Fluctuations of body images in anorexia nervosa: patients' perception of contextual triggers.

Unlabelled: Body image disturbance is a central diagnostic criterion of anorexia nervosa (AN). To a great extent, previous studies have conceptualized body image disturbance as a relatively stable and trait-like characteristic of the patient. There is, however, growing evidence that body images fluctuate in different situations and contexts. The aim of the present study was to explore which everyday contexts that patients with AN themselves associate with fluctuations in body image. Thirty-two women (20-35 years) who had been diagnosed with AN (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) within the last year participated. Semi-open and focused qualitative interviews were conducted, transcribed and analyzed using Grounded Theory techniques. The results suggest that body image is a dynamic phenomenon that may fluctuate in different situations and contexts. The participants linked such fluctuations to their own uncertainty about their real appearance. In lack of a stable and integrated experience of their own body, they were extremely sensitive towards body image threats and challenges in their daily life and reacted to these situations by fluctuations in their body image. Four contextual cues were found to trigger such changes in body image: these were eating food, being reminded of one's body appearance, relating to one's own emotional signals and interpreting other people's expressed and unexpressed opinions about oneself and one's appearance. Clinical and theoretical implications are discussed.

Key Practitioner Message: Individuals with anorexia nervosa may have quite varied body image experiences in different contexts. The contexts identified in this study may be a point of departure for clinicians in helping their patients to explore their subjective body image experiences and to connect these with emotional, cognitive and relational contexts in a psychologically meaningfully way.