Self-perception in anorexia nervosa: When the body becomes an object

Individuals with Anorexia Nervosa and Bulimia Nervosa present alterations in the way they experience their bodies. Body experience results from a multisensory integration process in which information from different sensory domains and spatial reference frames is combined into a coherent percept. Given the critical role of the body in the onset and maintenance of both Anorexia Nervosa and Bulimia Nervosa, we conducted a systematic review to examine multisensory integration abilities of individuals affected by these two conditions and investigate whether they exhibit impairments in crossmodal integration. We searched for studies evaluating crossmodal integration in individuals with a current diagnosis of Anorexia Nervosa and Bulimia Nervosa as compared to healthy individuals from both behavioral and neurobiological perspectives. A search of PubMed, PsycINFO, and Web of Sciences databases was performed to extract relevant articles. Of the 2348 studies retrieved, 911 were unique articles. After the screening, 13 articles were included. Studies revealed multisensory integration abnormalities in patients affected by Anorexia Nervosa; only one included individuals with Bulimia Nervosa and observed less severe impairments compared to healthy controls. Overall, results seemed to support the presence of multisensory deficits in Anorexia Nervosa, especially when integrating interoceptive and exteroceptive information. We proposed the Predictive Coding framework for understanding our findings and suggested future lines of investigation.Diagnoses of Anorexia Nervosa and Bulimia Nervosa have increased dramatically in recent years, taking on the characteristics of a mental health emergency. More research is therefore needed to better understand these conditions, especially given their complex and multifaceted nature. Patients affected by these conditions report significant alterations in body-self experience. Body experience results from a cross-modal integration process in which information from different sensory modalities and spatial frames is combined. Therefore, we systematically reviewed studies that focused on multisensory integration in patients affected by Anorexia Nervosa and Bulimia Nervosa, as it may play a key role in the onset and maintenance of these pathologies. Studies in this review found multisensory integration difficulties in patients with Anorexia Nervosa, but not enough studies were retrieved to draw conclusions regarding Bulimia Nervosa. We discussed findings trying to link behavioral, neuropsychological, and neuroscientific evidence in light of the predictive coding framework to provide a different perspective on patients' distorted body experiences. This may lead to new insights to refine our understanding of these complex and poorly understood disorders. 

The multisensory mind: a systematic review of multisensory integration processing in Anorexia and Bulimia Nervosa

Interoceptive influences on the production of self-serving lies in reputation risk conditions.

Recent evidence suggests that the body image disturbance often observed in patients with anorexia nervosa also extends to the body schema. According to the embodiment approach, the body schema is not only involved in motor execution, but also in tasks that only require a mental simulation of a movement such as motor imagery, mental rotation of bodies, and visuospatial perspective‐taking. The aim of the present study was to assess the ability of patients with anorexia to mentally simulate movements.

/pdf/beyond-body-image-what-body-schema-and-motor-imagery-can-1sth9uea.pdf

Beyond body image: what body schema and motor imagery can tell us about the way patients with anorexia nervosa experience their body

We explored how viewing one’s anthropometric virtual avatar would affect the viewer’s self-body perception through the comparative evaluation of self-concepts—self-esteem and self-compassion, within the framework of allocentric lock theory. We recruited 18 female adults, aged 18–21, who identified themselves to have some level of body image concerns, and who had had no clinical treatment for their body image. Participants were randomly assigned either to the experimental or control group. The experimental group participated in both body positivity program and virtual avatar program, whereas the control group attended the body positivity program, only. The results affirmed that the body positivity program served as a psychological buffer prior to the virtual avatar stimulus. After the virtual avatar experience, the participants demonstrated self-acceptance by lowering their expectation on how they should look like. The findings from exit interviews enriched the quantitative results. This study verified the mechanism of the altered processing of the stored bodily memory by the egocentric sensory input of virtual avatars, and offered practical potential of the study outcomes to be applied in various emerging fields where novel applications of virtual 3D technology are sought, such as fashion e-commerce.

/pdf/how-virtual-avatar-experience-interplays-with-self-concepts-1bgq1m42un.pdf

How virtual avatar experience interplays with self-concepts: the use of anthropometric 3D body models in the visual stimulation process

Objective Besides all visible somatic manifestations, distorted body representation is a key symptom for anorexia nervosa (AN). Body representation can be divided into a conscious component, body image, and an unconscious action-related one, body schema. As behavioral studies already explored the impact of a distorted body image in AN, we aimed to explore whether distortion also extends into unconscious body schema. This study is the first with an unbiased measurement of the body schema in a homogeneous sample of AN patients. Method Twenty-three patients diagnosed with AN and 23 healthy controls (HC) walked through a door like aperture varying in width. Door width was based on participants shoulder width and ranged from an aperture-to-shoulder-ratio of (A/S) 0.9 to 1.45. Shoulder rotation was measured as indication of perceived body width. To measure the unconscious body schema, we used a cover story pretending to investigate the influence of change of position on retention memory. Results We found a significantly higher critical A/S for AN than HC, which indicates that AN patients rotate their shoulders for relatively larger door widths than HC, thus unconsciously estimating their body size to be larger than in reality. Additionally, we found a correlation between negative body attribution and overestimation of bodily dimensions. Discussion As stated by the "allocentric-lock"-hypothesis, AN patients might be locked to a stored representation of their body that cannot be updated and remains at pre-AN conditions. We suggest future AN-therapy to counter body schema alterations by combining cognitive behavioral therapy and virtual reality therapy.

How the unconscious mind controls body movements: Body schema distortion in anorexia nervosa.

Differential effects of visually induced analgesia and attention depending on the pain stimulation site.

Synchronous Stimulation With Light and Heat Induces Body Ownership and Reduces Pain Perception.

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How the unconscious mind controls body movements: Body schema distortion in anorexia nervosa.

Differential effects of visually induced analgesia and attention depending on the pain stimulation site.

Synchronous Stimulation With Light and Heat Induces Body Ownership and Reduces Pain Perception.