Worrying about our weight or a bad hair day is common in our image-obsessed society. But persons with eating disorders spend nearly every waking moment--up to 80 to 90 percent of their day--obsessing about their appearance, say treatment professionals with the Eating Disorders Program at The Menninger Clinic in Houston.
In addition to the concern with body shape and size that is a symptom of all eating disorders, approximately 40 percent of patients also have body dysmorphic disorder (BDD), a distorted view and exaggerated vision of their appearance. Changing that distorted image is an important part of the treatment process for patients with eating disorders.
"Body image disturbance is one of the most difficult things to change when treating an eating disorder and is the last symptom to resolve from treatment," said Theresa Fassihi, PhD, a psychologist with the Eating Disorders Program at Menninger. "If a patient does not make some improvement on body image issues early in treatment, it is a significant risk factor for relapse into the eating disorder."
Dr. Fassihi and mental health counselor Deborah Henderson developed a 12-week program to help patients improve their body image, based on the work of British psychiatrist and researcher Christopher Fairburn. Patients in the program meet twice a week for cognitive-behavioral therapy and experiential therapy.
In the cognitive-behavioral therapy group, patients learn to identify negative beliefs about their body image and dispute those beliefs. For example, one exercise asks patients to estimate how much string it would take to wrap around a certain portion of their body that they are concerned about, such as their thigh or waist. Patients often think the amount is three times more than what it actually takes. When they measure the string, they realize the circumference is much smaller than imagined.
"With the dispute step, patients may begin to see their distorted thoughts become more balanced," Henderson said. "Instead of thinking hundreds of times in one day how big a certain body part is, they begin to balance out their thought process by using self-talk to focus on the new disputing evidence. We teach them to decrease the distorted thoughts and focus more on disputed thought."
Patients also participate in a body image party, in which they must come up with one word that describes their appearance. For example, a female patient may choose "grotesque" as her word. The group then gives her feedback that she is not in fact grotesque. As a result, the patient learns that the standard she has set for herself is too high, and her image of herself is different from the reality of what others think of her.
During the body image party, patients are also challenged to come up with a positive word about themselves, not related to their appearance. The positive words help patients see themselves as creative, funny or compassionate.
In experiential group therapy, patients assist one another to trace their bodies onto paper. At the beginning of the tracing exercise, patients draw what they think they look like, and then contrast it with an actual outline of their body. Often patients overestimate the size of their bodies. Seeing the difference between their estimated size and their real size can be enlightening for patients.
"Patients gain some important insights through the body image groups while at Menninger," Dr. Fassihi says. "They learn about how their body image issues impact their lives, and most seem to re-evaluate the importance they have been placing on appearance."
The Menninger Clinic is an international nonprofit specialty psychiatric center, providing treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to Houston in 2003 and is affiliated with Baylor College of Medicine and The Methodist Hospital. For 16 consecutive years, Menninger has been named among the leading psychiatric hospitals in U.S. News & World Report's annual ranking of America's Best Hospitals. Menninger is a 501(c)(3) organization.