Körperbildtherapie bei Essstörungen

Zusammenfassung. Theoretischer Hintergrund: Ein negatives Körperbild kann sich bei Essstörungen in einer Überschätzung der eigenen Körperdimensionen (perzeptive Komponente), negativen Gedanken und Gefühlen hinsichtlich des eigenen Körpers (kognitiv-affektive Komponente) sowie körperbezogenem Vermeidungs- und Kontrollverhalten (behaviorale Komponente) manifestieren. Fragestellung: Es soll überprüft werden, ob diese drei Komponenten eines gestörten Körperbildes durch ein kognitiv-verhaltenstherapeutisches Körperbildtherapieprogramm verbessert werden können. Methode: 24 Essstörungspatientinnen wurden vor und nach einer zehn Sitzungen umfassenden Körperbildtherapie sowie nach einem dreimonatige…

Can neurophysiological markers of anticipation and attention predict ADHD severity and neurofeedback outcomes?

Abstract Neurophysiological measures of preparation and attention are often atypical in ADHD. Still, replicated findings that these measures predict which patients improve after Neurofeedback (NF), reveal neurophysiological specificity, and reflect ADHD-severity are limited. Methods We analyzed children’s preparatory (CNV) and attentional (Cue-P3) brain activity and behavioral performance during a cued Continuous Performance Task (CPT) before and after slow cortical potential (SCP)-NF or semi-active control treatment (electromyogram biofeedback). Mixed-effects models were performed with 103 participants at baseline and 77 were assessed for pre-post comparisons focusing on clinical outcome p…

Inhibitory control pathway to disinhibited eating: A matter of perspective?

Abstract Recent studies highlight the importance of disinhibited eating and underlying inhibitory control deficits in the maintenance of obesity. So far, inhibition facets have been examined in isolation and findings are inconsistent due to different measures. This study illustrates the multifaceted nature of inhibitory control by comparing different inhibition stages in outpatients with chronic overweight (with binge eating disorder, BED, n = 24; Non-BED, n = 47) and healthy controls (HC, n = 30). Besides reporting impulsive patterns (UPPS), participants performed the Food Stroop (FST), Door Opening (DOT) and Stop Signal (SST) task with food and generic stimuli. The results showed a signif…

Dysfunktionale Kognitionen bei Essstörungen: Welche Inhaltsbereiche lassen sich unterscheiden?

Zusammenfassung. Theoretischer Hintergrund: Dysfunktionale Kognitionen tragen häufig zur Entstehung und Aufrechterhaltung einer Essstörung bei und sind zentral in der Behandlung selbiger. Fragestellung: Können dysfunktionale Kognitionen spezifischen Bereichen zugeordnet werden und differenzieren diese zwischen den unterschiedlichen Essstörungstypen? Methode: Es wurde eine Fragebogen (FEDK) entwickelt, der spezifische Bereiche dysfunktionaler Kognitionen bei Essstörungen erfasst. Zur Bestimmung der Faktorenstruktur wurden zwei Studien durchgeführt (n = 856; n = 120). Gruppenunterschiede (AN, BN, BED) und Zusammenhänge zur Essstörungspathologie (EDI-2, EDE-Q) wurden berechnet. Ergebnisse: Du…

Emotion regulation in adolescents with anorexia and bulimia nervosa: Differential use of adaptive and maladaptive strategies compared to healthy adolescents

Objective: Adolescents with anorexia (AN) and bulimia nervosa (BN) often struggle with emotion regulation (ER). These difficulties have predominantly been assessed across emotions, without considering adaptive and maladaptive ER separately.We compared adolescents with AN or BN to healthy adolescents (HCs) regarding the adaptive and maladaptive ER of three emotions. Methods: A treatment-seeking sample of 197 adolescents (atypical/full-threshold AN: N = 118, atypical/full-threshold BN: N = 32; HC: N = 47) reported emotion-specific ER with the FEEL-KJ questionnaire. Mixed models were calculated for adaptive and maladaptive ER to assess differences between emotions (anxiety, anger, sadness) and…

Drop-out and treatment outcome of outpatient cognitive-behavioral therapy for anorexia nervosa and bulimia nervosa.

In the present study, drop-out-analyses were carried out for a manual-based cognitive–behavioral therapy for 104 females with anorexia nervosa (AN) and bulimia nervosa (BN), in the service setting of a university outpatient clinic (naturalistic setting). A total of 22.9% of patients with AN terminated therapy prematurely (drop-outs), compared to 40.6% of patients with BN. Group differences between drop-outs and completers show that the group of drop-outs with BN had higher values in the depression score at the start of therapy and was almost two times more likely to have a comorbid disorder (odds ratio 1.69), whereas drop-outs with AN had higher values in the outcome-scale drive for thinnes…

What happens in the course of body exposure?

Abstract Objective Though body exposure seems to enhance outcome in cognitive-behavioural therapy of anorexia and bulimia nervosa, the underlying mechanisms are still unknown. Methods Participants with eating disorders (ED; n = 21) and normal controls (NC; n = 28) were exposed to their own bodies in front of a mirror for 40 minutes under standardized conditions. Emotions, cognitions, and saliva cortisol were assessed every 10 minutes during body exposure. Heart rate and skin conductance were recorded continuously. Results ED showed higher negative emotional and cognitive responses to body exposure compared to NC, whereas no group differences were found for physiological reactions. In the co…

Längerfristige Effekte einer essstörungsspezifischen KVT im naturalistischen Setting

In naturalistischen Studien konnte die Wirksamkeit der KVT bei Essstorungen aufgezeigt werden. Es fehlen Studien mit langerfristigen Effekten im Praxissetting. Insgesamt wurden n=99 Frauen mit der DSM-IV Hauptdiagnose einer Essstorung untersucht. Von 53,5% (n=53) lagen Daten mit langerfristiger Dauer vor. Als Messinstrumente wurden EDE-Q, BDI und BSI herangezogen, welche zu Beginn, am Ende sowie mind. 18 Monate nach Behandlungsende eingesetzt wurden. Die Pra-/Post-Effektstarken blieben im Langzeitverlauf stabil. Auch der Anteil der Responder blieb durchschnittlich gleich hoch (63,6%), wobei 25% den Responder-Status verloren und 22,7% im Langzeitverlauf eine Spontanremission zeigten. Die dur…

EEG Data Quality: Determinants and Impact in a Multicenter Study of Children, Adolescents, and Adults with Attention-Deficit/Hyperactivity Disorder (ADHD)

Electroencephalography (EEG) represents a widely established method for assessing altered and typically developing brain function. However, systematic studies on EEG data quality, its correlates, and consequences are scarce. To address this research gap, the current study focused on the percentage of artifact-free segments after standard EEG pre-processing as a data quality index. We analyzed participant-related and methodological influences, and validity by replicating landmark EEG effects. Further, effects of data quality on spectral power analyses beyond participant-related characteristics were explored. EEG data from a multicenter ADHD-cohort (age range 6 to 45 years), and a non-ADHD sc…

Differences in the nature of body image disturbances between female obese individuals with versus without a comorbid binge eating disorder: an exploratory study including static and dynamic aspects of body image.

Various components of body image were measured to assess body image disturbances in patients with obesity. To overcome limitations of previous studies, a photo distortion technique and a biological motion distortion device were included to assess static and dynamic aspects of body image. Questionnaires assessed cognitive-affective aspects, bodily attitudes, and eating behavior. Patients with obesity and a binge eating disorder (OBE, n = 15) were compared with patients with obesity only (ONB; n = 15), to determine the nature of any differences in body image disturbances. Both groups had high levels of body image disturbances with cognitive-affective deficits. Binge eating disorder (BED) par…

Food intake affects state body image: Impact of restrained eating patterns and concerns about eating, weight and shape

Body image disturbances play a significant role in the development of eating disorders. Since body image can vary in diverse contexts, the aim of the present experiment was to investigate whether it is affected by recent food intake. Fifty-seven females without clinically relevant eating disorders were randomly assigned to an experimental group (EG, n=28) that consumed a milkshake while watching a neutral film and a control group (CG, n=29) that only viewed the movie. Before and after the tasks, participants filled in the "Body Image States Scale" and the "Mood Questionnaire" and indicated their own "actual", "felt" and "ideal" body dimensions with a digital distortion technique based on a …

Two sides of the same coin? A new instrument to assess body checking and avoidance behaviors in eating disorders

Body checking (BC) and avoidance behaviors (BA) are the dominant behavioral features of body image disturbances (BID) that characterize most individuals with eating disorders (EDs). Whereas BC can be reliably assessed, a valid assessment tool for BA is lacking, preventing an adequate assessment of BID differences across different EDs (anorexia nervosa, AN; bulimia nervosa, BN; binge eating disorder, BED). A total of 310 women with EDs and 112 nonclinical controls completed measures of BC-, BA- and ED-related symptoms. BA did not differentiate between EDs, whereas BC did: it was highest in AN and BN, and lowest in BED. Multivariate analyses also discriminated AN from BN based on BC. Given th…

Preference for attractiveness and thinness in a partner: Influence of internalization of the thin ideal and shape/weight dissatisfaction in heterosexual women, heterosexual men, lesbians, and gay men

This study assesses whether characteristics of one's own body image influences preferences of attractiveness in a partner. The role of gender and sexual orientation is also considered. Heterosexual women (n=67), lesbian women (n=73), heterosexual men (n=61) and gay men (n=82) participated in an internet survey assessing attitudes towards the body and preferences of attractiveness in a partner. Men in particular were found to prefer attractive partners, regardless of sexual orientation. Weight/shape dissatisfaction was found to be a negative predictor for heterosexual men and women. For gay men, preferences were better explained by internalization and weight/shape dissatisfaction. No such as…

Are individuals with an eating disorder less sensitive to aesthetic flaws than healthy controls?

Abstract Objective This study aimed to investigate whether the positive evaluation of other people's bodies is due to difficulties in the recognition of flaws in attractive features of others. Method Thirty female individuals with an eating disorder (IEDs) and 30 normal controls (NCs) rated pictures of a woman's face in relation to various manipulated facial features. Accuracy rates, discrepancy scores, and response times were assessed. Participants also answered questionnaires relating to social comparison, internalization of the slender ideal, and eating disorder symptoms. Results NCs were significantly more accurate at detecting flaws and recognized the degree of manipulation better than…

Influence of Weight on Shared Core Symptoms in Eating Disorders

In terms of the transdiagnostic model of eating disorders, Anorexia Nervosa (AN), Bulimia Nervosa (BN), and Binge Eating Disorder (BED) share the same distinctive psychopathology. However, empirical evidence showing similarities between these eating disorder diagnoses for core symptoms is scarce, and the role of weight status is unclear. Data from a total of 168 female participants were collected between April 2004 and April 2008, at an outpatient unit specialized in eating disorder treatment. Core symptoms of eating disorders were measured via self-report questionnaires. In particular, women with BED and BN showed similar patterns of core symptomatology compared with AN. However, when body…

Body image avoidance affects interpersonal distance perception: A virtual environment experiment.

OBJECTIVE Eating disorders have a considerable influence on social contacts. The avoidance towards the own body may result in the avoidance of others. Previous research has found a preference for larger interaction distances in individuals with eating disorders (ED) as compared to control participants (CG). We aimed to replicate these findings and to investigate whether the body weight of the interactant moderates the effect. METHOD We recruited a female sample with mixed ED subtypes (n = 21) and a female CG (n = 28). Participants were immersed in a virtual environment and engaged in a number of fictitious social interactions. They approached a virtual person until a comfortable distance fo…

Memory bias for schema-related stimuli in individuals with bulimia nervosa

This study investigates whether individuals with bulimia nervosa (BN) have a memory bias in relation to explicit memory (cued and free recall vs. verbal and pictorial recognition tasks). Twenty-five participants diagnosed with BN and 27 normal controls (NC) were exposed to body-related, food-related, and neutral TV commercials, and then recall and recognition rates were assessed. Poorer recognition and recall of body-related stimuli was found for BN in comparison to NC, suggesting a memory bias. Results are discussed in relation to previous studies, along with suggestions as to how future studies can gain more insight into dysfunctions in information processing that can lead to the maintena…

Incontinence and constipation in adolescent patients with anorexia nervosa : Results of a multicenter study from a German web-based registry for children and adolescents with anorexia nervosa

OBJECTIVE: Nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) are common disorders in childhood and are frequently accompanied by comorbid psychiatric disorders. Despite a high association between urinary and fecal incontinence with psychiatric and neurodevelopmental disorders, research on comorbidity between incontinence and anorexia nervosa (AN) remains scarce. Yet, it is well known that somatic consequences of AN include metabolic and gastrointestinal disorders. The study sought to assess the prevalence of incontinence and constipation in children and adolescents with AN and to examine associations of these two symptoms with body weight at admission …

Validierung einer deutschsprachigen Version des Body Image Avoidance Questionnaire BIAQ

Zusammenfassung. Ziel dieser Studie ist die Validierung der deutschsprachigen Übersetzung des Body Image Avoidance Questionnaire (BIAQ). Der 19-Item-Fragebogen ist ein Instrument zur Selbstbeurteilung von Verhaltensweisen, die häufig bei Körperbildstörungen auftreten und mit Sorgen hinsichtlich der physischen Erscheinung einhergehen können. Er erfasst insbesondere körperbezogenes Vermeidungs- und Kontrollverhalten. Die deutschsprachige Version des BIAQ wurde an einer Stichprobe von n = 296 Studentinnen (KG) und n = 64 Frauen mit einer Essstörung (EG) überprüft. Die explorative Faktorenanalyse ergab im Gegensatz zur Originalversion die drei Faktoren “Kleidung“, “Soziale Aktivitäten“ und “Es…

Static and dynamic body image in bulimia nervosa: mental representation of body dimensions and biological motion patterns.

The aim of the present study was to find out whether in bulimia nervosa the perceptual component of a disturbed body image is restricted to the overestimation of one's own body dimensions (static body image) or can be extended to a misperception of one's own motion patterns (dynamic body image).Participants with bulimia nervosa (n = 30) and normal controls (n = 55) estimated their body dimensions by means of a photo distortion technique and their walking patterns using a biological motion distortion device.Not only did participants with bulimia nervosa overestimate their own body dimensions, but also they perceived their own motion patterns corresponding to a higher BMI than did controls. S…

Predictors of improved eating behaviour following body image therapy: A pilot study

Cognitive processes seem to play a vital role in eating disorders and body image. The current study, therefore, examines the impact and change of dysfunctional cognitions during a body image group therapy, which included 41 patients with an eating disorder. Dysfunctional cognitions were assessed with the 'Eating Disorder Cognition Questionnaire' both before and after treatment. Eating disorder psychopathology was also assessed. Results indicate a significant reduction of dysfunctional cognitions relating to 'body and self-esteem', 'dietary restraint', 'eating and loss of control', as well as 'internalisation and social comparison'. Furthermore, the changes in dysfunctional cognitions were a…

Seasonal variation of BMI at admission in German adolescents with anorexia nervosa.

Objective Recent preliminary studies indicated a seasonal association of BMI at admission to inpatient treatment for anorexia nervosa (AN), indicating lower BMI in the cold season for restrictive AN. An impaired thermoregulation was proposed as the causal factor, based on findings in animal models of AN. However, findings regarding seasonality of BMI and physical activity levels in the general population indicate lower BMI and higher physical activity in summer than in winter. Therefore, we aimed to thoroughly replicate the findings regarding seasonality of BMI at admission in patients with AN in this study. Method AN subtype, age- and gender-standardized BMI scores (BMI-SDS) at admission, …

Anticipatory effects of food exposure in women diagnosed with bulimia nervosa.

Objective. To investigate cephalic phase responses (CPRs) in women diagnosed with bulimia nervosa and to test the assumption that eating disordered individuals respond with more marked CPRs and higher increases in psychophysiological arousal to the presentation of food cues. Method. Thirteen female inpatients diagnosed with bulimia nervosa were compared to 15 non-eating disordered female volunteers. Participants were exposed to their preferred binge food in a single laboratory session with the possibility to eat immediately after the exposure trial. Results. The results show greater salivation responses to food exposure and lower sympathetic arousal in patients diagnosed with bulimia nervos…

Toward a Dimensional Assessment of Externalizing Disorders in Children : Reliability and Validity of a Semi-Structured Parent Interview

Objective: This study assesses the reliability and validity of the DSM-5-based, semi-structured Clinical Parent Interview for Externalizing Disorders in Children and Adolescents (ILF-EXTERNAL). Method: Participant data were drawn from the ongoing ESCAschool intervention study. The ILF-EXTERNAL was evaluated in a clinical sample of 474 children and adolescents (aged 6−12 years, 92 females) with symptoms of attention-deficit/hyperactivity disorder (ADHD). To obtain interrater reliability, the one-way random-effects, absolute agreement models of the intraclass correlation (ICC) for single ICC(1,1) and average measurements ICC(1,3) were computed between the interviewers and two independent rate…

Psychometrische Überprüfung einer deutschsprachigen Fassung des Body Checking Questionnaire (BCQ)

Zusammenfassung. Theoretischer Hintergrund: Körperbezogenes Kontrollverhalten stellt die behaviorale Manifestation eines gestörten Körperbildes dar. Fragestellung: Eine deutschsprachige Version des „Body Checking Questionnaire” (BCQ) soll hinsichtlich ihrer psychometrischen Kennwerte überprüft werden. Methode: 124 Frauen mit und 202 Frauen ohne Essstörungen sowie 64 Männer beantworteten neben dem BCQ weitere Fragebögen zu Ess- und Körperbildstörungen. Ergebnisse: Faktorenanalysen legen eine Ein-Faktor-Lösung nahe. Es ergab sich eine hohe interne Konsistenz, Test-Retest-Reliabilität und Differenzierungsfähigkeit zwischen Frauen mit und ohne Essstörungen sowie gesunden Personen beiderlei Gesc…

Influence of appearance-related TV commercials on body image state.

This study investigates the influence of media exposure on body image state in eating-disordered (ED) patients. The attitudinal and perceptual components of body image are assessed, as well as any associations with dysfunctional cognitions and behavioral consequences. Twenty-five ED patients and 25 non-ED controls (ND) viewed commercials either featuring appearance (AC; 5 min) or not featuring appearance (NC; 5 min). Both perceptual and attitudinal body image components changed markedly after the AC condition for ED patients, compared with the ND group and NC condition. Cognitions referring to dietary restraint and internalization/social comparison also changed significantly in ED patients…

Verbesserung der Impuls- und Emotionsregulation bei Binge-Eating-Störungen

Zusammenfassung. Impulsivität beeinflusst die Verarbeitung von störungsspezifischen Reizen und die Handlungskompetenz hinsichtlich der Nahrungsaufnahme. Neuere Studien adressieren daher unterschiedliche Facetten impulsiven Erlebens und Verhaltens, um eine Reduktion von Essanfällen und des Körpergewichts bei der Binge-Eating-Störung (BES) zu erzielen. ImpulsE ist ein Therapieprogramm zur Verbesserung der Impuls- und Emotionsregulationsfertigkeiten, welches mit einem computergestützten nahrungsbezogenen Inhibitionstraining kombiniert und mit einer Standardbehandlung (TAU) verglichen wurde. N = 31 Personen mit BES nahmen teil (n = 22 ImpulsE, n = 9 TAU). Die Ergebnisse zeigten Verbesserungen …

Does shape matter? preferences for a female therapist's figure among patients with eating disorders

Abstract Although the female therapist's figure has been a topic of discussion with regard to psychotherapy for eating disorders, it has not yet been addressed empirically. In this study, participants with eating disorders (n =34) and a control group of participants with anxiety disorders (n =30) were asked to indicate how important the therapist's figure is to them and what shape they would prefer a therapist to have. The therapist's figure was more important among participants with eating disorders than among those with anxiety disorders. Participants in both groups favored a therapist with an average figure. Within both groups, participants preferred their therapist to have a shape simil…

The impact of exposure to images of ideally thin models in TV commercials on eating behavior: an experimental study with women diagnosed with bulimia nervosa.

This study investigates whether eating behavior in women with diagnosed bulimia nervosa is influenced by prior exposure to images of ideally thin models. Twenty-six participants diagnosed with bulimia nervosa (BN) and 30 normal controls (NC) were exposed to body-related and neutral TV commercials; then food that typically triggers binge eating was provided, and the amount of food eaten was measured. No significant difference for food intake between NC and BN could be found, but food intake for BN was predicted by the degree of thoughts related to eating behaviors during exposure to the thin ideal. No impact of general body image or eating pathology on food intake could be found. The results…

Emotion recognition, emotional awareness and cognitive bias in individuals with bulimia nervosa

Difficulties recognizing emotion have been reported for eating disordered individuals in relation to perception of emotions in others and emotional self-awareness. It remains unclear whether this is a perceptual or cognitive-affective problem. Clarification is sought and the question of a cognitive bias is addressed when interpreting facially expressed emotions. Twenty participants with bulimia nervosa (BN) and 20 normal controls (NC) were assessed for ability to recognize emotional and neutral expressions. Emotional self-awareness was also assessed. Significant differences were found for emotional self-awareness. For emotional faces, only a poorer recognition of the emotion, surprise, for …

Improving Inhibitory Control Abilities (ImpulsE)-A Promising Approach to Treat Impulsive Eating?

Although there is preliminary evidence that inhibitory control training improves impulsive eating, less is known about the effects on eating behaviour and weight loss in clinical samples. Sixty-nine treatment-seeking adults with obesity (binge-eating disorder 33.3%; other specific feeding and eating disorders 40.6%) were randomly blockwise allocated to ImpulsE, an intervention to improve inhibitory control and emotion regulation abilities or a guideline-appropriate cognitive behavioural therapy (CBT)-based treatment as usual. Self-reported and performance-based impulsivity, eating disorder pathology and BMI were compared at baseline (T1), post-treatment (T2) and 1- or 3-month follow-up. Imp…

Zertifizierung einer Psychotherapeutischen Hochschulambulanz nach DIN EN ISO 9001