With effective treatment, eating disorder behaviors related to food and exercise subside. Many times loved ones perceive that this means the individual is “over” the eating disorder. But those who have suffered know that this is typically just the beginning.
That’s because body image often gets worse before it gets better as behaviors are decreased and eliminated. And it’s often the last part of the eating disorder to subside. As Jenni Schafer describes in her iconic book, Life Without Ed, negative body image often acts like bookends to the eating disorder – present at the beginning, and the last thing to resolve in the end.
Why is this???
The psychology of body image in eating disorders
I recently described in another post the metamorphosis of body image between childhood and adulthood.
Ask an adult what they like about their body and you’ll likely get a response along these lines:
- “Nothing.”
- “I guess I don’t mind my hair/eyes/etc.” (Often a part of the body that we don’t judge on its fatness. Also note the disqualifies of “I guess” and “I don’t mind.”)
- (Nervous laughing) followed by “I’m not really sure…” and they’ll avoid answering the question.
Ask a child (elementary age or younger) what they like about their body and this is what you’ll hear:
- “Everything!”
- “It’s big and strong!”
- “I love my legs/arms/belly!” (Any body part is appreciable for kids!)
You see, our body image tends to start out quite positively during childhood. We think that our bodies are awesome and that they do really cool things. But then our mentality starts to shift between adolescence and adulthood to where we view our bodies more critically.
For many people, their eating disorder starts with negative body image – wishing they could somehow change their body or lose weight to feel better about themselves. And so begins a pattern of behaviors intended to alter and “improve” the body that can spiral into the realm of eating disorder.
Recovery starts with identifying the eating disorder behaviors and working to cease them. This tends to bring up a ton of discomfort with body image, because without these behaviors they may fear what will happen to your body and their weight.
Getting a handle on the behavioral symptoms is just the first step though. Just because on the outside it might look like a person is “fixed” or “cured” because they appear to be eating “normally” doesn’t mean that they don’t have a ginormous internal struggle going on.
So what do you do when you’ve stopped using your eating disorder behaviors but your body image still sucks???
4 ways people who have recovered deal with body image
- Body neutrality: A twist on the “body positivity” concept that has become popular. For some people, especially when their body image really sucks, the idea of feeling positive about their body is very pie-in-the-sky. Plus, focusing on feeling positively towards your body is still focusing on your body. For many recovered people, feeling neutral about their body is more healing. They accept that their body is what it is and treat it well, without over-focusing on it. Give it a try and see what you think.
- Values and defusion: These concepts come from the world of ACT (Acceptance and Commitment Therapy), which is being shown to be very effective in the treatment of eating disorders.With values, you identify what is truly important to you across various realms of life. And then you step back and look at whether your behaviors support these values. For example, if you value relationships with your friends and family but are avoiding getting together with them because you feel bad about your body or you don’t want to face the food involved, then you aren’t truly aligning with your value of connection in those relationships.
Defusion is a technique where you notice your thoughts without attaching to them (i.e. fusing with them) or judging them. So you might say, “I notice that I’m having the thought that I’m fat.” You recognize that thoughts are just thoughts – they may or may not be true – and it doesn’t matter. It’s just a thought, and it will eventually pass. You need not “do” anything with it. So you’d notice this thought about feeling fat and continue on with your day in accordance with your values.
- Going deep: Ahhh, my personal favorite. Getting beneath the surface to understand the reasons you feel inadequate in the first place. This is where a skilled therapist comes in. Eating disorders and body image issues are the symptom, not the problem. What this means is that we don’t need to “fix” your body image – we need to understand why you feel that way and where these shameful thoughts are coming from. Almost always it is a blend of societal influence combined with seeds of shame that were planted way back in our past.Speaking of shame…
- Shame resilience: People who are recovered tend to have developed what’s called “shame resilience” along the way. This involves recognizing what your shame triggers are and learning how to deal with them by reaching out and being able to talk about it. This is a skill that takes a lot of practice but is well worth it. For people with eating disorders, negative body image thoughts tend to be an indicator of shame and a signal that you need to practice critical awareness of what is going on that triggered the shame so you can work through it. This will keep you out of the cycle of taking the negative body image thoughts literally and acting on ways to “fix” your body (i.e. using eating disorder behaviors).
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