Everything we have heard we are, and the way we were told to be,
is tied to our image. Behind this, there is a meaning that in
people with ED (Eating Disorders) acquires a value that ends up
becoming the centre of their lives, around which they revolve.
The goal of this presentation is to explain how you can work the
distortion of body image from the perspective of EMDR in order
to work on one of the source problems in Eating Disorders, such
as awareness of the real body and reach acceptance.
WHAT IS BODY
IMAGE?
One of the first definitions of body image is:
• The image we create in our mind regarding our own body, it means,
the way we see ourselves. Schilder (1935)
• In addition to the perception of our body, including the assessment of
our size, there is an emotional or attitudinal image, an evaluation,
that is, the way we feel about it.
• This is the aspect that we usually focus when we talk about negative
body image in people with Eating Disorders, using body
dissatisfaction or rejection.
WHAT IS DEFINED AS BODY IMAGE PROBLEM?
– A NEGATIVE BODY IMAGE may involve a
dissatisfaction or a negative evaluation of a
physical element or even an extreme obsession
with the physical aspect to the detriment of
normal functioning. (Lorraine Bell, 2010)
• Summary:
Perceptual Distortion
Failure to meet the
unrealistic targets of size
and weight that lead to
body image
dissatisfaction.
THE CONCEPT
Thompson (1992) proposed the concept of BODY
IMAGE DISORDER as a persistent state of
dissatisfaction and worry related to some aspect
of body image.
BODY DISSATISFACTION
PERCEIVED
SELF
DISCREPANCY
IDEAL
SELF
Body Image
Negative
Body Image
Body Image
Disorder
WHAT IS BODY
DIMORPHIC
DISORDER? (I)
• Body Dimorphic Disorder (BDD) is an absolute concern for a
physical defect or a defect perceived as it seems.
• leads to great stress and is not caused by another disorder such
as anxiety disorder, OCD, major Depression.
• It is likely to occur with Eating Disorders.
• The concern is directed to an obsessive body checking, skin
picking, spending excessive time to camouflage the defect, social
anxiety, unnecessary treatments and surgeries and sometimes
self-harm or suicide.
WHAT IS BODY
DIMORPHIC
DISORDER? (II)
• In most studies concern appears in adolescence
or early adulthood, however, studies find BDD in people of
all ages and both genders.
• People with BDD seek medical advice because of losing
jobs, studies anxiety, relationship problems but not by
the BDD itself, because they have many difficulties to
recognize that their perception is distorted.
Muscle Dysphormia disorder (MDD)
Bigorexy
•
Muscle Dysphormia (or more
informally bigorexy) is a
disorder in which a person
become obsessed with the idea
that they don´t have muscles
enough.
•
Is a very specific type of body
dysmorphic disorder, the person
is preoccupied with thoughts
concerning apperance, specially
muscles.
•
Researchs have identified that
AN and Mucle Dysmorhia have a
strong connection to low selfesteem commonly sprouting
from chilhood abuse.
BODY IMAGE DISTORTION IN
EATING DISORDERS
• University of Illinois professor
Janet M. Liechty conducted a
research study concluding that
body-image distortion predicts
future unsafe weight-loss
behaviors in young females.
• She says “usually, teens and their
parents only get weight-related
feedback from the doctor when
the child is overweight. But kids of
any weight can struggle with
body-image and poor-image can
negatively affect medical
outcomes in ways we often don´t
recognize”.
• Is the other side of the coin of
body image distortion.
• It is not inside of the eating
disorders box yet
• People see themselves as thin,
but they are actually overweight.
• People who suffer from fatorexia
have excessive weight and fail to
notice it. On the contrary, they
see themselves as thin and
healthy.
THE REJECTED SELF IMAGE
Rejected
Self
Image
Ideal
Self
Image
Distorted
Self
Image
• It is the image of yourself from the past that
you always compare yourself to and you never
want to be again.
- Gathering information about the default and
the Rejected self.
- Psycoeducation
- Working with defenses.
- Resources
- Applying the protocol
• How old were you when you first noticed the problem?
• Has it always been the same area the subject of the
complaint or sometimes you focus on other areas of
your body?
• When you think of this area of the body, what makes
you believe about yourself?
• How much time do you spend hiding or covering the
area of ​your complaint?
• What else was happening in your life when you
were first aware of this area?
• Is there someone in your family who has the same
problem?
Development of the protocol
• We offer psychoeducation in order to recover their
internal locus of control and sense of self and
strengthen it.
• We explain what self-esteem and self-image are. We
will obtain more information through the question,
"where did you learn to see yourself like that?”
• We can work in multiple sessions using standard
protocol to increasingly reinforce our work with the
rejected self.
• Rejection is not accepting, it is confronting or opposing.
• Shame is not showing oneself in order to hide what is
perceived as negative.
• Worry protects us from going back to being what we once
were.
• Defenses are the mechanisms through which the internal
system protects itself, so the person can become “functional”
• Many times, the body, or a part of the body, is not felt as
belonging to the self, it feels alien.
• The fear of change is an important
part of the work with body image
and the rejected self that must be
taken into account, particularly in
Anorexia Nervosa because if the
rejected self is accepted, they may
begin to improve and, if so, they
fear gaining weight and changing
their image.
• We need to take into
consideration this defense in case
the process becomes blocked.
• EMDR works by making a floating back in time
looking for the earliest or significant
memories in which the person has felt or seen in
the same way as is being seen in the present.
• In the distortion of body image, you take the
picture representing the refused self which the
person does not want to be anymore, being
usually the image always present and which is
compared to check the body.
Development of the protocol
• Place the image of yourself in front
of you.
• It is the image you always compare
yourself to and that you never want
to be again.
• That image has always been there all
these years ... it is called the rejected
self, the part of you that you do not
want to be anymore.
• This is the part of you that you
compare yourself with.
Development of the protocol
• We help identify beliefs that block the
development of the acceptance of the real
self.
• They are usually believes like:
“I’m not worthy", ” I'm not pretty so no one
will love me", "my body is not worthy",
"there's something wrong with me" …
Development of the protocol
• We explore which is the image that represents her rejected
self.
• The patient gives us an image and we tell her to look at it and
tell us if it generates any rejection, shame, or worry. These are
three of the defenses that present more difficulty in working
with the rejected self, but we give the patient the option to
give us another defense other than these three in the way of
any emotion or feeling that may come up.
• The patient gives us the defenses.
Development of the protocol
• We work with the SUD scale of 0 to 10 for each of the defenses, just as in
the standard protocol, where 0 = none and 10 = maximum.
• Once the client gives us each SUD, we ask where she feels it in the body.
• This is when we tell the patient to think of the image of the rejected self,
we name the defenses along with the SUD and the place where she feels
them, and we begin to stimulate.
• We use stimulation through several sets, allowing the processing of
whatever comes up, we then return to the rejected self and ask from 0 to
10 how much rejection or shame she feels when looking at her image and,
once it is measured, we continue processing.
Development of the protocol
• We know that processing is taking place
because rejection, shame, and worry start
turning into sadness for this rejected self.
Gradually, the defenses become weaker, giving
way to the emotions that were always
underneath.
Development of the protocol
• Once we reach this point, we measure the sadness and where it is
felt in the body. We tell her to focus on that part of herself and the
grief or sadness she feels for this part that has been rejected all
those years, and we begin to stimulate.
• Sometimes, when grief or sadness toward this part the patient
may feel that the part is not her. So then, we ask her to look at the
part in the eye with her imagination and to imagine that the part
looks at her (Loving Eyes, Knipe) and she looks at the part, thus
strengthening the bond.
• We encourage integration.
• We go back to the image and we check again.
MATERNAL FIGURE AND THE CONSTRUCTION
OF BODY IMAGE
• Maternal representations play a crucial role in the
construction of body image.
• The attachment figure meets the criteria that Kohut
attributes to the concept of self, which can be
considered as the recognition and acceptance of the
self.
• Negative feedback from mothers about daughter´s
figures and eating patterns significantly increased
daughter´s difficulties in these areas.
MATERNAL FIGURE AND THE CONSTRUCTION
OF BODY IMAGE
• Need for recognition that builds up self-esteem.
• Without this recognition and validation,
especially from the maternal figure, the concept
of self is built from a base of insecurity. So,
external confirmation will be sought in order to
achieve internal validation.
The mother as subject with multiple
motivations
• When we work with the rejected self, many times
the mother figure appears as part of the
processing.
• As a reference figure, since it often represents the
physical model from which to learn and do the
modeling.
• So when we process the rejected self, we also
process and restore the relationship with the
attachment figure.
EMAIL ADDRESS
NATALIA SEIJO
• PSYCHOLOGIST, TRAUMA and EATING DISORDERS specialist
• PRIVATE PRACTICE PSYCHOTHERAPY, TRAUMA AND EATING
DISORDERS
• North of Spain
• seijonatalia@gmail.com