Ertimiss Eshkevari

Increased plasticity of the bodily self in eating disorders

BACKGROUND The rubber hand illusion (RHI) has been widely used to investigate the bodily self in healthy individuals. The aim of the present study was to extend the use of the RHI to examine the bodily self in eating disorders (EDs). METHOD The RHI and self-report measures of ED psychopathology [the Eating Disorder Inventory - 3 (EDI-3) subscales of Drive for Thinness, Bulimia, Body Dissatisfaction, Interoceptive Deficits, and Emotional Dysregulation; the 21-item Depression, Anxiety and Stress Scale (DASS-21); and the Self-Objectification Questionnaire (SOQ)] were administered to 78 individuals with an ED and 61 healthy controls. RESULTS Individuals with an ED experienced the RHI significantly more strongly than healthy controls on both perceptual (i.e. proprioceptive drift) and subjective (i.e. self-report questionnaire) measures. Furthermore, both the subjective experience of the RHI and associated proprioceptive biases were correlated with ED psychopathology. Approximately 23% of the variance for embodiment of the fake hand was accounted for by ED psychopathology, with interoceptive deficits and self-objectification significant predictors of embodiment. CONCLUSIONS These results indicate that the bodily self is more plastic in people with an ED. These findings may shed light on both aetiological and maintenance factors involved in EDs, particularly visual processing of the body, interoceptive deficits, and self-objectification.

Psychological characteristics and motivation of women seeking labiaplasty.

BACKGROUND Labiaplasty is an increasingly popular surgical intervention but little is known about the characteristics and motivation of women who seek the procedure or the psychosexual outcome. METHOD A total of 55 women seeking labiaplasty were compared with 70 women who did not desire labiaplasty. Various general measures of psychopathology as well as specific measures (Genital Appearance Satisfaction; Cosmetic Procedure Screening for labiaplasty) were used. Labia measurements of the women seeking labiaplasty were also obtained. RESULTS Women seeking labiaplasty did not differ from controls on measures of depression or anxiety. They did, however, express increased dissatisfaction towards the appearance of their genitalia, with lower overall sexual satisfaction and a poorer quality of life in terms of body image. Women seeking labiaplasty reported a significantly greater frequency of avoidance behaviours on all the domains assessed, and greater frequency of safety-seeking behaviours for most of the domains. Key motivations reported for labiaplasty were categorized as cosmetic, functional or sexual. Of the 55 women seeking labiaplasty, 10 met diagnostic criteria for body dysmorphic disorder. CONCLUSIONS This is the first controlled study to describe some of the characteristics and motivations of women seeking labiaplasty. We identified a wide range of avoidance and safety-seeking behaviours, which occurred more frequently in the labiaplasty group than the control group. These could be used clinically as part of a psychological intervention for women seeking labiaplasty.

The Appearance Anxiety Inventory: Validation of a Process Measure in the Treatment of Body Dysmorphic Disorder

BACKGROUND At present there are no measures to identify the cognitive processes and behaviours that might mediate the outcome of treatment in people with Body Dysmorphic Disorder (BDD). AIMS To develop and validate a process measure that can be used to assess the progress of patients throughout therapy and in research for BDD. METHOD The psychometric properties of the Appearance Anxiety Inventory (AAI) were explored in a clinical group of participants diagnosed with BDD (Study 1) and in a non-clinical community group with high appearance concerns (Study 2). Item characteristics, reliability, and factor structure were analysed. Convergent validity with measures of related symptoms was assessed. RESULTS The AAI was found to have good test-retest reliability and convergent validity in the measurement of appearance anxiety. It was also sensitive to change during treatment. The scale was found to have a two-factor structure in the clinical group, with one factor characterized by avoidance, and a second factor comprised of threat monitoring. However, in the community sample it appeared to have a one-factor structure. CONCLUSION The results suggest that the AAI has the psychometric properties to determine whether changes in cognitive processes and behaviours can mediate the outcome following treatment in patients with BDD. This supports its potential usefulness in clinical and research settings.

Persistent Body Image Disturbance following Recovery from Eating Disorders

OBJECTIVE Individuals with an eating disorder experience the rubber hand illusion (RHI) significantly more strongly than healthy controls on both perceptual (proprioceptive drift) and subjective (self-report embodiment questionnaire) measures. This heightened sensitivity to visual information about the body, and/or reduced somatosensory information processing about the body, suggest an increased malleability of the bodily self. The aim of the present study was to explore whether this is a state phenomenon or a persisting individual trait that outlasts the period of acute eating disorder. METHOD The RHI and self-report measures of eating disorder psychopathology (EDI-3 subscales of Drive for Thinness, Bulimia, Body Dissatisfaction, Interoceptive Deficits, and Emotional Dysregulation; DASS-21; and the Self-Objectification Questionnaire) were administered to 78 individuals with an eating disorder, 28 individuals recovered from an eating disorder, and 61 healthy controls. RESULTS Proprioceptive drift in recovered individuals was intermediate between the acutely ill and HC groups. Subjective report of the strength of the illusion in recovered individuals was similar to acutely ill individuals. DISCUSSION These results suggest that increased malleability of the bodily self persists, at least partially, following recovery and may be a trait phenomenon in people with eating disorders. Those with a lifetime history of an eating disorder may have heightened sensitivity to visual information about the body and reduced somatosensory information processing of the body.

Validation of genital appearance satisfaction scale and the cosmetic procedure screening scale for women seeking labiaplasty

Abstract Background: Existing outcome studies on women seeking labiaplasty have not used a validated scale that is specific for satisfaction with genital appearance. They have also not screened for the presence of body dysmorphic disorder (BDD). There are therefore two primary aims of this study (1) to validate the Genital Appearance Satisfaction (GAS) scale in women seeking labiaplasty and (2) to modify and validate a version of the Cosmetic Procedures Screening questionnaire (COPS-L), which has previously been used to screen for BDD. Method: Two groups of women were recruited: a group desiring labiaplasty and a control group. All participants completed the GAS, the COPS-L and other general measures of mood, disgust sensitivity, sexual satisfaction and body image quality of life. Results: Both the GAS and COPS-L demonstrated good internal consistency, concurrent and convergent validity with measures of related constructs, and discriminated between women seeking labiaplasty and controls. Three factors were identified in the GAS but were not robust enough to recommend their use clinically as subscales. The COPS-L discriminated between women seeking labiaplasty with and without BDD. Discussion: We recommend that both the GAS and the COPS-L be routinely used for audit and outcome monitoring of interventions for women distressed by the appearance or function of their genitalia. The GAS has an advantage in assessing additional functional symptoms in such women. The COPS-L may be helpful in identifying women with BDD.

A comparison of risk factors for women seeking labiaplasty compared to those not seeking labiaplasty

Little is known about the factors associated with the desire for labiaplasty. We compared 55 women seeking labiaplasty with 70 women in a comparison group who were not seeking labiaplasty. Measures administered included the Perception of Appearance and Competency Related Teasing Scale, Childhood Trauma Questionnaire, Disgust Scale Revised, and the Genital Appearance Satisfaction scale with open-ended questions about their genitalia. Approximately a third of the labiaplasty group recalled specific negative comments in the past towards their labia, a proportion significantly greater than the three per cent in the comparison group. Participants reporting genital teasing also showed higher Genital Appearance Satisfaction scores than those who were not teased. However, women seeking labiaplasty were, compared to the comparison group, no more likely to have a history of neglect or abuse during childhood. There was no difference between the groups on disgust sensitivity or the perception of being teased in the past about their competence or appearance in general.

An Investigation of Interoceptive Sensitivity in Eating Disorders Using a Heartbeat Detection Task and a Self‐report Measure

BACKGROUND Interoception has been proposed to play an important role in the pathogenesis of eating disorders (EDs). OBJECTIVE The aim of this study was to examine a heart beat detection task (HBDT) as an objective index of interoceptive sensitivity in individuals with an ED. METHOD The self-report interoceptive deficits subscale of the Eating Disorders Inventory 3 was also used. RESULTS The results of the HBDT demonstrated no significant difference between individuals with an ED and healthy controls. However, performance on this task also did not appear to be different from that expected by chance. Thus, these results cast doubt on the utility of the present HBDT for measuring interoceptive sensitivity. CONCLUSION Overall, the findings indicate that further research is needed to develop valid, objective measures of interoceptive sensitivity to be used in EDs, so as to overcome the reliance on the Eating Disorders Inventory 3 self-report subscale and to determine how such measures relate to ED and general psychopathology.

Beliefs about Penis Size: Validation of a Scale for Men Ashamed about Their Penis Size

INTRODUCTION No measures are available for understanding beliefs in men who experience shame about the perceived size of their penis. Such a measure might be helpful for treatment planning, and measuring outcome after any psychological or physical intervention. AIM Our aim was to validate a newly developed measure called the Beliefs about Penis Size Scale (BAPS). METHOD One hundred seventy-three male participants completed a new questionnaire consisting of 18 items to be validated and developed into the BAPS, as well as various other standardized measures. A urologist also measured actual penis size. MAIN OUTCOME MEASURES The BAPS was validated against six psychosexual self-report questionnaires as well as penile size measurements. RESULTS Exploratory factor analysis reduced the number of items in the BAPS from 18 to 10, which was best explained by one factor. The 10-item BAPS had good internal consistency and correlated significantly with measures of depression, anxiety, body image quality of life, social anxiety, erectile function, overall satisfaction, and the importance attached to penis size. The BAPS was not found to correlate with actual penis size. It was able to discriminate between those who had concerns or were dissatisfied about their penis size and those who were not. CONCLUSIONS This is the first study to develop a scale for measurement of beliefs about penis size. It may be used as part of an assessment for men who experience shame about the perceived size of their penis and as an outcome measure after treatment. The BAPS measures various manifestations of masculinity and shame about their perceived penis size including internal self-evaluative beliefs; negative evaluation by others; anticipated consequences of a perceived small penis, and extreme self-consciousness.

Computerised CBT for depressed adolescents: Randomised controlled trial

BACKGROUND Depression in adolescents is a common and impairing problem. Effective psychological therapies for depression are not accessed by most adolescents. Computerised therapy offers huge potential for improving access to treatment. AIMS To test the efficacy of Stressbusters, a Computerised-CBT (C-CBT) programme for depression in young people. METHOD Multi-site, schools-based, RCT of C-CBT compared to Waiting List, for young people (N = 112; aged 12-16) with significant symptoms of depression, using multiple-informants (adolescents, parents, teachers), with follow-up at 3 and 6 months. RESULTS Relative to being on a Waiting List, C-CBT was associated with statistically significant and clinically meaningful improvements in symptoms of depression and anxiety according to adolescent self-report; and with a trend towards improvements in depression and anxiety according to parent-report. Improvements were maintained at follow-up. Treatment gains were similar for boys and girls across the participating age range. Treatment effect was partially mediated by changes in ruminative thinking. Teachers rated adolescents as having few emotional or behavioural problems, both before and after intervention. C-CBT had no detectable effect on academic attainment. In the month after intervention, young people who received C-CBT had significantly fewer absences from school than those on the Waiting List. CONCLUSIONS C-CBT shows considerable promise for the treatment of mild-moderate depression in adolescents.

Beliefs about Penis Size

INTRODUCTION No measures are available for understanding beliefs in men who experience shame about the perceived size of their penis. Such a measure might be helpful for treatment planning, and measuring outcome after any psychological or physical intervention. AIM Our aim was to validate a newly developed measure called the Beliefs about Penis Size Scale (BAPS). METHOD One hundred seventy-three male participants completed a new questionnaire consisting of 18 items to be validated and developed into the BAPS, as well as various other standardized measures. A urologist also measured actual penis size. MAIN OUTCOME MEASURES The BAPS was validated against six psychosexual self-report questionnaires as well as penile size measurements. RESULTS Exploratory factor analysis reduced the number of items in the BAPS from 18 to 10, which was best explained by one factor. The 10-item BAPS had good internal consistency and correlated significantly with measures of depression, anxiety, body image quality of life, social anxiety, erectile function, overall satisfaction, and the importance attached to penis size. The BAPS was not found to correlate with actual penis size. It was able to discriminate between those who had concerns or were dissatisfied about their penis size and those who were not. CONCLUSIONS This is the first study to develop a scale for measurement of beliefs about penis size. It may be used as part of an assessment for men who experience shame about the perceived size of their penis and as an outcome measure after treatment. The BAPS measures various manifestations of masculinity and shame about their perceived penis size including internal self-evaluative beliefs; negative evaluation by others; anticipated consequences of a perceived small penis, and extreme self-consciousness.