Körperbild bei Menschen mit einer körperdysmorphen Störung

Theoretischer Hintergrund Bei der körperdysmorphen Störung (KDS) handelt es sich um eine übermäßige Beschäftigung mit einem Makel in der äußeren Erscheinung, der für andere Menschen nicht wahrnehmbar ist. Die Klassifikation der KDS wurde vielfach diskutiert. Im DSM-5 erfolgte die Zuordnung der KDS zu dem Spektrum der Zwangsstörungen. Die KDS kann auch gemeinsam mit den Essstörungen als Störung des Körperbildes konzeptualisiert werden. Bislang jedoch wurden Körperbildmerkmale bei der KDS selten explizit untersucht. Methode Studie 1: In einer Fragebogenstudie untersuchten wir Körperbildmerkmale, die für die KDS besonders relevant sind. Hierfür wurde der „Körperdysmorphe Störung Fragebogen“ (Brunhoeber, 2009) eingesetzt. Es wurden Personen mit einer KDS, Personen mit einer Essstörung und Gesunde untersucht. Studie 2: In einer quasi-experimentellen Studie untersuchten wir kognitiv-affektive Körperbildmerkmale mit Hilfe einer in-vivo Spiegelbildexposition. Alle Teilnehmenden wurden gebeten, während einer Baseline-Bedingung, einer Spiegelexpositions-Bedingung und einer Followup-Bedingung ihre Gedanken laut auszusprechen („think-aloud“-Methode). Es wurden Personen mit einer KDS, Personen mit einer depressiven Störung und Gesunde untersucht. Zusätzlich wurden affektive Reaktionen im Verlauf der Spiegelübung erfasst. Zentrale Ergebnisse Studie 1: Die KDS-Gruppe zeichnete sich gegenüber den Essstörungen durch eine stärkere psychosoziale Belastung aufgrund der äußeren Erscheinung und stärkere familiäre Belastung aus. Studie 2: Die Spiegelexposition aktivierte bei Depressiven und bei Gesunden positive körperbezogene Gedanken, nicht jedoch bei Personen mit einer KDS. Die KDS-Gruppe reagierte in spezifischer Weise mit einem Anstieg von Traurigkeit und Ärger auf die Konfrontation mit dem eigenen Spiegelbild. Diskussion und Schlussfolgerung Die Ergebnisse verweisen auf eine Störung der Körperbildes bei Personen mit einer KDS. Psychosoziale und familiäre Beeinträchtigung aufgrund der Sorgen um das Aussehen ist in der therapeutischen Arbeit mit Betroffenen besonders zu beachten. Bei dem Einsatz von Spiegelbildkonfrontation geht es um den Aufbau positiver körperbezogener Gedanken. Die Aktivierung von Traurigkeit und Ärger erfordern effektive Strategien der Emotionsregulation, die in der Therapie erarbeitet werden können

Implicit approach-avoidance tendencies toward food and body stimuli absent in individuals with anorexia nervosa, bulimia nervosa, and healthy controls

Objective Body and food-related information are thought to activate cognitive biases and contribute to the maintenance of eating disorders (ED). Approach-avoidance biases may play an important role in the maintenance of dietary restriction and excessive food intake. Therefore, the present study aimed to examine approach-avoidance biases toward food and body stimuli in individuals with anorexia nervosa (AN), bulimia nervosa (BN), and healthy controls (HC). Methods The study included 42 individuals with AN, 24 individuals with BN, and 38 HCs. We used two implicit Approach-Avoidance Tasks (AAT) to assess approach-avoidance biases: participants completed a Food-AAT (high-calorie vs. low-calorie food) and a Body-AAT (thin vs. normal weight bodies). Additionally, explicit ratings of food and body stimuli were assessed. Results There were no significant Group × Stimulus × Direction interactions in the implicit Food-AAT or implicit Body-AAT. In explicit ratings, individuals with AN and BN reported less urge to eat and more regret if they ate high-calorie and low-calorie food; individuals with AN and BN rated normal weight bodies as less normal weight, less attractive and less desirable than HCs. There were no group differences in explicit ratings of the thin body. Discussion We did not find evidence for biased approach-avoidance tendencies toward food or body stimuli in individuals with AN or BN. Future studies are necessary to understand conflicting findings regarding approach-avoidance biases toward food and body stimuli in individuals with ED

Body-related cognitions, affect and post-event processing in body dysmorphic disorder

Background and objectives Cognitive behavioural models postulate that individuals with BDD engage in negative appearance-related appraisals and affect. External representations of one's appearance are thought to activate a specific mode of processing characterized by increased self-focused attention and an activation of negative appraisals and affect. Methods The present study used a think-aloud approach including an in vivo body exposure to examine body-related cognitions and affect in individuals with BDD (n = 30), as compared to individuals with major depression (n = 30) and healthy controls (n = 30). Participants were instructed to think aloud during baseline, exposure and follow-up trials. Results Individuals with BDD verbalized more body-related and more negative body-related cognitions during all trials and reported higher degrees of negative affect than both control groups. A weaker increase of positive body-related cognitions during exposure, a stronger increase of sadness and anger after exposure and higher levels of post-event processing, were specific processes in individuals with BDD. Limitations Individuals with major depression were not excluded from the BDD group. This is associated with a reduction of internal validity, as the two clinical groups are somewhat interwoven. Key findings need to be replicated. Conclusion The findings indicate that outcomes such as negative appearance-related cognitions and affect are specific to individuals with BDD. An external representation of one's appearance activates a specific mode of processing in BDD, manifesting itself in the absence of positive body-related cognitions, increased anger and sadness, and high levels of post-event processing. These specific processes may contribute toward maintenance of BDD psychopathology

Körperdysmorphe Störung und Essstörungen : Gemeinsamkeiten und Unterschiede im Überblick

Die körperdysmorphe Störung (KDS) zählt neben den Essstörungen zu den Störungen des Körperbildes. Dieser Artikel geht auf das Verhältnis zwischen KDS und Essstörungen ein, er beleuchtet folgende Fragen: KDS – was ist das? Was hat die KDS mit Essstörungen zu tun? Welche Gemeinsamkeiten und Unterschiede bestehen zwischen KDS und Essstörungen? Welche Implikationen haben Gemeinsam­keiten und Unterschiede für Diagnostik und Psychotherapie

Visual selective attention in body dysmorphic disorder, bulimia nervosa and healthy controls

Objective Cognitive behavioral models postulate that selective attention plays an important role in the maintenance of body dysmorphic disorder (BDD). It is suggested that individuals with BDD overfocus on perceived defects in their appearance, which may contribute to the excessive preoccupation with their appearance. Methods The present study used eye tracking to examine visual selective attention in individuals with BDD (n = 19), as compared to individuals with bulimia nervosa (BN) (n = 21) and healthy controls (HCs) (n = 21). Participants completed interviews, questionnaires, rating scales and an eye tracking task: Eye movements were recorded while participants viewed photographs of their own face and attractive as well as unattractive other faces. Results Eye tracking data showed that BDD and BN participants focused less on their self-rated most attractive facial part than HCs. Scanning patterns in own and other faces showed that BDD and BN participants paid as much attention to attractive as to unattractive features in their own face, whereas they focused more on attractive features in attractive other faces. HCs paid more attention to attractive features in their own face and did the same in attractive other faces. Conclusion Results indicate an attentional bias in BDD and BN participants manifesting itself in a neglect of positive features compared to HCs. Perceptual retraining may be an important aspect to focus on in therapy in order to overcome the neglect of positive facial aspects. Future research should aim to disentangle attentional processes in BDD by examining the time course of attentional processing

Classification of body dysmorphic disorder : What is the advantage of the new DSM-5 criteria?

Objective In DSM-5 the diagnosis of body dysmorphic disorder (BDD) has been subjected to two important changes: Firstly, BDD has been assigned to the category of obsessive–compulsive and related disorders. Secondly, a new criterion has been defined requiring the presence of repetitive behaviors or mental acts in response to appearance concerns. The aims of this study were to report the prevalence rates of BDD based on a DSM-5 diagnosis, and to evaluate the impact of the recently introduced DSM-5 criteria for BDD by comparing the prevalence rates (DSM-5 vs. DSM-IV). Methods BDD-criteria (DSM-IV/DSM-5), dysmorphic concerns, and depressive symptoms, were assessed in a representative sample of the German general population (N = 2129, aged 18–65 years). Results The association between BDD case identification based on DSM-IV and DSM-5 was strong (Phi = .95, p < .001), although point prevalence of BDD according to DSM-5 was slightly lower (2.9%, n = 62 vs. 3.2%, n = 68). Approximately one third of the identified BDD (DSM-5) cases reported time-consuming behavioral acts in response to appearance concerns. In detail, 0.8% of the German general population fulfilled the BDD criteria and reported repetitive acts of at least one hour/day. Conclusions The revised criteria of BDD in DSM-5 do not seem to have an impact on prevalence rates. However, the recently added B-criterion reflects more precisely the clinical symptoms of BDD, and may be useful for distinguishing between various severity levels related to repetitive behaviors/mental acts

An app-based blended intervention to reduce body dissatisfaction : A randomized controlled pilot study

OBJECTIVE: As a common experience in the general population, dissatisfaction with one's body is associated with a variety of psychological problems and unhealthy behaviors, including the development of eating disorders. Therefore, the purpose of the present study was to develop and evaluate an app-based intervention to reduce body dissatisfaction. METHOD: Participants reporting elevated levels of body dissatisfaction were randomly allocated to an app-based intervention (n = 26) or to a wait list group (n = 27). The app-based intervention included a brief counseling session and 14 days of training with the Mindtastic Body Dissatisfaction app (MT-BD). The MT-BD app uses gamification strategies to systematically foster approach of functional and avoidance of dysfunctional stimuli. The primary outcome was body dissatisfaction as assessed with the Body Dissatisfaction scale of the Eating Disorder Inventory-2 (Garner, 1991). Secondary outcome measures included severity of eating disorder symptoms and depressive symptoms. RESULTS: Participants in the intervention group showed significantly greater reductions in body dissatisfaction compared to the wait list group (d = -0.62). The intervention group also showed greater reductions in eating disorder symptoms compared to the wait list group (d = -0.46). Reductions in body dissatisfaction and eating disorder symptoms were sustained at a 1-month follow-up. CONCLUSION: We found preliminary evidence that an app-based intervention may significantly reduce body dissatisfaction. Further research using larger samples and targeting clinical populations is necessary to evaluate the potential of interventions such as MT-BD

Body image disturbance in body dysmorphic disorder and eating disorders : similarities and differences

Hintergrund: Sowohl die körperdysmorphe Störung (KDS) als auch Essstörungen (ESS) sind durch eine Störung des Körperbildes gekennzeichnet, jedoch ist wenig über Gemeinsamkeiten und Unterschiede hinsichtlich spezifischer Körperbildmerkmale bekannt. Fragestellung: Nach der vergleichenden Befunddarstellung zu perzeptiven, kognitiv-affektiven und behavioralen Körperbildmerkmalen hat die Arbeit das Ziel, kognitiv-affektive Körperbildcharakteristika im direkten Vergleich von KDS mit ESS zu untersuchen. Methode: Personen mit einer KDS (n = 31), Anorexia nervosa (n = 32), Bulimia nervosa (n = 34) und eine gesunde (n = 33) Kontrollgruppe wurden untersucht (Fragebögen, Interviews). Ergebnisse: KDS und ESS zeigten starke Körperunzufriedenheit und körper- und gewichtsbezogene Schamgefühle. Nicht nur bei der KDS, sondern auch bei den ESS zeigte sich eine Vielzahl subjektiver Makel im äußeren Erscheinungsbild. Die KDS-Gruppe sorgte sich jedoch seltener als ESS um Körpergewicht, Brust und Gesäß. Die ESS-Gruppen berichteten erwartungsgemäß stärkere Figur-/Gewichtssorgen und körper-/gewichtsbezogene Schuldgefühle. Diskussion: Körperunzufriedenheit charakterisiert sowohl KDS als auch ESS. Von den kognitiv-affektiven Körperbildmerkmalen differenzieren nur die Ausprägung von Figur-/Gewichtssorgen und körper-/gewichtsbezogene Schuldgefühle die beiden Gruppen. Vergleichsstudien zu perzeptiven und behavioralen Körperbildaspekten stehen aus.Background: Body dysmorphic disorder (BDD) and eating disorders (ED) are considered to be body image disorders; however, little is known about similarities and differences concerning specific body image characteristics. Objective: The aim of this study is to integrate findings on similarities and differences concerning body image characteristics in people with BDD and ED and to examine cognitive and affective features of disturbed body image in BDD and ED. Methods: Individuals with BDD (n = 31), anorexia nervosa (n = 32), bulimia nervosa (n = 34), and healthy controls (n = 33) were examined (questionnaire and interview measures). Results: There were high levels of body dissatisfaction and weight- and body-related shame in BDD and EDs. BDD and EDs worried about a considerable number of body parts. The BDD group worried less about weight, buttocks and breasts than the ED groups. The ED groups reported higher levels of shape and weight concerns and of weight- and body-related guilt. Discussion: BDD and EDs are characterized by high levels of body dissatisfaction. Disorder-specific cognitive-affective measures of body image, such as weight and shape concerns as well as weight- and body-related guilt, differ between the groups. Comparative studies are warranted that examine perceptional and behavioural features of body image