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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.

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.

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.

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.

Background The dissemination of evidence-based techniques is critical for the successful treatment of eating disorders in clinical practice. A growing number of studies suggests that body exposure is an effective technique to treat body image disturbance in eating disorders. However, the dissemination of body exposure among psychotherapists in clinical practice remains unclear. Methods An online survey was conducted among licensed psychotherapists in Germany. The dissemination of body exposure in clinical practice, psychotherapists’ characteristics (such as clinical training, attitudes towards exposure, confidence), and therapists’ experiences with benefits and side-effects of body exposure were assessed. Results Data of 230 psychotherapists were analysed. More than half of them (58.3%) applied body exposure in their clinical practice. Yet, body exposure was only offered to 37.3% of their eating disorder patients. Moreover, 56.7% of psychotherapists delivering body exposure indicated that they have not received any training in this technique. Self-reported confidence in delivering body exposure correlated significantly with the number of patients treated with body exposure. Psychotherapists who applied body exposure reported minor side-effects and that the majority of their patients profited from this technique. Conclusions Our results offer insights into the dissemination of body exposure in clinical practice in Germany. Overall, body exposure is still underused considering the empirical evidence demonstrating the potential of body exposure to treat body image disturbances effectively. Moreover, with regard to potential barriers of using body exposure, our data suggest that training opportunities for clinicians may facilitate the dissemination of this technique in clinical practice.

IntroductionChecking behaviour (CB) occurs in various mental health problems. Cognitive-behavioural models for these mental disorders share similar theoretical assumptions. Thus, they postulate a negative reinforcing effect of CB by reducing negative affect (ie, anxiety) and a maintenance of the pathology due to a lack of reality testing of concerns. This paper details methods for a systematic review that will be conducted to synthesise empirical evidence testing these theoretical assumptions across obsessive–compulsive, generalised anxiety, eating, body dysmorphic and illness anxiety disorder. The results are expected to foster our understanding of the mechanisms of action underlying CB, which is of high clinical relevance. Depending on whether or not the findings confirm the model assumptions regarding CB, the focus of treatments would need to be intensified or modified.Methods and analysisWe will search PsycINFO, PubMed, PSYNDEX and Scopus for studies investigating the emotional state in which CB is being used as well as the immediate and longer-term effects of CB on cognitive and emotional measures in clinical and analogue samples. The selection process, data extraction and quality assessment of included studies will be performed by two independent reviewers. In the case of inconsistencies, a third reviewer will be involved. Study results will be reported in a narrative synthesis.Ethics and disseminationEthics approval will not be required as this is a protocol for systematic review. The results are mainly disseminated through peer-reviewed publications.PROSPERO registration numberCRD42021238835.

Background Despite evidence that thinness and muscularity are part of the female body ideal, there is not yet a reliable figure rating scale measuring the body image of women which includes both of these dimensions. To overcome this shortcoming, the Body Image Matrix of Thinness and Muscularity - Female Bodies (BIMTM-FB) was developed. Methods The objective of this study is to analyze the psychometric properties of this measure. N  = 607 non-clinical women and N  = 32 women with eating disorders answered the BIMTM-FB as well as instruments assessing eating disorder symptoms and body image disturbance in order to test the convergent validity of the BIMTM-FB. To assess test-retest reliability, a two-week interval was determined. Results The results indicated that the body-fat dimension of the BIMTM-FB correlates significantly with the Contour Drawing Rating-Scale, the Drive for Leanness Scale (DLS) and the Body Appreciation Scale, while the muscularity dimension of the BIMTM-FB was significantly associated with the DLS and the Drive for Muscularity Scale, proving the convergent validity of the BIMTM-FB. High coefficients of test-retest reliability were found. Moreover, the BIMTM-FB differentiated between the clinical sample and the non-clinical controls. Conclusions The BIMTM-FB is a figure rating scale assessing both thinness and muscularity as part of the female body ideal. Due to its high reliability and validity, the BIMTM-FB can be recommended in research and practice.

Background Over the last 20 years, society’s perception of the ideal female body size in Western cultures has changed from thin to athletic, and many women practice sports to achieve well-toned bodies. However, to date, no study has investigated whether Muslim women who live in a Western country and veil their bodies strive for lean or muscular bodies too. The current cross-sectional survey therefore addressed this question. Methods Veiled Muslim women ( n  = 70), unveiled Muslim women ( n  = 50), Christian women ( n  = 79), and atheist women ( n  = 68) living in Germany answered several questionnaires assessing engagement in sports, body appreciation, and drive for leanness and muscularity. Univariate and multivariate analyses were conducted to compare the four groups. Results The results of univariate and multivariate analyses showed that Muslim women engaged less in sports and veiled Muslim women reported higher body appreciation than did Christian and atheist women. Although the groups did not differ significantly in drive for muscularity, Muslim women showed lower levels of drive for leanness than did Christian and atheist women. Conclusion Given that Muslim women engaged less in sports and strived less for a lean body compared to Christian and atheist women, a well-toned body might be less important for them. Nevertheless, as being active is beneficial for general health, barriers that prevent Muslim women from engaging in sports should be diminished.

Background Fear of weight gain is a characteristic feature of anorexia nervosa (AN), and reducing this fear is often a main target of treatment. However, research shows that 20% of individuals with AN do not report fear of weight gain. Studies are needed that evaluate the centrality of fear of weight gain for AN with a method less susceptible to deception than self-report. Methods We approximated implicit fear of weight gain by measuring implicit drive for thinness using implicit association tests (IATs). We asked 64 participants (35 AN, 29 healthy controls [HCs]) to categorize statements as pro-dieting vs. non-dieting and true vs. false in a questionnaire-based IAT, and pictures of underweight vs. normal-weight models and positive vs. negative words in a picture-based IAT using two response keys. We tested for associations between implicit drive for thinness and explicitly reported psychopathology within AN as well as group differences between AN and HC groups. Results Correlation analyses within the AN group showed that higher implicit drive for thinness was associated with more pronounced eating disorder-specific psychopathology. Furthermore, the AN group showed a stronger implicit drive for thinness than HCs in both IATs. Conclusion The results highlight the relevance of considering fear of weight gain as a continuous construct. Our implicit assessment captures various degrees of fear of weight gain in AN, which might allow for more individually tailored interventions in the future.