James C. Rosen

Epidemiologic Studies of Low-back Pain

The records of 3920 patients (2068 females, 1852 males) entering a model family practice unit between 1975 and 1978 have been analyzed. Eleven percent of males and 9.5% of females reported an episode of low-back pain during that 3-year interval. The complaint of medically reported low-back pain was significantly related to occupational factors such as truck driving (P<0.001), lifting, carrying, pulling, pushing, and twisting (P<0.001 for all variables) as well as nondriving vibrational exposure (P<0.001). Patients reporting low-back pain also reported more episodes of anxiety (P<0.001) and depression (P<0.001) and had more emotionally stressful occupations (P<0.001). The mean number of pregnancies was greater in women with low-back pain (2.6) than in those without (1.6) (P<0.001). The low-back pain sufferers were more likely to be cigarette smokers (P<0.001), particularly when smoking was accompanied by a chronic cough (P<0.001). This population is currently under prospective study to define the relevance of each of these risk factors to the complaint of low-back pain.

Body shape questionnaire: Studies of validity and reliability

OBJECTIVE The Body Shape Questionnaire (BSQ) is a useful measure of weight and shape concern. The purpose of this study is to contribute new psychometric information on the BSQ in order to assist clinicians and researchers who intend to use this measure. METHOD This paper reports average scores on American samples of clinical subjects referred for body image problems, obese persons seeking weight reduction, and nonclinical samples of college students and adults. RESULTS AND DISCUSSION The BSQ demonstrated good test-retest reliability, concurrent validity with other measures of body image, and criterion validity for clinical status.

Development of a Body Image Avoidance Questionnaire

The purpose was to design a self-report measure of behavioral tendencies that frequently accompany body-image disturbance. The result was a 19-item questionnaire that dealt with avoidance of situations that provoke concern about physical appearance, such as avoidance of tight-fitting clothes, social outings, and physical intimacy. The Body Image Avoidance Questionnaire had adequate internal consistency and test-retest reliability. The measure correlated highly with negative attitudes about weight and shape and with perceptual distortion of size. It distinguished women with bulimia nervosa from controls, it was sensitive to change following treatment for severe bodyimage disturbance, and it agreed with external raters. Norms for the measure and the factor structure were also provided. Although body-image disturbance is traditionally viewed as perceptual distortion of body size and negative attitudes about weight and shape, it is recommended that a multidimensional assessment also include attention to behavioral tendencies.

Cognitive-behavioral body image therapy for body dysmorphic disorder.

Body dysmorphic disorder (BDD) is a distressing body image disorder that involves excessive preoccupation with physical appearance in a normal appearing person. Prior case reports of behavior therapy were encouraging, but no controlled evaluation of behavior therapy or any other type of treatment had been conducted. In the present study, 54 BDD subjects were randomly assigned to cognitive behavior therapy or no treatment. Patients were treated in small groups for eight 2-hour sessions. Therapy involved modification of intrusive thoughts of body dissatisfaction and overvalued beliefs about physical appearance, exposure to avoided body image situations, and elimination of body checking. Body dysmorphic disorder symptoms were significantly decreased in therapy subjects and the disorder was eliminated in 82% of cases at posttreatment and 77% at follow-up. Overall psychological symptoms and self-esteem also improved in therapy subjects.

Prevalence of weight reducing and weight gaining in adolescent girls and boys.

: This is a survey of the prevalence of weight reducing and weight gaining in high school children. Our sample of 1,373 high school girls and boys was geographically, racially, and economically diverse. On the day of the survey, 63% of the girls and 16.2% of the boys reported being on weight reducing regimens; 9.1% of the girls and 28.4% of the boys were trying to gain weight. Most female reducers and male gainers were already normal weight. Compared to other racial groups, whites and Hispanics were more likely to be reducing, whereas blacks were more likely to be gaining. Exercise and moderate caloric reduction were most popular for weight reducing, and a small but significant number were regularly using fasting, vomiting, laxatives, and appetite suppressants. The direction of weight modification for girls and boys conformed to stereotyped physical ideals. The rate of weight reducing in female high school adolescents has increased significantly since similar surveys of American youths 20 years ago.

Bulimia nervosa: Treatment with exposure and response prevention

Fear of weight gain, binging, and self-induced vomiting are the salient features of bulimia nervosa in normal weight individuals. An exposure plus vomiting response prevention procedure was evaluated in a multiple baseline design across three classes of food stimuli for a patient suffering from chronic bulimia nervosa. Amount of food consumed without vomiting increased and subjective discomfort after eating decreased when exposure plus response prevention treatment was sequentially applied to each class of food. Complete cessation of vomiting and binging and minimal discomfort were subsequently achieved during a postexperimental response prevention phase. Treatment effects were maintained at 10-month follow-up. The results suggest that binging in bulimia nervosa is more a consequence of vomiting than vomiting is a consequence of binging. They also support the hypothesis that vomiting in bulimia nervosa is an escape-avoidance response reinforced by anxiety reduction, similar in function to compulsive hand washing and checking rituals in obsessive-compulsive neuroses.

Cognitive behavior therapy for negative body image in obese women

Negative body image is a major concern of overweight persons, yet current obesity treatment programs have not addressed this problem. In the present study, 51 obese women were randomly assigned to cognitive behavioral body image therapy (CBT) or no-treatment. Patients were treated in small groups for 8 two-hour sessions. Therapy included information to challenge negative stereotypes of obesity, modification of intrusive thoughts of body dissatisfaction and overvalued beliefs about physical appearance, exposure to avoided body image situations, and elimination of body checking. No assistance was provided to change eating or exercise behaviors. CBT subjects showed significantly improved body image. Psychological symptoms, self-esteem, overeating, and eating guilt also improved. Weight was unchanged for most subjects and unrelated to treatment outcome overall.

Bulimia in adolescents: Prevalence and psychosocial correlates

A bulimic episode during adolescence appears to be a risk factor for chronic eating disorders, yet little is known about the prevalence or psychosocial correlates of bulimia in this age group. The prevalence of bulimia was determined in a geographically, racially, and economically diverse sample of 1,373 high school boys and girls. In addition to DSM-III criteria, a minimum binge-eating frequency of once per month was employed. For bulimia, with purging, a minimum purging frequency of once per month was employed. Bulimia was identified in 9.6% of girls (with purging, 2.2%; without purging, 7.4%) and in 1.2% of boys (with purging, 0.1%; without purging, 1.1%). The two subtypes of bulimia subjects were demographically and psychologically equivalent. Bulimia subjects (combined) did not differ from normals on race, age, or SES. Bulimics exhibited more negative body image, negative self-esteem, social anxiety, and depression than normals. In the total sample of students, general eating disorder symptomatology was predicted by measures of body image, depression, and social anxiety in girls and by body image and depression in boys.

A comparison of eating disorders and body dysmorphic disorder on body image and psychological adjustment

Eating and body dysmorphic disorders are two diagnoses with body image disturbance as a central feature. No empirical study of the similarity of these disorders or any controlled study of body dysmorphic disorder were available. The present study compared 45 women with anorexia or bulimia nervosa to 51 men and women with body dysmorphic disorder (BDD) and 50 nonclinical controls. The eating disorder patients were mainly preoccupied with weight and body shape. BDD subjects had more diverse physical complaints and reported more negative self-evaluation and avoidance due to appearance. However, the two groups showed equally severe body image symptoms overall, and were clearly abnormal compared with controls. Both types of patients had negative self-esteem, but eating disorder patients had more widespread psychological symptoms. In conclusion, the disorders are comparable on psychological measures. Explanations of the minor differences and questions for future research on the relation between eating and body dysmorphic disorders are presented.

Body image assessment and treatment in controlled studies of eating disorders

OBJECTIVE This literature review examined the extent to which body image been assessed and treated in eating disorder treatment programs and the effectiveness of different treatments for body image change. METHOD Published reports of experimentally controlled clinical trials were examined for the use of measures and interventions that concerned body image. RESULTS About one third of psychotherapy studies assessed and treated body image. Cognitive behavioral eating disorder programs for bulimia nervosa result in modest body image improvement. Pharmacotherapy seems to be less effective than CBT, though few pharmacotherapy studies assessed body image. Although cognitive restructuring is widely used, behavioral interventions and self-monitoring that target body image have not been reported by most eating disorder programs. Little information is available on body image methods in anorexia nervosa and binge-eating disorder. DISCUSSION Given the importance of body image for the development and recovery from eating disorders, more systematic body image work should be incorporated into current treatment.