Paper presented by Dr. Emanuel Mian at the International Conference on Eating Disorders of the Academy of Eating Disorders- Barcelona 2006. Body image disturbances have been a challenge for researchers working on eating disorders in the last thirty years. Body focus and a general fear to gain weight are often cited as a causal and/or maintaining factor in eating disorders. For too long, research on body perception in eating disorders has been focusing on accuracy of body size estimation in a rather simplistic way. There is a strong need for new and valid instruments in body image assessment methods. The present study reports on the development of a body image assessment instrument combining a complex subject’s image simulation technique and simplicity of administration. Furthermore, we report on a pilot study, testing the new digital sys- tem in hospitalized eating disorder patients of St-Jozef’s Center (Belgium) and Villa Garda’s Clinic (Italy). Women with clinical eating disorders (n = 66) and normal controls (n = 34) estimated their actu- al (cognitive task), felt (affective task), supposed by others (meta- cognitive task) and desired (optative task) body size while using the computer-based simulation technique on a video screen. In the cog-

1. BODY IMAGE ASSESSMENT IN
EATING DISORDER PATIENTS:
testing a new digital method
Emanuel Mian1, Johan Vanderlinden2, Michel Probst2, Guido Pieters2, Riccardo Dalle Grave1
1
Department of Eating and Weight Disorder. Villa Garda Hospital Italy
2
Eating Disorder Unit. St-Jozef Kortenberg Belgium

2. Body Image Disturbance
Anorexia Nervosa
Disturbance in the way in which one ’’s body weight or
Disturbance in the way in which one s body weight or
shape is experienced, undue influence of body
shape is experienced, undue influence of body
(AN) weight or shape on self evaluation, or denial of the
weight or shape on self evaluation, or denial of the
seriousness of current low body weight.
seriousness of current low body weight.
Bulimia Nervosa Self evaluation is unduly
Self evaluation is unduly
influenced by body shape
influenced by body shape
and weight.
and weight.
(BN)
Eating disorders not Eating Disorder in which
Eating Disorder in which
otherwise specified someone has some but not
someone has some but not
all the symptoms
all the symptoms
of AN or BN
of AN or BN
(EDNOS)

3. Body Image Testing
Silhouettes Tests
Beebe et al. (1999)
Smeets et al. (1999) Collins (1991)

4. Letosa-Porta et al. (2005)
Gardner et al. (2005)
Shafran and Fairburn (2003) Tovè e et al.(2003)

5. How Body Image Revealer works
Subject’s Image •Easy Subministration
Capture •Quickness
•12 minutes between image capture and final output percentages
•2-buttons “driven by subject” technique to modify images
•Fully programmable for a frontal, side or back simulation
Mian Emanuel (2006)
permission for the use of this image required by Author
Standard curves/simulation patterns
SUBJECT STANDING 2,5 mt FAR FROM DIGITAL CAMERA and algorithm intervention for each subject
• Cognitive Task
How do you think you are?
• Affective Task
How do you feel you are?
• Meta-Cognitive Task
How do you think the others think you are?
• Optative Task
How do you want to look like?

6. CONTROL
AN BN EDNOS GROUP
(36) (10) (21) (34)
23 21 27 23
Age (+- 8) (+- 4) (+- 6) (+- 4)
17 22 19 19.2
BMI (+- 2) (+- 4) (+- 2) (+- 1)
B.A.T. 50.8 56 44 17
total scores
EDI 10.9 12.1 9 2.6
drive for thinness
subscale
EDI 13.4 16.3 12.5 4.1
body dissatisfaction
subscale
Scl-90-BIA-EDES-EAT26 were in the questionnaries we subministered to subjects

7. Case example
Real Image
no simulation
How do you think others How do you think you really
think you are? look like?
(underweight) (overweight)
Subject did not have clues or hints, and the starting distortion percentage was randomly set from +21% to -25%

8. Case example
Real Image
no simulation
How do you think others How do you think you really
think you are? look like?
(underweight) (overweight)
Follows the natural pattern fitting subject’s own body fat
distribution
Subject did not have clues or hints, and the starting distortion percentage was randomly set from +21% to -25%

9. Underweight Simulation Normal Overweight Simulation
The Body Image Revealer can manage subject’s images without taking into account neutral
objects using skin detection and boundary extrusion techniques .
Correlations between retest session on 53 subjects with
Bikini and with clothes, were used as a retest session and
as a reliability analysis
They ranged from r..79 to r.91
All correlations are significant at p<.05

10. Results
Body Image Revealer
AN BN EDNOS CONTROL p
(36) (10) (21) (34)
Cognitive
+14% +16% +17% +5 % .0016
Task*
Affective
+20% +16% +19% +6% .005
Task*
Meta-
Cognitive +8% +13%** +7% +4% .02
Task
Cognitive, Affective and Optative tasks correlated positively with EDI-
* The difference between Italian and Belgian BN patients was +15% vs +4%, further investigations
are on the way in order and all Body Image-related subscales of every
DT and BD to evaluate crosscultural differences
questionnaire we submitted
but this is another story…