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The Body Investment Scale: Construction and validation of a body experience

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Article  in  Psychological Assessment · December 1998

DOI: 10.1037/1040-3590.10.4.415

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Psychological Assessment Copyright 1998 by the American Psychological Ass~iafion, Inc.
1998, VOI. 10, No. 4, 415-425 1040-3590/98/$3.00

The Body Investment Scale: Construction and Validation

of a Body Experience Scale

Israel Orbach and Mario Mikulincer

Bar-Ilan University

A new measure of emotional investment in the body is presented. The Body Investment Scale (BIS)
pertains especially to self-destructive behavior and can be used to study a variety of normal and
pathological behaviors. Studies 1 and 2 describe the construction of the BIS, factor analysis, and a
group comparison (suicidal and nonsuieidal inpatients and normal adolescents). Study 3 tested the
relationship between the BIS, physical anhedonia, depression, and suicidal tendencies. Study 4
examined the relationship between the BIS, perceived early care, self-esteem, and suicidal tendencies.
The BIS consists of four internally reliable factors (body image feelings and attitudes, comfort in
touch, body care, and body protection). The construct validity hypotheses were confirmed: The
relevance of the BIS to self-destructive behavior and related processes is discussed.

A recent emphasis in the study of suicidal behavior pertains
to the bodily experiences of the suicidal person (Furman, 1984;
Maltsberger, 1993; Orbach, 1996; Russ, Shearin, Clarkin, Har-
rison, & Hull, 1993). Suicidal behavior involves a physical
attack on the body, and it is believed that such an attack may
be related to special attitudes and feelings toward the body. In
spite of growing interest in this area, there are few appropriate
tools for measuring such special bodily characteristics, and the
ones that exist do not fulfill the appropriate theoretical and
research needs for the study of self-destructive behavior and its
relation to the body. The studies presented here describe the
construction and validation of a new scale tapping an individu-
al's emotional investment in his or her body. The body aspects
measured in this scale pertain to (a) image, feelings, and atti-
tudes about the body; (b) body care; (c) body protection; and
(d) comfort in physical touch. Most of these aspects are missing
or very narrowly defined in existing scales.
The development of the Body Investment Scale (BIS) is pred-
icated on the contention that psychological self-representations
are founded first on body experiences in the early formative
years. Theoretically, this development begins with auditory, vi-
sual and kinesthetic sensations, physical contact, inner psycho-
physiological experiences, need satisfaction, parental reactions
to the infant's body, and the general affective tone of the parent-
child attachment behavior (Kruger, 1989; Van der Velde, 1985).
It is contended that, from early childhood and on, cognitive
and affective aspects of the bodily self develop in a mutual
complementarity to form the general sense of self. The recipro-
Israel Orbach and Mario Mikulincer, Department of Psychology,Bar-
Ilan Univea'sity,Ramat-Gan, Israel.
We would like to thank Amir Shaffer, Dana Holis, Ron Amit, Arik
Kuznitz, Noa Young, and Natalie Sagal for their assistance in this study.
Correspondence concerning this article should be addressed to Israel
Orbach, Department of Psychology, Bar-fian University, Ramat-Gan
52900, Israel. Electxonic mail may be sent to orbachi@mail.biu.ac.il.
415
cal relations between the bodily self and menial self vacillate
throughout life in both healthy and pathological functioning
(Erikson, 1971; Fisher, 1986).
The body and mental-self relationship is evidenced in many
mental disturbances involving physical self-harm. There is much
empirical data on the role of distorted bodily perception in
eating disorders (e.g., Bruch, 1973; Fisher, 1986; McAllister &
Caltabiano, 1994). Similarly, psychological distress may be ex-
pressed through body injury which in turn results in mental
relief (Halns, Williams, Brain, & Wilson, 1995; Walsh & Rosen,
1988). Negative attitudes and feelings toward the body and low
body image have been empirically found to characterize suicidal
youngsters (Orbach, Lotem-Peleg, & Kedem, 1995) and de-
pressed adolescents and adults (see Rierdan, Koff, & Stubbs,
1987), as well as individuals with low self-esteem (Koff, Rier-
dan, & Stubbs, 1.990). Moreover, suicidal individuals have been
found to tolerate more physical pain, and this tolerance was
related to the degree of psychological stress (Orbach, 1994;
Orbach, Mikulincer, King, Cohen, & Stein, 1997; Orbach, Palgi,
Stein, Har-Even, Lotem-Peleg, & Asherov, 1996; Orbach, Stein,
et al., 1996; Russ et al., 1993). Other empirical findings have
shown that prenatal and postnatal body experiences of young-
sters who committed suicide were different from those of control
groups. Medical files of suicidal youngsters showed that they
were carried longer in the womb and were breast-fed less (Les-
ter, 1991) and suffered from neonatal respiratory difficulties
after birth (Salk, 1985) more than their counterparts.
Four basic aspects of the bodily self have been identified as
most important to the issue of self-preservation versus self-
destruction: (a) body image feelings and attitudes, (b) comfort
in physical contact, (c) body care, and (d) body protection
(Orbach, 1996; see also Khantzian & Mack, 1983). It is believed
that bodily self-care and self-protection are not part of the auto-
matic biological mechanisms (Freud, 1949; Grossman, 1991),
but are assumed to be learned through identification with and
introjection of parental care and teachings (Bruch, 1973;
416 ORBACH AND MIKULINCER
Greenspan, 1979; Van der Velde, 1985). Indeed, observational
studies show a strong link between parental care behavior and
children's body care and protection behaviors (Briere, 1989;
Frankl, 1963; Green, 1978; Lewis, Solnit, Stark, Gabrielson, &
Klatskin, 1966).
Touching behavior by parents is also perceived as a life-
enhancing force. Harlow (1958) and Harlow and Suomi (1970)
provided empirical evidence of the need for contact comfort-
seeking in animal infants. Anisfeld, Casper, Nozyce, and Cun-
ningham (1990) reported that infants who were carried in soft
carriers (more physical contact) were more secure in their be-
havior later in life than infants who were carried in infant seats
(less physical contact). Further, skin-to-skin contact between
mother and low birthweight infants was at times more effective
than incubator treatments in stabilizing the medical condition
of such infants during a six-month follow-up (Field, Morrow,
Valdeon, Larson, Kuhn, & Schanberg, 1992; MacDonald, 1987;
Pelaez et al., 1993; Scholz & Samuels, 1992; Sloan, Leon-
Camacho, Rojas, & Stern, 1994). It has also been confirmed that
body image and feelings play an important role in psychosocial
adjustment later in life and not only in infancy and childhood
(Harris, 1995).
In contrast to the above, maternal physical neglect may have
a harmful effect on infants. For example, Spitz (1965) has
described in clinical studies how psychological maladjustment,
developmental arrest and physical deterioration, self-harm, and
high mortality were related to the absence of consistent maternal
care (and not to medical neglect). Likewise, Putnam and Stein
(1985) observed self-harm behavior (e.g., head banging) in
infants and small children and related it to maternal physical
neglect (see also Kraemer & Clarke, 1990).
On the basis of the theoretical approaches held by Van der
Velde (1985), Freud (1949), Furman (1984), and Orbach
(1996), we suggest that one of the important factors in self-
destructive behaviors is bodily love versus body rejection. It is
further suggested that the emotional investment in the body is
involved in the regulation of bodily self-destructive behavior
(Furman, 1984; Schanberg, 1997). Specifically with regard to
suicidal behavior, it has been postulated (Orbach, 1996) that
negative attitudes and feelings toward the body can be a facilita-
tor of suicidal behavior, because such attitudes and feelings
entail a lack of bodily pleasures and satisfactions. In the absence
of bodily love and satisfaction, the suicidal individual may carry
out self-destructive acts with greater ease than when positive
feelings toward the body exist. Indeed, negative feelings toward
the body have been found in several empirical studies on suicidal
behavior (Orbach et al., 1995; Petrie, Chamberlain, & Clarke,
1988), as well as in other self-harming behavior such as eating
disorders (McAllister & Caltabiano, 1994). Thus, the measure
of the above aspects of attitudes and feelings toward the body
may lead to a better understanding of bodily self-harm from the
perspective of the degree of emotional investment in the body.
A wide range of experiential, cognitive, affective, and behav-
ioral dimensions are measured by existing body questionnaires.
These include body perception (appearance, size, weight), con-
cept, awareness, image, satisfaction, and attitudes. Different in-
struments focus on different dimensions of the body, with some
overlap (e.g., Brown, Cash, & Mikulka, 1990; Cash, 1994; Gray,
1977; Jourard & Secord, 1955). None of the existing measures
centers on all four aspects we have delineated as most relevant
for the study of self-destructive behavior, and the body aspects
measured by the existing tools are defined differently than in
the scale introduced here.
Our purpose was to construct a scale measuring body image
feelings and attitudes, body care, protection of the body, and
comfort in touch, which may be related to an inner personality
structure of life-preserving and life-destroying tendencies. The
present theoretical reasoning implies that such a scale can iden-
tify and distinguish between various groups differing on self-
harming and self-destructive tendencies. In this series of studies
we describe the construction of the scale and compare suicidal,
psychiatric nonsuicidal, and normal groups with regard to bodily
investment (Studies 1 and 2). From a theoretical perspective
we assume that body investment tendencies will be meaningfully
related to bodily and mental manifestations involving physical
anhedonia, depression, self-esteem, and perceived early care.
These construct validity aspects were examined in Studies 3
and 4.1
Study 1
This study involved item construction and factor analyses
validity in two phases. We included both inpatients and normal
participants in this study in order to provide a wide basis for
generalization for future use of the scale for both normal and
psychiatric youngsters. No comparisons were made between
groups in this study.
Method
Phase 1
In the first phase of the study, we collected statements about the body
from hospitalized youngsters (58 boys and 45 girls, age range 13-19
years, with mixed diagnoses) and community youngsters (52 boys and
50 girls, age range 13-19 years) who volunteered for the study. Both
groups were recruited from various sites. We asked for statements about
body feelings, attitudes, and image; body care; body protection; and
body touch. The instructions guided the participants to freely generate
statements about the various aspects of body experience without provid-
ing any explicit definitions or examples of these aspects. Out of the 280
statements collected, 169 were dropped by the authors due to redun-
dancy, lack of clarity, and irrelevance. Some of the remaining items were
refined by the authors. The 111 remaining statements were arranged on
a 5-point scale, ranging from 1 (1 do not agree at all) to 5 (I strongly
agree). The scale was then presented to a new sample of hospitalized
(N = 69, 29 boys and 40 girls, age range 13-19 years, with mixed
diagnoses) and community youngsters (N = 89, 45 boys and 44 girls,
age range 13-19 years) from the Tel-Aviv area. The scores obtained
were subjected to a preliminary factor analysis yielding four factors:
(a) body feelings, attitude and image (this factor included three out of
the seven facets of the body experience construct); (b) body care; (c)
body protection; and (d) body comfort, totaling 61 items.
Phase 2
The purpose of Phase 2 was twofold: to include a sizeable sample of
suicide attempters in the validation process of the scale and to subject
the 61-item scale to a new factor analysis.
leach study consisted of a new sample. There were no overlaps
between studies or phases within the studies.
 BODY INVESTMENT SCALE
Participants
The inpatient participants (N = 74) included 44 suicidal youngsters
(24 boys, 20 girls) and 30 suicidal youngsters (16 boys, 14 girls with
mixed diagnosis) from a mental health center.: The age range was 13-
19 years (M = 16.5, SD = 2.27). The community volunteers (N = 80,
47 boys, 33 girls), also with an age range of 13-19 years (M = 16.03,
SD = 2.23), were recruited from the same geographical area as the
inpatients.
Procedure
All recruited inpatients and their parents were first approached by the
experimenter (a graduate student) to request permission for the inpa-
tients to participate in the study. Control participants were approached
with the permission of the school principal or community center direc-
tors. Control participants signed the consent by themselves and, if par-
ticipants were under 18, their parents' permission was also obtained.
The study was presented as research comparing attitudes and feelings
about the body?
Results
The participants' responses to the BIS (61 items) were ana-
lyzed by means of a factor analysis with Varimax rotation yield-
ing four main factors (eigenvalue > 1 ) that explained 47% of
the variance. Factor 1 included 24 items designed to tap body
image feelings and attitudes toward the body. Factor 2 included
13 items designed to tap comfort in physical touch. Factor 3
included 12 items designed to tap body care. Finally, Factor 4
included 12 items designed to tap attitudes and b e h a v i o r repre-
senting body protection. C r o n b a c h ' s alpha coefficients for scales
corresponding to each factor indicated appropriate internal con-
sistency (ranging from .80 to .95).
We have further reduced the n u m b e r of items in each factor
by selecting items that loaded higher than .50 in a particular
factor and less than .25 in the remaining factors. After this
procedure, each factor consisted of the six highest loading items,
totaling 24 items for the final scale. 4
Study 2
In this study, we performed a factor analysis o f the BIS items
and also compared the BIS scores across different groups. We
hypothesized that suicidal participants would differ from non-
suicidal and normal participants in the degree o f body invest-
ment. This hypothesis was based on previous findings showing
that suicidal youngsters report more negative attitudes toward
their bodies ( O r b a c h et al., 1995; Petrie et al., 1988) and that
parental touch was experienced b y suicidal youngsters as less
p l e a s a n t than by nonsuicidal youngsters (Pearce, Martin, &
Wood, 1995). We expected that suicidal participants would
show a lower degree o f body investment and that body invest-
ment scores would be associated with suicidal tendencies.
Method
Participants
The suicidal group consisted of 104 patients (75 boys, 29 girls), with
a mean age of 16,64 years (SD = 1.88) with a range of 13-19. They
were recruited from the inpatient units of two mental health centers in the
: 417
Tel-Aviv area. These participants were selected on the basis of suicidal
behavior as indicated in the medical files, self-reports, and information
obtained by the treating physicians. Almost all of them were admitted
to the hospital primarily because of suicidal behavior. The most recent
suicide attempts prior to hospitalization included the following: hanging
(11), drowning (11), self-stabbing (12), self-strangulation (13), at-
tempts that were stopped before execution (13), wrist-cutting (21), and
medication and poison overdose (23). 3
The nonsuicidal inpatient group, also from the above hospitals, con-
sisted of 102 patients (78 boys, 24 girls), with a mean age of 17.19
years and SD = 2.07 and age range of 13-19. They were roughly
matched to the suicidal group as to age and diagnosis. According to the
medical files, self-reports, and information from the treating physicians,
none of these participants had made any suicidal attempts or threats.
Self-mutilators with superficial cuts and low suicidal intention were
excluded from the study as there is controversy whether these patients
are suicidal or not (see Walsh & Rosen, 1988). The length of hospitaliza-
tion was similar in the two groups: M = 225.55 days, SD = 223.87,
range = 15-520 days for the suicidal group and M = 209.6 days, SD
= 241.5, and range = 10-490 days for the nonsuicidal group. 6
The control group of normal participants consisted of a community
sample of volunteers from the vicinity of the two hospitals. They com-
prised 69 boys and 46 girls, with a mean age of 16.38 years and SD =
208, and age range of 13-19 years. They were roughly matched to the
experimental group in age and gender. None of these participants evi-
denced any suicidal intentions, as reflected in their general information
questionnaire. There was no difference between the three groups with
regard to gender (by a chi-square analysis) or age (by a one-way analysis
of variance [ANOVA ]).
Measures
BIS. The final version of the BIS consists of four factors with six
items in each factor totaling 24 items. Factor 1 includes items related
to body image feelings and attitudes (e.g., I am satisfied with my appear-
ance). Factor 2 consists of items relating to comfort in touch (e.g., I
enjoy physical contact with others). Factor 3 includes items about body
care (e.g., Caring for my body will improve my well-being). Factor 4
contains items about body protection (e.g., It makes me feel good to
do something dangerous). The items were presented as a 5-point interval
scale ranging from 1 do not agree at all (1); 1 do not agree (2);
Undecided (3); Agree (4); Strongly agree (5). A high score indicates
a more positive feeling about the body, about touch, and more body care
and protection. The scores for each factor were calculated by averaging
2 Diagnostic procedures were identical in this study and Studies 2, 3,
and 4. The diagnoses for all inpatients, both suicidal and nonsuicidal,
were derived from medical files and confirmed by the treating physicians.
The proportions of diagnoses in each study were very similar: approxi-
mately 40% affective disorder; 25% conduct disorder; 20% personality
disorder; 15% non-affective disorder.
3 This procedure was similar in all studies.
As a further validation of the content, we have presented the final
version of the scale items in random order to two judges--a clinical
psychologist and an expert on testing. These judges were asked to sort
each item to one of the four factor categories or to a fifth category of
"none of the above." Both of the judges sorted the items in full congru-
ence with the factor analysis categories and in full agreement among
themselves.
5 Very similar proportions of types of suicide attempts were recorded
for Studies 3 and 4.
61n all studies, testing of inpatients started with the existing ward
population and then continued with new participants consecutively.
418 ORBACH AND MIKULINCER

all item scores in that factor, yielding four separate scores, one for each
factor.
Multi-Attitude Suicidal Tendencies Scale (MAST; Orbach et al.,
1991). This self-rating 5-point scale with 30 items provides four inde-
pendent scores of suicidal tendencies for adolescents: (a) attraction to
life, (b) repulsion by life, (c) attraction to death, and (d) repulsion by
death. High attraction to life and repulsion by death reflect low suicidal
tendencies, while high repulsion by life and attraction to death reflect
high suicidal tendencies. The validity of the scale for adolescents was
determined by means of factor analysis, discrimination (suicidal vs.
nonsuicidal attempters-ideators), and concurrent validity with other
scales (see Orbach et al., 1991). The internal consistency for the four
subseales was a = 0.83, 0.76, 0.76, and 0.83, respectively and the
internal consistency of the entire scale was a = 0.92 (Orbach et al.,
1991). Similar psychometric characteristics were reported by Osman,
Barrios, Panak, and Osrnan (1994). Each item is scored on a 5-interval
scale (1 = strongly disagree, 5 = strongly agree). The scores for each
attitude are computed by averaging all item scores of each attitude.
55% of the variance. Factor 1 (image feelings and attitudes
toward the body) explained 26% of the variance; Factor 2 (com-
fort in touch) explained 12% of the variance; Factor 3 (body
care) explained 10% of the variance. Finally, Factor 4 (body
protection) explained 7% of the variance. Cronbach's alpha
coefficients for scales corresponding to each factor indicated
appropriate internal consistency (.75, .85, .86, .92, respec-
tively). On this basis, four total scores were computed by aver-
aging items that load high on each factor. Table 1 presents the
final items of each factor and their factor loadings.
Intercorrelations among the four BIS factors were calculated.
The feeling and attitude factor correlated with touch ( r = .27 ),
with care ( r = .36), and with protection ( r = .37; all ps <
.01). Touch correlated with care ( r = .28; p < .05), but not
with protection. Care correlated with protection ( r = .47;
p < .01).

Procedure Suicidal Tendencies and Body Investment

All recruited inpatients and their parents were first approached by the
experimenter (a graduate student ).to request permission for the inpa-
tients to participate in the study. Control participants signed the consent
bY themselves and, if participants under 18, their parents' permission
was also obtained. The study was presented as research comparing
attitudes and feelings about the body. The scales were completed in
random order individually.
Results and Discussion
Factor Analysis
A factor analysis with Varirnax rotation of the 24-item version
scores yielded four main factors (eigenvalue > 1) and explained
A multivariate analysis for gender and group on the four body
investment scores yielded significant main effects for group,
F ( 8 , 636) = 12.40, p < .01, and gender, F ( 4 , 318) = 6.45, p
< .01. The interaction was not significant. Univariate ANOVAs
indicated that the main effect of group was significant in all the
four body investment factors, F ( 2 , 321) = 32.18, p < .01, for
body image feelings and attitudes; F ( 2 , 321) = 15.57,p < .01,
for comfort in touch; F ( 2 , 321 ) = 7.74, p < .01, for body care;
F ( 2 , 321) = 12,58, p < .01, for body protection. The means
and standard deviations of the three groups are presented in
Table 2. As expected, Scheff6 post hoc tests ( a = .05) revealed

Table 1
Loading of BIS in Rotated Factors
Scale item Feeling Touch Care Protection

13. I hate my body (R) .86 .17 .04 .05

10. I am satisfied with my appearance .85 .08 .21 .07
16. I feel comfortable with my body .85 .23 .26 .09
5. I am frustrated with my physical appearance (R) .82 .14 .17 .13
17. I feel anger toward my body (R) .81 .15 .13 .14
21. I like my appearance'in spite of its imperfection .80 .06 .18 .17
2. I don't like it when people touch me (R) .23 .74 .06 .01
11. I feel uncomfortable when people get too close to me
physically (R) .24 .72 .14 .21
20. I like to touch people who are close to me .26 .71 .10 .13
9. I tend to keep a distance from the person with whom I am
talking (R) .14 .69 .19 .06
6. I enjoy physical contact with other people .07 .63 .14 .03
23. Being hugged by a person close to me can comfort me .17 .53 .18 .09
14. In my opinion it is very important to take care of the body .28 .17 .80 .02
1. I believe that eating for my body will improve my well-being .30 .09 .72 .07
12. I enjoy taking a bath .18 .08 .67 .03
4. I pay attention to my appearance .12 .18 .65 .05
19. I use body care products regularly .17 .25 .60 .12
8. I like to pamper my body .15 .23 .57 -.06
3. It makes me feel good to do something dangerous (R) .19 .05 .21 .78
18. I look in both directions before crossing the street .08 .28 .06 .65
7. I am not afraid to engage in dangerous activities (R) .26 -.17 -.02 .69
15. When I am injured, I immediately take care of the wound .18 -.03 .03 .65
22. Sometimes I purposely injure myself (R) .06 -.17 -.02 .63
24. I take care of myself whenever I feel a sign of illness .03 .14 .28 .56

Note. R = scored in the reverse direction. BIS = Body Investment Scale.

 BODY INVESTMENT SCALE 419

Table 2
Means and Standard Deviations o f BIS'Factors According to Study Group and Gender

Body
Body image Body touch Body care protection
Participants M SD M SD M SD M SD
Control group
Boys (n = 69) 4.02 0.65 3.32 0.71 3.67 0.67 3.59 0.57
Girls (n = 46) 3.44 0.78 3.57 0.52 3.68 0.57 3.49 0.53
Nonsuicidal group
Boys (n = 102) 3.78 0.99 2.84 0.89 3.78 0.93 3,87 0.68
Girls (n = 78) 3.40 1.25 2.94 1.03 3.99 0.66 3.68 0.80
Suicidal group
Boys (n = 75) 2.93 1.29 2.94 0.98 3.42 0.95 3.30 0.84
Girls (n = 29) 2.98 1.18 2.75 0.80 3.34 1.01 3.12 0.98
Note. BIS = Body Investment Scale.

that suicidal patients scored lower in body image feelings and
attitudes, body care, and body protection than the nonsuicidal
inpatient and normal controls, No significant difference was
found between nonsuicidal patients and normal controls in the
above factors. In addition, both suicidal and nonsuicidal patients
scored lower in touch comfort than normal controls. The main
effect for gender was significant only in body feelings and atti-
tudes, F ( 1 , 3 2 1 ) = 19.06, p < .01, with men reporting more
positive feelings about the body (M = 3.58) than women (M
= 3.04).
The association between suicidal tendencies and body invest-
ment was also examined by Pearson correlations between
MAST factors and BIS factors. As can be seen in Table 3,
significant correlations were found between most of the vari-
ables. In accordance with predictions, all the significant correla-
tions indicated that positive body investment was related to
lower suicidal tendencies: The higher the scores in the four BIS
factors, the higher the attraction to life and the lower the repul-
sion by life; the higher the scores in body image feelings and
attitudes, touch comfort, and body protection, the lower the
attraction to death; and the higher the scores in body image
feelings and attitudes, body care, and body protection, the higher
the repulsion by death.
The findings of this study supported the four-factor structure
of the BIS as well as the association of these factors to suicidal
Table 3
Pearson Correlations Between MAST and BIS Factors
tendencies. With the exception of touch, the factors distin-
guished between the suicidal and nonsuieidal groups. Lack of
comfort in touch may be a shared characteristic of inpatients
regardless of suicidality. Finally, the finding that boys report
more positive feelings and attitudes about their bodies than do
girls replicates findings of earlier studies (Koff et al., 1990) and
thus provides additional support for the validity of the BIS.
Study 3
In Study 3, we examined the construct validity of the BIS
by exploring its relationship with suicidal tendencies, physical
anhedonia, and depression. Attitudes and feelings toward the
body in suicidal individuals may be manifested in a variety of
forms, one of which may be a diminished capacity to enjoy
sensual and bodily pleasures (see Furman, 1984). Nordstrom,
Schalling, and Asberg (1995) have recently reported that sui-
cidal inpatients were characterized by anhedonia. Therefore,
we assumed that suicidal individuals who, according to our
hypothesis, showed less body investment would experience a
higher degree of physical anhedonia compared with nonsuicidal
individuals. We further assumed that physical anhedonia would
be inversely related to the degree of investment in the body.
Anhedonia was also found to be a characteristic of depression
(Nordstrom et al., 1995). Thus, physical anhedonia attributed
to suicidal tendencies may be actually linked to depression
(commonly associated with suicide), rather than to the suicidal
tendencies themselves. Therefore, depression should be studied
as a control variable.

BIS factor
Method
Body Body Body
MAST factor image Body touch care protection Participants
Attracfiontulife .56** .19"* .52** .35** The suicidal inpatients consisted of 11 boys and 14 girls, with a mean
Attraction to death -.28** -.24** -.09 -.31"* age of 16.72 years, SD = 2.05. The nonsuicidal inpatients consisted of
Repulsion by life -.50** -.24** -.37** -.32**
Repulsion by death .21"* -.11 .18"* .32** 17 boys and 10 girls, with a mean age of 17.40 years, SD = 2.14. The
two groups were recruited from a mental health center in the Tel-Aviv
Note. MAST = Multi-Attitude Suicidal TendenciesScale. BIS = Body area. The community comxols consisted of 13 boys and 22 girls, with
Investment Scale. a mean age of 15.26 years, SD -- 0.99. The age range of the throe groups
**p < .01. was 13-19 years. These groups were almost identical to those in Study
420 ORBACH AND MIKULINCER
2 with regard to diagnosis, length of hospitalization (for the inpatients),
and demographic characteristics (for the three groups).
Measures and Procedure
The procedure of this study was identical to that of Study 2. In
addition to the MAST and BIS, participants responded to two
questionnaires.
Depression measure. The Cognitive Checklist (CCL; Beck, Brown,
Steer, & Eidelson, 1987) measures the frequency of automatic thoughts
relevant to depression (14 items). Each item is rated on a 5-point scale
as to how often each thought typically occurs to the respondents, ranging
from 0 (Never) to 4 (Always). The authors report a high degree of
reliability and validity. The alpha coefficient for internal consistency of
the scale was .95. Six-week test-retest reliability for depression was
.76 (Beck et al., 1987); high reliability was found as well with outpa-
tients with various Diagnostic and Statistical Manual of Mental Disor-
ders (3rd ed.; American Psychiatric Association, 1987) diagnoses (Steer,
Beck, Clark, & Beck, 1994). This scale was adapted to the Israeli
population by Orbach, Palgi, et al. (1996). 7 The internal consistency
(a) for the present study was .90. The general scores were computed
by averaging the item ratings. Higher scores reflect greater depression.
Physical Anhedonia Scale. This scale is a measure :of degree:of
pleasure derived from physical and bodily activities (eating, touching,
feeling, temperature, movement, smell, sexual relationship, and sound).
The original scale (Chapman, Chapman, & Roulin, 1976) consisted of
true-false items sampling a wide variety of pleasures, such as: "The
beauty of sunsets is greatly overrated" and "Physical intimacy is not
as much fun as people say." Although primarily used with adults, this
scale has also been used successfully with adolescents (Erlenmeyer-
Kimling, Cornblatt, Rock, & Roberts, 1993).
The modified version of the Physical Anhedonia Scale was used in
this study (see Blanchard, Bellack, & Muser, 1994). This scale consisted
of 61 items and was found to correlate highly with diagnostic differ-
ences, symptomatology, cognitive and affective functions (Blanchard et
al., 1994). This version was adapted to an Israeli adolescent population
by sharer, Segol, and Amit (1994) with Cronbach's alpha of .82. The
internal consistency in the present study was .92.
Results a n d Discussion
Anhedonia, Body Investment, and Suicidal Tendencies
In the first step of analysis, we examined differences in BIS
factors and anhedonia between study groups. The ANOVAs for
the four BIS factors yielded identical findings to those reported
in Study 1 and thus they will not be further reported. A two-way
ANOVA for group and gender on the anhedonia score yielded
significant main effects for study group, F ( 2 , 80) = 3.84, p <
.05, and gender, F ( 1 , 80) = 10.18, p < .01. The interaction
was not significant. Scheff6 post hoc tests revealed that suicidal
patients scored higher in physical anhedonia ( M = 2.85, SD =
.71) than nonsuicidal inpatients ( M = 2.47, SD = .51) and
normal controls ( M = 2.12, SD = .42). No significant difference
was found between the nonsuicidal and normal participants. In
addition, boys scored higher in anhedonia (M = 2.80, SD =
.58) than girls ( M = 2.44, SD = .49).
In the second step of analysis, Pearson correlations were com-
puted between anhedonia and the four BIS factors. Significant
associations were found between anhedonia and all four BIS
factors: r ( 8 5 ) = - . 3 2 , p < ,01, for body image feelings and
attitudes; r ( 8 5 ) = - . 4 8 , p < .01, for touch comfort; r ( 8 5 ) =
- . 6 3 , p < .01, for body care; and r ( 8 5 ) = - . 3 2 , p < .01, for
body, protection. The higher the investment in the body scores,
the lower the anhedonia score.
Depression and Body Investment
Pearson correlations revealed nonsignificant associations be-
tween the CCL depression score and the four BIS factors as
well as between CCL depression scores and anhedonia scores.
It is interesting that these nonsignificant associations were found
in each of the three study groups.
In order to examine whether depression moderates in the
association between suicidal tendencies and body investment,
we (a) performed a one-way ANOVA for study group on the
CCL depression score, and (b) introduced this score as a covari-
ate in the ANOVAs conducted on the BIS factors and the anhedo-
nia score. The ANOVA on depression yielded a significant effect
for study group, F(2, 80) = 41.15, p < .01. Scheff6 post hoc
tests indicated that suicidal and nonsuicidal patients reported
higher depressive cognitions ( M = 2.72, SD = 0.61, M = 2.51,
SD = 0.56, respectively) than did normal participants (M =
1.58, SD = 0.39). However, the analysis of covariance indicated
that the inclusion of the CCL depression score as a covariate
did not change the results of the original ANOVA conducted on
BIS factors and anhedonia. That is, although depression seems
t o characterize suicidal patients, it did not contribute to the
association between suicidal tendencies and body investment.
As predicted, suicidal participants scored higher on physical
anhedonia than nonsuicidal participants and anhedonia was re-
lated to the four BIS factors. Yet, although the suicidal group
appeared to be more depressed than the nonsuicidal groups,
depression was unrelated to the body investment scores and
anhedonia scores. Likewise, the depression scores were unre-
lated to the BIS and anhedonia scores of the suicidal partici-
pants. It is possible that the findings regarding depression are
due to the small sample used here and to the measure of a rather
limited aspect of depression as measured in the present study
(cognitive checklist).
Study 4
In Study 4, we utilized another construct validity procedure
and examined the relationship between body investment, per-
ceived early care (bonding), self-esteem, and suicidal behavior.
Our general theoretical approach posits a relationship between
early care and attachments, and body investment and suicidal
behavior (e.g., Blatt, 1974; Blatt & Homann, 1992; Khantzian &
Mack, 1983; Orbach, 1996; Van der Velde, 1985). In addition,
it is postulated that self-esteem regulates both suicidal behavior
(Hawton, O'Grady, Osborn, & Cole, 1982; Kosky, Silburn, &
Zubrick, 1990), as well as body investment (Kohut, 1971).
Kohut and Van der Velde (1985) believe that satisfying parental
7 The translation of measures from English to Hebrew and vice versa
was achieved by two translators who are fluent in both languages. One
translated the items from the original language (e.g., English) into the
new one (e.g., Hebrew) and the other one retranslated independently
from the new language into the original. At this point, both translators
discussed the differences between the two translatioias until agreement
was reached.
 BODY INVESTMENT SCALE
care is internalized by the child and results in increased self-
esteem and a life-preservation attitude. Parts of this theoretical
formulation have been empirically validated (e.g., Adam, 1994;
Hawton et al., 1982; Kosky, 1983; Kosky et al., 1990; Petrie et
al., 1988). In this study we intended to test the construct validity
of the BIS by using the above hypotheses and to examine the
relationship between different aspects of perceived early mater-
nal care (care and overprotection), self-esteem and suicidal
tendencies, and the four BIS factors.
Method
Participants
The suicidal inpatients consisted of 20 boys and 37 girls, with a mean
age of 16.61 years, SD = 1.91. The nonsuicidal inpatients consisted of
22 boys and 23 girls, with a mean age of 17.66 years, SD = 1.92. The
two groups were recruited from a mental health center in the Tel-Aviv
area. The community controls consisted of 26 boys and 20 girls, with
a mean age of 16.41 years, SD = 2.43. The age range of the three groups
was 13-19 years. These groups were almost identical to those of Studies
1 and 2 with regard to length of hospitalization diagnosis (for the inpa-
tients) and demographic characteristics, and the procedure was identical.
Measures
The procedure of this study was identical to that of Study 2. In
addition to the MAST and BIS, participants were asked to respond to
two questionnaires.
Parental Bonding Instrument (Parker, Tupling, & Brown, 1979).
This scale serves as a measure of maternal or paternal care and overpro-
tection as perceived by the child. It assigns mothers to one of four
contrasting quadrants (high and low care and high and low overprotec-
tion). This scale contains 12 "care" (e.g., "spoke to me with a warm
and friendly voice" ) and 13 "overprotection" items (e.g., "felt I could
not look after myself" ), with each item being scored on a 4-point,
Likert-type scale, as remembered in the child's first 16 years. This scale
was adapted to an Israeli adolescent population by Kuznitz (1994) and
the internal consistency in the present study was Cronbach's alpha =
.89. In this study we used the maternal bonding form of the scale.
Self-Esteem Scale (Rosenberg, 1965). This scale is a 10-item (7-
interval) scale. In the present study, a low score indicates a high self-
esteem level, while a high score indicates a low self-esteem level. This
scale was highly correlated with other self-esteem scales (see Silber &
Tippett, 1965) and a high predictive validity (Rosenberg, 1965). The
internal consistency for an Israeli sample of the scale was reported to
Table 4
Pearson and Beta Coefficients of BIS Factors as Predicted by Maternal Care,
Overprotection, and Self-Esteem
Body image Body touch
Variable r /3 r 15
Maternal care .20* -.07 .23**
Overprotection -.25** -.13 -.25**
Self-esteem .57** .58** .29**
F (3, 144) 26.95** 6.36**
R2 (%) 36.3 12.8
Note. BIS = Body Investment Scale.
*p <.05. **p<.01.
421
be a = .78 (Nadler, Mayseless, Peri, & Chemerinski, 1985). In the
present study, Cronbach's alpha was .87.
Results and Discussion
Perceived Bonding, Self-Esteem, and Body Investment
Table 4 and 5 present Pearson correlations and standardized
regression coefficients for the associations between BIS factors
on the one hand, and perceived maternal care, overprotection,
and self-esteem scores on the other. For the four BIS factors, the
multiple regression analysis revealed that they were significantly
predicted by the above variables, which explained between 13%
and 37% of their variance. Pearson correlations showed that the
BIS factors were significantly associated with both perceived
maternal care, overprotection, and self-esteem scores (see Table
4). However, only self-esteem made a unique significant contri-
bution to body image feelings and attitudes, touch comfort, and
body care, whereas perceived maternal care was the only vari-
able that made a unique significant contribution to body protec-
tion (see Betas). The higher the self-esteem, the more positive
the body image feelings and attitudes, the more touch comfort,
and the higher the body care. In addition, the higher the per-
ceived maternal rejection (low care), the lower the body
protection.
BIS Factors and Suicidal Tendencies
A multiple regression analysis revealed that the four M A S T
factors were significantly related to the BIS factors (see Table
5). For attraction to life, body image feelings and attitudes, and
body care made a significant contribution: The higher the three
BIS factors, the higher the attraction to life. For attraction to
death, body protection, and comfort in touch made a significant
contribution. The higher the body protection and comfort in
touch, the lower the attraction to death. For repulsion by life,
body image feelings and attitude and body care made a signifi-
cant contribution. The more positive the body image feelings
and attitude and body care, the lower the repulsion by life. For
repulsion by death, the body image feelings and attitudes and
touch comfort made a significant contribution. The more posi-
tive the image feelings and attitudes and touch comfort, the
higher the repulsion by death.
Body care Body protection
r /3 r t3
.06 .27** .05 ,33** .21"*
-.15 -.27** -.13 -.24** -.06
.22** .47** .42** .32** .19
15.66"* 9.18
24.6 16.1
422 OR.BACH AND MIKULINCER

Table 5
Pearson and Beta Coefficients of MAST Factors as Predicted by the BIS Factors

AL AD RL RD

BIS factor r /3 r /3 r /3 r /3
Body image .52** .38** -.18"* -.05 -.56** -.43** .37** .41"*
Comfo~ with touch -.15 .01 -.22** -.18" -.21"* -.04 .19"* .32**
Body care .47** .32** -.01 -.06 -.42** -.26** .21"* .05
Body promotion .31"* .09 -.27** -.24"* -.31"* -.08 ~27"* .15
F(4, 143) 21.90"* 4.66** 22.59** 12.31"*
R2(%) 38 11 39 26

Note. AL = Attraction to Life; AD = Attraction to Death; RL = Repulsion by Life; RD = Repulsion by

Death; MAST = Multi-Attitude Suicidal Tendencies Scale; BIS = Body Investment Scale.
**p < .01.

In line with our hypothesis, suicidal participants received
lower scores in body investment and self-esteem and lower
scores in perceived care. The suicidal tendencies represented
by the four different factors of the MAST were differentially
predicted by the BIS factors. The BIS factors themselves were
predicted by self-esteem and perceived early maternal care.
Hence, our theoretical construct was supported through the rela-
tionship of body investment and suicidal tendencies, on the one
hand, and through the relationship of the BIS factors with per-
ceived maternal care and self-esteem on the other. The relation-
ship between body protection and attraction to death is of special
interest. The suicidal tendency factor of attraction to death has
been identified as the most crucial factor of suicidal tendencies
(e.g., Orbach et al., 1991). The present finding, resonate with
the above as attraction to death, was best predicted by the BIS
factor of body protection, while at the same time body protection
was best predicted by perceived maternal care. Thus, the posited
theoretical relationship between early care, body investment,
and suicidal tendencies was supported by the findings of the
present study.
General Discussion
The four studies reported here examined the psychometrics
of the BIS. The findings show that the BIS measures four factors
(body image feelings and attitudes, comfort in physical touch,
body care, and body protection) with high internal consistency
in each factor. The construct validity studies point out the special
relevance of this scale to bodily experiences, perceived early
care, self-esteem, anhedonia, and self-destructive behavior.
The validity findings show that suicidal inpatients differed on
all four BIS factors from the control participants and from the
nonsuicidal inpatients (except for touch). Further, the various
factors of the BIS were significantly correlated with different
aspects of suicidal tendencies. The findings of Study 3 show
that the BIS factors were significantly related to bodily experi-
ences such as physical anhedonia--a major distortion in body
perception characteristic of suicidal individuals.
These findings suggest that negative aspects of the body as
measured by the BIS can be indicative of self-destructive pro-
cesses and can distinguish between suicidal and nonsuicidal
populations. Thus, suicidality seems to be closely related to
bodily experiences tapped by the BIS. In line with previous
suggestions (Orbach, 1994, 1996), we hypothesize that negative
bodily experiences may serve as a facilitator of suicidal behav-
ior, while positive bodily experiences may be a protective factor
against self-destruction and an inducer of life enhancement.
Some of the psychological processes involved in the relation-
ship between bodily experiences, self-destruction, and life en-
hancement were highlighted by the findings of Study 4. Suicidal
inpatients received lower BIS scores, lower perceived maternal
care, and higher overprotection scores, as well as lower self-
esteem scores compared with the two other groups. Further,
different aspects of suicidal tendencies were predicted by the
BIS scores. Of special interest are the findings showing that
attraction to death (the most potent predictor of suicidal behav-
ior by the MAST) was predicted by the BIS factor of body
protection. In another analysis, body protection itself was best
predicted by perceived maternal care. These findings resonate
with Orbach (1996) that there is a special relationship between
early maternal care, body protection attitudes, and the suicidal
tendency represented by attraction to death. This view was theo-
retically the basis for the construction of the BIS.
The findings of Study 2 show that there is a relative lack
of difference among the four subscales within each group of
participants. At the same time, the subscales (with the exception
of touch) successfully discriminated between the three groups.
This somewhat puzzling finding may suggest that the four scales
represent different facets of a unifying hypothetical construct,
such as a generalized sense of body experience affecting each
facet in a similar way. This is expressed in a lack of relative
difference among the four factors. Yet the generalized sense
of body experience varies in groups with different personality
characteristics. These variations may then be expressed through
the differences in the specific subscale score in group compari-
sons. It can be speculated that in some groups of people, the
generalized sense of body experience affects each specific facet
(elicited by the subscales) in a different way. One such group
of individuals may be those who suffer from anorexia whose
typical behavior suggests both an extreme preoccupation with
the body and continuous damage to the body (Bruch, 1973).
This behavioral pattern would suggest that anorexic individuals
will show a high degree of body care and a low degree of body
protection.
 BODY INVESTMENT SCALE
A major limitation of our s t u d i e s - - t o be dealt with in future
s t u d i e s - - i s the lack of test-retest reliability. Future studies with
the BIS should take into account other limitations, such as the
use of cross-sectional data and retrospective self-reports. More-
over, the influence of current mood on self-reports should also
be taken into account. In addition, our finding regarding the lack
of association between anhedonia and depression (by means of
Beck et al.'s [1987] CCL) should yet be carefully scrutinized.
Our findings show that bodily experiences are most relevant
to the study of self-destructive tendencies, and the BIS seems
to be a promising instrument for such investigations. Yet it may
also be most instrumental in the future exploration of related
pathological behavior, such as eating disorders, drug abuse, and
experiences of physical and sexual abuse. Moreover, the BIS
may also be useful in the study of the role of bodily experiences
and self-enhancement and health-promoting and behavior of
coping with physical illness.
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 BODY INVESTMENT SCALE 425

Appendix

The Body Investr~ent Scale (BIS)

Instructions for Participants

The following is a list of statements about one's experience, feelings, and attitudes of his/her body. There
are no fight or wrong answers. We would like to know what your experience, feelings, and attitudes of
your body are. Please read each statement carefully and evaluate how it relates to you by checking the
degree to which you agree or disagree with it. If you do not agree at all: circle (1). If you do not agree:
circle (2). If you are undecided: circle (3). If you agree: circle (4). If you strongly agree: circle (5). Try to
be as honest as you can. Thank you for your time and cooperation.

1. I believe that caring for my body will improve my well-being 1 2 3 4 5

2. I don't like it when people touch me. (R) 1 2 3 4 5
3. It makes me feel good to do something dangerous. (R) 1 2 3 4 5
4. I pay attention to my appearance. 1 2 3 4 5
5. I am frustrated with my physical appearance. (R) 1 2 3 4 5
6. I enjoy physical contact with other people. 1 2 3 4 5
7. I am not afraid to engage in dangerous activities. (R) 1 2 3 4 5
8. I like to pamper my body. 1 2 3 4 5
9. I tend to keep a distance from the person with whom I am talking. (R) 1 2 3 4 5
10. I am satisfied with my appearance. 1 2 3 4 5
11. I feel uncomfortable when people get too close to me physically. (R) 1 2 3 4 5
12. I enjoy taking a bath. I 2 3 4 5
13. I hate my body. (R) 1 2 3 4 5
14. In my opinion it is very important to take care of the body. 1 2 3 4 5
15. When I am injured, I immediately take care of the wound. 1 2 3 4 5
16. I feel comfortable with my body. 1 2 3 4 5
17. I feel anger toward my body. (R) 1 2 3 4 5
18. I look in both directions before crossing the street. 1 2 3 4 5
19. I use body care products regularly. 1 2 3 4 5
20. I like to touch people who are close to me. 1 2 3 4 5
21. I like my appearance in spite of its imperfections. 1 2 3 4 5
22. Sometimes I purposely injure myself. (R) 1 2 3 4 5
23. Being hugged by a person close to me can comfort me. 1 2 3 4 5
24. I take care of myself whenever I feel a sign of illness. 1 2 3 4 5

Note. R = scored in the reverse direction. Copyright 1998 by Israel Orbaeh and Marie Mikulincer.

Received January 23, 1998

Revision received June 24, 1998
Accepted July 30, 1998 •

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