Why brain problems need to be seen for what they are

As glad as I am to see Software Program Accurately Assesses Body Image in Patients With Anorexia it won't help us unless we also get rid of a deep societal distrust of larger body size.

It also won't help us unless we understand that brain-based distortions can't be reasoned with.

Imagine feeling 10% larger - or smaller, or taller, or shorter - than you are. Physically feeling it: seeing it in the mirror and feeling it in your limbs. Life will be constantly distressing as you try to reconcile it every time you breathe, walk, stand up, reach out to touch something. Imagine those around you don't understand and argue with you. They minimize your perception and your distress. You feel unsettled, mistrustful, disoriented. Imagine that you have a way to get rid of that feeling: eating less. When you eat less your feelings numb down. When you eat less you believe - both rationally and magically - that you will be smaller. That you will be more like what you feel you "should" be. But it doesn't work; the bar keeps moving. Your anxiety about not slipping back gets worse. You build rituals around keeping that anxiety away.

That is what I think of as body dysmorphia. I don't think we can talk people out of it. I don't think they get it from overvaluing thinness - I think it is a problem with the brain. I think we need to have compassion and insist on the best treatments. I think we need to understand this disjunction is not a choice or vanity.

Body dysmorphic disorder, which often involves misshapen limbs or facial deformation, can be successfully treated, for many people, with SSRIs. For those whose dysmorphia is caused by malnourishment**, regaining a healthy body composition can successfully treat the condition. Many eating disorder patients feel smaller once they gain enough weight: they repair the disconnect.

Frankly, I don't think we need this empirical test for the patients' sake - science already knows what they need. We need this test for the rest of us: so we understand and believe what they are experiencing and make sure they get the treatment they need and not more misunderstanding and alienation.

** This symptom is NOT seen in all eating disorder patients, especially children, and in those living in cultures less morally enthralled by thinness, and should NOT in my opinion be necessary for diagnosis. I would also be very concerned about too much focus on this kind of test and implanting a fear of larger body size in those who may not already have it. There is a validation of size phobia inherent in testing people for it!
***For an excellent and well-thought out theory on why malnourishment would bring on dysmorphia, read up on Guisinger.


  1. Laura,

    Thank you for this. Though when i was 12-19 i did harbor a fear of being fat, and believed i was fat, my thoughts and fears of whether or not i am fat have been absent for quite awhile.

    I dont know that it was ever really truly about being afraid of being fat, but rather a method of internal torture like cutting. It also for me has been ever since i was a kid a true food aversion.

    When i was younger i didn't eat much either i would throw away most of my meals and it was difficult to get me to eat then when the trauma set in, i discovered that anorexia could help me to control my emotional pain, and to control whether or not i live or die, it took over. Lots of other reasons....the least of which involve my fears of being fat or my belief that I am overweight.

    I know im a twig, it makes me cry, and i cant change anyway. I know im rail thin im not fooling myself, but understanding this fact has not gotten me personally any closer to recovering.

    So again thank you for pointing this out because though i recognize that for some body dysmorphic disorder is everything to do with their E.D for me though it is part to do with my E.D it is such a small part at this point, that understanding it isn't helping me much at all.


  2. D,

    Insight is over-rated. All the insight and motivation and desire to be well in the world can't help if it exists behind the wall of ED, and can't act on the world. That's not your fault. You need someone near you to offer shelter and protection from ED so your insight and intentions can get traction. Is there someone you can let in? Someone I could talk with? You are in there and you want to be let out!

  3. Laura I dont know. I have such trust issues. I promise as soon as I can figure who would be a good parental figure in my life I will talk to you again, and Ive even tried talking to my mother more after talking to you, but ive gotten sicker since talking to her.

    I do want recovery more than anything though so im not going to give up. But truly i dont know who i could reach out to, thats why i reached out to you.


  4. Jaded,

    This is going to sound harsh, I know, but it is true: reaching out to me when I have no power to really help isn't really reaching out. It may be part of your pre-contemplation, though. I think of the situation you are in as being in the Wizard of Oz story.

    You may, like Dorothy, see that the way home was there the whole time, but because you didn't believe you didn't use it.

    I can't promise that I can convince your mother or someone else in your life to take care of you the way you deserve, but I sure can try. I can also try to find ED resources in your local area who will work to get you safe from ED.

    Look down: are those Ruby Slippers on your feet?


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