The Connection Between Body Image & Eating Disorders

What Is Body Image?

Body image is a subjective way individuals perceive their body’s size, shape, and appearance. Body image includes thoughts, feelings, evaluations, and behaviors related to one’s body.¹ When an individual has a negative body image, they feel dissatisfied with their body,  regardless of whether or not their perception is accurate.

Types of Eating Disorders

The DSM-5 acknowledges five types of eating disorders: anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder (ARFID), and other specified feeding or eating disorders (OSFED). Not all behaviors that an individual experiences will fall under one diagnosis.

Some common eating disorders include:

• Anorexia nervosa: Anorexia nervosa is characterized by the intentional restriction of food to manipulate weight and shape. It leads to abnormally low body weight as a result of restriction and sometimes abuse of exercise.
• Bulimia nervosa: Bulimia nervosa involves feeling an immense loss of control around food, leading to overeating. Out of fear of weight gain, the individual will induce purging after eating. Bulimia nervosa may also involve the abuse of laxatives.
• Binge eating disorder:  Binge eating disorder is characterized by recurring episodes of eating a significant amount of food within a short period and marked with extreme distress. Binge eating disorder involves binging food in secret and comes with feelings of guilt and shame surrounding the binge.
• Avoidant/restrictive food intake disorder (ARFID):  ARFID is similar to anorexia nervosa, where there is a restriction of food intake; however, the motivation is not due to a desire to influence weight or shape. The individual may struggle with the color, texture, or amount of food for various reasons.²
• Pica: Pica involves the individual consuming items that are not considered food or that are edible. Examples include eating paper, rocks, dirt, or hair. Often, these cravings come from nutritional deficiencies.
• Other specified feeding or eating disorders (OSFED): OSFED is a catch-all for eating disorders that do not fall under a singular diagnosis. Examples include atypical anorexia, where all of the behaviors for anorexia are present without low weight being present. Another disorder is orthorexia, which involves a hyper-fixation of “healthy eating” and involves the removal of certain foods from the diet to achieve this.³

What Is the Connection Between Body Image & Eating Disorders?

The connection between body image and eating disorders is strong and complex. If a person has a negative body image, they may use behaviors like restricting, purging, or over-exercising in an attempt to change their body. This can result in them developing an eating disorder, such as anorexia. Eating disorders tend to worsen body image and body dysmorphia, creating a vicious cycle.

It is important to note that we are not born hating our bodies. A combination of genetics, environment, and societal pressure are all contributing factors in body image perception and eating disorder development.

Societal & Cultural Effects on Body Image & Eating Disorders

It is no secret that society impacts how we view our bodies and the measures we take to fit into the thin ideal. Our media frequently engages in body shaming and promotes weight loss, reminding the viewer that smaller is better. Cultural norms contribute to body image issues by setting unrealistic expectations that not everyone can meet. It is also important to note that social media pressures such as “thinspo” and “fitspo” formulate unrealistic expectations for everyone. Unfortunately, social media impacts eating disorders in a relentless and significant way, causing damage to body image and increasing the likelihood of an eating disorder developing.

How Body Positivity Can Prevent Eating Disorders

Body positivity and acceptance aim to prevent eating disorders by promoting a healthier body image as well as boosting self-esteem. Body Positivity advocates that everyone deserves to treat their bodies with kindness and have a positive self-image, no matter their shape, weight, or size.⁴ If you are looking to explore body positivity there are many books about body positivity that can teach you more about these values. You can also try daily body-positive affirmations to remind yourself that your body is worthy.

Early Signs of Body Image Issues Leading to Eating Disorders

It’s not always easy to understand how to know if you have an eating disorder. Early warning signs that body image issues may be developing into an eating disorder include frequent body checking in mirrors, negative comments on their body, weighing themselves on a scale, and commenting on food in a negative way (i.e., calories, fat content, sugar, carbs, etc.). Of course, we all have days where our body image might be worse than others; however, if you find that this is occurring frequently, this is an indicator of a larger issue.

Treatment Approaches for Eating Disorders & Body Image

Several evidence-based treatment modalities have proven to be effective in the treatment of poor body image and eating disorders. Treatment for eating disorders can occur on a few different levels, including outpatient eating disorder treatment, inpatient eating disorder treatment, and medical interventions for weight restoration. Some eating disorders, like binge eating disorder, may be treated with medication.

It is vital to consider the whole person when treating eating disorders. For example, if you only focus on physical stabilization, the individual will likely relapse due to the cause of the eating disorder not being addressed. Taking into account the physical, psychological, and social aspects of recovery from an eating disorder will give the individual a better chance of achieving long-term recovery.

Therapy

Therapeutic interventions are effective in improving body image and preventing or managing eating disorders. A therapist can help an individual develop coping skills for their eating disorder, as well as explore the messages they have received that resulted in their negative body image. Treatment approaches continue to develop and be modified with further research. The way we approached eating disorders 20 years ago is vastly different than how we approach eating disorders now.

Common therapies used for body image and eating disorders include:

• Enhanced cognitive behavioral therapy (CBT-E): CBT-E is one of the leading evidence-based treatments for eating disorders. This treatment focuses on factors that maintain the disorder as well as barriers to treatment.⁵
• Dialectical behavior therapy (DBT): A modality designed by Marsha Linehan involving different modules, including interpersonal effectiveness, mindfulness, distress tolerance, and emotion regulation. DBT for eating disorders provides practical techniques to cope with distress.
• Family-based treatment (FBT): Formerly referred to as the Maudsley Method, this is a home-based treatment approach that is effective in treating adolescents with anorexia or bulimia. Although this method does not address the root cause of the eating disorder, it focuses on stabilization through restoring weight and interruption of compensatory behaviors.

Nutritional Rehabilitation & Education

Working alongside a registered dietician (RD) who specializes in treating eating disorders and poor body image can assist in rebuilding a healthy relationship with food. A dietician who is specially trained to work with those struggling with eating disorders can often provide a neutral way of viewing food and focus on the many ways food can help you, not hurt you.

How to Find Professional Help for Body Image & Eating Disorders

Finding the right professional that you feel like you can connect with can seem like a daunting task. An online therapist directory can be a helpful resource and assist you in finding a professional who specializes in body image or eating disorders. Knowing what you are looking for will help narrow your search and make it less overwhelming to find the right therapist. Be sure to look for therapists who accept your insurance, specialize in your struggles, and are available. If you are finding that you need more support, you may want to look into virtual day treatment, like Within Health.

How to Support a Loved One With Body Image & Eating Disorders

Many feel lost as to how to support their loved one who is struggling with body image and an eating disorder. Often, things we think might help (offering tips on how to eat, what to eat, exercise, etc.) become more harmful. The best way to extend support is to ask your loved one how THEY would like to be supported. They will be more inclined to share how you can support them and will likely appreciate how this approach offers them control and autonomy.