Painting by numbers

Unfortunately, because diagnostic categorization of eating disorders are based primarily on body weight, statistics on recovery are also based on restored body weight.

Which is dumb. The illness is still there, at least for a while, and withdrawing treatment and alarm at the very time one most needs it mentally strikes me as cruel.

I am always happy to see research drawing together information on what we know is happening medically and what is happening cognitively. This research, Body attitudes in patients with eating disorders, looked at body attitudes but at intake and months after weight restoration.

And an interesting and important observation arises: Restrictive anorexia "patients indicated no significant improvement in body attitudes" while purging anorexics, bulimics, and EDNOS patients all did share improvement in that measure.

It is important to know, if this bears out, that restrictive anorexics may have more intractable body dysmorphia than other eating disorder patients. For one thing, so we don't promise patients that weight restoration will make that feeling go away. So we can better predict who WILL feel better on that measure. So we can search in a focused way for better treatment for body dysmorphic symptoms in those who are more at risk for relapse for that reason.


  1. This parallels my experience. My daughter restricted only. She yo-yo'd wildly in her weight, first with a 40 lb. loss, then a 40 lb. gain past her 'typical' weight. All within 1 1/2 years. Not long ago she told me she still strongly dislikes her body. She is fully weight restored and has gradually returned to her 'normal' range. She is so beautiful and it makes me sad that she cannot see it. It is truly baffling.

  2. Anne, have you read the book "The Broken Mirror?"

    I wonder if your daughter has Body Dysmorphic Disorder even independent of the ED. What I'm taking home from that research is that some people have BDD and refeeding doesn't resolve it - maybe it was the trigger in the first place for the restriction and therefore the cascade of the ED.

    BDD is treatable, with certain SSRIs and CBT. It helped me a lot to see that BDD wasn't a baffling lack of insight or an overvaluing of thinness; it is a real brain experience and a cruel one.

    You've probably already explored this, but I know that book was hugely helpful to me in understanding what was going on even after refeeding for some patients - including my daughter.

  3. I haven't read it. Perhaps I should. Convincing my daughter of yet more therapy could be difficult! She is actually on an SSRI again (her own decision), and I've suggested CBT in the past but she hasn't done it.

  4. Laura,
    Who is the author of "The Broken Mirror"?
    It may help me understand this baffling disorder that my daughter does suffer either from the ed or separate, I don't know...

  5. The author is Katherine A. Phillips, M.D., and there is a link to the book on the right of this post -> in the "My Favorites" amazon box.


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