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When the mind dislikes the body

By Deborah Etienne-Ward

Two disorders which have a theme of body dissatisfaction are Body Dysmorphic Disorder and Anorexia Nervosa. Both of these disorders usually first present during adolescence and are chronic in nature. This article aims to describe these disorders and disentangle some of their similarities and differences.

When the mind dislikes the body blog image

What is Body Dysmorphic Disorder?

Body Dysmorphic Disorder involves a preoccupation with a perceived flaw in physical appearance that is not obvious to other people. People with Body Dysmorphic Disorder will at some point have participated in repetitive behaviours such as mirror checking or mental acts such as comparing themselves to other people, in response to their perceived flaw. It is important to recognise that this preoccupation causes significant distress and/or interferes with the person’s ability to function in important areas of life (American Psychiatric Association, 2013).

What is Anorexia Nervosa?

Anorexia Nervosa is defined as a restriction of food leading to significantly low body weight, an intense fear of gaining weight or becoming fat, or persistent behaviour that interferes with weight gain despite being at a very low weight. People with Anorexia Nervosa also have a disturbance in the way that they experience their body weight or shape, evaluate themselves based on their weight or shape, or have a persistent lack of recognition of the seriousness of their low weight (American Psychiatric Association, 2013).

Similarities

These definitions highlight that both Body Dysmorphic Disorder and Anorexia Nervosa are focused around dissatisfaction with body image and a disturbance in the way that the body is perceived. Commonly shared signs of Body Dysmorphic Disorder and Anorexia Nervosa include mirror checking, body measuring, dieting, and excessive exercise (Mountford, Hasse, & Waller, 2006; Phillips, Menard, Fay, & Weisberg, 2006; Shafran, Fairburn, Robinson, & Lask, 2004). Moreover, both Body Dysmorphic Disorder and Anorexia Nervosa can lead to avoidance of places and activities due to feelings of self-consciousness about appearance (Phillips, 1996; Rosen, & Ramirez, 1998).

Differences

An important distinction between the two disorders is that the focus of body image in Anorexia Nervosa is on shape and weight. However, whilst people with Body Dysmorphic Disorder can have concerns about their shape and weight, their concerns can involve any part of the body such as their skin, hair, and nose (Phillips, 2005). In contrast to Anorexia Nervosa, Body Dysmorphic Disorder does not involve pathological eating, and significantly low weight. However, it is possible to have both Anorexia Nervosa and Body Dysmorphic Disorder at the same time. Additionally, some research has suggested that Body Dysmorphic Disorder might be a pre-cursor for some people with Anorexia Nervosa, with suggestions that 25% of people with Anorexia Nervosa display symptoms of Body Dysmorphic Disorder before reaching criteria to be diagnosed with Anorexia Nervosa (Rabe-Jablonska Jolanta & Sobow Tomasz, 2000).

Both Anorexia Nervosa and Body Dysmorphic Disorder are serious conditions that require appropriate intervention. BodyMatters offers treatment to clients who are experiencing difficulties with both Body Dysmorphic Disorder and Anorexia Nervosa. Please contact us if you would like further information.

For a complete review of the similarities and differences between Anorexia Nervosa and Body Dysmorphic Disorder please see: Hartmann, A.S., Greenberg, J.L., & Wilhelm, S. (2013). The relationship between Anorexia Nervosa and Body Dysmorphic Disorder. Clinical Psychology Review, 33, 675-685.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.)

Mountford, V., Haase, A., & Waller, G. (2006). Body checking in the eating disorders: Associations between cognitions and behaviors. International Journal of Eating Disorders, 39(8), 708–715.

Phillips, K. A. (1996). Body dysmorphic disorder: Diagnosis and treatment of imagined ugliness. The Journal of Clinical Psychiatry, 57(Suppl. 8), 61–64.

Phillips, K. A. (2005). Olanzapine augmentation of fluoxetine in body dysmorphic disorder. The American Journal of Psychiatry, 162(5), 1022–1023.

Phillips, K. A., Menard, W., Fay, C., & Weisberg, R. (2005). Demographic characteristics, phenomenology, comorbidity, and family history in 200 individuals with body dysmorphic disorder. Psychosomatics, 46(4), 317–325.

Rabe-Jablonska Jolanta, J., & Sobow Tomasz, M. (2000). The links between body dysmorphic disorder and eating disorders. European Psychiatry, 15(5), 302–305.

Rosen, J. C., & Ramirez, E. (1998). A comparison of eating disorders and body dysmorphic disorder on body image and psychological adjustment. Journal of Psychosomatic Research, 44(3–4), 441–449.

Shafran, R., Fairburn, C. G., Robinson, P., & Lask, B. (2004). Body checking and its avoidance in eating disorders. International Journal of Eating Disorders, 35(1), 93–101.

 

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