Clues in the Eye of the Beholder

When asked to draw a self-portrait, women with anorexia nervosa (AN) or bulimia nervosa (BN) draw themselves with markedly different features than do women who do not have eating disorders and who are considered to be or healthy normal weight. These were findings in a new joint study from the University of Haifa, Soroka University Medical Center, and Achva Academic College, Israel (The Arts in Psychotherapy 2010; 37:400).

According to one of the authors of the study, Dr. Rachel Lev-Wiesel, head of the Graduate School of Creative Art Therapies at the University of Haifa, a simple, nonintrusive self-figure drawing assessment women with or prone to developing eating disorders might help uncover unsuspected cases of disordered eating.

In their study, the authors examined 76 women, 36 of whom had been diagnosed as having AN or BN; 20 had no eating disorders but were overweight for their height, and 20 had no eating disorders and were considered of normal weight. Each of the participants completed two standardized questionnaires and used them to screen eating disorders and was then asked to draw a portrait of herself. No guidelines or limitations were given for the drawing.

Some of the women’s drawings revealed the following patterns:

• The neck: women with AN or BN tended to draw themselves with a larger-than-normal neck, or a disconnected neck, or no neck at all.
• The mouth: this feature was emphasized in drawings by women with AN or BN.
• The thighs: women with eating disorders drew themselves with wider thighs than did women in the other groups.
• The feet: Women with eating disorders tended to draw their self-portraits without feet or with disconnected feet.

There also were noticeable differences between women with AN and BN; for example, women with AN tended to omit breasts from their drawings, and drew less-defined body lines and smaller figures in relationship to the size of the page.

To test the reliability of the drawing test, the more pronounced results were compared with the two standardized eating disorders screening tests and a very strong correlation was found between all tests.

Dr. Lev-Wiesel noted that women with eating disorders usually tend to hide their disorder, even from professional therapists. They find it difficult to talk about their problem, so a simple and nonintrusive tool such as this simple request for a self-figure drawing might be a helpful tool, particularly in creative art therapy.