A significant feature of any eating disorder is having a self-evaluation that is very reliant on one's perception of body weight and shape. Body image disturbance is categorised as either distortion or disturbance. Kearney-Cooke and Striegal-Moore postulate two possible pathways to the development of body image disturbance: internalisation and projection. The key issues around body image disturbance have incorporated perceptual, physical, cognitive, emotional, behavioural and interpersonal dimensions which point to a multimodal approach to therapeutic treatment. The multimodal aspects of therapeutic treatment ensured that the cognitive elements were channelled and complemented by the exploration and expression of emotions. Structured feedback questionnaires showed substantive improvements in participant ratings of body image satisfaction, and the qualitative feedback questionnaires cited many changes in attitudes towards themselves, relationships and general wellbeing. Totenbier suggests that the formation of body image is based on reception of sensations coming from skin, viscera and muscles, and includes a sense of body unity, position and posture.