“Body image is the last to come.” What does that even mean?

Throughout all of my eating disorder-specific treatment I’ve always been told that “body image is the last to come.” In other words, you can recover physically and stop all/most behaviors, but the body image distortions may persist for many years. I was talking to a therapist about this about a year ago and she said to me, “Well, even though you’re not fully recovered yet, you must notice some improvement in the body image stuff.” I was in a particularly bad mood that day so I quickly responded with, “Actually no, there’s been no improvement whatsoever. I still despise my body just as much as I did at 12 years old, even more probably.” Haha.

I probably really did hate my body on that particular day, because my feelings about my body are often heavily influenced by my mood in general. However, part of the reason I was so quick to respond like that likely had something to do with my weird need to never let go of that part of my eating disorder. This is hard to explain to most people. Basically, I fear that if I ever stop hating my body (or even admit to hating it less), that I’ll start loosening up my “control” by way of allowing myself to eat more. This, I fear, will lead to me becoming less and less rigid about food which will then lead to me getting bigger and bigger, perhaps so gradually that I fail to notice until it’s “too late.” I’m speaking in present tense because as pathetic as it sounds, I do still have this fear at times, although I can usually see how irrational it is far faster and easier than I could before.

I’ve said before that loving or even liking your body should not be a prerequisite for recovery. I may not “hate” my body as much as I once did, but I still don’t like it and I would feel pretty discouraged if I thought I needed to in order to make any further progress. I realize now though that the body image aspect of eating disorders and recovery encompasses a lot more than liking or not liking your body.

Before I go on I should note that while body image issues affect most people with eating disorders, they don’t affect everyone to the same degree or some people even at all. The latest edition of the DSM tweaked the criteria for anorexia because it is now accepted that some people who exhibit all of the other criteria do not experience body image distortions or a drive to lose weight and become thinner. For a lot of these people, their eating disordered behaviors may be purely OCD-driven.

That said, the majority of people with EDs do experience at least some body image-related symptoms which may include body distortions (sometimes even warranting a co-occurring diagnosis of Body Dysmorphia), or frequent “body checking” or measuring behaviors. I experienced all of these at some point. While my distortions were never as severe as some people’s (i.e., I never thought I looked legitimately overweight when I was at my lowest weights), I still had trouble seeing that I was ever as thin as other people said I was, and I always saw myself as “chubby” at weights that were considered normal/healthy. Rarely was my eating disorder about fearing that I’d actually become overweight; it was more about always feeling the need to be thinner and never being satisfied no matter how low I got. I also believed that others were somehow judging my level of self-control, success, or worthiness based on my weight. Because I was always comparing myself to my lowest (and/or anyone who I thought happened to weigh less than me at the time), I assumed everyone else was as well. Like, shit… surely that person I ran into the other day noticed I was a good 6 lbs. higher than I was the last time she saw me, so she must be thinking I’ve become super lazy and relaxed in my eating and is judging me for that.

In terms of body checking and measuring, I’m kind of a professional. I was “body checking” long before I even knew what it was, even before my eating disorder fully took over. I was involved in competitive gymnastics for most of my childhood up until the age of 13, so I was naturally more aware of my body than a lot of kids my age. I would stand in front of a mirror for hours in a leotard observing the space between my thighs, the degree to which my stomach stuck out past my hip bones, the circumference of my upper arms, etc. This soon progressed to performing very specific “body checks” throughout the day at school, on the bus or in the car, at home, or in bed. My most common checks included wrapping my left hand around specific points on my right arm, wrapping both hands around each of my upper thighs, and feeling the bones on the tops of my shoulders and my chest to make sure they were still as prominent as the last time I checked (likely earlier that day). I also went through long stretches of time when I would keep daily records of various body part measurements (e.g., the circumferences of various points on my arms/legs, my waist, hips, chest, neck, etc.).

It’s been a fairly recent discovery of mine that many of these body image-related symptoms have actually gotten better. While in the depths of my disorder I was intensely focused on my body and all the hatred I had for it. I would spend entire therapy sessions whining about how disgusting and gross I was. I would be told “fat is not a feeling” and to dig deeper and talk about the real issues and half the time that just made me angrier, because in those moments I couldn’t see past the body stuff. Other times I would be up all night studying years worth of weight and body measurement records, driving myself insane. Why did XX weight correspond to a measurement of X in 2008 but not in 2010? Why were certain measurements getting smaller without my weight going down, or vice-versa? Even 1-2 years ago I remember complaining to my dietician (who is more like a therapist to me) about how distracting my body checking was during the day, so much that someone had even noticed me doing some of these weird things so frequently at work and asked, “uh… what are you doing?” Wow, how awkward. You mean not everyone wraps their hand around their arm about 10 times an hour?

For many years, I corresponded almost daily with my dietitian through email. It started out as checking in each night about how my day had gone with food and behaviors, but it quickly morphed into more casual sharing and venting. I recently looked back on some of the emails from 3-5 years ago and was reminded just how body-focused these emails were for a very long time. I was complaining about how my weight was up two-tenths of a pound that day, or how I couldn’t focus in class because I was so fixated on how swollen my face or legs were. At one point she told me she wasn’t going to reply to any more of my emails where I referred to myself as fat, gross, or disgusting, so I pulled up good old thesaurus.com and expanded my vocabulary. I was now corpulent, rotund and roly-poly.

Over the past year or so, I’ve gradually relied less and less on these body-checks or emails. In fact, I can’t remember the last time I actually sent an email to my dietitian that was even about my “gross” body. I still write about my body troubles but rarely do I refer to my body as gross or disgusting anymore. Does this mean I like my body? Hell no, but I do pretty well at least tolerating it now. Most of my emails and in-person sessions these days are not even about my body. They’re about deeper issues, stuff at work, my future, relationships with friends/family, etc.

For most of my life I’ve been constantly striving for something “better” than what I currently have. In terms of my body, this usually meant setting lower and lower weight loss goals without even stopping to consider that maybe I didn’t need or even want that. I used to say, “If I’m not losing, I’m gaining” which makes NO sense (what happened to maintaining?) but it was my way of ensuring I never became content. I used to have so many rules and rituals that I had to follow exactly. If I didn’t, I’d lose control and become lazy, fat, gross, unsuccessful, etc. I’m finally starting to see that all hell may actually not break lose if I don’t follow all of these rules and rituals to the letter. I let myself have a few drinks last weekend without majorly restricting or compensating before and after, which is pretty much unheard of for me. I also ate a few things that I normally would never allow myself to eat (without proper “compensation”) and guess what? I’m still alive, no fatter than I was last week. It’s like some kind of miracle.

I’m always telling people that in order to make any progress in recovery you must find other things in life to focus on. I cannot stress this enough right now. I’ve only been able to let go of some of my body obsessions and compulsions because I started replacing them with other more meaningful things– dedication to my job/career, writing in this very blog, cultivating new relationships, and letting people in more than ever before. It all sounds so cheesy, I know, but it’s the most useful piece of “advice” I can offer anyone.

Now because I wrote this, I’m sure I’ll have a moment or two next week when I’ll be saying to myself, “WTF Becca? Nothing has changed. This body is not ok and you must do x, y, and z to fix it.” This happens whenever I start to acknowledge my progress because as strange as it sounds, it’s often really scary to get better.

When people used to tell me that “body image is the last to come” I would get really depressed. What was the point of putting any effort into recovery if I was still destined to hate my body for the next undetermined number of years? These days this thought actually gives me hope. I may still not like my body, and even struggle to tolerate it some days, but I also have proof that I can lessen the impact it all has on me by bringing new and better things into my life.


One thought on ““Body image is the last to come.” What does that even mean?”

  1. Wow! My therapist has said this to me on multiple occasions; even my nutritionist has said I may never have a normal body image. It was quite depressing but now if I can manage tolerating it then that, I’ve decided, will be success.


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