Impact of Body Schema Distortion on Remission and Weight Regain in Anorexia Nervosa

"In VR, a spherical object approaches with linear trajectory the body of patients, it can be sent to 4 parts of the body (mid-arm/waist/hip/mid-thigh) both left and right side. Several conditions are presented, either the trajectory leads the object to touch the body, or it passes at ≠ distances from it. Patient is instructed to move only if he thinks the object will touch his body.~Procedure begins with a measurement taken on 3 body locations via the Move tool (shoulders/hips/thighs) to create an avatar allowing the tool to determine whether or not movement was necessary. Then, the movement of the patient is recorded. For each object/body distance, the software determines if dodging was necessary. The overestimation of the body schema corresponds to the average distance from which the patient considers that the object would have touched her body and performs a dodging movement, compared to her real morphological dimensions. This generates a body limit distortion % for each body area."

This questionnaire has been translated and validated (French version, Luminet et al., 2021). This is a self-reported measure of alexithymia in 24 items. It is designed to measure all the components of alexithymia for both negative and positive emotions. Five subscale scores and six composite scores can be obtained from the questionnaire, with high scores indicating higher levels of alexithymia.

This questionnaire (Detail and Flexibility Questionnaire, French version of Maria et al, 2020) assesses cognitive rigidity. This questionnaire assesses two frequently impaired cognitive dimensions in people with anorexia nervosa, central coherence and cognitive flexibility in daily functioning using 20 self-completed items.

"The Body Shape Questionnaire (BSQ, translated and validated in French by Rousseau et al., 2005) is a one-dimensional Anglo-Saxon self-questionnaire of 34 items that assesses concerns about body shape over the past four weeks. Responses are scored on a 6-point Likert scale. A score of 1 (never) means the problem is not present, up to a score of 6 (always) which means the problem is always present. The higher the score, the more the concern/dissatisfaction with one's body tends to be pathological."

Body overestimation is assessed by the computerized silhouette test (adapted from Gardner \& Brown, 2010, Van der Linder et al., 2017). Twenty-seven Body Mass Index silhouettes ranging from 11 to 40 are presented to participants in random order. For each silhouette presented, the participant answers whether or not the silhouette presented corresponds to her current silhouette. A body underestimation index is calculated as follows: Estimated figure average BMI - actual BMI.

"Allows self-assessment of symptoms of eating disorders. It is composed of 91 questions grouped into 11 subscales that assess specific cognitive and behavioral dimensions: desire for thinness, bulimia, body dissatisfaction, feeling of inefficiency, perfectionism, interpersonal distrust, interoceptive sensitivity, fears relating to maturity, asceticism. , impulsiveness and social insecurity. For each item, participants can answer always, usually, often, sometimes, rarely or never. The score for each item is between 0 and 3. The subscale scores are calculated by simply adding all the item scores for each specific subscale. This questionnaire has demonstrated good internal consistency, test-retest reliability, and validity (Garner, 1991)"

"Or Eating Disorders Examination - Questionnaire (Fairburn \& Beglin, 2008). This questionnaire assesses eating behaviors and concerns about weight and body shape, using 28 items focusing on these aspects over the past 28 days."

The Spielberger Anxiety Scale (STAI) State and Trait. This questionnaire includes two distinct scales: one evaluating the current state of anxiety (STAI form Y-A: feelings of apprehension, tension, nervousness and worry that the subject feels at a precise precise moment) and the second evaluating the anxious personality trait (STAI form Y-B: feelings of apprehension, tension, nervousness, and worry that the subject usually feels). The Y version was developed in order to eliminate the items having appeal to depression compared to the initial form. Each scale has 20 items. This questionnaire has good psychometric qualities regarding validity, reproducibility and inter-individual sensitivity. It correlates well with other anxiety questionnaires in a literature review of anxiety questionnaires (Elwood, 2012).

Beck Depression Inventory (Beck, 1987). The inventory is composed of items related to depressive symptoms as well as physical symptoms. This is a questionnaire that gives a quantitative estimate of the intensity of depression. Investigators will use the abbreviated version consisting of 13 items, each item comprising 4 sentences corresponding to 4 degrees of increasing intensity of a symptom on a scale of 0 to 3. The total score corresponds to the sum of the different items and makes it possible to judge the presence of depression and its intensity.