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:

Measurements

Attempts by researchers to measure variances in body image include the FAI index, developed in a 2014 study (Zaccagni 2014). The FAI (feel-status minus actual-status inconsistency) index is used to assess someone's weight perception. FAI scores range from -3 to +3: Negative FAI values mean weight status underestimation, positive FAI values mean weight status overestimation and a FAI score of 0 means a realistic perception of one's weight status. The study found that women tend to have positive FAI values (overestimating their weight) while men had negative FAI values (underestimating their weight). [9] Further studies have used the FAI index to study body image among natives and immigrants in Italy and North Africa. [10] [11]

Another study (Zaccagni 2020) developed a refined version of the FAI index, called the FAIFAT index. This index (feel-fat-status minus actual-fat-status inconsistency) was meant to address possible fat status perception inconsistencies by bioelectrical impedance analysis (BIA). [12]

See also

Related Research Articles

An eating disorder is a mental disorder defined by abnormal eating behaviors that adversely affect a person's physical or mental health. These behaviors include eating either too much or too little. Types of eating disorders include binge eating disorder, where the patient keeps eating large amounts in a short period of time typically while not being hungry; 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 simply as bulimia, is an eating disorder characterized by binge eating, followed by purging or fasting, as well as 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 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, who 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.

<span class="mw-page-title-main">Appetite</span> Desire to eat food

Appetite is the desire to eat food items, usually due to hunger. Appealing foods can stimulate appetite even when hunger is absent, although appetite can be greatly reduced by satiety. Appetite exists in all higher life-forms, and serves to regulate adequate energy intake to maintain metabolic needs. It is regulated by a close interplay between the digestive tract, adipose tissue and the brain. Appetite has a relationship with every individual's behavior. Appetitive behaviour also known as approach behaviour, and consummatory behaviour, are the only processes that involve energy intake, whereas all other behaviours affect the release of energy. When stressed, appetite levels may increase and result in an increase of food intake. Decreased desire to eat is termed anorexia, while polyphagia is increased eating. Dysregulation of appetite contributes to ARFID, anorexia nervosa, bulimia nervosa, cachexia, overeating, and binge eating disorder.

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">Body image</span> Aesthetic perception of ones own body

Body image is a person's thoughts, feelings and perception of the aesthetics or sexual attractiveness of their own body. The concept of body image is used in several disciplines, including neuroscience, psychology, medicine, psychiatry, psychoanalysis, philosophy, cultural and feminist studies; the media also often uses the term. Across these disciplines, there is no single consensus definition, but broadly speaking, body image consists of the ways people view themselves; their memories, experiences, assumptions, and comparisons about their appearances; and their overall attitudes towards their respective heights, shapes, and weights—all of which are shaped by prevalent social and cultural ideals.

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.

<span class="mw-page-title-main">Underweight</span> Below a weight considered healthy

An underweight person is a person whose body weight is considered too low to be healthy. A person who is underweight is malnourished.

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.

Avoidant/restrictive food intake disorder (ARFID) is a feeding or eating disorder in which individuals significantly limit the volume or variety of foods they consume, causing malnutrition, weight loss, and/or psychosocial problems. Unlike eating disorders such as anorexia nervosa and bulimia, body image disturbance is not a root cause. Individuals with ARFID may have trouble eating due to the sensory characteristics of food ; executive function disregulation; fears of choking or vomiting; low appetite; or a combination of these factors. While ARFID is most often associated with low weight, ARFID occurs across the whole weight spectrum.

Purging disorder is an eating disorder characterized by the DSM-5 as self-induced vomiting, or misuse of laxatives, diuretics, or enemas to forcefully evacuate matter from the body. Purging disorder differs from bulimia nervosa (BN) because individuals do not consume a large amount of food before they purge. In current diagnostic systems, purging disorder is a form of other specified feeding or eating disorder. Research indicates that purging disorder, while not rare, is not as commonly found as anorexia nervosa or bulimia nervosa. This syndrome is associated with clinically significant levels of distress, and that it appears to be distinct from bulimia nervosa on measures of hunger and ability to control food intake. Some of the signs of purging disorder are frequent trips to the bathroom directly after a meal, frequent use of laxatives, and obsession over one's appearance and weight. Other signs include swollen cheeks, popped blood vessels in the eyes, and clear teeth which are all signs of excessive vomiting.

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 food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin.

The thin ideal is the concept of the ideally slim female body. The common perception of this ideal is a woman who possesses a slender, feminine physique with a small waist and little body fat. The size that the thin ideal woman should be is decreasing while the rate of female obesity is simultaneously increasing, making this iconic body difficult for women to maintain. This creates a gap between the actual appearance of an average woman’s body and its expected appearance which, depending on the extent to which a woman internalizes the necessity of living up to this ideal for her well-being and peace of mind, may have serious psychological effects.

Other specified feeding or eating disorder (OSFED) is a subclinical DSM-5 category that, along with unspecified feeding or eating disorder (UFED), replaces the category formerly called eating disorder not otherwise specified (EDNOS) in the DSM-IV-TR. It captures feeding disorders and eating disorders of clinical severity that do not meet diagnostic criteria for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), avoidant/restrictive food intake disorder (ARFID), pica, or rumination disorder. OSFED includes five examples:

Emotional eating, also known as stress eating and emotional overeating, is defined as the "propensity to eat in response to positive and negative emotions". While the term commonly refers to eating as a means of coping with negative emotions, it sometimes include eating for positive emotions, such as overeating when celebrating an event or to enhance an already good mood.

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). "Asomatognosia P. Bonnier. Asthma. Revue Neurol 1905;13:605-9". Epilepsy & Behavior. International Classics in Epilepsy and Behavior. 16 (3). Translated by Crump T, Lama S: 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 (29 May 2013). "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.
  9. ↑ Zaccagni, Luciana; Masotti, Sabrina; Donati, Roberta; Mazzoni, Gianni; Gualdi-Russo, Emanuela (11 February 2014). "Body image and weight perceptions in relation to actual measurements by means of a new index and level of physical activity in Italian university students". Journal of Translational Medicine. 12: 42. doi: 10.1186/1479-5876-12-42 . ISSN   1479-5876. PMC   3923553 . PMID   24512483.
  10. ↑ Gualdi-Russo, E; Rinaldo, N; Khyatti, M; Lakhoua, C; Toselli, S (October 2016). "Weight status, fatness and body image perception of North African immigrant women in Italy". Public Health Nutrition. 19 (15): 2743–2751. doi:10.1017/S1368980016000872. hdl: 11392/2353035 .
  11. ↑ Kern, Matthias Robert; Heinz, Andreas; Stevens, Gonneke W.J.M.; Walsh, Sophie D.; Willems, Helmut (November 2020). "'What's a normal weight?' – Origin and receiving country influences on weight-status assessment among 1.5 and 2nd generation immigrant adolescents in Europe". Social Science & Medicine. 264: 113306. doi:10.1016/j.socscimed.2020.113306.
  12. ↑ Zaccagni, L; Rinaldo, N; Bramanti, B; Mongillo, J; Gualdi-Russo, E (14 January 2020). "Body image perception and body composition: assessment of perception inconsistency by a new index". Journal of translational medicine. 18 (1): 20. doi: 10.1186/s12967-019-02201-1 . PMC   6961355 . PMID   31937320.
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