Body checking explained

Body checking is a compulsive behaviour related but not exclusive to various forms of body dysmorphic disorders. It involves frequently collecting various information about one’s own body in terms of size, shape, appearance or weight. Frequent expressions of this form of behaviour entails for example mirror checking, trying to feel one’s own bones, pinching the abdomen, frequent body weight measurement and comparing your own body to that of others.^[1] Studies have shown that an increased rate of body checking correlates with an overall increased dissatisfaction with the own body.^[2]

Characteristics

Compulsive body checking can be observed in many forms. Some of the more common signs are:

• Constant weighing
• Constantly checking oneself in the mirror^[3]
• Recording bodily changes
• Measuring body parts
• Comparing the body to other peoples bodies^[4]

Compulsive body checking behaviors are considered to overly emphasize the importance of one‘s body and its shape, which often occurs as a symptom in people with obsessive–compulsive disorder and eating disorders like anorexia nervosa and bulimia nervosa. Checking behaviors are common among those groups, because body checking temporarily induces stress relief and thereby reinforces the habit. In the long term it contributes to increased overall body dissatisfaction and can prevent full recovery.^[5]

Components

Cognitive

People who engage in body checking tend to have discrepancies between their own body ideals and their subjective representation of their bodies. The desired body ideals are created by comparing oneself to other people and making upward comparisons.^[6] These upward comparisons are often perpetrated by the use of social media, where it is easy to find pictures of one's desired body. Since social media pictures are often edited and people try to present themselves perfectly, body ideals are often very extreme and impossible to achieve.^[7] Additionally, people with eating disorders have a disturbed image of their body, subjectively perceiving themselves as less attractive than they are.^[8]

Affective

A negative image about one's own body is linked to several negative feelings or emotions, such as anxiety (of being judged about one's body), shame (about your own body), anger/ aggression (at yourself or others for looking the way they look) and fear (of becoming even less attractive).^{[9] [10] [11] [12]} Self-objectification theory can be used to explain these affective responses. People with body image disturbances often look at themselves from a third-person view, reducing their self-worth to the way they look. If their appearances do not match their expectations some or all of the above emotions can be experienced.^[13]

Diagnosis

Body checking becomes problematic when it causes distress, has a negative impact on a person’s mood, causes withdrawal from social interactions, when it disrupts someone's daily functioning at work or outside of it. This can lead to an eating disorder or the worsening of an existing one. A healthcare provider can offer treatment recommendations to help with uncontrollable body checking behavior. The diagnostic assessment for body checking includes asking about personal and family medical history and performing a physical exam. The healthcare provider can refer the person to a psychologist or psychiatrist for further assessment. These mental health professionals can then diagnose a patient with body dysmorphic disorder (BDD) by evaluating the person’s attitude, behavior, and symptoms.^[14]

Treatments

Body checking is most commonly a symptom of eating disorders (ED) and body image disturbance (BID).^[15] Treatments of EDs and BID involve treatments for body checking. Isolated research regarding body checking treatments without relating disorders is rare, as most individuals experience (severe) body checking in relation to their ED. Treatment of ED is mostly multidisciplinary, containing psychological as well as medical treatments.

Treatments used with body checking are:

• Psychotherapy can be used to treat eating disorders and symptoms such as body checking.^{[16] [17] [18] [19]}
• Family therapy. Improvements of symptoms like body checking in people with EDs after family therapy have been shown in several cases, but there is little evidence yet for the effectiveness of family therapy on EDs.^{[20] [21]}
• Cognitive behavioral therapy is a treatment that aims to teach how to recognise and change harmful thought patterns that lead to negative actions, such as body checking. Regarding EDs and BID, it focuses on reducing negative self-evaluation, body checking behaviour and self-objectification.
• Acceptance and commitment therapy. Pilot studies of acceptance and commitment therapy have shown significant increase in body satisfaction and decrease in body checking in trials with patients with BID.^[22]
• Mirror exposure entails organised exposure to body image, typically in forms of standing in front of a mirror. A study investigating in the effects of mirror exposure on BID found significant results regarding a decrease in body checking as a result of mirror exposure.^[23]

References

1. Web site: Body Checking: What is it and how do I stop? . 2022-05-18 . Central Coast Treatment Center . en-US.
2. Web site: Ekern B . 2020-10-30 . What is Body Checking and Why is it Dangerous? . 2022-05-18 . Eating Disorder Hope . en-US.
3. Web site: Body Checking: What is it and how do I stop? . 2022-05-15 . Central Coast Treatment Center . en-US.
4. Web site: What is Body Checking, Why is it Harmful, and How Do I Stop? . 2022-05-15 . Pono A . Hawaii Eating Disorder Treatment Center . en-US.
5. Web site: Savin J . 2020-10-14 . How to tell if you're body checking (you may not even realise you're doing it) . 2022-05-15 . Cosmopolitan . en-GB.
6. Web site: Self-Discrepancy Theory and Body Image . 2022-05-15 . en-US.
7. Fardouly J, Vartanian LR . Social media and body image concerns: Current research and future directions. . Current Opinion in Psychology . June 2016 . 9 . 1–5 . 10.1016/j.copsyc.2015.09.005 .
8. Mond JM, Hay PJ, Rodgers B, Owen C . Recurrent binge eating with and without the "undue influence of weight or shape on self-evaluation": implications for the diagnosis of binge eating disorder . Behaviour Research and Therapy . 45 . 5 . 929–938 . May 2007 . 17010307 . 10.1016/j.brat.2006.08.011 .
9. Levinson CA, Rapp J, Riley EN . Addressing the fear of fat: extending imaginal exposure therapy for anxiety disorders to anorexia nervosa . Eating and Weight Disorders . 19 . 4 . 521–524 . December 2014 . 24691784 . 4183728 . 10.1007/s40519-014-0115-6 .
10. Goss K, Allan S . Shame, pride and eating disorders . Clinical Psychology & Psychotherapy . 16 . 4 . 303–316 . July 2009 . 19639646 . 10.1002/cpp.627 .
11. Kartal Yağız A, Kuğu N, Semiz M, Kavakçı Ö . [The Relationship Between Anger Expression, Body Image and Eating Attitudes in Social Anxiety Disorder] ]. Turkish . Turk Psikiyatri Dergisi = Turkish Journal of Psychiatry . 27 . 1 . 15–22 . 2016 . 27369681 .
12. Espeset EM, Gulliksen KS, Nordbø RH, Skårderud F, Holte A . The link between negative emotions and eating disorder behaviour in patients with anorexia nervosa . European Eating Disorders Review . 20 . 6 . 451–460 . November 2012 . 22696277 . 10.1002/erv.2183 .
13. Book: Calogero RM . Objectification Theory, Self-Objectification, and Body Image . 574–580 . Encyclopedia of Body Image and Human Appearance . 2012 . 10.1016/B978-0-12-384925-0.00091-2 . 9780123849250 .
14. Web site: Body Dysmorphic Disorder: Symptoms, Causes, Diagnosis, Treatments . 2022-05-17 . Cleveland Clinic.
15. Shafran R, Fairburn CG, Robinson P, Lask B . Body checking and its avoidance in eating disorders . The International Journal of Eating Disorders . 35 . 1 . 93–101 . January 2004 . 14705162 . 10.1002/eat.10228 .
16. Locher C, Meier S, Gaab J . Psychotherapy: A World of Meanings . Frontiers in Psychology . 10 . 460 . March 2019 . 30984050 . 6448000 . 10.3389/fpsyg.2019.00460 . free .
17. Position of the American Dietetic Association: Nutrition intervention in the treatment of anorexia nervosa, bulimia nervosa, and other eating disorders . Journal of the American Dietetic Association . 106 . 12 . 2073–2082 . December 2006 . 17186637 . 10.1016/j.jada.2006.09.007 . American Dietetic Association .
18. Gelin Z, Fuso S, Hendrick S, Cook-Darzens S, Simon Y . The effects of a multiple family therapy on adolescents with eating disorders: an outcome study . Family Process . 54 . 1 . 160–172 . March 2015 . 25243337 . 10.1111/famp.12103 .
19. Wilson GT . July 1999 . Cognitive behavior therapy for eating disorders: progress and problems . Behaviour Research and Therapy . en . 37 . S79–S95 . 10.1016/S0005-7967(99)00051-0. 10402697 .
20. Glenn E, Freeman DS . January 1993 . Multigenerational Family Therapy . Family Relations . 42 . 1 . 108 . 10.2307/584934 . 584934 . 0197-6664.
21. Dare C, Eisler I, Russell G, Treasure J, Dodge L . Psychological therapies for adults with anorexia nervosa: randomised controlled trial of out-patient treatments . The British Journal of Psychiatry . 178 . 3 . 216–221 . March 2001 . 11230031 . 10.1192/bjp.178.3.216 . 9230712 . free .
22. Pearson AN, Follette VM, Hayes SC . February 2012 . A Pilot Study of Acceptance and Commitment Therapy as a Workshop Intervention for Body Dissatisfaction and Disordered Eating Attitudes . Cognitive and Behavioral Practice . 19 . 1 . 181–197 . 10.1016/j.cbpra.2011.03.001 . 1077-7229.
23. Delinsky SS, Wilson GT . Mirror exposure for the treatment of body image disturbance . The International Journal of Eating Disorders . 39 . 2 . 108–116 . March 2006 . 16231342 . 10.1002/eat.20207 .