Body image disturbance in eating disorders

Body image disturbance (BID) is a frequent symptom in patients with eating disorders. The symptom occurs mainly in patients with anorexia nervosa continuing to perceive themselves as average weight or even overweight despite being severely underweight.[1] An altered perception of one's body and a severe state of bodily dissatisfaction characterizing the body image disturbance. This symptom is included among the diagnostic criteria for anorexia nervosa in DSM-5 (criterion C).[2] The disturbance is associated with significant bodily dissatisfaction and is a source of severe distress, often persists in eating disorders after treatments,[3][4] and is considered hard to treat.[3] Thus, effective body image interventions could improve the prognosis in patients with ED, as Hilde Bruch suggested.[5] Unfortunately, there is no hard evidence that current treatments for body image disturbance effectively reduce eating disorders' symptoms.[6] Furthermore, pharmacotherapy is ineffective in reducing body misperception and it has been used to focus on correlated psychopathology (mood or anxiety disorders).[7] However, to date, research and clinicians are developing new therapies as virtual reality experiences,[8][9] mirror exposure[10] or multisensory integration body techniques,[11][12] which are showing promising results.