Many who suffer from eating disorders claim that they see themselves as “fat”. Despite decades of research into the phenomenon, behavioural evidence has failed to confirm that eating disorders involve visual misperception of own-body size. I illustrate the importance of this phenomenon for our understanding of perceptual processing, outline the challenges involved in experimentally confirming it, and provide solutions to those challenges.

A distorted representation of one's own body is a diagnostic criterion and core psychopathology of both anorexia nervosa (AN) and bulimia nervosa (BN). Despite recent technical advances in research, it is still unknown whether this body image disturbance is characterized by body dissatisfaction and a low ideal weight and/or includes a distorted perception or processing of body size. In this article, we provide an update and meta-analysis of 42 articles summarizing measures and results for body size estimation (BSE) from 926 (...) individuals with AN, 536 individuals with BN and 1920 controls. We replicate findings that individuals with AN and BN overestimate their body size as compared to controls (ES= 0.63). Our meta-regression shows that metric methods (BSE by direct or indirect spatial measures) yield larger effect sizes than depictive methods (BSE by evaluating distorted pictures), and that effect sizes are larger for patients with BN than for patients with AN. To interpret these results, we suggest a revised theoretical framework for BSE that accounts for differences between depictive and metric BSE methods regarding the underlying body representations (conceptual vs. perceptual, implicit vs. explicit). We also discuss clinical implications and argue for the importance of multimethod approaches to investigate body image disturbance. (shrink)

Empiricist models explain delusional beliefs by identifying the abnormal experiences which ground them. Recently, this strategy has been adopted to explain the false body size beliefs of anorexia nervosa patients. As such, a number of abnormal experiences of body size which patients suffer from have been identified. These oversized experiences convey false information regarding the patients’ own bodies, indicating that they are larger than reality. However, in addition to these oversized experiences, patients are also exposed to significant evidence suggesting their (...) bodies are in fact thin. This situation poses a conundrum: why do patients appear strongly influenced by the former kinds of evidence while the latter has little effect? To solve this conundrum, I suggest a two-factor account. First, I discuss research on the biases patients exhibit in how they gather, attend to and interpret evidence related to their own body size. Such biases in evidence treatment, I suggest, cause oversized experiences to be sought out, attended to and accepted, while veridical body size experiences are ignored or explained away. These biases constitute the second factor for this empiricist model, accounting for the unwarranted conviction with which these beliefs are held. Finally, in line with recent research into self-deception, I propose that, paradoxically, these biases in evidence treatment arise from patients’ own desires. (shrink)

Bodily awareness seems to present the body as a topologically connected whole, composed of many parts. In consequence, the source of topological and mereological content of bodily awareness comes into question. In particular, it may be asked whether (a) such content is provided by the bodily sense, i.e., sensory mechanisms which, like proprioception, presents the body “from the inside,” or (b) it is a product of “exteroceptive” elements of bodily awareness, which represents the body “from the outside” in a similar (...) way to that of other physical objects. This paper argues that while passive touch and proprioception are unlikely to present the body as a topological and a mereological whole, such content is likely to be provided by kinesthesis. In consequence, it is plausible that holistic topological and mereological bodily content is present in virtue of certain mechanisms of bodily sense. (shrink)

We evaluate a growing trend towards anti-representationalism in cognitive science in the context of recent research into the development and maintenance of anorexia nervosa in cognitive neuropsychiatry. We argue two things: first, that this research relies on an explanatorily robust concept of representation—the concept of a long-term body schema; second, that this body representation underlies our most basic environmental interactions and affordance perception—the psychological phenomena supposed to be most hospitable to a non-representationalist treatment.

Body dissatisfaction has long been considered an integral component of and driving force behind anorexia nervosa. In this paper, I characterise body dissatisfaction in terms of problematic beliefs about body size and the value of thinness. I suggest two methods for understanding these beliefs. Regarding body size beliefs, I suggest focusing on certain forms of misleading phenomenal evidence that sufferers of anorexia nervosa are exposed to. Regarding beliefs about the value of thinness, I suggest focusing on the benefits of such (...) beliefs. (shrink)

In this paper, I discuss what I call the oversized experiences that anorexic patients suffer from. It has been known for some time that anorexic patients mentally picture their bodies as larger than reality. While this constitutes one kind of oversized experience, I claim there is another, less explored kind. This is an experience of the body as oversized in relation to the affordances of its environment. I discuss recent evidence suggesting anorexic patients exhibit distorted affordance perception. I then discuss (...) how this distorted affordance perception also constitutes an oversized experience of the body. Along with sociocultural influences, I claim oversized experiences ground negative propositional attitudes regarding body size. (shrink)

This paper aims at considering the conceptual status of feeding and eating disorders (FEDs). Now that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has changed the classification and some relevant criteria of FEDs, it is particularly relevant to evaluate their psychiatric framework and their status as mental disorders. I focus my efforts on addressing only one specific question: Do FEDs fit the DSM-5 general definition of mental disorder? In DSM-5 a mental disorder is defined as a syndrome that (...) reflects adysfunctionand is usually associated with significantdistress or disability. More importantly, there is an explicit statement saying thatallmental disorders listed in the manual must meet the requirements highlighted by the general definition. Thus, I evaluate whether or not FEDs are really meant to reflect a dysfunction and are usually associated with significant distress or disability. (shrink)

This paper aims at considering the conceptual status of feeding and eating disorders (FEDs). Now that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has changed the classification and some relevant criteria of FEDs, it is particularly relevant to evaluate their psychiatric framework and their status as mental disorders. I focus my efforts on address- ing only one specific question: Do FEDs fit the DSM-5 general definition of mental disorder? In DSM-5 a mental disorder is defined as a syndrome (...) that reflects a dysfunction and is usually associated with significant distress or disability. More importantly, there is an explicit statement saying that all mental disorders listed in the manual must meet the requirements highlighted by the general definition. Thus, I evaluate whether or not FEDs are really meant to reflect a dysfunction and are usually associated with significant distress or disability. (shrink)

Mental disorder (earlier entitled “illness” or “disease”) is ascribed to deviations from normal thoughts, reasoning, feelings, attitudes, and actions that are considered socially or personally dysfunctional and apt for treatment. Schizophrenia, depression, and bipolar disorder are core examples. The concept of mental disorder plays a role in many domains, including medicine, social sciences such as psychology and anthropology, and the humanities, including literature and philosophy. Philosophical discussions are the primary focus of the present entry, which differs from the entry on (...) Philosophy of Psychiatry in noting several different approaches—not only those of the philosophy of science and mind, but also those arising from phenomenology and social theory. -/- Mental disorder is a widely contested concept and there are longstanding debates on whether disorders are biological or social in nature. Even uncontroversial disorders, such as those listed above, were not always regarded as disorders in the past (Porter 2002). Moreover, the status of mental disorder has frequently indicated ethical, as much as other deficiency (Irwin 2013). Such reminders direct our attention to contemporary medical psychiatry’s sometimes uncompromisingly neurobiological, and avowedly value-free “medical model”, with its incumbent analogies and assumptions, and to the general question of how the taxa of psychiatric classifications are to be viewed as objects of natural science. This model has received intensive philosophical scrutiny, including arguments that deny these conditions are deficiencies at all. Along with issues arising from cognitive psychology and the neurosciences, such foundational matters make up much of the following entry. Because of their focus on issues central to the philosophy of mind and ethics (e.g., the mind-body problem, moral responsibility, agency and identity), analyses of mental disorder have extensive implications for those fields. As clinical phenomena, they also reflect an inescapable, everyday, social reality, giving theoretical inquiries additionally urgent practical, moral, and legal implications. (shrink)

Anorexia nervosa patients exhibit distorted body-representations. Specifically, they represent their bodies as larger than reality. Given that this distortion likely exacerbates the condition, there is an obligation to further understand and, if possible, rectify it. In pursuit of this, experimental paradigms are needed which manipulate the spatial content of these representations. In this essay, I discuss how virtual reality technology that implements full-body variants of the rubber-hand illusion may prove useful in this regard, and I discuss some issues related to (...) the clinical application of this method. -/- . (shrink)

Body dissatisfaction has long been considered an integral component of and driving force behind anorexia nervosa. In this paper, I characterise body dissatisfaction in terms of problematic beliefs about body size and the value of thinness. I suggest two methods for understanding these beliefs. Regarding body size beliefs, I suggest focusing on certain forms of misleading phenomenal evidence that sufferers of anorexia nervosa are exposed to. Regarding beliefs about the value of thinness, I suggest focusing on the benefits of such (...) beliefs. (shrink)

Anorexia Nervosa is widely recognized as having both cognitive and affective dimensions. Current accounts typically explain the perplexing behaviors associated with this eating disorder by emphasizing either its cognitive components—particularly false beliefs related to the denial of the patient’s actual conditions—or its affective components, such as the intense fear of gaining weight. I will argue that neither approach is sufficient to fully capture the complexity of Anorexia Nervosa. This paper explores a more comprehensive approach that goes beyond the cognition-affect dichotomy, (...) aligning better with the DSM-5 criteria for Anorexia Nervosa. These criteria suggest that while both affective and cognitive components play significant roles, neither the cognitive element nor the affective element is necessary or sufficient to define the condition on its own. I propose that this can be achieved by drawing an analogy with addiction, where both conditions can be seen as stemming from and maintained by an all-consuming fixation that permeates individuals’ lives and profoundly influences their behaviors. In Anorexia Nervosa, this fixation manifests as a pervasive preoccupation with body size and weight. What distinguishes these behaviors is their internal self-endorsement, aligning with the well-documented ego-syntonic nature of Anorexia Nervosa: sufferers perceive these behaviors as consistent with their feelings, values, and ideals, making them resistant to change. Understanding Anorexia Nervosa within the framework of addiction, particularly by recognizing the pivotal role of ego-syntonic fixation, allows for a more comprehensive approach to the disorder that sheds light on its high resistance to treatment and the challenges faced in clinical interventions. (shrink)

There are two ways in which we are aware of our bodies: reflectively, when we attend to them, and pre-reflectively, a kind of marginal awareness that pervades regular experience. However, there is an inherent issue with studying bodily awareness of the pre-reflective kind: given that it is, by definition, non-observational, how can we observe it? Kuhle claims to have found a way around this problem—we can study it indirectly by investigating an aspect of reflective bodily awareness: the sense of bodily (...) ownership. Unfortunately, I argue, there is little reason to believe a relationship between pre-reflective bodily awareness and the sense of bodily ownership exists. Until more work is done, pre-reflective bodily awareness remains beyond our empirical grasp. (shrink)