Validity of Virtual Reality Body Exposure to Elicit Fear of Gaining Weight, Body Anxiety and Body-Related Attentional Bias in Patients with Anorexia Nervosa
Open accessAbstract
Fear of gaining weight (FGW), body image disturbances, associated anxiety and body-related attentional bias are the core symptoms of anorexia nervosa (AN) and play critical roles in its development and maintenance. The aim of the current study is to evaluate the usefulness of virtual reality-based body exposure software for the assessment of important body-related cognitive and emotional responses in AN. Thirty female patients with AN, one of them subclinical, and 43 healthy college women, 25 with low body dissatisfaction (BD) and 18 with high BD, owned a virtual body that had their silhouette and body mass index. Full-body illusion (FBI) over the virtual body was induced using both visuo-motor and visuo-tactile stimulation. Once the FBI was induced, the FBI itself, FGW, body anxiety and body-related attentional bias toward weight-related and non-weight-related body areas were assessed. One-way analyses of covariance (ANCOVA), controlling for age, showed that AN patients reported higher FGW, body anxiety and body-related attentional bias than healthy controls. Unexpectedly, patients with AN reported significantly lower FBI levels than healthy participants. Finally, Pearson correlations showed significant relationships between visual analog scales and body-related attentional bias measures, compared to other eating disorder measures. These results provide evidence about the usefulness of virtual reality-based body exposure to elicit FGW and other body-related disturbances in AN patients. Thus, it may be a suitable intervention for reducing these emotional responses and for easing weight recovery.
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The imagination and anxiety levels reported by AN patients in the current study are similar to the results of previous research that even used more personalized avatars, adapted to the participants' real bodies.
“Further, the imagination and anxiety levels reported by anorexia nervosa patients in the current study are similar to the results of previous research that even used more personalized avatars, adapted to the participants’ real bodies [60, 61].”
From Anxiety matters: a pilot lab study into food, weight, and virtual body exposure in anorexia nervosa (2024) · cites this paper as [60]
The Procedure (section 2.4; page unavailable) says the avatars’ silhouettes were adjusted to match photographs of participants’ bodies, and the Results (section 3.2; page unavailable) report body-anxiety and full-body-illusion levels in patients with anorexia nervosa. The paper does not report an imagination measure or compare its levels with those of the citing study, so the claimed similarity in imagination and anxiety levels cannot be established from this source alone. (LLM, conf=0.78)
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Self-citationFear of gaining weight: its validity as a visual analogue scale in anorexia nervosa
Rushford, N. (2006) · European Eating Disorders Review · doi:10.1002/erv.682 · Cited by 13 · cited 1× · see citing works
“FBI and FGW were assessed using a VAS; even though VASs are usually considered as a valid measure to assess this sort of construct (for instance, FGW among patients with AN [63]), they should be complemented with evidence-based questionnaires.”
Method
Flagged first, then by citations
1 of the 69 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Virtual reality in the diagnostic and therapy for mental disorders: A systematic review
Wiebe, A., Kannen, K., Selaskowski, B., Mehren, A., Thöne, A.-K., Pramme, L., Blumenthal, N., Li, M., Asché, L., Jonas, S., et al. (2022) · Clinical Psychology Review · doi:10.1016/j.cpr.2022.102213 · Cited by 223 · see citing works
Porras-Garcia, B., Ferrer-Garcia, M., Serrano-Troncoso, E., Carulla-Roig, M., Soto-Usera, P., Miquel-Nabau, H., Fernández-Del castillo Olivares, L., Marnet-Fiol, R., de la Montaña Santos-Carrasco, I., Borszewski, B., et al. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10040682 · Cited by 81 · see citing works
“For further details on this procedure, see [69].”
BackgroundResultSelf-citationBrizzi, G., Sansoni, M., Lernia, D. D., Frisone, F., Tuena, C., & Riva, G. (2023) · Journal of Eating Disorders · doi:10.1186/s40337-023-00930-9 · Cited by 51 · see citing works
Di Natale, A. F., Pizzoli, S. F. M., Brizzi, G., Di Lernia, D., Frisone, F., Gaggioli, A., Rabarbari, E., Oasi, O., Repetto, C., Rossi, C., et al. (2024) · Current Psychiatry Reports · doi:10.1007/s11920-024-01523-2 · Cited by 37 · see citing works
“…virtual avatar match - ing one’s BMI proved to be a useful intervention tool, as it resulted in a reduction of fear of weight gain, body anxiety, and attentional bias towards weight-related body parts in patients with AN compared to healthy controls, according to Porras-Garcia and colleagues [36 ].”
ResultUse of Virtual Reality in Psychiatric Diagnostic Assessments: A Systematic Review
Geraets, C. N. W., Wallinius, M., & Sygel, K. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.828410 · Cited by 31 · see citing works
“In two studies, self-resembling avatars were made for body image assessment (23, 24).”
BackgroundMethodInfluentialPortingale, J., Krug, I., Liu, H., Kiropoulos, L. A., & Butler, D. L. (2024) · Clinical Psychology Science and Practice · doi:10.1037/cps0000223 · Cited by 23 · see citing works
(2021) · MDPI eBooks · doi:10.3390/books978-3-0365-0517-6 · Cited by 22 · see citing works
Meschberger‐Annweiler, F., Ascione, M., Porras-García, B., Ferrer‐García, M., Moreno-Sanchez, M., Miquel-Nabau, H., Serrano‐Troncoso, E., Carulla‐Roig, M., & Gutiérrez‐Maldonado, J. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12062185 · Cited by 17 · see citing works
“, [32]), to assess body image distortion and body dissatisfaction [33], to elicit and reduce fear of gaining weight and body anxiety in patients with AN through VR-based body exposure [34], and to modify and improve BIDs in healthy individuals (e.”
BackgroundMethodSelf-citationAgüera, Z., & Jiménez‐Múrcia, S. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9124047 · Cited by 17 · see citing works
“[24] provide evidence about the usefulness of virtual reality-based body exposure to elicit fear of gaining weight and other body-related disturbances in patients with AN.”
BackgroundVarious Types of Virtual Reality-Based Therapy for Eating Disorders: A Systematic Review
Ciążyńska, J., Maciaszek, J., & Maciaszek, J. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11174956 · Cited by 19 · see citing works
“(2020) [23] 2 AN BD BMI EDI-3 EDI-BD PASTAS BIAS-BD BAS VAS VR-exposure HTC-VIVE HMD Computer with Nvidia RTX 2080 (graphic card) HMD FOVE (Eye-Tracking) Hand controllers Body trackers FOVE setup 0.”
BackgroundInfluentialSchroeder, P. A., Gehrer, N. A., Reents, M., Reimer, N., Vagedes, J., & Svaldi, J. (2023) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2022.0385 · Cited by 13 · see citing works
“Several methodological differences might explain this pattern: Compared with previous research, 24,27 exposure duration was brief, was paired with a free-viewing instruction, was preceded by visuomotor and visuo-tactile embodiment inductions, and rudimentary self-avatar animations were included.”
InfluentialInhibitory Learning during Exposure Treatment in Anorexia Nervosa: A Practical Guide
Melles, H., Duijvis, S., & Jansen, A. (2023) · Behavioral Sciences · doi:10.3390/bs13050370 · Cited by 11 · see citing works
“Since VR is found to elicit similar emotional reactions to the same situations in real life [92,93], virtual eating offers the opportunity to challenge food-related threat expectancies (e.”
BackgroundRiva, G., Natale, A. F. D., Frisone, F., & Rossi, C. (2023) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2023.29299.ceu · Cited by 9 · see citing works
Body Dissatisfaction and Body-Related Attentional Bias: Is There a Causal Relationship?
Mendoza‐Medialdea, M. T., Meschberger‐Annweiler, F., Ascione, M., Rueda-Pina, A., Rabarbari, E., Porras-García, B., Ferrer‐García, M., & Gutiérrez‐Maldonado, J. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12175659 · Cited by 9 · see citing works
“Another difference is that previous studies have often examined the body as a whole without specifically investigating the potential differential effects of individual body parts on gaze patterns, particularly in relation to their weight-related or non-weight-related characteristics [35,36].”
BackgroundSelf-citationGender differences in bodily experience: Insights from virtual reality body illusion
Brizzi, G., Frisone, F., Rossi, C., & Riva, G. (2024) · Acta Psychologica · doi:10.1016/j.actpsy.2024.104386 · Cited by 8 · see citing works
Addressing Body Image Disturbance through Metaverse-Related Technologies: A Systematic Review
Perez, M., Pineda-Rafols, A., Egea-Romero, M. P., Moreno, M. G., & Rincón, E. (2023) · Electronics · doi:10.3390/electronics12224580 · Cited by 7 · see citing works
“Consequently, 81 papers were deemed eligible for a full text review; 71 of them [ 47– 115] being excluded”
Effect of virtual reality self-counseling with the intimate other avatar
Yamashita, Y., & Yamamoto, T. (2024) · Scientific Reports · doi:10.1038/s41598-024-65661-6 · Cited by 7 · see citing works
“For example, one study has reported that patients with anorexia nervosa experienced greater anxiety about their body and have lower levels of full-body illusion than healthy controls, when they owned a virtual body that had their silhouette and body mass index 33 .”
BackgroundArrom-Llabrés, M., Mendoza-Medialdea, M. T., & Gutiérrez-Maldonado, J. (2025) · Applied Sciences · doi:10.3390/app15063334 · Cited by 5 · see citing works
“One category involves VR-based body exposure therapy aimed at reducing body dissatisfaction and related emotional responses, which has shown effectiveness in improving body image disturbances [17,18].”
Self-citationVirtual reality-based exposure therapy for Eating Disorders - a systematic review (Preprint)
Ciążyńska, J., Malik, J., & Maciaszek, J. (2022) · doi:10.2196/preprints.36408 · Cited by 5 · see citing works
An, Z., Krug, I., Portingale, J., & Butler, D. L. (2022) · Journal of Eating Disorders · doi:10.1186/s40337-022-00608-8 · Cited by 5 · see citing works
“In summary, whilst still in its infancy, research investigating embodiment illusions in ED participants indicates that stronger embodiment illusions are experienced by ED participants than HCs.”
BackgroundInfluentialAnxiety matters: a pilot lab study into food, weight, and virtual body exposure in anorexia nervosa
Melles, H., & Jansen, A. (2024) · Journal of Eating Disorders · doi:10.1186/s40337-024-01094-w · Cited by 5 · see citing works
“Further, the imagination and anxiety levels reported by anorexia nervosa patients in the current study are similar to the results of previous research that even used more personalized avatars, adapted to the participants’ real bodies [60, 61].”
ResultAscione, M., Serrano‐Troncoso, E., Carulla‐Roig, M., Martínez, A. B., Álvarez, F. G., Meschberger‐Annweiler, F., Porras-García, B., Ferrer‐García, M., & Gutiérrez‐Maldonado, J. (2024) · Applied Sciences · doi:10.3390/app14114340 · Cited by 3 · see citing works
“Following these initial steps, the environment, and the ET device integrated into the then induced through visuo-motor and visuo-tactile minutes (for further details, see [46]).”
MethodSelf-citationAscione, M., Carulla‐Roig, M., Meschberger‐Annweiler, F., Serrano‐Troncoso, E., Martínez, A. B., Guerrero‐Álvarez, F., Miquel-Nabau, H., Mendoza‐Medialdea, M. T., Porras-García, B., Ferrer‐García, M., et al. (2026) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70273 · Cited by 1 · see citing works
“Additional details are reported in (Porras-Garcia et al. 2020).”
Self-citationSchroeder, P. A., Gehrer, N. A., Reents, M., Reimer, N., Vagedes, J., & Svaldi, J. (2022) · doi:10.31234/osf.io/uk4v7 · Cited by 1 · see citing works
Maalin, N. (2020) · Lincoln Repository (University of Lincoln) · doi:10.24385/lincoln.24326464
Brizzi, G., Sansoni, M., Frisone, F., Lernia, D. D., Tuena, C., & Riva, G. (2023) · doi:10.31234/osf.io/hs8wv
Melles, H. (2024) · doi:10.26481/dis.20240704hm
Meschberger‐Annweiler, F., Ascione, M., Porras-García, B., Mendoza‐Medialdea, M. T., Prieto-Perpiña, J., Escolano, A. F., Rodríguez, J. R., Ferrer‐García, M., & Gutiérrez‐Maldonado, J. (2024) · Virtual Reality · doi:10.1007/s10055-024-01051-7
Self-citationAlharbi, W. A., Keeler, J. L., Benbow, Y., Vega, M. O., Ting, N., Himmerich, H., & Treasure, J. L. (2026) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-026-10046-5
Meschberger‐Annweiler, F., Carulla‐Roig, M., Ascione, M., Porras-García, B., Serrano‐Troncoso, E., Ferrer‐García, M., & Gutiérrez‐Maldonado, J. (2026) · Cyberpsychology Behavior and Social Networking · doi:10.1177/21522715261451681
Self-citationNatale, A. F. D., Frisone, F., Brizzi, G., & Rossi, C. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-36741-0.00011-5
Meschberger‐Annweiler, F., Ascione, M., Mendoza‐Medialdea, M. T., Serrano‐Troncoso, E., Carulla‐Roig, M., Ferrer‐García, M., & Gutiérrez‐Maldonado, J. (2026) · Cyberpsychology Behavior and Social Networking · doi:10.1177/21522715261463323
“…assessment and avatar creation: Body image was evaluated using questionnaires on body anxiety (PASTAS) and body dissatisfaction (EDI-BD), Virtual avatars were created based on established methods from prior studies, 17,32,43,44 through photographic procedure detailed in the Supplementary Data.”
InfluentialSelf-citationBrizzi, G., Signorelli, A., & Riva, G. (2026) · Lecture notes of the Institute for Computer Sciences, Social Informatics and Telecommunications Engineering · doi:10.1007/978-3-032-26235-6_1
Attentional bias toward one’s own body: A systematic review of eye-tracking studie
Chen, Q., & Gutiérrez‐Maldonado, J. (2026) · Body Image · doi:10.1016/j.bodyim.2026.102167
Self-citationBrizzi, G., Boltri, M., Borsci, S., Chan, R. W., Yildirim, F., Truijen, S., Riva, G., & Scataglini, S. (2026) · Computers in Human Behavior Reports · doi:10.1016/j.chbr.2026.101360
- Authors
- Porras-Garcia, B., Ferrer-Garcia, M., Serrano-Troncoso, E., Carulla-Roig, M., Soto-Usera, P., Miquel-Nabau, H., Shojaeian, N., de la Montaña Santos-Carrasco, I., Borszewski, B., Díaz-Marsá, M., Sánchez-Díaz, I., Fernández-Aranda, F., & Gutiérrez-Maldonado, J.
- Affiliations
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Passeig de la Vall d’Hebron 171, 08035 Barcelona, Spain
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Sant Joan de Déu of Barcelona; Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Spain
- Hospital Sant Joan de Déu Barcelona (ES)
- Universitat de Barcelona (ES)
- Department of Psychiatry and Mental Health, Hospital Clínico San Carlos, Madrid, Calle del Prof Martín Lagos, s/n, 28040 Madrid, Spain
- Hospital Clínico San Carlos (ES)
- Department of Psychiatry and Mental Health, Hospital Universitario de Bellvitge- IDIBELL and CIBEROBN, Barcelona; Carrer Feixa Llarga s/n, 08907 Hospitalet del Llobregat, Spain
- ORCID
- Venue
- Journal of Clinical Medicine
- Publisher
- MDPI AG
- Published
- 2020-10-05
- Volume
- 9
- Issue
- 10
- Pages
- 3210
- ISSN
- 2077-0383 (ISSN-L)
- PMC
- PMC7600187
- OpenAlex
- W3089894712
- Cited by
- 35
- References
- 69
- Citations by year
- 2026: 8 · 2025: 1 · 2024: 8 · 2023: 8 · 2022: 6 · 2021: 2 · 2020: 2
- FWCI
- 1.80
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Clinical Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Spanish Ministry of Science and Innovation (PID2019-108657RB-I00)
- AGAUR, Generalitat de Catalunya (2017SGR1693)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
- Social Sciences › Psychology › Clinical Psychology › Body Image and Dysmorphia Studies
- Keywords
- anorexia nervosa, fear of gaining weight, body image anxiety, full-body illusion, body dissatisfaction, visuo-tactile stimulation, body image disturbance, weight recovery
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