Mirror exposure in adolescents with anorexia nervosa: a feasibility study on body image disturbance and attentional bias

Eat Weight Disord. 2026 Jun 8;31(1):54. doi: 10.1007/s40519-026-01880-2.

ABSTRACT

PURPOSE: Body image disturbances (BID) are central to anorexia nervosa (AN), influencing its development, maintenance and relapse. While mirror exposure (ME) has been shown to reduce BID in adults, research in adolescents is limited. This pilot randomized controlled trial examined the feasibility and effects of ME, added to treatment as usual (TAU), in adolescent inpatients with AN. In addition, we explored changes in body-related attentional bias as a potential mechanism of change.

METHODS: Adolescent female inpatients with AN were randomized to receive either 12 ME sessions over 4 weeks (ME group, n = 11) or TAU (n = 13) in a pre-post design. Primary outcomes were global measures of BID and eating disorder (ED) pathology. Attentional bias was assessed using two eye-tracking paradigms.

RESULTS: Relative to TAU, ME did not improve BID or ED pathology. Both groups showed reductions in BID over time. Exploratory post-hoc analyses indicated reductions in body control and avoidance behaviors in the ME but not the TAU group. An attentional bias toward self-defined unattractive body parts was present but did not change over time in either group.

DISCUSSION: In this pilot trial, ME did not provide additional benefits over TAU in improving global BID or ED pathology in adolescent inpatients with AN. Improvements in BID may reflect general therapeutic effects of inpatient treatment. Exploratory analyses indicated potential effects on specific body-related behaviors but require cautious interpretation due to limited power. Future research should examine for whom and at what stage body image-focused interventions may be beneficial.

LEVEL OF EVIDENCE: Level I, randomized controlled trial.

TRIAL REGISTRATION: The study is registered on the German Clinical Trial Register (DRKS; registration number: DRKS0019104).

PMID:42260182 | DOI:10.1007/s40519-026-01880-2