Those of us who treat people with eating disorders are used to addressing body image distortion with our patients. Body image distortion has to do with a person's perception of her body size. Compared to the real body size, any difference in their perception of it is a distortion. We all distort our body image to some extent, since we cannot view ourselves from someone else's perspective. The closest we come to viewing our whole body accurately is through mirrors and images of ourselves, yet those, too, distort our true size to some degree.
Some distortion is normal, but when the distortion is extreme, it can be a serious problem. You see this with people who have clinical eating disorders such as anorexia and bulimia. In such cases, people perceive their bodies to be significantly bigger than they really are. An anorexic woman who weighs 90 pounds can think she is obese.
Less common is a body image distortion in which people perceive their bodies to be smaller than they are. While this may not appear to be much of a concern, it can lead to a host of problems. Here are some:
Gaining excessive weight: Particularly if you're not active and tend to eat mindlessly, perceiving yourself as being thinner than you are can lead to weight gain that creeps up. It's not unusual for a person with a reverse body image distortion to suddenly realize, usually after a significant life event, that he or she is obese.
Denying health needs: Because of the mistaken belief that if a person isn't overweight he's healthy, overweight people with a reverse body image distortion (believing that they aren't overweight) may think there's no need to be concerned about their health. Or it may not even enter their mind. Important health issues that should be addressed, such as exercise, nutrition and health screenings, may be ignored.
Missing dangerous symptoms: Significant health problems such as diabetes, heart attack and stroke may seem to appear suddenly to the person with a reverse body image distortion, though there were signs all along that a problem was brewing. Bill, for example, would periodically get a tightness in his chest, but it would go away fairly quickly. It wasn't until he landed in the hospital that he realized the symptoms were serious, and that they related to his health and weight. From Bill's perspective, his body hadn't changed much in 30 years, but it had.
Lacking motivation to change: Combining a reverse body image distortion with denial leaves a person with little motivation to change behavior or lifestyle. Having a good grasp of reality is important to fuel the motivation to be healthy.
Rationalizing: We all rationalize on occasion, but if you do it chronically about your health and self-defeating lifestyle because you perceive yourself to be smaller than you are, you're likely to put important things off that affect your health.
Distorting the size of others: Sometimes parents distort the size of their children. There have been cases of parents of morbidly obese children who verbalize that their child is "pleasantly plump" or "just big for his age." These may be extreme examples, but there are other cases of differing degrees that are just as concerning. A young child's well-being is dependent on caregivers, as children don't have the same ability as an adult to make logical decisions about their health. Even if they did, they don't have the power to follow through with such decisions without the help of adults. Parents must look at children objectively, setting aside biases they may have about how they want things to be.
What should you do if you suspect you have a reverse body image distortion? Look for signs that you might be distorting and, as a result, not facing reality. Perhaps people have been trying to get you to see that you need to take better care of your health or that of your children. Maybe lab results have been inching in the wrong direction. Perhaps you have clothes in the back of your closet that you don't wear anymore because they no longer fit. Or you might be wearing loose clothes with elastic bands, not because they're more comfortable but because they make you less aware of weight gain.
Working on a reverse body image issue and its effects can be complicated, so don't be concerned if you can't seem to get things under control on your own. It's not unusual to need the help of a qualified professional.
Dr. Lavinia Rodriguez is a Tampa psychologist and expert in weight management. She is the author of "Mind Over Fat Matters: Conquering Psychological Barriers to Weight Management." Send questions to her at firstname.lastname@example.org.