Clinical and personality correlates of body size overestimation in anorexia nervosa and bulimia nervosa

Abstract

A video camera technique was used to assess perceived actual and ideal size in patients with a restricting type of anorexia nervosa (n = 17), bulimia nervosa patients with previous anorexia (n = 23), bulimia nervosa patients with no previous anorexia (n = 24), phobic controls (n = 18), and normals (n = 33). Bulimic patients with previous anorexia demonstrated a significantly greater tendency to overestimate their actual body size (p <.05) than subjects in the restricting anorexic or control groups. Previously anorexic bulimics also demonstrated more overall clinical and personality disturbance than any of the other groups (p <.01). Body size overestimation and dissatisfaction were strongly associated with the duration and severity of the eating disturbance in previously anorexic bulimics but there were no clear relationships between clinical or personality disturbances and body size distortions in the restricting anorexic or never‐anorexic bulimic groups. Results are discussed with respect to the importance of refining diagnostic criteria for subtypes of anorexia and bulimia nervosa. Multitrait‐multimethod methodologies are recommended for purposes of elucidating “body image disturbance” and its importance in the etiology and maintenance of eating disorders.

Body image assessment in patients with bulimia nervosa and normal controls

“…Contrary to some reports (Freeman et al, 1985;Norris, 1984;Touyz et al, 1985) but consistent with others (Birtchnell et al, 1985;Huon & Brown, 1986), the bulimics in the present study did not overestimate their body size and shape. Rather, they were the most accurate of the groups.…”

“…Perhaps not surprisingly, the resulting findings have been mixed. Whereas some studies have indicated that bulimics show distinctive patterns of body image distortion or dissatisfaction (e.g., Freeman, Thomas, Solyom, & Koopman, 1985;Willmuth et al, 1985), others (e.g., Birtchnell et al, 1985;Huon & Brown, 1986) have not. Cooper and Taylor (in press) have argued that studies of body image estimation that have not included a control population are uninterpretable because subjects' responses are easily influenced by specific procedures in the testing situation (e.g., the degree of image distortion possible, size of TV screen, and experimental instructions).…”

Body image disturbance: Time to abandon the concept for eating disorders?

“…However, many normals are dissatisfied also with their body and wanted to be thinner (Touyz, et al, 1984;Freeman, et al, 1985). Furthermore, the data on bodily dissatisfaction or disparagement are more consistent for bulimics than for anorectics.…”

“…On image distortion, four studies (Meerman, 1983;Freeman, et al, 1985;Huon & Brown, 1986;Whitehouse, et al, 1988) found no difference between anorectics and controls, one found greater variability (Touyz, Beumont, Collins, McCabe, & Jupp, 1984) and one found both greater variability and overestimation in the patients (Collins, Beumont, Touyz, Krass, Thompson, & Philips, 1987). On the analogue method, two found no difference (Ben-Tovim & Crisp, 1984;Thompson, Berland, Linton, & Weinsier, 1986), although upon reanalyzing the data and comparing specifically the two underweight groups with the controls, Thompson (1987) did find the anorectics to overestimate their body width significantly.…”

“…The most commonly used questionnaire is probably the Eating Disorder Inventory (Lindholm & Wilson, 1988;Whitehouse, Freeman, & Annadale, 1988), others include the Body Distortion Questionnaire, Body Parts Satisfaction Questionnaire (Lindholm & Wilson, 1988). Most studies also used some measure of general psychopathology not related specifically to body image such as the Minnesota Multiphasic Personality Inventory, the Beck Depression Inventory, and the SCL-90 (Williamson, Kelley, Davis, Ruggier, & Blouin, 1985;Freeman, Thomas, Solyom, & Koopman, 1985). Those perceptual studies that also asked the subjects to estimate their preferred or ideal shape were probably measuring an affective component in addition to a perceptual one also (Buree, Papageorgis, & Solyom, 1984;Freeman, et al, 1985), although this was usually not stated explicitly.…”