Effectiveness of an Alternative Forced Choice Paradigm in adolescent girls with eating disorders and depression and their reductions of negative body-related attitudes – A pilot study

Body Image Distortion (BID) is a complex, multifactorial condition most closely associated with eating disorders (EDs), but also found in other disorders including depression (DEP), especially in young people. Although BID predicts treatment outcomes and relapse rates, they are only addressed by a few studies and treatment interventions. Recently training interventions to shift an individual’s categorical boundary when judging other peoples’ bodies as “thin”/”fat” were proved to be able to shift that boundary towards higher BMIs with confrontational feedback about the choices made by adults with sub-clinical ED-symptoms. This shift was accompanied by improvements in BID-related symptoms and general ED pathology. This new pilot-study tests the feasibility and functionality of using this intervention in 24 female, adolescent in-patients, diagnosed with an ED or DEP. They participated in 8 interactive sessions, following a counterbalanced cross-over design, containing a 4-session interventional (corrective feedback) and 4-session control (maintaining feedback) condition. Follow-up measures were obtained after 2 weeks. The results revealed significant adaptive changes of the position of the categorical BMI boundary as well as clinically relevant improvements in ED-related psychometrics in both diagnostic groups in the intervention condition. In contrast to the previous studies, a negative impact on both psychophysical and psychometric measures could be observed in the control condition. The implications of these results are discussed for feasibility of using this training in this special target group with suggestions for improving the task for further studies.