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These authors contributed equally to this work.
Introduction
Body image distortion is a key symptom of eating disorders in the commonly used diagnostic systems. In DSM-IV anorexia nervosa is characterized by the 'intense fear of gaining weight or becoming fat, even though underweight' and a 'disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight' (APA, 2000, p. 316). Furthermore, body image distortion is an important point of application for psychotherapeutic interventions (Gerlinghoff et al. 1999) and the persistence of this distortion following treatment presents a negative prognostic factor (Lay & Schmidt, 1999).
In behavioral research on anorexia nervosa two components of body image are widely accepted: (a) the estimation of one's own body size and (b) the attitude towards one's own body in terms of an emotional evaluation (Slade, 1994; Skrzypek et al. 2001). Various techniques for the assessment of body size perception have been used, including video distortions (Probst et al. 1998), paper questionnaire methods (Stunkard et al. 1983) and computer-based image distortion methods (Johnstone et al. 2008). Common methods used to assess the emotional evaluation of one's own body size are self-report questionnaires or perceptual methods examining the perceived difference between current body size and ideal body size (Stunkard et al. 1983; Williamson et al. 1989).
The overestimation of one's body size by patients with anorexia nervosa has been found in several studies (Molinari, 1995; Gardner & Bokenkamp, 1996; Lautenbacher et al. 1997; Gila et al. 1998; Smeets & Kosslyn, 2001; overestimation for a subpopulation, Probst et al. 1998; review by Skrzypek et al. 2001). Emotional body evaluation tasks, like satisfaction ratings, often produce larger differences between patients with anorexia nervosa and controls than body size estimation tasks (Skrzypek et al. 2001).
Neuroimaging studies concerning body image distortions in anorexia nervosa have revealed an inconsistent pattern of results. Seeger et al. (2002) reported a stronger activation of the amygdala for patients viewing distorted images of their own body in a pilot study. These results support the assumption that alterations in emotional body...