One focus of my practice is concerned with how clients regard their bodies. It comes up often with women who have eating disorders, but can also come up with men and those who are not especially troubled by food. Many people in our culture feel unacceptable to themselves because of body size and shape. Just as women can be preoccupied with feeling fat, men can be preoccupied with their height, or baldness, or the size of their nose. The way we come to think and feel about our bodies can affect our lives in powerful ways.

In my post-graduate training I learned to run body image workshops for women. In these groups we would do psycho-education, visualizations, and many exercises geared toward clarifying and correcting the individual problems of group members. These days, I have been doing this work with people on a one-to-one basis. At any given time I always have several patients grappling with difficulties in this area.

Sometimes I discuss food and dieting with patients, and the use of a twelve-step program. Sometimes I use a mirror and drawing materials, to help a patient confront and express feelings about their bodies. Often people need help understanding the family, social and environmental influences that have driven them to have distortions about their bodies.

Preoccupations about body image issues can sometimes mask other problems. I have had patients with health concerns, such as metabolic irregularities, who have been unable to care properly for themselves because they had trouble separating cosmetic concerns from medical concerns. Often patients are obsessed about how unacceptable their bodies appear to them, when the underlying problem has to do with failures in relationships. The body is often symbolic for other concerns in people's lives. In therapy, we need to look at both the underlying issues and the behaviors, in order to make progress, and experience change.

Distortions in Thinking and Feeling
The simple experience of viewing oneself in a mirror can be extraordinarily complex for the eating disordered person, because her perceptions of Self can shift so dramatically, from moment to moment, depending on the results of social interactions. These changes in moods can happen in the blink of an eye, and for some people, many, many times throughout a single day. People given to eating disorders are often hypersensitive to other people's moods, and this results in wild swings in self-image.

I have been working on a cartoon series that illustrates how these kinds of distortions work. Check back periodically for new comics.