for Body Image Disturbances
Disturbed body image is a central feature of body dysmorphic disorder (BDD) and eating disorders. Patients suffering from these disorders often experience two distinct forms of body image disturbance: perceptual distortion and body dissatisfaction. Perceptual distortion is the more dramatic disturbance, as exemplified by emaciated patients with eating disorders who perceive themselves as fat, or clear-skinned patients with BDD who see themselves as disfigured by acne scarring. Body dissatisfaction seems to be the more frequent disturbance; although it is assumed to stem from the imaginary imperfection, body dissatisfaction is only modestly, if at all, correlated with perceptual distortion.
Important similarities between BDD and eating disorders extend beyond body image disturbance. Because these disorders all have prominent obsessive and compulsive features, it can be valuable to view them as part of an obsessive–compulsive spectrum. (See discussion of this spectrum in Hollander, 1996.) The obsessions of patients with eating disorders include fear of fatness, as well as preoccupation with the focus of their body dissatisfaction (weight and body shape) and worry about managing their perceived flaw (e.g., via exercise, diet, food preparation and consumption, or purging). They also retain obsessive and compulsive traits after substantial remission of their anorexia nervosa or bulimia nervosa symptoms. The obsessive thoughts of patients with BDD focused on their body dissatisfaction (most often, skin, facial features, or hair, but can be any body part) and worry