Ralph Grabhorn

Separating two components of body image in anorexia nervosa using fMRI

BACKGROUND Body image distortion is a key symptom of anorexia nervosa. In behavioral research two components of body image have been defined: attitudes towards the body and body size experience. Neuroimaging studies concerning own body image distortions in anorexia nervosa have revealed an inconsistent pattern of results and are constrained by the fact that no direct distinction between the different parts of body image has been made. METHOD The present study therefore set out to investigate the neural correlates of two parts of the own body image using functional magnetic resonance imaging (fMRI): satisfaction rating and size estimation for distorted own body photographs in patients with anorexia nervosa and controls. RESULTS Anorectic patients were less satisfied with their current body shape than controls. Patients further demonstrated stronger activation of the insula and lateral prefrontal cortex during the satisfaction rating of thin self-images. This indicates a stronger emotional involvement when patients are presented with distorted images close to their own ideal body size. Patients also overestimated their own body size. We were able to show complex differential modulations in activation of the precuneus during body size estimation in control and anorectic subjects. It could be speculated that a deficit in the retrieval of a multimodal coded body schema in precuneus/posterior parietal cortex is related to body size overestimation. CONCLUSIONS We were able to find specific behavioral responses and neural activation patterns for two parts of body image in anorexia nervosa and healthy controls. Thus, the present results underline the importance of developing research and therapeutic strategies that target the two different aspects of body image separately.

The importance of reflective functioning to the diagnosis of psychic structure

OBJECTIVE This pilot study examines the connection between the concept of Fonagy and Targets reflective functioning and the structure axis of operationalized psychodynamic diagnostics (OPD) and assesses the potential of both scales to predict therapy success. METHOD In the study, 24 (female) patients of the psychotherapy ward of the Frankfurt University Hospital for psychosomatic medicine and psychotherapy aged 18 to 55 were assessed on the basis of a 90-minute, semi-structured interview with regard to their capability for reflective functioning as well as with regard to their structural level according to OPD. In addition, the SCL-90-R was administered at the beginning and end of the 3-month in-patient therapy. RESULTS A significant correlation was found between reflective functioning and the structure axis of OPD. Reflective functioning also predicted improvement in overall mental condition through a 3-month in-patient therapy. This remained significant even when the influence of the overall assessment of structure according to OPD was removed. CONCLUSIONS The independence of the concept of reflective functioning (RF) and its implications for the clinical stance are discussed.

Body image distortions in bulimia nervosa: investigating body size overestimation and body size satisfaction by fMRI

BACKGROUND Body image distortion is a key symptom of eating disorders. In behavioral research two components of body image have been defined: attitudes towards the body and body size estimation. Only few fMRI-studies investigated the neural correlates of body image in bulimia; those are constrained by the lack of a direct distinction between these different body image components. METHODS The present study investigates the neural correlates of two aspects of the body image using fMRI: satisfaction rating and size estimation of distorted own body photographs in bulimia nervosa patients (15) and controls (16). RESULTS Patients were less satisfied with their current body shape than controls and preferred to be thinner. The amount of insula activity reflects the pattern of the satisfaction rating for patients and controls. Patients also overestimated their own body size. For control subjects, an activated cluster in lateral occipital cortex was sensitive for body size distortions, whereas bulimic patients did not demonstrate such a modulation. Furthermore, bulimic subjects did not recruit the middle frontal gyrus (MFG) in contrast to controls during the body size estimation task, maybe indicating a reduced spatial manipulation capacity. Therefore, this activation pattern of lateral occipital cortex and MFG might be responsible for body size overestimation in bulimia. CONCLUSIONS The present results show that bulimic patients exhibit two distinct deficits in body image representations similar to anorectic patients and that specifically associated neuronal correlates can be identified. Concludingly, our study support psychotherapeutic strategies specifically targeting these two aspects of body image distortions.

Object Relations and Interpersonal Problems in Sexually Abused Female Patients: An Empirical Study With the SCORS and the IIP

In this study, we examined how retrospective reports of experiencing traumatic sexual abuse in childhood relates to both the development of self-representations and object representations and the occurrence of interpersonal problems. A total of 30 psychosomatic female patients who reported sexual abuse in childhood were compared with a corresponding number of eating-disordered patients and a nonclinical control group. The object relations technique (ORT; Phillipson, 1955), evaluated using the Social Cognition and Object Relations Scale (SCORS; Westen, 1985, 1991b), and the Inventory of Interpersonal Problems (Horowitz, Rosenberg, Baer, & Ureno, 1988) were used to measure the groups. The patients reporting sexual abuse achieved significantly lower scores in the cognitive scales of the SCORS; in the affective scales, they differed from the control group but not from the patients with an eating disorder. Concerning interpersonal problems, the patients reporting childhood sexual abuse reported interpersonal conflicts more frequently. The results of the study support the influence of traumatic sexual abuse on the formation of self-representations and object representations and on the occurrence of interpersonal conflicts.

Narcissistic Regulation of the Self and Interpersonal Problems in Depersonalized Patients

Background: Psychoanalytical theories coincide in understanding depersonalization (DP) as a disorder of narcissistic self-regulation. DP is described as an ego defense against overwhelming shame resulting in a splitting of an observing ego detached from the experiencing self. In contrast to a behavioral-cognitive theory on DP, which suggests that the catastrophic appraisal of normal transient DP maintains the disorder, psychodynamic approaches stress that DP is an important defensive function for the individual. We examine this psychodynamic aspect more closely as it relates to narcissistic self-regulation and interpersonal behavior in depersonalized patients. Sampling and Methods: Thirty-five patients with pathological DP are compared with 28 patient controls concerning their narcissistic self-regulation and interpersonal behavior. For the assessment, we used the German Narcissism Inventory and the Inventory of Interpersonal Problems. The two groups were controlled for sociodemographic data, comorbidity with a personality disorder, and the General Severity Index of the Symptom Check List-90-R. Results: Bonferroni-corrected group comparison showed that the depersonalized patients are characterized by perceiving themselves as helpless, hopeless, socially isolated and worthless, perceiving others as bad and disappointing, and that they avoid interpersonal relations and reality significantly more than other patients with equal symptom severity. Conclusions: Treatment approaches on DP should take the issue of low self-esteem, pervasive shame and the related defensive social avoidance into account. Further empirical research on psychodynamic concepts of DP is warranted also for the sake of linking modern neurobiological findings with clinical experience.

Depersonalization and social anxiety

Although the literature on depersonalization (DP) indicates links between DP and anxiety disorders, there has been no systematic investigation of the association of DP with social anxiety. The present study explores a hypothesized connection between DP and social anxiety by using correlative and regression analyses in a sample of 116 psychotherapy inpatients, 54 outpatients with epilepsy, and 31 nonpatients. Corresponding to our hypothesis, we found a connection of medium to large effect size between DP and social fears exceeding the impact of general psychopathologic symptom severity both for the psychotherapy patients and the nonpatients. The association of social anxiety with DP merits further research. A general consideration of DP in clinical and neurobiological trials on anxiety disorders like social phobia is warranted.

Neural adaptation to thin and fat bodies in the fusiform body area and middle occipital gyrus: an fMRI adaptation study.

Visual perception can be strongly biased due to exposure to specific stimuli in the environment, often causing neural adaptation and visual aftereffects. In this study, we investigated whether adaptation to certain body shapes biases the perception of the own body shape. Furthermore, we aimed to evoke neural adaptation to certain body shapes. Participants completed a behavioral experiment (n = 14) to rate manipulated pictures of their own bodies after adaptation to demonstratively thin or fat pictures of their own bodies. The same stimuli were used in a second experiment (n = 16) using functional magnetic resonance imaging (fMRI) adaptation. In the behavioral experiment, after adapting to a thin picture of the own body participants also judged a thinner than actual body picture to be the most realistic and vice versa, resembling a typical aftereffect. The fusiform body area (FBA) and the right middle occipital gyrus (rMOG) show neural adaptation to specific body shapes while the extrastriate body area (EBA) bilaterally does not. The rMOG cluster is highly selective for bodies and perhaps body parts. The findings of the behavioral experiment support the existence of a perceptual body shape aftereffect, resulting from a specific adaptation to thin and fat pictures of ones own body. The fMRI results imply that body shape adaptation occurs in the FBA and the rMOG. The role of the EBA in body shape processing remains unclear. The results are also discussed in the light of clinical body image disturbances. Hum Brain Mapp 34:3233–3246, 2013.

Visual adaptation to thin and fat bodies transfers across identity.

Visual perception is highly variable and can be influenced by the surrounding world. Previous research has revealed that body perception can be biased due to adaptation to thin or fat body shapes. The aim of the present study was to show that adaptation to certain body shapes and the resulting perceptual biases transfer across different identities of adaptation and test stimuli. We designed two similar adaptation experiments in which healthy female participants adapted to pictures of either thin or fat bodies and subsequently compared more or less distorted pictures of their own body to their actual body shape. In the first experiment (n = 16) the same identity was used as adaptation and test stimuli (i.e. pictures of the participant’s own body) while in the second experiment (n = 16) we used pictures of unfamiliar thin or fat bodies as adaptation stimuli. We found comparable adaptation effects in both experiments: After adaptation to a thin body, participants rated a thinner than actual body picture to be the most realistic and vice versa. We therefore assume that adaptation to certain body shapes transfers across different identities. These results raise the questions of whether some type of natural adaptation occurs in everyday life. Natural and predominant exposure to certain bodily features like body shape – especially the thin ideal in Western societies – could bias perception for these features. In this regard, further research might shed light on aspects of body dissatisfaction and the development of body image disturbances in terms of eating disorders.

Altered Visual Adaptation to Body Shape in Eating Disorders: Implications for Body Image Distortion

Previous research has shown that after adapting to a thin body, healthy participants (HP) perceive pictures of their own bodies as being fatter and vice versa. This aftereffect might contribute to the development of perceptual body image disturbances in eating disorders (ED). In the present study, HP and ED completed a behavioral experiment to rate manipulated pictures of their own bodies after adaptation to thin or fat body pictures. After adapting to a thin body, HP judged a thinner than actual body picture to be the most realistic and vice versa, resembling a typical aftereffect. ED only showed such an adaptation effect when they adapted to fat body pictures. The reported results indicate a relationship between body image distortion in ED and visual body image adaptation. It can be suspected that due to a pre-existing, long-lasting adaptation to thin body shapes in ED, an additional visual adaption to thin body shapes cannot be induced. Hence this pre-existing adaptation to thin body shapes could induce perceptual body image distortions in ED.

Body-Shape Adaptation Cannot Be Explained by Adaptation to Narrow and Wide Rectangles

Visual adaptation to certain body shapes alters visual perception of subsequently presented pictures of bodies. We investigated whether these effects can be explained by adaptation to low-level visual objects, ie narrow and wide rectangles. Participants (n = 29) adapted to manipulated photographs of their own bodies, depicting them either unrealistically thin or fat. The perceived shapes of their own bodies were subsequently assessed by an interleaved staircase paradigm. A second experiment (n = 29) used the same design to test for adaptation effects evoked by narrow and wide bars. After adapting to a thin picture of own body, participants also judged a thinner than actual body picture to be the most realistic and vice versa, resembling a typical aftereffect. Importantly, this effect could not be replicated by adaptation to narrow and wide bars, demonstrating that the body-shape aftereffect cannot be explained by adaptation to low-level properties. The results support the existence of a perceptual body-shape aftereffect, resulting from a specific adaptation to thin and fat body shapes.