SENIOR THESIS
   Kelly Timmons
BODY IMAGE ANALYSIS: A VIRTUAL REALITY ASSESSMENT TOOL
ABSTRACT INTRODUCTION METHOD
RESULTS DISCUSSION RELEVANT LINKS

ABSTRACT

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.

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INTRODUCTION
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, 1998). 
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 decisions. 
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 their body. 
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?

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Method
Subjects
Twenty-two 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.
Material 
Virtual Reality Room:
The virtual 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. 
Stunkarard, Sorenson, and Schlusinger’s (1983) 9-pt. Pictoral body image scale:
For criterion 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.
Eating Disorder Inventory (EDI-2):
All subjects 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.
Procedures:
The subjects 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.
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Results
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.

 

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DISCUSSION

A 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.
Seventeen 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.
 One 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. 
 Another 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 . 
 We did 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. 
Although, 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.
A significant 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.
Although the 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. 
 


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