Body image in eating disorders: Integrating aesthetic and functional body experience

The aim of this thesis was to extend knowledge related to assessment and treatment of negative body experience in eating disorders (EDs), with an emphasis on the role of body functionality in reducing body dissatisfaction. To achieve this, questionnaires about body appreciation, especially body functionality needed further clinical validation to facilitate research of body experience therapy. In Chapter 2 and 3 we evaluated the psychometric properties of the Dutch versions of the Body Cathexis Scale (BCS) and the Functionality Appreciation Scale (FAS) in both a female ED sample and a female community sample. In conclusion, these studies showed that the Dutch versions of both questionnaires are valid, reliable and valuable to measure body satisfaction and body functionality appreciation in people with EDs. Furthermore, we argued that body exposure protocols have to be developed and evaluated to better target negative body experience in EDs. In Chapter 4 we presented the development and description of a body-oriented treatment protocol with focus on positive body exposure. We discussed the scientific basis of the protocol: positive body experience (PBE) and described its content and structure, illustrated by clinical case vignettes. An important and innovative aspect of the protocol is that during body exposure the focus lies not only on aesthetic, but also on functional body experience. In Chapter 5 a pilot pre-post study is presented, that evaluated the outcomes of positive body exposure with regard to changes in negative body experience and eating pathology and factors that influence these changes. Significant positive changes in body experience, eating pathology and depressive symptoms were found. A limitation of all our studies was that we had to restrict our samples to female participants, because only a very small minority of the participants in the ED samples were men. It is therefore unclear whether our findings can be applied to men with an ED. Another limitation concerns the research design of the pilot study. The lack of a control group and follow-up measures in our clinical study imply that the results must be interpreted with caution. Since Randomized Control Trials (RCTs) are not always feasible or only to be executed with considerable compromises in terms of applicability in a clinical setting, we recommend that future research could use alternative designs like single case or cohort studies. In our discussion we highlight the importance of body experience problems in EDs. We argue that negative body experience may be a core problem in EDs. This makes an effective treatment of body experience problems an important element of the treatment of EDs. We have underlined the importance of positive body exposure that contains and integrates both positive aesthetic and functional body experience and made a first step towards description and evaluation of such a protocol.