“My Body Is My Template”: Why Do People Suffering from Anorexia Nervosa See Their Bodies Differently?

Abstract

Though anorexia nervosa (AN) is classified as an eating disorder, a central disturbance seems to be a distorted body size, which does not allow the sufferer to see her emaciated body as it really is. During body processing in healthy women, a fronto-parietal network is activated. In AN similar cortical activation occurs during processing of other women’s bodies suggesting that the functional architecture of the anorexic brain is intact. However, the activation during self-processing is quite discrepant with inhibition of the fronto-parietal network, and decreased activation in the insula, the prefrontal cortex and precuneus compared with healthy controls. The convergence of emerging neuropsychiatric research in conjunction with psychosocial data allows the development of explanatory models for the disturbance in body size awareness. There seems to be a discrepancy between the internal representation of the body and the anorexic brain’s ability to correct it. Parietal lobe dysfunction, insula hypofunction, and amygdala-hippocampal hyperfunction may be contributing factors. The distorted body size causes distress and phobic avoidance of an ever-increasing list of factors associated with food and weight gain. There is a breakdown in self-awareness that leads the anorexic woman to deny her low weight, which is congruent with her experience, albeit irrational, of the judgment of those around her.