08/06/2016 13:28 BST | Updated 07/06/2017 06:12 BST

Seeing My Eating Disorder In The Mirror

As someone who has recovered from Anorexia Nervosa, people are often interested in what I saw in the mirror during my eating disorder. You may have seen this digitally manipulated image by photographer Ross Brown, in which a girl in an emaciated body sees a very fat body reflected in the mirror, but personally I have never seen myself reflected in this popular representation.

In defence of Ross Brown, the image is supposed to capture the experience of body dysmorphia, rather than that of Anorexia Nervosa (AN). Body Dysmorphic Disorder (BDD) is a diagnosable condition in its own right, and whilst many people with AN experience body dysmorphia (or in some cases, may also have a diagnosis for BDD), it is important to distinguish these conditions. People with BDD may express specific preoccupations with aspects of body image rarely discussed in the context of eating disorders, such as skin, hair, facial features or symmetry, and which may be unrelated to weight concerns or eating habits. Unfortunately, this distinction is rarely made, and the image, or replicas of it, is used indiscriminately for both BDD and AN.

During an assessment for admission to an inpatient eating disorder unit, I was asked: "What do you see in the mirror?" and given a scale ranging from 'extremely thin' to 'extremely fat'. I placed myself on the extreme left, adding something about how I was probably "off the scale". If I was insulted by the seeming obviousness of this exercise, the look of scepticism returned by the consultant destroyed me. Three years later, whilst looking over the notes from my admission, I discovered the scrawled annotation: "Knows she is very thin. Not sure why she has not managed to gain weight." Professionals, as well the general public, struggle to make sense of AN in the absence of body dysmorphia.

The photograph's title, "What They Really See", makes an impossible knowledge claim. Who is the 'they'? I reacted viscerally when I read a description attached to the image on The Frisky. It asks: "Do you believe (or know) that anorexics see such a drastic difference when looking at themselves? Is this the altering lens through which the fashion industry sees its models?" I still don't know whether or not these questions are meant to be reflexive, and whether that even makes a difference. There is some evidence suggesting that people with Anorexia Nervosa may experience body distortion as the result of a multisensory impairment in spatial orientation that can be located in the brain. However, it does not resolve the fundamental problem I have with assuming that everyone with an eating disorder interprets their body in the same distorted way.

I don't deny that, for many people, body dysmorphia is a central part of their eating disorder. But I am also interested in the way that a stereotype which anticipates distorted self-image, may actually shape how body image develops across the course of an eating disorder. If we insist that people with eating disorders see themselves in a certain way, could they come to believe it precisely because we have inscribed that belief in them?

When I was in residential treatment, there were no full-length mirrors (except, interestingly enough, in the one room reserved for male patients, which suggests to me that body image and eating disorders is a particularly gendered issue). I was actively discouraged from thinking about my rapidly changing body, and so it became simultaneously unspeakable and unsee-able. Add to this the communal living setting and strict 15 minute limit on bathroom-time, and you will understand why I became increasingly unfamiliar with my physical, material body. As my treatment came to an end, I spent days at home in which I saw my full-frontal body reflected in a full-length mirror, and took leisurely, private showers, in which I came to discover my newly weight-restored body.

The potential for psychological fall-out after experiencing sudden alterations in physical appearance are well documented in the cases of burns victims, amputees, and even people undergoing drastic weight loss surgery. The reactions of people with eating disorders are rarely legitimised in the same way because their self-image was apparently already broken prior to this new alteration. I see why limiting mirrors in treatment centres is thought to serve a therapeutic purpose, but shielding me from my own reflection not only assumed that my body represented a danger to my mental health, it severed the relationship I had with my body. After gaining weight at the expected rate of 1kg a week largely out of my own sight, as well as that of friends and families, the estrangement I felt towards my body was not symptomatic of a distorted way of seeing, but a wholly rational response to becoming re-acquainted with a body that had visibly changed.

I sympathise with Brown's efforts to use digital manipulation to capture the experience of body dysmorphia, but the distorted photographic lens is not a perfect proxy for the perceptions of someone with an eating disorder. It is a powerful photograph, but it is also a crude and singular caricature of an experience that is nuanced and multiple.