Neuropsychological Correlates of Body Image Disturbance

NEUROPSYCHOLOGICAL CORRELATES OF BODY IMAGE DISTURBANCE

A thesis submitted to Kent State University in partial fulfillment of the requirements for the degree of Master of Arts

by Kelly Marie Stanek May, 2009

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Thesis written by

Approved by JohnGunstad,Ph.D. , Advisor MaryAnnStephens,Ph.D.,Chair,DepartmentofPsychology JohnR.D.Stalvey,Ph.D.

,Dean,CollegeofArtsandSciences















TABLE OF CONTENTS LIST

OF

TABLES………………………………………………………………………..iv















LIST OF TABLES 1. Descriptive Statistics for Body Image, Demographic, Medical, Psychological, and















Introduction

Body image disturbance (BID) has become increasingly prevalent in the last

The term body image most generally refers to the internal representation of one’s















2 investigating the neuropsychological correlates of a multidimensional conceptualization of BID in a non-eating-disordered sample. A Multi-Dimensional Definition of Body Image Disturbance Early discussion of the internal representation of one’s body incorporated the

satisfaction, body esteem, body schemas; Thompson et al., 1999; Thompson, 2004), but also to the appreciation of the dimensional nature of the BID construct. While BID is still

















3 facets: perceptual, attitudinal, and behavioral disturbance. These three components of BID are elaborated upon below. Behavioral Body Image Disturbance The behavioral component of BID encompasses the behavioral correlates of body-

Attitudinal Body Image Disturbance Attitudinal body image entails subjective satisfaction with one’s body and

















4 As originally highlighted in description of anorexic symptomatology, body size

The Neuropsychology of Body Image Disturbance A great deal of research has focused on psychosocial correlates and risk factors

















5 (Gardner, 1996; Smeets, Smitt, Panhuysen, & Ingleby, 1997). Another large body of

Cognitive Dysfunction and Body Image Disturbance: A Conceptual Basis The symptomatology of BID provides numerous opportunities for links between

















6 Few studies have directly examined neuropsychological correlates of body

Attitudinal disturbances. Although existing evidence points strongly toward sociocultural mechanisms for

















7 increased body mass is a robust linear predictor of body dissatisfaction (Stice and

Behavioral disturbances. Although no studies to date have directly examined the relationship between



















8 Evidence for Cognitive Dysfunction in Anorexia and Obesity As mentioned, additional evidence for associations between BID and cognitive



















9 Cooper, Taylor, Cooper, & Fairburn, 1987) a self-report questionnaire of attitudinal and

Although these studies provide evidence that deficits in multiple cognitive



















10 reduced physical activity, may influence the degree of cognitive dysfunction in obese individuals (Cicconetti, Riolo, Priami, Tafaro, & Ettore, 2004). In summary, evidence for neuropsychological dysfunction in individuals prone to

Evidence for Cognitive Dysfunction in Body Image Disturbance



















11 and breadth of neuropsychological tests administered and by the exclusion of other relevant cognitive domains and components of the multidimensional BID construct. The Current Study No study to date has examined the association between cognitive function and



















Methods Participants Study participants were recruited from the Kent State University Department of





















13 sample reported a past history of disordered eating. Given the low frequency of reported

Procedure





















14 Behavioral body image disturbance. The Body Checking Questionnaire (BCQ; Reas et al., 2002) was used to quantify





















15 Perceptual body image disturbance. Body size misperception was assessed using a novel procedure that measured the





















16 underestimation of body size and positive index scores indicated participant





















17 Body fat percentage was assessed as a secondary measure of body composition,























18 1991; Shean & Baldwin, 2008; Santor, Zuroff, Ramsay, Cervantes, & Palacios, 1995).























19 Neuropsychological Assessment























20 Attention and working memory.























21 test, with higher vigilance decrement values indicating poorer sustained attention and























22 particularly concentration and executive function and has demonstrated satisfactory





















































































specific that BID,cognitive OCD, and deficit depression in younger may each adultsrepresent with depression behaviorally and cognitive distinct phenotypes slowing hasfor a been demonstrated higher form of frontal in dysfunction. OCD (Gualtieri, Evidence Johnson, for& regional Benedict, white 2006; matter Tsourtos, abnormalities Thompson, in & Stough, both OCD and 2002; depression Roth, Baribeau, (Li et al., Milovan, 2007; Menzies & O’Conner, et al., 2004). 2008), Yet supports in the current the notion study, of a













possible endophenotype unexpected, decreased executive but meaningful. functioning for the While disorder and zero-order sustained (Menzies correlations attention et al., 2008). in indicated zero-order In conjunction, that correlation higherthese levels of findings body analyses, checking support attitudinal were the associated BID idea was of a not shared with significantly decreased frontal mechanism related working to memory, any and neuropsychological present visual an attention, intriguing variable possibility sustained after accounting attention, for future for and weight study executive of status, the underlying functioning, age, and other neuropathology only psychological the relationship of BID. variables. Although between Given body white the













frontal body argument size, dysfunction. that perceptual the perceptual It BID is also waslikely component unrelated that this to ofneuropsychological finding BID does was not influenced involve test pure by performance the visuospatial operational in any definition domain deficit, but after ofrather, attitudinal accounting may be BID, for inseparable control as subjective variables. from ratings theNotably, cognitive of body zero-order and areaaffective satisfaction correlation aspects tend analyses of toBID be strongly associated indicated (Skrzypek, a Wehmeier significant with &association Remschmidt, psychological between 2001;Thompson disorders greater such body as et misperception depression al., 1999; Keel, (Wiederman and 2005). poorer In&the visual













not associated BID may function with and either be measurable behavioral independently, or attitudinal BID others in the have current cited sample evidence merits brief discussion, that suggesting giventhe that concept BID was of body operationally size misperception defined as a and multifaceted its measurement construct maywith be interrelated from inseparable behavioral, the cognitive attitudinal, and affective and perceptual aspectscomponents. of BID (Garner This&lack Garfinkel, of association 1981;













the accuracy behavioral aspects and directionality of BID is dueoftobody issues size of estimation measurement in healthy and construct samplesdefinition. (Penner, Body Thompson, size misperception & Coovert, was1991; measured Williamson, using a Cubic, novel technique & Gleaves,in1993; the current Gustavson study. et A al., 1990; Valtolina, silhouette scale was 1998). used In order to estimate to clarify body whether size andthe shape construct and compared of BID is to truly independent













nature of healthy research young design. BID, individuals, several Whileaspects thisthe study of current the wascurrent able sample tomethodology provide may have important lacked may limit the evidence variability generalizability. for an in weight As mentioned range, association cognitive earlier, between abilities, issues processing related and body speed to image operationalizing anddisturbances behavioraland manifestations necessary measuring toeach fully of BID, of appreciate the discussion BID components subtle of these relationships results highlighted cannot thatspeak in may this exist. tostudy underlying Similarly, may have mechanisms while influenced restriction forresulting cognitive of ageassociations and impairment gender with was or the also psychological relevant directionality to theof and research this neuropsychological relationship. question, Longitudinal it may variables. be prudent studies to may notehelp that elucidate findings related whether tothese the nature of BID and its neuropsychological correlates may not generalize to BID in other populations. Future studies might investigate whether the nature of BID is similar in women of varying age, obese women, and women with eating disorders.













information eating disorder processing may alsospeed present andwith the behavioral cognitive difficulties manifestations related of to BID slowed in young information women without disordered processing. While these eating. difficulties A lack ofare association not likelybetween to appear body universally size misperception, or require as measured by substantial modification the discrepancy of existing between treatments an individuals for BID, estimation cliniciansofshould size and be aware shape and of the independent potential for mental raters’ estimation slowing andofadjust that individuals clinical strategy size and and shape, expectations and the accordingly. attitudinal and behavioralshould Clinicians manifestations also be aware of BIDofwas thealso potential revealed. for mild As illustrated executive above, and attentional these findings add to current dysfunction in clients understanding with behavioral of the nature and attitudinal of BID as symptoms a multidimensional of BID, depending and continuously on the occurring severity ofpsychological likely comorbid disturbance conditions, outside including of eating depression disordered and OCD. and obese While populations. etiology These and directionality findings alsoofprovide the association important between clinicalbehavioral implications BID forand assessment mental slowing and treatment is yet













processing speed in individuals without eating pathology seeking treatment for BID. As suggested earlier, it is possible that behavioral and, to a lesser degree, attitudinal manifestations of BID, may be linked to subtle alterations of normal brain structure in frontal regions. As such, longitudinal studies involving brain imaging in addition to BID treatment might be valuable. Finally, the lack of association between the perceptual and the cognitive, behavioral, and affective dimensions of BID in a non-clinical sample leads to the hypothesis that BID assessment and treatment focusing on perceptual aspects of the disturbance might be ineffective for a client desiring alleviation of cognitive, behavioral,

























changed? a cross sectional investigation of college women and men from 1983 to 2001. Journal of Consulting and Clinical Psychology, 72, 1081-1090.













(2004). of body Neuropsychology image disturbance. of eating British disorders: Journal aofsystematic Psychology, review 87, 327-337. of the Garner, literature. D. M., & Revista Garfinkel, Brasileira P. E. (1981). de Psiquiatria., Body image 26,in107-117. anorexia nervosa: Measurement theory and clinical implications. International Journal of Psychiatry and













Masheb, R.M. abnormalities Gustavson, A.R., (2005). in normal Pappas, Body aging: T.,checking & McCaul, a quantitative andK. avoidance (1990). review. Body-image andNeuropsychology, the coredistortion features of 14(2), among eatingand 224-32 male disorders female among collegeobese and high menschool and women students, seeking and eating-disordered bariatric surgery. patients.













Keel, PRey-Osterieth abnormalities . (2005) Eating in Complex Disorders young adult Figure: . Upper withMethodological major Saddle depressive River, NJ: considerations disorder: PrenticeaHall. diffusion and interrater tensor Lezak,reliability. imaging M.D., Howieson, study. Archives Brain D.B., ofResearch, Clinical & Loring, Neuropsychology, 1168 D.W. , 124-128. (2004) Neuropsychological 5, 1-14. Assessment













anorexics: Much ado about very little? Journal of abnormal psychology, 100, 9093.













of the Body Checking Psychometric Properties Questionnaire: and Clinical A Correlates self-report inmeasure Obese Men of body and Women checking with behaviors. Binge Eating International Disorder. International Journal of Eating Journal Disorders, of Eating31, Disorders, 324-333.39, 326-331.













Verbal Avoidance of Disorder inmethodological a college-age and Diagnostic in nonverbal Eating sample. differences Disorders. Scale: memory Journal A brief on processing International the of self-report Genetic outcome in patients Psychology, Journal measure of bodyof with size of Eating 169(3), Anorexia, obsessive-compulsive estimation Disorders 281-288. Bulimia, studies , 35(1), and in Skrzypek, disorder: 93-101. anorexia Binge-Eating S., Wehmeier, nervosa. its relationship Disorder. P British . M.,Psychological & to Journal Remschmidt, clinical ofvariables. Clinical Assessment H. (2001). Psychology Neuropsychology , 12 Body , 123-131. , 36(2), image263-277. ,assessment 22, 262-72. using body size estimation in recent studies on anorexia nervosa. A brief review.













estimates and bulimic of disturbance body size, actual in a noneating-disordered size, and ideal body ratings: college theoretical sample: A and clinical implications. Journal neuropsychological analysis. of Clinical Perceptual Psychology, and45, Motor 473-478. Skills, 73, 335-338.













et al. (2000). Body image assessment for obesity (BIA-O): Development of a new procedure. International Journal of Obesity, 24, 1326-1332.













Neuropsychological Demographic Medical and Disturbance Psychological Variables Variables Variables Body Image Variables Age BMI JLO BSMP













to aid interpretation. BSMP = Body Size Misperception Index; BCQ = Body Checking Questionnaire; BASS = Body Areas Satisfaction Scale; BMI = body mass index; CES-D = Center for Epidemiological Studies Depression Scale; MOCI = Maudsley Obsessional Compulsive Inventory; AMNART = American version of the National Adult Reading Test; JLO = Judgment of Line Orientation; CFT-DR = Complex Figure Test-Delayed Recall; SS-F = Spatial Span-Forward Trial; LNS = Letter-Number Sequencing; ARCPTVD = Adaptive Rate Continuous Performance Test-Vigilance Decrement; ARCPT-ISI = Adaptive Rate Continuous Performance Test-Information Processing Speed Index; FAB = Frontal Assessment Battery; Stroop-CW = Stroop Test-Color-Word Trial.

























Judgment 2. BCQ of Line Orientation; CFT-DR = Complex Figure Test-Delayed Recall; SS-F = Spatial 3. BASS Span-Forward Trial; LNS = Letter-Number Sequencing; ARCPT-VD = Adaptive Rate 4. JLO Continuous Performance Test-Vigilance Decrement; ARCPT-ISI = Adaptive Rate Continuous 5. CFT-DR Performance Test-Information Processing Speed Index; FAB = Frontal Assessment 6. SS-F Battery; Stroop-CW = Stroop Test-Color-Word Trial. *p 7.< LNS .05. **p < .01. ***p < .001.

























= Body Areas Satisfaction Scale; BMI = body mass index; CES-D = Center for Epidemiological Studies Depression Scale; MOCI = Maudsley Obsessional Compulsive Inventory; AMNART = American version of the National Adult Reading Test; JLO = Judgment of Line Orientation; CFT-DR = Complex Figure Test-Delayed Recall; SS-F = Spatial Span-Forward Trial; LNS = Letter-Number Sequencing; ARCPT-VD = Adaptive Rate Continuous Performance Test-Vigilance Decrement; ARCPT-ISI = Adaptive Rate Continuous Performance Test-Information Processing Speed Index; FAB = Frontal Assessment Battery; Stroop-CW = Stroop Test-Color-Word Trial. *p < .05. **p < .01. ***p < .001.

Neuropsychological Correlates of Body Image Disturbance

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