I’ve been told more than a couple of times that negative body image is one of the last things to go in eating disorder recovery. Doesn’t that seem unfair? You want to think that you’ll feel better and be more accepting of yourself with the start of treatment, and that will motivate you to eat better and take care of yourself and move on past the disorder. And maybe at some point in treatment the nutrition kicks in and decreases the depression and anxiety that starvation heightens… but even then you can still be crawling out of your skin. In a more logical world, positive body image would precede recovery.

Today’s rant was inspired by this article on BDD (Body Dysmorphic Disorder) treatment… or really, lack-thereof. I find the suggestion of Prozac + psychotherapy a little depressing, and for a couple of reasons:

1. Prozac has not been proven to be effective for patients under 85% IBW.
2. Only half the people treated in the trial were even helped by Prozac.
3. I’ve been on Prozac and had psychotherapy!

Unfortunately I don’t have any clever suggestions for treating BDD. I’ve never found a body image group to be particularly helpful. The only thing that has helped me is weight maintenance. Even if you can’t stand your weight, maintaining feels a lot better than gaining. I feel too heavy no matter what my weight is. But… there is some relief in being able to wake up and put on the same pair of jeans that you did last week. Somehow being able to cognitively rationalize that I did not gain 10 lbs over night puts my mind at ease, just a little bit…

I don’t really see BDD being an aggressively-pursued area of research in the near future… but wow do I wish something revolutionary would be unearthed.