Towards the unification of body image disorders

In the course of this discussion of body image disorders there has been little opportunity to discuss culture bound disorders although of course it should not be overlooked that obesity, anorexia and bulimia nervosa are to some extent culture bound, but prevalent within our own society. There are many different specific syndromes presenting with physical symptoms, often based upon hypochondriacal concern about the body. For example, koro which occurs in South East Asia presents with an overwhelming preoccupation that the penis will retract into the abdomen and hence cause death; there is thus both a fear for virility and a fear for life. Can there be unification of these very different concepts? Although the answer is probably negative, classification becomes more meaningful if epistemological unity is achieved, and phenomenological psychopathology is the most likely root to achieve this. There is therefore a need to concentrate upon the precise description of the patients' own internal experience, using this for categorisation of the symptoms. Objectivity has been held up in medicine as the ideal; however, in order to make progress in this area there is a need to structure subjectivity. Body image, as the concept of the body, is a part of self image; ultimately the only way to explore the self is to study self description using empathy as a diagnostic instrument.