People with an eating disorder live in a paradox: worried about image and weight, poor body awareness makes it difficult for them to perceive the needs and signals of an ultimately foreign body.
The different ways in which eating disorders can manifest themselves – anorexia , bulimia , binge eating and other related disorders – although apparently very different in terms of symptoms, have several traits in common.
Among these there is a usually very low body awareness : although these people are very worried about their weight and the food they eat, they have a lot of difficulty in perceiving their internal signals . The body is perceived / evaluated above all for what appears on the outside (in the mirror, in the photograph, in the size of the clothes or in the weight on the scale), but it remains substantially “mute” regarding internal perceptions.
This makes it difficult to correctly recognize the sensations of hunger and satiety and feeds more or less severe despairs of the shape and body boundaries, making the body something alien and indecipherable.
Assess the body from the outside
Both in anorexic-restrictive forms and in bulimic and uncontrolled disorders, people with an eating disorder struggle to correctly assess the shape and size of their body .
The body image – that is, the subjective experience that one has of one’s own image in the mirror – changes according to one’s mood : many may find their physical “defects” particularly intolerable when one is down in the dumps and succeed instead to observe oneself with greater indulgence when one is in a good mood.
But people with an eating disorder – whether it results in a restrictive, bulimic or totally uncontrolled diet – can experience these physiological fluctuations to a rather extreme degree. The sensation may be that of feeling as if you have gained 10 or 20 kilos as soon as you notice a slight swelling, of seeing yourself too fat even if you read a low number on the scale or of not being able to evaluate a weight gain or loss without “external” parameters – the scale, the size of the clothes, a photograph – that reveal a change in weight (sometimes this happens even for significant weight gains).
The lack of body awareness that can characterize people with an eating disorder makes it rather difficult to perceive “from the inside” their body sensations , their movements, the feelings of tiredness, fatigue, thirst, appetite.
They therefore tend to rely on purely “external” criteria both to evaluate the shape and size of the body ( the size of the clothes, the weight on the scale , get into a certain garment, etc.) and to try to regulate their diet, failing to perceive and to use internal signals of hunger and satiety . Therefore, the calorie content of the foods, the tables or the nutritional schemes will be used to establish how much and what to eat (especially in the restrictive forms and in the periods of diet that cyclically alternate in many bulimic or uncontrolled forms).
Similarly, the mere “sight” of palatable and high-calorie foods (which often these people would like to forbid) can act as a “trigger” for one or more binges, nullifying previous efforts.
Body anesthesia and emotional anesthesia
The low body awareness associated with eating disorders translates into a sort of “anesthesia” / insensitivity to body sensations, which is associated in parallel with an emotional anesthesia .
In fact, perceiving and managing one’s moods can also be difficult: both the physical body and the emotions are indecipherable dimensions , often impossible to use to self-regulate one’s diet as well as other physical and psychological needs (which are often not correctly distinguished from each other). This parallelism is not surprising: eating disorders are only apparently and superficially disorders that affect appetite or aesthetics .
Instead, they denounce the difficulty in recognizing and self-regulating their own needs, physical and psychological : often in these cases the emotions cannot be recognized as such nor expressed in words, therefore any state of tension will be expressed on a concrete level through food (abused as calming or refused / controlled) and the body (subject to violent despair, restrictions, grueling workouts, extreme dietary practices or uncontrolled filling) without the person being aware of either.
Psychotherapy for eating disorders
Psychotherapy paths for eating disorders often face in parallel both the work on body awareness (recognizing and respecting one’s physical states such as hunger, satiety, need for rest, etc.), and that on emotional awareness (giving a name to emotions and learn to manage them instead of “swallowing” them or delude oneself to control them through the uncontrolled or restrictive use of food).
One of the objectives of these paths is to ensure that emotions can be recognized and used as useful signals to orient oneself in relationships and decisions. And that, in parallel, the body sensations are correctly interpreted and listened to, letting food become again (or in many cases become for the first time) only food …
