There were times when Amanda Hwu could feel her thighs itching. They were flawed, and she wanted them gone. They were not her own; they were “dead weight.” Sometimes, she imagined tearing into them, those things, and freeing herself at long last from their fleshiness.  

The obsession began during her senior year of high school. She would target an area — her thighs, her cheeks — and fixate on them, letting her insecurity fester.

What Hwu didn’t know at the time was that there was a name for what she was going through: body dysmorphic disorder.

With the May 2013 release of the updated Diagnostic and Statistical Manual of Mental Disorders, mental health professionals are considering making a greater distinction between clinical eating disorders and this similar, lesser-known entry.

“I don’t think I had an eating disorder; I had disordered eating,” Hwu, sophomore in LAS, said. “There’s that differentiation that’s important. My problems surrounded physical sensations of how I felt about my body. Never full-out starvation.”

When Hwu discovered that her symptoms aligned closely with those of the disorder, she said it was “liberating.” According to the current manual, the DSM-IV, which was published in 1994, patients suffering from body dysmorphic disorder have “a preoccupation with a defect in appearance,” which is either only in their head or they have unnecessary concerns about it.

This differs from clinical eating disorders, which also focuses on body image dissatisfaction and begins in adolescence, but is solely characterized by disturbances in eating behavior. 

While DSM-V reviewers say that current data shows that both require different treatment approaches, certain features of body dysmorphic disorder and eating disorders not otherwise specified can sometimes overlap and result in a misdiagnosis. They are currently considering preliminary recommendations to “specifically mention concerns with body fat and weight in the criterion to further aid clinicians in differentiating eating disorders from BDD,” according to a DSM-V review. 

Andi Phillips, former health educator at University Laboratory High School, said she thinks it is important for this distinction to be made, and the public should become more familiar with the differences between body dysmorphic disorder and eating disorders, as it may influence how patients are treated clinically. 

“For all people, Body Dysmorphia traits or not, body image issues can lead to an individual walking a very thin line between disordered behavior and the pathological symptoms of an eating disorder,” Phillips said. 

Phillips said that she also believes the disorder is often under-diagnosed because it can be confused with other disorders that it shares commonalities with.  

At Kevin Elliott Counseling in Champaign, CEO Kevin Elliott said in an email that he has worked with individuals who suffer from body dysmorphic disorder “on a few occasions,” but it is rare that his practice provides treatment for the disorder.

“I do believe that it is probably under-reported and under-diagnosed, both because of clients’ unwillingness to bring it up out of embarrassment and a lack of willingness to draw attention to the perceived flaw,” Elliott said. “Also because it may not be prominent in the minds of therapists, as they assess presenting issues.” 

The DSM-V will enable therapists and clinicians to better help those with body dysmorphic disorder. But a diagnosis only goes so far for Hwu and others like her; while Hwu has come a long way since she considered her body parts enemies, she knows that her struggle is far from over.

“I know for the rest of my life, at least for the forseeable future, it will come in waves for me,” she said. “The difference is that a few years ago, that idea would have terrified me, but today I truly believe that I have the resources and strength I need to carry me through the more difficult times.”

Editor’s note: A previous version of this article stated that Andi Phillips was the health educator at University Laboratory High School. Phillips is the former health educator at University Laboratory High School. The Daily Illini regrets this error. 

Emma can be reached at [email protected].