Interesting thoughts on body image in anorexia

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?"

Yet throughout much of the eating disorder, I didn't perceive myself as obese. I saw myself as average. As long as I stuck to my rituals of eating certain foods at a certain time, I felt okay. I did feel larger if I ate the "wrong" thing, or too much of it, or ate at the wrong time. The feelings of "fat" were very much like the feelings of contamination I felt when I was deep into the OCD hand-washing. Performing the rituals--purging, exercising, restricting, or hand-washing--relieved this anxiety. The problem is that anorexia further distorts body image, so there is never such a thing as thin enough.

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!

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Kelly said...

Wow, really interesting!
I also liked your part about the gyros:)

Cathy (UK) said...

Well, I guess you know my thoughts on body image in my experiences of anorexia nervosa Carrie... I actually visually saw myself as being very thin when my BMI was 13, 14, 15, 16, 17... I hated that thin image and covered my body up in baggy clothes because I didn't want to draw attention to my emaciation, which personally I hated. I was a thin child and never had body image issues. However, I did find the physical changes of puberty frightening.

What kept me in severe (restricting) anorexia nervosa for nearly 30 years was the behaviours themselves. Controlling my food intake, counting calorie intake (and fat, carbs, protein...) + calories output (through exercise) made me feel in control of my body, my emotions and my life. The less I ate, the harder eating became because I felt so uncomfortably full. I chose my anorexic behaviours over engaging in life, because I was scared of 'life' and social interactions. (I do have social anxiety and OCD that pre-date my anorexia nervosa). I also have traits on the autism spectrum - especially systemising. I find people difficult to understand and to read. These traits became especially evident during my teens when social interactions become more complex.

Although the behaviours of anorexia nervosa are relatively homogeneous, the causes amd 'meanings' of those behaviours to each individual may be heterogeneous. There's a review on 'non fat phobic' anorexia nervosa in this month's International Journal of Eating Disorders...

As usual, great post Carrie :)

Katie said...

I relate to Cathy's experience as well - I saw myself as thin when I was anorexic, although I didn't realise quite how sick I was until I started getting better. I was starving myself in part because I knew I was more attractive at a normal weight and I felt safer looking androgynous. The other motivation was that it was such an effective way of dampening my anxiety (which again, like Cathy, also far predates my anorexia). I was convinced that without the anorexia making me flat and numb I would go crazy. I often wonder if there is a difference in the physiology or chemistry between anorexics who are genuinely convinced that they need to lose weight because they are fat and those who have more atypical thought processes.
Really interesting post :)

Lulu said...

That is so fascinating! Remembering back to when I was anorexic, I definitely had a sense of disconnection from my own flesh, and I remember describing it as a dense cotton-wool substance, clinging to and shrouding me. I also recall feeling extremely impure and contaminated by my fat, as you described – despite obviously realising, rationally, its necessity, it felt like something smothering me. When I initially gained weight in recovery, it felt like blocks of unfamiliar foam that had simply been glued to me (I’m improving now and accepting it as mine).

What I’m wondering is what prompts the abnormalities in those specific brain regions? How do they explain why, rather than existing consistently throughout a sufferer’s life, they abruptly emerge at a certain stage, prompting the onset of the eating disorder? It doesn’t seem to explain why the distorted perception commonly emerges following trauma or upheaval. (Is there something about trauma that actually acts in the brain and stimulates those regions?) Also, nor does it explain why the sensations of perceived obesity intensify as the anorexia worsens (which I would imagine should incriminate the malnutrition itself as instigating those thoughts. So does this theory suggest that starvation alters brain chemistry in those specific areas responsible for the obesity thoughts?)

Anyway, I had to smile reading your final remark and I completely agree, it’s certainly heartening to read more diverse and credible explanations, rather than merely the myopic, generalised (and self-indulgent) assumptions of the media blaming itself. said...

Cathy's experience has been mine as well. When I was at my thinnest, I was embarrassed by myself because I knew how thin I was. Now I have no idea what I weigh, but I'm pretty sure I'm smack dab in the middle of "normal" and I don't stand out as too thin. Now that I'm "normal," I do feel and perceive myself as pretty huge. When I was at my worst, one thing that kept me from eating more (besides the behaviors themselves) was fear of being fat. I felt trapped because, on one hand, I was embarrassed by how thin I was. On the other hand, I "knew" that if I ate more I would instantly become "obese." I thought my body would never travel through the middle/slim range.

Cobalt60 said...

Reading this was one of those "click" moments for me. Kind of said all of those things that I'd been trying to get out for a long time.

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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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