Form and formulation: Examining the distinctiveness of body image constructs in treatment-seeking patients with binge-eating disorder.

Abstract

Objective Body-image disturbance is a core aspect of eating disorders, yet the clinical manifestations of individuals’ weight and shape concerns are complex, vary considerably, and are poorly understood by clinicians and researchers. This study aimed to distinguish different aspects of body-image disturbance – including weight/shape dissatisfaction, weight/shape overvaluation, weight/shape preoccupation, and fear of weight gain – in patients with binge-eating disorder (BED). Examining how each specific body image construct relates to biopsychosocial features of BED could contribute to the refinement of conceptualization and treatment planning. Method The current study assessed body-image disturbance and eating-disorder psychopathology in 748 treatment-seeking patients with BED using established investigator-based interviews reliably administered by doctoral clinicians. Results The four body image constructs, although related to one another, showed some important similarities in associations with biopsychosocial clinical features, as well as some important distinctions. The relation between overvaluation and self-esteem was, as conceptualized, more strongly negative than for other body image variables, and preoccupation was more associated than other body image variables with eating concerns. Biopsychosocial features of BED were associated with different forms of body-image disturbance, but associations of body image variables with BMI were not significant and associations with binge-eating frequency did not differ across body image variables. Conclusion Manifestations of body-image disturbance in BED are complex and understanding the distinctions between different body image constructs can contribute to treatment formulation.

Core psychopathology in anorexia nervosa and bulimia nervosa: A network analysis

“…In this case, future network research could model shape and weight overvaluation as a latent variable, indicated by highly central items (e.g., shape overvaluation, weight overvaluation, desiring weight loss; Epskamp, Rhemtulla, & Borsboom, ). At the same time, certain indicators of shape and weight concerns are differentially associated with ED and comorbid symptoms (Lydecker, White, & Grilo, ). Thus, a second future direction is that time‐series data could be used to construct intraindividual networks (e.g., Epskamp, van Borkulo, van der Veen, Servaas, Isvoranu, Riese, & Cramer, accepted pending revision), with shape and weight overvaluation and other shape and weight concerns indicators modeled as observed variables.…”

“…A third future direction is to obtain a more nuanced understanding of shape and weight concerns in people with AN and BN. For instance, shape and weight overvaluation, fearing weight gain, and desiring weight loss may have unique relations with other ED symptoms (c.f., Lydecker et al, ). In addition, factor analytic studies of the EDE and EDE‐Q do not often replicate the proposed four‐factor structure (e.g., Byrne, Allen, Lampard, Dove, & Fursland, 2010; Peterson et al, ).…”

Examining the distinctiveness of body image concerns in patients with anorexia nervosa and bulimia nervosa

“…Disturbances in body image are part of the diagnostic criteria (American Psychiatric Association, ) for anorexia nervosa (AN) and bulimia nervosa (BN) and are conceptualized to play critical a role in the maintenance of other eating‐disorder (ED) psychopathology such as extreme dietary restriction, binge eating, purging, low weight, and associated eating‐related concerns (Fairburn, ). Understanding distinctions between different body‐image constructs in EDs has long been confused despite centrality to cognitive‐behavioral models (Fairburn, ) and relatively understudied (Lydecker, White, & Grilo, ).…”

“…Research has consistently supported the distinction between dissatisfaction and overvaluation (Grilo et al, ; Wade, Zhu, & Martin, ) and the prognostic importance of overvaluation (Grilo, White, Gueorguieva, Wilson, & Masheb, ). More recently, studies have yielded empirical evidence regarding potential variations in associations between the other EDE‐based specific body‐image constructs and measures of ED psychopathology (Blechart et al, ; Grilo, Ivezaj, Lydecker, & White, in press; Linardon et al, ; Linardon, Fuller‐Tyszkiewicz, de la Piedad Garcia, Messer, & Brennan, ; Lydecker et al, ; Mitchison et al, ) and outcomes (Calugi & Dalle Grave, ). A few recent studies have jointly considered several body‐image constructs.…”

“…Thus, recent emerging research (Blechart et al, ; Lydecker et al, ; Mitchison et al, ) has highlighted the potential importance of finer grained understanding of the complexity and different specific aspects of body‐image disturbances. However, generalizability of the emerging findings from these diverse samples, ranging from nonclinical community (Grilo et al ), college (Linardon et al, ), high‐school (Mitchison et al, ) to treatment‐seeking adults with BED (Lydecker et al, ) and adolescents with AN (Calugi & Dalle Grave, ) to adult patients with AN and BN is unknown and represents an important gap in the literature. Blechart et al () found that overvaluation of shape/weight was associated with nonappearance‐related self‐evaluation domains in patients with AN and BN but that these associations were stronger in BN; this study, however, did not consider other body‐image constructs.…”