Eating Disorders and Body Image Research

Eating Disorders: An Overview

Threshold Eating Disorders (APA, 2013)

• Anorexia Nervosa (AN)
• Bulimia Nervosa (BN)
• Binge Eating Disorder (BED)
• Other Specified Feeding or Eating Disorder (OSFED)
• Avoidant/Restrictive Food Intake Disorder (ARFID)

Anorexia Nervosa (AN)

Core DSM-5 Criteria

1. Significantly low body weight: Considered in the context of age, sex, and growth trajectory.
2. Intense fear of gaining weight: Or persistent behavior that avoids weight gain.
3. Distorted body image: Includes denial of the seriousness of low weight.

Subtypes

• Restricting Type: No bingeing or purging behaviors in the last 3 months.
• Binge-Eating/ Purging Type: Recurrent bingeing or purging behaviors.

Bulimia Nervosa (BN)

Core DSM-5 Criteria

1. Recurrent binge eating: Characterized by eating a large amount of food with a sense of loss of control.
2. Recurrent compensatory behaviors: Examples include vomiting, fasting, or excessive exercise.
3. Self-evaluation influenced by body weight/shape.
4. Frequency: Occurring at least once a week for 3 months.

Binge Eating Disorder (BED)

Diagnostic Criteria

1. Bingeing: Occurring at least once a week for 3 months.
2. Associated Features: Includes three or more of the following:
   • Eating rapidly.
   • Eating when not hungry.
   • Eating in secret due to embarrassment.
   • Eating until feeling uncomfortably full.
   • Feeling guilt or disgust afterward.
3. Absence of Compensatory Behaviors: No regular use of vomiting, laxatives, or other methods to counteract the binge eating.
4. Distress: Causes marked distress.

Other Specified Feeding or Eating Disorder (OSFED)

• Eating disorder symptoms that do not meet the full criteria for Anorexia Nervosa (AN), Bulimia Nervosa (BN), or Binge Eating Disorder (BED).

Avoidant/Restrictive Food Intake Disorder (ARFID)

• Restrictive eating: Not due to concerns about weight or shape.
• Reasons: May include sensory issues, fear of choking, or lack of interest in food.

Emotion Dysregulation in BED & FA

Research Overview

• Food addiction (FA) and binge eating disorder (BED) are linked to shared and unique deficits in emotion regulation among females seeking bariatric surgery.
• Negative affect/extreme emotional state - Problematic eating behaviors may act as a coping strategy
• Binge eating and Food Addiction as a coping mechanism for intense emotional states

Question

• How FA and BED, two types of eating pathologies in the obesity spectrum, vary from one another in terms of emotion dysregulation?

DERS Scores

• Comparison of DERS (Difficulties in Emotion Regulation Scale) scores of patients by their group allocation.

  • Groups: BED/FA, BED, FA, Obesity only.

• Emotional Eating

  • Comparison of emotional eating severity of patients by their group allocation.
  • Groups: BED/FA, BED, FA, Obesity only.

• Scores

  • NON-ACCEPTANCE
    • BED/FA $= 20.41$
    • BED $= 17.93$
    • FA $= 18.54$
    • Obesity only $= 16.93$
  • GOALS
    • BED/FA $= 24.77$
    • BED $= 12.58$
    • FA $= 19.37$
    • Obesity only $= 16.94$
  • IMPULSE
    • BED/FA $= 17.65$
    • BED $= 16.48$
    • FA $= 24.6$
    • Obesity only $= 11.77$
  • AWARENESS
    • BED/FA $= 16.6$
    • BED $= 14.62$
    • FA $= 15.05$
    • Obesity only $= 14.4$
  • STRATEGIES
    • BED/FA $= 20.28$
    • BED $= 10.91$
    • FA $= 11.22$
    • Obesity only $= 11.37$
  • CLARITY
    • BED/FA $= 12.93$
    • BED $= 15.03$
    • FA $= 8.96$

  EMOTIONAL EATING

  • BED/FA $= 46.8$
  • BED $= 42.14$
  • FA $= 40.45$
  • Obesity only $= 27.29$

Body Image in Eating Disorders

Significance

• Central Risk Factor: Body image is a central risk factor for the onset and maintenance of eating disorders (EDs).
• Harmful Behaviors: It drives harmful behaviors such as restriction, purging, and bingeing.
• Understanding Development/Recovery: Essential to understanding both development and recovery in EDs.

Body Image Dissatisfaction (BID)

• Prevalence: BID is highly prevalent in women in Western cultures.
• Root: Rooted in overvaluation and internalization of the thin ideal.

Cultivation Theory

Media Influence

• Long-term media exposure: Shifts values to match media ideals.
• Shift toward thin: Since the 1980s, there has been a shift toward thinness as the ideal.
• Media-promoted ideals: Drive body image dissatisfaction and ED symptoms.
• Internalization: Internalization of these ideals fosters ED development, especially in women.

Male Body Image

Increasing Research Focus

• Before 2000: Only 44 PsycInfo publications on male BID.
• From 2000–2022: 468 peer-reviewed studies.
• Significance: Signifies a growing recognition of male body image concerns.
• Similarities to Women: Like women, men experience BID driven by societal ideals.

Body Image Ideals for Men

• Desire for increased muscularity.
• Desire for thinness.
• Combination: Or a combination of muscularity + leanness.
• Multidimensional: BID in men is multidimensional and tied to emerging eating disorder symptoms and poor mental health outcomes.

Research Gap: Drive for Thinness (DFT) and Drive for Muscularity (DFM)

Gap in Literature

• No prior review of how Drive for Thinness (DFT) and Drive for Muscularity (DFM) measures are applied to assess male BID.

Research Aim

• Conduct a scoping review of studies measuring male BID
  • Classify BID measures into 3 categories:
    1. Thinness-oriented
    2. Muscularity-oriented
    3. General appearance/nonspecific

Purpose

• Evaluate how often thinness measures are applied to men.
• Identify potential misalignment in assessment approaches.

Addressing Underrepresented Groups

Groups at Elevated ED Risk

• Race, ethnicity, size, age, SES, sexual orientation, gender identity.

Social Media's Role

• Why focus on male and LGBTQ+ populations?
  • Historically neglected
  • Increasing prevalence of EDs
  • Unique sociocultural pressures and BID expressions.