Body Image, Eating Disorders and Obesity - J. Thompson (APA) WW

1). However, researchers and clinicians did not immediately build on hersuggestion by targeting the body image problems of individuals with eatingdisorders. In 1987, Garner, Fairburn, and Davis cataloged 22 different treat-ment components in the 19 treatment outcome studies contained in theirreview. None of these intervention strategies included a focus on bodyimage issues. In his 1990 review, Rosen found that the "overwhelmingmajority" (p. 205) of 75 studies either (a) did not treat or measure bodyimage or (b) did not assess body image changes, despite targeting bodyimage problems during treatment. None of the 20 pharmacological studiesmeasured body image (see chapter 14, this volume, for an update on thisliterature). Of the 40 psychological treatment outcome studies reviewed byRosen (1990), approximately one third involved some procedure to modifybody image. Many of these trials were uncontrolled, with the exception ofseveral studies with bulimia nervosa. Of the few controlled studies,cognitive-behavioral procedures appeared to offer the most promise forimproving body image concerns. Rosen (1990) concluded that it was"ironic and alarming that there is still no definite answer to questions oftreatment effectiveness for body-image disturbance" (p. 208).

Rosen (in press) recently revisited this issue. His second review ofthis area included studies that employed an experimental design with ran-dom assignment of subjects to treatment and, minimally, one other con-dition. If studies did not contain specific details delineating procedurestargeting body image concerns, they were not labeled as including a bodyimage therapeutic component. It should be noted that this review proce-dure may have eliminated some investigations that addressed some aspectof body image in their overall treatment program, but failed to provide adiscussion of the information within the text of the article. Rosen foundthat 21 of the 31 studies that used a psychological intervention (usuallycognitive-behavioral therapy) included a body image component. How-ever, he also found that the intervention was typically minimalistic, usuallyinvolving some psychoeducational information relevant to the sociocul-tural bases of eating disorders or cognitive restructuring procedures thatincluded some focus on thoughts or beliefs about shape and body size. Noneof the studies used the set of techniques that have been found to be effec-tive for body image problems in non-eating-disordered females, individualswith body dysmorphia, or obesity (see chapters 4, 7, and 17, this volume).For instance, no study used exposure or response prevention procedures todeal with body image avoidance or included a self-monitoring form todocument relevant thoughts regarding size, shape, and weight (outside ofbinge eating episodes).

Our own review of the research paralleled the findings of Rosen'sreview (in press), suggesting little systematic effort to target body imagedisturbance concurrent with a selection of dependent measures capable ofdocumenting change in this critical aspect of eating disorders. Many of the

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