Experimental investigation of disturbances in body image estimation in anorexia nervosa patients, and ballet and gymnastics pupils

Abstract

Three different methods were used to study perceptual disorders of body image in 36 anorexia nervosa patients and 35 age‐matched ballet/gymnastics pupils: (1) a video distortion of width of head and whole body of the subject; (2) a modification of the Image Marking Procedure first described by Askevold (1975); and (3) the Body Image Screening Scale, a paper‐pencil version (not in a scale of 1:1, but diminished) of (2) (Fichter & Meermann, 1981). Concerning the video task (1), both groups under investigation show underestimation of their own body dimensions (head, whole body “en face,” whole body “en profile”) and of a female dummy. Underestimation seems to be due to the method used. For the other techniques (2,3), we found the known overestimation of body dimensions in anorexia nervosa patients. But the ballet/gymnastics pupils show overestimation as well. Anorexia nervosa patients show significantly higher overestimation in both techniques only for the thighs, calves, and hips. In neither task 1 nor task 3 were there significant differences found between patients and pupils in estimating the size of a female dummy, confirming that our methods deliver information about body image disturbances and not about a more general perceptual disorder including external objects. The diagnostic and therapeutic implications of body image disturbances in anorexia nervosa are discussed.

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

“…The findings indicate that the measures produced acceptably reliable results. On the image marking procedure (Strober, Goldenberg, Green, & Saxon, 1979) and the optical distortion technique (Meerman, 1983;Freeman, et al, 1985), the intercorrelations between the estimations of different body parts or profiles are also high. A few studies have attempted to determine the convergent or construct validity of the different measures of body image.…”

“…Curiously, the authors did not attempt to reconcile their findings with their earlier, contradictory ones (Dolce, et al, 1987). Although Meerman (1983) stated that his methods "deliver information about body image disturbance and not about a more general perceptual disorder," actual data to support his claim were lacking in his report, as he did not provide correlational data on estimates of the body and the dummy. Furthermore, in his study, the inaccuracy in estimating the size of the body and of the dummy in both patients and controls occurred in the same direction (i.e., underestimation) on image distortion, whereas on image marking they seemed to have both occurred in the opposite direction (i.e., overestimation).…”

“…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.…”

“…On silhouette-card sorting, Buree, et al (1984) found no significant overestimation among the anorectics but the data were difficult to interpret. The two studies using image marking found anorectics to overestimate significantly one or more body parts (Meerman, 1983;Whitehouse, et al, 1988). In summary, some anorectics overestimate their body widths more so than did normals but this overestimation is by no means a characteristic shared by all or …”

Body images in anorexia nervosa and bulimia nervosa

“…Allebeck, Hallberg, and Espmark (1976) have used an adjustable television image, while Garfinkel and Garner (1982, p. 138) relied on self-report data. But it no longer seems fruitful to add to this body of literature which shows that although some patients with anorexia nervosa overestimate their body size (Slade & Russell, 1973;Askevold, 1975), others underestimate it (Garner, Garfinkel, Stancer, & Moldofsky, 1976;Garfinkel, Moldofsky, Garner, Stancer, & Coscina, 1978) and that inaccurate body size estimations are made by nonpatient girls and women (Crisp & Kalucy, 1974;Strober, Goldberg, Green, & Saxon, 1979;Ben-Tovim, Whitehead, & Crisp, 1979;Klesges, 1983;Meerman, 1983). Progress can only be made by clarifying the processes involved in these judgements.…”