Academic journal article Journal of Eating Disorders

A Qualitative Analysis of Participants' Reflections on Body Image during Participation in a Randomized Controlled Trial of Acceptance and Commitment Therapy

Academic journal article Journal of Eating Disorders

A Qualitative Analysis of Participants' Reflections on Body Image during Participation in a Randomized Controlled Trial of Acceptance and Commitment Therapy

Article excerpt

Author(s): Maria Fogelkvist[sup.1], Thomas Parling[sup.2], Lars Kjellin[sup.1] and Sanna Aila Gustafsson[sup.1]

Plain English summary

Many patients with an ED have difficulties with their body image, and struggle to change it. Body image issues are something many people experience, but for a person with an ED it is linked to poorer treatment outcomes and relapses after treatment. In this article we asked patients with an ED to write their reflections on body image. What body image is, how they perceived their own body image, how they wanted it to change, and whether they perceived any changes after a treatment intervention. We found that body image meant different things for different patients. Some described that body image meant how they evaluated their bodies. Some described whether their perceptions of their own bodies were realistic or not. Some described their relationship to their body and others how it was linked to their self-esteem. There were also differences in how they wished their body image to change. Many found that their body image changed after treatment. They still evaluated themselves negatively, but found that they could focus more on other areas in life that felt more important.


Body dissatisfaction has been defined as "discontent with some aspect of one's physical appearance" [1], and is a risk factor both for developing an eating disorder (ED) [2] and for relapse after remission from an ED [3]. Although there have been advances in research and the treatment of ED, many patients do not remit despite receiving treatment in accordance with evidence-based practice [4, 5]. Even patients who clinically remit from an ED often continue to be dissatisfied with their body shape and weight [6]. This dissatisfaction can be seen as part of a normative discontent [3], but is nevertheless associated with a risk of relapse to an ED [7] and poor quality of life [8]. Thus, there is a need to further develop or adapt interventions that may increase the remission rate, address persistent body image problems and reduce relapse rates.

Body image is a complex concept, and according to Cash [9] "It encompasses one's body-related self-perceptions and self-attitudes, including thoughts, beliefs, feelings, and behaviors". But, for those afflicted with negative body image, what does it mean to have a negative body image, or to be dissatisfied with one's body? There are numerous studies investigating different ways of measuring aspects of body image [10, 11]. However, we only found two studies that explored patients' views on body image with open questions. In a study by Espeset, Nordba, Gulliksen, SkA[yen]rderud, Geller & Holte [12] they explored the views of body image in different contexts in the daily lives of patients with anorexia nervosa (AN). They found that the participants' descriptions could be divided into a subjective or objective reality. Depending on how they integrated these two concepts they were categorized as integrated, in denial, dissociated or delusional. These categories were suggested to be used as a continuum to classify severity of body image disturbances, where delusional is the most severe form. They also found that some participants described their body image as stable, while others found it to fluctuate depending on context. The same research team continued to investigate the fluctuations of body images among patients with AN [13]. They concluded that this fluctuation was possible due to an uncertainty about their objective appearance, and found four different contextual cues that made their body image fluctuate; 'Eating food', 'Body awareness', 'Emotional experiences' and 'Interpersonal influences'. These two studies are, to the best of our knowledge, the only ones that have probed patients' views on the concept of body image. We were unable to find any studies on patient's thoughts on how they would like their body image to change due to treatment. …

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