Page 87 - JCBP-2-4

Journal of Clinical and
Basic Psychosomatics Adverse life events and body image

in the form of overestimation when looking at themselves interpersonal ALEs affect the activation of regions involved
in the mirror. In addition, if they have a family dynamic in body awareness. These regions have been linked to
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based on physical appearance, they may judge themselves emotional regulation and show changes in adults who
with the notion of the body image that their parents helped suffered childhood abuse. Thus, promoting a connection
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to create. 11,14 Moreover, patients in the ED group who had to the inner emotional world by encouraging patients to
interpersonal ALEs showed a higher level of perfectionism feel their bodies may lead to altered body evaluation in
than those in the other two groups. Conversely, the RMDD individuals with interpersonal ALEs. This supports the
14
and control groups underestimated their body shape in and notion that body evaluation is not only socially influenced,
out of the mirror, indicating a tendency to adapt their body as individuals with ALEs may also experience an alteration
shape to social requirements. Patients in both groups had in their ability to mentalize, which is associated with
11
higher BMIs than those in the ED group. emotional dysregulation. This concept is supported by
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Patients in the ED group, who reported pre-13 ALEs, the finding that in the ED group, body dissatisfaction
regardless of type, had significantly higher visual and non- was significantly related to non-visual BID, whereas in
visual BID than those in the other two groups. Body identity the control group, body dissatisfaction was related to
is formed through sensory experiences in the early months visual BID. Furthermore, social bias may influence visual
of life and develops during the 1 few years of life when perception, and emotional bias may create a negative
st
the mother/parent–child relationship is paramount. 12,14,29 embodiment that generates non-visual BID. 14,31-33
ALEs have been implicated in the development of body Consistent with this idea, several studies have indicated
image. 12,16,30 Individuals with secure attachments and the prevalence of somatoform symptoms, emotion
trusting relationships are generally more satisfied with dysregulation, insecure attachment, and anxiety in adults
their bodies. 12,14,30 Therefore, it is hypothesized that the who experienced interpersonal ALEs in childhood. 34,35
presence of interpersonal ALEs during early adolescence The ED population with interpersonal ALEs has been
affects body image. Negative emotions related to previous described as having insecure attachment in addition to
interpersonal ALEs may influence body perception when body dissatisfaction and emotion dysregulation. 14,30 This
patients close their eyes. may lead to challenges in identifying bodily sensations
To test this hypothesis, the body that patients visually and distinguishing them from emotional states, as
perceived was distinguished from the body that they reported previously in patients with ED. 32,33 Our findings
accurately perceived after closing their eyes and physically are consistent with this idea, as we found higher non-
feeling their body shape before selecting the figure that visual BID in patients with pre-13 ALEs. ALEs may lead
corresponded to their true appearance. Patients with ED to insecure attachment, which in turn is related to an
overestimated their body shape, both visually and non- unacknowledged emotional state affecting the body. 14,32
visually, whereas participants in other groups tended to The lack of positive family experiences or emotions such
underestimate their body shape. as shame after bullying has been associated with a negative
33
The RMDD group overestimated their body shape when body image. Family functioning based on control may
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they felt their body, but not when they looked at themselves influence how people experience their bodies. The
in the mirror. This non-visual overestimation occurs in ED group reported less support from their parents or
patients who are overweight, and they underestimate their peers. Thus, we cannot exclude the possibility that BID
body shape in the mirror. In general, underestimation is is influenced by an insecure attachment derived from
associated with a high BMI. When patients with depression patients’ family experiences.
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look at themselves in the mirror, they judge themselves At the intragroup level, pre-13 interpersonal ALEs
with the social requirement of a thin body. In line with this identified patients with ED who show higher levels
finding, a recent study reported body distortion associated of perfectionism and significantly different levels of
with weight bias in patients with depression with the impulsivity. At the intergroup level, the ED group with
31
negative effects influencing perception. Thus, the visual interpersonal ALEs (regardless of age) had higher levels
BID of patients with depression might be based on this of perfectionism than the other two groups. Patients with
weight bias, whereas the non-visual BID might respond to depression and those without mental illness did not show
negative emotions derived from ALEs. 15 significant differences with regard to body image and ALE

Interestingly, the non-visual bias is intensified when category. Only patients with RMDD and interpersonal ALEs
non-visual senses are engaged, such as interoceptive, had lower levels of impulsivity (P = 0.002). This difference
proprioceptive, and emotional experiences, which could be explained by the sample size, with the RMDD
become apparent after closing the eyes. This indicates that group reporting a lower proportion of interpersonal ALEs.

Volume 2 Issue 4 (2024) 7 doi: 10.36922/jcbp.4662