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This study contributes to the quantitatively large, yet narrow in scope research on body image in gay men by assessing whether gay and heterosexual men systematically differ on various dimensions of body image disturbance and associated pathology, i.e., eating disorder and body dysmorphic disorder symptoms. Moreover, we examined the influence of general everyday discrimination experiences and involvement with the gay community on body image. N = 216 men (n = 112 gay men, n = 104 heterosexual men) participated in an online survey measuring the discrepancy between self-rated current and ideal body fat/ muscularity; drive for leanness, muscularity, and thinness; body satisfaction; body-related avoidance and checking; appearance fixing; overall body image disturbance; eating disorder and body dysmorphic disorder pathology; general everyday discrimination experiences; and involvement with the gay community. Gay men showed a greater discrepancy between self-rated current and ideal body fat; higher drive for thinness, body-related avoidance, appearance fixing, overall body image disturbance, eating disorder and body dysmorphic disorder pathology; and lower body appreciation than heterosexual men (all p ≤ .05). Contrary to expectation, everyday discrimination experiences were more strongly associated with body image disturbance and eating disorder/ body dysmorphic disorder pathology in heterosexual men than in gay men (all p ≤ .05). Gay community involvement was not associated with any body image disturbance-, ED-, or BDD aspect in gay men (all p ≥ .20). The results suggest greater body image disturbance in gay men than in heterosexual men regarding cognitions, emotions, behaviors, and perception as well as higher eating disorder and body dysmorphic disorder pathology. The results also suggest the dilemma of a thin, yet muscular body ideal in gay men. Surprisingly, discrimination experiences and involvement with the gay community did not explain differences in body image disturbance. Gay men may have become resilient to discrimination over time, and body ideals might differ across gay sub-communities.

The goal of the present review is to give an overview of the current findings on various facets of body image disturbance in Binge Eating Disorder such as body dissatisfaction, overconcern with weight and shape, body-related checking and avoidance behavior, misperception of body size, and body-related cognitive bias. In addition, treatments for a disturbed body image in BED and evidence of body image disturbance in youth with binge eating are reviewed. The results show that a disturbed body image in BED is present in the form of overconcern with weight and shape. Furthermore, there are hints that body dissatisfaction, as well as body-related checking and avoidance behavior, are also impaired. Research concerning misperception of body size in BED has been neglected so far, but first findings show that individuals with BED rate their own body shape rather accurately. Furthermore, there are first hints that body-related cognitive biases are present in individuals with BED. Moreover, in children and adolescents, there are first hints that body dissatisfaction, as well as shape and weight concerns, seem to be associated with loss of control and binge eating. Treatments aimed directly at the convertibility of a disturbed body image in BED have revealed encouraging outcomes. In conclusion, body image disturbance seems to occur in BED, and first studies show that it can be treated effectively.

Mirror exposure (ME) is an effective technique to improve body image. However, evidence on the underlying mechanisms and the optimal verbalization instruction during ME is lacking. Therefore, this experimental study analyzed mechanisms of ME and therapeutic outcomes by comparing positive (PV) and negative (NV) full-body verbalization. N = 73 healthy females were randomized to a PV or an NV condition. PV participants verbalized positively while NV participants verbalized negatively about their whole body. Each participant underwent three standardized ME sessions. Before and after each ME session, positive affect, negative affect and body satisfaction were assessed. Before the first and after the third ME, participants completed questionnaires on cognitive-affective and behavioral aspects of body image, eating pathology and self-esteem. Regarding within-ME changes, the results indicate that positive affect and body satisfaction decreased while negative affect increased in the NV group but not in the PV group. In contrast, regarding between-ME changes, decreased negative affect as well as positive affect and increased body satisfaction were observed in both groups. However, eating pathology remained stable, whereas body-checking behavior increased and the PV condition was followed by higher levels of self-esteem compared to the NV condition. These findings suggest that both PV and NV improve negative affect and body satisfaction between-ME, and thus seem to be effective ME instructions. Given that NV led to increased negative affect within-ME and did not influence self-esteem, PV might represent the favorable instruction during ME for body-satisfied women.

Body checking is a common behavior in both the general population and individuals with body image disturbances. Cognitive-behavioral theories postulate that body checking reduces negative emotions in the short term, but over time contributes to the development and maintenance of eating disorder pathology. So far, few experimental studies have assessed these longer-term consequences, mostly under laboratory conditions, yielding inconsistent findings, and without considering individual vulnerability and specific personality traits. In a naturalistic experimental cross-over design, women with low ( n = 76) vs. high ( n = 103) body concern completed an online survey on trait characteristics (e.g., intolerance of uncertainty). After a two-day baseline to assess the daily amount of habitual body checking, participants underwent two three-day experimental conditions in randomized order, in which they were asked to exhibit typical vs. threefold increased body checking. Before and after conditions, participants completed state measures of eating disorder symptoms, body dissatisfaction, affect, and general pathology online. In women with high body concern, body image-related symptoms (i.e., drive for thinness, body dissatisfaction) and negative affect worsened in the increased body checking condition, whereas in the typical body checking condition, positive affect increased and no negative impact emerged. Conversely, women with low body concern remained unaffected, except for higher drive for thinness following the increased condition. Bulimic and depressive symptoms did not change in either group. The inclusion of intolerance of uncertainty from an exploratory perspective generally did not impact the results. Our findings regarding the high-risk group underscore the potential etiological relevance of body checking for body image disturbances and eating disorders. For individuals at risk and those already affected by eating disorders, it seems important to address individual body checking as early as possible within psychoeducation to prevent a presumably harmful increase in this behavior. Personality factors influencing vulnerability to body checking need to be further examined.

There is evidence that gender as well as sexual orientation can affect body image. In particular, heterosexual women and homosexual men seem to be more vulnerable to a negative body image compared to homosexual women and heterosexual men. One reason for this may be derived from the fact that heterosexual women and homosexual men try to attract male romantic partners: As men place more importance on physical attractiveness than do women, the pressure to fulfill the sociocultural beauty ideal is thus increased. The present online study investigated differences in appearance-related partner preferences and their associations with measures of body image and eating pathology in homosexual and heterosexual women and men. The non-representative sample consisted of 893 participants ( n  = 201 lesbian women, n  = 192 gay men, n  = 349 heterosexual women, and n  = 151 heterosexual men), who completed silhouette measures assessing their perception and expectations regarding body fat and muscularity of their own body and the body of a potential romantic partner, as well as questionnaires on drive for thinness, drive for muscularity, and eating pathology. Overall, few differences in appearance-related partner preferences emerged between the four groups. However, compared to heterosexual women, homosexual men appeared to prefer higher muscularity in potential romantic partners, which was also associated with increased drive for thinness and muscularity and increased eating pathology. The present findings indicate that, irrespective of sexual orientation, women and men tend to share similar standards regarding their own and a potential partner’s physical appearance, potentially suggesting an increased hegemony of heteronormative beauty ideals in women and men in general.

Background Body dysmorphic disorder (BDD) is particularly prevalent yet highly understudied and undertreated in adolescence. This study evaluates the efficacy of an internet-based, therapist-guided cognitive behavioral therapy (CBT) for adolescents and young adults with BDD compared to supportive online therapy as an active control condition. Methods In a single-blind, randomized controlled trial, N  = 45 adolescents (aged 15–21 years) of all genders from German-speaking countries were assigned to 12 sessions of internet-based CBT (iCBT) or 12 weeks of supportive online therapy. The primary outcome was change in expert-rated BDD symptom severity from pre- to post-intervention (Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder, BDD-YBOCS). Secondary outcomes included the remission and responder rate, changes in delusionality of appearance beliefs (BABS), self-rated BDD symptom severity (FKS), BDD cognitions (FKDK), quality of life (KINDL-R), and depressive symptoms (PHQ-9) from pre to post and to a 4-week follow-up. Results iCBT was more efficient than supportive online therapy on the BDD-YBOCS ( p  =.002), with a large between-group effect size at post-intervention (Hedges’ g ( SE ) = 0.93 (0.42)), and on all secondary measures ( p  <.05), except for depressive symptoms ( p  =.068). All secondary outcome measures also showed significant improvements from pre to post iCBT, with moderate to large effect sizes, and gains were stable until the 4-week follow-up period. iCBT participants showed higher remission (61.5%) and responder rates (66.7%), compared to controls (0% and 26.7%), but only the difference in remission reached significance. Conclusion The results indicate the efficacy of internet-based CBT in comparison to an active control condition, thus contributing to the limited intervention research in adolescent BDD and adding a much-needed treatment option. Trial registration : The trial was pre-registered on 2020/06/08 at the German Clinical Trials Register, DRKS00022055.

Purpose To examine self-reported pica substances, situational triggers for, and associated psychosocial burden of pica eating in adolescents and adults in a Western European population. Methods A total of 78 individuals aged 16 years and over, who indicated consuming a substance that in their opinion is not considered as food, participated in an online survey. Two questionnaires assessed eating disorder and general psychopathology, and a third asked about the substances consumed, duration and frequency of consumption, triggers for consumption, emotions thereafter, and interest in treatment. Results The most frequently reported substances included foods in an uncooked or non-edible form, body parts/fluids, grass, leaves, paper, and earth-like substances, with 54 (69.23%) participants reporting a substance that would qualify as pica substance according to DSM-5. The main triggers for consumption were taste of the substance/indulgence, boredom, curiosity, and release of internal tension. The most common emotion after consumption was relief. Pica eating frequency was not significantly related to eating disorder and general psychopathology (both p  > 0.05). A total of 24 individuals considered their pica eating as disruptive, of whom only eight declared an interest in treatment. Conclusions The kind of substances consumed is in line with the previous reports in other populations. Pica eating does not seem to be associated with significant psychosocial burden; only a subgroup indicated that they experience it as disruptive and expressed interest in treatment. Nevertheless, for these individuals, triggers for pica eating and emotions thereafter might provide first hints for the development of interventions. Level of Evidence Level V, cross-sectional descriptive study.

Body checking refers to the repeated evaluation of one’s own body. As a safety mechanism, it is prevalent in various mental disorders, including eating disorders, body dysmorphic disorder, and illness anxiety disorder. While the type and manner of body checking behavior may differ between these disorders, cognitive-behavioral models highlight similar mechanisms underlying this behavior. According to the models, body checking is assumed to arise in response to negative affect, offer immediate relief, and increase psychopathology in the longer term as a mechanism of negative reinforcement. The objective of this review is to empirically evaluate these assumptions for eating disorders, body dysmorphic disorder, and illness anxiety disorder. Therefore, we conducted a systematic literature review across four electronic databases, with N  = 43 studies meeting the inclusion criteria. The assumption that body checking occurs in response to negative affect was supported. However, findings regarding its short- and long-term role in maintaining negative affect were inconsistent. Therefore, our results may suggest the need to re-evaluate the etiologically proposed negative reinforcement mechanism of body checking in eating disorders, body dysmorphic disorder, and illness anxiety disorder. To facilitate the interpretation of study findings, future studies should distinguish between short- and long-term effects of body checking. Plain English summary Body checking refers to the repeated and critical evaluation of one’s body and contributes to the maintenance of eating disorders, body dysmorphic disorder, and illness anxiety disorder. While individuals with these disorders engage in disorder-specific checking behaviors, the cognitive-behavioral theories underlying these behaviors are similar. These theories propose that body checking arises in response to negative affect, provides short-term relief, and increases negative affect in the long term. The present literature review aims to empirically assess these theoretical assumptions across eating disorders, body dysmorphic disorder, and illness anxiety disorder, including N  = 43 studies meeting the inclusion criteria. The findings support the notion that body checking occurs in situations characterized by negative affect and contributes to increased negative affect in the long term. However, evidence regarding the short-term role of checking behavior in reducing negative affect was inconsistent, challenging the theoretical assumption of immediate relief. Our results suggest reevaluating the proposed short-term reduction in negative affect, indicating that checking behavior may not provide an immediate reduction of negative affect as previously assumed.

Evasion of cell death is a hallmark of cancer, and consequently the induction of cell death is a common strategy in cancer treatment. However, the molecular mechanisms regulating different types of cell death are poorly understood. We have formerly shown that in the epidermis of hypomorphic zebrafish hai1a mutant embryos, pre-neoplastic transformations of keratinocytes caused by unrestrained activity of the type II transmembrane serine protease Matriptase-1 heal spontaneously. This healing is driven by Matriptase-dependent increased sphingosine kinase (SphK) activity and sphingosine-1-phosphate (S1P)-mediated keratinocyte loss via apical cell extrusion. In contrast, amorphic hai1a fr26 mutants with even higher Matriptase-1 and SphK activity die within a few days. Here we show that this lethality is not due to epidermal carcinogenesis, but to aberrant tp53-independent apoptosis of keratinocytes caused by increased levels of pro-apoptotic C 16 ceramides, sphingolipid counterparts to S1P within the sphingolipid rheostat, which severely compromises the epidermal barrier. Mathematical modelling of sphingolipid rheostat homeostasis, combined with in vivo manipulations of components of the rheostat or the ceramide de novo synthesis pathway, indicate that this unexpected overproduction of ceramides is caused by a negative feedback loop sensing ceramide levels and controlling ceramide replenishment via de novo synthesis. Therefore, despite their initial decrease due to increased conversion to S1P, ceramides eventually reach cell death-inducing levels, making transformed pre-neoplastic keratinocytes die even before they are extruded, thereby abrogating the normally barrier-preserving mode of apical live cell extrusion. Our results offer an in vivo perspective of the dynamics of sphingolipid homeostasis and its relevance for epithelial cell survival versus cell death, linking apical cell extrusion and apoptosis. Implications for human carcinomas and their treatments are discussed.

Body dysmorphic disorder (BDD), together with its subtype muscle dysmorphia (MD), has been relocated from the Somatoform Disorders category in the DSM-IV to the newly created Obsessive-Compulsive and Related Disorders category in the DSM-5. Both categorizations have been criticized, and an empirically derived classification of BDD is lacking. A community sample of N = 736 participants completed an online survey assessing different psychopathologies. Using a structural equation modeling approach, six theoretically derived models, which differed in their allocation of BDD symptoms to various factors (i.e. general psychopathology, somatoform, obsessive-compulsive and related disorders, affective, body image, and BDD model) were tested in the full sample and in a restricted sample (n = 465) which indicated primary concerns other than shape and weight. Furthermore, measurement invariance across gender was examined. Of the six models, only the body image model showed a good fit (CFI = 0.972, RMSEA = 0.049, SRMR = 0.027, TLI = 0.959), and yielded better AIC and BIC indices than the competing models. Analyses in the restricted sample replicated these findings. Analyses of measurement invariance of the body image model showed partial metric invariance across gender. The findings suggest that a body image model provides the best fit for the classification of BDD and MD. This is in line with previous studies showing strong similarities between eating disorders and BDD, including MD. Measurement invariance across gender indicates a comparable presentation and comorbid structure of BDD in males and females, which also corresponds to the equal prevalence rates of BDD across gender.