Body checking and avoidance in women: Associations with mental and physical health-related quality of life
Highlights
► Body checking, avoidance, and quality of life were examined in 214 women. ► Body checking and body avoidance were associated with quality of life impairment. ► Body checking predicted mental health impairment, controlling for related variables. ► Body avoidance predicted physical health impairment. ► Checking and avoidance predicted eating disturbance.
Introduction
Body checking and avoidance behaviors are considered manifestations of body dissatisfaction and core eating disorder psychopathology. Both body checking and avoidance are associated with overvaluation of shape and weight (Grilo et al., 2005, Latner, 2008, Reas et al., 2005), a disturbance central to eating disorders (Fairburn, Cooper, & Shafran, 2003). Body checking and avoidance have been associated with eating disorder psychopathology in women with eating disorders (Calugi et al., 2006, Mountford et al., 2007), obese individuals with BED (Reas et al., 2006, Reas et al., 2005), and obese individuals seeking weight-loss treatment through surgery (Grilo et al., 2005) or behavior therapy (Latner, 2008). Experimental research suggests that body checking increases body dissatisfaction and attentional bias toward the body (Shafran et al., 2007, Smeets et al., 2011) and attenuates the normal decrease in negative emotions that occur during body exposure (Vocks, Kosfelder, Wucherer, & Wächter, 2008).
Only limited research has examined the correlates of body checking in non-clinical samples (Haase et al., 2011, Reas et al., 2002), where body checking also appears to be associated with eating disorder psychopathology. Research in non-clinical samples is essential when examining the impairment or psychopathology associated with a specific symptom, as treatment-seeking samples are likely to have elevated symptoms coinciding with greater impairment.
Avoidance of situations that trigger body image concerns has been associated with eating disorder psychopathology and body dissatisfaction among adults with eating disorders, non-clinical adults (Rosen, Srebnik, Saltzberg, & Wendt, 1991), and non-clinical adolescents (Maïano, Morin, Monthuy-Blanc, & Garbarino, 2009). A high proportion of women with eating disorders (61%) report avoidance of body exposure, contact with one's own body parts, and self-weighing, and many patients alternate between repeated checking and targeted avoidance (Shafran, Fairburn, Robinson, & Lask, 2004). Experimental research has demonstrated that avoidance of body/shape related concepts increases undergraduate women's concerns about eating and body shape (Engel et al., 2006).
Health-related quality of life (QOL) is a useful but under-utilized outcome measure for assessing functional impairment in individuals with eating disorders (Hay and Mond, 2005, Jenkins et al., 2011). QOL impairment in eating disorders is a growing focus of research (Bamford and Sly, 2010, Latner et al., 2008), but further studies are needed on the contribution of specific behaviors to impairment in functioning (Jenkins et al., 2011). Studies have investigated the contribution to QOL of binge eating (Mond, Latner, Hay, Owen, & Rodgers, 2010), loss-of-control eating (Jenkins, Conley, Rienecke Hoste, Meyer, & Blissett, 2012), purging (Gonzalez-Pinto et al., 2004, Hay, 2003), exercise (Mond, Hay, Rodgers, & Owen, 2006), and overweight (Mond & Baune, 2009). Although studies have begun to uncover the association between body dissatisfaction and QOL impairment (Cash and Fleming, 2002, Lobera and Ríos, 2011, Mond et al., 2011), no studies have investigated whether body checking or avoidance are associated with health-related QOL.
As expected, checking and avoidance are highly correlated with more general weight and shape concerns (Calugi et al., 2006, Mountford et al., 2007, Reas et al., 2002); thus, there may be some overlap between these constructs. However, investigating checking and avoidance and their association with quality of life may prove to be clinically valuable. Checking and avoidance behaviors may comprise clear and discrete targets of treatment that could improve quality of life. These targets may be approachable through behavioral treatment methods that may be relatively easy to disseminate, such as exposure and response prevention (Delinsky & Wilson, 2010).
Therefore, in the present study we aimed to examine the associations between body checking and QOL, and between body avoidance and QOL, in non-clinical women. We also aimed to examine the relative contributions of body checking and body avoidance to QOL and to eating disturbances, even when accounting for depressive symptoms and correlated demographic variables.
Section snippets
Participants
Participants included 214 women recruited from a large university and surrounding community in the South Island of New Zealand. Recruitment involved advertising around the university campus, in community newspapers/newsletters, at workplaces, and on community center notice boards. Eighty-six percent of the sample was Caucasian, 8% was Asian, and 6% was New Zealand Maori; 52% of the participants were enrolled as university students. BMI and age are shown in Table 1. This study was approved by
Results
Correlational analyses indicated significant positive associations between checking/avoidance and impairment in mental and physical QOL, nearly all QOL subscales [except bodily pain], eating psychopathology, and depressive symptoms (Table 2). Correlations with eating psychopathology were typically in the large range (greater than r = .5) and correlations with QOL were typically in the medium range (r = .3; Cohen, 1992). BCQ and BIAQ scores were also correlated with each other (r = .58). Age was
Discussion
In non-clinical women, body checking and avoidance were significantly correlated with most mental and physical subscales of QOL and with both the mental and physical component summary scales, with medium effect sizes. Body checking and avoidance were also associated with measures of eating disturbance, consistent with research in clinical samples (Grilo et al., 2005, Latner, 2008, Mountford et al., 2007, Reas et al., 2006).
The present findings also demonstrated that even above and beyond the
Role of funding sources
No funding was provided for this study.
Contributors
Authors JL, JV, and GB designed and the study and collected the data. Authors JL, JM, and DG wrote the first draft of the manuscript, and all authors contributed to and have approved the final manuscript.
Conflict of interest
The authors declare that they have no conflicts of interest.
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