The revolting body:Self-disgust as a key factor in anorexia nervosa

In this article, we present a theoretical model that points to disgust-induced avoidance as a mechanism that can help explain the persistent and excessive food restriction in individuals with anorexia nervosa (AN). Disgust is characterized by intense negative feelings of revulsion and an overwhelming and irresistible urge to avoid potential disgust elicitors. When eating, or even the prospect of eating, elicits overwhelming feelings of disgust in individuals with AN, this could explain why food restriction persists even when someone is in a state of starvation. Following this model, disgust is elicited by the expected impact of food on the own body ("becoming fat") resulting in body-related self-disgust. We argue that limiting food intake may serve to avoid self-disgust. This implies that when self-disgust remains unchanged after treatment of AN, residual levels of self-disgust after treatment could make individuals vulnerable to relapse

Negative Body Image Is Not Related to Spontaneous Body-Scaled Motoric Behavior in Undergraduate Women

Body image disturbance is a core characteristic of anorexia nervosa, which might be grounded in distortions in schematic body representations. In line with this, several studies showed that when walking through door-like apertures of different widths, individuals with anorexia nervosa move as if their bodies are larger than they actually are. They turn their body at a higher aperture/shoulder width ratio than healthy individuals. We examined whether oversized body-scaled motoric behaviors may not be restricted to anorexia nervosa but concern a general feature of negative body image attitudes. Therefore, we investigated the relation between negative body image as assessed with shape and weight concerns subscales of the Eating Disorder Examination Questionnaire and aperture/shoulder width turning ratios in women with a healthy weight (n = 62). We found that a more negative body image was unrelated to higher aperture/shoulder width turning ratios. Bayes analysis provided moderate evidence for the null hypothesis that spontaneous body-scaled motoric behaviors are not involved in negative body image. Future studies should disentangle whether being underweight per se is related to distinctive spontaneous body-scaled motoric behaviors or whether an “oversized” body schema is a unique characteristic of anorexia nervosa, potentially contributing to the persistence of this disorder

Subjective disgust and facial electromyography responses towards unedited and morphed overweight self-pictures in women with varying levels of eating disorder symptomatology

Individuals with an eating disorder (ED) often report to be disgusted by their body. Body-related self-disgust could play an important role in the development and maintenance of EDs. We investigated if women with relatively high ED symptom scores indeed respond with disgust upon exposure to their body as indexed by facial electromyography (fEMG) of the m. levator labii superioris and self-report. Given that one's self-disgust may increase/decrease depending on the relative distance of the own body to the thin ideal, we also assessed women's disgust for overweight- and thin-morphs of their body. Female undergraduate students (N = 104) were photographed and presented with their (morphed) body pictures, next to disgust-relevant and overweight body control pictures. Higher levels of ED symptoms were associated with stronger self-reported disgust to unedited body-pictures and overweight-morphs. Disgust to thin-morphs was unrelated to ED symptoms. Participants generally showed heightened facial disgust towards overweight morphs, yet the strength of facial disgust was unrelated to ED symptoms. Thus, the findings provide evidence for the involvement of heightened body-related self-disgust in ED symptomatology, albeit only on the basis of self-report

Implicit measures of actual versus ideal body image : relations with self-reported body dissatisfaction and dieting behaviors

Body dissatisfaction refers to a negative appreciation of one’s own body stemming from a discrepancy between how one perceives his/her body (actual body image) and how he/she wants it to be (ideal body image). To circumvent the limitations of self-report measures of body image, measures were developed that allow for a distinction between actual and ideal body image at the implicit level. The first goal of the present study was to investigate whether self-reported body dissatisfaction is related to implicit measures of actual and ideal body image as captured by the Relational Responding Task (RRT). Secondly, we examined whether these RRT measures were related to several indices of dieting behavior. Women high in body dissatisfaction (n = 30) were characterized by relatively strong implicit I-am-fat beliefs, whereas their implicit I-want-to-be-thinner beliefs were similar to individuals low in body dissatisfaction (n = 37). Implicit body image beliefs showed no added value over explicit body image beliefs in predicting body dissatisfaction and dieting behavior. These findings support the idea that the interplay between ideal and actual body image drives (self-reported) body dissatisfaction. However, strong support for the view that it would be critical to differentiate between explicit and implicit body image beliefs is missing

Reducing body dissatisfaction by means of an evaluative conditioning procedure in undergraduate women:A replication study

The aim was to investigate whether a computer-based evaluative conditioning (EC) procedure using positive social feedback is effective in enhancing body satisfaction. Prior findings in three small-scale studies were mixed showing positive effects in pre-clinical samples, but not in a clinical sample of eating disorder patients. Therefore, our main goal was to replicate the original finding of Martijn et al. (2010) in a well-powered unselected sample of 129 female undergraduates. We assessed the impact of EC on questionnaire measures of body satisfaction as well as on affective ratings of the participants' body pictures used in the task to verify whether the EC procedure was effective in heightening the subjective valence of these pictures. Supporting the validity of the current EC procedure, participants in the experimental condition rated their own pictures after the training as more positive than participants in the control condition. However, this effect of the EC procedure did not transfer to the self-report indices of body satisfaction. In addition, women with relatively high body concern did not profit more from the EC procedure than women with relatively low body concern. Together, these findings suggest that the EC procedure in its present form is not ready for use as an intervention for improving body satisfaction. However, it seems worthwhile to investigate in future studies how the EC procedure can be further strengthened in a way that effects on stimulus ratings eventually also 'spill over' to the level of self-reported body satisfaction.</p

What’s not to like? Enhancing women’s body satisfaction by means of an evaluative conditioning procedure with positive social feedback

The prevalence of a negative body image among women is high. Because of its serious consequences for individuals’ mental health, there is an urgent need to improve current body image interventions. Recent studies using evaluative conditioning to strengthen the association between women’s body and positive (social) stimuli have shown promising results. In two experimental studies, we tested whether incorporating more age appropriate positive social stimuli as unconditioned stimuli (USs) can strengthen the conditioning procedure as a means to enhance women’s body satisfaction. In the experimental condition, participants’ body pictures were systematically followed by the Facebook like-button and youthful smiling faces (study 1, experimental condition: n = 68; control condition: n = 67) or positive Emojis (study 2, experimental condition: n = 64; control condition: n = 67). The results indicated that neither conditioning procedure enhanced participants’ body satisfaction more than a control procedure, and in both studies, there was no valence transfer from the positive USs to the body pictures. Thus, incorporation of age appropriate USs did not result in the anticipated conditioning effects. These findings challenge the utility of current evaluative conditioning procedures as an intervention technique to address a negative body image

Punishment sensitivity and the persistence of anorexia nervosa:High punishment sensitivity is related to a less favorable course of anorexia nervosa

OBJECTIVE: Cross-sectional research provides robust evidence that individuals with anorexia nervosa (AN) report higher punishment sensitivity (PS) than individuals without an eating disorder (ED). High PS might interfere with treatment motivation and the ability to learn from experience. The current study took a longitudinal approach to test predictions that follow from the proposed relevance of PS as a factor in the persistence of AN symptoms. More specifically we tested (1) if higher PS at the start of treatment was related to less improvement in ED symptoms after one year, and (2) if a decrease in ED symptoms was associated with a concurrent decrease in PS. METHOD: Participants were 69 adolescents with a diagnosis of AN at the start of treatment of whom 62 participated again one year later. ED symptom severity and PS were assessed at both time points. RESULTS: Findings showed that (1) higher PS at the start of treatment was related to less improvement in ED symptoms, and (2) an improvement in ED symptoms was related to a decrease in PS. DISCUSSION: These findings are consistent with the proposed relevance of PS in the persistence of AN and suggest that it might be beneficial to address high PS in treatment. PUBLIC SIGNIFICANCE: Consistent with the view that punishment sensitivity (PS) is related to the persistence of anorexia nervosa, high PS at the start of treatment was related to less improvement in eating disorder symptoms in patients with anorexia nervosa. Furthermore, an improvement in eating disorder symptoms was associated with a concurrent decrease in PS, suggesting that PS can be subject to change and may be a relevant target for treatment

Disgust as the motor behind food restriction in anorexia nervosa

In dit artikel presenteren we een theoretisch model waarin we beschrijven hoe de emotie 'walging' kan helpen om te begrijpen waarom mensen met anorexia nervosa (AN) doorgaan met het vermijden van voedsel ondanks dat ze uitgehongerd raken. Walging kenmerkt zich door intens negatieve gevoelens van weerzin en een overweldigende reflexmatige drang tot vermijding die heel moeilijk is te weerstaan. Wanneer het eten van voedsel walging uitlokt bij mensen met AN, zou dat kunnen verklaren waarom voedselvermijding zo persistent is. Recent is er meer aandacht gekomen voor het fenomeen dat walging zich niet alleen richt op objecten of gedragingen buiten jezelf, maar dat ze ook kan optreden ten opzichte van jezelf. Mogelijk is het bij mensen met AN niet zozeer het voedsel zelf dat walging uitlokt, maar gaat het om de impact die het voedsel zou kunnen hebben op het zelf. Het beperken van de voedselinname zou een manier kunnen zijn om zelf-walging te vermijden, opgeroepen door de perceptie van het eigen (toekomstige) lichaam als te dik. Wanneer er in de behandeling van AN niets verandert aan deze zelf-walging, blijft de motor draaien en ligt terugval op de loer. We bespreken verschillende interventies die mogelijk kunnen helpen om zelf-walging bij mensen met AN te verminderen.In this article we present a theoretical framework that points to disgust-inducedavoidance as a mechanism that can help explain the persistent and excessive food restriction in individuals with anorexia nervosa (AN). Disgust is characterized by intense negative feelings of revulsion and an overwhelming and irresistible urge towards avoidance. When eating food triggers disgust, this can explain the strong urge to avoid food intake that is characteristic of individuals with AN. Recently, more attention has been given to the phenomenon that not only external objects, but also the self can lead to disgust. Potentially, in individuals with AN not so much food or eating itself elicits disgust, but the potential impact of food on the self. We argue that limiting food intake may reflect a means to avoid self-disgust that is elicited by perceiving the own future) body as ‘too fat’. This implies that when self-disgust remains unchanged following treatment of AN, the motor keeps running and small changes in (perceived) body shape and weight may reactivate the urge to avoid food intake thereby paving the way for relapse. We discuss several options that may be helpful in decreasing self-disgust in individuals with AN

Hidden scars in depression? Implicit and explicit self-associations following recurrent depressive episodes

To help explain the recurrent nature of major depressive disorder, we tested the hypothesis that depressive episodes and/or the duration of depressive symptoms may give rise to persistent dysfunctional implicit and/or more explicit self-associations, which in turn may place people at risk for the recurrence of symptoms. We therefore examined, in the context of the Netherlands Study of Depression and Anxiety, whether the strength of self-depressed associations at baseline was related to the number of past episodes (retrospective analysis; n = 666), and whether the duration of symptoms between baseline and follow-up predicted self-depressed associations at 2-year follow-up (prospective analysis; n = 726). The lifetime Composite International Diagnostic Interviews and Life Chart Interview were used to index the number of depressive episodes; the Implicit Association Test and its explicit equivalent were used to index self-associations. Consistent with the hypothesis that self-depressed associations strengthen following prolonged activation of negative self-associations during depressive episodes, individuals' implicit and explicit self-depressed associations correlated positively both with the number of prior depressive episodes at baseline and with the duration of depressive symptoms between baseline and 2-year follow-up. There was evidence that these relationships held, particularly in the prospective study, even when controlling for neuroticism and current depressive symptoms, whereas the retrospective relationship between number of episodes and implicit self-associations fell just short of significance