In the search for understanding of the disease of anorexia, a great deal of emphasis is placed on the issue of distorted body perception, and how it can influence the person’s self-image and the resulting behaviors.
The majority of the women in the US, with or without an eating disorder, have a heightened awareness and self criticism of their body shape and size. Society sends the message that thinness equals beauty and perfection, and that a person’s worth is based on physical attributes, which fuels the irrational thinking. Our diet-obsessed society can contribute markedly to the anxiety and obsessive behaviors, with regard to weight issues in the anorexic.
Misperceptions and distortions are sometimes already in place before anorexic symptoms begin. Dieting and weight loss can have a snowball affect, as each lower weight goal is reached, it is still not low enough. Each weight standard that an anorexic sets for herself, is replaced by a lower weight requirement, and a cycle begins. There is never a weight that is low enough. As this continues, the distortion of body image worsens. The drive for perfection perpetuates the cycle, never reaching a point that is good enough.
Anorexics frequently lack the ability to see reality about their own body. The distortions they see in themselves, seldom apply to others around them. Starvation contributes greatly to the distortions, which also increase comparisons, fears, and even paranoia about food, weight, and the desperate need for control. An anorexic becomes acutely aware of her body size, how many bones she can feel, how her clothes fit, if she is getting smaller. There is an odd sense of safety and security in staying emaciated and being able to feel bones without flesh. Smaller is always the goal. There is a visceral discomfort that can not be adequately described. Especially in times of stress and anxiety, there is an actual feeling of body expansion. It may develop into hypersensitivity to being touched by others, or even to having parts of their own bodies touch (legs, arms, etc.). This seems to center more in the mid body. The sensation of clothing touching their body may also set off extreme discomfort, as if proof that their body is growing larger. “Checking” may become an obsession. There is a need to continually feel their abdomen for anything other than flatness. The circumference of their upper arm may have significance to them, whether or not it is small enough to enable the fingers to encircle it.
For some, analyzing their mirror image may become constant, always looking, comparing, and seeking validation of a need to lose weight. The comparison issue also strengthens the misperception. They truly perceive themselves as being bigger than others, who may actually weigh 30-50 lbs. more than they do. There is nothing rational about the physical or psychological view that they have of themselves, while starvation effects are still present. In recovery, when the weight restoration process begins, body discomfort and distortion often worsens. Gaining weight, and the bodily changes that are associated with it signifies many different things to different people. It coincides with the loss of the anorexic identity, and the many fears involved with that. It nearly always indicates a loss of control, which to some also means that their weight is no longer in control. Some may be reliving their years of physical puberty, only then developing physical/sexual female characteristics, which makes the struggle with the image of their changing body even greater. This can stimulate memories and fears with past abuse issues, or fear of maturity and womanhood.
Normalizing body perception and acceptance is, I believe, one of the last issues to resolve in recovery. It requires continuous work on developing a healthy self-concept, including confidence and acceptance of who you are as a person, not solely as a physical body. As I have learned to distinguish my emotional and psychological issues, along with generalized anxiety, from eating, food and weight, I am much more able to prevent body discomfort, and to deal with it when I can’t. For me, the presence of body discomfort, emotional or physical, serves as a red flag that something deeper is going on. I can’t always identify the underlying emotions, but the key is accepting them and moving on.