NEDA TOOLKIT for Parents
Body Image
A common feature in many eating disorders is distorted
body image, and an overemphasis on the importance
of weight and shape to one’s value as a person. Our
cultural emphasis on dieting, thin models, and digitally
altered images certainly plays a role. However, if
the body image distortions were only caused by
media factors, nearly everyone would suffer from an
eating disorder. Nor do cultural factors explain the
documented existence of eating disorders in cultures
and time periods without a cultural emphasis on
thinness. New research is showing that individuals
with eating disorders have differences in the way they
perceive their own shape and size that appears to be
strongly influenced by biology.
Everyone has a body image. Researchers define body
image as the way we picture and perceive our bodies
in our minds, and this perception is shaped by broader
cultural factors, our own individual experiences, and
by how our brains perceive the size of our bodies and
how they move through space. Only in more recent
years have scientists begun to tease apart how these
neurological factors can affect the development of
body image in eating disorders.
It appears that several regions of the brain are involved
in this body image distortion. In a neuroimaging study
of women recovered from binge/purge anorexia,
researchers found that higher serotonin receptor
activity in the left parietal cortex was associated
with lower drive for thinness (Bailer et al., 2004). A
separate study also found abnormal activation of the
parietal cortex when individuals with anorexia were
asked to look at pictures of themselves (Wagner et al.,
2003). The parietal cortex helps to create a map of the
body using the sensory information it processes, and
researchers have hypothesized that problems with
creating this body map may at least in part underlie
body image distortions in eating disorders (Titova et
al., 2013). This hypothesis is supported by research
that showed patients currently ill with anorexia had
problems retrieving accurate information about their
body shape that caused them to overestimate their
current body size (Mohr et al., 2010).
These distortions also appear to involve the brain’s fear
circuitry. Scientists in Germany asked three adolescents
currently hospitalized for anorexia to view pictures
of their own body that had been digitally altered to
appear larger and thus simulate the teens’ actual body
image. When the teens with anorexia looked at the
digitally altered images of their bodies, the activity
in their fear circuits increased significantly when
compared to the activity when these teens viewed
digitally altered images of healthy teen bodies (Seeger
et al., 2002).
Although more research has been done looking at the
neurobiology of body image in people with anorexia,
it appears that many of the same processes may occur
in people with bulimia. When researchers asked 13
women with anorexia, 16 women with bulimia, and 27
healthy controls to view pictures of their own bodies in
a bikini, the activity in the parietal cortex was similar in
both groups of eating disordered women (Vocks et al.,
2010). Studies have found that body image dissatisfaction
plays a role in binge eating disorder (Grilo & Masheb,
2005), as does body image distortion (Mussell et al.,
1996); however, no neurobiological studies have been
completed to determine the nature of these body
image issues.
In adolescent girls without eating disorders, scientists
have found that the extent to which a teen girl
believes that her body should conform to the cultural
ideal of extreme thinness (known as thin ideal
internalization) appears to be somewhat heritable
(Suisman et al., 2012). The authors of the study believe
that perfectionism may play a role in this, as highly
perfectionistic people may likely express the need or
desire to have a “perfect” body. Indeed, independent
studies have found that, in individuals without
eating disorders, people who have higher levels of
perfectionism also experience higher levels of body
dissatisfaction (Wade & Tiggemann, 2013). It’s also not
yet clear how thin ideal internalization interacts with
the neurobiological differences discussed above to alter
a person’s risk for an eating disorder.
References Bailer, U. F., Price, J. C., Meltzer, C. C., Mathis, C. A., Frank,
G. K., Weissfeld, L., ... & Kaye, W. H. (2004). Altered 5-HT2A
receptor binding after recovery from bulimia-type anorexia
nervosa: relationships to harm avoidance and drive for
thinness. Neuropsychopharmacology, 29(6), 1143-1155.
doi:10.1038/sj.npp.1300430 Grilo, C. M., & Masheb, R. M. (2005). Correlates of body
image dissatisfaction in treatment‐seeking men and women
with binge eating disorder. International Journal of Eating
Disorders, 38(2), 162-166. DOI: 10.1002/eat.20162
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