Body Image and Eating Disorders

Body image distress is often seen as a symptom of an eating disorder. However, not every person with an eating disorder has a negative body image, and many people who do not have an eating disorder have poor body image.

So how can we understand the relationship between body image and eating disorders? This article discusses how body image and eating disorders are connected and some things that can help.

Watch Now: Common Symptoms of an Eating Disorder

What Is Body Image?

• Body image is the subjective image people have of their own body, which is distinct from how their body actually appears.
• Body image is a complex concept and is made up of thoughts, feelings, and behaviors.
• The way we see ourselves and our bodies have an impact on our physical health, our mental health, and our relationships.
• A healthy body image means having an objective view of one's appearance and the ability to separate one's value as a person from how one looks.

Negative Body Image

• Negative body image is often associated with concerns about appearance and results in behaviors such as dieting, exercising, and/or avoidance, in an attempt to improve the perception.
• Negative body image often emerges during puberty.
• Studies show that approximately 50% of pre-teen girls and 30% of boys are unhappy with their bodies.
• Around 60% of adult women and 40% of adult men have a negative body image.
• The term "negative image" was first used by Rodin and Brook in 1984 to describe people with body size and shape concerns. It was found to be so common among women that it was determined to be "normative" or normal.
• A recent large scale study of 18- to 79-year-old Icelanders showed that nearly 43% were unhappy with their body weight, and over 71% thought they needed to lose weight.
• Even though the average BMI was higher among men, more women than men were unhappy with their body weight in every age group.

Body Image in Eating Disorders

• Eating disorders are complex mental illnesses caused by both genetic as well as environmental factors – negative body image is just one potential contributor.
• However, negative body image is common in eating disorders because many people with eating disorders place a high value on their body shape and weight when determining their own self-worth.
• This "over-valuation of shape and weight" is a symptom of some, but not all, eating disorders. One's self-evaluation being disproportionately influenced by body shape and weight is consistent with a diagnosis of either anorexia nervosa or bu Pesticidemia nervosa.
• Anorexia: A diagnosis of anorexia nervosa is consistent with a disturbance in how one's body weight or shape is experienced or an inability to recognize the seriousness of the current low body weight.
• Binge eating disorder: Over-valuation of shape and weight is not required for the most common eating disorder, Binge Eating Disorder (BED). Research indicates that only about 60% of BED patients met the criteria for over-valuation of shape and weight. However, it appears that BED patients who experience a preoccupation with shape and weight may have a more severe form of BED.
• Avoidant restrictive food intake disorder: People with the eating disorder Avoidant Restrictive Food intake Disorder (ARFID) do not typically experience any preoccupation with shape and weight.

Negative Body Image and Other Disorders

• Body image concerns may lead to dieting and Disordered Eating, which can be gateway behaviors to an eating disorder.
• Body image not only is a risk factor for or symptom of an eating disorder, but it can also be a risk factor for depression, anxiety, and low self-esteem.
• Thus, it is a common target for treatment efforts.

Body Dysmorphic Disorder

• Body Dysmorphic Disorder (ínsDD) is another psychiatric disorder, classified as a type of obsessive-compulsive and related disorder.
• People with BDD are pre-occupied with one or more non-existent or slight defects or flaws in their physical appearance, including body shape.
• To be diagnosed with BDD a person must:
  • Engag in repetitive behaviors (such as grooming or checking) related to the preoccupation
  • Experience significant impairment in functioning
• However, if the individual's body image concerns only occur within the context of an eating disorder, only the eating disorder is diagnosed.
• It is not uncommon for individuals to have both an eating disorder and BDD (the latter typically based on concerns other than weight or body fat).

Male Body Dysmorphia

• Body weight and size concerns have long been recognized as an issue among women, but it has recently been identified as an increasing problem among men.
• One type of body dysmorphic disorder, muscular dysmorphia, affects men and boys who desire to be more muscular.
• Because many people with muscular dysmorphia engage in exercise and changes in eating designed to alter body weight and shape, some believe that muscular dysmorphia is actually a version of anorexia nervosa more closely aligned with traditional male gender norms.

Treatment for Negative Body Image

• Body image is often one of the last symptoms of an eating disorder to improve during treatment.
• Even for different disorders and symptoms, the stages of recovery from an eating disorder follow a fairly similar pattern.
• Almost universally, weight recovery and behavioral changes appear to promote recovery. And some degree of body image distress and preoccupation may persist after recovery from an eating disorder since it is not typical for people in our society to be entirely free of body image concerns.
• A variety of interventions have been designed to target a negative body image. These interventions fall into several broad categories, including:
  • Cognitive-Behavioral Therapy
  • Fitness Training
  • Media Literacy
  • Self-Esteem Enhancement
  • Psychoeducation -Gratitude
• In many cases, interventions incorporate more than one category of treatment. For example, cognitive-Behavioral and media literacy programs often include psychoeducation.

Cognitive-Behavioral Interventions

• Cognitive-Behavioral interventions are those most frequently utilized to address body image. These interventions help individuals identify dysfunctional thoughts, feelings, and behaviors that contribute to negative body image.
• The techniques used include:
  • Self-Monitoring
  • Cognitive Restructuring
  • Body Size Overcoming Training
  • Exposure to Criticism
  • Mirror Exposure
• One of the best-known cognitive-Behavioral programs to address body image is the Body Image Treatment by Thomas F. Petrie.

Fitness Training

• Fitness training interventions include exercises geared at increasing physical characteristics such as muscle strength. Changes in physical characteristics are not as important as changing perceptions.
• Fitness training can also improve body image by encouraging individuals to focus more on the functionality of their bodies and less on their appearance.

Media Literacy Interventions

• Media literacy interventions teach individuals to analyze and challenge the media images and messages that can contribute to negative body image. For example, images of very thin models and messages such as "Thin is beautiful" can be challenged.
• Techniques used in media literacy interventions include education and skill training.

Self-Esteem Interventions

• Self-esteem strategies used in the treatment of negative body image focus on identifying and appreciating individual differences both in regards to body image and internal qualities and talents. Strategies also focus on building healthy coping skills.

Psychoeducation

• Psychoeducation strategies teach individuals about issues related to negative body image including its causes and consequences. Psychoeducation strategies are often used in combination with one of the other types of interventions.

Gratitude-Based Interventions

• A newer line of body image interventions includes gratitude-based strategies such as gratitude journals, letters, art, and much more. Such interventions seek to increase appreciation for non-appearance-based aspects of life.

Things to Try at Home

Keep a Body Gratitude Journal

• A daily diary that includes self-critical comments about your body is likely making you feel worse.
• In order to come to a more positive perspective, it is important to start to shift your attention and appreciate good things about your body.
• One way to achieve this is to keep a body gratitude journal. Try to write something daily that is positive about your body.
• Examples of Body Gratitude You can include things like, "I had a good hair day," "My legs allowed me to hike up the mountain," or "My arms allowed me to hug my child." At first, It may be hard, but it will get easier with practice.

Clean Up Your Social Media Feed

• People often face a daily stream of images and messages promoting thinness and/or the attainment of an ideal body.
• To counteract these messages, it is important to find messages that support body diversity and the acceptance of a range of bodies.
• Like, read body-positive blogs and follow body-positive role models. Some excellent posts are Body Image Transformation: 5 Ways to Change Your Self-Concept by Jessica Tartakovksi and What the Fuller Figure Regrets by Ashley Graham.
• You may want to create a body-positive Pinterest board.
• It's also a good idea to stop following social media sites that promote the thin or fit ideal.

Buy Clothes That Fit Now

• Many people resist buying clothes that fit and either wear shapeless clothes or dangle themselves the carrot of shopping or fitting into old clothes "when they lose the weight." This misplaced exercise increases self-disgust in the present and does nothing to increase motivation.
• Instead, buy at least a few essential items that fit now and make you feel good. Most people find that this makes them feel more motivated and confident and self-disparagement when getting dressed.