How to do Body Image Work in Eating Disorder Recovery: The Body Image Healing Continuum
How to Help Clients with Eating Disorders with Body Image
Body image work is often treated as a late-stage task in eating disorder treatment, something to address once eating patterns have stabilized and medical symptoms have improved. In practice, body image is woven throughout the recovery process in eating disorder treatment, across the team of providers.
For many clients, eating disorder behaviors help create distance from the body. Put simply, eating disorder behaviors (including mental behaviors) are coping skills that work well, at least in the short term. It doesn’t need to be stated that these coping skills do far more harm than good, especially in the long term. Food restriction, compulsive exercise, bingeing, purging, body checking, and other behaviors used to cope via experiential avoidance often function to reduce awareness of hunger, fullness, emotions, physical sensations, and other aspects of embodied experience. Furthermore, body shame may provide a more concrete place to focus distress that originates elsewhere.
This makes body image work much more complex than helping someone “feel better” about their appearance.
The IEDE Body Image Healing Continuum
Developed and copywrited by Inclusive Eating Disorder Education (IEDE). The Continuum offers a framework for conceptualizing body image healing as a dynamic shift from dissociation toward embodiment and integration. The continuum includes six overlapping areas of healing: Body Tolerance, Body Neutrality, Body Grief, Body Respect, Body Peace & Appreciation, and Body Liberation.
This article is an abbreviated form of the Body Image & Dysmorphia in Eating Disorder Treatment full course, available for purchase as a stand alone course, and is also included in the Inclusive Eating Disorder Specialist (IEDS) Certification training.
Inclusive Eating Disorder Education (IEDE) teaches the Body Image Healing Continuum, which helps clinicians conceptualize this work through the broader process of moving from dissociation toward embodiment. The continuum includes five overlapping and non-linear areas of healing:
Body Tolerance
Body Neutrality
Body Grief
Body Respect
Body Peace & Appreciation
Body Liberation
These are not rigid stages or milestones that clients must complete in order. People move forward, backward, and between them throughout recovery and throughout life.
The Body Image Healing Continuum was developed by IEDE’s Cofounder, Veronica Rocha, LPC-S, IEDAS-C, with the help of her teams at IEDE and ACED, and all her own education including many different modalities of eating disorder treatment over the past 20 years. Two notable texts in this area that Veronica is informed by:
Beyond a Shadow of a Diet, 3rd Edition by Judith Matz, LCSW
https://judithmatz.com/books/beyond-a-shadow-of-a-diet/Trauma-Informed Approaches to Eating Disorders, Second Edition
Editors: Andrew Seubert, NCC, LMHC and Pam Virdi, MEd, RMN, CPN
https://www.springerpub.com/trauma-informed-approaches-to-eating-disorders-9780826147974.html?srsltid=AfmBOorZj5XLZ78YFPl3LmE_yicwqmlY7Y6VxP7q1yzPUfuzxSuG-hHR
Body Image Defined: It Is More Than Perceived Appearance
Body image includes the mental representation we hold of our bodies, along with how we experience the body as a source of pleasure, connection, and function. It develops through psychological, social, cultural, biological, historical, and interpersonal influences. Body image also includes how we feel inside our bodies, how we experience the world around us, and how we experience ourselves. Thus, body image is deeply connected to our sense of self, how secure we feel in our bodies, in our lives, in relationships, in our work, and in our physical and social environments. Body image informs our secure, structured sense of self.
Body image also changes.
Our bodies age; our weight, shape, and size is dynamic; illnesses happen; disability happens; our hormones fluctuate. Some of us go through pregnancy, menopause, injury, gender transition, different medications, and countless other experiences alters how we live in and relate to our bodies. For this reason, making “accept your body” or even “like your body” the endpoint of body image work in eating disorder treatment creates a more fragile ongoing recovery process post treatment.
Someone can dislike aspects of their appearance and still have a profoundly healed relationship with their body amid all it’s changes and transitions.
A more apt clinical question could be:
Can this person inhabit their body, appropriately respond to its needs, and build a meaningful life without appearance determining their worth or driving their behavior? What barriers are in the way? What is the roadmap to get them there, with respect to their own values and treatment goals?
Begin Your Treatment Conceptualization With Understanding of the Function of Body Image Distress
Before attempting to work on body image distress in treatment, clinicians need to understand what it is doing for the client.
Body shame may function as:
a form of avoidance or distraction from painful emotions
a way to disconnect from bodily sensations
an attempt to create a sense of control (i.e., safety) during instability
protection against weight stigma or social rejection
an effort to obtain or preserve thin privilege
a strategy for navigating gender expectations or gender expression
a response to racism, ableism, anti-fat bias, medical discrimination, or other forms of oppression
A client living in a larger body may have experienced very real discrimination in medical settings, employment, relationships, travel, clothing access, or public spaces. A transgender client may experience legitimate distress about physical characteristics that conflict with their gender. A client may have learned early in life that appearance brought approval, safety, belonging, or protection.
Effective treatment makes room for both internal healing and the external realities clients continue to navigate.
1. Body Tolerance: Learning to Be Inside the Body
For some clients, the earliest work has little to do with mirrors or appearance, especially those clients who are dissociated or “numbed out” and who have trauma in their history or current lives. This work begins with sensation.
Body tolerance involves increasing the client’s ability to experience what is happening inside the body without immediately running to escape, numb, suppress, or alter it.
That may include gradually tolerating:
hunger and fullness
skin touching skin
changes in the abdomen after eating
fatigue
temperature
emotion - this is usually the biggest one and includes the physical sensations that emotion brings
physical discomfort
pleasure
interoceptive sensations that have been ignored for years
For clients with significant dissociation or trauma histories, this work can be very slow. Somatic and trauma-informed approaches may become important components of treatment.
The clinical goal is to gradually expand the client’s capacity to remain present inside their body.
2. Body Neutrality: Moving Away From Constant Evaluation, Comparison, Objectification
Many clients have learned to experience their body primarily as something being viewed, judged, and objectified.
“How do I look?”
“How does this part compare with someone else’s?”
“What does my appearance say about me?”
Body neutrality begins when we start to bring awareness to this constant, invisible process of evaluation. Attention shifts toward function, experience, and observation without assigning moral value.
They begin practicing something more sustainable: the body can simply exist without being continuously judged. It is neither good or bad, morally. It just exists.
3. Body Respect: Appropriately Caring for a Body You May Not Like
Body respect adds behavior to the process: a client does not need to admire their body before feeding it, for example.
They do not need to love their thighs before allowing them to rest. They do not need to feel confident before buying clothes that fit. Body respect involves recognizing bodily needs and responding to them while reducing behaviors that harm, punish, or neglect the body.
This can include nourishment, medical care, sleep, comfortable clothing, movement that respects physical capacity, reducing compulsive checking, changing harmful social media exposure, or establishing boundaries around body and weight commentary.
For many clients, this is a significant shift: “How I feel about my body does not have to determine how I treat it.”
4. Body Peace & Appreciation: Building a Different Relationship
Over time, body image work can become less centered on managing distress and more centered on relationship. Clients may begin experiencing the body as an ally, a home, or a vehicle for connection and pleasure.
Appreciation does not require appearance based gratitude, but it can begin to include compassion. It can emerge through compassionate, present actions:
resting when tired
enjoying food
feeling sunlight or warm water on the skin (sitting with pleasure for sustained periods of time)
laughing with friends with presence
experiencing sexuality or intimacy with no or less objectification
playing, creating
participating more fully in life
Periods of flow, when a person becomes absorbed in experience and temporarily forgets how they look, can be particularly meaningful.
Self-consciousness begins taking up less space and lived experience begins taking up more.
5. Body Liberation: Becoming the Subject of Your Own Life
Body liberation extends far beyond individual coping skills and eating disorder recovery, and begins to look at the broader system that we live within, and to deeply question it.
Body liberation as a concept asks clients (and all of us) to thoughtfully examine our larger belief systems that teach us that our body determines our value. These beliefs are invisible, much like the air we breathe. This realm of deeper body image work requires clients to identify their own values.
Some examples of systems that beg for deeper examination and need to be held against a client’s own values: Anti-fat bias, racism, patriarchy, ableism, healthism, beauty standards, gender expectations, consumer culture, medical weight stigma, and so on. Clients begin recognizing these forces without automatically accepting them as personal truths.
The shift is profound!
from looking at the body to living inside it
from self-objectification to embodiment
from appearance based worth to values based identity
from controlling the body to building a life
Body Image Work is Woven Throughout Eating Disorder Treatment
The familiar idea that “body image comes last” contains an important truth: nutritional rehabilitation can improve cognitive flexibility, emotional regulation, and the capacity to engage deeply in body image work. But body image work cannot simply be postponed until the end.
As nourishment improves, sensations return, bodies change, and emotions become more accessible. Clients lose some of the numbing and avoidance functions previously provided by the eating disorder. Your clients need here-and-now tools and a language to describe living inside their increasingly present body.
Body image treatment belongs embedded throughout eating disorder treatment, while changing in prioritization and emphasis according to the client’s needs, medical status, trauma history, identities, environment, and stage of recovery.
A More Expansive Goal for Body Image Healing
Clinicians can unintentionally create another impossible standard when recovery becomes synonymous with liking or loving the body.
Some clients will experience genuine affection for their bodies. Others may not. Both can recover.
The deeper work is helping people develop enough tolerance, neutrality, respect, peace, and liberation that their lives become larger than the project of managing their appearance.
The Body Image & Dysmorphia in Eating Disorder Treatment course (standalone course and included in the IEDS Certification) explores the Body Image Healing Continuum in much greater clinical depth, including case conceptualization, assessment, stage-specific interventions, clinician self-reflection, in-depth education about body dysmorphic disorder (BDD), trauma-informed considerations, and practical tools that can be incorporated into eating disorder treatment.
For therapists, dietitians, medical providers, and coaches working with eating disorders, body image competency is needed. It is part of understanding what the eating disorder protects, what recovery asks the client to feel again, and how we help people return to their bodies without asking them to conform to another prescribed ideal.
FAQs
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The IEDE Body Image Healing Continuum is a clinical framework for understanding the many forms body image healing can take during eating disorder recovery.
It expands the goal beyond improving satisfaction with appearance and considers a client's capacity to tolerate embodied experience, reduce self-objectification, grieve body related losses, care for the body with respect, experience greater peace within the body, and ultimately live with greater freedom from cultural body ideals.The six areas of the continuum are Body Tolerance, Body Neutrality, Body Grief, Body Respect, Body Peace & Appreciation, and Body Liberation.
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Body image work can be woven throughout eating disorder recovery rather than reserved for the final stages of treatment.
Nutritional rehabilitation can improve cognitive flexibility and a client's capacity to engage in deeper body image work, but increasing nourishment can also bring physical sensations, emotions, body changes, and awareness back online. Clients may need support tolerating these experiences as they reduce reliance on eating disorder behaviors.The focus of body image work can therefore change across treatment according to the client's nutritional and medical stability, trauma history, level of dissociation, identities, environment, and current capacity for embodiment.
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No. Body love is neither a necessary nor universally appropriate goal of body image healing.
A client can dislike aspects of their appearance while learning to tolerate being in their body, nourish it adequately, respond to its needs, reduce harmful behaviors, and build a meaningful life that is less governed by appearance.
For this reason, the IEDE Body Image Healing Continuum emphasizes embodiment, neutrality, respect, peace, and liberation rather than requiring positive feelings about how the body looks. -
Body grief involves acknowledging and experiencing losses connected to the body without requiring the client to immediately accept, appreciate, or feel differently about those losses.
Clients may grieve a previous body, a hoped-for body, changes related to weight restoration, aging, illness, disability, hormones or injury, or the loss of privilege and social safety associated with occupying a more socially valued body.
They may also grieve the belief that achieving a particular body would eventually provide belonging, confidence, desirability, health, control (aka the illusion of safety), or relief.Making room for this grief allows clients to remain connected to recovery while acknowledging that body change can involve meaningful and sometimes very real losses.
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Body liberation describes a deeper shift away from organizing identity, worth, and daily life around cultural ideals of body size, shape, appearance, health, ability, or desirability.
The most powerful piece of the IEDE Body Image Healing Continuum, body liberation involves moving from looking at the body to living inside of it.
Clients increasingly experience themselves as the subject of their lives rather than an object to be evaluated. Body related thoughts and distress may still occur, particularly within a culture where anti-fat bias and appearance based privilege remain present, but those experiences have less power to determine behavior, identity, or quality of life.Body liberation is therefore less about reaching a permanent emotional state and more about developing an increasingly embodied, values-informed way of living.
Disclaimer: This blog is for educational and informational purposes only and is not intended to provide medical, mental health, legal, ethical, or supervisory advice. Reading this content does not establish a therapist-client, consultant-client, supervisee-supervisor, or training relationship with Inclusive Eating Disorder Education.
Eating disorder care can involve complex medical, psychological, ethical, cultural, and scope of practice considerations. Clinicians and organizations are responsible for using their own clinical judgment, following applicable laws and licensing board requirements, consulting with qualified supervisors or legal/ethical advisors when needed, and referring clients to appropriate medical, nutritional, psychiatric, or higher level of care services when clinically indicated.
This content should not be used as a substitute for formal training, clinical consultation, supervision, legal guidance, or individualized treatment planning.