Early in their treatment most patients with formal eating disorders have a gross misunderstanding of the meaning of “body image”. These patients are aware that the term refers to how the body is viewed, but the method for altering poor body image is imagined to be changing the body. When patients understand that it is the distortions in the mind that require change they often feel discouraged. Anything contrary to a loathsome view of their bodies is what these patients view as distorted. Patients experience such negativity as objective truth that negates competing sources of self-evaluation.
Worsening their dilemma is the cycle of futility created by patients’ belief in an inferior body co-existing with, and reinforced by an obsessive pursuit of impossible physical perfection. This cycle is difficult to interrupt because both the pursuit of perfection and the belief in physical inferiority are driven by a deeply held assumption that appearance, weight, and shape are inextricably linked to self-worth. Patients’ self reports often indicate acknowledgment of accomplishments, talents, intelligence, creativity, compassion, and other aspects of personal value. However, these are seen as inconsequential compared to the value of appearance. Multitudinous evidence of personal value is summarily dismissed because the patient believes her true standard of worth (her body) is sub-standard. She believes that her worth would be proven if only her body were perfect; and because that perfection is hopelessly elusive, her value is unalterably undermined.
Images of idealized female beauty are marketed as the normal and desired standard, and are virtually inescapable in our media saturated culture. Exposure to this relentless urging to pursue unreal physical perfection and thinness is thought to detrimentally influence the self-esteem of most girls and women. Indeed, evidence suggests that the non-clinical population experiences significant and persistent body dissatisfaction. A research summary from the Social Issues Research Centre cites a study indicating that 81% of girls had already dieted by the age of ten. The centre also cites recent research indicating an increase in body dissatisfaction among adolescent and middle-aged males, attributed in part to increased presentations of unrealistic images of male beauty.
Among the clinical population, most, but not all patients with eating disorders suffer from distorted body image, according to a study in the American Journal of Psychiatry. The authors suggested that, if replicated, their findings might indicate a need for revision of the DSM diagnostic criteria for formal eating disorders, which currently include body image distortion. That said, while many women with normal eating habits adopt a critical stance toward their bodies, and not all persons with eating disorders suffer from extreme body image distortions, it is rare in our clinic to see a patient who does not suffer more than the average person from distorted body image. Rita Carter in her book Mapping the Mind states, “anorexics…may have impaired hypothalamic function”, positing that “limbic area dysfunction is increasingly seen to play a part in eating disorders”. Carter also names cultural influences as culpable in patients’ distorted body images. “An anorexic’s ambition to be thinner-than-thin, or the bulimic’s determination to prevent their body from absorbing what they have eaten, are conceived in the conscious part of the brain and clearly have a lot to do with the way that a person thinks.” Carter suggests that eating disorders are open to interventions that address both physiological disturbances and mental distortions.
Mental distortions are addressed in Walker Wellness Clinic’s body image groups for adolescents and adults with evidence-based interventions based on Cognitive Behavioral Therapy methods and Dialectical Behavioral Therapy. Patients are shown how to reduce anxiety and loosen the grip of negative beliefs by distancing themselves from distorted thoughts and overwhelming emotions. Patients then become more open to exploring and disputing negative self-talk and other self-defeating habits. The resulting glimpse of a more affirming relationship with the body introduces a sense of hope; and hope becomes the patient’s strongest ally in exchanging a sense of futility for the will to continue the arduous process of body image alteration.