‘Too Fat to Fit Though the Door’

Body perception disorders among patients with anorexia nervosa (AN) may be more pervasive than previously thought, according to results of a recent study at Utrecht University. Dutch researchers found that not only do these patients have a conscious perception of a disordered body image, but unconscious body schema representation disturbances as well. (Body schema is an unconscious action-related representation of the body.)

Typically patients with AN have high levels of body dissatisfaction and visually perceive/imagine that their bodies are fatter than they really are. Dr. Anouk Keizer and colleagues at the University of Utrecht, the Netherlands, investigated body-scaled action in a small study of 19 patients (13 with AN and 6 with eating disorders not otherwise specified, or EDNOS) and 20 healthy undergraduate students, who served as controls.

The test: walking through door-like openings

The patients were asked to walk through door-like openings varying in width while performing a task designed to divert their attention. The participants walked toward a table placed behind an aperture, which consisted of two grey movable wooden partitions. After each trial, the participant waited behind a screen while the experimenter prepared the setup for the following trial. Twelve different aperture widths were used, and repeated 3 times. Cameras placed on the participant’s shoulders and on the edges of the apertures recorded each session. The participants were not told that the test involved body image but that it was measuring haptic memory, so the participant concentrated on walking, not on moving through the opening.

When the angle of the participant’s shoulders was larger than the natural doorway, the participant rotated her body in order to fit through the opening.

Then, after the aperture task, participants were asked to estimate their body width and specifically their shoulder width. To assess general body size, the participants stood on the starting point with the aperture widely set. The experimenter then pushed the panels ever-closer together until the participant indicated the point at which she would fit exactly in the opening.

Larger than life

Just as Dr. Keizer and colleagues had anticipated, patients with AN perceived their bodies as larger than they were, and this perception influenced the way their physical movements. Patients with AN reported significantly greater body sizes than did controls, implying that AN patients rotated their shoulders for relatively larger apertures than did controls. There were no differences between patients with AN and EDNOS, who had been placed in a single test group.

For AN patients experiencing their bodies as fat goes beyond simply thinking about and perceiving themselves in such a way; it is also reflected their physical movements. The results also raised further questions about the relationship between disturbances in body-size-related perceptions and actions. Should the AN patients’ altered body scale actions be seen as distinct and separate from previously identified body image disturbances? Or, if as is more likely, they’re causally related, how do these connections work?