One of the most challenging aspects of an eating disorder can be the perceptual experiences one has as it relates to body image and the internalized feelings associated with their perceptions (see body-dysmorphia page on this site). While not everybody with an eating disorder also reports body image distortions or distress, most eating disorder suffers do experience some level of distorted perceptions. Unfortunately, body image distress can increase the risks of relapse ten-fold, increase urges for self-harm and suicide, and often remain as one of the last aspects of an eating disorder to resolve.
When treating body image issues, it is important that a psycho-bio-educational process begin with the patient to help them understand exactly what is taking place in the brain. Many studies have shown how changes with brain blood flow patterns and brain functioning can lead to the type of perceptual distortions one experiences with an eating disorder. From this perspective, patients (and families) need to understand that there are true organic, physical processes taking place and that create these false perceptions that appear real. In turn, there develops a large gap in understanding the patient who may see themselves as “huge,” despite being under weight or of average weight. The perception of the image the patient sees is their reality and attempts to reassure the patient that they are otherwise only leads to the patient feeling less misunderstood and more mistrusting of the reassurance.
An analogy I often use is one that is similar to what takes place in a 3-D movie. With a 3-D movie, one wears special glasses that can make it seem as if images on the movie screen are actually coming off the screen and the mind thinks they are real objects that can be touch. Probably anyone who has been to a 3-D movie has experienced the feeling that something was flying at them and reacted by putting their hands up or jerking their head out of the way. And even though, you know that you are there in a theater with special glasses that create that effect, your brain’s natural tendency is to react to something that’s not really there as if it was in reality. With a good 3-D movie, you can try your hardest to not react, but you still will likely go through the physiological experience with your nerves as if it was truly happening.
With body image distortion, there are changes in the brain that has a patient perceiving what they see as reality and the only way to take off these glasses is by finding recovery. What they perceive seems real and the brain and body’s physiology reacts to it by emitting an emotional response and related behaviors to try and self-sooth. The first part of treating body image distress is to help the patient understand what is going biologically in order to adapt new interpretations of their perceptions and find appropriate coping skills to manage the related emotional aspects which can feel very real for a significant period of time throughout the recovery process.