How women with and without eating disorders perceive their own and others’ bodies: a case-control study

Background: Body dissatisfaction is a key part of the psychopathology of eating disorders, but there is a lack of consensus as to whether the dissatisfaction arises from misperception of body size, and if such misperception applies to others’ as well as own size. Methods: We conducted a case control study of women with and without an eating disorder, confirmed using the Eating Disorders Examination. We used a range of measures to investigate differences between groups in their perception of others’ and own body size, and satisfaction with own size, including rating photographs of other women, manipulating an avatar to “own” and “ideal” size, and novel implicit measures (Lexical Decision and Implicit Association Tasks). Results: We recruited 30 cases and 30 controls. Cases rated 12% more photographs of other women as overweight and 7% fewer as underweight, even after adjusting for participant BMI. We found no evidence for a difference between groups in the accuracy of their avatar representation of own size, but cases rated themselves as larger using a VAS scale and had a smaller avatar-demonstrated “ideal BMI” (case ideal BMI: 15.5 (95% CI 14.1, 16.9); control ideal BMI: 21.6 (95% CI 21.6 (20.4, 22.8)). We found no strong evidence for between-group differences on implicit measures. Discussion: Our results suggest that people with eating disorders are equally accurate at judging size, but have lower set points for their view of “normal weight” than controls. This lower threshold for what constitutes “normal” weight may contribute to patients with eating disorders’ dissatisfaction with their own size.