Body Image Therapy for Anorexia – what is it and how does it work?

Today’s post is for eating disorder awareness week, which this year has a focus on early detection and intervention. Often, sufferers are unable to access treatment until they have been ill for some time, which makes recovery so much harder than if treatment happened once symptoms first began. As well as having obvious benefits for patients, there is also a financial advantage of early intervention (sadly, cost has to be taken into consideration when deciding if a new treatment is worth it). With the current state of the NHS it is important from a financial point of view, as preventive rather than curative medicine is much cheaper overall. So with the benefits of early intervention being brought to our attention, today I thought I’d write about a type of treatment for anorexia – Body Image Therapy.

For those of you who aren’t already aware of the symptoms, Anorexia Nervosa is characterised by:

  • severely restricting food intake, leading to extremely low body weight
  • a fear of gaining weight
  • distorted body image perceptions, with sufferers believing they are fatter than they are.

 

Contrary to what you might think, it isn’t just girls and young women who can have anorexia, men make up about 10% of total suffers (although some studies estimate higher). It is also becoming more common, with inpatient hospital admissions increasing by about 7% a year since 2005. As well as this increase, raising awareness and improving treatment is so important as anorexia has the highest mortality rate of any mental illness.

One of the reasons anorexia can be so hard to overcome is that sufferers have a distorted body image and believe they are much bigger than they truly are. This reinforces the cycle of restricting food or overexercising, and makes anorexia hard to beat. Studies have also shown (e.g. Fairburn et al, 1985) that the symptom of body image disturbances is also a predictor for relapse once therapy has been completed.

screen-shot-2017-02-27-at-20-09-47

Diagram adapted from Fairburn et al (2008)

Therefore, it makes sense to include body image therapy when treating a patient with anorexia. It is a type of cognitive therapy, which aims to reduce the harmful thoughts about body and weight. One type of body image therapy is Mirror Therapy, in which patients view their body in front of a mirror during a therapy session. Exposure can be increased over time and leads to an immediate emotional response which can be discussed during therapy. The therapist encourages the patient to look at their body as a whole rather than focus on perceived flaws, and to describe their body accurately as opposed to using negative language. This helps patients to learn that there are other ways of viewing their body and the consequences of negative thoughts about it (Delinsky & Wilson, 2006). Over time, cognitive therapy with mirror therapy has been shown to be more effective in terms of reducing body dissatisfaction and avoidance compared to cognitive therapy alone (Key et al, 2001).

Body image training in anorexia is therefore important as it could help to overcome the cognitive processes which make it hard to break the cycle of disordered eating and improve recovery rates for people suffering from an eating disorder.

Thanks for reading, and don’t forget to help spread awareness using the hashtag #eatingdisorderawarenessweek

If you would like to read more about the possible causes of eating disorders then see a previous post here or read about body dysmorphia in anorexia here

If you or someone you know is suffering from an eating disorder then there is help available. Contact your doctor or charities such as Beat, who can provide you with the correct support.

 

 

Grey Matter vs White Matter

This week’s post is about the cells that make up our brain. You might already know (especially if you read this post https://freudforthought.wordpress.com/2013/11/18/the-brain/) that our brain cells are divided into two types: grey matter and white matter.

Grey matter is another name for the brain cell bodies.

White matter is made up from all of the brain cell axons – the long arms of the cells which connect them to each other.

The image below of a cross section of the brain shows you how much of each type of matter is present, and where they are distributed within the cortex.

GrayMatter-WhiteMatter

As you can see, most of the grey matter is located on the surface of the cortex, with most of the white matter in the centre (with the exception of grey matter medial temporal lobe structures such as the hypothalamus). They are also both present in the spinal cord, with the central spinal column made from grey matter, and surrounded by white matter tracts. About 40% of the brain is made from grey matter, and various neuroimaging studies have shown that these areas are responsible for motor coordination, vision, memory, and decision making.

In research into psychological disorders, it is important to find out whether mainly grey or white matter is affected. For example in anorexia, this would be useful to establish, as if mainly grey matter is lost then it would suggest abnormal function of body processing areas within the brain, whereas if it was mainly white matter it suggests it is the connections between areas involved in body processing are affected. Fonville et al (2014) investigated this and found that grey matter is reduced in anorexia patients, so could be involved in the onset of the disorder. However, they also concluded that there has not been enough research into how white matter is affected, and whether these levels return to normal after recovery. This research is still in early days, and more needs to be done in order to find a more definitive answer about the roles of white and grey matter in anorexia.

I hope you found this post interesting, and thanks for reading!

Body Dysmorphia in Anorexia

Okay, so there hasn’t been a post in a while, no thanks to my dissertation – an 8,000 word essay on “Is there a neuro-cognitive basis of body dysmorphia in anorexia nervosa”. While I doubt many people would actually want to read the whole thing, this is a fascinating topic, so this post will be a (very) shortened version – hope you enjoy!

 

Firstly, if you’d like more information about anorexia and other eating disorders, check out my previous post https://freudforthought.wordpress.com/2014/01/27/eating-disorders/, which gives a pretty good background.

So what is body dysmorphia? Basically, I was trying to find out if there was any abnormality in the brain which causes sufferers of anorexia to feel as though they are fat, when in fact they are seriously underweight. It is important to find this out, as if body dysmorphia is not treated in anorexic patients,  it could prevent full recovery by maintaining restricted eating patterns (Heilbrun & Friedburg, 1990). Having body dysmorphia also makes suffering from anorexia more likely, therefore early intervention could prevent people from developing the disorder.

The Multidimensional Model of Body Dysmorphia

I focused on evaluating the multidimensional model of body dysmorphia in anorexia, which was proposed by Cash and Deagle (1997). This states that there are two main processes underlying body dysmorphia:

– Perceptive: involves deficits in perceptual processing of body stimuli, and less activation in areas of the brain involved in perceiving body image.

– Attitudinal: split into affective and cognitive components. The affective component states that anorexia sufferers show more activation of the amygdala to body stimuli, which suggests increased emotional involvement and possibly a fear response to body-related stimuli. The cognitive component states that sufferers overestimate their body size due to inaccurate body schema.

Perceptive Component

In order to find out whether anorexic patients have abnormal perceptual body processing, you first need to look at how healthy people process their body image. Downing et al (2001) found that the extrastriate body area (EBA) in the posterior and inferior temporal sulcus is active during body shape perception in the healthy population. Another area – the fusiform body area (FBA) has been identified (Taylor and Downing, 2011). These are shown in the image below:

eba and fba

These areas are thought to detect changes in body shape (Aleong and Paus, 2009), which could explain why anorexic patients don’t recognise their thinner body shape. The first study which showed that these areas could be dysfunction in anorexia was carried out by Uher et al (2005). They used fMRI to measure neural activity while healthy, anorexia nervosa and bulimia nervosa participants were presented with line drawings of overweight, underweight or normal female bodies. They found less activity in the EBA in anorexic women, which suggests a functional abnormality in this area.

 

Affective Component

The two key pieces of evidence for this are increased amygdala activation to body images (Seeger et al, 2002), and more anxiety in AN patients when shown body images, compared to controls (Friedrich et al, 2006). Seeger et al found that anorexic patients show a more activation of the amygdala when they are presented with distorted pictures of their own body. This suggests a higher emotional involvement in body images as the amygdala has been shown to be involved in emotion processing (e.g. Birbaumer et al, 1998).Friedrich et al found that AN patients show more anxiety than healthy controls when shown pictures of thin models, which again suggests higher levels of emotion caused by body images.

 

Cognitive Component

This states that AN patients have unrealistic body schema, which causes them to view themselves as being fatter than they actually are. But why do AN have larger body schema? One theory is that it could be caused by rapid weight loss, meaning the body schema is not updated. This was first shown by Guardia et al (2010), who, as body schema are involved in action, investigated how anorexic patients estimate body size in relation to actions. This study used a doorway aperture method – participants had to imagine whether or not they could walk through an doorway of varying sizes at normal speed and without turning sideways. They found that anorexic patients significantly overestimated their shoulder width compared to controls, which suggests a dysfunctional body schema.

Another study (Metral et al, 2014) found that anorexic patients act like they are fatter than they are too. This used the same method as the one described above. However, instead of just imagining whether or not they could pass through an aperture, participants had to then actually carry out that action.

 

Therefore, it is likely that a combination of all these factors causes patients with anorexia to view themselves as being fatter than they actually are, and continue to restrict their diet as they believe they need to lose weight. It is therefore vitally important to break this cycle by treating body dysmorphia, in order to allow anorexic patients to view their true body size, and enable them to make a full recovery.