Cognitive—Behavioral Treatment of Body-Image Disturbances

The human condition is inherently one of embodiment. Mind-body controversies aside, the function and appearance of the body is life shaping. This is true both in terms of others’ reactions to our bodies as we develop and interact with our social world and in terms of how we perceive and react to our own conditions of embodiment. The psychology of physical appearance (Cash, 1990; Jackson, 1992) considers both perspectives—the “outside view” concerning the social effects of appearance and the “inside view” that pertains to our highly personalized experiences of our own looks. The latter, in a broad sense, is what psychologists have come to call body image. This distinction is crucial because in appearance, as in other respects, we do not see ourselves as others see us (Cash, 1990).

[1]  H. Leitenberg,et al.  Exposure plus response-prevention treatment of bulimia nervosa. , 1988, Journal of consulting and clinical psychology.

[2]  Thomas F. Cash,et al.  In Pursuit of the Perfect Appearance: Discrepancies Among Self‐Ideal Percepts of Multiple Physical Attributes 1 , 1994 .

[3]  J. Brooks-Gunn,et al.  The effects of delayed menarche in different contexts: Dance and nondance students , 1985, Journal of youth and adolescence.

[4]  Thomas F. Cash,et al.  Body Images: Development, Deviance, and Change , 1991 .

[5]  J. Kelley.  Sexual Permissiveness: Evidence for a Theory* , 1978 .

[6]  The Psychological Significance of Secondary Sexual Characteristics in Nine- to Eleven-Year-Old Girls. , 1988 .

[7]  L. Hsu,et al.  Body image disturbance: Time to abandon the concept for eating disorders? , 1991 .

[8]  A. Stunkard,et al.  Obesity and the body image. II. Age at onset of disturbances in the body image. , 1967, The American journal of psychiatry.

[9]  J. Rosen,et al.  Cognitive behavior therapy with and without size perception training for women with body image disturbance. , 1990 .

[10]  Thomas F. Cash,et al.  Women's body images: The results of a national survey in the U.S.A. , 1995 .

[11]  Seymour Fisher,et al.  Development and structure of the body image , 1986 .

[12]  S. Bloch,et al.  Psychotherapy and Dysmorphophobia: A Case Report , 1988, British Journal of Psychiatry.

[13]  C. Peter Herman,et al.  Undieting: A program to help people stop dieting , 1992 .

[14]  J. Rosen,et al.  Development of a Body Image Avoidance Questionnaire , 1991 .

[15]  J. E. Stake,et al.  The consequences of being overweight: A controlled study of gender differences , 1987 .

[16]  A. Ross,et al.  Relationship of body image to self-concept. , 1968, Journal of consulting and clinical psychology.

[17]  T. F. Cash,et al.  Prejudice toward fat people: the development and validation of the antifat attitudes test. , 1997, Obesity research.

[18]  D. Munjack.  The behavioral treatment of dysmorphobia , 1978 .

[19]  T. F. Cash,et al.  Why Do Women Exercise? Factor Analysis and Further Validation of the Reasons for Exercise Inventory , 1994, Perceptual and motor skills.

[20]  W. G. Johnson,et al.  Eating disorders: assessment and treatment. , 1985, Clinical obstetrics and gynecology.

[21]  M. Hersen,et al.  Progress in Behavior Modification , 1983 .

[22]  T. F. Cash,et al.  Body-image disturbances and self-discrepancy theory: expansion of the Body-Image Ideals Questionnaire , 1995 .

[23]  K. Brownell,et al.  Psychological correlates of obesity: moving to the next research generation. , 1995, Psychological bulletin.

[24]  T. F. Cash,et al.  Body image, physical attractiveness, and depression , 1985 .

[25]  T. F. Cash.  DEVELOPMENTAL TEASING ABOUT PHYSICAL APPEARANCE: RETROSPECTIVE DESCRIPTIONS AND RELATIONSHIPS WITH BODY IMAGE , 1995 .

[26]  Christopher G. Fairburn.  The Definition of Bulimia Nervosa: Guidelines for Clinicians and Research Workers , 1987 .

[27]  K. Phillips.  Body dysmorphic disorder: the distress of imagined ugliness. , 1991, The American journal of psychiatry.

[28]  K. Brownell,et al.  Teasing, body image, and self-esteem in a clinical sample of obese women. , 1994, Addictive behaviors.

[29]  J. Lacey,et al.  Body image and its disturbances. , 1986, Journal of psychosomatic research.

[30]  Hilde Bruch,et al.  Perceptual and conceptual disturbances in anorexia nervosa. , 1962 .

[31]  Seymour Fisher,et al.  The evolution of psychological concepts about the body. , 1990 .

[32]  T. F. Cash,et al.  The development and validation of the Body-Image Ideals Questionnaire. , 1995, Journal of personality assessment.

[33]  K. Brownell,et al.  The social self, body dissatisfaction, and binge eating in obese females. , 1994, Obesity research.

[34]  F. Scogin,et al.  Efficacy of self-administered treatment programs: meta-analytic review , 1990 .

[35]  R. Lerner,et al.  The role of body image in psychosocial development across the life span: A developmental contextual perspective. , 1990 .

[36]  P. Maccorquodale,et al.  Self-Image and Premarital Sexuality. , 1979 .

[37]  A. Stunkard,et al.  Obesity and the body image. 1. Characteristics of disturbances in the body image of some obese persons. , 1967, The American journal of psychiatry.

[38]  T. F. Cash,et al.  Cognitive-Behavioral Body-Image Therapy: Extended Evidence of the Efficacy of a Self-Directed Program , 1997 .

[39]  T. F. Cash.  Body image and weight changes in a multisite comprehensive very-low-calorie diet program , 1994 .

[40]  L. Tucker.  Relationship between Perceived Somatotype and Body Cathexis of College Males , 1982 .

[41]  A. Drewnowski,et al.  Men and body image: are males satisfied with their body weight? , 1987, Psychosomatic medicine.

[42]  K. Mitchell,et al.  Heterosexual Social Competence, Anxiety, Avoidance and Self-Judged Physical Attractiveness , 1976, Perceptual and motor skills.

[43]  A. Stunkard,et al.  SOCIAL FACTORS IN OBESITY. , 1965, JAMA.

[44]  M. Taylor,et al.  The development and validation of the body shape questionnaire , 1987 .

[45]  G. Wilson,et al.  Cognitive-behavioral treatment of bulimia nervosa: a controlled evaluation. , 1986, Behaviour research and therapy.

[46]  T. F. Cash.  Body-Image Attitudes among Obese Enrollees in a Commercial Weight-Loss Program , 1993, Perceptual and motor skills.

[47]  T. F. Cash.  Body-Image Affect: Gestalt versus Summing the Parts , 1989 .

[48]  D. Garner,et al.  Comparison of cognitive-behavioral and supportive-expressive therapy for bulimia nervosa. , 1993, The American journal of psychiatry.

[49]  D. Luchins,et al.  Is There an Obsessive Psychosis? Aetiological and Prognostic Factors of an Atypical Form of Obsessive-Compulsive Neurosis * , 1985, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[50]  B. Kerr,et al.  Comparison of interventions for women experiencing body image problems. , 1987 .

[51]  J. Rosen,et al.  Body-image disturbances in eating disorders. , 1990 .

[52]  J. Thompson,et al.  Multiple aspects and correlates of body figure ratings: A replication and extension of Fallon and Rozin (1985) , 1988 .

[53]  Shelly Chaiken,et al.  Gender Differences in Concern with Body Weight and Physical Appearance Over the Life Span , 1990 .

[54]  H. Doll,et al.  Predictors of 12-month outcome in bulimia nervosa and the influence of attitudes to shape and weight. , 1993, Journal of consulting and clinical psychology.

[55]  J. Thompson,et al.  Body image: extent of disturbance, associated features, theoretical models, assessment methodologies, intervention strategies, and a proposal for a new DSM diagnostic category--body image disorder. , 1992, Progress in behavior modification.

[56]  A. Beck,et al.  Depression: Causes and Treatment , 1967 .

[57]  B. Walsh,et al.  Self-Mutilation: Theory, Research, and Treatment , 1988 .

[58]  Thomas F. Cash,et al.  Current and vestigial effects of overweight among women: Fear of fat, attitudinal body image, and eating behaviors , 1990 .

[59]  J. Rosen,et al.  Cognitive behavior therapy for negative body image , 1989 .

[60]  P. Garfinkel.  Evidence in support of attitudes to shape and weight as a diagnostic criterion of bulimia nervosa , 1992 .

[61]  J. Thompson,et al.  A Comparative Evaluation of Cognitive-Behavioral Therapy (CBT) Versus Exercise Therapy (ET) for the Treatment of Body Image Disturbance , 1994, Behavior modification.

[62]  Dc Washington.  Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. , 1994 .

[63]  Body weight and body image among college women: perception, cognition, and affect. , 1986, Journal of personality assessment.

[64]  Neil S. Jacobson,et al.  Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. , 1991 .

[65]  E. Foa,et al.  Stop Obsessing!: How to Overcome Your Obsessions and Compulsions , 1991 .

[66]  E. Rothblum,et al.  Gender differences in social consequences of perceived overweight in the United States and Australia , 1988 .

[67]  J. Rodin,et al.  A prospective study of disordered eating among college students , 1989 .

[68]  J. Thompson,et al.  Development and validation of the Physical Appearance Related Teasing Scale. , 1991, Journal of personality assessment.

[69]  H. Markus.  Self-schemata and processing information about the self. , 1977 .

[70]  T. Wadden,et al.  The heterogeneity of obesity: Fitting treatments to individuals. , 1991 .

[71]  T. F. Cash,et al.  Self-Disclosure Correlates of Physical Attractiveness: An Exploratory Study , 1975, Psychological reports.

[72]  D. Kirschenbaum,et al.  Cognitive-behavioral therapy for bulimia: an initial outcome study. , 1985, Journal of consulting and clinical psychology.

[73]  J. Brennan,et al.  Depression and Body Image Satisfaction , 1981 .

[74]  J. Rodin,et al.  Behavioral and psychological implications of body dissatisfaction: Do men and women differ? , 1988 .

[75]  P. Mikulka,et al.  Attitudinal body-image assessment: factor analysis of the Body-Self Relations Questionnaire. , 1990, Journal of personality assessment.

[76]  T. Wadden,et al.  Three-year follow-up of the treatment of obesity by very low calorie diet, behavior therapy, and their combination. , 1988, Journal of Consulting and Clinical Psychology.

[77]  J. Rodin,et al.  Women and weight: a normative discontent. , 1985, Nebraska Symposium on Motivation. Nebraska Symposium on Motivation.

[78]  W. DeJong,et al.  The stigma of obesity: the consequences of naive assumptions concerning the causes of physical deviance. , 1980, Journal of health and social behavior.

[79]  J. Rosen,et al.  Cognitive Behavior Therapy for Negative Body Image in Obese Women , 1995 .

[80]  R. Rubin.  Koro (Shook Yang) A Culture-Bound Psychogenic Syndrome , 1982 .

[81]  D. Garner,et al.  Body Image in Anorexia Nervosa: Measurement, Theory and Clinical Implications , 1982, International journal of psychiatry in medicine.

[82]  G. Clum,et al.  A meta-analysis of self-help treatment approaches , 1993 .

[83]  J. Mayer,et al.  Obesity — Its Possible Effect on College Acceptance , 1966 .

[84]  Emotional Response Patterns to Body Weight-Related Cues , 1983 .

[85]  Hsu Lk.  Is there a disturbance in body image in anorexia nervosa , 1982 .

[86]  D. Williamson,et al.  Assessment of Eating Disorders: Obesity, Anorexia, and Bulimia Nervosa , 1989 .

[87]  A. Munro.  Monosymptomatic Hypochondriacal Psychosis , 1980, British Journal of Psychiatry.

[88]  A. Beck.  Cognitive therapy and the emotional disorders: A. T. Beck , 1987, British Journal of Psychiatry.

[89]  D. Krueger.  Body Self and Psychological Self. A Developmental and Clinical Integration of Disorders of the Self. New York (Brunner/Mazel) 1989. , 1989 .

[90]  B. Vitiello,et al.  Dysmorphophobia misdiagnosed as obsessive-compulsive disorder. , 1990, Psychosomatics.

[91]  M. Olmsted,et al.  Brief group psychoeducation for bulimia nervosa: assessing the clinical significance of change. , 1990, Journal of consulting and clinical psychology.

[92]  R. Klesges.  An analysis of body image distortions in a nonpatient population , 1983 .

[93]  T. F. Cash,et al.  Body images, body-size perceptions, and eating behaviors among African-American and white college women. , 1992 .

[94]  T. F. Cash,et al.  New Assessments of Weight-Related Body Image Derived from Extant Instruments , 1991, Perceptual and motor skills.

[95]  S. Abramowitz,et al.  Educative/support groups and subliminal psychodynamic activation for Bulimic college women , 1989 .

[96]  Keith P. Sentis,et al.  Thinking Fat: Self‐Schemas for Body Weight and the Processing of Weight Relevant Information1 , 1987 .

[97]  T. F. Cash,et al.  Content analysis: a comparison of manual and computerized systems. , 1990, Journal of Personality Assessment.

[98]  R. Kellner.  Somatization and Hypochondriasis , 1985 .

[99]  Steven J. Kass,et al.  A Factor Analytic Study of the Boredom Proneness Scale , 1990 .

[100]  Binge eating disorder: reliability and validity of a new diagnostic category. , 1994 .

[101]  A. H. Schulman,et al.  Mirror-image response during the first two years of life. , 1977, Developmental psychobiology.

[102]  H. A. Pines,et al.  No Fat Persons Need Apply , 1979 .

[103]  T. Giles.  Distortion of body image as an effect of conditioned fear. , 1988, Journal of behavior therapy and experimental psychiatry.

[104]  C. Fairburn,et al.  Three psychological treatments for bulimia nervosa. A comparative trial. , 1991, Archives of general psychiatry.

[105]  L. Braddock.  Dysmorphophobia in Adolescence: A Case Report , 1982, British Journal of Psychiatry.

[106]  T. F. Cash,et al.  Cognitive-behavioral body image therapy: Comparative efficacy of group and modest-contact treatments , 1995 .

[107]  J. Stern,et al.  Maintenance and relapse after weight loss in women: behavioral aspects. , 1990, The American journal of clinical nutrition.

[108]  R. Michels,et al.  Diagnostic and Statistical Manual of Mental Disorders, 3rd ed , 1981 .

[109]  G. Huon,et al.  Body images in anorexia nervosa and bulimia nervosa , 1986 .

[110]  K. Brownell,et al.  Handbook of Eating Disorders: Physiology, Psychology, and Treatment of Obesity, Anorexia, and Bulimia , 1986 .

[111]  Roy F. Baumeister,et al.  A Three-Component Model of Children's Teasing: Aggression, Humor, and Ambiguity , 1991 .

[112]  E. Hollander,et al.  Treatment of body-dysmorphic disorder with serotonin reuptake blockers. , 1989, The American journal of psychiatry.

[113]  C. Fairburn,et al.  Cognitive treatments for eating disorders. , 1993, Journal of consulting and clinical psychology.

[114]  T. Brown,et al.  Body Image in Anorexia Nervosa and Bulimia Nervosa , 1987, Behavior modification.

[115]  D. Barlow.  Causes of sexual dysfunction: the role of anxiety and cognitive interference. , 1986, Journal of consulting and clinical psychology.

[116]  D. Ciliska.  Beyond dieting : psychoeducational interventions for chronically obese women : a non-dieting approach , 1990 .

[117]  C. Fairburn,et al.  Binge eating: nature, assessment and treatment , 1993 .

[118]  K. Brownell.  Dieting and the search for the perfect body: Where physiology and culture collide , 1991 .

[119]  T. Brown,et al.  Body-image disturbances in adolescent female binge-purgers: a brief report of the results of a national survey in the U.S.A. , 1989, Journal of child psychology and psychiatry, and allied disciplines.

[120]  J. Thompson,et al.  Body Image and Eating Disturbance in Young Females , 1989 .

[121]  T. F. Cash.  The psychology of physical appearance: Aesthetics, attributes, and images. , 1990 .

[122]  Nichola. Rumsey,et al.  The Social Psychology of Facial Appearance , 1998 .

[123]  R. Archer,et al.  Physical Attractiveness and Maladjustment Among Psychiatric Inpatients , 1985 .

[124]  J. Thompson,et al.  Body Image Disturbance: Assessment and Treatment , 1992, Behaviour Change.

[125]  T. F. Cash,et al.  The nature and extent of body-image disturbances in anorexia nervosa and bulimia nervosa: a meta-analysis. , 1997, The International journal of eating disorders.

[126]  K. Phillips,et al.  Body dysmorphic disorder: does it have a psychotic subtype? , 1993, The Journal of clinical psychiatry.

[127]  R. Freedman,et al.  Cognitive-behavioral perspectives on body-image change. , 1990 .

[128]  M. Drake.  Diagnostic and Statistical Manual of Mental Disorders (3rd ed. rev.) , 1988 .

[129]  D. Williamson,et al.  Development of a simple procedure for assessing body image disturbances. , 1989 .

[130]  E. Hollander,et al.  Dermatology and conditions related to obsessive-compulsive disorder. , 1992, Journal of the American Academy of Dermatology.

[131]  J. Rosen.  The nature of body dysmorphic disorder and treatment with cognitive behavior therapy , 1995 .

[132]  P. McKenna.  Disorders with Overvalued Ideas , 1984, British Journal of Psychiatry.

[133]  P. D. Silva.  Book reviewThe etiology of bulimia nervosa—The individual and family context: J.H. Crowther, D.L. Tennenbaum, S.E. Hobfell and M.A.P. Stephens (Eds): Hemisphere, Washington (1992). xvi + 252 pp. £35.00 , 1994 .

[134]  C. Friedmann,et al.  Extraordinary Disorders of Human Behavior , 2012, Critical Issues in Psychiatry.

[135]  T. F. Cash,et al.  Psychological effects of androgenetic alopecia on women: comparisons with balding men and with female control subjects. , 1993, Journal of the American Academy of Dermatology.

[136]  R. Montemayor,et al.  Developing Social Competency in Adolescence , 1990 .

[137]  J. Crowther,et al.  An evaluation of behavioral and cognitive‐behavioral group interventions for the treatment of bulimia nervosa in women , 1992 .

[138]  Linda A. Jackson,et al.  Physical Appearance and Gender: Sociobiological and Sociocultural Perspectives , 1992 .

[139]  J. Graham,et al.  The Psychology of cosmetic treatments , 1985 .

[140]  Joel Fischer,et al.  Measures for Clinical Practice: A Sourcebook , 1987 .

[141]  T. F. Cash.  Your Body, Yourself : A Psychology Today Reader Survey , 1985 .

[142]  L. Sank,et al.  A Therapist’s Manual for Cognitive Behavior Therapy in Groups , 1984 .

[143]  G. Wilson,et al.  Assessment of bulimia nervosa: An evaluation of the eating disorders examination , 1989 .

[144]  W H Dietz,et al.  Social and economic consequences of overweight in adolescence and young adulthood. , 1993, The New England journal of medicine.

[145]  S. Wolchik,et al.  An empirically validated, short-term psychoeducational group treatment program for bulimia , 1986 .

[146]  Thomas F. Cash,et al.  Cognitive-behavioral treatment of women's body-image dissatisfaction. , 1987 .

[147]  A. Fallon,et al.  Sex differences in perceptions of desirable body shape. , 1985, Journal of abnormal psychology.

[148]  D. Meichenbaum.  Stress inoculation training , 1985 .

[149]  B. Silverstein,et al.  The role of the mass media in promoting a thin standard of bodily attractiveness for women , 1986 .

[150]  A. Fallon,et al.  Culture in the mirror: Sociocultural determinants of body image. , 1990 .

[151]  J. Yaryura-Tobias,et al.  Exposure, response prevention, and cognitive therapy in the treatment of body dysmorphic disorder , 1993 .

[152]  L. Penner,et al.  Procedures, problems, and progress in the assessment of body images. , 1990 .

[153]  J. Rodin,et al.  Fat distribution as a risk factor for weight and eating concerns. , 1990 .

[154]  A. C. Downs.  The social biological constructs of social competency. , 1990 .

[155]  Isaac Marks,et al.  Dysmorphophobic Avoidance with Disturbed Bodily Perception , 1988, British Journal of Psychiatry.

[156]  Gerald C. Davison,et al.  Clinical Behavior Therapy , 1976 .

[157]  K. Phillips,et al.  Body dysmorphic disorder: 30 cases of imagined ugliness. , 1993, The American journal of psychiatry.

[158]  David M. Garner,et al.  Confronting the failure of behavioral and dietary treatments for obesity , 1991 .

[159]  M. Olmsted,et al.  Efficacy of a brief group psychoeducational intervention for bulimia nervosa. , 1991, Behaviour research and therapy.

[160]  M. Connors,et al.  Treatment of bulimia with brief psychoeducational group therapy. , 1984, The American journal of psychiatry.

[161]  T. F. Cash.  Body-Image Attitudes: Evaluation, Investment, and Affect , 1994, Perceptual and motor skills.