Body image disturbances following recovery from anorexia nervosa

Abstract

One of the key symptoms of anorexia nervosa (AN) is an experience of enlarged body size. This experience, often referred to as body image disturbance (BID), has been shown to be persistent and hard to treat. Previous research indicates that BID is multifaceted, comprising body attitudes (cognition and affect) and body perception. However, BID is often regarded as a cognitive-affective disturbance and treated as such, with a form of cognitive behavioural therapy. Exclusively treating cognitive-affective disturbance might not be optimal given the multifaceted nature of BID, which also involves perception. This leads to the question, have recovered patients actually recovered from BID? In this PhD thesis I investigated BID following recovery from AN. I included patients with AN, patients who have completed their eating disorder treatment (recovered) and controls. Givens BID’s multifaceted nature, I studied it from different angles, using theories and methods from cognitive neuroscience, humanistic psychology and positive psychology. In part I of this thesis I focused on body representation. In chapter 2 I systematically investigated different aspects of body representation: body attitudes, visual body size, tactile body size, and affordance perception. In chapter 3 I designed a novel method for testing tactile distance estimation, which assesses whether estimates are exclusively determined by participants’ tactile perception or also influenced by their attitudes. In Part II of this thesis I focused on multisensory integration. In chapter 4 I used the size weight illusion to study multisensory integration in (object) perception. In part III, I explored a relatively overlooked aspect of BID in AN. In chapter 5, I measured the sense of control over the body’s motor actions. In Part IV, chapter 6, I looked at whether functionality appreciation can enhance body appreciation (a distinct aspect of positive body image) and decrease negative body image. The main results showed that patients who completed their eating disorder treatment still overestimate their body size, compared to controls, but generally show no difference in body attitudes (positive or negative). In other words, key symptoms of AN are still present after successful treatment completion. These results deserve attention as perceptual disturbances in AN are a predictor for relapse. In this thesis I further suggest ways to correct for perceptual overestimation of body size. One of which is the Hooptraining (www.hoepeltraining.nl). This training focusses on providing patients with perceptual feedback to correct their enlarged mental body representation.