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May 22, 2018

New Approach to Body Image

Woman looking at her reflection

Contributor: Camille Williams, MA, NCC, LCPC, Eating Disorder Program Coordinator at Timberline Knolls Residential Treatment Center

Thoughts can be very powerful, especially obsessive thoughts that surface over and over again. With an eating disorder, thoughts about body image may be the most frequent throughout the day. Negative body image thoughts can have a significant impact on a person’s view of self and behaviors.

Such as “I am so fat and need to restrict all day” or “my body is disgusting” so there’s no way I can go out in public.” These examples demonstrate how easily a thought can dictate worth and command a person’s behaviors.

CBT Approach to Body Image

There are many therapeutic approaches and techniques that challenge distorted thinking. Cognitive Behavioral Therapy (CBT) encourages exploration about whether or not the thought is fact, “am I actually disgusting “or “is my perception distorted?”

Another approach promotes change from negative to positive, instead of thinking “I am fat,” the individual reframes to “my body is good enough.” These techniques are incredibly beneficial and promote recovery.

However, CBT can be challenging for individuals with eating disorders because it is difficult to believe in the reframed thoughts. This is most likely due to the obsessive thoughts being so strongly in place; they carry a lot of “weight” in dictating a person’s worth and behaviors.

DBT and ACT Therapies

Dialectical Behavioral Therapy (DBT) may be a more appropriate place to begin because the significance and power of thoughts can be decreased. In DBT an individual will observe and acknowledge thoughts and values to determine worth and behaviors.

Woman in hatIn this way, an individual can begin to recover without “fixing” negative body-image thoughts. A complementary therapeutic approach to DBT is called Acceptance and Commitment Therapy (ACT). It promotes acceptance of thoughts and feelings and acting in ways that align with commitments.

One component of ACT is called thought defusion, which emphasizes the separation between thoughts and self. If an individual has struggled with negative thoughts about their body for years, it is unlikely that the thought will be easily changed or removed; instead, a person can work to accept the thought and respond differently.

The pattern reinforced with an eating disorder is “I’m fat” followed by eating disorder behaviors. An individual with this type of disorder can get very attached to this pattern as an attempt to find relief from body image thoughts.

This is often unsuccessful and usually leads to increased obsessive thoughts and further dissatisfaction with self and body. Unfortunately, this cycle also moves an individual further from recovery and deeper into the eating disorder.

Create a New Pattern

A new pattern can be created through applying DBT and ACT techniques. Thought defusion starts with changing the thought “I’m fat” to “I’m having the thought that I’m fat.” It acknowledges that the negative body image thoughts are still present and valid.

Thought defusion helps separate self from thoughts and creates space rather than defining self by a thought. A person is able to be less fused to their thoughts, and therefore, thoughts can begin to have less impact on determining worth or dictating behaviors.

As the impact of negative body thoughts decreases, it will be easier to apply the DBT skill of radical acceptance to body image work. Ultimately, an individual may continue to struggle with negative thoughts about the body, and overall there can be an understanding and appreciation of the body the way it is.

This acceptance will also help the individual increase effectiveness in achieving recovery goals and commitments.


Camille WilliamsAbout the Author: Camille Williams, MA, NCC, LCPC

As the Eating Disorder Program Coordinator, Camille supports the development of curriculum, supervises the eating disorder specialist, and provides group therapy. She also educates and trains all staff on campus and advocates for eating disorder awareness through publications.

Camille started at Timberline Knolls as a Behavioral Health Specialist. She then transitioned into the Eating Disorder Specialist (EDS) role. In this position for nearly five years, she developed her skills and competence in working with the eating disorder population.

Camille received a Bachelor of Arts degree in both psychology and sociology from Augustana College in Rock Island, IL. She then went on to earn a Master of Arts in Clinical Professional Psychology from Roosevelt University, IL.

Camille is a member of the International Association of Eating Disorder Professionals (IAEDP).


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.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on May 21, 2018.
Reviewed on May 22, 2018 by Jacquelyn Ekern, MS, LPC

Published on EatingDisorderHope.com

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