Dr.Tasaduk Hussain Itoo
Body image disturbance is one of the most common clinical features attributed to eating disorders. Most contemporary theories consider body dissatisfaction to be the most immediate or proximal antecedent to the development of an eating disorder and empirical studies indeed confirm this association. It is generally agreed that the body image construct is multidimensional, involving attitudinal as well as perceptual components.
A predictor for an eating disorder
Body dissatisfaction is one of the most important risk factors for restrictive dieting which, in turn, predicts the onset and the maintenance of serious eating disorders.
It is a major predictor of relapse in both anorexia and bulimia nervosa; patients who do recover report that body image is one of the major impediments to lasting change. The most challenging problem is how to affect lasting change in body dissatisfaction among those with eating disorders.
Methods used to help body image
Various methods have been used to attempt to correct distorted body size estimation. One method has been to provide corrective feedback to anorexia nervosa patients with the aim of improving accuracy over time. This can be accomplished in several ways.
One strategy involves providing feedback on standardized measures of size estimation. Another involves directing patients to study their body in a mirror and try to develop a more objective or realistic view of their weight or shape. Some studies have shown that this exercise may have value in helping patients overcome denial of the severity of their disorder.
However, most clinicians agree that directly changing body size perceptions has very limited role in the treatment of anorexia nervosa. It is not surprising that confronting patients with their own distorted self-perception has little therapeutic effect since most patients have a long history of feedback by friends, family and therapists that they are too thin and must gain weight.
Finding the origin
Body size overestimation can be thought of as a perceptual anomaly that is often observed in eating disorders. This is similar to other situations where people are encouraged to not rely on a particular perceptual state but rather defer to a higher-order judgment regarding the perception – for instance a person trying to decide whether or not to drive a car after drinking alcohol. Accordingly, patients are encouraged to view their body-size mis-perception as an unfortunate perceptual disability (like being a color-blind person trying to coordinate his or her wardrobe).
In this case, it is preferable to rely on objective data or a trustworthy person, rather than self-perception to determine actual body size. Body image usually does not improve early in the process of recovery from anorexia nervosa, and in fact, it often becomes worse during weight gain. If it does improve, it is often in the later stages of recovery.
Treatment
There has been remarkable advancement in recent years in the technology for treating body dissatisfaction in those at risk for eating disorders, and for obese individuals. The application of these approaches to anorexia nervosa has been less fully developed. Treatment for anorexia nervosa requires increasing weight and weight gain is not uncommon in those with bulimia nervosa which predictably increases body dissatisfaction in the short-term.
Cognitive restructuring can be focused on identifying the idiosyncratic meaning that “being thin” and “weight control” has for the patient, and then finding more elegant personal and interpersonal solutions that do not require the life-long physical, psychological and interpersonal disadvantages of maintaining anorexia nervosa.
Focusing on the good aspects, and avoiding the bad
Developing a more positive body image often involves avoiding certain self-defeating practices, like:
Weighing
Looking in the mirror
Wearing revealing clothing
Compulsive exercise
These provide short-term relief, but become rituals that only accentuate anxiety, discontentment and dysphoria. These can be replaced by body image enhancement activities (yoga, movement, pleasure walks, listening to music,) that emphasize the body as a source of pleasure rather than a vehicle for control, mastery or self-definition.
Addressing relationships to improve body image
It is also vital to understand the role of the interpersonal context in body dissatisfaction and to address peer relationships in promoting change. Recent evidence indicates that girls tend to select friends who are similar to themselves in terms of body dissatisfaction and bulimic symptoms but dissimilar in terms of dieting and that body dissatisfaction is predicted by peer conversations about dieting, body consciousness and thin idealization.
Promoting a healthy “Normal”
It has been our experience that promoting healthy group norms is one of the most important targets of intervention over the course of therapy. Additionally, a major impediment to change can be parental attitudes toward weight and shape or parents’ overvaluation of thinness that can have a detrimental effect on the treatment of their children.
This issue must be approached with sensitivity to the historical factors influencing parental attitudes; however, treatment must focus on changing the family imperatives that interfere size acceptance as well as respect for individual differences of a wide array of attributes.
Prevention programs
Psycho-educationally oriented prevention programs can reduce body dissatisfaction and reduce ameliorate disorder symptoms. We rely heavily upon psycho-education as well as cognitive approaches to challenging body image disturbance and these have led to clinically and statistically significant changes in body dissatisfaction over the course of time.
(The author is a resident Doctor at Acharya Shri Chander College of Medical Sciences & Hospital Jammu)
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