- What Is Body Checking and When Does It Become a Problem?
- What is body checking?
- What are the catalysts for obsessing over appearance?
- When body checking becomes a problem
- Shape Checking and Body Image
- How Much Do We Actually Shape Check?
- Reducing the Frequency of Shape Checking
- Disd Body Parts
- A Reflection of Your Mind
- A Mirror Isn’t Accurate Anyway
- Change Does Not Happen Quickly
- Preoccupation Doesn’t Work
- Reducing the Practice Gets Better with Time
- Body Checking
- Sneaky Little Mirror Stops
- Body checking is so often portrayed in movies. I can’t tell you how many movies i’ve seen where a young woman stares at herself in the mirror, uses her hands to smooth out her clothes, touches her belly, turns to the side to see how she looks. Often, she looks disappointed, let down, and lets out a sigh.
- What is Body Checking?
- Don’t We All Body Check Though?
- And we will continue to struggle as long as we take the messaging from society at face value without challenging or questioning it
- Why I Was Body Checking
- Body Checking No More
- Ditching The Scale
- How I Came to Terms With An Important Part of My Eating Disorder: Body Checking
- READ THIS NEXT
- Body Checking and Avoidance in BED
- A recent study
- More than half were affected
- Transient mood swings may explain the alternating behaviors
- Body Checking: Safety Behaviors In Recovery
What Is Body Checking and When Does It Become a Problem?
Taking progress photos, body circumference measurements, body fat tests, and more are all common practices in the fitness and weight-loss industries.
In fact, snapping mirror selfies has been touted by countless fitness experts and influencers as a way to keep track of progress while still employing a “don't know, don't care” approach to the scale.
(Related: Real Women Share Their Favorite Non-Scale Victories)
But just as the scale can encourage an obsession with numbers, constantly looking at your body for changes-also known as body checking-can also become an unhealthy practice. How do we find the line between tracking progress and becoming obsessed? Mental health and fitness experts weigh in.
What is body checking?
“Body checking is an obsessive behavior in which an individual focuses on certain features of his or her body, often multiple times a day,” explains Gene Beresin, M.D., executive director of The Clay Center for Young Healthy Minds at Massachusetts General Hospital. Body checking behaviors include:
- Checking the size of one's stomach, legs, or other parts of the body. This includes pinching “fat.”
- Weighing oneself multiple times a day.
- Frequently looking in the mirror in different outfits.
- Focusing on how clothes feel, such as pants being too tight.
- Comparing one's perception of their body shape with others around them.
- Obsessively taking measurements of one's waist, arms, legs, etc.
And while body checking is common in those with diagnosed eating disorders, anorexia and bulimia, it also can occur on its own, especially in people who are very concerned about their appearance, says Dr. Beresin. And it's known the more people use social media, the more concerned they are about their appearance.
That's why this issue is gaining traction right now. “Body checking is of particular concern now in the pervasive digital age, because we know from many studies that media can significantly-and usually negatively-influence body image,” says Dr. Beresin.
What are the catalysts for obsessing over appearance?
While it's not always a precursor, most experts in the field point to the influence of social media as one of the biggest factors attributed to this increase in body checking. “We live in an era of image-dominant forms of expression and communication,” points out Lisa Diers, R.D.N., a registered dietitian and yoga therapist who specializes in eating disorder treatment.
“In recent years, I've begun asking my new nutrition or yoga therapy clients about their social media consumption and any known negative side effects,” says Diers.
“A response I commonly hear is a feeling of poorer body image, increased comparison to those they follow, and feeling they don't 'measure up' after scrolling on social-even when following body positive influencers.”
And while many in the online fitness community encourage self-love and the concept of loving your body and wanting to change it at the same time, it's hard not to wonder if this approach might be encouraging people to cross over into body checking territory.
“Following groups or people who place an extreme value on the body and how it looks is fertile ground for body checking,” says Diers. If the focus is on appearance, then how can you “know” if things are on the right track without looking or checking, she says.
Wanting to make a change to your body isn't the problem, though. Instead, it comes down to the individual and how they handle different methods of tracking progress.
“I accept that many people have a body shape in mind they are the most comfortable with and feel the most confident being,” says Claire Fountain, a yoga instructor, certified personal trainer, and wellness influencer. “Can someone engage in body checking or these measurements and not be consumed? Absolutely.
Can someone else be triggered and get on a downward spiral? Also yes. The latter is who should avoid these tracking measures, no matter how appealing or normalized they might be.”
When body checking becomes a problem
So how can you tell if your progress photos and mirror double-takes are actually a problem? Well, the biggest clue that you need to do something about body checking is when it's taking time away from other parts of your life.
“The amount of time spent engaging in body checking, especially time that interferes with activities related to normal functioning, is an indication of when it's a problem,” says Ash Nadkarni, M.D.
, a psychiatrist and instructor at Harvard Medical School.
“For instance, if someone is engaging in body checking compulsively and frequently, and they ignore their other self-care needs or they begin to isolate from others and lose relationships or they can't function at work, this is suggestive of the behavior being a problem.”
If that's not making sense, consider your relationship with progress photos and other methods of tracking by asking yourself some simple questions. “A good question to ask oneself is: 'Could I quit these habits and feel totally okay with myself?'” says Fountain.
“'Could I go without taking images of my body? Could I be okay if these images or measurements showed something I didn't consistently? Do I attach morality (I'm good or I'm bad) to these measurements?'” Any concerns? You may want to think about taking some of the following steps:
Consult a professional. If you notice any of these red flags, Dr. Beresin recommends visiting a clinician who specializes in eating disorders. They can either provide or point you in the direction of therapy that will help.
Remove mirrors, scales, or whatever else you are using to body check for a while.
“Of course, the ultimate goal is to be able to see yourself in a mirror without criticism or to know your weight without fear and judgment,” says Diers.
“In order to achieve that goal, sometimes it helps to remove the triggers initially in order to have a break from the behavior and find some peace.”
Take a break from social media if you find it triggering. “Remove apps from your phone, require a manual login, or plan other things to do besides social,” says Diers.
“Notice how it makes you feel after a few days or a week. Next, decide if or how you will go back to social in a more balanced and nourishing way.
” (Related: The Best Goal Has Nothing to Do with Your Weight and Everything to Do with Your Phone)
Challenge and change your habits. “Changing or stopping body checking is about creating new patterns of behavior,” says Diers. When you notice yourself body checking, take note of what you're doing when it happens.
Try to stop it by doing something else or breathing through the urge to check. “Notice what triggers body checking and see if some of those triggers can be removed or managed in other ways. Try to be curious, not furious with yourself.
You are gathering information to try to make a positive change. It takes practice and patience.”
Above all, remember you're more than how you look. “It's only ONE portion of who you are,” says Diers. “Beauty really is on the inside, and when that beauty is nurtured, it shines through.”
Shape Checking and Body Image
Contributor: Tresa Clemmensen M.Sc. C.C.C, Westwind Counselling & Eating Disorder Recovery Center
Spending time looking at your body in the mirror and checking it can become very problematic and most often leads to a higher dissatisfaction in how you feel about your body and appearance.
There are different ways you can check your body and this can include looking in the mirror, using your hands or a tape measure, assessing the tightness of your clothing, using the scale, and comparing yourself with others.
These checks may happen at standard times throughout the day or happen sporadically and most often they happen automatically without much thought.
How Much Do We Actually Shape Check?
You might be aware that you shape check your body, but you may not be aware of how much you are actually engaging in it. It is important to spend some time practicing being aware of when, and the types of shape checks you engage in. Becoming more conscious of this will help you be able to work on reducing and eliminating this behavior that fuels body dissatisfaction.
One of the biggest reasons it is important to eliminate this behavior is that it keeps preoccupation with your body high and dissatisfaction even higher. Most ly you are not looking in the mirror and making positive remarks, but making highly critical and degrading remarks.
When you look in the mirror and think negative comments, it also has an effect on your mood state. Most leave the shape check thinking that there is something wrong with their body or something needs fixing or improved upon.
Reducing the Frequency of Shape Checking
Beginning to question your shape checking is a helpful strategy in reducing the activity. If you can see the negative effects this behavior is having, you will be more ready and willing to reduce. Below are some helpful points to help you question your own forms of shape checking:
Disd Body Parts
You most ly spend time looking at aspects of your body that you already dis, which is a guaranteed way to maintain body dissatisfaction and keeps concerns about your appearance at the front of your mind.
A Reflection of Your Mind
What you see in the mirror is strongly influenced by how you are thinking about your body. If you experience negative thoughts about your body, this is going to affect how you see your body.
Additionally, if you are looking for a flaw, you will find it and once this is seen it will be hard to ignore. Repeatedly checking your body will only work to magnify the perceived flaw.
A Mirror Isn’t Accurate Anyway
Although you may think the checking is giving you accurate information about how your body looks or has changed, it cannot do this in a reliable way.
For instance, looking in the mirror in the morning and comparing how you look in the evening will not provide accurate information, unless you have a photographic memory, which most of us do not.
Change Does Not Happen Quickly
You may be checking your body to see if your shape has changed but the rate at which you are checking your bodies does not justify the frequency. The shape of your body will fluctuate throughout the day, which does not reflect actual change.
The only way of determining whether your body is ly to be changing in size is to examine how your weight is changing over time, through the use of a weigh scale.
Preoccupation Doesn’t Work
You may feel that checking your body provides you with reassurance that their shape or size has not changed. However, this is extremely unhelpful because it keeps you preoccupied with your shape and increases body dissatisfaction.
Reducing the Practice Gets Better with Time
Shape checking is a behavior that can be reduced and eventually eliminated. Although at first you may find it distressing to not look at your body in these ways, it will get better in time and it will have a positive effect on your overall body image.
Body acceptance and body satisfaction cannot be achieved by critically examining yourself in a mirror. Work towards appreciating your body for all the wonderful things it allows you to do.
What is your experience with shape checking, and what tools have you in your recovery to help you overcome a poor body image?
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.
Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on March 13th, 2015
Published on EatingDisorderHope.com
Trigger warning: this is a stream-of-consciousness post about body checking: a very intimate, often overlooked symptom of America’s eating disorder. The post goes over negative self talk and certain ED behaviors that may bring up emotions for some. If you don’t feel strong enough in your recovery to read, please exercise self love and listen to that intuitive part of you. xo
Sneaky Little Mirror Stops
3 years ago, I moved into a brand new apartment. My first space that was all mine. No roommates, just me. A perfectly suited space that I could do whatever with. It felt a clean slate. In a small apartment, you end up doing the same trail hundreds of times a day a little ant building an empire.
I spent my days walking around my little studio, to the kitchen and through my bedroom then to my little dining room nook and then to the bathroom, going about my day. The same foot steps over and over on the creaking wood. That little loop I did so often, hundreds of times a day.
There were many mirrors around the apartment. At one point, I started lifting up my shirt to check my stomach during that little trail. I was doing this roughly 30 times a day. Anytime I caught my reflection in the hallway, bathroom, or closet mirror, I’d lift up my shirt and check my abdomen.
What was I looking for?
I didn’t know it at the time, but I was body checking.
I was looking to see what my body looked . But not in a normal way. I was looking to criticize it, to see if it had changed. I was so fearful of it changing, that I would obsessively check it to make sure that it stayed the same. Obviously, it didn’t. It never does. All things change: and bodies are no exception to that rule.
On particularly anxious days, I’d even take a photo of my belly with my phone. Then later on in the week or month, I’d analyze the photo and look at my present belly to see if it looked the same. I even had an iPhoto album named “Progress” to store my pictures to see how my body had morphed, grew, shrunk, etc.
I was so used to seeing “Progress Photos” on Instagram that it didn’t occur to me this behavior was dangerous and flirting with my ED.
I thought it was perfectly normal, in fact, I thought it was responsible of me to make sure I was staying fit! I’d hold myself accountable this way. A few cleanse programs I know even encourage people to take before and after photos.
Multiple large fitness accounts grew their crazy following from these before/afters. As humans, we love seeing progress. It’s motivating, it’s positive, it’s celebratory.
Body checking is so often portrayed in movies. I can’t tell you how many movies i’ve seen where a young woman stares at herself in the mirror, uses her hands to smooth out her clothes, touches her belly, turns to the side to see how she looks. Often, she looks disappointed, let down, and lets out a sigh.
Pretty soon, the body checking was becoming tortuous for me. I felt a slave to the mirror. I’ve been in recovery from my eating disorder for 10 years. I consider myself a survivor, a recovered, thriving person. Though I was not “actively” anorexic or bulimic, I was exercising a major behavior that contributes and feeds an eating disorder: body checking.
What is Body Checking?
According to this article, there are many ways we body check: pinching your body’s abdomen,* weighing your body frequently, trying on a certain pair of jeans, looking at specific parts of your body in the mirror, or trying to feel your bones.
*note that I don’t use “your abdomen”, but “your body’s abdomen”: because your abdomen is not your self. You have an abdomen, you are not an abdomen. It’s great to know this important difference.
How nuts is that? I never realized that trying on “those jeans”, you know, the ones we use to measure how good we look, is a form of body checking. I sure am guilty of that…aren’t we all? After I threw out my scale, I no longer could track how much I was gaining/losing.
Throwing out the scale was one of the most liberating decisions I’ve ever made, but I was still keeping tabs of my body’s shape in subtle, sneaky ways, completely oblivious that these behaviors were dangerous, causing me anxiety and depression, and feeding the phobia of weight gain/change.
Don’t We All Body Check Though?
Now that I’ve been reading so much about mindfulness and buddhism, I know that change is not only inevitable, it is the ONLY constant in life. This pertains to everything: relationships, work, moods, and of course…bodies.
As hard as this can be to accept, it’s inevitable. Look at your parents. At one point, they were younger, just you. Look at the old family albums. Then look at your parents again. They aged. Their hair might have turned colors. Their skin, saggier. Their bodies, different.
Even think of how you have changed: you were once a baby, and now you’re obviously not a baby anymore because you’re reading this article (if there are any babies reading this, congratulations, I look forward to seeing what sort of amazing innovations you bring to our society when you grow older).
Every human body checks, but it is when it comes hand in hand with an eating disorder, a fear of gaining weight, or losing control of my shape, that it becomes an issue.
There are so many different levels of an eating disorder. I believe it’s a sliding scale. Many people express symptoms and behaviors of an ED without actively struggling or needing hospitalization. It just depends on how honest they want to be with themselves, or how aware they are of their own behavior.
I call body checking a common symptom of America’s eating disorder because America struggles deeply with contradicting messaging about bodies. We are obsessed with health and take diets and exercise regimes to the extreme, yet we have an obesity epidemic.
Most of our A-List stars on television are on the thinner side yet the commercials in between their shows sell Special-K Thin Bars and Big Mac Burgers. Don’t get me wrong, we’ve come a looooong way. But we still have work to do.
Despite the body positive movement, we still struggle.
And we will continue to struggle as long as we take the messaging from society at face value without challenging or questioning it
Humans begin body checking from a very young age. Think of a baby wistfully looking at its toes, or a toddler lifting up its shirt and proudly exclaiming, “look at my belly!”. The human body is a fascinating thing, and when we make the link that our body is ours, it never really loses its appeal.
Why I Was Body Checking
I noticed this was a problem when I began body checking obsessively, and was getting more and more depressed. It was my first time living alone, and I was paying much more than I was used to.
Needless to say, I was undergoing a big change, and it was making me anxious AF.
This big change was playing into my fear of change, and I was resorting to my old, standard behavior of transferring that fear of change onto my body.
Classic eating disorder behaviors.
Most of the time, body checking felt a habitual action that I had no control over. It’s not that intellectually I wanted to lift up my shirt and look at my belly fat…I didn’t want to do that at all. My highest self does not care what my belly looks . But it was habitual and I couldn’t help it…or so I thought.
Body checking made me feel I was in control, a knee-jerk compulsive action that I did to make myself feel better about my body. Body checking in the mirror was a slot machine. I’d look at my body to see if it looked smaller, thinner, or unchanged. If so, my brain would reward itself with positive affirmations.
“Great job, you look great, now, DON’T GAIN A POUND! If you gain a pound, you’re a loser. Actually, you’re already a loser because you still don’t look good enough.”
When I’d body check and notice that my belly looked ‘different’ in not a good way, my brain would fire,
“You are a fat lazy slob. See? You have no discipline. You’re a pig. Lose the weight.”
Either way, it was a lose-lose situation.
A part of me may have thought body checking would make me feel safer, more in control. But in reality, body checking was just feeding this horribly mean and critical demon inside of me.
Body Checking No More
Once I accepted that no matter what my belly looked , I’d hardly be satisfied, I made the decision to stop body checking. This decision changed my life. I was no longer preoccupied with my shape, weight, or the way my body looked. I felt free.
I stopped cold turkey, I stop everything I want to quit. I decided I wasn’t allowed to do it anymore, so I wouldn’t be tempted. I took the option off the table.
I considered covering my mirrors up with sheets, or removing my mirrors completely I did my sophomore year in college to rebel against the notion that we needed to look ‘perfect’ before leaving the house every day.
But I didn’t feel the need to go that extreme. I simply just.. stopped.
A big part of my ED journey is accepting the changes, the natural ebbs and flows, not only with my body, but with life. Staying present in the moment, and accepting whatever comes up without judgement.
If and when the urge to body check comes up again, I just remind myself of how it’s a trap for me: and how it’s anti-self love for me. Self love is taking responsibility for my current actions and how they will affect my future mindset.
Self love is accepting my belly, whatever its shape, size, firmness, roundness.
Self love is not looking in the mirror to scrutinize my body, it’s walking right past the mirror, smiling at myself, and moving onto the next activity.
Do you body check? If so, how has it affected your life?
Ditching The Scale
Last summer, I spoke here about how I had ditched the scale.
How I Came to Terms With An Important Part of My Eating Disorder: Body Checking
Trigger warning: This post touches on body checking behaviors, which can be triggering in itself, but are also often associated with eating disorders and other undetermined issues with disordered eating. Readers’ discretion advised.
I found out I was technically a body checker last week. Prior to that, I had no language for the thing I had grown so accustomed to: body checking.
I first came across the term in a blog post. This was new, I thought. Finally, there was a word for this thing that I had been doing since I was a teenager.
My eyes read it again: “body checking.” Now that it had a name, I felt a newfound validity in my experience. It had a name and so, it finally felt confrontable.
In the past, I thought maybe I had body dysmorphia because I had read once that people with dysmorphia obsessively looked at themselves. But the rest of the symptoms never felt right.
I’ve been treated for an eating disorder and have gone to therapy for the past six years.
My eating disorder and body image have always been a part of my therapy, but never once was “body checking” a phrase we had talked about.
It started back when I was in high school. I made varsity cheerleading at 14 years old and at first, I didn’t think about my body a lot.
My body wasn’t the result of my eating habits; at least it didn’t seem it. Maybe, I figured, I was lucky to be born petite.
I ate whatever I wanted, which was mostly penne a la vodka, ice cream, and other empty carbs. I didn’t know what a vegetable was, nor did I care to.
I was the smallest one on the team, which sometimes felt a reward — partially because the other girls seemed to think so (and told me so) but also because it meant I got to be a flyer, the one they chuck in the air. I d being a flyer. It didn’t make me feel small and powerless; I felt strong. My body was strong, I worked hard, and had the abdomen and flipping abilities to prove it.
By 16, I had a growth spurt and one day at practice, my coach called me, “a big flyer,” then amended, “well, a tall one.” I was maybe 5’3″ then, which may not seem tall but you have to consider I went from forever being 4’9″ to suddenly 5’3″. In the cheerleading world, a 5’3″ flyer is relatively tall. Overnight, I wasn’t the smallest.
And then… I fell into body checking without even knowing I was doing it. I would walk past a mirror and think, oh wait, let me go back. Let me look. Let me make sure my body is this way, or that way, or the same. Sometimes I’d stand in the restroom of a public place, balking at my naked belly, shirt up, rubbing my belly or sucking it in. Is this what I looked ?
When I got to college, I shared a quad with three other girls. We had one cheap, floor-length mirror from Target. It hung on the back of our door. I would stand in front of it obsessively, smoothing the shirt over my stomach or peeling it up to peer hard at my belly. Was it fat? I’d sit down at my desk to do work, then rush over to the mirror again. Had it changed? Was it fat now?
This is textbook body checking. Unbeknownst to me, I’ve been doing it for a decade.
There are a lot of different eating disorder (ED) behaviors that fall into the category of body checking. First and foremost, body checking denotes a type of looking at your body that is not qualified as “normal.” It is qualified as “obsessive” or “unrealistic.
” In the most heightened state of the behavior, I would check my appearance in the reflection of cars in the parking lot, try on my smallest pair of 24 jeans from high school, fall asleep with my hand over my naked hip bone to assure it was sticking out enough.
Obsessively weighing yourself can be a form of body checking, as is feeling your bones, walking past mirrors, pinching parts of your body, or trying on clothes.
Body checkers might also obsessively ask family members or friends: What do you think of my body? They might ask their family and friends to compare: Is my body skinnier or fatter than that girl’s? or Do you think I’m skinnier than her? While it is true that body checking behaviors do not necessarily warrant an eating disorder diagnosis, the two do often go hand in hand. In fact, body checking behaviors are often more frequent in people with eating disorders anorexia nervosa, bulimia nervosa, and binge eating disorder. In a way, body checking is a compulsion to ensure you have not gained weight.
It’s a way for the mind to feign control. A body checker may think: If I look at my body this often, then I can keep it from changing; then I can keep it under control.
I finally got to a point, post-grad, when the compulsion to body check was debilitating and I moved the mirror in my apartment to the common space. By removing it from my room, I took a little part of my autonomy back. I didn’t want to spend my time obsessing over the mirror anymore. That was my first step in both ED and body checking recovery.
Which brings me to about a week ago. I’ve been mostly free of my body checking behaviors for about two years. Then last week, when I heard it had a name, that it was real, that every therapist who couldn’t term my ailment failed me, things got a little hard again. I thought about it too much, worried my gaze in the mirror lingered…
But I know better and would rather relinquish that control. Because that kind of control is exhausting and I’d much rather be at peace with who I am and what I look . Part of that means acknowledging and accepting that what I look sometimes changes.
Now, I am at a point in my life where I have done a lot of emotional work. Body checking temptations are sometimes there, sometimes not.
I’ve noticed that for me, body checking behavior relapses often coincide with the inflation of other mental health issues.
When I experience bouts of anxiety, I may change my eating habits, and if I change my eating habits, I sometimes fall back into that well-known body checking.
The point is not that these behaviors stop altogether but that I recognize them. I don’t want to body check anymore; I want to move forward in my ED recovery and live my life without the need for control. Wouldn’t it be so much better to love this body and genuinely be grateful for it?
READ THIS NEXT
Lily Collins on Playing a Character with Anorexia After Her History of Eating Disorders
Photo: Photo by Mikail Duran
Steph Osmanski is a freelance writer and social media consultant who specializes in health and wellness content. Her words have appeared in Seventeen, Life & Style, Darling Magazine, and more. She is currently pursuing an MFA in Creative Writing at Stony Brook Southampton and writing a memoir.
Body Checking and Avoidance in BED
Reprinted from Eating Disorders ReviewSeptember/October 2005 Volume 16, Number 5
©2005 Gürze Books
Overweight patients with binge eating disorder (BED) may be overconcerned with body shape and weight, as shown by two alternate behaviors–frequently checking their bodies yet paradoxically avoiding their bodies at other times.
An example of body checking is pinching or measuring specific body parts to judge “fatness.” Body avoidance is an opposite behavior, where a person avoids tight-fitting clothing or tries to avoid looking in mirrors. Body avoidance may prevent patients from overcoming their irrational beliefs about shape and weight, and may interfere with enjoyment of any successful weight loss.
For patients with bulimia nervosa and anorexia nervosa, the frequency of checking and body avoidance is positively and significantly related to the degree of over-evaluation of shape and weight.
Furthermore, weight checking appears to lead to further dietary restraint regardless of a net loss, gain, or stable weight.
These results lend support to the hypothesis that checking and avoidance may maintain eating disorders.
A recent study
According to Dr. Deborah L. Reas and colleagues, clinical lore holds that overweight patients with BED often use body avoidance behaviors, but are believed to check their bodies less than normal-weight BED patients (Int J Eat Disord 2005;37:342). Dr.
Reas and colleagues recently studied a group of overweight adults seeking treatment (BMI>25). The 80 men and 297 women all met Diagnostic and Statistical Manual of Mental Disorders, 4th revision (DSM-IV) criteria for BED.
The authors used the Body Shape Questionnaire (BSQ) the Eating Disorder Examination-Questionnaire (EDE-Q), and the Three-Factor Eating Questionnaire (TFEQ), a 51-item self-report questionnaire with three subscales reflecting 3 eating-related domains.
Two of the three subscales in the TFEQ, the Cognitive Restraint and Disinhibition subscales, were used to measure the relationship between dieting behavior and the tendency to overeat with body checking and body avoidance.
More than half were affected
More than half (57.4%) of the participants reported that they often, usually, or always pinched areas of their bodies to check for fatness. The majority (53.8%) always avoided wearing clothing that made them particularly aware of their body shape.
There weren’t any marked differences between men and women on the body-checking item; however, men and women differed significantly on their scores for body avoidance.
Women reported greater avoidance of clothing that made them particularly aware of their shapes than did men.
Body checking and body avoidance were not mutually exclusive; instead, the behaviors either occurred at the same time or alternated.
A significant pattern of relationships remerged between checking and restraint and conversely between body avoidance and binge eating, according to the authors.
These patterns lend support to the potential role of checking and avoidance behaviors and maintenance of eating disorders.
Transient mood swings may explain the alternating behaviors
The authors speculate that patients swing back and forth between feelings of being in or control, marked either by periods of intense body checking accompanied by dietary restraint or conversely, body avoidance accompanied by disinhibition and binge eating. Those transient mood states might help explain why a patient might vacillate between the two behaviors.
Body Checking: Safety Behaviors In Recovery
What are body-checking behaviors? I would prefer not to go through the list because it’s a bit 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 ly 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 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 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.