to Changing Body Image
DAVID W. KRUEGER
Body image is integral to the sense of self and self-organization. The self and its emotional processes are inherently embodied, cocreated within a relationship, and continuously revised. There is no realm of thought, feeling, or action that can be conceived without bodily engagement and expression. As noted in my earlier chapter in this volume, "Psychodynamic Perspectives on Body Image," the extent to which an individual experiences affects as mental states (i.e., as feelings) rather than solely as body sensations depends on how well primary caregivers facilitated and correctly identified and labeled affective and somatic experiences for the infant and growing child. A preverbal sense of having a boundary between the self and the world (of being within one's skin) and the experience of a solidified sense of self are established through interaction with attuned others. As a cohesive sense of self evolves, the boundary between mind and body dissolves. In the absence of empathic attunement by primary caregivers, the child continues to experience feelings internally, as a body state or experience, or registered only when embedded within an action sequence, but not differentiated and distinguished as feelings within a mental state.
Empathic attunement and accurate labeling of physical and emotional states teach the child how to (1) identify, differentiate, and desomatize affect, (2) develop an emotional literacy, and (3) experience self-efficacy and mastery. A caregiver's failure to attune empathically to the child leads to unawareness of feeling in the child or to the development of psychosomatic symptoms to bridge an unintegrated mind and body. These acquired limitations in articulating and communicating feeling compromise the child's ability to self-reflect and regulate affect, as well as to distinguish between and