Looking in the mirror more than once a day is normal behaviour if it’s a ‘physique update’, progress check, feeling good in clothes, or like how you look etc.
What is not normal behaviour, however, is finding many ways to body check about 30-50 times a day as it has become compulsive with the disorder.
For those who don’t know what body checking behaviours are, they are a way to quite literally check how your body looks, in your eyes. It’s a means of validating your size, however, it can cause anxiety if you don’t like the way you are at the current time of the body checking. There are many ways body checking can be carried out, but these are the ones I do:
- Pinching Fat
- Lifting shirt in the mirror
- Checking my face on my phone after a meal
- Holding my stomach
- Pulling my jeans up over my stomach an abnormal amount of times to supposedly, help push my stomach in
If I’m laying on the sofa or my bed I’ll pinch my stomach to check what’s there. After every meal, I’ll hold my stomach, because naturally, it’ll be bigger after I’ve eaten a meal. It still feels weird as my routine is changing and I hate feeling full. So feeling bigger for me at this time is where I’m extremely anxious and worrying about how I look, letting the guilt kick in, etc. I’ll go into the bathroom at different points of the day and lift my shirt up to check the size of my stomach, turning around, looking from the front and side angles, checking how much weight I feel I need to lose. I’ll sit on the tube and hold my stomach or when I am out and about as it is less obvious, and I’ll also pull my jeans up a lot through the day.
I literally haven’t seen a more depressed face of a person looking at their body. Any angle, I guarantee I cover it.
At first, it came from just checking if I felt ‘leaner’ or smaller once a week after I started macro counting and wanted to see physical changes. It then became checking in the mirror once a day, if I’m smaller than the day before or more bloated. This soon became a few times a day. I didn’t accept that I would bloat due to hormones. If I’ve eaten a larger meal than normal, then I’ll turn my camera onto selfie mode and assess whether my face looks bigger than it did before I ate. I have the idea that when I eat more, my stomach will become bigger and so will my face.
This is something that has become a massive issue now. At first, I thought it was just normal as I wanted to see changes, and it calmed down for a while, or it was only after a ‘cheat meal’. With the change of routine in my eating habits e.g not eating cereal for dinner and regularly snacking, I’m finding the urge to do it more, and it is an act that comes with any eating disorder.
I would do it to compare the weight changes e.g. the picture on the left was in November last year, and the right was May this year. I knew I put on weight since then, and I know it will increase anxiety but it gets to a point where I can’t easily stop it. Also, once I saw myself at my lowest weight, I don’t forget that size or the way I looked then. Therefore, every check I do is a reminder to get back to how I was.
I thought it was just me and I panicked, thinking who else who do this about 40 times a day?! But then talking to my therapist, I realised it’s totally normal for someone who has an eating disorder to do this. There’s so much information on how to beat it and my therapist has given me activities on how to reduce it. At the end of the day, it’s all about body dysmorphia and the way we react to food.
The most annoying thing about it is body checking has the ability to determine the way I start my day. If I’m feeling bigger, or fat (even though my therapist reminds me ‘feeling fat’ isn’t a feeling, you can’t feel green either!) then it puts me in a bad mood. If I’m doing something with friends or doing an activity then it’s not that bad. But going to uni or was a pain as I had to sit down and may feel uncomfortable.
I was surprised at how little people discuss this as it is a major behaviour with body dysmorphia. But this is something I’m determined to reduce, and I can’t wait to eventually stop doing it!
What are body-checking behaviors? I would prefer not to go through the list because it’s a bit like firing up a flame thrower in a moth-filled sky—those carefully navigating their recovery efforts don’t need exposure to the list of behaviors. Suffice to say that for a person who has no eating disorder, body-checking behaviors are fleeting and involve a passing conscious observation of the body’s shape. The behavior might involve tactile confirmation of the body’s shape (using hands to smooth clothes, grab loose flesh etc.) or it may simply involve a visual assessment (reflection in a full-length mirror from different angles).
The behaviors themselves do not suggest the presence of an eating disorder. Instead these behaviors are co-opted by the presence of an active eating disorder to serve as avoidant safety behaviors to try to alleviate the threat response associated with approaching and eating food.
They are similar to going back to check if you left the oven on. Again, everyone has experienced a time where they return home because they cannot recall turning off the curling iron, stovetop element, etc. But for those with obsessive-compulsive disorder, the act of going to check becomes itself an anxiety-avoidant behavior that only serves to keep ratcheting up the anxiety with each check-again loop.
Body-checking behaviors begin pretty much from day one. A baby will be fascinated by her own toes and a toddler will gleefully lift up her shirt to show everyone her amazing belly “My belly!” All these interactions with their own bodies allow children to develop their brain’s ability to interpret stimuli from the senses: sight, hearing, taste, smell, touch, heat, pressure, pain, balance, vibration, movement, and internal status.
Body-checking behaviors in adults who are not dealing with an anxiety disorder may not occur with the same frequency or absorption as they do when the brain is developing, but they still occur and likely provide updates to allow the brain to maintain an accurate connection with all the sensory stimuli it receives.
When these behaviors get co-opted by the threat response system, that’s when the quality-of-life goes in the toilet. The dominant initial hypothesis in scientific literature for this eventuality in those with eating disorders was that body checking magnifies perceived imperfections, serving to maintain body size preoccupation and the fear of losing control (thus maintaining dietary restriction). 1 This hypothesis arose from the post-hoc rationalizations provided by patients: “Body checking helps me to control my weight.” Further investigations identified that eating disorder patients tend to veer back and forth from intense body-checking behaviors to avoidance of those behaviors. 2
Imagine you had an intense phobia of birds but had to work in a wild bird sanctuary or end up on the streets with no shelter or food. Your job is to sweep out the birds’ enclosures and restock their feed and water. The feed and water is handled first. The birds come to the feed area when you refill it, and you close them off in that area so you are able to enter their main enclosure safely to sweep it out.
Now imagine the number of avoidant safety behaviors you might develop in that circumstance to try to get through the day. You have to approach the very thing that sends your threat identification system into absolute chaos every single day. Without some specific guided support from a trained exposure and response prevention (ERP) therapy provider, your world would careen from hyper-vigilance to avoidance and back again. The phobia would inexorably increase in intensity and each moment of your day would be chaotic and traumatizing.
Whereas your non-phobic colleagues are careful (these are raptors with sharp claws and beaks), you are mired in multiple steps to keep checking that the birds are safely stowed in the feed area. You try to avoid looking at the birds at all but then are forced to keep checking where they are in the feed enclosure before you enter the main enclosure. It’s a circular nightmare.
For someone with an active eating disorder, approaching food multiple times a day to survive is like cleaning out those wild bird enclosures. It’s not surprising that all manner of sensory update behaviors that are normal to all human beings get co-opted as a way to try to get the threat response to ease up just enough to get the job done of eating to survive another day.
So what do you do with these behaviors in recovery? Body checking is normal; but how it’s been co-opted to reinforce anxiety is disordered.
I’ve mentioned choosing the battles in recovery when it comes to not weighing yourself in the blog post Weighing Yourself: Don’t Do It. The fundamental focus for the brain retraining facets of recovery is to apply therapy efforts on approaching and eating the food.
You might think you are afraid of losing control of your weight or size, or your health or identity, but that’s the conscious mind conjuring up reasons for why the threat response has fired up in the first place. That your threat response has misidentified food as a threat is an anomaly—a not fully understood set of connections that your brain is predisposed to make and reinforce. You are compelled to explain that strange anomaly using sociocultural frameworks.
Most of us have experienced déjà-vu—a distinct sense that we have experienced before the exact scene or conversation that we are having now. Déjà-vu occurs for migraineurs, those under stress or fatigue, during neural development between the ages of 15-25, and the instances decrease with age. The most recent hypothesis for this is that there may be fleeting delays between sensory input and interpretation that create a double-input experience for the brain. 3
There are also many ingenious (and disturbing) experiments that will mess with proprioception (the sense of our own body in 3-dimensional space) where we can extend the sense to treat a rubber hand as our own or experience a sense that our own hand is not ours. 4 What is interesting with these experiments is that our conscious mind does phenomenal contortions to try to explain the aberrant sensory inputs we experience. Your explanation of the reason for avoiding food is no different—just the creative conscious mind trying to make meaning of an anomalous and fundamentally meaningless set of stimuli inputs (in this case the threat identification system going on high alert because you are approaching food).
When you find yourself locked in body-checking behaviors, or desperately trying to avoid applying them, you can use your creative conscious mind to help you maneuver these behaviors back into their normal range of application. Identify either the repetitive application or avoidance of these behaviors as the co-option of normal brain-stimulus-interpretation updates for the purpose of trying to lower the threat response to food. Brining it to your conscious attention might look something like this:
“I am not afraid of losing control of my weight, shape, health, or identity. I am not going to feel any more at ease when it comes to eating whether I avoid the mirror or spend time squeezing my thighs to see if they have changed in shape at all or not. I will feel more at ease with eating by practicing my eating. I will go eat.”
For the woman working in the wild bird sanctuary with a phobia of birds, she won’t resolve the panic by either calling in sick or spending an extra ten minutes repeatedly checking that the feed enclosure really is locked off and all the birds really are in that feed enclosure before she enters the main enclosure. She will make progress when she decides to hire an ERP therapist who will help her to specifically to address the phobia itself. And yes of course as part and parcel of that work, she will be addressing the conscious decision not to apply repetitive safety or avoidance behaviors while in the presence of the birds. However, this therapeutic approach is done in a very methodical and stepped process to ensure success.
An active eating disorder has much in common with an active phobia. The application of ERP for the treatment of eating disorders is something a team of researchers at Columbia Psychiatry have been investigating in the past few years and I have referenced their work in other blog posts here well. 5
As the research chasm delays the transition of new treatment options from research validity to wide-spread practitioner application, it’s not easy to find an ERP practitioner who will be familiar with using the approach to help those with active eating disorders. 6 Nonetheless, ERP is an established treatment approach for PTSD and phobias so it will be possible to find a competent practitioner even if she is not familiar with its application for eating disorders specifically.
If body-checking and avoidance behaviors have been co-opted by an active eating disorder as a bunch of spiraling safety and avoidance behaviors to try to manage eating the food, then see if you cannot find an ERP practitioner to help. In the meantime remind yourself that the behaviors will not alleviate the underlying panic around eating. Only approaching and eating the food will alleviate the panic over time.
Is body checking in the eating disorders more closely related to diagnosis or to symptom presentation?
Body checking behaviours and cognitions are seen as underlying the core pathology of eating disorders—the over-evaluation of eating, shape and weight. While it has been demonstrated that levels of behaviours and cognitions differentiate eating-disordered women from non-eating-disordered women, little is known with regard to how these findings relate to diagnostic group. This study aimed to determine whether body checking cognitions and behaviours are best understood with regard to diagnostic category or symptom presentation. Eighty-four eating-disordered women (with diagnoses of anorexia nervosa, bulimia nervosa, binge eating disorder or other Eating Disorders Not Otherwise Specified) completed measures of body checking behaviours and cognitions and eating psychopathology. Results showed that different aspects of body checking were more closely associated with diagnosis and with symptom presentation. Anorexia nervosa and binge-eating-disorder patients had particularly low levels of body checking behaviours and some related cognitions. However, the belief that body checking allows one to be accurate in knowing one’s weight was associated with bingeing and vomiting behaviours, rather than diagnosis. Future directions for research include understanding the links between body checking phenomena and neurological features. Clinical implications are discussed.