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Body Dysmorphic Disorder: Diagnosis & Treatment
Body Dysmorphic Disorder: Diagnosis & Treatment - 10 CEUs

Section 23
The Impact of Child Insecurity on Body Dysmorphic Disorder

CEU Question 23 | CE Test | Table of Contents | Body Dysmorphia
Social Worker CEUs, Counselor CEUs, Psychologist CEs, MFT CEUs

Mirror, Mirror
What lies behind a distorted body image? To answer this question, Vocks's team took photographs of 56 people suffering from eating disorders and 209 healthy subjects used as controls. The scientists then asked the test subjects to adjust their images on a computer screen until they "recognized" themselves. Additionally, they asked both groups to give their virtual "me" the figure that they wished they had. Whereas all the respondents had similar notions of an "ideal" figure, the bulimics and anorexics all significantly overestimated their real body mass. In contrast, the subjects who were not suffering from eating disorders believed that they were slimmer than they actually were.

Barbara Mangweth, a psychologist at the Innsbruck Medical University in Austria, reached similar conclusions in a study of men suffering from eating disorders conducted in 2004. In collaboration with researchers at the Biological Laboratory of Psychiatry at McLean Hospital in Belmont, Mass., Mangweth compared 27 anorexic and bulimic men with 21 male mountain climbers and 21 male controls. The subjects held similar ideas about the ideal male figure but proffered dramatically different assessments of their own bodies. Unlike the climbers and the controls, the bulimics and anorexics all believed that they had about twice as much body fat as they actually had. Mangweth concluded that a faulty body image — rather than an exaggerated notion of what is ideal — is crucial to the development of eating disorders.

We still do not have an adequate understanding of why some people are subject to such distortions. Vocks and her colleagues suspect the problem involves information processing. According to their theory, the sensory organs of people with eating disorders correctly register their form, but negative thoughts filter the input. For example, memories of being teased about their looks as a child or teen may override how some bulimics and anorexics would otherwise see themselves. Because these individuals lack the emotional support to hold up a more flattering view, insecurity flourishes in them.

Clearly, insecurity helps to warp body image. Our view of ourselves often comes from how others see us or how we think they see us. If this reflection is not sufficiently positive, self-image will suffer, sometimes from the very start of childhood. Optimally, parental nurturing leads to a sound relationship balanced between security and independence. Yet studies have confirmed that some 30 percent of all children lack such an attachment relationship. Without feeling safe and accepted, these children are at risk of falling into an addictive cycle involving food or other substances. Other family dynamics contribute to poor self-image. Although eating disorders occur in all kinds of families, those affected often share certain traits. They are typically well situated and well educated and, to the outside world, appear to function harmoniously. Frequently, however, the children feel tremendous pressure to excel, the parents set high standards, and negative emotions such as anger or jealousy are suppressed. In keeping with these high standards, people with eating disorders strive to be model students or, as adults, to lead perfect lives. Even so, they usually feel that they never measure up.

Apart from a dearth of positive feedback, some individuals develop eating disorders in response to specific childhood traumas. According to the findings of Stephen Wonderlich's group at the Eating Disorders Institute in Fargo, N.D., sexual abuse in particular may increase the odds. Similarly, children whose parents are divorced or alcoholic are clearly at risk. Several teenagers seen at the Pediatric and Child Psychiatry Clinic in Essen, Germany, where one of us (Eggers) is director, reported that they felt overwhelmed when their parents divorced, unable to mediate or remain loyal to both sides. Self-hatred can easily arise from such perceived inadequacy — with terrible long-term consequences.

Certainly eating disorders are not exclusively the result of personal problems, but negative feedback from or neglect by family and friends can, at least in part, predispose an individual to anorexia, bulimia or binge eating. In these instances, many parents do not know how to help and feel guilty that they are unable to guide their child. As a result, family therapy can be an important component of an overall strategy in which problems are worked out together. Frequently, the eating disorder is merely the last link in a chain of unhappy events.

Unrealistic Ideals
The standards of beauty promoted by Hollywood films and the fashion industry today only magnify the problems behind most eating disorders. Until the end of the 19th century, curvaceous women were considered just as beautiful as their less voluptuous sisters. But aesthetics changed dramatically during the century that followed. Studies show that most people now prefer the look of bodies that weigh several percentage points below normal.

It is difficult to measure the direct effect that glossy magazines and other media images have on dieting behaviors, but Fiji offers an interesting case study. Anne E. Becker, director of the Adult Eating and Weight Disorders Program at Massachusetts General Hospital, documented eating habits in the Pacific nation throughout the 1990s. In 1995 — almost immediately after the introduction of television on the island — she found that only 3 percent of schoolgirls, who were on average 17 years old, reported that they had vomited to control their weight. By 1998, though, that number had surged to 15 percent. And 74 percent of the girls described feeling "too big or fat" at least sometimes, even though Fijians traditionally associate robust body shapes with higher social rank.

For those in Vocks's program, finding the courage to bare their perceived faults in front of a group does often pay off. The 90-minute sessions are no substitute for long-term treatment, but Vocks's patients frequently change their eating habits for the better and often manage to raise their own battered sense of self-worth. Perhaps most important, many learn that the body they have long hated is beautiful in another's eye.  In the U.S., recorded cases of eating disorders have doubled since the 1960s. A faulty body image — rather than an exaggerated ideal — is crucial to the development of eating disorders.

Beauty Is Truth
Dove's Campaign for Real Beauty, featuring "real women with real curves," aims to help women who are not model-thin embrace their unique beauty. In 2004 Dove commissioned a global study from Nancy Etcoff of Harvard University, Susie Orbach of the London School of Economics, and Jennifer Scott and Heidi D'Agostino of StrategyOne, an applied research firm based in New York City. After interviewing some 3,200 women in 10 countries, the authors found that only 2 percent considered themselves beautiful and that almost half believed they were too fat.
- Eggers, Christian, Liebers, Verena; Through a Glass, Darkly; Scientific American Mind, 15552284, 2007, Vol. 18, Issue 2

Personal Reflection Exercise #5
The preceding section contained information regarding the impact of child insecurity on body dysmorphic disorder.  Write three case study examples regarding how you might use the content of this section in your practice.

Peer-Reviewed Journal Article References:
Shanok, N. A., Reive, C., Mize, K. D., & Jones, N. A. (2020). Mindfulness meditation intervention alters neurophysiological symptoms of anxiety and depression in preadolescents. Journal of Psychophysiology, 34(3), 159–170.

Stanley, B., Currier, G. W., Chesin, M., Chaudhury, S., Jager-Hyman, S., Gafalvy, H., & Brown, G. K. (2018). Suicidal behavior and non-suicidal self-injury in emergency departments underestimated by administrative claims data. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 39(5), 318–325.

Summers, B. J., & Cougle, J. R. (2018). An experimental test of the role of appearance-related safety behaviors in body dysmorphic disorder, social anxiety, and body dissatisfaction. Journal of Abnormal Psychology, 127(8), 770–780.

Online Continuing Education QUESTION 23
According to Eggers, what kind of family history is most typical for clients with body dysmorphia and eating disorders? Record the letter of the correct answer the CE Test.

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