Body Image

Women using image filters - River Centre Clinic

Body Dysmorphia, Social Media & Image Filters

Social media is a popular tool for communication and entertainment. Few people would question the fact that people are spending an increasing amount of time on these new media platforms. In recent years, social media has become much more visual in presentation and layout. However, it is the evolution of the technology used to manipulate and alter images that have researchers concerned. (more…)

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LGBTQ & TRANS Flags

Eating Disorders Are More Common For Transgender Youth

For many years, eating disorders were historically associated with women who were young, straight and white. Yet, issues surrounding body image and eating behavior actually affect people from all demographic backgrounds. Healthcare professionals are increasingly aware that eating disorders are a challenging mental health condition for a wide variety of people. These mental health concerns appear among all socio-economic, sexual orientations and ethnic backgrounds.

In particular, the rates of individuals who suspect that they have an undiagnosed eating disorder are much higher for the LGBTQ+ community. If one does a deeper analysis of the term LGBTQ+, transgender individuals appear to have the highest rate of eating disorders.

However, much of this population often go without professional treatment or medical care. Transgender people may forgo receiving treatment due to a lack of access to healthcare, financial pressures or discrimination. Some transgender individuals have reported negative feelings after interacting with healthcare providers. At times, there is a feeling that healthcare practitioners are not sensitive to the psychological and medical needs of transgender patients.

Recent studies are starting to indicate that transgender people, particularly the youth, are more susceptible to developing eating disorders. Researchers suggest that prejudice, harassment and unstable home environments for transgender youth are some of the reasons for the higher rate of eating disorders among this population.

Research published in the Journal of Adolescent Health found that transgender youth were four times more likely than cisgender, heterosexual, female peers to report a diagnosed eating disorder and twice as likely to report abusing weight loss pills and engaging self-induced vomiting.

One theory for this disturbingly high rate among transgender youth is that these individuals are unhappy with their physical appearance. They have eating behaviors that are perhaps attempting to halt the development of certain physical features that do not match their gender identity.

A recent Canadian study surveyed 923 transgender youth between the ages of 14 to 25 who were scattered across the country. The survey found that, as a sexual minority, these youth experienced a much higher rate of harassment and discrimination. Also, out of the youth surveyed, there was a higher prevalence of eating disorders among individuals who had reported experiencing harassment and discrimination.

According to Dr. Judith Brisman, founder of the Eating Disorder Resource Center, eating disorders reflect how someone feels about themselves. Dr. Brisman states that transgender women appear to have more concerns with body image versus other transgender groups. Dr. Brisman agrees with previous studies that suggest that transgender youth are using restrictive eating behaviors in an attempt to control their body’s appearance in order to achieve a beauty ideal that is nearly impossible to attain.

Another study examined self-reported eating disorders among American college students and the associations of sexual orientation and gender identity. This research also discovered elevated rates of eating disorder behaviors among transgender, cisgender and other sexual minority populations.

It is clear that eating disorders impact all people. However, research indicates that the LGBTQ+ community is at a heightened risk of developing eating-related disorders.  In the transgender community, especially the youth, are particularly vulnerable to eating disorders. What is needed is a safe and accepting environment that helps transgender youth feel connected to others and provides protection from harmful stigmas.

About us:

For additional information about eating disorder treatments in the LGBTQ+ community, contact the River Centre Clinic. Their medical facility provides experienced treatment options for adults and adolescents. For questions and professional help with eating disorders call 877-212-5457 or 419-885-8800.

They are located in Northwest Ohio in the town of Sylvania and provides state-of-the-art treatment location in a modern, spacious and tranquil setting. River Centre Clinic is designed to provide a safe and attractive alternative to hospital-based programs.

For online self-diagnosis, take River Centre Clinic’s EAT-26 assessment. The Eating Attitudes Test is quick and provides anonymous feedback.

Follow us on Twitter:  @River_Centre

Transgender Youth, LGBTQ+, Eating Disorders

Contributor: ABCS RCM

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Body Image in Eating Disorders

What is Body Image Disturbance?

Body image disturbance is one of the most common clinical features attributed to eating disorders. Most contemporary theories consider body dissatisfaction to be the most immediate or proximal antecedent to the development of an eating disorder and empirical studies indeed confirm this association.

It is generally agreed that the body image construct is multidimensional, involving attitudinal as well as perceptual components. The perceptual deficit was best described by Hilde Bruch in her seminal publications based on years of clinical experience (1) and almost 40 years ago, one of us (DG) published one of the first empirical studies documenting size estimation in anorexia nervosa(2).

While size overestimation generated tremendous interest over the years, it has had limited impact on the understanding and the treatment of the disorder.

Nevertheless, recent research has linked body image disturbance to both psychopathology measured by the Eating Disorder Inventory(3) and temperamental characteristics confirming Bruch’s early observations regarding the relationship of body image disturbance to other core features such as poor interceptive awareness and feelings of ineffectiveness(4).

Eating Disorders Without Body Dissatisfaction

Although body dissatisfaction may be one of the most common modes of entry into an eating disorder, early case descriptions of anorexia nervosa and evidence from non-Western cultures indicate that some patients voluntarily reach an emaciated weight for a variety of psychological reasons body but do not show the characteristic body dissatisfaction.

Some of earliest 19th century clinical descriptions of anorexia nervosa do not even mention body dissatisfaction as a clinical feature of the disorder. Cases of apparent anorexia nervosa from China and India lack the “fear of becoming fat” or the body dissatisfaction so prominent in Western cases.

Some Patients Began Restricting Food Intake Because of “Spiritual” Concerns
Even in Western culture, research studies, as well as clinical experience, indicate that there is a small minority of patients who present with a very low weight but who deny body dissatisfaction at any point during the development of their disorder.

Some of these patients began restricting their food intake because of “spiritual” concerns, fears of choking, aversion to the texture of certain foods, food allergies, or a brief phase of physical illness. These cases have been traditionally classified as “atypical”; however, the diagnostic designations may be too restrictive as evidenced by the changes to the DSM-5.

Body Dissatisfaction is Still a Major Risk Factor

Nevertheless, to point out the exceptions is not to deny the overwhelming evidence that body dissatisfaction is one of the most important risk factors for restrictive dieting which, in turn, predicts the onset and the maintenance of serious eating disorders.

It is a major predictor of relapse in both anorexia and bulimia nervosa; patients who do recover report that body image is one of the major impediments to lasting change. The most challenging problem is how to affect lasting change in body dissatisfaction among those with eating disorders.

Methods to Correct Distorted Body Size

Various methods have been used to attempt to correct distorted body size estimation. One method has been to provide corrective feedback to anorexia nervosa patients with the aim of improving accuracy over time. This can be accomplished in several ways.

One strategy involves providing feedback on standardized measures of size estimation. Another involves directing patients to study their body in a mirror and try to develop a more objective or realistic view of their weight or shape.

Confronting patients With Their Own Distorted Self-perception has Little Therapeutic Effect
Some studies have shown that this exercise may have value in helping patients overcome denial of the severity of their disorder. However, most clinicians agree that directly changing body size perceptions has very limited role in the treatment of anorexia nervosa.

It is not surprising that confronting patients with their own distorted self-perception has little therapeutic effect since most patients have a long history of feedback by friends, family and therapists that they are too thin and must gain weight. This alone seems to have little impact.

A Cognitive Approach to Re-Interpreting Body Image

In our treatment setting, we prefer a cognitive approach aimed at re-interpreting the meaning of body size overestimation rather than trying to change it directly. Body size overestimation can be thought of as a perceptual anomaly that is often observed in eating disorders.

This is similar to other situations where people are encouraged to not rely on a particular perceptual state but rather defer to a higher-order judgment regarding the perception – for instance, a person trying to decide whether or not to drive a car after drinking alcohol.

Accordingly, patients are encouraged to view their body-size misperception as an unfortunate perceptual disability (like being a color-blind person trying to coordinate his or her wardrobe). In this case, it is preferable to rely on objective data or a trustworthy person, rather than self-perception to determine actual body size.

Body image usually does not improve early in the process of recovery from anorexia nervosa, and in fact, it often becomes worse during weight gain. If it does improve, it is often in the later stages of recovery.

Treatment For Anorexia Nervosa

There has been remarkable advancement in recent years in the technology for treating body dissatisfaction in those at risk for eating disorders, and for obese individuals. The application of these approaches to anorexia nervosa has been less fully developed.

Treatment for anorexia nervosa requires increasing weight and weight gain is not uncommon in those with bulimia nervosa which predictably increases body dissatisfaction in the short-term.

Cognitive restructuring can be focused on identifying the idiosyncratic meaning that “being thin” and “weight control” has for the patient, and then finding more elegant personal and interpersonal solutions that do not require the life-long physical, psychological and interpersonal disadvantages of maintaining anorexia nervosa.

Within the context of a broader cognitive approach to anorexia nervosa (5), we have found group therapy focused on the “appearance assumptions” from Cash’s workbook particularly useful (6).

Avoiding Self-Defeating Practices

Developing a more positive body image often involves avoiding certain self-defeating practices (e.g. weighing, looking in the mirror, wearing revealing clothing and compulsive exercise) that provide short-term relief, but become rituals that only accentuate anxiety, discontentment and dysphoria.

These can be replaced by body image enhancement activities (yoga, movement, pleasure walks, listening to music,) that emphasize the body as a source of pleasure rather than a vehicle for control, mastery or self-definition. We emphasize the importance of viewing the functional aspects of the body rather than the ascetic features.

Finally, one of the most potent set of interventions derives from education about discrimination related to obesity (7) and the important advancements in advocating Health at Every Size as it’s health and civil rights implications (8).

Addressing Peer Relationships to Promote Change

It is also vital to understand the role of the interpersonal context in body dissatisfaction and to address peer relationships in promoting change. Recent evidence indicates that girls tend to select friends who are similar to themselves in terms of body dissatisfaction and bulimic symptoms but dissimilar in terms of dieting (9) and that body dissatisfaction is predicted by peer conversations about dieting, body consciousness and thin idealization (10).

These findings point to the importance of controlling for friendship selection when examining the role of peers in adolescent body image and eating problems. These findings can be extrapolated to group therapy in clinical settings by underscoring the importance of healthy and unhealthy group affiliations and their impact on recovery and relapse.

Changing Parental Attitudes Toward Weight

It has been our experience that promoting healthy group norms is one of the most important targets of intervention over the course of therapy.

Additionally, a major impediment to change can be parental attitudes toward weight and shape or parents’ overvaluation of thinness that can have a detrimental effect on the treatment of their children.

This issue must be approached with sensitivity to the historical factors influencing parental attitudes; however, treatment must focus on changing the family imperatives that interfere size acceptance as well as respect for individual differences of a wide array of attributes.

Psycho-Educationally Oriented Prevention Programs

Finally, the remarkable advancement in recent years in the technology for treating body dissatisfaction in those at risk for eating disorders, and for obese individuals can be applied in the treatment of serious eating disorders. Psycho-educationally oriented prevention programs can reduce body dissatisfaction and reduce ameliorate disorder symptoms in college women that are sustained over a two-year follow-up (11).

Although the application of these approaches to those with clinical eating disorders has been less fully developed, we rely heavily upon psycho-education as well as cognitive approaches to challenging body image disturbance (12) and these have led to clinically and statistically significant changes in body dissatisfaction over the course of our Adult Partial Hospitalization and Adolescent Residential Programs.

Sources:

1. Bruch, H., Perceptual and conceptual disturbances in anorexia nervosa. Psychosomatic Medicine, 1962. 24(2): p. 187-&.

2. Garner, D.M., et al., Body image disturbances in anorexia nervosa and obesity. Psychosom Med, 1976. 38(5): p. 327-36.

3. Garner, D., Eating Disorder Inventory-3 Professional Manual. Psychological Assessment Resources, Inc, 2004.

4. Zanetti, T., et al., Clinical and Temperamental Correlates of Body Image Disturbance in Eating Disorders. European Eating Disorders Review, 2013. 21(1): p. 32-37.

5. Garner, D.M., K. Vitousek, and K.M. Pike, Cognitive Behavioral Therapy for Anorexia Nervosa, in Handbook of Treatment for Eating Disorders1997.

6. Cash, T.F., The body image workbook1997, Oakland, CA: New Harbinger.

7. Garner, D.M. and S.C. Wooley, Confronting the failure of behavioral and dietary treatments for obesity. Clinical Psychology Review, 1991. 11(6): p. 729-780.

8. Bacon, L., et al., Size acceptance and intuitive eating improve health for obese, female chronic dieters. Journal of the American Dietetic Association, 2005. 105(6): p. 929-936.

9. Rayner, K.E., et al., Adolescent Girls’ Friendship Networks, Body Dissatisfaction, and Disordered Eating: Examining Selection and Socialization Processes. Journal of Abnormal Psychology, 2013. 122(1): p. 93-104.

10. Lee, K., Engaging in peer conversation about slimming predicts body dissatisfaction in Chinese college women: A study in Hong Kong. Social Influence, 2013. 8(1): p. 1-17.

11. Stice, E., et al., Efficacy Trial of a Selective Prevention Program Targeting Both Eating Disorders and Obesity Among Female College Students: 1- and 2-Year Follow-Up Effects. Journal of Consulting and Clinical Psychology, 2013. 81(1): p. 183-189.

12. Garner, D.M. and C.D. Keiper, Anorexia and bulimia, in Handbook of clinical psychology competencies, J.C. Thomas and M. Hersen, Editors. 2010, Springer: New York. p. 1429-1459.

Contributed by the following River Centre Clinic Staff:

David M. Garner, Ph.D. is the Owner and Administrative Director

Julie J. Desai, M.A. is the Director of the Adult Partial Hospitalization Program

Meggan Desmond, LISW is the Director of the Adolescent Residential Program

The River Centre Clinic has almost two decades of experience providing innovative treatment to adults and adolescents suffering from eating disorders. It has developed a ground-breaking approach to treatment, based on extensive experience and research, designed to reduce costs without compromising high quality of care.

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