Body image (neuroscience)

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Body image is a complex construct, [1] often used in the clinical context of describing a patient's cognitive perception of their own body. The medical concept began with the work of the Austrian neuropsychiatrist and psychoanalyst Paul Schilder, described in his book The Image and Appearance of the Human Body first published in 1935. [2] The term “body image” was officially introduced by Schilder himself and his widely used definition is: “body image is the picture of our own body we form in our mind, that is to say the way in which the body appears to ourselves”. [3] In research with the term “body image” we currently refer to a conscious mental representation of one’s own body, which involves affects, attitudes, perceptual components and cognition. [4] On the contrary the term “body schema” was initially used to describe an unconscious body mental representation fundamental for action. [5] Keizer and colleagues (2013) suggest the following definition: “[body schema is] an unconscious, sensorimotor, representation of the body that is invoked in action. [6] In light of recent scientific developments regarding the multisensory integration of body sensations, the distinction between body image and body schema appears simplistic and probably no longer useful for scientific research and clinical purposes. [7]

Contents

Clinical significance

In the clinical setting, body image disturbances are relatively frequent [8] and involve both psychiatric and neurological disorders. Disturbances in the perception of one's body are present in psychiatric disorders such as:

Body image disorders are common in eating disorders and are referred to as "body image disturbance. [4]

Disturbances in the body image are also present in neurological conditions such as:

See also

Related Research Articles

<span class="mw-page-title-main">Anorexia (symptom)</span> Medical symptom

Anorexia is a medical term for a loss of appetite. While the term outside of the scientific literature is often used interchangeably with anorexia nervosa, many possible causes exist for a loss of appetite, some of which may be harmless, while others indicate a serious clinical condition or pose a significant risk.

An eating disorder is a mental disorder defined by abnormal eating behaviors that negatively affect a person's physical or mental health. Types of eating disorders include binge eating disorder, where the patient eats a large amount in a short period of time; anorexia nervosa, where the person has an intense fear of gaining weight and restricts food or overexercises to manage this fear; bulimia nervosa, where individuals eat a large quantity (binging) then try to rid themselves of the food (purging); pica, where the patient eats non-food items; rumination syndrome, where the patient regurgitates undigested or minimally digested food; avoidant/restrictive food intake disorder (ARFID), where people have a reduced or selective food intake due to some psychological reasons; and a group of other specified feeding or eating disorders. Anxiety disorders, depression and substance abuse are common among people with eating disorders. These disorders do not include obesity. People often experience comorbidity between an eating disorder and OCD. It is estimated 20–60% of patients with an ED have a history of OCD.

<span class="mw-page-title-main">Bulimia nervosa</span> Type of eating disorder

Bulimia nervosa, also known as simply bulimia, is an eating disorder characterized by binge eating followed by purging or fasting, and excessive concern with body shape and weight. This activity aims to expel the body of calories eaten from the binging phase of the process. Binge eating refers to eating a large amount of food in a short amount of time. Purging refers to the attempts to get rid of the food consumed. This may be done by vomiting or taking laxatives.

Orthorexia nervosa (ON) is a proposed eating disorder characterized by an excessive preoccupation with eating healthy food. The term was introduced in 1997 by American physician Steven Bratman, M.D. He suggested that some people's dietary restrictions intended to promote health may paradoxically lead to unhealthy consequences, such as social isolation; anxiety; loss of ability to eat in a natural, intuitive manner; reduced interest in the full range of other healthy human activities; and, in rare cases, severe malnutrition or even death.

Binge eating disorder (BED) is an eating disorder characterized by frequent and recurrent binge eating episodes with associated negative psychological and social problems, but without the compensatory behaviors common to bulimia nervosa, OSFED, or the binge-purge subtype of anorexia nervosa.

<span class="mw-page-title-main">Depersonalization</span> Anomaly of self-awareness

Depersonalization can consist of a detachment within the self, regarding one's mind or body, or being a detached observer of oneself. Subjects feel they have changed and that the world has become vague, dreamlike, less real, lacking in significance or being outside reality while looking in. It can be described as feeling like one is on "autopilot" and that the person's sense of individuality or selfhood has been hindered or suppressed.

<span class="mw-page-title-main">Body dysmorphic disorder</span> Mental disorder

Body dysmorphic disorder (BDD), also known in some contexts as dysmorphophobia, is a mental disorder defined by an overwhelming preoccupation with a perceived flaw in one's physical appearance. In BDD's delusional variant, the flaw is imagined. When an actual visible difference exists, its importance is disproportionately magnified in the mind of the individual. Whether the physical issue is real or imagined, ruminations concerning this perceived defect become pervasive and intrusive, consuming substantial mental bandwidth for extended periods each day. This excessive preoccupation not only induces severe emotional distress but also disrupts daily functioning and activities. The DSM-5 places BDD within the obsessive–compulsive spectrum, distinguishing it from disorders such as anorexia nervosa.

The mental status examination (MSE) is an important part of the clinical assessment process in neurological and psychiatric practice. It is a structured way of observing and describing a patient's psychological functioning at a given point in time, under the domains of appearance, attitude, behavior, mood and affect, speech, thought process, thought content, perception, cognition, insight, and judgment. There are some minor variations in the subdivision of the MSE and the sequence and names of MSE domains.

Muscle dysmorphia is a subtype of the obsessive mental disorder body dysmorphic disorder, but is often also grouped with eating disorders. In muscle dysmorphia, which is sometimes called "bigorexia", "megarexia", or "reverse anorexia", the delusional or exaggerated belief is that one's own body is too small, too skinny, insufficiently muscular, or insufficiently lean, although in most cases, the individual's build is normal or even exceptionally large and muscular already.

The obsessive–compulsive spectrum is a model of medical classification where various psychiatric, neurological and/or medical conditions are described as existing on a spectrum of conditions related to obsessive–compulsive disorder (OCD). "The disorders are thought to lie on a spectrum from impulsive to compulsive where impulsivity is said to persist due to deficits in the ability to inhibit repetitive behavior with known negative consequences, while compulsivity persists as a consequence of deficits in recognizing completion of tasks." OCD is a mental disorder characterized by obsessions and/or compulsions. An obsession is defined as "a recurring thought, image, or urge that the individual cannot control". Compulsion can be described as a "ritualistic behavior that the person feels compelled to perform". The model suggests that many conditions overlap with OCD in symptomatic profile, demographics, family history, neurobiology, comorbidity, clinical course and response to various pharmacotherapies. Conditions described as being on the spectrum are sometimes referred to as obsessive–compulsive spectrum disorders.

The Eating Attitudes Test, created by David Garner, is a widely used 26-item, standardized self-reported questionnaire of symptoms and concerns characteristic of eating disorders. The EAT is useful in assessing "eating disorder risk" in high school, college and other special risk samples such as athletes. EAT has been extremely effective in screening for anorexia nervosa in many populations.

The Eating Disorder Diagnostic Scale (EDDS) is a self-report questionnaire that assesses the presence of three eating disorders; anorexia nervosa, bulimia nervosa and binge eating disorder. It was adapted by Stice et al. in 2000 from the validated structured psychiatric interview: The Eating Disorder Examination (EDE) and the eating disorder module of the Structured Clinical Interview for DSM-IV (SCID)16.

<span class="mw-page-title-main">Anorexia nervosa</span> Type of eating disorder

Anorexia nervosa (AN), often referred to simply as anorexia, is an eating disorder characterized by low weight, food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin.

The differential diagnoses of anorexia nervosa (AN) includes various types of medical and psychological conditions, which may be misdiagnosed as AN. In some cases, these conditions may be comorbid with AN because the misdiagnosis of AN is not uncommon. For example, a case of achalasia was misdiagnosed as AN and the patient spent two months confined to a psychiatric hospital. A reason for the differential diagnoses that surround AN arise mainly because, like other disorders, it is primarily, albeit defensively and adaptive for, the individual concerned. Anorexia Nervosa is a psychological disorder characterized by extremely reduced intake of food. People with anorexia nervosa have a low self-image and consider themselves overweight.

<span class="mw-page-title-main">Eating disorders and memory</span> Memory impairments linked to eating disorders

Many memory impairments exist as a result from or cause of eating disorders. Eating disorders (EDs) are characterized by abnormal and disturbed eating patterns that affect the lives of the individuals who worry about their weight to the extreme. These abnormal eating patterns involve either inadequate or excessive food intake, affecting the individual's physical and mental health.

Cognitive behavioral therapy (CBT) is derived from both the cognitive and behavioral schools of psychology and focuses on the alteration of thoughts and actions with the goal of treating various disorders. The cognitive behavioral treatment of eating disorders emphasizes on the minimization of negative thoughts about body image and the act of eating, and attempts to alter negative and harmful behaviors that are involved in and perpetuate eating disorders. It also encourages the ability to tolerate negative thoughts and feelings as well as the ability to think about food and body perception in a multi-dimensional way. The emphasis is not only placed on altering cognition, but also on tangible practices like making goals and being rewarded for meeting those goals. CBT is a "time-limited and focused approach" which means that it is important for the patients of this type of therapy to have particular issues that they want to address when they begin treatment. CBT has also proven to be one of the most effective treatments for eating disorders.

Paul E. Garfinkel is a Canadian psychiatrist, researcher and an academic leader. He is a professor at the University of Toronto and a staff psychiatrist at Centre for Addiction and Mental Health (CAMH).

Body image disturbance (BID) is a common symptom in patients with eating disorders and is characterized by an altered perception of one's own body.

Atypical anorexia nervosa is an eating disorder in which individuals meet all the qualifications for anorexia nervosa, including a body image disturbance and a history of restrictive eating and weight loss, except that they are not currently underweight. Atypical anorexia qualifies as a mental health disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), under the category Other Specified Feeding and Eating Disorders (OSFED). The characteristics of people with atypical anorexia generally do not differ significantly from anorexia nervosa patients except for their current weight.

Body checking is a compulsive behaviour related but not exclusive to various forms of body dysmorphic disorders. It involves frequently collecting various information about one’s own body in terms of size, shape, appearance or weight. Frequent expressions of this form of behaviour entails for example mirror checking, trying to feel one’s own bones, pinching the abdomen, frequent body weight measurement and comparing your own body to that of others. Studies have shown that an increased rate of body checking correlates with an overall increased dissatisfaction with the own body.

References

  1. ↑ Hosseini SA, Padhy RK (2021). "Body Image Distortion". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID   31536191 . Retrieved 2021-07-31.
  2. ↑ Schilder PA (1935). The Image and Appearance of the Human Body. Psyche Monographs. London: Kegal Paul, Trench, Trubner & Co. ISBN   978-1-136-33828-1.
  3. ↑ "Review of the book The image and appearance of the human body, by P. Schilder". Journal of Consulting Psychology. 15 (2): 170. 1951. doi:10.1037/h0052115.
  4. 1 2 Artoni P, Chierici ML, Arnone F, Cigarini C, De Bernardis E, Galeazzi GM, et al. (March 2021). "Body perception treatment, a possible way to treat body image disturbance in eating disorders: a case-control efficacy study". Eating and Weight Disorders. 26 (2): 499–514. doi:10.1007/s40519-020-00875-x. PMID   32124409. S2CID   211728899.
  5. ↑ Bonnier P (November 2009). Translated by Crump T, Lama S. "Asomatognosia P. Bonnier. Asthma. Revue Neurol 1905;13:605-9". Epilepsy & Behavior. International Classics in Epilepsy and Behavior. 16 (3): 401–3. doi:10.1016/j.yebeh.2009.09.020. PMID   19854683. S2CID   34502886.
  6. ↑ Keizer A, Smeets MA, Dijkerman HC, Uzunbajakau SA, van Elburg A, Postma A (2013-05-29). "Too fat to fit through the door: first evidence for disturbed body-scaled action in anorexia nervosa during locomotion". PLOS ONE. 8 (5): e64602. Bibcode:2013PLoSO...864602K. doi: 10.1371/journal.pone.0064602 . PMC   3667140 . PMID   23734207.
  7. ↑ Pitron V, de Vignemont F (August 2017). "Beyond differences between the body schema and the body image: insights from body hallucinations" (PDF). Consciousness and Cognition. 53: 115–121. doi:10.1016/j.concog.2017.06.006. PMID   28658652. S2CID   4917066.
  8. ↑ Denes G (1999). "Disorders of Body Awareness and Body Knowledge". In Denes G, Pizzamiglio L (eds.). Handbook of Clinical and Experimental Neuropsychology. Psychology Press. pp. 497–506. doi:10.4324/9781315791272-28. ISBN   978-1-315-79127-2. S2CID   216407191.
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