I’ve always been fascinated by the “disconnect” between how I experienced [perceived] my speaking voice and how it sounded when I heard it from a recorded device. Likewise, there’s the discrepancy between several photographs of us, even taken at the same place and around the same time frame. How can we look so different in each photograph? Of course, we’re the only ones that notice a difference. If you “factor out” the placing of a positive or, usually critical, assessment of how you sound or look, it’s reasonable to conclude there is some degree of difference between how the world sees and hears us and how we do.

Body image, as it relates to most of those suffering with an eating disorder, and its “cousin”, body dysmorphic disorder, is perhaps the most pronounced example how these “disconnects of perception”” dominate the thoughts and feelings of ones’ daily life. To illustrate this “in the eyes of the beholder” phenomenon, many of you may be familiar with the “old or young woman” optical illusion [see below]. Although there may be an infinite number of “theories” as to how the brain processes the physical world vis-à-vis our senses, the fact remains there is no clear cut understanding as to account for the relentless hatred for an undernourished and emaciated body being “too fat” or a pop star enlisting an army of surgeons to alter his nose repeatedly until he must wear a mask in public. At the very least, it would be reasonable to say many of those suffering with anorexia, bulimia, and in many cases binge eating disorders, have in common some degree of “confusion” as to how they really appear.

I would argue, after many years of working with people with all “flavors” of eating disorders, most instances of these issues are not about vanity per se. In fact, the of people I’ve worked with struggle with issues of control, perfectionism, and an exaggerated sense of “being less than.” Indeed, there is a vast difference between the needs and wants of someone with a “weight problem” and one with a bona fide eating disorder. The latter having to deal with the confusion of perceived body image and the former dealing more with dieting off and on. That said, let’s look at a theory I have born out of experience rather than demonstrated in a laboratory.

Through the years, I’ve come to experience mood disorders, in particular forms of depression, as the “chicken before the egg” with body image and body dysmorphic confusion. In reality, it is more rule than the exception; a mood disorder accompanies, if not “pre-dates” the onset of an eating disorder. To be clear, our mood will more often than not “color” our perception. In other words, the more depressed, the more negative our view of ourselves, and the world. The “smoke and mirrors” effect of an eating disorder then goes something like this: “I look in the mirror and I see myself as _________ and that is what I am most depressed about.” If I were able to change the way I look then I would not be depressed.” Hence the “anti-depression fix becomes either changing the body or finding a way to numb the pain by self medicating with food or binge eating and purging, or any number of permeations on the eating disorder theme.

Optical Illusion- Perception

I am not proposing the solution to a body image issue is simply “buying into” this theory or notion. What I would suggest is at a minimum conceding your “perception” is a confused one and giving consideration to putting your energy into a recovery process. That process would give equal time to following a treatment plan including a healthy food plan, abstaining from your eating disorder behavior[s] [with professional help if necessary], and finding help to appropriately manage your depression / mood disorder. Last, but not least, I would be remiss to not mention more than half of the people we see at Milestones also have relied upon alcohol, drugs, or other compulsions in addition to their ED in a misguided attempt to “control” their depression and perceptions.

In sum, body image disturbances are a prominent feature of most eating disorders. Whether they are a symptom of an underlying issue with a mood disorder such as depression or generalized anxiety disorders, a manifestation of past trauma, or any number of factors often associated with eating disorders may not be relevant. What matters is the need to acknowledge body image disturbance is a symptom of a disease and needs to be dealt with beyond ones’ self. A wise person once reflected: "We can't solve problems by using the same kind of thinking we used when we created them." He was Albert Einstein. I think he was on to something.

Marty Lerner, Ph.D.

Author's Bio: 

Dr. Lerner is the founder and executive director of the Milestones in Recovery Eating Disorders Program located in Cooper City, Florida. A graduate of Nova Southeastern University, Dr. Lerner is a licensed and board certified clinical psychologist who has specialized in the treatment of eating disorders since 1980. He has appeared on numerous national television and radio programs that include The NPR Report, 20/20, Discovery Health, and ABC’s Nightline as well authored several publications related to eating disorders in the professional literature, national magazines, and newspapers including USA Today, The Wall Street Journal, New York Times, Miami Herald, Orlando and Hollywood Sun Sentinels. An active member of the professional community here in South Florida since finishing his training, Dr. Lerner makes his home in Davie with his wife Michele and daughters Janelle and Danielle and their dog, Reggie.