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Body Image Flexibility: A secret key to recovery in eating disorders?

Written by Dr. Danielle Keenan-Miller

Negative thoughts about one’s weight, shape, and body size are a common thread across eating disorders. For anorexia and bulimia, placing excess importance on one’s appearance is an essential component of diagnosis. Although overvaluation of weight and shape are not required in binge eating, placing a lot of value on one’s physical appearance is associated with more severe binge eating patterns, along with depression and lower self-esteem (1).

One key to overcoming eating disorders may be body image flexibility, the ability to experience and tolerate a wide range of thoughts and feelings about one’s body without letting body image get in the way of engaging in important life activities (2). A new study (3) tested the importance of body image flexibility in recovery from a wide range of eating disorders in a group of adults seeking cognitive behavioral therapy. The researchers found that greater body image flexibility predicted lower eating disorder symptoms during and after treatment. In a related finding, people who reported lower levels of avoiding looking at their bodies also showed a higher degree of improvement over the course of treatment. Said another way, feeling like you cannot function if you’re having negative thoughts about your body or trying to avoid experiences that would remind you of your body shape and size make it harder to recover from an eating disorder, even when getting treatment.

The message for health care providers and people in recovery is that it’s important to learn to live with your body and cultivate a willingness to engage with the world even on days that you’re not feeling great about how your body looks or feels. The long road to recovery from an eating disorder is going to include both hard and easy days– times where it’s easy to accept your body as it is and days where that is going to feel uncomfortable. It’s okay to hold both of those sets of feelings with kindness and compassion, and to nonetheless move towards the goals and values that are most important in your life.

  1. Grilo, C.M. (2013). Why no cognitive body image feature such as overvaluation of shape/weight in the binge eating disorder diagnosis? International Journal of Eating Disorders, 46, 208-211. doi:10.1002/eat.22082
  2. Sandoz, E.K., Wilson, K.G., Merwin, R.M., & Kellum, K.K. (2013). Assessment of body image flexibility: the Body-Image Acceptance and Action Questionnaire. Journal of Contextual Behavioral Science, 2, 39-48.
  3. Pellizer, M.L., Waller, G., & Wade, T.D. (2018). Body image flexibility: a predictor and moderator of outcome in transdiagnostic outpatient eating disorder treatment. International Journal of Eating Disorders. Doi: 10.1002/eat.22842
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