Vol.:(0123456789) 1 3 Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity https://doi.org/10.1007/s40519-019-00680-1 ORIGINAL ARTICLE Comparison of body image evaluation by virtual reality and paper- based fgure rating scales in adolescents with anorexia nervosa: retrospective study Sheldon Fisher 1  · Ahmad Abdullah 2  · Isabelle Charvin 1  · David Da Fonseca 1,3  · Flora Bat‑Pitault 1,3 Received: 18 December 2018 / Accepted: 15 March 2019 © Springer Nature Switzerland AG 2019 Abstract Purpose Assessment of the symptoms of body image disorder (BID) is crucial in anorexia nervosa (AN). Recent techno- logical advancements such as virtual reality (VR) have improved the visual perception with 3D avatars and the feeling to be the avatar with the immersive conditions. This retrospective study examines the hypothesis that VR with standardized 3D avatars would improve body image perception and then body image evaluation by adolescents with AN, compared to the paper-based fgure rating scales (FRS). Methods Data of 31 female adolescents with AN were retrospectively studied. Paired data of perceived and desired body forms in addition to body perception index (BPI) (p = 0.2) and body dissatisfaction (p = 0.6), obtained by both VR and FRS were compared. Furthermore, correlation with validated psychometric questionnaires was also studied. Head-tracking tech- nology allowed for the implicit measurement of explicit choices of patients. Results Participants with AN overestimated own body size regardless of the assessment tool used. BPI and body dissatisfac- tion did not difer signifcantly between FRS and VR. VR-based evaluation was correlated with the psychometric parameters BID and body dissatisfaction. Head tracking revealed signifcantly longer participant engagement with avatars representing malnutrition and underweight states, while those least engaged corresponded to obesity. Conclusions Results of BID evaluation by VR standardized 3D avatars are comparable to those obtained by paper-based FRS. These fndings suggest that comparable results obtained by both tools of evaluation refect primarily the role of afective-cog- nitive perturbation in BID. The perceptive component could be better evaluated using biometric-enhanced assessment tools. Level of evidence Level V, cross-sectional descriptive study (evaluation data retrospectively studied). Keywords Anorexia nervosa · Body image evaluation · Virtual reality · Body image disorder · Adolescent Introduction The lifelong prevalence of anorexia nervosa (AN) in adoles- cents and young adults is estimated at 0.3–0.9% [1, 2]. Due to its major somatic complications and a high suicide rate, anorexia nervosa remains the most fatal psychiatric disorder with a mortality rate of 1% per year of disease evolution in clinical populations [1]. Furthermore, it is important to note that relapse rates are as high as 40% during the frst 12 months following complete discharge from specialized care [3]. For these reasons, multidisciplinary management of AN is complex and represents a public health challenge. One of the most challenging aspects of managing AN is body image disorder (BID) according to diagnostic and sta- tistical manual of mental disorders, Fifth Edition (DSM-5) [4]. BID is a key determinant of disease evolution, as more * Sheldon Fisher sheldon.fsher@ap-hm.fr 1 Child and Adolescent Psychopathology Unit, Salvator University Hospital, Public Assistance-Marseille Hospitals, Aix-Marseille University, 249 Boulevard Sainte-Marguerite, 13009 Marseille, France 2 Pole of Endocrinology, Nutrition, Diabetes and Obesity, Conception University Hospital, Aix-Marseille University, Public Assistance-Marseille Hospitals, Marseille, France 3 Institute of Neuroscience Timone, CNRS, Aix-Marseille University, Marseille, France