Losing weight, gaining confidence? actual weight does not predict body (dis)satisfaction and self-esteem in adolescents with anorexia nervosa.

Background: In line with modern-day beauty ideals, many adolescent girls strive to have a slender figure. Thus, low body weight is expected to be related to greater body satisfaction and self-esteem in adolescent girls. However, for adolescents with anorexia nervosa (AN) this is often not the case: despite being underweight, they exhibit high levels of body dissatisfaction and low self-esteem. Negative cognitive biases for information related to one's body might explain this disconnection between body weight and body (dis)satisfaction/self-esteem in adolescents with AN. The present study explores the association between actual weight, negative cognitive biases, and body dissatisfaction/self-esteem in both adolescents with AN and adolescents without mental disorder (healthy controls; HCs).

Methods: Weight was assessed as Body Mass Index Standard Deviation Score, interpretation bias for body-related information was assessed with an experimental paradigm (Scrambled Sentences Task), body dissatisfaction was measured using the Body Shape Questionnaire, and self-esteem was measured using the Rosenberg Self-Esteem Scale in n = 40 12-18-year-old adolescent girls with AN and n = 40 HCs. Hierarchical regression analyses were calculated to investigate whether weight and/or interpretation biases predicted body dissatisfaction and self-esteem.

Results: In adolescents with AN, negative body-related interpretation bias was a significant positive predictor of body dissatisfaction and negative predictor of self-esteem while body weight did not predict any of the outcome measures. In HCs, both weight and negative interpretation bias were significant positive predictors of body dissatisfaction and significant negative predictors of self-esteem.

Conclusion: The results show a disconnection between body weight and body (dis)satisfaction/self-esteem in adolescents with AN and highlight the association between negative cognitive biases for body-related information and body (dis)satisfaction/self-esteem. The negatively biased processing of information related to one's body could confirm the perception of the body as flawed and not thin enough and hinder adolescents with AN to perceive their bodies' thinness, even in the state of severe underweight. The results underline the need to target negatively biased cognitions about the body in AN treatment.