The nature and significance of body image disturbance
A disturbance in body image is generally recognised as central to the eating disorders. Although misperception of body size has been examined extensively in anorexia nervosa, there has been no satisfactory study of a disturbance in body size perception in relation to the eating disorder bulimia nervosa. In addition, concern about body shape, which also constitutes an important aspect of body image disturbance, has received little systematic research attention, probably because there has been no satisfactory measure of this concern. A series of studies was conducted which aimed to overcome the problems and limitations associated with the research on body image. The significance of body image disturbance was investigated among patients with bulimia nervosa; and similar disturbances among women in the community were evaluated. A measure of concern with shape, the Body Shape Questionnaire, was developed and validated. The responses of a large series of patients with bulimia nervosa were obtained, and the relationship between concern with shape and other clinical variables was investigated. A particularly high level of such concern in these patients was found to be associated with markedly disturbed eating behaviour and a high level of general psychological disturbance, most notably depressed mood and self-depreciation. Body size perception in bulimia nervosa was also investigated. Using an image distortion method, the patients were found to overestimate their size significantly more than a control group, and were markedly more dissatisfied with their body size. Similar to concern with shape, disturbances in body size perception were found to be associated with disturbed eating behaviour and a high level of psychological disturbance. Among a sub-sample of patients who received treatment, both aspects of body image disturbance were found to improve; and changes in body image were closely related to improvements in eating habits and attitudes and were accompanied by a concurrent improvement in mood. Some women in the community were found to show disturbances in body image similar to those found in the patients with bulimia nervosa. A series of studies was conducted to identify factors related to these disturbances. A high level of concern with shape was found to emerge at a young age, and was associated with a number of factors which have also been established as significant in patients with eating disorders; notably disturbed eating habits and attitudes and depressed mood. For the subgroup of women in whom concern with shape was found to be labile, changes in these concerns were found to co-vary with mood. As in patients with eating disorders, among women in the community a disturbance in body size perception was found to be closely related to depressed mood and concern with shape; and some evidence was found to support the hypothesis that depressed mood may exacerbate disturbances in body size perception, particularly in the context of a high level of concern with shape. The series of studies has demonstrated that patients with bulimia nervosa show a disturbance in body image; that such disturbance is meaningfully related to other features of the eating disorder; and that similar features also predict such disturbance among women in the community with no syndromal eating disorder. In these studies of body image disturbance in patients with bulimia nervosa, patients with anorexia nervosa and women in the community, a consistent finding was that depressed mood was strongly predictive of such disturbance. The research has implications for the understanding of the psychopathology of eating disorders and possibly for the treatment of body image disturbance as it arises in these conditions.