How certainty appraisal might improve both body dissatisfaction and body overestimation in anorexia nervosa: a case report

BACKGROUND: Patients with anorexia nervosa often report a conscious alteration of body image representation, with both body overestimation and body dissatisfaction. Cognitive and behavioural therapy is effective for treating many psychiatric disorders but often fails to treat anorexia nervosa and body image distortions. Although patients are aware of their weight loss, they continue to feel overweight - as if there were a conflict between a previous (maybe already false) body representation and the new one. These distortions are linked to negative emotions focused on the body but which can extend to the self (e.g. disgust and sadness). CASE PRESENTATION: The present case report is the first in which the Appraisal Tendency Framework has been applied to decrease body image distortions in a patient with anorexia nervosa. The Appraisal Tendency Framework is usually used to understand how emotions influence decision making. Here, we report on a 24-year-old woman who suffered from anorexia nervosa and body image distortions, and was treated as an inpatient with conventional cognitive and behavioural therapy for an eating disorder. Body image distortions were assessed before and after the patient completed an adaptation of the Iowa Gambling Task, coupled with the induction of a heuristic processing emotion. We hypothesized that allowing the patient to focus on the emotional cues in the modified Iowa Gambling Task would improve her decisions about her true body shape. CONCLUSION: All body image measures were improved after the protocol. Consequently, we suggest that the Appraisal Tendency Framework might be a valuable means of investigating body image issues in eating disorders and anorexia nervosa. Further studies are required to expand and detail these findings. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s40337-018-0216-0) contains supplementary material, which is available to authorized users.