To propose a theoretical model accounting for the meaning and function of body image disturbances for individuals with eating disorders. This model departs from available conceptualizations of body image focused on attractiveness and emphasizes the role of body image preoccupations in the regulation of self-esteem and affect.
Method:
This model was developed on the basis of the author's clinical observations and the available empirical research.
Results:
Three main functions of body image are described. The first one, “affiliation,” consists of using one's appearance in the establishment of interpersonal relationships, both at the level of friendship and romance. The second function, “avoidance,” consists of using one's body image to avoid abuse, be it psychological, physical, or sexual. The third function, “expression,” consists of using one's body image to communicate to the self and others one's capacity for accomplishment or one's inner feelings of dejection.
Conclusion:
This model is designed to be a therapeutic tool within body image therapy. Body image therapy can be most effective when focused on the unique meaning of body image for each individual patient.
CashTF. The treatment of body image disturbances. In: ThompsonJK, editor. Body image, eating disorders, and obesity. Washington (DC): American Psychological Association; 1996. p 83–107.
2.
BirtchnellSALaceyJHHarteA.Body image distortion in bulimia nervosa. Br J Psychiatry1985;147:408–12.
3.
GarnerDMGarfinkelPEStangerHCMoldofskyH.Body image disturbances in anorexia nervosa and obesity. Psychosom Med1976;38:327–36.
4.
HomeRLVan VactorJCEmersonS.Disturbed body image in patients with eating disorders. Am J Psychiatry1991;148:211–5.
5.
PostGCrowtherJH. Restricter-purger differences in bulimic adolescent females. Int J Eat Disord1987;6:757–61.
6.
SundaySRHalmiKAWerdannLLeveyC.Comparison of body size estimation and eating disorder inventory scores in anorexia and bulimia patients with obese, and restrained and unrestrained controls. Int J Eat Disord1992;11:133–49.
7.
ThompsonJKDolceJJ. The discrepancy between emotional vs rational estimates of body size, actual size, and ideal body ratings: Theoretical and clinical implications. J Clin Psychol1989;45:473–8.
8.
WilliamsonDAKelleyMLDavisCJRuggieroLBlouinDC. Psychopathology of eating disorders: A controlled comparison of bulimic, obese, and normal subjects. J Consult Clin Psychol1985;53:161–6.
9.
DaceyCMNelsonWMIIIClarkVFAikmanKG. Bulimia and body image dissatisfaction in adolescence. Child Psychiatry Hum Dev1991; 21:179–84.
10.
GarfinkelPEGoldbloomDDavisROlmstedMPGarnerDMHalmiKA. Body dissatisfaction in bulimia nervosa: Relationship to weight and shape concerns and psychological functioning. Int J Eat Disord1992;11:151–61.
11.
GarnerDMGarnerMVVan EgerenLF. Body dissatisfaction adjusted for weight: The body illusion index. Int J Eat Disord1992;12:263–71.
12.
RosenJCGrossJVaraL.Psychological adjustment of adolescents attempting to lose or gain weight. J Consult Clin Psychol1987;55:742–7.
13.
FichterMMMeisterIKochHJ. The measurement of body image disturbances in anorexia nervosa. Br J Psychiatry1986;148:453–61.
14.
SladeP.A review of body-image studies in anorexia nervosa and bulimia nervosa. J Psychiatr Res1985;19:255–65.
15.
GarnerDMGarfinkelPEOlmstedMP. An overview of sociocultural factors in the development of anorexia nervosa. In: DarbyPLGarfinkelPEGarnerDMCoscinaDV, editors. Anorexia nervosa: Recent developments in research. New York: Alan R Liss; 1983. p 65–82.
16.
PolivyJGarnerDMGarfinkelPE. Causes and consequences of the current preference for thin female physiques. In: HermanCPZannaMPHigginsET, editors. Physical appearance, stigma and social behavior: The Ontario symposium1986;3:89–112.
17.
Striegel-MooreRHSilbersteinLRRodinJ.Toward an understanding of risk factors for bulimia. Am Psychol1986;41:246–63.
18.
ThompsonJKCoovertMDRichardsKJJohnsonSCattarinJ.Development of body image, eating disturbance, and general psychological functioning in female adolescents: Covariance structure modeling and longitudinal investigations. Int J Eat Disord1995;18:221–36.
19.
ThompsonJKHeinbergLJ. Preliminary test of two hypotheses of body image disturbance. Int J Eat Disord1993;14:59–63.
20.
StormerSMThompsonJK. Explanations of body image disturbance: A test of maturational status, negative verbal commentary, social comparison, and sociocultural hypotheses. Int J Eat Disord1996;19:193–202.
21.
HewittPLFlettGLEdigerE.Perfectionism traits and perfectionistic self-presentation in eating disorder attitudes, characteristics, and symptoms. Int J Eat Disord1995;18:317–26.
22.
StraumanTJVooklesJBerensteinVChaikenSHigginsET. Self-discrepancies and vulnerability to body dissatisfaction and disordered eating. J Pers Soc Psychol1991;61:946–56.
23.
RyleAEvansCDH. Some meanings of body and self in eating-disordered and comparison subjects. Br J Med Psychol1991;64:273–83.
24.
DykensEMGerrardM.Psychological profiles of purging bulimics, repeat dieters, and controls. J Consult Clin Psychol1986;54:283–8.
25.
GracePSJacobsonRSFullagerCJ. A pilot comparison of purging and non-purging bulimics. J Clin Psychol1985;41:173–80.
26.
GarnerDMGarfinkelPE. Body image in anorexia nervosa: Measurement, theory and clinical implications. Int J Psychiatry Med1981;11:263–84.
27.
FreudA.The ego and the mechanisms of defense. London: Hogarth Press; 1946.
28.
FallonARozinP.Sex differences in perceptions of desirable body shape. J Abnorm Psychol1985;94:102–5.
29.
RozinPFallonA.Body image, attitudes to weight, and misperceptions of figure preferences of the opposite sex: A comparison of men and women in two generations. J Abnorm Psychol1988;97:342–5.
30.
DwyerJTFeldmanJJSeltzerCCMayerJ.Adolescent attitudes toward weight and apperance. Journal of Nutrition Education1969;1:14–9.
31.
OppenheimerRHowellsKPalmerRLChalonerDA. Adverse sexual experience in childhood and clinical eating disorders: A preliminary description. Journal Psychiatr Res1985;19:357–61.
32.
FolsomVKrahnDNaimKGoldLDemitrackMASilkKR. The impact of sexual and physical abuse on eating disordered and psychiatric symptoms: A comparison of eating disordered and psychiatric inpatients. Int J Eat Disord1993;13:249–57.
33.
PopeHGJHudsonJI. Is childhood sexual abuse a risk factor for bulimia nervosa?Am J Psychiatry1992;149:455–63.
34.
RortyMYagerJRossottoE.Childhood sexual, physical, and psychological abuse in bulimia nervosa. Am J Psychiatry1994;151:1122–6.
35.
WallerG.Sexual abuse and the severity of bulimic symptomatology. Br J Psychiatry1992;161:90–3.
36.
WallerGHamiltonKRoseNSumraJBaldwinG.Sexual abuse and body-image distortion in the eating disorders. Br J Clin Psychol1993;32:350–2.
37.
BruchH.Perceptual and conceptual disturbances in anorexia nervosa. Psychosom Med1962;24:187–94.
38.
BruchH.Eating disorders: Obesity, anorexia nervosa and the person within. New York: Basic Books; 1973.
39.
GarnerDMOlmstedMPPolivyJ.Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. Int J Eat Disord1983;2:15–34.
40.
MintzLBBetzNE. Prevalence and correlates of eating disordered behaviors among undergraduate women. Journal of Counseling Psychology1988;35:463–71.
41.
SkinnerBF. The behavior of organisms. New York: Appleton-Century-Crofts; 1938.
42.
MowrerOH. On the dual nature of learning: A reinterpretation of “conditioning” and “problem-solving.”Harvard Educational Review1947;17:102–48.
43.
CashTFBrownTA. Body image in anorexia nervosa and bulimia nervosa: A review of the literature. Behav Mod1987;11:487–521.
