I found an article by the world-famous neuroscientist VS Ramachandran that really got me thinking. The title of the article is "Sexual and food preference in apotemnophilia and anorexia: interactions between 'beliefs' and 'needs' regulated by two-way connections between body image and limbic structures," and most of it is uber-technical and, though interesting, not that relevant to eating disorders.
One paragraph, however is. From near the end of the article, here it is:
Another body image disturbance is anorexia nervosa. A striking feature of this disorder is that counter-intuitively their appetite is often normal, yet the patients refrain from eating because they perceive themselves to be obese (eg when looking in a mirror). We suggest that the primary disorder is not in hypothalamic appetite centers, but, as in apotemnophilia, in the body image representation constructed in the polysensory [superior parietal lobe (SPL)]; that is, the SPL homunculus itself is obese and distorts the perception of one's body. The perceived discrepancy between body image (and a failure to construct an allocentric 'objective' view of the body) leads to acute discomfort that, in turn, reduces long-term food intake behavior rather than, and irrespective of, current appetite. Such a theory would flatly contradict the standard physiological model of food intake being regulated entirely by appetite and satiety. The organism strives for long-term weight change, which can shift long-term food consumption surreptitiously by 're-setting' one's appetite 'thermostat'. Correcting this primary body image disturbance may therefore be the only way to cure the condition which should be seen as a problem in long-term energy regulation rather than a simple appetite problem.
First, some vocabulary. I inserted links with definitions in the above descriptions (probably obvious, since I doubt Dr. Ramachandran would cop to using Wikipedia in a research article). This paragraph is, like the rest of the article, very technical and not written with laypeople like you and I in mind.
Regardless, what Dr. Ramachandran seems to get getting at is that, in anorexia nervosa, sufferers actually perceive their bodies to be 'obese' and restrict their food intake to lose weight to remove all of the flesh and fat that they don't believe is really theirs, similar to how people with body integrity identity disorder (BIID, the more common and speller-friendly name for apotemnophilia) wish to have a limb amputated. To some degree, this makes sense to me.
I have always perceived myself as a very large person. Although I was never tiny or waiflike, I also was well within normal limits on my growth charts. Being teased about my weight only cemented this fact in my brain. I recently told my mom that I had to have been one of the largest girls in my high school class, and she gave me this look like, "What planet have you been living on?"
Even now, I occasionally like to think of placing myself on a spit like the roasted lamb they use to make gyros, and just have some butcher slowly carve away the excess flesh. It doesn't really seem like me. Yes, I get that liposuction won't change a damn thing about me, but to suddenly strip away all of the parts that weren't me and seem so unnecessary wouldn't distress me in the slightest. Suddenly losing a toe would affect me deeply, even aside from things like, you know, pain and blood and balance.
Let me reassure you that I'm not cracked and I know body fat is important and I'm not about to ask the Greek guy down the street if he has a hankering for some gyros. From a rational standpoint, I get that this is pretty strange and not that based in reality. However, this is also how I tend to experience the world. Gaining weight, to me, is like requiring someone with BIID who amputated a limb to wear a prosthetic device.
It's interesting how all of these issues--body image, OCD, anorexia--have all become mixed up into one thing with me. And it's refreshing to see information on body image and eating disorders that's not all about OMG TEH MODELZ!! Do super-skinny models help my whacked-out brain? Not at all. But I think that body image distortion can be far deeper than the pages of Cosmo and Vogue.
Enough about me, though. Tell me what you think!