Implicit mechanisms of body image alterations: The covert attention exposure effect


Visual exposure to extreme-sized bodies elicits explicit self-body image variations. Several features of such modulation remain to be clarified. In this study we explored whether this effect: (i) acts on implicit mechanisms in modifying one’s body-size perception, (ii) is body-exposure-specific also at the implicit level, and (iii) is modulated by interoceptive sensibility. We assigned a covert attention task to 100 women, exposing them to extreme-sized bodies (thin and fat) or extreme-sized objects (thin and fat bottles). Before and after the attentional exposure, we tested the association between the “self/others” and “thin/fat” concepts using an Implicit Association Test. We also collected a measure of interoceptive sensibility by means of a self-report questionnaire. Results showed that participants exposed to fat bodies implicitly presented a stronger association between the “self” and “thin” concepts. This association was significantly weaker in the group exposed to thin bodies. This effect was absent after exposure to thin and fat bottles. Notably, participants with a higher tolerance of negative bodily interoceptive signals were less susceptible to the malleability of body image exerted by the exposure attentional task. Our findings shed new light on the relationship between the perception of internal (e.g., visceral) and external (e.g., visual) signals in the representation of our body.

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  1. Bessenoff, G. R. (2006). Can the media affect us? Social comparison, self-discrepancy, and the thin ideal. Psychology of Women Quarterly. doi:

  2. Brooks, K. R., Mond, J. M., Stevenson, R. J., & Stephen, I. D. (2016). Body image distortion and exposure to extreme body types: Contingent adaptation and cross adaptation for self and other. Frontiers in Neuroscience. doi:

  3. Calì, G., Ambrosini, E., Picconi, L., Mehling, W. E., & Committeri, G. (2015). Investigating the relationship between interoceptive accuracy, interoceptive awareness, and emotional susceptibility. Frontiers in Psychology, 6(August), 1–13. doi:

    Article  Google Scholar 

  4. Cash, T. F., Cash, D. W., & Butters, J. W. (1983). Mirror, Mirror, on the Wall...?. Personality and Social Psychology Bulletin. doi:

  5. Cash, T. F., & Deagle, E. A. (1997). The nature and extent of body-image disturbances in anorexia nervosa and bulimia nervosa: A meta-analysis. International Journal of Eating Disorders, 22(2), 107–125. doi:<107::AID-EAT1>3.0.CO;2-J

    Article  PubMed  Google Scholar 

  6. Cash, T. F., & Smolak, L. (2011). Body image. a handbook of science, practice and prevention. In Journal of Gerontological Nursing. doi:

  7. Challinor, K. L., Mond, J., Stephen, I. D., Mitchison, D., Stevenson, R. J., Hay, P., & Brooks, K. R. (2017). Body size and shape misperception and visual adaptation: An overview of an emerging research paradigm. Journal of International Medical Research. doi:

  8. Champion, H., & Furnham, A. (1999). The effect of the media on body satisfaction in adolescent girls. European Eating Disorders Review, 7(3), 213–228. doi:<213::AID-ERV229>3.0.CO;2-W

    Article  Google Scholar 

  9. Corning, A. F., Krumm, A. J., & Smitham, L. A. (2006). Differential social comparison processes in women with and without eating disorder symptoms. Journal of Counseling Psychology. doi:

  10. Cserjési, R., Vermeulen, N., Luminet, O., Marechal, C., Nef, F., Simon, Y., & Lénárd, L. (2010). Explicit vs. implicit body image evaluation in restrictive anorexia nervosa. Psychiatry Research. doi:

  11. Domschke, K., Stevens, S., Pfleiderer, B., & Gerlach, A. L. (2010). Interoceptive sensitivity in anxiety and anxiety disorders: An overview and integration of neurobiological findings. Clinical Psychology Review. doi:

  12. Doricchi, F., Macci, E., Silvetti, M., & Macaluso, E. (2010). Neural correlates of the spatial and expectancy components of endogenous and stimulus-driven orienting of attention in the posner task. Cerebral Cortex. doi:

  13. Emanuelsen, L., Drew, R., & Köteles, F. (2015). Interoceptive sensitivity, body image dissatisfaction, and body awareness in healthy individuals. Scandinavian Journal of Psychology. doi:

  14. Festinger, L. (1954). A theory of social comparison processes. Human Relations. doi:

  15. Garfinkel, S. N., Seth, A. K., Barrett, A. B., Suzuki, K., & Critchley, H. D. (2015). Knowing your own heart : Distinguishing interoceptive accuracy from interoceptive awareness. Biological Psychology, 104, 65–74. doi:

    Article  PubMed  Google Scholar 

  16. Garfinkel, S. N., Tiley, C., O’Keeffe, S., Harrison, N. A., Seth, A. K., & Critchley, H. D. (2016). Discrepancies between dimensions of interoception in autism: Implications for emotion and anxiety. Biological Psychology. doi:

  17. Garner, D. M., & Garfinkel, P. E. (2005). Body image in anorexia nervosa: measurement, theory and clinical implications. The International Journal of Psychiatry in Medicine. doi:

  18. Glauert, R., Rhodes, G., Byrne, S., Fink, B., & Grammer, K. (2009). Body dissatisfaction and the effects of perceptual exposure on body norms and ideals. International Journal of Eating Disorders. doi:

  19. Greenwald, A. G., & Farnham, S. D. (2000). Using the implicit association test to measure self-esteem and self-concept. Journal of Personality and Social Psychology. doi:

  20. Greenwald, A. G., Mcghee, D. E., Jordan, L. K., & Schwartz, J. L. K. (1998). Measuring Individual Differences in Implicit Cognition. Journal of Personality and Social Psychology. doi:

  21. Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. K. (1998). Measuring individual differences in implicit cognition: The implicit association test. Journal of Personality and Social Psychology. doi:

  22. Greenwald, A. G., Nosek, B. A., & Banaji, M. R. (2003). Understanding and using the Implicit Association Test: I. An improved scoring algorithm. Journal of Personality and Social Psychology, 85(2), 197–216. doi:

    Article  PubMed  Google Scholar 

  23. Griffen, T. C., Naumann, E., & Hildebrandt, T. (2018). Mirror exposure therapy for body image disturbances and eating disorders: A review. Clinical Psychology Review. doi:

  24. Hamilton, K., & Waller, G. (1993). Media influences on body size estimation in anorexia and bulimia. An experimental study. British Journal of Psychiatry.

  25. Hummel, D., Grabhorn, R., & Mohr, H. M. (2012). Body-shape adaptation cannot be explained by adaptation to narrow and wide rectangles. Perception. doi:

  26. Hummel, D., Rudolf, A. K., Untch, K. H., Grabhorn, R., & Mohr, H. M. (2012). Visual adaptation to thin and fat bodies transfers across identity. PLoS ONE. doi:

  27. JASP Team (2018). JASP (Version 0.8.6)[Computer software]

  28. Katkin, E. S., Morell, M. A., Goldband, S., Bernstein, G. L., & Wise, J. A. (1982). Individual Differences in Heartbeat Discrimination. Psychophysiology. doi:

  29. Mehling, W. E., Gopisetty, V., Daubenmier, J., Price, C. J., Frederick, M., & Stewart, A. (2009). Body Awareness : Construct and Self-Report Measures. 4(5). doi:

  30. Mehling, W. E., Price, C., Daubenmier, J. J., Acree, M., Bartmess, E., & Stewart, A. (2012). The Multidimensional Assessment of Interoceptive Awareness (MAIA). PLoS ONE. doi:

  31. Mohr, H. M., Rickmeyer, C., Hummel, D., Ernst, M., & Grabhorn, R. (2016). Altered visual adaptation to body shape in eating disorders: Implications for body image distortion. Perception. doi:

  32. Moreno-Domínguez, S., Servián-Franco, F., Reyes del Paso, G. A., & Cepeda-Benito, A. (2018). Images of thin and plus-size models produce opposite effects on women's body image, body dissatisfaction, and anxiety. Sex Roles. doi:

  33. Muth, J. L., & Cash, T. F. (1997). Body-image attitudes: What difference does gender make? Journal of Applied Social Psychology, 27(16), 1438–1452. doi:

    Article  Google Scholar 

  34. Myers, P. N., & Biocca, F. A. (1992). The elastic body image: the effect of television advertising and programming on body image distortions in young women. Journal of Communication. doi:

  35. Paulus, M. P., & Stein, M. B. (2010). Interoception in anxiety and depression. Brain Structure & Function. doi:

  36. Porges, S. (1993). Body perception questionnaire. Laboratory of Developmental Assessment, University of Maryland.

  37. Posavac, H. D., Posavac, S. S., & Posavac, E. J. (1998). Exposure to media images of female attractiveness and concern with body weight among young women1. Sex Roles. doi:

  38. Posavac, H. D., Posavac, S. S., & Weigel, R. G. (2003). Reducing the impact of media images on women at risk for body image disturbance: three targeted interventions. Journal of Social and Clinical Psychology. doi:

  39. Posner, M. I. (1980). Orienting of attention. Quarterly journal of experimental psychology, 32(1), 3–25

  40. Preston, C., & Ehrsson, H. H. (2016). Illusory obesity triggers body dissatisfaction responses in the insula and anterior cingulate cortex. Cerebral Cortex, 26(12), 4450–4460. doi:

    Article  PubMed  Google Scholar 

  41. Rouder, J. N., Morey, R. D., Speckman, P. L., & Province, J. M. (2012). Default Bayes factors for ANOVA designs. Journal of Mathematical Psychology, 56(5), 356–374. doi:

    Article  Google Scholar 

  42. Salvato, G., De Maio, G., & Bottini, G. (2017). Exploring biased attention towards body-related stimuli and its relationship with body awareness. Scientific Reports, 7(1). doi:

  43. Salvato, Gerardo, De Maio, G., & Bottini, G. (2019). Interoceptive sensibility tunes risk-taking behaviour when body-related stimuli come into play. Scientific Reports, 9(1), 2396. doi:

    Article  PubMed  PubMed Central  Google Scholar 

  44. Salvato, Gerardo, Patai, E. Z., McCloud, T., & Nobre, A. C. (2016). Apolipoprotein ɛ4 breaks the association between declarative long-term memory and memory-based orienting of spatial attention in middle-aged individuals. Cortex, 82, 206–216. doi:

    Article  PubMed  PubMed Central  Google Scholar 

  45. Salvato, Gerardo, Patai, E. Z., & Nobre, A. C. (2016). Preserved memory-based orienting of attention with impaired explicit memory in healthy ageing. Cortex, 74, 67–78. doi:

    Article  PubMed  PubMed Central  Google Scholar 

  46. Schandry, R. (1981). Heart Beat Perception and Emotional Experience. Psychophysiology. doi:

  47. Skrzypek, S., Wehmeier, P. M., & Remschmidt, H. (2001). Body image assessment using body size estimation in recent studies on anorexia nervosa. A brief review. European Child and Adolescent Psychiatry. doi:

  48. Slade, P. D. (1988). Body image in anorexia nervosa. British Journal of Psychiatry.

  49. Spielberger, C. D., Gorsuch, R. L., Lushene, P. R., Vagg, P. R., & Jacobs, A. G. (1983). Manual for the State-Trait Anxiety Inventory (Form Y). Manual for the statetrait anxiety inventory STAI. doi:

  50. Stephen, I. D., Hunter, K., Sturman, D., Mond, J., Stevenson, R. J., & Brooks, K. R. (2019). Experimental manipulation of visual attention affects body size adaptation but not body dissatisfaction. International Journal of Eating Disorders. doi:

  51. Stephen, I. D., Sturman, D., Stevenson, R. J., Mond, J., & Brooks, K. R. (2018). Visual attention mediates the relationship between body satisfaction and susceptibility to the body size adaptation effect. PLoS ONE. doi:

  52. Stice, E. (2002). Risk and maintenance factors for eating pathology: A meta-analytic review. Psychological Bulletin. doi:

  53. Teige-Mocigemba, S., Klauer, K. C., & Sherman, J. W. (2010). A practical guide to Implicit Association Tests and related tasks. In Handbook of Research Methods in Social and Personality Psychology. doi:

  54. Thompson, J. K., Heinberg, L. J., & Tantleff-Dunn, S. (1991). The physical appearance comparison scale. The Behavior Therapist.

  55. Tsakiris, M., Jimenez, A. T., & Costantini, M. (2011). Just a heartbeat away from one's body: interoceptive sensitivity predicts malleability of body-representations. Proceedings of the Royal Society B: Biological Sciences, 278(1717), 2470–2476. doi:

    Article  PubMed  Google Scholar 

  56. Want, S. C. (2009). Meta-analytic moderators of experimental exposure to media portrayals of women on female appearance satisfaction: Social comparisons as automatic processes. Body Image. doi:

  57. Winkler, C., & Rhodes, G. (2005). Perceptual adaptation affects attractiveness of female bodies. British Journal of Psychology. doi:

  58. Zamariola, G., Cardini, F., Mian, E., Serino, A., & Tsakiris, M. (2017). Can you feel the body that you see? On the relationship between interoceptive accuracy and body image. Body Image. doi:

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The data and materials for all experiments are available upon reasonable request. The study was not preregistered.

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Salvato, G., Romano, D., De Maio, G. et al. Implicit mechanisms of body image alterations: The covert attention exposure effect. Atten Percept Psychophys 82, 1808–1817 (2020).

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  • Attention
  • Visual perception
  • Embodied perception