Automatic Negative Thoughts Can Contribute to Body Dysmorphia

Eating disorders are serious and often fatal illnesses associated with severe disturbances in people's eating behaviors and food-related thoughts and emotions, according to the National Institute of Mental Health (NIMH). Some of the most common forms of eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder (BED) and avoidant restrictive food intake disorder (ARFID).

While treatment plans and facilities to cure eating disorders have come a long way—ranging from psychotherapy, medical care and monitoring to nutritional counseling and medications—eating disorder recovery is still a complex time in a patient's life. Our lifestyles and media diets play an important role in defining how we view ourselves and what body shape we regard as "normal." These factors can sometimes lead to a reemergence of intrusive or negative thoughts that may be detrimental to recovery.

Call them automatic negative thoughts instead

Shelley Jensen, a registered clinical counselor in British Columbia who specializes in eating disorders, characterized an intrusive thought as "an unwanted, repetitive thought that can pop in one's mind at any time and can become disturbing or distressing."

In the clinical world, intrusive thoughts are closely associated with obsessive-compulsive disorder. They may be defined as negative thoughts the individual doesn't believe or subscribe to but has a hard time eliminating. It may be more effective to label them as "automatic negative thoughts" because the individual does believe them on a base level.

Shelley Ugyan, a registered clinical counselor in Vancouver, British Columbia, with more than 15 years of experience dealing with eating disorders, believes automatic negative thoughts represent a binary, black-and-white method of perception and thinking. Individuals struggling with automatic negative thoughts focus on the negative.

"So when you focus on the negative with your body, it's constantly a problem. There's constantly an issue. It's never good enough," Ugyan explained.

At times, automatic negative thoughts and body dysmorphia can work hand in hand, making people unable to accept their real physical selves.

Body dysmorphia is common

One in 50 people in the United States have body dysmorphic disorder (BDD), which is about 2.4 percent of the population.

"Body dysmorphic disorder is a mental disorder characterized by an obsessive idea of perceived defects or flaws in one's appearance," Jensen said. "This can include the face, skin, hair and body. Body dysmorphia is an exaggeration of the feature that defines the self."

Body dysmorphia can cause people to feel ashamed, embarrassed and anxious. Patients may start avoiding social situations because they don't want to be seen in public. Some initial signs of body dysmorphia may include checking the scale frequently or being constantly critical of the body part they've zoned in on.

"Often, reality and perception are skewed," Jensen said. "A client with BDD and an eating disorder may have a 'phantom fat' feeling that is a symptom of an uncomfortable feeling that they aren't used to or refuse to acknowledge. This is not vanity, it's hallucination. Some clients see themselves as 40 percent larger than they actually are."

Recovery and core beliefs

Some of the root causes of body dysmorphia can be traced back to a person's childhood, Ugyan explained. There are some key emotional components that need to be met in a person's childhood and when they go unmet, in this case, the human brain will adapt to its current environment.

"As we grow up, we're adaptable as human beings and we develop a core belief on how the world operates and who we are within the world based on the core needs that were met or not met in childhood," Ugyan noted. "That's usually where these distortions come from. They really go way far back and they end up coming out in body- or in food-related eating disorders. But they didn't originate there."

A core belief such as "I'm not good enough" often manifests in thoughts related to appearance. When a person has negative thoughts such as "I'm too fat," "I'll never be able to date someone because of how I look" or "I'm ugly," what they're really feeling is loneliness and low self-worth.

In her own experience of working with people with eating disorders, Ugyan has found the disorder is both about the food and not about the food. Ugyan presented an analogy to explain the thought processes of people struggling with eating disorders, body dysmorphia and automatic negative thoughts: Maladaptive belief systems are similar to outdated software in need of updating. Habits and beliefs that were adaptive in childhood may become maladaptive in adults because old ways of operating are no longer compatible with current life.

Updating and rebooting the system

"When people say, 'I don't know why I can't just stop this' or 'I don't know why I just keep defaulting back to this belief all the time' or 'I've always been like this,' it's the old operating system," Ugyan explained. "The issue is that when we're operating from that old, outdated operating system, it runs on autopilot. And that's why people can't change it."

The solution is to update the outdated operating system through therapy.

"Therapy works to update the operating system to a present-day operating system, where you're present and you're conscious and you have a choice; not only the choice of what you're eating if you've got an eating disorder, but the choice of the thoughts that you're having," Ugyan said. "So those automatic negative thoughts aren't running the show, because you updated them. You're now living in a current place of your truth, here and now."

This work is done in three ways.

"We do that cognitively by shifting those automatic negative beliefs," Ugyan said. "But we also do it emotionally and behaviorally as well, because sometimes those files stem from emotional patterns or disruptions in childhood that are not about thoughts per se but come from events that may have been traumatic."

Other times, behaviors need to be updated.

As those operating files within the belief framework get updated, people can have a choice and can be conscious of what they're doing. They're able to identify triggering thoughts and catch them in the moment.

"I believe anyone can recover," Ugyan said. "But you have to want it."

Recovery is a long journey, and Jensen emphasized the importance of having compassion for yourself.

"We are always in a state of change whether that be physically or emotionally," she explained. "Our bodies are telling us everything we need to know. With support and care together, we can turn up the volume."