Klaske A. Glashouwer

Consistent with the view that disgust is involved in the persistence of eating disorder symptomatology, it has been found that disgust propensity is related to a negative body image. Importantly, earlier research in non-clinical samples provided preliminary evidence that this relationship could be statistically accounted for by self-disgust. The current study tested the robustness of this finding and examined if this pattern would also be evident when including individuals with and without clinically diagnosed anorexia nervosa (AN). In addition, we tested whether the relationship between self-disgust and negative body image would be especially pronounced in individuals with high disgust sensitivity. Finally, we explored whether body checking and body avoidance could statistically account for the relationship between self-disgust and negative body image. To test these hypotheses, female adolescents with ( n = 64) and without ( n = 62) AN diagnosis completed questionnaires administered online. Results showed that (1) the relationship between disgust propensity and negative body image could be statistically accounted for by self-disgust; (2) disgust sensitivity did not moderate the relationship between self-disgust and negative body image, and; (3) the relationship between self-disgust and negative body image could be statistically accounted for by body checking, but not by body avoidance. Together, these findings are consistent with the view that self-disgust may be an important factor in the persistence of a negative body image in anorexia nervosa.

Background: Bulimia nervosa is a severe mental disorder associated with several physical and mental health complications. The aim of this review is to provide an overview of existing theoretical models regarding the development and maintenance of bulimia nervosa. A second aim is to develop a synthesis to allow for a more complete understanding of bulimia nervosa, which may help to develop and refine interventions in the future. Methods: PsycInfo, PubMed, PSYNDEX, Scopus, and Google Scholar will be searched for studies presenting models of bulimia nervosa. Topic modeling will be used to gain initial insights into related factors. Additionally, two independent expert reviewers will screen the literature and select models of bulimia nervosa as well as associated datasets for additional empirical analyses. In the case of discrepancies, a third reviewer will be consulted. The similarities between the identified models of bulimia nervosa will be summarized in a narrative synthesis. Depending on the number of identified models and available datasets, models will be tested using existing datasets. Discussion: The review seeks to summarize existing models regarding the development and maintenance of BN. The results could be used as a starting point for developing adequate models, testing these models, and subsequently using them to inform evidence-based intervention programs in the future. Systematic review registration: This systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 30.09.2024 (CRD42024581179).

Volgens Glashouwer helpen huidige behandelingen veel jongeren, maar is er juist winst te behalen in het beter begrijpen van de processen die bepalen waarom herstel soms wél en soms niet op gang komt. Door die kernprocessen scherper in kaart te brengen, kunnen behandelingen gerichter en effectiever worden ingezet. Glashouwer richt zich in haar onderzoek op mogelijke processen die herstel beïnvloeden, zoals emoties als zelf-walging, hardnekkige interactiepatronen tussen jongeren en hun omgeving, en de manier waarop jongeren hun eigen lichaam ervaren. Om die processen beter te begrijpen combineert ze interviews en vragenlijsten met experimenteel onderzoek, onder meer in virtual reality. Daarnaast werkt ze samen met collega’s aan nieuwe behandelonderdelen die stap voor stap worden getest en bijgesteld. Onderzoek en praktijkervaring laten zien dat jongeren beter worden bereikt wanneer informatie en steun aansluiten bij hun leefwereld. Online platforms, anonieme chatfuncties en evidence-based zelfhulpmiddelen verlagen de drempel om zorgen te delen en eerder hulp te zoeken. In haar oratie pleit Glashouwer voor meer focus: richt onderzoek en innovatie op de processen die een eetstoornis in stand houden of helpen doorbreken. Daarnaast benadrukt zij het belang van vroegsignalering, digitale toegankelijkheid en sterke samenwerking tussen instellingen, zodat jongeren sneller hun weg naar passende zorg vinden. De komende jaren wil ze verder uitzoeken welke processen herstel stimuleren en interventies ontwikkelen die direct op die kennis voortbouwen. Doel is dat goed onderbouwde ideeën sneller de behandelpraktijk bereiken

Objective: Negative body image is thought to play an important role in the onset and maintenance of anorexia nervosa and bulimia nervosa. The intervention Expand Your Horizon ( EYH ), which is focused on increasing functionality appreciation, is being investigated as a potential approach for improving body image. This study investigated the themes that were identified when adolescent girls with an eating disorder are asked to describe their body functionality within the context of EYH . Method: Fifty‐eight girls with an eating disorder received the EYH intervention and wrote about everything their body can do and why these functions are meaningful to them. The qualitative data were analyzed via Thematic Analysis. Results: We identified five themes from the data: body functions as a means to experience and regulate emotions; body functions as a vehicle to form social connections; body functions as a means to experience independence and identity; how body functions are intertwined with the eating disorder; and the aesthetic body. Discussion: This study highlights the importance of body functionality in the experiences and perceptions of adolescent girls with eating disorders. The findings support the idea that adolescents with eating disorders are able to appreciate their bodies for what they can do rather than focusing solely on their appearance.

Objective: This study examines the relationships between self‐disgust, body dissatisfaction (BD), and attentional biases (AB) toward weight‐related body areas, exploring whether self‐disgust predicts attentional avoidance and moderates the relationship between BD and AB.Method: Using virtual reality and eye‐tracking technology, 78 female students viewed their virtual bodies in a mirror to assess gaze patterns as an indicator of attentional bias.Results: BD was positively associated with both AB and self‐disgust. Contrary to expectations, self‐disgust correlated with increased attention to weight‐related areas rather than avoidance and did not moderate the BD–AB relationship.Discussion: These findings suggest that self‐disgust may reinforce attention toward weight‐related areas, contributing to negative body image. Future research should explore these mechanisms in clinical populations to inform targeted interventions.

Comparing oneself against internalized body ideals which have extremely low BMI is seen as an important source of body dissatisfaction. The aim of this study was to investigate a novel body image training designed to shift internalized norms for body size towards less extreme positions. Effects of the intervention on body image and eating disorder symptoms were investigated in twelve adolescent girls with an eating disorder using a replicated randomized two-phase single-case experimental design. Participants (N = 12) received six 10-minute training sessions alongside treatment as usual. Participants' starting point in time for the training was randomly assigned between day 8 and 14 within the continuous 23-day study window. Participants were presented 3D images of a female model who varied in BMI, and on each presentation had to judge the model as either “thin” or “fat”. By giving feedback which challenged their judgements, the aim was to gradually increase the BMI representing the transition from thin to fat judgements, thereby shifting participants’ body size norms towards a more realistic standard. Primary outcome measures were assessed on each of the 23 days. Results showed a significant overall small effect of the training on body image. No significant overall decrease in eating disorder symptoms was found. Although these findings are promising, the small effect size and differences between participants suggest that the training procedure should be improved before further investigating this training in clinical practice.

Objective: In the last decade, body image research has increasingly focused on the distinction between negative and positive body images as separate constructs. Functionality appreciation is a crucial component of positive body image and might be an important source for coping with body image problems. The intervention Expand Your Horizon (EYH; Alleva et al. 2015a) was designed to increase functionality appreciation and has demonstrated positive effects on body image across different adult populations. In the current research, we investigated the short‐term effects of a single‐session EYH in adolescent girls with an eating disorder.Method: Fifty‐eight adolescent girls with an eating disorder were randomly assigned to the EYH condition or an active control condition. Different aspects of positive and negative body images were assessed before and after the intervention.Results: Participants in the experimental condition showed higher scores than the control condition on positive body image after the writing exercise, but no effects on negative body image were found. Exploratory analyses showed that improvements in the positive body image remained stable 15–30 min after the writing exercise.Discussion: These outcomes suggest that writing about body functionality leads to direct increases in positive body image but not to decreases in negative body image. An important step for future studies would be to test the full three‐session version of EYH and investigate its effects over the longer term. This could help to determine the robustness of the present findings and the potential of EYH as a complementary intervention to existing treatments.

Objective: Recent studies underscore the relevance of life meaning to the maintenance of eating disorders. A previously conducted randomized controlled trial tested a meaning‐centered intervention for female university students with high weight and shape concerns. After a 6‐week online intervention led by a trainer, participants in the intervention condition scored higher on life meaning and lower on eating disorder symptoms and general distress compared to a waitlist group. Method: Given that the original study took place during COVID‐19, this study replicated the design to test the findings' robustness. Results: Compared to the waitlist condition ( n = 68), participants in the intervention condition ( n = 63) again scored higher on the presence of life meaning at post‐assessment and follow‐up. Participants in the intervention condition also showed moderately lower internalizing symptoms at both timepoints, whereas eating disorder symptoms were only reduced in those with relatively high baseline symptom severity. Conclusions: Thus, also without social distancing measures, the intervention increased life meaning and reduced eating disorder symptoms and comorbid internalizing symptoms in women with weight and shape concerns.

Objective: This study differentiated between self‐reported punishment responsivity (PR) and motivation to avoid punishment (MP) and examined their relationship with anorexia nervosa (AN) and its course in a combined cross‐sectional and longitudinal approach. We explored whether inconsistent findings regarding reward sensitivity may be explained by previous research not differentiating between reward responsivity (RR) and motivation to approach reward (MR).Method: Participants were 69 adolescents with AN and 69 adolescents without AN matched on age, sex and educational level. Eating disorder (ED) symptom severity, PR, MP, RR, and MR were assessed at the start of treatment and 1 year later.Results: Only PR was higher in patients with AN than in the comparison group. Both PR and MP decreased over the course of 1 year, however, only the reduction in PR was related to the reduction in ED symptoms. Lastly, only higher baseline PR was independently related to less improvement in ED symptoms over the course of 1 year.Conclusion: There was no support for the involvement of RS or its specific dimensions in AN. Most critical, the findings suggest that specifically the PR dimension of punishment sensitivity is related to the persistence of AN and could be an important target for treatment.