Wow, body image. Such a difficult topic, in my opinion. I do think it is the very last thing to change in an eating disorder, which is really quite unfair. At the same time, I think there can be significant improvement in body image, both for physiological and psychological reasons, as ED behaviors stop.
Physiologically, we know from the Keys Study that body image concerns can be created from starvation alone. In short, the Keys Study showed that when they starved down totally normal men (this was for a completely non-ED related study, by the way), they developed dissatisfaction with their appearance. The men did not have EDs, but began to illustrate a number of behaviors we typically think as being caused by the ED. This study is the main thing that has illustrated that starvation must be addressed prior to, or at least at the same time as, working on the psychology of the ED, because many ED thoughts and feelings can improve with appropriate food intake and weight. In these men, weight gain alone corrected the body image concerns.
I have a colleague who developed cancer, and had to have chemotherapy. She lost a significant amount of weight, and one day, she looked at me and said she finally understood the body image part of eating disorders. She told me that, before she got cancer, she was satisfied with her appearance and weight. However, after losing weight, she found herself reticent to regain weight, though recognized this made no sense. So, this example also demonstrates how starvation alone causes body image concerns.
But, let me tell you, trying to convince a currently low weight patient that they will FEEL BETTER about their body as they gain weight....that's a pretty hard sell. And, it's not that they will LOVE their body. I have come to describe it this way: You will feel better about your body at that weight then you think you will at this weight. A confusing concept.
The other thing I noticed in working with patients with binge eating disorder was that, once they stopped bingeing, even when their weight stayed the same, they reported improved body image. I think this makes sense, because who can feel good about their body when they are subjecting themselves to any ED symptom.
So, how do I treat body image? Well, I guess I don't really. In those who need to gain weight, I guess I don't much see the benefit. As I explain to them, if I help them accept their weight during weight gain, they just have to keep reaccepting their weight. I think that would be maddening. I certainly know there is research evidence that some body image approaches help, but I guess I'm just not convinced they help enough, and instead may increase focus on one's body.
I think what has impacted me the most was one group I ran in a treatment center. I had asked the group members what they wanted to talk about, and they got me; they wanted to talk about body image. Aack! Somewhere in that group, I spit out a sentence I didn't think was of much consequence. I told the group members my personal approach to body image. It came out something like this:
Sometimes, I don't like what I see in the mirror in the morning; but, then I look at myself, say, "I
have (bleeeep) to do," and head in to work to treat eating disorders.
My point with this was simple; that passions, goals, wants, interests, can outweigh what is seen in the mirror. If I stood there in the mirror and focused on how I looked, I would lose time doing my passion.
Now, I thought this was just one of those random sentences that comes out of my mouth. I was shocked when patient after patient came up to me over the next few months, saying this one random sentence really changed their view of body image. So, I guess that has always been my focus. Figure out what is more important than the image you see in the mirror. Sure, there are other things you can do....don't body check, pick out parts of your body you do like or value, stop the critical thoughts. But, more so, figure out what is more important....your appearance, or what you want to do with your life?
What things have helped you with body image concerns?