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Virtual Reality and Body Image Distortions: are we facing a new treatment?

by Maria Anna Perotta

Immersive Virtual Reality (VR) creates interactive computer-generated worlds. These worlds can replace real-world sensory perceptions with digitally generated ones, producing the sensation of being in life-sized new environments. In fact, VR allows such tight control over the stimuli presented, that therapeutic strategies can be effectively implemented with precision using VR (Freeman et al., 2017). A good example is that VR has been used in Eating Disorder (ED) studies, exploring two main aspects of ED syndromes: Body Image (BI) distortions and uncontrolled eating. To help with BI distortions, VR is usually used to present three-dimensional figures of the patient’s body, so as to help the patient to reach an awareness of BI distortion and then providing the possibility to face and modify distortions. Here VR is being used to support a more realistic view of the body and a potential decrease in BI dissatisfaction. Furthermore, to decrease uncontrolled eating, VR can provide scenarios that simulate real-life situations and to encounter food cues known to trigger the patient’s disordered eating behavior (De Carvalho et al., 2017).

To use VR technology in the assessment and, especially, the treatment of body image disturbances in ED, there are two main research groups: one is the group of Riva in Italy and the other is the group of Perpiñá in Spain (Perpiñá et al., 2000). They were two of the early research group to adopt these types of treatment. Both groups use VR to improve cognitive-behavioral therapy, although each highlight different benefits of using this technology or justifies its use in different ways (Ferrer-García & Gutiérrez-Maldonado, 2012).

Type of Virtual Reality treatment for Anorexia Nervosa

Riva and their team developed an innovative software for the assessment of body image disturbances, called Body Image Virtual Reality Scale (BIVRS). The BIVRS is a non-immersive, 3D graphical interface through which the participant can choose between nine figures male and female, ranging from underweight to overweight. Participants must choose those figures that best fit their self-perceived and their desired body size. The index of the body image dissatisfaction is given by the discrepancy between the two measures (Riva, 1998).

Keizer and colleagues developed another research design to help with the treatment of body image disturbances in patients with Anorexia Nervosa; in particular, they used the Full Body Illusion (FBI). Participants with AN were asked to estimate their body size on shoulders, abdomen, and hips before FBI was induced, then they were asked again about their body size after the FBI, and then they were asked again after 2 hours and 45 minutes. In this study, results shows that patients with AN decrease the overestimation of their shoulders, abdomen, and hips directly after the FBI was induced (Keizer et al., 2016).

Virtual Reality and Bulimia Nervosa

Anorexia Nervosa is not the only eating disorder treated in the recent VR studies. In fact, in the year 2015, it was described a case report by Roncero and Perpiñá of a 17-year-old girl with Bulimia Nervosa (BN) assessed the effect of VR as a therapeutic tool to normalize eating patterns, as part of a cognitive-behavioral therapy treatment. The VR software consisted of a kitchen with two areas that contained elements to cook, drink and eat. The patient could access the foods freely or block them if desired. She could also perform alternative actions in the virtual environment, like a phone call. At the end of the treatment, the patient showed a reduction in Binge Eating episodes and food avoidance. Moreover, the patient showed an overall improvement, such as a decrease in drive for thinness and bulimia measures (Roncero & Perpiñá, 2015).

In conclusion, Virtual Reality may be considered a promising strategy for the assessment and treatment of Eating Disorders. In the future, new studies could bring fascinating results. In fact, it might be interesting to see how cognitive behavioral therapy, or others, can be combined with Virtual Reality for the treatment of Eating Disorders.


  • De Carvalho, M., Dias, T., Duchesne, M., Nardi, A., & Appolinario, J. (2017). Virtual reality as a promising strategy in the assessment and treatment of bulimia nervosa and binge eating disorder: A systematic review. Behavioral Sciences,7(4), 43.

  • De Carvalho, M., Dias, T., Duchesne, M., Nardi, A., & Appolinario, J. (2017). Virtual reality as a promising strategy in the assessment and treatment of bulimia nervosa and binge eating disorder: A systematic review. Behavioral Sciences, 7(4), 43.

  • Ferrer-García, M., & Gutiérrez-Maldonado, J. (2012). The use of virtual reality in the study, assessment, and treatment of body image in eating disorders and nonclinical samples: A review of the literature. Body Image,9(1), 1-11.

  • Freeman, D., Reeve, S., Robinson, A., Ehlers, A., Clark, D., Spanlang, B., & Slater, M. (2017). Virtual reality in the assessment, understanding, and treatment of mental health disorders. Psychological Medicine,47(14), 2393-2400.

  • Keizer, A., Van Elburg, A., Helms, R., & Dijkerman, H. C. (2016). A virtual reality full body illusion improves body image disturbance in anorexia nervosa. PLOS ONE, 11(10).

  • Perpi˜ná, C., Botella, C.,&Ba˜nos, R. M. (2000). Imagen Corporal en los Trastornos Alimentarios. Evaluación y Tratamiento Mediante Realidad Virtual. Valencia: Promolibro.

  • Roncero, M., & Perpiñá, C. (2015). Normalizing the eating pattern with virtual reality for bulimia nervosa: A case report. Revista Mexicana De Trastornos Alimentarios, 6(2), 152-159.

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