Skip to main content Accessibility help

Separating two components of body image in anorexia nervosa using fMRI

  • H. M. Mohr (a1) (a2) (a3), J. Zimmermann (a1) (a2), C. Röder (a4), C. Lenz (a2) (a5), G. Overbeck (a2) (a5) and R. Grabhorn (a2) (a5)...



Body image distortion is a key symptom of anorexia nervosa. In behavioral research two components of body image have been defined: attitudes towards the body and body size experience. Neuroimaging studies concerning own body image distortions in anorexia nervosa have revealed an inconsistent pattern of results and are constrained by the fact that no direct distinction between the different parts of body image has been made.


The present study therefore set out to investigate the neural correlates of two parts of the own body image using functional magnetic resonance imaging (fMRI): satisfaction rating and size estimation for distorted own body photographs in patients with anorexia nervosa and controls.


Anorectic patients were less satisfied with their current body shape than controls. Patients further demonstrated stronger activation of the insula and lateral prefrontal cortex during the satisfaction rating of thin self-images. This indicates a stronger emotional involvement when patients are presented with distorted images close to their own ideal body size. Patients also overestimated their own body size. We were able to show complex differential modulations in activation of the precuneus during body size estimation in control and anorectic subjects. It could be speculated that a deficit in the retrieval of a multimodal coded body schema in precuneus/posterior parietal cortex is related to body size overestimation.


We were able to find specific behavioral responses and neural activation patterns for two parts of body image in anorexia nervosa and healthy controls. Thus, the present results underline the importance of developing research and therapeutic strategies that target the two different aspects of body image separately.


Corresponding author

*Address for correspondence: Dr Dipl. Psych. H. M. Mohr, Department of Biological Psychology, Institute of Psychology, Johann Wolfgang Goethe University, Mertonstrasse 17, 60054Frankfurt, Germany. (Email:


Hide All
APA (2000). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), 4th edn, text revision. American Psychiatric Publishing: Washington, DC.
Beato-Fernández, L, Rodríguez-Cano, T, García-Vilches, I, García-Vicente, A, Poblete-García, V, Castrejon, AS, Toro, J (2009). Changes in regional cerebral blood flow after body image exposure in eating disorders. Psychiatry Research 171, 129137.
Clement, U, Lowe, B (1996). Validation of the FKB-20 as scale for the detection of body image distortions in psychosomatic patients. Psychotherapie, Psychosomatik, Medizinische Psychologie 46, 254259.
Craig, AD (2009). How do you feel – now? The anterior insula and human awareness. Nature Reviews Neuroscience 10, 5970.
Fallon, AE, Rozin, P (1985). Sex differences in perceptions of desirable body shape. Journal of Abnormal Psychology 94, 102105.
Fassino, S, Pierò, A, Gramaglia, C, Abbate-Daga, G (2004). Clinical, psychopathological and personality correlates of interoceptive awareness in anorexia nervosa, bulimia nervosa and obesity. Psychopathology 37, 168174.
Fitzgerald, DA, Posse, S, Moore, GJ, Tancer, ME, Nathan, PJ, Phan, KL (2004). Neural correlates of internally-generated disgust via autobiographical recall, a functional magnetic resonance imaging investigation. Neuroscience Letters 11, 9196.
Gardner, RM, Bokenkamp, ED (1996). The role of sensory and nonsensory factors in body size estimations of eating disorder subjects. Journal of Clinical Psychology 521, 3–15.
Gerlinghoff, M, Backmund, H, Franzen, U, Gorzewski, B, Fenzel, T (1999). Structured day care therapy program for eating disorders. Psychotherapie, Psychosomatik, Medizinische Psychologie 47, 1220.
Gila, A, Castro, J, Toro, J, Salamero, M (1998). Subjective body-image dimensions in normal and anorexic adolescents. British Journal of Medical Psychology 71, 175184.
Johnstone, AM, Stewart, AD, Benson, PJ, Kalafati, M, Rectenwald, L, Horgan, G (2008). Assessment of body image in obesity using a digital morphing technique. Journal of Human Nutrition and Dietetics 21, 256267.
Johnstone, T, van Reekum, CM, Oakes, TR, Davidson, RJ (2006). The voice of emotion an fMRI study of neural responses to angry and happy vocal expressions. Social Cognitive and Affective Neuroscience 1, 242249.
Lautenbacher, S, Kraehe, N, Krieg, JC (1997). Perception of body size and body satisfaction in recovered anorexic women, comparison with restrained and unrestrained eaters. Perceptual and Motor Skills 84, 13311342.
Lay, B, Schmidt, MH (1999). Relapses in the course of anorexia nervosa. Zeitschrift für Kinder und Jugendpsychiatrie und Psychotherapie 27, 207219.
Molinari, E (1995). Body-size estimation in anorexia nervosa. Perceptual and Motor Skills 811, 2331.
Nitschke, JB, Dixon, GE, Sarinopoulos, I, Short, SJ, Cohen, JD, Smith, EE, Kosslyn, SM, Rose, RM, Davidson, RJ (2006). Altering expectancy dampens neural response to aversive taste in primary taste cortex. Nature Neuroscience 9, 435442.
Phan, KL, Wager, TD, Taylor, SF, Liberzon, I (2004). Functional neuroimaging studies of human emotions. CNS Spectrum 9, 258266.
Pollatos, O, Kurz, AL, Albrecht, J, Schreder, T, Kleemann, AM, Schöpf, V, Kopietz, R, Wiesmann, M, Schandry, R (2008). Reduced perception of bodily signals in anorexia nervosa. Eating Behaviour 9, 381388.
Probst, M, Vandereycken, W, Coppenolle, HV, Pieters, G (1998). Body size estimation in anorexia nervosa patients: the significance of overestimation. Journal of Psychosomatic Research 44, 451456.
Reed, CL, Farah, MJ (1995). The psychological reality of the body schema: a test with normal participants. Journal of Experimental Psychology: Human Perception and Performance 212, 334343.
Rolls, ET, Grabenhorst, F (2008). The orbitofrontal cortex and beyond: from affect to decision-making. Progress in Neurobiology 86, 216244.
Sands, R, Maschette, W, Armatas, C (2004). Measurement of body image satisfaction using computer manipulation of a digital image. Journal of Psychology 138, 325337.
Schwoebel, J, Coslett, HB (2005). Evidence for multiple, distinct representations of the human body. Journal of Cognitive Neuroscience 17, 543553.
Seeger, G, Braus, DF, Ruf, M, Goldberger, U, Schmidt, MH (2002). Body image distortion reveals amygdala activation in patients with anorexia nervosa – a functional magnetic resonance imaging study. Neuroscience Letters 21, 2528.
Sirigu, A, Grafman, J, Bressler, K, Sunderland, T (1991). Multiple representations contribute to body knowledge processing. Brain 114, 629642.
Skrzypek, S, Wehmeier, PM, Remschmidt, H (2001). Body image assessment using body size estimation in recent studies on anorexia nervosa. A brief review. European Child and Adolescent Psychiatry 10, 215221.
Slade, PD (1994). What is body image? Behaviour Research and Therapy 32, 497502.
Smeets, MA, Kosslyn, SM (2001). Hemispheric differences in body image in anorexia nervosa. International Journal of Eating Disorders 29, 409416.
Stunkard, AJ, Sorensen, T, Schulsinger, F (1983). Use of the Danish Adoption Register for the study of obesity and thinness. Research Publications – Association for Research in Nervous and Mental Disease 60, 115–1120.
Talairach, T, Thournoux, P (1988). A Coplanar Stereotactic Atlas of the Human Brain. Thieme Verlag: Stuttgart.
Tremblay, L, Schultz, W (1999). Relative reward preference in primate orbitofrontal cortex. Nature 398, 704708.
Uher, R, Murphy, T, Friederich, HC, Dalgleish, T, Brammer, MJ, Giampietro, V, Phillips, ML, Andrew, CM, Ng, VW, Williams, SC, Campbell, IC, Treasure, J (2005). Functional neuroanatomy of body shape perception in healthy and eating-disordered women. Biological Psychiatry 15, 990997.
Wagner, A, Ruf, M, Braus, DF, Schmidt, MH (2003). Neuronal activity changes and body image distortion in anorexia nervosa. Neuroreport 14, 21932197.
Williamson, DA, Davis, CJ, Bennett, SM, Goreczny, AJ, Gleaves, DH (1989). Development of a simple procedure for assessing body image disturbance. Behavioral Assessment 11, 433446.
Zald, DH, Pardo, JV (2000). Functional neuroimaging of the olfactory system in humans. International Journal of Psychophysiology 362, 165181.


Separating two components of body image in anorexia nervosa using fMRI

  • H. M. Mohr (a1) (a2) (a3), J. Zimmermann (a1) (a2), C. Röder (a4), C. Lenz (a2) (a5), G. Overbeck (a2) (a5) and R. Grabhorn (a2) (a5)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed