Emotional eating and in vivo norepinephrine transporter availability in obesity: A [11 C]MRB PET pilot study.

OBJECTIVE: Emotional eating (EE) has been linked to norepinephrine dysfunction. Therefore, we aimed to investigate the relationship between EE and norepinephrine transporter (NET) availability. METHOD: Ten severely obese individuals (body mass index (BMI) 42.4 ± 3.7 kg/m2 ) and ten non-obese, healthy controls (BMI 23.9 ± 2.5 kg/m2 ) matched for age and sex were studied using (S,S)-[11 C]-O-methylreboxetine ([11 C]MRB) positron emission tomography (PET). Kinetic modeling of regional tissue time activity curves was performed using multilinear reference tissue model 2 (MRTM2, with the occipital cortex as a reference region) to estimate binding potential based on individual PET-MR coregistration. To test for associations of EE and NET availability, participants completed the EE subscale of the Dutch Eating Behavior Questionnaire before scanning. RESULTS: Obese individuals and non-obese, healthy controls did not significantly differ regarding EE scores and regional NET availability. For obese individuals only, correlative data analyses pointed to a sinoidal distribution pattern as a higher degree of EE related to lower NET availability in the locus coeruleus and to higher NET availability in the left thalamus. DISCUSSION: These results indicate that central in vivo NET availability is altered in EE of individuals with obesity. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:152-156).

Hunger and disinhibition but not cognitive restraint are associated with central norepinephrine transporter availability.

The relationship between food-intake related behaviours measured by the Three-Factor Eating Questionnaire (TFEQ) and in vivo norepinephrine transporter (NET) availability has not been explored yet. We investigated ten obese individuals (body mass index (BMI) 42.4 ± 3.7 kg/m2) and ten normal-weight healthy controls (HC, BMI 23.9 ± 2.5 kg/m2) with (S,S)-[11C]-O-methylreboxetine ([11C]MRB) positron emission tomography (PET). All participants completed the TFEQ, which measures cognitive restraint, disinhibition and hunger. Image analysis required magnetic resonance imaging data sets onto which volumes-of-interests were drawn. Tissue time activity curves (TACs) were obtained from the dynamic PET data followed by kinetic modeling of these regional brain TACs applying the multilinear reference tissue model (2 parameters) with the occipital cortex as reference region. Obese individuals scored significantly higher on the hunger subscale of the TFEQ. Correlative data analysis showed that a higher degree of hunger correlated negatively with the NET availability of the insular cortex in both obese individuals and HC; however, this finding was more pronounced in obesity. Further, for obese individuals, a negative correlation between disinhibition and NET BPND of the locus coeruleus was detected. In conclusion, these initial data provide in vivo imaging support for the involvement of the central NE system in maladaptive eating behaviors such as susceptibility to hunger.

The central nervous norepinephrine network links a diminished sense of emotional well-being to an increased body weight.

OBJECTIVES: The neurobiological mechanisms linking obesity to emotional distress remain largely undiscovered. METHODS: In this pilot study, we combined positron emission tomography, using the norepinephrine transporter (NET) tracer [(11)C]-O-methylreboxetine, with functional connectivity magnetic resonance imaging, the Beck depression inventory (BDI), and the impact of weight on quality of life-Lite questionnaire (IWQOL-Lite), to investigate the role of norepinephrine in the severity of depression (BDI), as well as in the loss of emotional well-being with body weight (IWQOL-Lite). RESULTS: In a small group of lean-to-morbidly obese individuals (n=20), we show that an increased body mass index (BMI) is related to a lowered NET availability within the hypothalamus, known as the brain's homeostatic control site. The hypothalamus displayed a strengthened connectivity in relation to the individual hypothalamic NET availability to the anterior insula/frontal operculum, as well as the medial orbitofrontal cortex, assumed to host the primary and secondary gustatory cortex, respectively (n=19). The resting-state activity in these two regions was correlated positively to the BMI and IWQOL-Lite scores, but not to the BDI, suggesting that the higher the resting-state activity in these regions, and hence the higher the BMI, the stronger the negative impact of the body weight on the individual's emotional well-being was. CONCLUSIONS: This pilot study suggests that the loss in emotional well-being with weight is embedded within the central norepinephrine network.

Sex differences in serotonin-hypothalamic connections underpin a diminished sense of emotional well-being with increasing body weight.

BACKGROUND/OBJECTIVES: The neurobiological mechanisms linking obesity to emotional distress related to weight remain largely unknown. PARTICIPANTS/METHODS: Here we combined positron emission tomography, using the serotonin transporter (5-HTT) radiotracer [(11)C]-3-amino-4-(2-dimethylaminomethylphenylsulfanyl)-benzonitrile, with functional connectivity magnetic resonance imaging, the Beck Depression Inventory (BDI-II) and the Impact of Weight on Quality of Life-Lite questionnaire (IWQOL-Lite) to investigate the role of central serotonin in the severity of depression (BDI-II), as well as in the loss of emotional well-being with body weight (IWQOL-Lite). RESULTS: In a group of lean to morbidly obese individuals (n=28), we found sex differences in the 5-HTT availability-related connectivity of the hypothalamus. Males (n=11) presented a strengthened connectivity to the lateral orbitofrontal cortex, whereas in females (n=17) we found strengethened projections to the ventral striatum. Both regions are known as reward regions involved in mediating the emotional response to food. Their resting-state activity correlated positively to the body mass index (BMI) and IWQOL-Lite scores, suggesting that each region in both sexes also underpins a diminished sense of emotional well-being with body weight. Contrarily to males, we found that in females also the BDI-II positively correlated with the BMI and by trend with the activity in ventral striatum, suggesting that in females an increased body weight may convey to other mood dimensions than those weight-related ones included in the IWQOL-Lite. CONCLUSIONS: This study suggests sex differences in serotonin-hypothalamic connections to brain regions of the reward circuitry underpinning a diminished sense of emotional well-being with an increasing body weight.

16p11.2 Locus modulates response to satiety before the onset of obesity.

BACKGROUND: The 600 kb BP4-BP5 copy number variants (CNVs) at the 16p11.2 locus have been associated with a range of neurodevelopmental conditions including autism spectrum disorders and schizophrenia. The number of genomic copies in this region is inversely correlated with body mass index (BMI): the deletion is associated with a highly penetrant form of obesity (present in 50% of carriers by the age of 7 years and in 70% of adults), and the duplication with being underweight. Mechanisms underlying this energy imbalance remain unknown. OBJECTIVE: This study aims to investigate eating behavior, cognitive traits and their relationships with BMI in carriers of 16p11.2 CNVs. METHODS: We assessed individuals carrying a 16p11.2 deletion or duplication and their intrafamilial controls using food-related behavior questionnaires and cognitive measures. We also compared these carriers with cohorts of individuals presenting with obesity, binge eating disorder or bulimia. RESULTS: Response to satiety is gene dosage-dependent in pediatric CNV carriers. Altered satiety response is present in young deletion carriers before the onset of obesity. It remains altered in adolescent carriers and correlates with obesity. Adult deletion carriers exhibit eating behavior similar to that seen in a cohort of obesity without eating disorders such as bulimia or binge eating. None of the cognitive measures are associated with eating behavior or BMI. CONCLUSIONS: These findings suggest that abnormal satiety response is a strong contributor to the energy imbalance in 16p11.2 CNV carriers, and, akin to other genetic forms of obesity, altered satiety responsiveness in children precedes the increase in BMI observed later in adolescence.

A novel measure to assess self-discrimination in binge-eating disorder and obesity.

Stigmatized obese individuals tend to internalize the pervasive weight stigma, which might lead to self-discrimination (SD) and increased psychopathology. While explicit and implicit weight stigma can be measured using self-report questionnaires and Implicit Association Tests (IATs), respectively, the assessment of SD relied solely on self-report. The present study sought to develop an IAT measuring implicit SD (SD-IAT) in samples of obese individuals with and without binge-eating disorder (BED). Seventy-eight individuals were recruited from the community and individually matched in three groups. Obese participants with BED, obese participants without BED (OB) and a normal weight control group without eating disorder psychopathology (HC) were assessed with the SD-IAT and other measures relevant for convergent and discriminant validation. Results revealed significantly higher implicit SD in the BED group when compared with both OB and HC. Furthermore, significant correlations were found between the SD-IAT with body mass index, experiences of weight stigma, depressive symptoms and implicit self-esteem. Finally, implicit SD predicted eating disorder psychopathology over and above group membership, and experiences of weight stigma. This study provides first evidence of the validity of the SD-IAT. Assessing implicit SD might further increase understanding of weight stigma and its significance for psychosocial functioning among vulnerable obese individuals.

[Prevalence of chronic pain in Germany. A representative survey of the general population]. / Prävalenz chronischer Schmerzen in Deutschland. Befragung einer repräsentativen Bevölkerungsstichprobe.

BACKGROUND: There are no up to date data from representative samples of the general German population on the prevalence of debilitating pain and of pain diseases available. METHODS: A cross-sectional survey of a representative sample of the German general population including persons ≥ 14 years of age was conducted in 2012 based on face-to-face interviews using standardized questionnaires. Chronic pain was assessed by the widespread pain index (WPI), disability by the subscales physical functioning and role function of the European Organisation for Research and Treatment of Cancer (EORTC QLQ-C30) and psychological distress by the patient health questionnaire (PHQ-4). Chronic pain with associated physical and social impairments was defined by at least one pain site over 3 months in the WPI and at least one response of a moderate or severe impairment in both subscales of the EORTC 30 QLQ-C30. Chronic pain with associated physical, mental and social impairment (pain disease) required in addition a probable depressive and/or anxiety disorder in the PHQ-4. RESULTS: A total of 2,515 out of 4,480 (56.1 %) of contacted persons finished the study of which 32.9 % reported chronic pain, 5.4 % reported chronic pain with associated physical and social impairments and 2.3 % associated physical, mental and social impairments. No participants with local pain (only one pain site) but 24.0 % of participants with widespread pain (6-19 pain sites) met the criteria of a pain disease. CONCLUSIONS: The reports of chronic pain in epidemiological studies do not necessarily imply a suffering (physical, psychological and social impairment) from pain.

[Child and adolescent obesity, psychosocial consequences and treatment strategies]. / Psychosoziale Folgen von Adipositas im Kindes- und Jugendalter und Strategien zu deren Behandlung.

Being overweight and obese in childhood and adolescence is associated with various somatic and psychosocial sequelae. Psychosocial problems can negatively influence the future weight trajectory. Therefore, weight reduction or stabilization should be complemented by the treatment of significant psychosocial problems. This review provides an overview of the psychosocial problems associated with being overweight and obese in childhood and adolescence. Evidence on weight-related stigmatization and discrimination, eating disorder symptoms, general psychopathology, impaired quality of life, lowered self-esteem, social skill deficits, as well as academic problems is summarized. Furthermore, state-of-the-art diagnostic and therapeutic procedures for the psychosocial problems are summarized. Future research should focus on the development of interventions targeting the destigmatization of obesity, as experiences of stigmatization and discrimination likely aggravate the psychosocial sequelae of overweight and obesity.

Prevalence of pica and rumination behaviours in adults and associations with eating disorder and general psychopathology: findings form a population-based study.

AIMS: Pica and rumination disorder are known as feeding disorder diagnoses in childhood, but little is known about their occurrence in adulthood. This study aimed to assess prevalence rates of one-time and recurrent pica and rumination behaviours (PB and RB) in adults, including sociodemographic subgroups, and to examine associations with other eating disorder and general psychopathology. METHODS: The representative population sample (N = 2403) completed measures on PB and RB, symptoms of avoidant/restrictive food intake disorder (ARFID), body image and symptoms of depression and anxiety. RESULTS: Any PB and RB were reported in 5.33 and 5.49%, respectively, while recurrent PB or RB occurred in 1.08 and 0.71%, respectively. Co-occurrence was high, with 35.29% of recurrent PB in RB, and 23.08% vice versa. Prevalence rates of recurrent PB or RB did not differ by gender, weight status, educational or migration history from those without recurrent behaviours. Adults with v. without recurrent PB and RB showed more symptoms of ARFID, general eating disorders depression and anxiety, and behavioural symptoms of eating disorders (with the exception of compensatory behaviours in recurrent PB), and less positive body image. However, there were no differences regarding age and body mass index. CONCLUSIONS: Our findings highlight the clinical significance of PB and RB in adults regarding both prevalence and associations with other psychopathological symptoms. In particular, associations with body image need to be investigated further, as in contrast to other eating disorders, body image disturbance is not yet represented in the diagnostic criteria for pica and rumination disorder. In sum, the findings highlight the need for clinical attention for these disorders and related behaviours in adults.

Macrosomia: a new formula for optimized fetal weight estimation.

OBJECTIVES: To develop and test a specific formula for estimating weight in the macrosomic fetus. METHODS: Ultrasound estimations of fetal weight were carried out within 1 week of delivery in 424 singleton fetuses with a birth weight of > or = 4000 g. Exclusion criteria were multiple pregnancy, intrauterine death and major structural or chromosomal anomalies. Stepwise regression modeling was used to derive a prediction formula with birth weight as the dependent variable and maternal booking weight and fetal biometric measurements as independent parameters. After a new formula for estimated fetal weight (EFW) had been developed in a formula-finding group (n = 284), it was compared with commonly used weight equations (evaluation group, n = 140). RESULTS: The new formula (log(e)EFW = 7.6377445039 + 0.0002951035 x maternal weight + 0.0003949464 x head circumference + 0.0005241529 x abdominal circumference + 0.0048698624 x femur length) proved to be superior to established equations, with the smallest mean error (mean +/- SD, -10 +/- 202 g), the smallest mean percentage error (mean +/- SD, -0.03 +/- 4.6%) and the lowest mean absolute percentage error (3.69 (range, 0.05-13.57)%) when studied in the evaluation group. With the new formula, 77.9% of estimates fell within +/- 5% of the actual weight at birth, 97.1% within +/- 10%, and 100% within +/- 15% and +/- 20%. CONCLUSIONS: The new formula allows better weight estimation in the macrosomic fetus.

Regional and age-specific patterns of pandemic H1N1 influenza virus seroprevalence inferred from vaccine clinical trials, August-October 2009.

The extent of the H1N1 pandemic has been estimated from case counts and deaths but the proportion of exposed populations with inapparent infections has not been described in detail. We analysed haemagglutination-inhibition (HI) antibody titres of pre-vaccination sera from pandemic vaccine trials conducted in six countries on four continents to provide an indication of A/CA/07/2009(H1N1)-like influenza seroprevalence in those populations. Among 7,962 subjects, ranging in age from 12 months to over 60 years, the proportions with HI antibody titres > or =40 to the H1N1pnd virus in the period from August to October 2009 were, by country: Costa Rica 26.4%, United States (US) 22.5%, Switzerland 16.9%, Germany 12.6%, Belgium 10.1%, and Japan 5.9%. Age-specific seropositivity rates in the samples were higher in children and adolescents in Costa Rica and in the US than in Europe and in Japan. The low proportion of seropositive children in Europe and Japan suggests that little local viral transmission had occurred in those regions even as late as September and October 2009, while in the US and Costa Rica, the greater proportion of previously infected children and young adults suggested that a significant number of asymptomatic infections had occurred during the first pandemic wave. Nevertheless, in all locations, the majority of the population remained susceptible to the pandemic virus at the beginning of the influenza season in the northern hemisphere, justifying the implementation of public health interventions.

[Personal responsibility for health. An interdisciplinary discussion on obesity as an example]. / Verantwortung für die eigene Gesundheit. Eine interdisziplinäre Diskussion am Beispiel der Adipositas.

Considering obesity as an example, the present study has developed an ethical, legal and psychological understanding of personal responsibility, which aims at enabling and activating health promoting behaviour. Enhancing individual capabilities and modifying social and political factors that have an effect on individual behaviour are highlighted as a promising, appropriate and ethically sound strategy of prevention.

A new sonographic weight formula for fetuses

PURPOSE: Birth weight is an important predictive parameter for neonatal morbidity and mortality in the small fetus. Accurate estimation of fetal weight is therefore a valuable tool for determining the further obstetric management. The majority of studies presenting new formulas have included relatively small samples with a narrow range of birth weights, mostly term fetuses. In a previous study, we evaluated several weight formulas over the whole range of birth weights and in defined subgroups. We were able to show that some regression formulas appeared to be favorable within these subgroups. Notably, the highest levels of inaccuracy were found in the group of infants with a birth weight of less than 2500 g. This led us to hypothesize that a formula based on the lower birth weight group might increase the accuracy of weight estimation. The aim of the present study was therefore to develop a new specific formula for estimating weight in fetuses less than or equal to 2500 g and to compare the new regression formula with commonly used weight equations. MATERIALS AND METHODS: This study included 260 pregnancies. The inclusion criteria were a singleton pregnancy; birth weight equal to or less than 2500 g; an ultrasound examination with complete biometric parameters within 7 days prior to delivery; and an absence of structural or chromosomal malformations. The data for the first 130 newborns were used to develop a new formula. The remaining 130 infants were used to evaluate the new regression formula and to compare it to commonly used weight equations. Stepwise regression analysis was carried out with the birth weight as the dependent variable and biometric parameters as independent parameters to obtain the best-fit formula. RESULTS: The mean absolute percentage error for the new formula was 7.71 %. Compared to the other formulas, it generated the highest intraclass correlation coefficient. By the limits of agreement, the new formula demonstrated only a slight tendency towards underestimating fetal weight, and it provided the smallest range of all weight equations. CONCLUSION: With proper application, our new formula can improve the accuracy of fetal weight estimation.

Data-efficient deep learning of radiological image data for outcome prediction after endovascular treatment of patients with acute ischemic stroke.

Treatment selection is becoming increasingly more important in acute ischemic stroke patient care. Clinical variables and radiological image biomarkers (old age, pre-stroke mRS, NIHSS, occlusion location, ASPECTS, among others) have an important role in treatment selection and prognosis. Radiological biomarkers require expert annotation and are subject to inter-observer variability. Recently, Deep Learning has been introduced to reproduce these radiological image biomarkers. Instead of reproducing these biomarkers, in this work, we investigated Deep Learning techniques for building models to directly predict good reperfusion after endovascular treatment (EVT) and good functional outcome using CT angiography images. These models do not require image annotation and are fast to compute. We compare the Deep Learning models to Machine Learning models using traditional radiological image biomarkers. We explored Residual Neural Network (ResNet) architectures, adapted them with Structured Receptive Fields (RFNN) and auto-encoders (AE) for network weight initialization. We further included model visualization techniques to provide insight into the network's decision-making process. We applied the methods on the MR CLEAN Registry dataset with 1301 patients. The Deep Learning models outperformed the models using traditional radiological image biomarkers in three out of four cross-validation folds for functional outcome (average AUC of 0.71) and for all folds for reperfusion (average AUC of 0.65). Model visualization showed that the arteries were relevant features for functional outcome prediction. The best results were obtained for the ResNet models with RFNN. Auto-encoder initialization often improved the results. We concluded that, in our dataset, automated image analysis with Deep Learning methods outperforms radiological image biomarkers for stroke outcome prediction and has the potential to improve treatment selection.

Specific weight formula for fetuses with abdominal wall defects.

OBJECTIVES: To develop and to evaluate a specific sonographic weight formula for fetuses with abdominal wall defects. METHODS: For formula finding, 380 preterm singleton pregnancies without fetal anomalies were included. Ultrasound examinations with complete biometric parameters were performed within 7 days before delivery. Stepwise regression analysis was carried out with birth weight as the dependent variable and sonographic parameters (abdominal measurements not included) as independent variables to obtain the best-fit formula. The new equation was evaluated in a group of 97 fetuses with either gastroschisis or omphalocele. RESULTS: In the evaluation group, the mean (SD) percentage error of the new equation was -0.84 (12.03), showing no systematic bias. The mean absolute percentage error was 9.29. The new specific method provided significantly greater accuracy than commonly used formulae. CONCLUSIONS: This specific weight formula for fetuses with abdominal wall defects is an accurate method of estimating fetal weight.

Cue reactivity in male restrained eaters: the role of negative cognitions as predictors of food intake.

OBJECTIVE: While restrained eating is one of the most well-established risk factors of eating disorders in females, its role for eating disturbances in males remains largely unclear. The present study investigates eating behaviour in response to food cues and negative cognitions in male restrained eaters. METHODS: Twenty-four restrained eaters and 21 unrestrained eaters volunteered in a cue reactivity experiment consisting of two exposure trials with and without response prevention. Food and macronutrient intake were monitored, and negative cognitions were assessed using a self-report cognition inventory. RESULTS: Male restrained eaters consumed a larger amount of food, specifically carbohydrates, than unrestrained eaters. This greater food intake was predicted by negative cognitions about self-esteem and occurred in restrained eaters who had reported binge eating episodes in the diagnostic interview. DISCUSSION: Results suggest marked cue reactivity in male restrained eaters with an increased risk of overeating in those who experience low situational self-esteem and who are binge eaters.

Serotonin transporter gene promoter methylation status correlates with in vivo prefrontal 5-HTT availability and reward function in human obesity.

A polymorphism in the promoter region of the human serotonin transporter (5-HTT)-coding SLC6A4 gene (5-HTTLPR) has been implicated in moderating susceptibility to stress-related psychopathology and to possess regulatory functions on human in vivo 5-HTT availability. However, data on a direct relation between 5-HTTLPR and in vivo 5-HTT availability have been inconsistent. Additional factors such as epigenetic modifications of 5-HTTLPR might contribute to this association. This is of particular interest in the context of obesity, as an association with 5-HTTLPR hypermethylation has previously been reported. Here, we tested the hypothesis that methylation rates of 14 cytosine-phosphate-guanine (CpG) 5-HTTLPR loci, in vivo central 5-HTT availability as measured with [11C]DASB positron emission tomography (PET) and body mass index (BMI) are related in a group of 30 obese (age: 36±10 years, BMI>35 kg/m2) and 14 normal-weight controls (age 36±7 years, BMI<25 kg/m2). No significant association between 5-HTTLPR methylation and BMI overall was found. However, site-specific elevations in 5-HTTLPR methylation rates were significantly associated with lower 5-HTT availability in regions of the prefrontal cortex (PFC) specifically within the obese group when analyzed in isolation. This association was independent of functional 5-HTTLPR allelic variation. In addition, negative correlative data showed that CpG10-associated 5-HTT availability determines levels of reward sensitivity in obesity. Together, our findings suggest that epigenetic mechanisms rather than 5-HTTLPR alone influence in vivo 5-HTT availability, predominantly in regions having a critical role in reward processing, and this might have an impact on the progression of the obese phenotype.

Caffeine intake is related to successful weight loss maintenance.

The effect of caffeine intake on weight loss maintenance has not been examined in humans. We compared the daily consumption of coffee and caffeinated beverages between 494 weight loss maintainers and 2129 individuals from the general population controlling for sociodemographic variables, body mass index and physical activity level. Weight loss maintainers reported to consume significantly more cups of coffee and caffeinated beverages compared with the participants in the general population sample. Thus, consumption of caffeinated beverages might support weight loss maintenance. Further studies should investigate possible mechanisms.

Bacterially expressed human Fc gamma RIIb is soluble and functionally active after in vitro refolding.

A recombinant soluble form of the human Fc gamma receptor was produced by engineering a cDNA construct containing the extracellular part of the mature protein. After expression in bacteria as inclusion body, the polypeptide was highly purified and was refolded in vitro with a method that was developed for the renaturation of immunoglobulin fragments. With this method oxidation of the disulfide bridges within the domains of the protein is done in the presence of an artificial 'chaperone' which protects the polypeptide molecules from unwanted protein protein interactions thereby inhibiting the incorrect oxidation of the SH-groups. and misfolding of the protein. The refolded recombinant soluble Fc gamma RIIb showed several characteristics of the native receptor: (i) it was recognized by a series of monoclonal antibodies specific for, and in most cases produced against the native cell-surface receptor: (ii) it is bound to its ligand (the Fc-region of different immunoglobulins) under very diverse conditions: and (iii) it is competed strongly and specifically with the native cell surface receptor for both ligand and antibody binding in experiments with distinct read-outs; (iv) monoclonal antibodies produced against the recombinant protein specifically recognized Fc gamma RIIb on different cells. From these data it was concluded that the recombinant soluble Fc-receptor was in a native, functionally active form, and its function was not affected by the lack of glycosylation.

Psychological responses to body shape exposure in patients with bulimia nervosa.

One of the unresolved issues regarding research on bulimia nervosa concerns the question as to how patients diagnosed with bulimia nervosa respond to body image exposure. In addition, it remains unclear whether there are differential responses associated with different exposure techniques (e.g. in vivo exposure vs. exposure by visualization). The aim of the present study was to investigate psychological responses to body image exposure. Twenty participants diagnosed with bulimia nervosa (DSM IV) and twenty non-eating disordered individuals were exposed to their body image using a video recording (video confrontation). In addition, they were asked to imagine and describe the appearance of their body (imagery task). Results indicate that self-reported negative emotions increased in response to both, video confrontation and imagery task, in the clinical as well as in the control group. Furthermore, video confrontation led to more pronounced group differences than exposure by visualization (imagery task). Participants diagnosed with bulimia nervosa took less time to describe their waist, hips and bottom compared to non-eating disturbed controls. This last result could be interpreted in terms of avoidance behavior and other mechanisms during body image exposure.