Association for Behavior Analysis International

Body image disturbance and body dysmorphic disorder (BDD) have been understood using a conventional nosological framework. However, taxonomic considerations do not provide a way to conceptualize these behaviors in a way that allows a treatment to emerge based on more than symptom reduction. This symposium presents 3 aspects of developing a theoretically based and empirically derived intervention for body image disturbance and body dysmorphic disorder from work at multiple sites across the country. First, we present a contemporary behavior analysis of body image problems using relational frame theory to create a context in which body image disturbance can be understood as an expression of psychological inflexibility. Next, data from 2 studies will be presented on the relationship between psychological inflexibility, interpersonal repertoires, and body image disturbance as well as convergent validity data for a new measure of psychological inflexibility about body image. The final paper brings both the theory and data from these studies together, providing an empirical foundation to the development of an intervention for these behavior problems. Our discussant will highlight conceptual strengths and weaknesses to this approach and how the empirical studies and intervention correspond with contemporary behavioral interventions.

Body image disturbance has been associated with significant problems in mental health, physical health, and social functioning. Psychologists have long approached body image disturbance in terms of the rationality or accuracy of the individuals experience. Consistent with a wide trend in mental health, several emerging behavioral body image interventions focus instead on improving an individuals awareness of, openness to, and flexibility with the dynamic bodily experience. Early findings support body image inflexibility as the mechanism by which body image causes dysfunction in peoples lives and, conversely, body image flexibility as the mechanism by which interventions on body image might be successful. This theoretical paper will explore body image inflexibility from a behavior analytic perspective, emphasizing the conditions under which body image inflexibility is learned. In particular, the authors propose relational learning processes involved in body image inflexibility and subsequent dysfunction. Implications for training body image flexibility will be discussed.

Data from two studies are presented in this paper. First, data from a study of over 500 participants are provided to demonstrate the empirical relationship between experiential avoidance repertoires, interpersonal problems with expressing emotions, and body image disturbance. Interestingly, these data show that, while intrapersonal difficulties can predict the diagnosis of Body Dysmorphic Disorder, only interpersonal problems predict the severity of those problems. This dynamic model suggests both factors are essential in understanding body image disturbance. Results from a second study will be presented in which 300 participants were administered a newly developed assessment of body image problems. This data demonstrate a relationship between psychological inflexibility and a variety of measures of body image satisfaction, disturbance, and general psychological distress. Overall, these data provide empirical support for a behavior analytic conceptualization of body image problems that directly corresponds to an intervention that targets both inter- and intrapersonal behavioral repertoires.