**2. Body image**

Body image is "a person's mental picture of how good or bad their physical appearance is, especially when compared with how they think they should look**".** [6] Within this simple definition, one can already see part of the difficulty because it focuses on how we think we should look. A comparison is introduced even in the definition. Comparisons can exacerbate negative perceptions, especially when comparing oneself to unobtainable images and struggling to accurately perceive oneself. "Your body image is what you think and how you feel when you look in the mirror or when you picture yourself in your mind. This includes how you feel about your appearance; what you think about your body itself, such as your height and weight; and how you feel within your own skin." [7] Body image encompasses many elements. Individuals who struggle with eating disorders, particularly anorexia nervosa, can have challenges with the perception of their bodies when they look in the mirror or see pictures of their own images. They not only feel negatively about themselves but can also struggle to perceive their bodies accurately.

When women struggling with an eating disorder were presented with an image of themselves and asked to photo-shop the image to what they believed they looked like, they routinely distorted portions of their body making themselves appear much heavier. This was opposed to a control group who made minimal adjustments to the images and accepted the photograph as an actual representation of how they looked. [8] Other studies indicate that individuals with anorexia nervosa might not overestimate their body size but that the disturbance comes because of their distorted view of a desired body. [9] This was further substantiated by [8]. When individuals with eating disorders photo-shopped their bodies to a desired state, these images were often extremely distorted and demonstrated unrealistic body goals. One study [10] suggests that individuals without an eating disorder often rate themselves as more attractive than others rate them. Whether this is true for the majority of individuals is not clear. It does seem, though, that individuals who do not struggle with an eating disorder often have a more compassionate relationship with their bodies. They recognize what their bodies do for them rather than

being disconnected from their bodies. An individual with anorexia nervosa has disturbances that affect the person's functioning such that it is difficult to experience his/her body as an integrated aspect of self or develop a coherent narrative over time. [11] Clinically, individuals with anorexia nervosa often seem at war with their bodies, often seeing them as something that can be manipulated and brought under control even as these actions are taking them further and further away from being able to function in life. For women with bulimia, when they were asked to focus on their bodily sensations and estimate the width of their body, they overestimated their size by 13%, while the controls' estimates of how wide their bodies "felt" corresponded to actual sizes. [12] A positive body image is associated with psychological well-being. [13] It is clear that we need to consider how individuals can come to love their bodies and their selves.

### **3. Body dysmorphic disorder and obsessive compulsive disorder**

Anorexia Nervosa and Body Dysmorphic Disorder (BDD) appear to share certain characteristics, such as a distorted and dissatisfied perception of one's body. The similarities and differences, i.e. how they are classified can be important to consider. As [14] notes, although they are classified differently—under feeding/ eating disorders for anorexia nervosa and obsessive compulsive disorders for body dysmorphic disorder—their similarities may warrant classification as "body image disorders" and benefit from therapies that target body image disturbances. This overlap is important to consider as is the role that obsessive compulsive symptoms may play within eating disorders, specifically anorexia nervosa. Clinically, a number of patients whom I have worked with who struggle with anorexia nervosa often demonstrated obsessive compulsive tendencies. Typically their obsessive– compulsive behaviors revolved around food—not wanting to mix foods, needing to eat foods in a certain order, requiring a certain number of chews per bite, calculating and recalculating calories for the day to ensure that the total is correct. The intertwining of obsessive–compulsive behaviors and anorexia nervosa is interesting when considering a study that looked at emotional intuitiveness for individuals struggling with OCD (obsessive compulsive disorder). The authors [15] found that people with high obsessive–compulsive tendencies had more difficulty accessing internal states because of their continual doubting. Constant monitoring of thoughts can use up cognitive resources that can then make it difficult for individuals with OCD to have the resources available for actually experiencing the emotional states. [15] As individuals get more distant from their internal states, they start to doubt their own experiences or feelings and this can develop into a negative cycle. This is important to consider because individuals with anorexia nervosa often seem disconnected from their emotions. Often they use the illness as a mode of control and as a way to numb away feelings of discomfort. In [15] they suggest that many emotions do not stand up to constant monitoring but anxiety can "survive" this constant assessment and may even increase. These connections underscore some of the challenges for individuals with eating disorders as they try to recognize both their external and internal beauty. Individuals with anorexia nervosa share characteristics with BDD and as such cannot accurately assess their body and their external beauty. They often see it in a distorted perspective. The significant OCD tendencies that we see in individuals struggling with AN can affect their assessment of self. The disconnection with their emotions and the constant swirl of anxiety can make them doubt much of their inner life and challenge their recognition of their own emotional states and inner beauty.

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