Addressing Body Dissatisfaction in Women in Larger Bodies Using Exposure-based Interventions: A Case Report

Exposure therapy has been examined as a treatment for eating disorders, but research has yet to determine how to adapt these approaches for those in larger bodies who experience weight stigma. This case study reports on the use of values-based exposure interventions to reduce body dissatisfaction and body-related concerns in a woman with binge eating disorder in a larger body. We used a values-based approach to mirror and body image exposure that focused on fear tolerance and valued actions, as opposed to belief disconfirmation or habituation-based approaches to exposure, which may invalidate weight stigmatizing experiences. The client was a white cisgender woman in her late 20’s with binge eating disorder and major depressive disorder enrolled in trial of Transdiagnostic Network-Informed Personalized Treatment for eating disorders. Symptoms were assessed at pre-, mid-, post-treatment and one-month follow-up. The client was highly satisfied with treatment and experienced clinically significant reductions in eating disorder symptoms and shape and weight concerns. Decreases in body dissatisfaction, feeling fat, and overvaluation of weight and shape were large. Clinical impairment decreased, and quality of life increased. A detailed description of the approach to body image exposure for those in larger bodies is provided. Using a values-based approach to body image exposures may help account for weight stigma experienced by those in larger bodies while decreasing avoidance of personally meaningful experiences, body dissatisfaction, and eating disorder symptoms.