The Body Image Approach Test (BIAT): A Potential Measure of the Behavioral Components of Body Image Disturbance in Anorexia and Bulimia Nervosa?

A disturbed body image with fluctuating behavioral patterns of body related avoidance (BA) and body checking (BC) characterizes individuals with eating disorders (EDs) such as anorexia (AN) or bulimia nervosa (BN). So far, these behavioral body image components are mostly assessed via self-report instruments thereby neglecting their behavioral and partially automatic characteristics. Therefore, behavioral measures of BA and BC are needed. The present study investigates a behavioral assessment task for BA and BC in a sample of patients with diagnosed EDs and healthy controls. The sample consisted of 40 women diagnosed with either BN (N = 19) or AN (N = 21; ED sample) and 24 non-eating disordered, healthy female controls (HC). Within the Body Image Approach Task (BIAT) participants viewed photos of their own body (self-image) and a matched control body (other-image) by zooming the photos closer toward them (image became more focused) on the screen. The BIAT yields zoom-levels recorded separately for self- relative to other-images. Further measures were attractiveness ratings of these body images as well as questionnaire measures of BA, BC, and general ED symptomatology. Results showed that despite strong body dissatisfaction and clearly negative ratings of self- relative to other-images in both EDs, no group differences were found in approach to self-images on zoom-level as measured with the BIAT. Correlational analysis in each group indicated that zoom-level was positively related to BA scores in the HC group only. Yet, stepwise regression analyses revealed that attractiveness ratings explained most of the variance accounted by BA in predicting zoom-level. In sum, the BIAT seems suitable to assess BA and self-rated body attractiveness, but only in healthy individuals with subclinical levels on these constructs. It does not seem to capture the body image satisfaction or the behavioral components of body image disturbances in AN or BN or it conflates the opposed influences of BA and BC. Further experimentation is needed to adapt measures of behavioral body image components to the processes evoked in patients with ED during confrontation with body images.