gms | German Medical Science

Background: Individuals with eating disorders (ED) are characterized by a disturbed body image which encompasses fluctuating behavioral patterns of body image avoidance and body checking. Experimental measures of these clinically relevant behavioral patterns are currently missing. Using the Behaviour Approach Test, a well-established behavioral measure of phobic anxiety, as a starting point, we developed the Body Image Approach Test (BIAT).

Methods: Participants were asked to explore an initially blurred photo of their own body on the screen. Approach was implemented by allowing participants to “zoom in”, i.e. enlarge and focus the photo. A photo of another person matched in BMI served as control stimulus. Twenty-one women with Anorexia Nervosa, 18 women with Bulimia Nervosa and 23 healthy female controls completed the BIAT. Following each picture, participants rated the attractiveness, body shape and satisfaction for the presented picture. Zoom level and viewing time served as dependent measures. Participants’ checking and avoidance behavior were assessed with the Body Checking Questionnaire and Body Image Avoidance Questionnaire.

Results: The self-report ratings revealed a general difference in the perception of the stimulus material. ED patients rated themselves as less attractive, with a bigger body size and were less satisfied with their own image, whereas healthy controls rated themselves as more attractive, satisfied and with a normal body shape (ps<.01). Also, self-ratings correlated highly negative with body checking and avoidance (ps<.001). For the BIAT, no difference was found in zoom or viewing times between the two groups. As an exploratory analysis, participants were split into high vs. low body checkers. A significant interaction emerged between the amount of body checking, picture type and angle (F=3.42, p<.05). High-checkers avoided pictures of themselves taken from the side, whereas they zoomed in more into pictures from others.

Conclusions: The BIAT seems to tap into the specific construct of checking behavior rather than general ED psychopathology. So far, it cannot differentiate between patients and healthy controls. Probably the stimulus selection is highly relevant. Pictures taken from the side may reveal more easily fat pads or other unattractive parts that are necessary to evoke differences in approach behavior. Future research is needed to explain the unexpected impact of checking behavior on zoom level between self and other. One possible mechanism may be social comparisons.