The Concept of Body Image Disturbance in Anorexia Nervosa: An Empirical Inquiry Utilizing Patients' Subjective Experiences

Abstract

We explored the concept body image disturbance (BID) by utilizing the subjective experience of 32 women (aged 20–39 years) diagnosed with AN (DSM-V). Using methods from Grounded Theory we identified four phenotypes of BID—“Integration,” “Denial,” “Dissociation,” and “Delusion”—which differed according to whether the patients overestimated their own body size (“Subjective reality”), and whether they acknowledged the objective truth that they were underweight (“Objective reality”). The results suggest that BID should be conceptualized as a dynamic failure to integrate subjective experiences of one's own body appearance with an objective appraisal of the body. Conceptual, diagnostic and clinical implications are discussed.

Acknowledgments

This research is in collaboration with the Modum Bad Research Institute, to whom the authors are indebted for their contribution in preparing the project and practical arrangements for data collection. The authors want in particular to thank Dr. Øyvind Rø and Professor Asle Hoffart and for their valuable help in developing this article. We also want to thank Professor Walter Vandereycken for comments on an earlier draft of this paper. The project is supported by grants awarded by the Research Council of Norway and by the Norwegian Foundation for Health and Rehabilitation through The Norwegian Council for Mental Health.

Notes

¹Body mass index (BMI) is calculated as weight in kilograms/height in meters²

²BMI information was not available for one participants and lowest BMI information was unavailable for five participants.