Body Dysmorphia

TW: detailed discussion of body dysmorphia, ED behaviour mentions, description of being underweight, negative self talk

Despite popular understandings to the contrary, body dysmorphia and anorexia are not the same thing and are often considered separately as psychiatric diagnoses. In terms of the diagnostic criteria, both include disruption or disturbances in self-image or body image, with anorexia being focused upon being unable to perceive one’s own low weight or minimising it’s severity. Body dysmorphia, on the other hand, usually means some undue preoccupation with a certain feature or features of one’s body causing, at times, extreme discomfort and disturbance.

I would argue that most people with eating disorders probably struggle with a level of body dysmorphia, specifically around perceived weight loss or gain. I didn’t think that I did until I started to recover. I thought that I saw myself realistically and that people were making a fuss or it was just that I looked a bit different. I thought nobody noticed. Part of this is that the voice of your disorder tells you lies about it in order to justify carrying on with the weight loss. Without it, if you were able to see yourself clearly, you’d be more able to recover.

You reach a point where people are a little scared. They sigh with relief when you explain because, really, there is no plausible explanation other than some other extreme illness. You know that people are looking but nobody evens bothers to harass you any more because it would be weird to harass someone so clearly sick. I heard some men on the street say to their friend that I looked too sick and he shouldn’t shout anything at me.

Others try to convince themselves you’re just very ‘fit’ or something. You just haven’t been eating enough lately. I don’t know…anything.

Still you want to lose more weight. Not to look good. Maybe you convince yourself sometimes that this looks good but deep down you know…you know you’re angular now, things don’t fit right, your ribs stick out, your knees look too big for your scrawny legs, your face is drawn and gaunt. Still maybe now it’s about proving something; how sick you are, maybe. Or just chasing the sense of achievement you temporarily feel when you see the number on the scale go down, your next goal reached. Or it just feels safe now to keep doing what you’re doing. Safer than seeing reality.

I’ve gained a lot recently through a combination of eating properly and stopping my compulsive intensive exercising. The process of gaining weight during eating disorder recovery is deeply painful because it is everything you’ve been working against for so long. All of your behaviours centre around this all-consuming fear of gaining weight. Everything you do is to avoid this; the restriction, the exercise, the purging. When you stop all this your body is so grateful but there is also a lot of pain and discomfort as it heals itself. It’s hard to feel you’re doing the right thing, even though you are.

Body dysmorphia for me manifests as constant ‘body checking’ – looking at myself in the mirror, specifically my stomach and my face, and feeling disgust at any perceived weight gain or ‘fat’. Taking photos of myself and trying to analyse how fat or thin I look, looking at photos other people have taken of me to see how prominent my stomach looks or if my face looks ‘too round’. I often think clothes won’t fit me because I’m too big but when I try them on they’re fine, maybe a little tighter – nothing like what I’d imagined. This behaviour feels obsessive and hard to move away from.

I often feel that I ‘don’t know what I look like’ – a bizarre concept, since I so obsessively look in the mirror and at photos, yet my brain cannot register what I am seeing. I know, somehow, that what I’m perceiving is not reality but I can’t perceive the reality at all. My partner and friends reassure me, try to give my perspective but it’s difficult to believe anything they say.

‘Body checking’ is common in anorexia when you are fixated upon your weight and any perceived changes to it. In body dysmorphic disorders it is also common to ‘check’ and fixate on the part of your body with the perceived flaw and to become distressed by this. It can interrupt your every day life, make you unable to go out and socialise out of worry, you can spend hours obsessing over it and needing it to be different. In some ways it is similar to how some transgender people feel when experiencing gender dysphoria, though I don’t think conflating the two is useful since gender dysphoria comes out of a genuine incongruence with the gendered body one has.

Yet, as I recover I am able to see that the way I look now really is more healthy, that my body is no longer crying out at me all the time. Making peace with my body feels like it will be a long process. Constantly denying my hunger, pushing my body to exhaustion, ignoring it’s pain and my own feels as though it has caused a rift that I need to heal. It’s hard to do this with a constant inner critic, a genuine fear response to any behaviours I think will cause weight gain. Intellectually, I understand what I need to do but I am waiting for my emotions to catch up.

Some things that have helped – I went to a free form dance class, one that was about connecting with your body and moving in a way that suited it, suited what it felt; rather than a particular form. I’ve gone back to yoga but I’m approaching it in a way that feels more in tune with my body, rather than the way I used to which was to push myself hard to gain strength. It’s hard finding the line at the moment. I’m trying to feed myself regularly with meal plans and not to feel guilty when I am hungry, to try and enjoy food again. Being around other people helps a lot.

I’d hoped to write a post on sexuality and gender, I also wanted to write about bureaucratic violence and work stress and how they contribute to and are a part of eating disorders as an adult. I’ve started but my thoughts need more time to develop. I wanted to post this to explain a little of the experiences and where I’m at. I hope if anyone else is having these experiences this could make them feel they’re not alone and that others understand them. I hope if this isn’t something you’ve experienced you have a greater understanding.

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