Embodiment and Eating Disorders

Theory, Research, Prevention and Treatment

Hillary L. McBride, Janelle L. Kwee, Hillary L. McBride, Janelle L. Kwee

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781351660167
• Edition: 1
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

This is an insightful and essential new volume for academics and professionals interested in the lived experience of those who struggle with disordered eating. Embodiment and Eating Disorders situates the complicated – and increasingly prevalent – topic of disordered eating at the crossroads of many academic disciplines, articulating a notion of embodied selfhood that rejects the separation of mind and body and calls for a feminist, existential, and sociopolitically aware approach to eating disorder treatment. Experts from a variety of backgrounds and specializations examine theories of embodiment, current empirical research, and practical examples and strategies for prevention and treatment.

Part I

Theoretical and Philosophical Perspectives of Embodiment and Eating Disorders

What is embodiment, and what is its role in the prevention and treatment of eating disorders? This section includes chapters that explore this question from a theoretical perspective, weaving together existential, phenomenological, and feminist perspectives on eating disorders. This includes a chapter addressing how body image and embodiment are different, an exploration of eating disorders as a feminist issue, and the re-centering of the body in eating disorder work, the development of embodiment, the history of embodiment in the discipline of philosophy, and how we may begin to better understand embodiment through research and measurement of experiences and constructs which are difficult to explore through traditional academic approaches.

1 Embodiment and Body Image

Relating and Exploring Constructs

Hillary L. McBride

Our bodies, and our relationships with them, are rife with paradox: known and unknown, constant and changing, often visible to others in ways invisible to ourselves. The skin on my face is made up of different cells than when I was first born, but looking at a photo of my face in childhood, people would recognize the face they see in the photo as my face: different, yet paradoxically the same. My body has always been me and been my own. Yet moving through the world and time, depending on the stage of life, the context, the need, the choice, our bodies can feel less ‘our own’ and more an object to be seen and judged, touched, used, had. These paradoxes reveal the tensions wrapped up in our human bodies, hinting at the richness and complexity of our existence, the body itself, our relationships to our own bodies and the bodies of others, and our intellectual understanding of ‘body’.

With something as apparently concrete as the body, it is intriguing that there is such little consensus among academics about how we understand and describe our relationship to our bodies, as it parallels the domains of human experience: somatic, affective, cognitive, relational/spiritual. Although there are constructs such as body image and embodiment which have even been used empirically and philosophically to better understand the body-self relationship, there has been no conclusive resolution to the decades-long theoretical debate about what those words mean and how they are related to each other or not (Garner & Garfinkel, 1981; Smolak, 2006).

The divergent approaches to conceptualizing our relationships to and experiences of our bodies give us opportunity for rich dialogue and nuanced understandings. How these theories fit together, and do so within a particular sociopolitical context – where bodies are sites of power and oppression – requires further exploration. In this chapter, we explore the relationship between body image and embodiment as constructs that can inform research, treatment, and prevention of eating disorders.

Body Image

Body image was defined in the early 20th century by Schilder as “the picture of our own body which we form in our mind, that is to say, the way which the body appears to ourselves” (1950, p. 11). Currently, certain definitions of body image appear more regularly than others in the academic literature, even though there is no consistently agreed-upon theoretical definition. Most often, these definitions describe body image as the cognitive appraisal, perception, or evaluation of one’s own appearance and body shape, and the related or resulting affect (Smolak, 2006). These cognitive and affective dimensions of body image include appearance evaluation and orientation, esteem of one’s body, and the accuracy of size perception (Avalos, Tylka, & Wood Barcalow, 2005; Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999). Theories of body image differ as to what is included in the umbrella term of body image and what is not. For example, Cash’s definition of body image is the “multifaceted psychological experience of embodiment, especially but not exclusively one’s physical appearance” (Cash, 2004, p. 1); he further expanded the definition of body image to “one’s body-related self-perceptions and self-attitudes, including thoughts, beliefs, feelings, and behaviors” (p. 1). Unlike other theorists, Cash includes a dimension of embodiment in his definition of body image. The addition of a person’s body- or appearance-related behavior is not included in all definitions of body image and has been identified as the cognitive behavioral theory of body image (Cash, 2002). The behavioral component is sometimes referred to as appearance or body investment, implying a body/appearance behavior influenced by cognition and affect (Cash, 2002).

Although body image appears to reside within the person and is attributed to one’s own subjective thoughts and feelings, there is research to indicate that a person’s cognition and affect about his or her own appearance is influenced by the sociopolitical context (Hardit & Hannum, 2012). Certain appearances are more valuable, and others are less valuable, with some appearances even being oppressed and marginalized (Fisher, 2000; Piran & Cormier, 2005; Young, 2005). Based on what messages are communicated about desirable bodies, a person’s cognitive appraisal of his or her own body and the resulting affect can be greatly impacted. We learn how to evaluate our appearance, and against what to evaluate it, based on what is around us and what is considered ideal or desirable. The tripartite model (Hardit & Hannum, 2012) has been helpful in identifying which sources of information are significant in communicating information about desirable bodies: these sources are media, peers, and parents/family. Each of these sources works together reciprocally to perpetuate social discourses about ideal bodies and what kind of appearance is valuable in each society.

Body image has been a central focus of eating disorder research and treatment, and there is evidence that the two may be reciprocally related (Cash & Brown, 1987; Cash & Deagle, 1997). It has been identified that negative body image is not simply the opposite of positive body image. The terms negative body image and positive body image suggest the overall perspective a person has when reflecting on the mental image of his or her body: a positive reflection is one that feels enjoyable and approving, while a negative reflection may be characterized by dissatisfaction, disapproval, or shame (Striegel-Moore & Cachelin, 1999). However, these terms imply, incorrectly, that body image is a single construct with either a positive or a negative dimension. This creates a false binary of polar opposites in which the same ideas exist on either side of the construct, but one is felt positively, while the other is felt negatively. Similar to depression versus happiness, happiness is not simply the absence of depression, and depression is not simply the absence of happiness: positive body image cannot be simplified as the absence of negative body image.

Although positive body image and negative body image both refer to a cognitive evaluation of one’s appearance, these terms are actually describing different events, experiences, and qualities in people (Avalos et al., 2005; Smolak, 2006; Tylka, 2011). Despite how difficult it is for a consensus to be reached on what body image is, scholars such as Tylka (2011) and Williams and colleagues (2004) have begun to attempt to identify what healthy body image is and what characterizes the people who possess it. Healthy body image is thought to include a general satisfaction with one’s body, less distress in relation to appearance (than those with negative or unhealthy body image), higher levels of optimism and self-esteem, radical self-acceptance, and positive beliefs about their body as it contributes to their functioning and lives overall. Tylka (2011) has identified that healthy body image includes

favorable opinions of the body regardless of actual appearance; acceptance of the body despite weight, body shape and imperfections; respect for the body by attending to its needs and engaging in healthy behaviours; and protection of the body by rejecting unrealistic media images.

(p. 57)

Although much more simple to understand as a positive or negative binary, this popular conceptualization of body image has created a limited understanding of the complexity of how we relate to our bodies, as well as the multiplicity of cognitive and affective responses people may have when thinking about their appearance. Body image and body appreciation, or body satisfaction, appear to be related terms, in that they all reflect some affective and cognitive response or relationship to one’s body. However, their relationship is complicated and difficult to explain. It has since been articulated that women can simultaneously feel pride and joy when reflecting on certain parts of their bodies, while feeling shame and judgment toward themselves when thinking about other aspects of their appearance (Ogle & Damhorst, 2005). For example, researchers exploring women’s thoughts and feelings about their bodies at midlife have found that women may feel negatively about one aspect of their appearance, such as increased weight, but feel positively about another aspect of their appearance, such as few wrinkles (Hurd Clarke & Korotchenko, 2011). While these can coexist, it is important to note that a woman’s body image, although positive, may reinforce internalization of sociocultural ideals and may not necessarily be a sign of acceptance of one’s self. For example, valuing few wrinkles is a result of existing in a culture that believes wrinkles are bad. Further, research addressing midlife women also identifies the complexity of understanding body image as a construct: women may not like their appearance and body size or shape, but may reluctantly accept it. Thus, poor body image and appearance acceptance may coexist.

The Limitations of Body Image as a Construct

Although as a construct body image can be helpful to begin to understand how we cognitively perceive our outward appearance, the term is limited in its ability to capture the complexity of an individual’s relationship with his or her body. Moreover, these limitations may be harmful for our understanding of a fully integrated and experiential self.

Read again Schilder’s original definition of body image: “the picture of our own body which we form in our mind, that is to say, the way which the body appears to ourselves” (1950, p. 11). The language he uses has a specific focus: notice words like picture and appearance to capture how we think about what we look like, and the mental construction of an outward reality visible fully to others, but never fully to ourselves. While more current definitions of body image, as described earlier, have expanded to include the cognitive and affective responses, and even for some scholars the behavior resulting from that mental construction of our appearance, the term remains the same: body image – where image represents the visual, the visible, something seen. Smolak (2006) also highlights that body image includes an evaluative component, in which a person is reflexively judging his or her own appearance or mental image of his or her own body. Evaluation, however, exists in a sociocultural context that is particularly articulate about what is desirable and what is considered good in terms of appearance and image (Piran & Cormier, 2005). This evaluation occurs as a mental measuring up of one’s own appearance, or mental image of the body, according to how well it meets expectations, shaped by explicit and implicit narratives of attractiveness, desirability, and social value (Smolak, 2006).

What is missing in these current definitions of body image is the remainder of what it means to be human: the invisible knowing, the experience, the subjective and internal reality. To be in-bodied. Body image as a construct can never ever fully capture the complexity of a person’s relationship with his or her body, because relationship – especially with one’s self – is not limited to appearance alone, to the visible, to what is seen by others. For example, my relationship with myself, with my body, might be one of turmoil and conflict: even though I may like my appearance, and others around me might also find my appearance to be desirable and attractive, an experience of illness makes it difficult for me to move through the world in a way that feels safe. Unfortunately, in a culture that values the image of women’s bodies over other and all aspects of the self, for women, it is rare to have the experience of being a self that is not limited to appearance.

In their article (De)Constructing Body Image, Gleeson and Frith (2006) critique the manner in which body image as a construct is assumed to be real (and therefore measurable), static, and located within the individual. They state, “assuming that body image ‘exists’ means that we forget to ask important questions about how this construct comes into being, and how it is deployed and given meaning” (2006, p. 86). Both feminist theory and phenomenology highlight the necessity of critiquing the use of language and constructs as they shape our lived experiences. Thus, in the conceptualization of women’s bodies, social oppression, and eating disorders, body image as a construct is inadequate for understanding or promoting the fullness of women’s experiences of life and self. In our efforts as researchers, theorists, clinicians, educators, and members of society concerned with the prevention and treatment of eating disorders, we must strive for more than positive body image – which reflects only an outside view of the body. Rather, and in addition, we need to consider the experiential aspects of the body: the lived experience of the body from the inside.

Embodiment

Unlike body image, as described earlier, embodiment is the experience of the body as engaged in the world; it is a person’s experience of living as a body (Piran & Teall, 2012). The work of philosophers, particularly in the field of phenomenology, made significant contributions to the development of the construct, as noted in the work of Sartre, Merleau-Ponty, Levinas, and Henry (see Weber, this volume). Later utilized in the field of critical sociology, embodiment has come to represent not only the solitary, individual, and inner experience of the body but also the way that the experience of the lived body is shaped by social discourse, relationships, and the other (Allan, 2005; Piran & Teall, 2012).

Phenomenologist Max van Manen makes an important epistemological case for the importance of embodiment when considering human experience. His work, Phenomenology of Practice, indicates that...