Body Image Work in Eating Disorder Treatment

Body image thoughts are almost always the hardest part of any eating disorder recovery. Although not everyone has these thoughts and may have other difficult parts of recovery, body image tends to be a big challenge to address.

First, body image is subjective. Even if clinicians can counter body image norms in many different ways, these data points aren’t very convincing. Besides, we process our own body image very differently from other bodies. There is some compelling research to show that processing one’s own body image uses non-visual brain centers. So body image is likely more about self-perception than it is about what we see in the mirror. It’s hard to convince someone to see themselves differently when they aren’t even seeing themselves at all.

Second, body image and weight are markers for people to assess their success or failure. Each morning on the scale or each day trying on an outfit is a referendum. Is today a good day or bad day? Can I feel good today or need I feel awful? Too many people with eating disorders conflate appearance with well-being in a very automatic, unconscious way. Taking away this assessment would leave them with no way to function that day.

Third, body image is everywhere. We are bombarded with media and photos of people all day long. When body positivity was prevalent, at least some of those bodies were not extremely thin. In the GLP-1 era, bodies are all extremely thin again in media and even in shrinking celebrities, family or friends. It’s hard to address body image when the world presents a very different message.

Work on body image takes a circuitous route. The focus in recovery must be more profound from the start and center on what matters in life, whether that is work, family, friends or community. People in recovery need to look inward and find a path that matters to them which, to start out, is at least as important as body image.

At first this new path may only compete with body image rights for attention. Through the process of getting well, a new focus can begin to replace and hopefully supersede the all consuming body image thoughts.

In the end, the body image concerns can still exist and insert itself into one’s consciousness. There is a big difference between intermittent body thoughts and an all consuming focus. Life needs to mean more than distorted and disturbing body image thoughts and be about other things that matter a whole lot more.