Body Image, Eating Disorders, and Obesity: An Integrative Guide for Assessment and Treatment

1). However, researchers and clinicians did not immediately build on her suggestion by targeting the body image problems of individuals with eating disorders. In 1987, Garner, Fairburn, and Davis cataloged 22 different treatment components in the 19 treatment outcome studies contained in their review. None of these intervention strategies included a focus on body image issues. In his 1990 review, Rosen found that the "overwhelming majority" (p. 205) of 75 studies either (a) did not treat or measure body image or (b) did not assess body image changes, despite targeting body image problems during treatment. None of the 20 pharmacological studies measured body image (see chapter 14, this volume, for an update on this literature). Of the 40 psychological treatment outcome studies reviewed by Rosen (1990), approximately one third involved some procedure to modify body image. Many of these trials were uncontrolled, with the exception of several studies with bulimia nervosa. Of the few controlled studies, cognitive-behavioral procedures appeared to offer the most promise for improving body image concerns. Rosen (1990) concluded that it was "ironic and alarming that there is still no definite answer to questions of treatment effectiveness for body-image disturbance" (p. 208). Rosen (in press) recently revisited this issue. His second review of this area included studies that employed an experimental design with random assignment of subjects to treatment and, minimally, one other condition. If studies did not contain specific details delineating procedures targeting body image concerns, they were not labeled as including a body image therapeutic component. It should be noted that this review procedure may have eliminated some investigations that addressed some aspect of body image in their overall treatment program, but failed to provide a discussion of the information within the text of the article. Rosen found that 21 of the 31 studies that used a psychological intervention (usually cognitive-behavioral therapy) included a body image component. However, he also found that the intervention was typically minimalistic, usually involving some psychoeducational information relevant to the sociocultural bases of eating disorders or cognitive restructuring procedures that included some focus on thoughts or beliefs about shape and body size. None of the studies used the set of techniques that have been found to be effective for body image problems in non-eating-disordered females, individuals with body dysmorphia, or obesity (see chapters 4, 7, and 17, this volume). For instance, no study used exposure or response prevention procedures to deal with body image avoidance or included a self-monitoring form to document relevant thoughts regarding size, shape, and weight (outside of binge eating episodes). Our own review of the research paralleled the findings of Rosen's review (in press), suggesting little systematic effort to target body image disturbance concurrent with a selection of dependent measures capable of documenting change in this critical aspect of eating disorders. Many of the TREATMENT OF BODY IMAGE DISTURBANCE

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