People with eating disorders struggle more with body image than with any other part of their illness. Even when eating behaviors have normalized, body image distortion often persists for years afterwards before fading.
The first component of body image thoughts manifests as a brain distortion. The visual image of one’s body is transformed in the brain into something very different from reality. At the most extreme, people who are very underweight see a much larger person on the mirror. Others may only see a body that disgusts them no matter its appearance.
As one’s own reflection is associated with such negative thoughts and feelings, it becomes impossible to disconnect the internal reaction from the way their body actually looks.
I have seen many people have an experience that highlights the power of body image distortions. These patients have told me that they will catch the reflection of their silhouette in a store window and not realize they are seeing themselves. In that moment, they describe having a positive feeling about that body and often a jealous reaction that they wish it was their body. Once they realize it actually is their body, the reaction immediately changes to seeing a body they hate which leads to disgust and hatred.
This moment makes clear how body image symptoms can be seen as a brain malfunction. The brain of someone with an eating disorder can process one’s own image very differently depending on the context. The exact same body can be a source of envy or the locus of disgust depending on whose body it is.
The connection of positive or negative feelings with one’s body grows from years of associations with how one feels about oneself. The core of the negative associations starts at a younger age and coalesces around body and body image through the process of childhood and into an eating disorder. The next post will focus on this process.
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