with a large, significant deterioration in state body image and affect. Attentional biases possibly contribute to the negative effects of critical examinations of one's body and of upward comparisons. There seems to be a specific positive bias toward subjectively ideal hypermuscular bodies in MD in conjunction with a negative bias toward oneself. Insofar as this pattern might maintain the severe muscularity dissatisfaction, it should be explicitly targeted by cognitivebehavioral interventions.

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The early vigilance in AN and the subsequent decrease in attention to unattractive body parts is in line with our assumptions. However, no indication of attentional avoidance was found. The current findings partially support the vigilance-avoidance theory for the exposure to one's own body in adolescents with AN.