Body Checking and Body Avoidance

Messages promoting the benefits of thinness are all around us. Nowhere is this more marked than in a ballet studio. The very setting of ballet study and performance can promote body checking and body avoidance. Walls in a typical ballet studio are all mirrored, designed to help teachers and students study exacting ballet body positions. However, they also promote body checking and body comparisons. Body checking involves behaviors such as scrutinizing specific body parts in the mirror and comparing their body to others, while body avoidance might include staying away from full-length mirrors and always wearing baggy clothing.

The pressure to be thin persists throughout a dancer’s life, from acceptance in a beginning ballet class to performers on the professional ballet stage. Some ballet dancers have described trying to avoid looking at mirrors to ignore this, but it usually has the opposite effect-allowing such fears to persist and even worsen.

A study of disorders among dancers

Dr. Catherine R. Drury and colleagues at the Department of Psychiatry and Behavioral Sciences at the University of California, San Francisco, recently devised a study of factors that distinguish between pathological and adaptive or professionally natural body checking and avoidance. Very few studies have examined the connection. And, as the authors note, there is no tool to help detect unhealthy levels of body checking among dancers, particularly those who choose ballet. To add to this, directors of dance schools often do not know what steps to take when they suspect an eating disorder like anorexia nervosa, for example, among their students, or where to find help and/or resources for students who may be at risk. And, there is no eating disorder assessment tool specifically tailored to dancers that might aid in the detection of clinical levels of body checking and avoidance.

The study format

The authors sought to record existing measures of body checking and to examine connections between body checking and avoidance of food and eating disorders when depression, clinical perfectionism, depression, and anxiety are also present. The authors theorized there would be a strongly positive correlation between body checking and avoidance and eating disorder pathology, and a moderately positive correlation between body checking and avoidance and clinical perfectionism, depression, and anxiety.

Male and female (78.8% female) professional and students studying to be professional dancers were recruited from six elite dance companies and two dance conservatories, and a physical therapy studio serving dancers. Dr. Drury conducted recruitment meetings with each dance company and conservatory, during which dancers were informed of the nature and purpose of the study. Collaborators at each site then sent an email to all dancers with a link to the online consent form and questionnaires. The final group of 80 participants included 35 professional dancers and 45 pre-professional dancers who provided informed consent and completed at least one study questionnaire: The Body Checking Questionnaire 3 (BCQ), the Body Image Avoidance Questionnaire (BIAQ), and the Body Checking and Avoidance Questionnaire (BCAQ)..

The BCQ asks respondents to indicate the frequency with which they engage in 23 different body-checking behaviors (for example, “I check my reflection in glass doors or car windows to see how I look”). For the BIAQ, respondents indicate the frequency with which they avoid 19 body-image-related situations, such as “I avoid physical intimacy” or “I avoid going clothes shopping.” The BCAQ assesses how often respondents engage in various body-checking behaviors for a range of body parts, such as “Looked in the mirror at your thighs,” or “Touched your stomach”), or “Avoid these behaviors because of the distress they may cause.” In a recent 52-study meta-analysis on body checking and avoidance in eating disorders, the BCQ and BIAQ were the most frequently used measure (Euro Eat Disord Rev. 2018. 26:159).

An open-ended question was added: “Are there any behaviors not listed previously that you engage in to check or avoid your appearance, size, and/or shape? If yes, please explain.” Respondents were advised not to include any identifying information.

The participants also completed three more questionnaires: The Eating Disorder Examination Questionnaire (EDE-Q), The Clinical Perfectionism Questionnaire (CPQ), and the Beck Depression Inventory.

Results

There were moderate-to-strong correlations between body checking and avoidance and clinical perfectionism, depression, and anxiety. Higher levels of body checking and body avoidance were moderately related to higher clinical perfectionism, depression, and anxiety. Exploratory analyses found no significant differences between ballet dancers and dancers of other dance types; most professional dancers scored in the normative range on measures of body checking and body avoidance.

Of the 80 dancers who responded to the open-ended prompt question, a third (32.4 % of professional dancers and 33.3 % of pre-professional dancers) indicated that they engage in behaviors to check or avoid their appearance, size, and/or shape that are not measured by the BCQ, BIAQ, or BCAQ. Six dancers described more detailed mirror-checking behaviors; for example, one wrote, “I try to squeeze my waist in the mirror or pull back my thighs to see what I would look like if I were a little smaller.” Respondents also indicated checking their legs, thighs, breasts, hips, and face, and one described measuring her thighs regularly to monitor increases or decreases in size. Several dancers (n = 6) used photos and/or videos of themselves to check their body shape, to compare their current body size to past photos or videos of themselves (n = 4), or to compare their bodies to those of their peers.

What earlier studies have shown

Although this is the first study to examine body checking and body avoidance among a sample of dancers, earlier studies have used the EDE-Q to find links to eating disorders among dancers. As the authors note, a 2014 study by Arcelus and colleagues (Eur Eat Disord. 22:92) reported lower levels of overall eating disorders among female and professional ballet dancers and dancers from other styles of dance. Other studies have shown comparable EDE-Q global scores among female professional and college-level ballet dancers. Mixed-gender samples of ballet and jazz and contemporary dance students have produced lower EDE-Q scores than the authors found (Res Dance Edu. 2024. 4:1). Additionally, while limited research comparing ballet dancers to dancers from other genres suggests greater risk of eating disorders among ballet dancers, there were no differences between dance genres in the current study, which may have been a result of the small sample size and insufficient power to detect a significant difference between groups.

Discrepancies in findings across studies are also likely partially explained by systemic and environmental factors that differentially influence eating disorder risk in different dance settings, including the degree to which dance company or school leadership promotes a thin body ideal, how often teachers and directors critically comment on dancers’ bodies, and other pressures to be thin, including comments about weight and connecting thinness and success in the dance world.

Strengths and challenges

According to the authors, the primary strength of this study is its exploration of an important and mostly understudied risk, that of body checking and body avoidance among ballet dancers. The study is novel in that it compared multiple types of professional dances, and included an elite professional sample of dancers. It was, however, limited by its small sample size. And, recruiting participants for the study was not easy. As Dr. Drury described, although she was well known professionally by many professionals at the recruitment sites, two dance companies that initially agreed to participate withdrew due to concerns about its content, and union representatives at one recruitment meeting expressed fears that the results of the study would contribute to the dance field’s negative reputation in the media. Furthermore, due to scheduling constraints and union rules, attendance at recruitment meetings was not mandatory, and one dance company was unable to schedule a meeting.

According to the authors, the study does give an early foundation of data on body checking and body avoidance among dancers. The aspects of eating disorders pathology that feature prominently in evidence-based assessments and treatments may be an important target of underlying eating disorders among dancers.