**Abstract**

It has been well documented that individuals struggling with eating disorders don't have clear perceptions of their own bodies. Yet they overly rely on their body image as their sense of self. Even the criteria of certain eating disorders recognize that individuals are strongly affected by their body weight and shape, which is often seen through a distorted lens. Individuals with eating disorders, particularly anorexia nervosa, struggle not only with recognizing their external beauty but also their internal positive qualities. Their perfectionism and critical sense of self leads them to have negative views of their beauty and self-worth. This chapter will look at some of the reasons individuals with eating disorders struggle to appreciate their own beauty, internally as well as externally, and will offer some tools to help with these struggles. Many individuals, even those without disordered eating, struggle with critical self-perception. Perhaps this chapter can help us all become more compassionate to ourselves as we consider our external and internal aspects of beauty.

**Keywords:** Body image, eating disorders, perfectionism, beauty, self-identity, compassion

### **1. Introduction**

Individuals with eating disorders often don't recognize their beauty. Those suffering from anorexia nervosa and bulimia nervosa struggle with accurate perceptions of their body weight and shape and unduly rely on body weight to define self-worth. [1] It is important to recognize that these individuals value themselves based on their weight and shape and yet often cannot accurately assess themselves in the physical dimension. I have worked with individuals in our eating disorders clinic who were emaciated but yet feared coming into a medical appointment because they would be weighed. The fear was not only about the number, which causes anxiety for many individuals with eating disorders, but a fear that they were so heavy that they would break the scale and/or exam table. One patient described that when he walked, he felt like he was breaking tiles because he was so heavy. He was actually severely underweight. Individuals with eating disorders struggle both in recognizing how they actually look and appreciating the beauty of their healthy bodies. They rely on their body weight to help define their self-worth and when they feel so negatively about how they look, they also struggle with seeing positives in themselves even their internal qualities.

When I have asked individuals in groups to share something that they like about themselves, they often describe that they like how they care about other people. They do not hold this same level of care or compassion for themselves. Individuals, particularly those with anorexia nervosa, can struggle with "repressed narcissism" such that they put other peoples' needs before their own. This can lead them to completely disregard their own needs, wants and desires. They see themselves as not worthy of being taken into consideration. These negative views can become intertwined. They see their body in a negative light and yet rely on their weight and body shape to define their self-worth. This can make them feel worthless and that negative feeling can contribute to them being even more self-critical about their worth and their body.

Additional challenging traits, such as perfectionism, are often associated with eating disorders and can further undermine a person's acceptance of his/her uniqueness and value. Perfectionistic tendencies makes it difficult for many individuals with eating disorders to complete certain tasks (such as sending emails) but also makes it hard for them to acknowledge their positive traits. They are often are so self-critical that they can never match their internal expectations. When asked in groups how they would define another person's success, the answer would often be, that the person would be successful if she tried her best. So if in school she got a "B" or a "C" but had tried her hardest, that person should still be seen as a success. However if they themselves didn't achieve a 100 percent on an assignment, then they saw themselves as worthless. Often there was a vast difference between their expectations of others and their expectations of themselves. Studies have linked disordered eating with body dissatisfaction, low self-esteem and perfectionism, especially in girls. [2] They struggle not only with dissatisfaction of their external beauty but struggle with their internal acceptance of self. The do not see their external or internal beauty.

Another chapter in this text, *Blossoming for Whom? Social Approval and Body Image*, looks at the role of social acceptance and body image disturbances in individuals struggling with eating disorders. [3] When individuals are faced with images and expectations that are not achievable, their own sense of beauty can be affected. Models are not only much thinner than the average woman but hours of styling and then subsequent photo-shopping make media images unattainable. If one bases her sense of value on external beauty standards, then it is understandable why she struggles with her sense of self when measured against these unrealistic expectations. If individuals struggling with eating disorders, do not see themselves in a realistic way, measure themselves against unreachable goals and link their self-value to these external perceptions, then it is understandable why they underestimate both their external and internal beauty. In addition, when individuals struggle with self-criticism and perfectionistic expectations, they often do not recognize their internal positives and by extension the beauty of their soul.

Are there ways to help individuals who struggle with eating disorders challenge these negative views? Can any of these tools help others who might not struggle with an eating disorder but who also struggle with low self-esteem and a negative view of self? My clinical roles include not only work within an eating disorders clinic but also providing therapy to students at Penn State College of Medicine. It is clear from my work with these individuals that although many do not struggle with eating disorders, they often struggle with a negative sense of self. Many describe elements of "the imposter syndrome", which affects many individuals even those functioning at a very successful level. They worry that they will be found out—that even though they have been successful and have received praise, it is only because they are fooling other people. When others discover who they really are—they will be seen as an imposter. How can any of us accept ourselves and discover our

#### *Do Individuals with Eating Disorders See Their Own External and/or Internal Beauty? DOI: http://dx.doi.org/10.5772/intechopen.97508*

external and internal beauty? It seems like an impossible task considering all of the expectations that are placed on us. For individuals who struggle with eating disorders this journey can be even more difficult. Yet part of recovery will be working to discover and accept their own unique beauty.

While eating disorders and negative body image can affect all individuals, including men, my examples will be mostly from women that I work with in my clinic. They make up much of my treatment group. Some studies have suggested that body image disturbances and subsequent eating disorders occur at higher rates in groups of individuals who are trying to develop relationships with men because these women or gay men are often judged by their physical attractiveness. [4] In many societies, especially Westernized society, women are often evaluated and judged by their physical appearance. They are often exposed to comments or actions that focus only on their external appearance and objectify them as sexual possessions. Exposure to sexually objectifying comments can have a significant negative influence on women, not only when those comments are made directly but even when they are experienced secondhand. [5] It is for these reasons that this chapter will mainly focus on the experience of women, as they battle their illnesses, their negative self-perceptions and negative self-evaluations. They often don't see their external or internal beauty. Perhaps, there are ways to help them discover and accept their positive traits.
