It can be said that we have two bodies: one that others can see and one that we think we have. Consequently, we can be fat and believe that we are thin and therefore don't need to reduce. Or, we can be like teenage Karin who only weighed 28 kg when she cried to her therapist that she was too fat and must slim!
Many people with eating disorders think they are fat when they have eaten too much or when they feel anxiety. When calm and relaxed, they might see themselves more realistically. Their starvation is a continual risk factor for a compulsive eating attack. They know that they might not stop eating and are afraid of losing control.
Fear of becoming fat can be experienced as being fat. Many people who have been thin as children continue to think of themselves as thin when adults, even if they are overweight. For overweight children, the opposite is true, even if they develop anorexia nervosa!
Eating disorder patients base their evaluation of themselves exclusively on their weight and body image.
They think that if they are thin enough they can face the challenges of life: find a partner, a satisfying job, have friends, and be admired.
This cognitive prejudice leads them to have non-stop problematic thoughts about their body (such as: "I have a swollen belly", "my legs are too fat", "I am a useless fat woman", " I have gained a kilo so today and tomorrow I have to refrain from food", "I am so fat that I disgust people", "I cannot weigh more than 40 Kg", etc.) and in time they are prone to become perfect obsessions.
In addition there is also the incapacity to evaluate the body image from an objective point of view.
For these reasons a lot of eating disorder patients reach underweight and malnutrition levels that can seem incredible, if you forget that their self-esteem corresponds to their capability to maintain their weight under strict control.
When you are a victim of this self vision, the whole situation of life, even things that have nothing to do with the body, can set people off worrying about the body and weight, causing anxiety and new attempts at further control.
To break this cognitive-behavioural vicious circle that exists between the unwell body image and the excessive importance that these patients give to the body and body image is one of the principal tasks of Eating disorder therapy.
There are indeed a range of techniques aimed at body restructuring that, linked to other therapeutic techniques, help patients to overcome contempt for their bodies and begin to love it again.