The major purpose
of this study is to identify body image disorders using virtual reality.
After identifying the subjects with a negative body image, it was noted
that negative body image is not related to a decrease in cognitive functioning,
as predicted. Specifically, decision making and the time involved
in the decision making process did not differ between groups. The
decision making involved in the study was choosing the figure that best
represented the subjects ‘own’ figure and choosing the ‘ideal’ figure for
the subject in the VR. Twenty-two non-clinical, female college students
completed the Eating Disorder Inventory-2 (EDI-2), and selected figures
from Stunkarard, Sorenson, and Schulsinger’s (1983) 9-pt. Pictoral Body
Image Scale. Those who scored high on questions pertaining to drive
for thinness and body dissatisfaction on the EDI-2, did not suffer a cognitive
focus requiring them more time to make the decision in the virtual room.
There was a significant correlation between social insecurity scores (EDI-2)
and the time spent in the virtual room. The ideal figure chosen in
the virtual room was significantly thinner than the ideal figure chosen
on paper. The results from the EDI-2 were compared with the chosen
figures from both the paper/pencil format and the virtual, and compared
with the length of time spent in the virtual room.
Body Image Analysis: A Virtual
Reality Assessment Tool
Body image is how one sees one self,
how one feels others perceive them, what one believes about appearance,
how one feels about their body, and how one feels ‘in’ their body.
Body image is the mental picture a person has of his/her body as well as
their thoughts, feelings, judgements, sensations, awareness, and behavior.
Body image is developed through interactions with people and the social
world. It is our mental picture of ourselves in the world (Maynard,
Even women without eating disorders
experience body dissatisfaction at some point in their life. Body
dissatisfaction is defined as being concerned or unhappy with weight, another
feature, or both (Haworth-Hoepner, 1998). Body image dissatisfaction
is so epidemic in our society that it is almost considered normal (Maynard,
1998). How one perceives there own body and how unhealthy eating habits
develop can be traced back to a very young age. Many factors can
contribute to negative perceptions about our body. The media plays
a large role, as well as the family. Many females base their ideal
body images on cultural stereotypes, such as, magazine models or movie
stars (Schlundt, Johnson 1990)
According to Cash (1995), a main
factor in how perceived body image develops is family influences.
Negative feelings about one’s own body image can lead to serious eating
disorders, depression, low self-confidence, low self-esteem, as well as
other problems in life functioning. The family is where one first
learns their identity and develops their sense of self. Individuals
develop a normal or distorted body image in the context of family life.
Among the potential influences on body image development are experiences
of appearance-related teasing and criticism during childhood or adolescence.
Facial characteristics and weight were most often targeted. Family
members, especially brothers, are often implicated. Women who reported
having had more prevalent and distressing experiences of this nature held
more dissatisfying and disturbing body images (Cash, 1995). Family
characteristics of women with anorexia or bulimia cited were found to have
come from environments in which perfection, control, and enmeshment are
the norms, and in which issues of weight and appearance are prominent (Haworth-Hoepner,
2000). Constant criticism from one or both parents about weight
or appearance can have severe negative effects.
Ohring, (1997) explored continuities
and discontinuities in female adolescents body dissatisfaction and the
association of these patterns to the development of eating problems and
depressive symptoms in early adulthood. Ohring (1997) found that
different patterns of body image disturbance during adolescence were associated
with distinct long-term psychological outcomes. Girls who repeatedly
experienced elevated levels of body dissatisfaction during early and mid-adolescence
were at risk for relatively high levels of eating problems and depressive
symptoms in early adulthood. In contrast, girls who did not experience
these high levels of body dissatisfaction during adolescence reported relatively
normal psychological adjustment in early adulthood.
A healthy body image is essential
in developing as a healthy confident person. Body image influences
behavior, self-esteem, and our psyche. When we feel bad about our
body, our satisfaction and mood plummets (Maynard, 1998).
The disturbances of body image associated
with eating disorders can be conceptualized as a type of cognitive bias.
Overestimation can be considered as a complex judgement bias linked to
attentional and memory bias for body related information. If information
related to body is selectively processed and recalled more easily, it is
apparent how the self-schema becomes so highly associated with body-related
information. For example, "if the memories related to body are also
associated with negative emotion, activation of negative emotion should
sensitize the person to body-related stimuli causing even greater body
size overestimation (Williamson 1996)"
Schlundt and Johnson (1990) identify
a variety of cognitive distortions that occur within patients with body-image
problems. Unrealistic ideal body: the patient has an ideal body image
that is based on cultural stereotypes, such as, magazine models or movie
stars. Given her body build she will never achieve this ideal appearance.
Social comparison: this problem involves focusing on the positive features
of another women’s appearance and comparing them to one’s own perceived
negative features. The other women’s beauty, thinness, or attractiveness
is exaggerated while one’s own attractiveness is denigrated. Obsession
with certain parts: often, certain body parts are identified as being too
fat or unattractive. The individual’s evaluation of her appearance
is based on her thoughts and feelings about this single body part.
Often, the perceived negative features of the body part are greatly exaggerated.
Failure to attend to positive features: the woman who is obsessed with
the unattractiveness of a particular body part often fails to attend to
or perceive the strength of her other physical features. Misattribution:
unpleasant experiences, failures, and other negative outcomes are misattributed
to one’s physical features. For example, breaking up with a boyfriend
could be perceived as being caused by a weight problem when if fact, it
was caused by factors completely unrelated to body weight. Magical
belief in the power of weight loss: the patient believes that losing weight
or changing the shape or size of certain body parts will result in solving
all of her problems. This intensifies the perceived need for weight
loss and tends to cause the individual to become even more obsessed with
body weight. There is a circular interaction among behaviors, emotions,
and cognition in body image disturbances.
Certain cognitive characteristics
such as low self-esteem, distorted beliefs about the ‘meaning’ of weight,
shape and appearance, dichotomous logic, and perfectionism result in an
over concern about one’s body size (Riva, Bacchetta, Baruffi, Rinaldi,
Molinari 1999). Body image disturbance is an essential characteristic
of anorexia nervosa, and stresses the importance of the misperception of
body size, interoceptive disturbances, and personal ineffectiveness.
It is important to find out how girls perceive their body. Although
some anorexics overestimate their body size, others underestimate (Huon
1986), thus, emphasizing the need to know where the problem lies, before
a treatment plan can be devised. Also, important is the need to differentiate
between how a girl with a distorted body image ‘feels’ their body is, how
they ‘think’ their body is and how their body ‘actually is.’ Estimates
of anorexic patients show that their bodies ‘feel’ fatter than they ‘think’
they are fat. It is hard to help a patient understand that they are
not fat, if they ‘feel’ fat. The patients feelings are essential
to developing the proper treatment plan.
Treatment of body image disorders
focuses mainly on two direct and specific approaches: A cognitive/behavioral
approach and a visual/motorial approach. A cognitive/behavioral approach
aims at influencing patient’s feelings of dissatisfaction with different
parts of their bodies by means of individual interviews, relaxation and
imaginative techniques. A visual/motorial approach makes use of video
recording of particular gestures and movements with the aim of influencing
the level of bodily awareness.
The cognitive approach for body
image disorders: Cognitive therapy is designed to alter behavior by having
an impact on the way the individual processes information about the self
and the environment while at the same time providing training and experience
necessary to implement new coping strategies. The therapist plays
the role of educator and facilitator, and attempts to guide the client
into changing the way he or she thinks and behaves in everyday situations.
The therapist engages in assessment, diagnosis, and intervention and in
doing so, structures learning experiences designed to change the patient’s
use of erroneous perceptions and misinterpretations and their impact on
Behavioral Approach: Unhappy feelings
and illogical thoughts about one’s body do not just arise. These
thoughts and feelings are elicited by and/or influence events that occur
in daily life. To reduce and eliminate self-induced abnormal behaviors
two specific behavioral treatment protocol are normally used.
Visual Motor Approach: The goal
of body image therapy is to develop an awareness of the distortion.
An attempt is made to teach patients that body image is changeable and
that women can reorganize the perceptions and feelings they have about
Virtual Reality Treatment: The integration
of the different methods (cognitive, behavioral and visual-motorial) commonly
used in the treatment of body experience disturbances within a virtual
environment is helpful in influencing the way the body is experienced.
This leads to a greater awareness of the perceptual and sensory/motorial
process associated with them (Riva, 1998).
Virtual reality has been used in
many studies as a therapy method for eating disorders. Virtual reality
provides a safe environment for the patient to practice new thoughts and
behaviors revolving around body image. Because virtual reality can
be used in a medical setting there is no need for public situations.
Virtual reality can create an environment that stimulates the real world
and at the same time can assure the researcher full control of all the
parameters implied. Virtual reality has been found to be of use in
the treatment of eating disorders.
Decision-making is affected by negative/positive
feelings about the body. Negative feelings about the body can
lead to lower self-esteem and less confidence in oneself, and therefore,
make decision making more difficult. Negative body image can lead
to low self-esteem and lower confidence levels, which is why body image
should be looked at as a factor in decision making. Findings by Bechara,
Demasio, and Demasio (2000) indicated that decision making and working
memory are distinct operations of the prefrontal cortex and there is an
emotional mechanism that biases decision making. Negative body image
can lead to an overall negative way of thinking. How does this factor
into everyday cognitive functioning? Is there a connection between
decision making and how one perceives their body?
subjects participated in the study. Females from a small New England
liberal arts college in New England volunteered as subjects. The
majority of the participants were form introductory psychology courses.
They did receive extra class credit for participation. The subjects
ages ranged from 18-22. The group mean weight was 134 (ranging from
95lbs-174lbs.) and the groups mean height was 65inches (five foot four
inches). The means are excluding one subject, who chose not to enter
her current height and weight. The height and weight were recorded
to the best of the participant’s knowledge. They were not measured
and weighed as part of the study.
room was created using Superscape, a program for designing virtual reality
environments. The room was presented on a 600 MHz Pentium II Processor
with a VGA color display. The participants will enter the room in
which nine figures are displayed randomly throughout. The figures
are against the walls and range from extremely underweight to extremely
overweight with variations in between. The subjects will use the
mouse to guide themselves throughout the room. Distractions in the
room may be a large fish tank in the center, as well as two large windows
looking outside, two staircases, a ceiling fan, and double doors.
Spector, a feature on the computer, will record everything that the subject
does while in the room. It will display every two seconds what the
subjects spent most time looking at. The figures on the wall were
scanned onto the computer and placed randomly throughout virtual reality
room from Stunkarard, Sorenson &Schulsinger’s (1983) 9-Point Pictoral
Body Image Scale. The study is focusing on females; therefore, the
figures in the room will be female only.
Sorenson, and Schlusinger’s (1983) 9-pt. Pictoral body image scale:
validity purposes the 9 point pictoral scale was administered in two forms.
In the form of paper/pencil, in which they were asked to answer: place
an ‘x’ through the figure which most represents your own, and circle the
ideal figure to have. They also answered the same question by looking
at the figures scattered throughout the virtual room.
completed the EDI-2. Half completed the EDI-2 before entering the
virtual room to choose the figures. The other half completed the
EDI-2 after their virtual experience. The results from the EDI-2
will be used for reliability in distinguishing subjects with greater drives
for thinness and higher percentages of body dissatisfaction.
came on two nights. Two participants came at a time; scheduled to
arrive every twenty minutes. When they arrived they read and signed
the consent form. One subject would begin with the EDI-2 and the
paper/pencil format of Stunkarard, Sorenson, and Schlusinger's (1983) 9-pt
scale. The other subject would begin with the figure selection from
the virtual room. When they entered the virtual room they received
instruction on how to move around and to zoom in and out on the figures.
They were told how to stop moving to look directly at one frame.
They were instructed to write down the number of the figure that most represented
their own and the ideal figure that they would like to have.
This experiment was designed using
virtual reality as an assessment tool for body image analysis. The
hypothesis was that females with a negative body image would take longer
to make decisions, specifically regarding their own weight and figure shape.
The results of negative body image and time in the virtual reality did
not support the hypothesis. Time in the virtual room did not correlate
with the subject’s weight, drive for thinness, or their body dissatisfaction
scores (EDI-2). No significant findings were found between the choices
made on Stunkarard, Sorenson, & Schulsinger’s (1983) 9-pt pictoral
scale and the subject’s overall time spent in the VR. No significant
correlation was found between the subject's drive for thinness, bulimia,
body dissatisfaction, ineffectiveness, perfectionism, interpersonal distrust,
interceptive awareness, or impulse regulation scores (EDI-2) and the time
spent in the VR. In conducting this experiment no significant correlation
was found between the subject's drive for thinness, bulimia, body dissatisfaction,
ineffectiveness, perfectionism, interpersonal distrust, interceptive awareness,
or impulse regulation scores (EDI-2) and the choice of own and ideal figure
from the 9-pt scale.
We did find a slightly significant
correlation between asceticism scores on the EDI-2 and time spent in the
VR. More significant were the scores on social insecurity correlated
with the time spent in the VR. We did a mean split for
time spent in the VR: creating groups for ‘long’ time spent, ‘medium’ time
spent, and ‘short’ time spent in the room. The median time was 180seconds
(3 minutes) in the room. ‘Long’ would be over three minutes in the
room, and ‘short’ would be any time less than three minutes. ‘Medium’
was three minutes. We did an analysis of variance with the groups’
time spent and there score on the social insecurity (EDI-2). No significant
difference was discovered between the medium and long group, so they were
grouped together. The higher the social insecurity scores were, the
longer amount of time was spent in the virtual room trying to make a decision.
The group that spent <180 seconds had the least social insecurities.
In a 2-tailed test of significance
it was found that the ideal paper/pencil choice differed significantly
from the ideal VR choice. In the VR there was a desire to be even
thinner. People, when in the virtual world, tend to look to be lighter
than when in the real world. (t=6.2; df=21; p=00) The figures
range from extremely thin to extremely large (1-9). The choices in
the VR were significantly lower than the choice made from the paper.
great deal of research done on body image, and how having unhealthy body
image can lead to more serious problems has been done. Body image
is often discussed in relation to eating disorders (anorexia nervosa and
bulimia). Less research has been done on how negative body image
effects self-esteem and confidence levels, which in turn affect cognitive
functioning (specifically, making decisions). The major purpose of this
study was to identify body image dissatisfaction using virtual reality.
After identifying the groups with the greatest drives to be thin and with
high body dissatisfaction scores, we predicted they would spend more time
in the virtual room trying to make a decision regarding their figure size
and shape. We hypothesized that a negative body image would lead
to a decrease in cognitive functioning, specifically affecting the time
it takes to make a decision. Our results did not support this hypothesis.
We found significant differences in the paper pencil ‘ideal’ choices and
the virtual room ‘ideal’ figure choices. In the virtual room the
female participants displayed an even stronger desire to be thin than they
did on the paper pencil selection. This implies that virtual reality
could be helpful in identifying body image dissatisfaction. Having
the figures displayed 3-dimensionally on a wall, and allowing the subjects
to walk around the room at their own pace to look at each, gives them a
better sense of reality. This allows the subject to use more senses
in making the decision of what they ‘think they are’ and what they ‘would
like to be’ walking around the VR, rather than just looking at a sheet
of paper. Subjects had the advantage of being able to look
close up at the figures and also from a distance by using the mouse to
zoom in and out.
out of twenty-two participants had a desire to be thinner: their ideal
figure was smaller than their actual figure. Six of the seventeen
participants chose the skinniest possible figure in the VR. Two participants
out of twenty-two chose their ideal figure in the VR to be the same as
their own body. One chose her own body to be the skinniest (#1) in
the VR and showed satisfaction with this, by selecting #1 as her ideal
also. The second subject chose #2 (which, is the second skinniest
figure), she too, showed satisfaction with this by selecting the same choice
as her ‘ideal.’ These subjects answered differently in the VR.
One (who selected #1 in the VR) chose #3 on paper as her own and #2 on
paper as her ideal. (The figures range from smallest to largest:
1-9.) The second chose #4 on paper as her own and #2 on paper as
her ideal. These two subjects differed from the majority, who selected
smaller figures in the VR, than they chose on paper. Two other subjects
went against the majority, desiring a larger figure than they thought they
had. In the VR and in the paper pencil test one chose her own to
be #1 and her ideal to be larger, #3. The other subject chose on
paper pencil #3 as her own and #2 as her ideal. In VR she chose #1
as her own and #2 as her ideal. In real world (paper/pencil) she
desired a smaller figure than she thought she had, but in the virtual world
she chose a larger figure than what she had. Also noted: the figure
selected as her own in the virtual world was thinner than her figure selected
as her own on the paper and pencil form. One subject chose the ideal
to be the same as her own figure in both the VR and on paper and pencil.
She found herself to be figure #2 and her ideal figure to be #2 on paper.
In VR she chose #1 as her own and her ideal. Again, the VR figure
was thinner than the figure on paper. The differences in choice between
real world and virtual world are notable. In future body image analysis
the virtual world should be considered as a means of analysis as well as
a possible means of treatment in negative body image.
problem with the study was the order of the figures. The figures
on the paper were in order from smallest to largest. In the virtual
room, the figures were randomly placed throughout. This could be
a contributing factor to the amount of time spent in the room. It
was obvious that the figures were from the same scale, but it was harder
to distinguish between the average size figures. The height and weight
of the subjects were from the subject’s best knowledge, to be more accurate,
they should have been measured, weighed and then recorded at the time of
the study. One participant did not volunteer her current weight
and height for the study. The means were averaged without her.
factor to be considered is the age range of the participants. Many
of the subjects were 18 years of age. Haworth-Hoepner (1998) found
that even woman without eating disorders experience body dissatisfaction
at some point in their life. Studies have found that the time period
in which negative body image begins can help in understanding the psychological
effects that develop. The participants in this study have since passed
adolescence and have entered into young adulthood. It could have
been beneficial to this study to examine closer the different scores and
choices between the subjects who are 18 and the subjects who are 22.
Cash (1995) has found that how one perceives their own body develops at
a very young age. Did the subjects in this study always have a desire
to be thinner? Or is it something that they have recently been thinking
about? The time period in which negative body image develops is crucial
in predicting the extent of psychological damage that may later occur .
find a significant correlation between asceticism scores (EDI-2) and time
spent in the VR. Asceticism is systematic self-denial for some ideal.
One, who is ascetic, is one who lives a life of contemplation and rigorous
self-denial for religious purposes. Ascetic people are characterized
as rigid and severe.
no direct correlation was found between body dissatisfaction and time spent
in the virtual room, the correlation between social insecurity and time
spent in the virtual room leaves for some interesting research to be done.
Schlundt & Johnson (1990) identified a variety of cognitive distortions
that occur within patients with body image disorders. As far as we
know none of the subjects involved in the study suffered from a clinical
level type of body image disorder. Some of the scores on the EDI-2
were high, and there was a strong desire to be thinner, when choosing from
the 9-pt. Scale. An unrealistic ideal body is common in females today.
Social comparison: focusing on the positive features of other women's appearance
and comparing them to one's own perceived negative features, was also discussed
by Sclundt & Johnson (1990). Unrealistic ideal body and social
comparison are problems that are prevalent at this time period in our society.
An interesting question to ask subjects would be how they feel their figure
compares with that of their friends/roommates. Many groups of friends
have a similar style (dress, hair). These groups also, tend (especially
in college) to develop similar eating habits and workout habits.
This could be an interesting study to further understand how young adult
females are influenced about body image, and how it effects them psychologically.
difference was found in what subjects saw as ideal in the virtual world
as compared to the real world. In the virtual world the choices for
ideal figure where even thinner than on paper. These two findings
could be looked at more specifically. Being in the virtual world
creates a sense of ‘realness’ that paper cannot produce. People see
figures in a more ‘lifelike’ way; they are not simply outlines on a sheet
of paper. Perhaps, in a broader sense, social insecurity has something
to do with body dissatisfaction. If one is insecure about themselves
in the social world, and in social situations, they may have a harder time
making decisions, because they are overwhelmingly concerned about what
others think of them. Participants who scored high in social insecurity
and spent more time in the virtual room may have thought that I wanted
them to take a longer time. Possibly the subjects had less self-confidence
to look around and say, ‘that looks like me’ or ‘ I would like to have
that figure.’ They had to look around at each figure longer, before
being able to come to a conclusion as to what they were and what they wanted.
This study did not support my hypothesis directly, but perhaps, if done
again with more subjects and in a different set up, it could be found that
body image dissatisfaction does play a role in time taken to make decisions.
Some considerations could be to give the EDI-2, have the subjects select
the paper/pencil figure and then, have them enter the virtual room, with
the pictures arranged in order (1-9). Another consideration could
be to go through the steps of this study, and then give a decision-making
questionnaire, and analyze relationships found.
relationship between body image and time in the virtual room did not appear
significant in this study, it is interesting that social insecurity was
so strongly correlated with time in the virtual room and also with the
desire to be thin. Maynard (1998), states that body image is developed
through interactions with people in the social world. Further research
should look at this relationship between social insecurity and time spent
making decisions. Body image perception is considered a factor in
how secure one is in the ‘social’ aspect of life.
Return to Top