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Abstract Assessing body image disturbance in patients with anorexia nervosa using biometric self-avatars in virtual reality: attitudinal components rather than visual body size estimation are distorted
Simone C Mölbert1,2,3, Anne Thaler2,3, Betty Mohler2, Stephan Streuber4, Michael J Black5, Hans-Otto Karnath6, Stephan Zipfel1, Katrin E Giel1
1Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany/2Max Panck Institute for Biological Cybernetics, Tübingen, Germany/3Graduate Training Centre of Neuroscience, IMPRS, University of Tübingen, Tübingen, Germany/4Ecole Polytechnique Federale de Lausanne, Lausanne, Switzerland/5Max Planck Institute for Intelligent Systems, Tübingen, Germany/6Center of Neurology, Division of Neuropsychology, University of Tübingen, Tübingen, Germany

Aims: Body image disturbance (BID) is a core symptom of Anorexia Nervosa (AN), but as yet its distinctive features are unknown. Here we use individual 3D-avatars in virtual reality to investigate contributions of weight perception and evaluation to BID. Method: We investigated n=24 women with AN and n=24 healthy controls. Based on 3D body scans, we created individual avatars for each participant. Each avatar was biometrically manipulated to gradually represent +/- 20% of the participant’s weight. Avatars were presented on a stereoscopic life-size screen and participants had to identify/adjust their current and desired body weight. Additionally, eating pathology, body dissatisfaction and self-esteem were assessed. Results: Both groups underestimated their weight, with a trend that women with AN underestimated more than controls. Both groups indicated a desired weight lower than their actual weight, and in percent of own body weight, controls even more so. Of note, the average desired body of women with AN was severely underweight, while the control’s desired body was normal weight. Correlation analyses revealed that desired body size, but not accuracy of body size estimation, was associated with eating disorder symptoms. Conclusions: Our results contradict the widespread assumption that BID is driven by overestimation and emphasize the role of attitudinal components for BID. According to our observations, clinical interventions should target a change in desired weight.

Category
Psychological