Abstract
Objective: Body image dissatisfaction is as well a risk factor for eating disorders (ED) and a central feature of ED. The exact nature of body image in adolescent ED is still debated. This study examined attitudinal body image in adolescent anorexia nervosa (AN) and bulimia nervosa (BN), and the association of age, maturational timing, duration of eating disorder, actual weight and general psychological distress with the attitudinal body image in ED. Methods: The study group consisted of an outpatient clinical sample of adolescents attending for assessment because of eating disorders. The attitudinal body image of 57 adolescents (girls) aged 14–21 years was studied at the beginning of the treatment. The attitudes to body shape, body size, appearance, tone and femininity were studied by a Likert format scale and by the body dissatisfaction (BD) and drive for thinness scales (DT) from EDI-2 inventory. Results: Bulimics reported more body image dissatisfaction than anorectics. In multivariate analyses BN and higher general psychological distress had strong associations with body image dissatisfaction. Longer duration of ED and earlier menarche were also associated with negative body image. Discussion: Attitudinal body image differs between adolescent AN and BN. The psychological distress has a great impact on body image in ED, which should be taken into account in assessment and in treatment interventions.
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Probst M., Vandereycken W., Vanderlinden J., Van Coppenolle H.: The significance of body size estimation in eating disorders: its relationship with clinical and psychological variables. Int. J. Eat. Disord., 24, 167–174, 1998.
Sands R.: Reconceptualizing of body image and drive for thinness. Int. J. Eat. Disord., 28, 397–407, 2000.
Thompson J.K., van den Berg P.: Measuring body image attitudes among adolescents and adults. In: Cash T.F., Pruzinsky T. (Eds.), Body image. A handbook of theory, research, and clinical practice. New York, The Guilford Press, 2002, pp. 142–154.
Gardner R.M.: Assessment of body image disturbance in children and adolescents. In: Thompson J.K., Soak L. (Eds.), Body image, eating disorders, and obesity in youth. Assessment, prevention, and treatment. Baltimore, MD, United Book Press, 2002, pp. 193–213.
Ben-Tovim D.I., Walker M.K.: A quantitative study of body-related attitudes in patients with anorexia and bulimia nervosa. Psychol. Med., 22, 961–969, 1992.
Cash T.F., Deagle E.A. 3rd: The nature and extent of body-image disturbances in anorexia nervosa and bulimia nervosa: a meta-analysis. Int. J. Eat. Disord., 22: 107–125, 1997.
Slade P.D.: What is body image? Behav. Res. Ther., 32, 497–502, 1994.
Levine M.P., Smolak L.: Body image development in adolescence. In: Cash T.F., Pruzinsky T. (Eds.), Body image. A handbook of theory, research, and clinical practice. New York, The Guilford Press, 2002, pp. 74–82.
Cooper P.J., Goodyear I.: Prevalence and significance of weight and shape concerns in girls aged 11–16 years. Br. J. Psychiatry, 171, 542–544, 1997.
Field A.E., Camargo C.A., Taylor C.B., Berkey C.S., Frazier A.L., Gillman M.W., Colditz G.A.: Overweight, weight concerns, and bulimic behaviors among girls and boys. J. Am. Acad. Child Adolesc. Psychiatry, 38: 754–760, 1999.
Corcos M., Flament M.F., Giraud M.J., Paterniti S., Ledoux S., Atger F., Jeammet P.: Early psychopathological signs in bulimia nervosa. A retrospective comparison of the period of puberty in bulimic and control girls. Eur. Child Adolesc. Psychiatry, 9, 115–121, 2000.
Stice E., Shaw H.E.: Role of body dissatisfaction in the onset and maintenance of eating pathology. A synthesis of research findings. J. Psychosom. Res., 53, 985–993, 2002.
Wertheim E.H., Paxton S.J., Schutz H.K., Muir S.L.: Why do adolescent girls watch their weight? An interview study examining sociocultural pressures to be thin. J. Psychosom. Res., 42, 345–355, 1997.
Kaltiala-Heino R., Rimpelä M., Rissanen A., Rantanen P.: Early puberty and early sexual activity are associated with bulimic-type eating pathology in middle adolescence. J. Adolesc. Health, 28, 346–352, 2001.
Van der Ham T., van Strien D.C., van Engeland H.: Personality characteristics predict outcome of eating disorders in adolescents: A 4-year prospective study. Eur. Child Adolesc. Psychiatry, 7, 79–84, 1998.
Ohring R., Graber J.A., Brooks-Gunn J.: Girls’ recurrent and concurrent body dissatisfaction: correlates and consequences over 8 years. Int. J. Eat. Disord., 31,404–415, 2001.
Gupta M.A., Johnson A.M.: Nonweight-related body image concerns among female eating-disordered patient and nonclinical controls: some preliminary observations. Int. J. Eat. Disord., 27, 304–309, 2000.
American Psychiatric Association (APA). DSM-IV: Diagnostic and Statistical Manual of Mental Disorders. Washington DC, 4th Edition, International Version, 1995.
WHO. International Statistical Classification of Diseases and Related Health Problems (ICD-10), Geneva, vol 1, 1992.
Skrzypek S., Wehmeier P.M., Remschmidt H.: Body image assessment using body size estimation in recent studies on anorexia nervosa. A brief review. Eur. Child Adolesc. Psychiatry, 10, 215–221, 2002.
Bruch H.: Perceptual and conceptual disturbances in anorexia nervosa. Psychosom. Med., 24, 187–194, 1962.
Garner D.M.: Body image and anorexia nervosa. In: Cash T.F., Pruzinsky T. (Eds.), Body image. A handbook of theory, research, and clinical practice. New York, The Guilford Press, 2002, pp. 295–303.
Baluch B., Furnham A., Huszcza A.: Perception of body shapes by anorexics and mature and teenage females. J. Clin. Psychol., 53, 167–175, 1997.
Womble L.G., Williamson D.A., Netemeyer S.B., Netemeyer R.G.: Risk factors for the development of bulimic symptoms in high school girls: a one-year longitudinal study. J. Gender, Culture, Health, 3, 227–241, 1998.
Stice E.: Body image and bulimia nervosa. In: Cash T.F., Pruzinsky T. (Eds.), Body image. A handbook of theory, research, and clinical practice. New York, The Guilford Press, 2002, pp. 304–311.
Fernandez-Aranda F., Dahme B., Meermann R.: Body image in eating disorders and analysis of its relevance: a preliminary study. J. of Psychosom. Res., 47, 419–428, 1999.
Joiner T., Wonderlich S.A., Metalsky G.I., Schmidt N.B.: Body dissatisfaction: A feature of bulimia, depression, or both? J. Soc. Clin. Psychol., 14, 339–355, 1995.
Attie I., Brooks-Gunn J.: Development of eating problems in adolescent girls: A longitudinal study. Devel. Psychol., 25, 70–79, 1989.
Leon G.R., Fulkerson J.A., Perry C.L., Early-Zald M.B.: Prospective analysis of personality and behavioral vulnerabilities and gender influences in the later development of disordered eating. J. Abnorm. Psychol., 104, 140–149, 1995.
Beumont P.J.V., Russell J.D., Touyz S.W.: Psychological concerns in the maintenance of dieting disorders. In: Szmukler G., Dare C., Treasure J. (Eds.), Handbook of eating disorders: theory, treatment and research. Chichester, John Wiley and Sons Ltd, 1995, pp. 221–241.
Rosen J.C.: Body-image disturbances in eating disorders. In: Cash T.F., Pruzinsky T. (Eds.), Body Images. Developmental deviance and change. New York, The Guilford Press, 1990, pp. 190–214.
Pruzinsky T., Cash T.F.: Understanding body images: Historical and contemporary perspectives. In: Cash T.F., Pruzinsky T. (Eds.), Body image. A handbook of theory, research, and clinical practice. New York, 2002, pp. 3–12.
Fairburn C.G., Welch S.L., Doll H.A., Davies B.A., O’Connor M.E.: Risk factors for bulimia nervosa: a community-based case-control study. Arch. Gen. Psychiatry, 54, 509–517, 1997.
Taylor C.B., Sharpe T., Shisslak C., Bryson S., Estes L.S., Gray N., McKnight K.M., Crago M., Kraemer H.C., Killen J.D.: Factors associated with weight concerns in adolescent girls. Int. J. Eat. Disord., 24, 31–42, 1998.
Wichstrom L.: Social, psychological and physical correlates of eating problems. A study of the general adolescent population in Norway. Psychol. Med., 25, 567–579, 1995.
Buddeberg-Fisher B., Klaghofer R., Reed V.: Associations between body weight, psychiatric disorders and body image in female adolescents. Psychother. Psychosom., 68, 325–332, 1999.
Cooley E., Toray T.: Disordered eating in college Freshman women: A prospective study. J. Am. Coll. Health, 49, 229–236, 2001.
Tomori M., Rus-Makovec M.: Eating behavior, depression, and self-esteem in high school students. J. Adolesc. Health, 26, 361–367, 2000.
Rierdan J., Koff E.: Weight, weight-related aspect of body image, and depression in early adolescent girls. Adolescence, 32, 615–625, 1997.
Keel P., Mitchell J.E., Davis T.L., Crow S.J.: Relationship between depression and body dissatisfaction in women diagnosed with bulimia nervosa. Int. J. Eat. Disord., 30, 48–56, 2001.
Pollice C., Kaye W.H., Greeno C.G., Weltzin T.E.: Relationship of depression, anxiety, and obsessionality to state of illness in anorexia nervosa. Int. J. Eat. Disord., 21, 367–376, 1997.
Ivarsson T., Råstam M., Wentz E., Gillberg C., Gillberg C.: Depressive disorders in teenage-onset anorexia nervosa: a controlled longitudinal, partly community-based study. Compr. Psychiatry, 41, 398–403, 2000.
Garner D.M., Olmstead M.P., Plivy J.: Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. Int. J. Eat. Disord., 2, 15–34, 1983.
Garner D.M.: Manual for the eating disorder inventory — 2 (EDI-2). Odessa, FL, Psychological Assessment Resources, 1991.
Kordy H., Treasure J.: EUR 19212–COST Action B6 — Efficiency of psychotherapeutic treatment of eating disorders. Luxembourg, Office for Official Publications of the European Communities, 1999.
Derogatis L.R., Rickels K., Rock A.: The SCL-90 and the MMPI: A step in the validation of a new selfreport scale. Br. J. Psychiatry, 128, 280–289, 1976.
Holi M.M., Sammallahti P.R., Aalberg V.A.: A Finnish validation study of the SCL-90. Acta Psychiatr. Scand., 97, 42–46, 1998.
Ruuska J, Kaltiala-Heino RK, Koivisto AM, Rantanen P.: Puberty, sexual development and eating disorders in adolescent outpatients. Eur. Child Adolesc. Psychiatry, 12, 214–220, 2003.
Fairburn C.G., Cooper Z., Shafran R.: Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behav. Res. Therapy, 41,509–528, 2003.
Wiederman M.W., Pryor T.L.: Body dissatisfaction, bulimia, and depression among women: the mediating role of drive for thinness. Int. J. Eat. Disord., 27, 90–95, 2000.
Wade T.D., Bulik C.M., Neale M., Kendler K.S.: Anorexia nervosa and major depression: shared genetic and environmental risk factors. Am. J. Psychiatry, 157, 469–471, 2000.
Stein D., Orbach I., Shani-Sela M., Har-Even D., Yaruslasky A., Roth D., Meged S., Apter A.: Suicidal tendencies and body image and experience in anorexia nervosa and suicidal female adolescent inpatients. Psychother. Psychosom., 72, 16–25, 2003.
Cooper M., Hunt J.: Core beliefs and underlying assumptions in bulimia nervosa and depression. Behav. Res. Therapy, 36, 895–898, 1998.
Steinhausen H.C., Raus-Mason C., Seidel R.: Followup studies of anorexia nervosa: a review of four decades of outcome research. Psychol. Med., 21, 447–454, 1991.
Nicholls D., Chater R., Lask B.: Children into DSM don’t go: A comparison of classification systems for eating disorders in childhood and early adolescence. Int. J. Eat. Disord., 28, 317–324, 2000.
Fernandez-Aranda F., Dahme B., Meerman R.: Body image in eating disorders and analysis of its relevance: A preliminary study. J. Psychosom. Res. 47, 419–428, 1999.
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Ruuska, J., Kaltiala-Heino, R., Rantanen, P. et al. Are there differences in the attitudinal body image between adolescent anorexia nervosa and bulimia nervosa?. Eat Weight Disord 10, 98–106 (2005). https://doi.org/10.1007/BF03327531
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DOI: https://doi.org/10.1007/BF03327531