Body image disturbance is considered a core characteristic of eating disorders and body dysmorphic disorder (BDD), however its definition has been unclear within the literature. This study examined the multidimensional nature of body image functioning among individuals with either anorexia nervosa (AN; n = 35), bulimia nervosa (BN; n = 26), or BDD (n = 56), relative to female (n = 34) and male (n = 36) psychiatric controls. Participants were recruited from 10 treatment centers in the United States and England and completed psychometrically validated and standardized self-report measures of body image. Overall, the AN, BN, and BDD groups were characterized by significantly elevated disturbances in most body image dimensions relative to their gender-matched clinical controls. There was variability, however, in the comparisons among the three groups of interest, including foci of body dissatisfaction and body image coping patterns. On omnibus indices of body image disturbance and body image quality of life, patients with BDD reported more body image impairment than those with eating disorders. Although AN, BN, and BDD are characterized by body image disturbances, similar and partially distinctive cognitive, behavioral, and emotional elements of body image functioning exist among these groups. The study's empirical and clinical implications are considered.
Body image is a “multifaceted psychological experience of embodiment” that encompasses evaluative thoughts, beliefs, feelings, and behaviors related to one's own physical appearance (Cash, 2004, p. 1). Based on cognitive-behavioral theory (Cash, 2002a), the degree to which individuals are invested in their appearance depends greatly on the core self-schemas related to their appearance (Cash et al., 2004a and Markus, 1977). These body image self-schemas serve as a cognitive template for one's appearance evaluation and body image emotions. When triggered by contextual events, body image thoughts and emotions prompt adjustive, self-regulatory activities, or coping strategies (Cash, Santos, & Williams, 2005). Disturbances in these cognitive, behavioral, and emotional elements of body image are considered core to the psychopathology of anorexia nervosa (AN), bulimia nervosa (BN), and body dysmorphic disorder (BDD; Cash and Deagle, 1997, Fairburn and Harrison, 2003 and Phillips, 1991). However, the existing research has not permitted a comprehensive understanding of the relative degree of disturbance of such aspects of body image among these clinical groups. The purpose of the present study was to compare and elucidate more fully the specific body image disturbances of individuals with AN, BN, and BDD.
