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Participants were 65 obese men and women who were randomly assigned to either weight control or weight control plus cognitive behavioral body image therapy. Both conditions showed clinically significant improvements in body image at posttreatment and 1-year follow-up. Adding body image therapy to weight control did not result in greater psychological improvements and did not result in better maintenance of body image change when participants regained weight after treatment. Weight loss and maintenance were equivalent between groups. Adding body image therapy did not improve or detract from weight loss. Although body image therapy has been shown to be effective in obese persons, it appears that a well-rounded cognitive-behavioral weight control program is effective as well.

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OBJECTIVE: To create inventories of stigmatizing situations faced by obese people and ways of coping with stigmatization, and to examine how stigma and coping are related to psychological distress in an obese patient population. DESIGN: Study 1: Items were generated by asking obese people to list stigmatizing situations they had encountered and their ways of coping. Study 2: Obese patients were surveyed about the frequency with which they encountered each form of stigmatization and employed each form of coping. Cross-sectional data on current psychological adjustment were obtained. SUBJECTS: Study 1: 63 obese patients (body mass index, BMI > 40 kg/m2); 38 obese non-patients, seven professionals who work with obese patients and 32 obese female authors from the print media. Study 2: 112 gastric bypass patients (BMI 33.9-80.9 kg/m2) and 34 less obese patients (BMI 27.1-57.2 kg/m2). MEASUREMENT: Study 1: Collection of stigmatizing situations and coping responses. Study 2: Frequency of stigmatizing experiences and coping responses, psychological symptoms, body image, and self esteem measures. RESULTS: Study 1 resulted in two objective questionnaires, consisting of 50 situations and 99 responses. Study 2 found that stigmatization is a common experience, and that obese subjects frequently engage in some effort to cope with stigma. More frequent exposure to stigmatization was associated with greater psychological distress, more attempts to cope, and more severe obesity. Certain coping strategies are associated with greater distress.

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Eating and body dysmorphic disorders are two diagnoses with body image disturbance as a central feature. No empirical study of the similarity of these disorders or any controlled study of body dysmorphic disorder were available. The present study compared 45 women with anorexia or bulimia nervosa to 51 men and women with body dysmorphic disorder (BDD) and 50 nonclinical controls. The eating disorder patients were mainly preoccupied with weight and body shape. BDD subjects had more diverse physical complaints and reported more negative self-evaluation and avoidance due to appearance. However, the two groups showed equally severe body image symptoms overall, and were clearly abnormal compared with controls. Both types of patients had negative self-esteem, but eating disorder patients had more widespread psychological symptoms. In conclusion, the disorders are comparable on psychological measures. Explanations of the minor differences and questions for future research on the relation between eating and body dysmorphic disorders are presented.

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OBJECTIVE: This literature review examined the extent to which body image been assessed and treated in eating disorder treatment programs and the effectiveness of different treatments for body image change. METHOD: Published reports of experimentally controlled clinical trials were examined for the use of measures and interventions that concerned body image. RESULTS: About one third of psychotherapy studies assessed and treated body image. Cognitive behavioral eating disorder programs for bulimia nervosa result in modest body image improvement. Pharmacotherapy seems to be less effective than CBT, though few pharmacotherapy studies assessed body image. Although cognitive restructuring is widely used, behavioral interventions and self-monitoring that target body image have not been reported by most eating disorder programs. Little information is available on body image methods in anorexia nervosa and binge-eating disorder. DISCUSSION: Given the importance of body image for the development and recovery from eating disorders, more systematic body image work should be incorporated into current treatment.

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OBJECTIVE: The Body Shape Questionnaire (BSQ) is a useful measure of weight and shape concern. The purpose of this study is to contribute new psychometric information on the BSQ in order to assist clinicians and researchers who intend to use this measure. METHOD: This paper reports average scores on American samples of clinical subjects referred for body image problems, obese persons seeking weight reduction, and nonclinical samples of college students and adults. RESULTS AND DISCUSSION: The BSQ demonstrated good test-retest reliability, concurrent validity with other measures of body image, and criterion validity for clinical status.

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The Body Dysmorphic Disorder Examination (BDDE) is a semi-structured clinical interview designed to diagnose body dysmorphic disorder and to measure symptoms of severely negative body image. It tape into preoccupation with and negative evaluation of appearance, self-consciousness and embarrassment, excessive importance given to appearance in self-evaluation, avoidance of activities, body camouflaging, and body checking. The BDDE had adequate internal consistency and test-retest and interrater reliability. It correlated with measures of body image, negative self-esteem, and psychological symptoms, and was sensitive to change following treatment of body dysmorphic disorder. The BDDE distinguished body dysmorphic disorder patients from clinical and non-clinical control subjects and agreed with other clinicians' diagnosis of body dysmorphic disorder. The BDDE provided unique information in predicting clinical status when controlling for psychological adjustment and other measures of body image.

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Body dysmorphic disorder (BDD) is a distressing body image disorder that involves excessive preoccupation with physical appearance in a normal appearing person. Prior case reports of behavior therapy were encouraging, but no controlled evaluation of behavior therapy or any other type of treatment had been conducted. In the present study, 54 BDD subjects were randomly assigned to cognitive behavior therapy or no treatment. Patients were treated in small groups for eight 2-hour sessions. Therapy involved modification of intrusive thoughts of body dissatisfaction and overvalued beliefs about physical appearance, exposure to avoided body image situations, and elimination of body checking. Body dysmorphic disorder symptoms were significantly decreased in therapy subjects and the disorder was eliminated in 82% of cases at posttreatment and 77% at follow-up. Overall psychological symptoms and self-esteem also improved in therapy subjects.

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The Body Dysmorphic Disorder Examination (BDDE) has several advantages for the assessment of body image in eating disorder patients. It measures distressing self-consciousness, preoccupation with appearance, overvalued ideas about the importance of appearance to one's self-worth, and body image avoidance and checking behaviors. The BDDE is relevant for any type of appearance complaint and is not limited to weight or body shape concerns. The BDDE measures the useful targets for body image therapy. In a sample of eating disorder patients, the Body Dysmorphic Disorder Exam had good internal consistency and was significantly correlated with other measures of body image. It added new information to the discrimination of women with eating disorders from clinical and nonclinical controls beyond that provided by other measures of body image.

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Two studies on resting metabolic rate (RMR) in bulimia nervosa were conducted. The first study compared RMR before treatment in 25 normal-weight women with bulimia nervosa and 20 control subjects of similar height, weight, body composition, age, and activity level. No significant difference in RMR adjusted for fat-free weight was observed. The second study sought to determine whether RMR in women with bulimia nervosa changed if they ceased vomiting and resumed eating in a more normal fashion after cognitive-behavioral treatment. There was no differential change in RMR from pre- to posttreatment for the "improved" bulimics (9 of 12 subjects who received treatment) relative to 13 control subjects who were also tested twice at the same time intervals as the treated bulimia nervosa subjects. These findings do not support the hypothesis that normal-weight women with bulimia nervosa have a suppressed RMR, nor is it altered with treatment compared with matched control subjects.

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A comparison of cognitive-behavior therapy alone, desipramine alone, and cognitive-behavior therapy combined with desipramine was made in the treatment of bulimia nervosa. The study was terminated early with an N of only 7 subjects per condition because of a high drop-out rate and lack of positive response in the desipramine alone group compared to the other two groups. By this time it was also apparent that at posttreatment and at 6 months follow-up no benefit was being realized from combining cognitive-behavior therapy with desipramine.

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Prior research has shown that psychopathology and stress are associated with eating disorder symptoms, but the relations among these variables were confounded by concurrent measurement at a single point in time. The present study examined the relations among stress, psychological, and eating disorder symptoms prospectively over 4 months in 143 adolescent girls. In cross-sectional analyses at follow-up, controlling for baseline levels, stress and eating disorder symptoms each predicted changes in the other. Eating disorder symptoms were not predicted by psychological symptoms nor vice versa. Stress was predicted by eating disorder symptoms from the first assessment to follow-up. On balance, the results are somewhat stronger for the argument that eating disorder symptoms are predictive of subsequent psychological stress over short periods of time.

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Independent experiments have been performed at two centers, to evaluate the dosimetric properties of their respective 109Cd K X-ray fluorescence (XRF) bone lead measurement systems. Measurements were made of the dose to several points on the skin on the lower leg, at the surface of the tibia, in the red marrow tibia cavity, at the midcalf, and in the abdominal region occupied by the conceptus. Overall agreement between the two data sets was found. Similarities and differences are discussed. The effective dose values for an in vivo measurement of tibia lead concentration in 1-, 5-, and 10-year-old and adult subjects were calculated from one data set to be 1100, 420, 190, and 34/38 (male/female) nSv, respectively, for an in vivo median precision (one standard deviation) of 4.9 micrograms Pb (g bone mineral)-1 for a 30-min adult measurement.

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This is a survey of the prevalence of weight reducing and weight gaining in high school children. Our sample of 1,373 high school girls and boys was geographically, racially, and economically diverse. On the day of the survey, 63% of the girls and 16.2% of the boys reported being on weight reducing regimens; 9.1% of the girls and 28.4% of the boys were trying to gain weight. Most female reducers and male gainers were already normal weight. Compared to other racial groups, whites and Hispanics were more likely to be reducing, whereas blacks were more likely to be gaining. Exercise and moderate caloric reduction were most popular for weight reducing, and a small but significant number were regularly using fasting, vomiting, laxatives, and appetite suppressants. The direction of weight modification for girls and boys conformed to stereotyped physical ideals. The rate of weight reducing in female high school adolescents has increased significantly since similar surveys of American youths 20 years ago.

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The Minnesota Multiphasic Personality Inventory (MMPI) profiles of 205 male and 157 female patients with acute and chronic low back pain (LBP) were studied for replicable homogeneous subgroups using three cluster-analysis procedures. Two normal and three clinically elevated profile subgroups were identified. The two normal subgroups were characterized by relatively normal musculoskeletal condition and were least disabled, but they differed somewhat from each other in duration of pain, presence of physical abnormalities, and daily functioning. The third subgroup had the following characteristics: an elevated neurotic triad, greatest duration of symptoms, most abnormal physical findings, greatest limitation of motion, most pain complaints during physical examination, and the fewest number of intact functional activities. The fourth subgroup, with an elevated neurotic triad plus subclinical elevations on other scales, had somewhat less musculoskeletal impairment but had extensive work disability, financial compensation, and previous surgeries. The fifth and most pathologic profile subgroup surprisingly consisted largely of acute-pain patients whose musculoskeletal condition and daily functioning were similar to those of the normal subgroups. Patients in the three abnormal MMPI subgroups were exposed to more LBP physical-risk factors in the workplace. Implications for psychological treatment with these different profile types are discussed.

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