Why can't someone with anorexia see how thin they are?

Why can't someone with anorexia see how thin they are?

There's a component of anorexia that we call body image distortion. This is where they look at themselves in the mirror and they see themselves as huge. Physiologically, actually what's happening, is that the brain is going through the phase of malnourishment and the brain releases a chemical called leptin. Leptin, when its secreted in high amounts in the brain makes the person have that body image distortion that they have. So leptin is a chemical in the brain. When I have an anorexic patient telling me, "I'm huge, can't you see how big I am?" She is actually seeing that, and she's not making that up. She is seeing herself that big because of leptin, and the excessively high levels of leptin. The way leptin levels start to drop is only through eating. So when she stabilizes with her food, and when she starts eating three meals a day and three snacks, everything we're gently having her do, then as the leptin levels go down then she says, "oh my God, I'm so thin! I never realized how thin I got Dr. Kakyia." So then her body image becomes more realistic, so then she sees herself for really how thin she is, but only after she nourishes herself will what she sees in the mirror begin to change.