Trapped in the mirror

Eating disorders aren't, of course, the only disorders to feature a distorted body image. Another illness whose major diagnostic criteria is an inability to perceive yourself accurately is body dysmorphic disorder (BDD). Thought to be closely related to OCD, BDD is diagnosed when a person spends an inordinate amount of time worrying and obsessing over a particular body part not looking "right."

While some people with BDD might just obsess about this problem, others take drastic measures to "fix" the problem. A woman worried about her skin may wear heavy makeup, have surgery or laser treatments, or even refuse to leave the house. A man who feels his nose is too big may have repeated plastic surgery or even break his own nose to try and "fix" things.

Although BDD is tremendously debilitating, many people perceive it as vanity-on-overdrive, a view remarkably similar to the view of eating disorders as a diet-gone-too-far.

Says researcher Kieran O'Connor, who studies this disorder:

"It's as if these people are looking at themselves in a mirror that deforms their image," says O'Connor, who completed his clinical training in England. "They'll carry on an internal conversation and convince themselves that there's a problem with their bodies, although it's not based in reality. I've seen people who have flagrant physical flaws, yet are preoccupied by a completely different aspect of their appearance."

These internal conversations, this pseudo-brainwashing from within, reminds me of eating disorders. When a sufferer says "I feel fat!" believe them. That is his or her reality. However absurd it may seem, when a person is otherwise normal-looking or even dramatically underweight, he or she sees fat. No, it's not rational, and that's the point. They didn't reason themselves into it, and you can't reason them out.

Moreso, I think the connections to BDD and OCD will prove very important to teasing out how and why eating disorders (especially anorexia) develop. O'Connor says of BDD, "The source is difficult to pin down – whether genetic, parental influence or stress – but the consequences can be serious, including suicide."

Two small pet peeves about the otherwise easy-to-read, enlightening article:

  • The best way to help a person break free from an OCD-esque behavior is not to figure out why it happened but to figure out how to stop it. Cognitive-behavioral therapy is the only proven way to help reduce obsessions and compulsions. Analysis can come later.
  • Anorexia is not caused by bad body image. Poor body image can precede an eating disorder, sure. But it doesn't cause it. Most women I know dislike or misperceive their bodies- but most of them don't have an eating disorder. Bad body image really kicks in as the eating disorder progresses.

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IrishUp said...

"They didn't reason themselves into it, and you can't reason them out."


Carrie - can you make this into, like a brand or something we can stamp people with. Like clueless clinicians, so they can see it on their foreheads every morning?

Sry, going around the mulberry bush again with the treatment team, sigh...

Carrie Arnold said...

You should do like Moses and burn the bush...

Well, I guess that wasn't Moses, really, but the sentiment still holds.

I've been using that theme to help my mom deal with, uh, recalictrant relatives. It's helpful to keep in mind when dealing with people who are unreasonable not from muleish-ness but because they just don't get it and can't see it and probably won't (or at least not until much later as it is with AN) and you still have to move forward.

A:) said...

Interesting. . .

I had a psych class today and apparently there is a condition where the brain cannot recognize certain facial expressions or misconstrues them.

I wondered (in my ignorant way) if people with AN or BN could possibly have some biological difference that causes misperception of body appearance/facial expressions.

I have also been told that the inability to see your appearance worsens as starvation worsens. . .


IrishUp said...

there is some interesting research that indicate that AN pts do have problems with interpreting social cues like facial expressions. The findings indicate they are much more likely to view faces as negative, and inflate the negative they see (ie what looks disappointed to non-AN subjects is classed as angry by AN subjects).
There's a great talk by a psychiatrist named Sloane Madden out of AUS that's on the web, which summarizes what's known (and not known!) of the neurobiology of ED, if you're interested.

Carrie - the damn thing must be kudzu. Everytime we start to think we've uprooted it for good - WHOOPs - there it is again! Old habits die hard, and old prejudices even harder, but old treatment paradigms take the cake!

Carrie Arnold said...


You are wondering in your not-so-ignorant way. There are several experiments that show what you're saying. I don't have internet at home right now, but I will add it to my list to try and see if I can dig them up.


And that kudzu does appear to be Roundup Ready, huh? Sorry to hear your ongoing difficulties.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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nour·ish: (v); to sustain with food or nutriment; supply with what is necessary for life, health, and growth; to cherish, foster, keep alive; to strengthen, build up, or promote


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