I’ve been reading a lot of literature on bodies and eating disorders lately as I gear up to write the theoretical paper that becomes the basis of my PhD qualifying exam. Perhaps unsurprisingly, I’ve become a little preoccupied with teasing out my understanding of the relationship between body image and eating disorders in an era in which even saying those words in the same sentence sparks visceral reactions among listeners.
This post is not about whether body image causes eating disorders or not (sorry to disappoint). It is, however, about one of the best articles I’ve stumbled across thus far that seeks to shed some light on the ways in which those with eating disorders (specifically anorexia nervosa, in this case) might experience bodily sensations, which in my view is much more interesting than quibbling about whether body image is the primary causal factor for eating disorders.
In the article, Zucker et al. (2013) explore “subjective body experience,” meaning internal feelings of the body. They situate this work in a growing body of research focused on how people with eating disorders actually feel in their bodies, including but not limited to what the body looks like. As they describe, this body of research is focused on whether and how people with eating disorders might have “disturbed” experiences of bodily sensation. I’ve put disturbed in quotation marks here; one of the areas in which I’m still on the fence as to whether or not I agree with the authors is this idea that there is some normative way of experiencing and sensing the body. Nonetheless, I think this article deserves a little attention.
Zucker and colleagues gathered a sample of 59 women, 20 of whom had a current diagnosis of anorexia, 15 of whom had a previous diagnosis of AN but were weight restored, and 24 healthy controls. They used both neuropsychological and self-report measures to try to get a sense not only of body image, actual behaviours, and underlying temperament, but also the physical experience of the body.
One of the most interesting results is that the authors found a link between AN and sensitivity to sensory experience. Women in their study who had current or past diagnoses of AN seemed to wish to avoid sensory experiences, perhaps because they were more intense for this group. This is a very interesting relationship that makes sense to me; it also goes against some prior studies that reveal the opposite, suggesting that people with AN may not experience their bodies as strongly as healthy controls (e.g., Ainley & Tsakiris, 2013).
To me, it makes intuitive sense that people with AN have a strong sense of being in their bodies, and feel things strongly. This could mean that symptoms are a way of coping with the extreme sensations; essentially, seeking a way to numb overwhelming sensation.
Interestingly, being sensitive to physical stimuli was also linked to BMI, where those who had the lowest lifetime BMI were also the most sensitive. (Important note: I don’t mean sensitive in the emotional sense used in popular culture, and neither do the authors- I mean literally sense-itive!) The authors of the article provide 3 possible reasons for the link:
1. Illness severity: meaning that sensitization is among the several symptoms that are heightened amongst those with very severe eating disorders
2. Low BMI acts as a mute for sensory experience: this would be in line with my comment above about how symptoms might act as a “numbing” mechanism
3. Low BMI impacts the “sensory threshold”: this perspective would be somewhat contradictory to the second, meaning that those with a lower BMI actually become more aware of what is going on in their body because they are in a state of perpetual danger
I think it is interesting (and great) that the authors provide all three hypothetical explanations for the relationship; this helps to underline the fact that this is not an easy relationship to tease out. Likewise, they highlight the provisional nature of the findings, noting that we would need to delve much more deeply into the concept of sensitization to understand this link. It’s just good research and good form to give this kind of caveat, but I find that it is less and less present in research I read these days.
Another interesting finding was that body image disturbance on self report was also linked to sensory experience. This underscores the idea that (surprise surprise) body image is about more than just image- it is also about feeling. So, perhaps we could think more seriously about “body image” beyond how closely someone emulates a thin ideal?
So what does it mean?
You might be wondering: why should I care which came first, the eating disorder or the different experience of the body? This matters because a better understanding of the link between body sensation, body image, and eating disorders can inform our research and treatment strategies, which could focus on more than a superficial question about “how’s your body image today?” as a gauge of one’s experience of their body.
As I mentioned at the beginning, I’m still unsure how I feel about any suggestion that there is “a” normal way of feeling in our bodies. Obviously, we each only know what it feels like to be in our own body. Even with research data to support “normal” sensation, I think that there is a degree of subjectivity in terms of what being in a body is actually like and how this then relates to how we see ourselves and our bodies.
Still, I think that this study has a great deal of value, mostly in terms of what it says about the complexity of “body image.” The authors are getting at something I also hope to explore in my research: the idea that body image depends not only on the seen but the felt. Unlike other studies on sensation, which have left me wanting more than just a rubber hand illusion, this one used a deep understanding of the complexities of eating disorders to present some possible relationships between body sensation, body image, and eating disorders. It also gave me hope that my specialization paper is not so far “out there,” which doesn’t hurt!
Zucker NL, Merwin RM, Bulik CM, Moskovich A, Wildes JE, & Groh J (2013). Subjective experience of sensation in anorexia nervosa. Behaviour research and therapy, 51 (6), 256-65 PMID: 23523866