When Poor Body Image Persists After Recovery

A trait that overcomes internal cues and affects the sense of the bodily self.

For some patients, negative body image persists even after they have recovered and are back at a healthy normal weight. According to results from recent studies by a team of British and Australian researchers, increased malleability of the bodily self may be a trait phenomenon in people with eating disorders (In J Eat Disord. 2014; 47:400).

According to the authors, few studies to date have considered the bodily self in people who have recovered from an eating disorder. Instead, more often the focus has been on physiological functioning. Ertimiss Eshkevari, PhD, from Kings College, London, and colleagues at the Australian National University, Canberra, used the rubber hand illusion test and several self-report questionnaires to study 28 individuals with eating disorders, 28 former patients who had recovered from an eating disorder, and 61 healthy controls. The goal was to learn whether changing body image is a state phenomenon or a persisting individual trait that outlasts the acute period of an eating disorder.

A test of an illusion made real

In the rubber hand illusion, subjects view a rubber hand placed in front of them in the same position as their own hand (but not visible to them). When the fake hand is stroked synchronously with stroking the participant’s real (and unseen) hand, the participant feels the touch on the fake hand as if the fake hand were real. This test thus evaluates touch, vision, and proprioception. In an earlier rubber hand illusion experiment, the authors found that persons with eating disorders felt the illusion to a far greater degree than did normal subjects. The authors’ more recent study was an attempt to study this phenomenon further.

Study participants were recruited from student and staff members at a tertiary care institution in the United Kingdom, from an eating disorder research volunteer database, and from individuals who responded to posters advertising the study. All participants completed the Structural Clinical Interview for Diagnosis, Research Version (SCID-1), the Eating Disorders Inventory-3 (EAD-3), and the Self-Objectification Questionnaire, a 10-item self-report assessment of how much individuals view their bodies in observable, appearance-based objectified terms versus non-observable, competence-based, non-objectified terms. Of the 28 patients with histories of eating, 20 had AN, 6 had BN, and 2 had EDNOS. The control group included 68 persons with no history of eating disorders.

Recovered patients and those with current eating disorders had higher stress, depression, and anxiety

While there were no significant differences between groups in age, years of education, or handedness, the healthy controls had significantly higher body mass indexes (BMI, or kg/m²) and significantly lower levels of body dissatisfaction than did the ED and recovered (REC) groups. The ED and REC groups were significantly more stressed, depressed, and anxious than were the healthy controls, and the ED group was significantly more depressed, stressed, and anxious than were the REC group. The REC and ED group reported greater drive for thinness, bulimia, interoceptive deficits, and emotional dysregulation than did the healthy controls.

The results from the rubber hand test provide some evidence for malleability of the self as a trait. On other measures, recovered patients scored between acutely ill patients and controls, suggesting a stored quality to some disturbances. This suggests that eating disorders involve a trait vulnerability associated with heightened sensitivity of visual information about the body.

Some possible clinical applications

The authors feel that these results may help improve understanding of what causes eating disorders and why they persist. For example, it may be that before the onset of illness a person may have heightened sensitivity to external visual information—relating to the thin ideal. The authors also feel that their study results suggest that an imbalance between internal and external representations of the body is a trait of eating disorders rather than just a feature of the disorder in the acute state. Because of this, the eating disorder patient continues to experience a disturbed body self despite regaining weight. Sensory of kinesthetic training may be helpful for reversing these effects and improving accuracy of body image.