Eating Disorder Treatment as a Process of Mind–Body Integration: Special Challenges for Women

Abstract

The concept of body image remains too focused on internal representation and not enough on internal experiencing. Body image is but one expression of the more foundational body self. When an eating disorder is conceptualized as an attempt to manage an impaired sense of body self (and associated disregulation), the ultimate goal of treatment becomes embodiment. The eating disordered body must be worked with as an actual as well as symbolic body and understood within its own developmental trajectory. The gender-specificity of eating disorders is explored by focusing on three particular bodily challenges for females in our society: (1) Women are more likely than men to unconsciously use their bodies as repositories for their dissociated need and desire, (2) girls’ bodies are mirrored in a more distorted and overstimulating manner than boys’ and (3) because girls are the same biological sex as their usual primary caretakers, they are more likely to be used as narcissistic extensions. A clinical example is presented, illustrating the influence of these female bodily challenges on the development of body self and eating disorders and how these issues play out in treatment. An intensive clinical focus on the patient’s and therapist’s body states allows for the desomatization and integration of dissociated affect, resulting in a more integrated body–mind self and a decreased need for an eating disorder.