Body Image Captures Wide Reach in Eating Disorders

By Goodwin, Natalie P. | Addiction Professional, September-October 2014 | Go to article overview

Body Image Captures Wide Reach in Eating Disorders


Goodwin, Natalie P., Addiction Professional


Body image concerns among women are well-documented. Body image dissatisfaction has become somewhat of a normative experience for women. Can you remember the last time you heard a woman say, "I look good today"? More often you hear women tearing themselves apart and criticizing their every perceived flaw.

Yet now we also are seeing an increase in the prevalence of body image and eating disorder issues among men and sexual minorities. From my experience at The Menninger Clinic, a leading psychiatric hospital in Houston, I can attest that body image concerns are often heightened in those identifying as homosexual, and possibly even more pronounced in patients experiencing gender dysphoria who may identify as transgender.

With the growing number of male eating disorder patients, I have had the opportunity to work with several men identifying as gay who have communicated the intense pressures they experience to fit the ideal image of a muscular, tanned, fit, tall, well-groomed, sexy man. Some have said they feel this pressure may even be more pronounced than it is for women.

Now imagine desiring to be female but residing in a physically male body. Or imagine the dangerous strategies someone might employ to uphold the body ideal of their desired gender. A physically male adult desiring to be female may restrict food intake to avoid gaining weight or muscle. A physically female adult may over-exercise to attempt to develop a more muscular physique, but then restrict food intake to avoid developing curves.

These ideologies and behaviors produce a very different conversation about how one manages feelings about body image dissatisfaction. Body image dissatisfaction transcends the typical focus on weight and becomes all-encompassing. The conversation becomes one of how to help patients make peace with relatively unchangeable body parts that they do not feel are consistent with their sense of self. Assisting patients with body image struggles in these contexts proves especially difficult. While some opt for surgery and hormone therapy that can assist them in making peace with their bodies, others may not have the resources for those options, and in these cases body image work in therapy is essential to gaining peace of mind.

Body image therapy

I enforce with my patients the philosophy of radical acceptance and the idea of inherent self-worth; these are two evidence-based Dialectical Behavior Therapy (DBT) concepts that I have integrated into my work with eating disorder patients. In thinking through how we can help patients achieve body image satisfaction, I pose to clinicians that we must help patients identify how societal trends have caused us to forget that to be human is to be imperfect.

We know that patients often avoid mirrors because what they see is so distressing to them, especially when they see body parts with which they cannot identify. When we fear something or avoid it, it becomes bigger and more powerful in our minds. That's why body image distortion represents another key factor of the work we must do with our patients. The parts of their appearance they struggle with the most become all they see, and often are incredibly pronounced in their mind.

I explain to patients that their image becomes somewhat like a phobia for which they use avoidance to cope, but that this ends up exacerbating the problem. This is a very challenging process, but when people can meet with their physical body without revulsion, and maybe even some compassion and acceptance, it becomes a powerful moment.

Our treatment for body image distortion includes helping patients reintegrate themselves with their body and end the avoidance. Our work helps patients connect with their body and foster a more positive relationship between their sense of self and their body. To do this, we have patients write letters to and from their body. …

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