**4.1 Research objectives and variables**

150 New Insights into the Prevention and Treatment of Bulimia Nervosa

The body appears to be a "container" for the psychological self which integrates internal and external experiences, thereby stimulating the emergence of a coherent identity

Bulimic episodes of uncontrolled binge eating and destructive compensatory behaviours (e.g. self-induced vomiting, fasting, abuse of laxatives, diuretics or slimming pills, etc.) allow a bulimia sufferer to maintain his or her positive self-portrait and self-assessment which in turn are affected by the person's body experiences as well as the cognitive evaluation of his/her own physical appearance. Engaging in compulsive, self-destructive behaviours, a bulimic individual applies a variety of specific symbols related to the person's sensomotoric experiences, which is aimed at bridging the body and mind [Krueger]. Bulimic symptoms appear to represent the individual's attempt to satisfy his or her needs and compensate for developmental emotional deficits by resorting to substances (e.g. food, alcohol or drugs) or to certain activities (e.g. self-induced vomiting, purging, compulsive spending, impulsive sex, etc.). This can also be regarded as a form of escape from "painful" emotions [Krueger].

**3. A cognitive perspective on body image disturbances in bulimia nervosa**  The most common terms that cognitive theories refer to in their attempts to define body perception include such notions as: self-image, body image, self-knowledge and selfassessment. Body image is frequently defined as a cognitive self-schema construct, that is, a system of conscious generalizations regarding the body [Pervin]. According to cognitive psychologists, body image is one of the fundamental components of the body self. It is commonly referred to as sensual image of sizes, shapes and forms of the body as well as feelings regarding the mentioned features of the whole body or one of its specified parts [Thompson, Cash, Pruzinsky]. Thompson and his co-researchers made an attempt at systematizing the notions related to body image [Thompson, Cash, Pruzinsky]. Defining the feelings regarding the body, they identified the following aspects: weight satisfaction which can be measured in terms of a discrepancy between the actual (current) and the ideal (most desired) weight; body satisfaction which most frequently refers to the specified body parts (e.g. breast, thighs or hips); appearance satisfaction, that is, satisfaction with general appearance or its specified elements such as certain parts of the face, or the body parts that carry connotations of weight (e.g. the lower part of the body). Thompson and his coresearchers identified the phenomenon of inadequate body mass perception, and linked it to the concept of appearance orientation measured in terms of a degree of cognitive and behavioral involvement in physical appearance. Appearance anxiety seems to reflect the feelings of dissatisfaction and discomfort which occur as a result of excessive focus on body

Garner and Garfinkel distinguished the following two forms of body image disturbances: inadequate body percept and body dissatisfaction [Rabe-Jabłońska,Dunajska]. In their studies the psychologists put forward the view that the former refers to inadequate perception of the body size; whereas the latter is related to an emotional attitude towards

Developed by E.T. Higgins, Self-Discrepancy Theory provides a platform for understanding the development of body image. Higgins's theory posits that the structure of the body self determines an individual's self-perception and self-evaluation of his or her own body features (the actual self), as well as the person's thoughts and aspirations regarding the ideal body image (the ideal self), and the mental evaluation of the body features and

[Krueger].

image [Thompson].

the body [Rabe-Jabłońska, Dunajska].

The main aim of this research was to determine the strength level for the characteristics of the body self structure in a group of selected 30 young Polish females suffering from bulimia nervosa, and in the control population of females who were similar in age and social status, and were not revealing any eating disorders or mental disturbances. The main question addressed in this study was: "Do the examined women who suffer from bulimia nervosa significantly differ from the healthy females in terms of the strength level for the characteristics of their body self structure?"

The main independent variable in the research was clinically diagnosed bulimia nervosa in the examined females. Its indicators included bulimic symptomatology as well as a medical diagnosis code (F.50.02, according to the ICD-10 classification).The main variable was the structure of the body self, defined, referring to the subject literature, as a complex construct constituting the following configuration: emotional experience related to body and its functions, as well as mental concept (perception and thoughts) regarding physical

A Psychological Profile of the Body Self Characteristics in Women Suffering from Bulimia Nervosa 153

The methods applied in the research included an inventory (i.e. the Eating Disorder Inventory (EDI) devised by Garner, and Thompson's Body Dissatisfaction Inventory) as well as projective techniques such as Thompson's Silhouette Test and a thematic drawing: "body image". The inventories and projective techniques applied in the research procedures, aimed at making a psychological diagnosis of the investigated variables, are fully described

The Eating Disorder Inventory devised by Garner is one of the instruments most frequently used to measure the patterns of behaviour and attitudes dominating the clinical picture of anorexia and bulimia nervosa, including those related to the process of perceiving and experiencing body [Thompson]. The following 3 scales, considered the purposes they had been devised for, were applied in the research: the Body Dissatisfaction Scale, the

The Body Dissatisfaction Scale was used to measure the indicators of the body self component called "body image". The scale allowed to evaluate the level of the overall body satisfaction, and ever increasing discreditation of one's own appearance, body shape and weight as well as the particular body parts. It consisted of ten items. Each research participant was rated on a 0 to 40 point scale. The score ranging from 40 to 36 was interpreted as a very high level of discreditation of one's own body shape and size as well as body dissatisfaction. The score ranging from 35 to 22 points to considerable dissatisfaction with body shape, size and weight, and to negative feelings regarding body parts. The score

The "Interoceptive Deficits" Scale was applied to measure the level of interoceptive awareness in the group of examined females. It allowed to evaluate the level of perplexity, which occurs in the process of recognizing and responding to emotional states and body sensations, and helped to assess the level of fear of high affection and of losing control. The scale consisted of eight items. Each research participant was rated on a 0 to 32 scale. A high score (13-32 points) points to a high degree of perplexity and discreditation of the experienced emotions. It proves that instead of being experienced, emotions undergo intellectual evaluation aimed at checking whether they are well-grounded, desired and justified. It can be assumed that a high score on this scale is interpreted as a significant risk factor which contributes to development of an eating disorder. A low score (0-10 points) indicates a properly retained ability to deal with and accept positive and negative emotions

The "Maturity Fear" scale served as an instrument for measuring the level of approval of psychosexual development. Maturity fear is related to the exhibited tendency, a desire to regain the pre-pubescent appearance [Higgins]. The examined subjects were rated on a 0 to 32 point scale. A high score (between 13 and 32) denotes a strong desire for being younger and regaining childhood security. It also proves the conviction that the requirements set during the period of maturity are too high. A low score (between 0 and 5) indicates a high level of psychosexual development acceptance, and mental transition to the stage of

The second measurement instrument applied in the research was the Body Dissatisfaction Inventory devised by K. Thompson [Cash, Pruzinsky, Thompson]. It was used to measure the level of satisfaction and dissatisfaction with weight, body shape and appearance in the

regarding one's own body. It is also an indicator of mental health [Higgins].

in the subject literature [Thompson, Hornowska, Paluchowski, Oster].

Interoceptive Deficits Scale, and the Maturity Fear Scale.

ranging between 21 and 0 denotes the norm [Higgins].

**4.3 Research methods** 

maturity [Higgins].

appearance [Cash, Pruzinsky, Thompson,Garner]. The major components of the variable which were empirically examined in the study included:


An additional control variable was body mass index BMI. It has been announced that individuals who fall into the BMI range of 19.5 to 24.5 have a healthy weight. A BMI of under 19.5 is usually referred to as underweight. A Body Mass Index reading over 24.5 is considered overweight.

#### **4.2 Subjects**

102 Polish females participated in the research. The subjects were selected intentionally. Clinical population No. I consisted of 52 females clinically diagnosed with bulimia nervosa (the F.50.02 code, according to the ICD criteria of psychiatric classification). Whereas clinical population No. II was comprised of 50 women with no history of past or present eating disorders or other mental disturbances (e.g. bulimia or anorexia nervosa, psychogenic binge eating). The additional criteria which excluded participation in the research included: improper intellectual development, chronic somatic conditions (visible disability and body distortions), and organic changes in the CNS. The data mentioned above was gathered by means of clinical interviews conducted among the examined individuals. The aforementioned factors may affect the development of body image. Hence, the females exhibiting any of the dysfunctions mentioned above were excluded from the group of research subjects. During the research, all bulimic participants remained under medical care. The mean duration of treatment in the group of the examined bulimic females ranged from 2 to 12 months. A mean age in the research sample ranged from 21 to 25 years. The research was conducted anonymously with the personal consent obtained from each participant, and with the approval of a Human Research Ethics Committee.
