A recent joint study by researchers from two universities and a college in Israel found that women who have eating disorders (bulimia or anorexia) depict themselves quite differently in drawings than women without eating disorders. In fact, the drawings by the women with eating disorders had specific characteristics that were quite prominent. The study, which appeared in The Arts in Psychotherapy, was conducted as a joint effort by researchers at Soroka University Medical Center, Achva Academic College, and the University of Haifa. The study used 76 female participants. Just under half of the women involved (36 to be exact) had a diagnosis of either bulimia or anorexia. The other 40 participants did not have an eating disorder. They were equally divided into two groups – normal weight and overweight. The study participants were instructed to complete two questionnaires. The questionnaires were standardized screening instruments for eating disorders. The participants were also instructed to complete a self-figure drawing. They were not given any other specific instructions regarding the drawing. When the drawings were evaluated by those conducting the study, they discovered four areas of the body in which the differences were the most notable. These areas were the mouth, neck, thighs, and feet. Specifically, the women with eating disorders:

• Placed more emphasis on the mouth than those without anorexia or bulimia.
• Either drew themselves with no neck, a large neck, or a neck that wasn’t connected to their body.
• Drew themselves with bigger thighs.
• Were inclined to draw themselves with no feet or with feet that were disconnected from their body.

The study also found that certain characteristics in the drawings can help determine the type of eating disorder a woman may have. For example, the drawings by participants diagnosed with anorexia typically didn’t have any breasts. Compared to the size of the page, the drawings were also smaller. Another notable characteristic of the drawings by the anorexic females was less definition in the lines of the body. It’s long been known that women with eating disorders – particularly anorexia nervosa – tend to have a distorted perception of their body. This study, however, suggests the possibility of diagnosing the presence of an eating disorder by using a simple self-portrait. Using this method for assessment may feel less threatening and intrusive than standard diagnostic methods which typically involve answering a lot of very personal and uncomfortable questions. As Professor Rachel Lev-Wiesel of the University of Haifa explained, it may also help identify those who are at risk of developing an eating disorder. When the results were compared with two different screening instruments for eating disorders, they showed a high degree of reliability for the drawing test. The drawings that showed the most most prominent differences were used for this comparison. Body image distortion is one of the criteria for a diagnosis of anorexia nervosa. According to the DSM (Diagnostic and Statistical Manual of Mental Disorders), individuals with anorexia typically either see their entire body as fat, or they perceive certain parts of their body – usually their stomach, thighs, and buttocks – as too fat, even when they are dangerously underweight. They often obsessively measure or estimate their weight or body size by constantly weighing themselves, frequently looking in the mirror, or measuring various parts of their body. Individuals with bulimia also often have a distorted body image, although it is not part of the criteria for a diagnosis of the disorder. However, like anorexics, bulimics base their self-esteem to a significant degree on their weight and body shape. For anorexics, losing weight is considered a very impressive feat. It shows how incredibly disciplined they are. Gaining weight, however, is considered a significant failure as it suggests they have no self-control. Women with anorexia as well as bulimia have a tremendous fear of gaining weight and go to significant, if not extreme, lengths to prevent weight gain. They are consistently dissatisfied with their weight and body shape, and typically desire to lose weight regardless of whether or not they need to. With anorexics, the excessive desire to continue losing weight even when they are dangerously thin and malnourished puts them at very high risk for serious medical complications, including death. Anorexia is a particularly difficult disorder to treat because individuals with this disorder are in such denial. Sadly, they can only be forced into treatment if they are a minor or, once they are an adult, when there are imminent serious health risks and they are deemed a danger to themselves as a result. Even once they get into treatment, the road to recovery is a long one and some don’t fully recover despite treatment. Only a small percentage of individuals with an eating disorder ever get treatment for it. This is especially concerning because the mortality rate for eating disorders is higher than that of any other psychiatric disorder. In fact, statistics show that about 1 out of every 5 individuals with anorexia nervosa will die prematurely as a direct or indirect result. Karen Carpenter, the famous singer who died in 1983 at the age of 32, had anorexia. Her death was reportedly due to heart failure related to her long battle with anorexia. Nearly 50% of individuals with eating disorders also suffer from depression. It is not surprising, then, that many also die from suicide. Recent statistics show that eating disorders affect approximately 24 million people in the U.S. alone. Hopefully, studies such as this one from researchers in Israel will benefit individuals who either already have an eating disorder or who are at risk for developing one. Using a simple self-portrait drawing as a means of assessment may help more people finally receive the treatment they need.