Body Image Disturbance in Anorexia Nervosa

Body image disturbance is a diagnostic criteria for Anorexia Nervosa (AN) in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5). There is a perceptual distortion in the brain which prevents individuals from seeing how emaciated their bodies really are. This is a type of “agnosia,” or “without knowledge,” in that individuals do not recognize that they are ill, and in a way, this protects them from understanding the true level of severity of their eating disorder. 

Ironically, as the individual’s weight decreases, the corresponding body image distortion increases, such that the thinner the person is in reality, the "fatter” they feel that they look.  Fortunately, this correlation tends to reverse in recovery, where individuals are more accurately able to perceive their body size once they have returned to a restored weight. 

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When I was ill with AN, I did not believe my family, friends, and providers that I was very thin. When I looked through my eyes, I only saw areas of my body that needed to shrink in their size. It was not until I was hospitalized as an inpatient for AN that an art therapist taught me a way to challenge my body perception by literally drawing my body (“Body Tracing”). I would lay down on a large piece of paper, with someone else marking reference points for my head, shoulders, wrists, hips, and feet. I would then connect the dots and draw what I thought my body size was. After, I would lay down again, and someone else would trace the real outline of my body. The discrepancy between my perceived body size and my actual body size was very large when I was ill. I had drawn my body several inches wider all around than what I really was.  After looking at the drawing for a while, I could see that I was not as “fat” as I thought or felt I was. For me, this was a sobering objective “reality check,” and a reminder that I could not accurately perceive my body size. It was like looking in a fun-house mirror. This exercise did not change my actual vision, but importantly, it proved to me that I could not trust my own eyes. I kept that body tracing for years, and as I recovered from AN, I repeated the exercise. Over time, my perception grew closer to my actual body size, though it still is not completely accurate yet.


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Esposito, R. , Cieri, F. , Giannantonio, M. and Tartaro, A. (2018), The role of body image and self‐perception in anorexia nervosa: the neuroimaging perspective. J Neuropsychol, 12: 41-52. doi:10.1111/jnp.12106

Esther Via, Ximena Goldberg, Isabel Sánchez, Laura Forcano, Ben J. Harrison, Christopher G. Davey, Jesús Pujol, Ignacio Martínez-Zalacaín, Fernando Fernández-Aranda, Carles Soriano-Mas, Narcís Cardoner & José M. Menchón (2016) Self and other body perception in anorexia nervosa: The role of posterior DMN nodes, The World Journal of Biological Psychiatry, 19:3, 210-224, DOI: 10.1080/15622975.2016.1249951 

About the Author: Heather

Heather, MSW, LICSW, QCSW, ACSW has served on the Board of the National Eating Disorders Association (NEDA) since 2013, and collaborates with her NEDA colleagues on Eating Disorder research studies, papers, and presentations. Through her position at Brown University Department of Psychiatry and Human Behavior, she has also been collaborating with her local Rhode Island Hospital/Hasbro Children’s Hospital Eating Disorders Partial Hospital, Outpatient, and Home-Based clinical programs since 2013.  Heather had Anorexia Nervosa for 23 years, and has been recovered since 2012. 


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