Psychologists with the Eating Disorders Program at Houston's Menninger Clinic say that women with eating disorders can spend nearly every waking moment - up to 90 percent of their day - obsessing about their appearance. These women, and others who suffer body dysmorphic disorder (BDD), can be helped with behavioral and group therapy specifically targeting body image issues, says Menninger's Theresa Fassihi.
"Body image disturbance is one of the most difficult things to change when treating an eating disorder and is the last symptom to resolve from treatment," explained Fassihi. "If a patient does not make some improvement on body image issues early in treatment, it is a significant risk factor for relapse into the eating disorder."
Fassihi's 12-week program consists of both cognitive-behavioral therapy and experiential therapy. In the cognitive-behavioral therapy group, patients learn to identify negative beliefs about their body image and dispute those beliefs. For example, one exercise asks patients to estimate how much string it would take to wrap around a certain portion of their body, such as their thigh or waist. Patients often think the amount is three times more than what it actually takes. When they measure the string, they realize the circumference is much smaller than imagined.
"With the dispute step, patients may begin to see their distorted thoughts become more balanced," said Menninger's Deborah Henderson. "Instead of thinking hundreds of times in one day how big a certain body part is, they begin to balance out their thought process by using self-talk to focus on the new disputing evidence. We teach them to decrease the distorted thoughts and focus more on disputed thought."
Patients also participate in a body image party, in which they must come up with one word that describes their appearance. For example, a female patient may choose "grotesque" as her word. The group then gives her feedback that she is not in fact grotesque. As a result, the patient learns that the standard she has set for herself is too high, and her image of herself is different from the reality of what others think of her.
In the experiential group therapy strand, patients assist one another to trace their bodies onto paper. At the beginning of the tracing exercise, patients draw what they think they look like, and then contrast it with an actual outline of their body. Frequently, patients overestimate the size of their bodies. Seeing the difference between their estimated size and their real size can be enlightening for patients. "Patients gain some important insights through the body image groups while at Menninger," Fassihi said. "They learn about how their body image issues impact their lives, and most seem to re-evaluate the importance they have been placing on appearance."
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Source: Menninger Clinic