The Significant and Distinct Attitudes Towards Body Image in BN and BED

Despite overarching similarities, patients with bulimia nervosa (BN) and patients with binge eating disorder (BED) have significant differences in body image, according to study findings published in the Journal of Eating Disorders.

Researchers characterized differences between individuals with BN, BED, and those with neither BN nor BED in perceptual, affective, and cognitive body image including self-reported body image, weight-based stereotypes, and body size estimation.

The researchers recruited consecutive patients from outpatient departments and inpatient services (for eating disorders) at centers in Tübingen and Essen, Germany and in Padova, Italy. Control participants with no eating disorders prior to inclusion were recruited from all 3 local communities.

The researchers recruited patients with BN or subsyndromal BN (n=22), patients with BED or subsyndromal BED (n=22), and control participants matched by body mass index (BN vs non-overweight control participants [n=22]; BED vs overweight control participants [n=22]). Control group participants who reported a current or lifetime diagnosis of mental disorder were excluded.

All groups included a preponderance of women (BN, 1 man; BED, 1 man; control group, 3 men). Participants in BN and BED vs those in the control group had lower self-esteem, greater depression, reported eating concern, more restrained eating, and overall eating disorder symptoms; no difference was found in these variables between participants in BN vs BED.

Participants in BN and BED vs the control group reported stronger habits and more negative body image in comparing their physical appearance, with no between-group differences in BN vs BED.

Patients in the BN group slightly overestimated their body weight and participants in the BED group and healthy control individuals underestimated their own body weight. Patients with BN and their matched non-obese control participants slightly overestimated their body shape; patients with BED and their matched obese control participants slightly underestimated their body shape.

The investigators found no significant difference in self-reported weight-based stereotypes (Fat Phobia Scale). In the experimental approach, patients in both study groups reported negative body image, although patients with BN expressed negative attributes more strongly associated with higher body weight vs patients with BED or control individuals.

Patients with BN vs BED or control participants assigned more positive attributes to lean bodies. Patients with BN also assigned negative attributes to high body weight beginning at a lower body mass index (BMI) compared with the BED and control groups.

No statistical significance was found for a differential rating of positive, negative, or neutral words (adjectives) for any of the groups. Adjectives such as “feminine” or “open-minded” were generally rated more positively than adjectives like “impulsive” or “lazy”.

Study limitations include participants may have guessed the focus of the investigators’ task and adjusted their responses to a socially accepted level.

“Observations from this study suggest that clinical treatment of body image disturbance in patients with BN and BED should address negative body image and weight-based stereotypes in a differentiated way,” the researchers concluded.

This article originally appeared on Psychiatry Advisor