Body Checking and Avoidance in BED

Overweight patients with binge eating disorder (BED) may be overconcerned with body shape and weight, as shown by two alternate behaviors–frequently checking their bodies yet paradoxically avoiding their bodies at other times.

An example of body checking is pinching or measuring specific body parts to judge “fatness.” Body avoidance is an opposite behavior, where a person avoids tight-fitting clothing or tries to avoid looking in mirrors. Body avoidance may prevent patients from overcoming their irrational beliefs about shape and weight, and may interfere with enjoyment of any successful weight loss.

For patients with bulimia nervosa and anorexia nervosa, the frequency of checking and body avoidance is positively and significantly related to the degree of over-evaluation of shape and weight. Furthermore, weight checking appears to lead to further dietary restraint regardless of a net loss, gain, or stable weight. These results lend support to the hypothesis that checking and avoidance may maintain eating disorders.

A recent study

According to Dr. Deborah L. Reas and colleagues, clinical lore holds that overweight patients with BED often use body avoidance behaviors, but are believed to check their bodies less than normal-weight BED patients (Int J Eat Disord 2005;37:342). Dr. Reas and colleagues recently studied a group of overweight adults seeking treatment (BMI>25). The 80 men and 297 women all met Diagnostic and Statistical Manual of Mental Disorders, 4th revision (DSM-IV) criteria for BED. The authors used the Body Shape Questionnaire (BSQ) the Eating Disorder Examination-Questionnaire (EDE-Q), and the Three-Factor Eating Questionnaire (TFEQ), a 51-item self-report questionnaire with three subscales reflecting 3 eating-related domains. Two of the three subscales in the TFEQ, the Cognitive Restraint and Disinhibition subscales, were used to measure the relationship between dieting behavior and the tendency to overeat with body checking and body avoidance.

More than half were affected

More than half (57.4%) of the participants reported that they often, usually, or always pinched areas of their bodies to check for fatness. The majority (53.8%) always avoided wearing clothing that made them particularly aware of their body shape. There weren’t any marked differences between men and women on the body-checking item; however, men and women differed significantly on their scores for body avoidance. Women reported greater avoidance of clothing that made them particularly aware of their shapes than did men.

Body checking and body avoidance were not mutually exclusive; instead, the behaviors either occurred at the same time or alternated. A significant pattern of relationships remerged between checking and restraint and conversely between body avoidance and binge eating, according to the authors. These patterns lend support to the potential role of checking and avoidance behaviors and maintenance of eating disorders.

Transient mood swings may explain the alternating behaviors

The authors speculate that patients swing back and forth between feelings of being in or out of control, marked either by periods of intense body checking accompanied by dietary restraint or conversely, body avoidance accompanied by disinhibition and binge eating. Those transient mood states might help explain why a patient might vacillate between the two behaviors.