Body image distress is often seen as a symptom of an eating disorder. However, not every person with an eating disorder has a problematic body image, and many people who do not have eating disorders 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 treatments that can help.
Watch Now: Common Signs 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 construct and is made up of beliefs, thoughts, perceptions, feelings, and behaviors. The way we see ourselves and our bodies have an impact on our health, our mental health, and our relationships.
A healthy body image involves an objective perception 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 characterized by dissatisfaction with appearance and engaging in behaviors such as dieting, checking, and/or avoidance, in an attempt to ameliorate the dissatisfaction. Negative body image often emerges during childhood.
Studies show that approximately 50% of preadolescent girls and 30% of boys dislike their bodies. Around 60% of adult women and 40% of adult men have a negative body image.
The term “normative discontent” was first used by Rodin and colleagues in 1984 to describe dissatisfaction with body size and shape. It was found to be so widespread 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 dissatisfied with their body weight, and over 71% thought they needed to lose weight.
Even though the average BMI was higher among males, more females than males were dissatisfied with their body weight in every age group.
Body Image Issues in Eating Disorders
Eating disorders are complex mental illnesses caused by genetic as well as environmental factors – negative body image is just one potential contributor. However, negative body image is prominent 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-evaluation 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 bulimia nervosa.
Anorexia: A diagnosis of anorexia nervosa is additionally 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-evaluation of shape and weight is not required for binge eating disorder (BED), the most common eating disorder. Research indicates that only about 60% of BED patients met the criteria for over-evaluation of shape and weight. However, it appears that patients with BED 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 dissatisfaction may lead to dieting and disordered eating, which can be gateway behaviors to an eating disorder.
Body dissatisfaction is not only 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 prevention efforts.
Body Dysmorphic Disorder
Body dysmorphic disorder (BDD) is another psychiatric disorder, classified as a type of obsessive-compulsive and related disorders. People with BDD are preoccupied with one or more nonexistent or slight defects or flaws in their physical appearance, including body shape.
To be diagnosed with BDD a person must:
Engage in repetitive behaviors (such as checking or reassurance-seeking) related to the preoccupation Experience 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 patients to have both an eating disorder and BDD (the latter focusing on concerns other than weight or body fat).
Muscle Dysmorphia
Body weight and size dissatisfaction 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, muscle dysmorphia, affects primarily men and boys who desire to be more muscular.
Because many people with muscle dysmorphia engage in exercise and changes in eating designed to influence body weight and shape, several researchers believe that muscle 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 accounting for different treatments and symptoms, the stages of recovery from an eating disorder follow a fairly similar pattern.
Almost universally, weight recovery and behavioral changes appear to precede psychological 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 therapyFitness trainingMedia literacySelf-esteem enhancementPsychoeducationGratitude
In many cases, treatments incorporate more than one category of intervention. For example, cognitive-behavioral treatments 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 modify dysfunctional thoughts, feelings, and behaviors that contribute to negative body image.
The techniques used include:
One of the best-known cognitive-behavioral programs to address body image is the Body Image Workbook by Thomas Cash.
Fitness Training
Fitness training interventions include exercises geared at improving physical capabilities such as muscle strength. Objective improvements in physical fitness are not as important as perceived improvements.
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 critically evaluate 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 advocacy 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
Psychoeducational strategies teach individuals about issues related to negative body image including its causes and consequences. Psychoeducational 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, lists, reflections, and meditations. Such interventions seek to increase appreciation for non-appearance-based aspects of oneself.
Strategies to Try at Home
Here are some self-help strategies based on some of the interventions above that you can do on your own to improve body image:
Keep a Body Gratitude Journal
A daily routine that includes self-deprecating comments about your body is likely making you feel worse. In order to come to a more balanced 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 canyon,” or “My arms allowed me to hug my child.” At first, It may be hard, but it will get easier with practice.
Clean Your Social Media Feed
People often face a daily barrage of images and messages emphasizing thinness and/or the attainment of an ideal physique. To counteract these messages, it is essential to find messages that support body acceptance and the inclusion of a range of bodies.
Instead, read body-positive blogs and follow body-positive role models. Some excellent posts are Body Image Booster: 5 Ways To Strengthen Your Self-Respect by Margarita Tartakovsky and What the Dying Regret by Kerry Egan.
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 reward of shopping or fitting into old clothes “when they lose the weight.” This misguided exercise increases misery 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 confident and reduces anxiety and self-disparagement when getting dressed.
Challenge Avoidance and Stop Body Checking
Avoidance and body checking have been implicated in the persistence of eating disorders. Avoidance can involve the complete covering up, refusing to wear appropriate clothes for the situation (wearing a hoody in the summer, refusing to wear shorts or a sleeveless top on a summer day, refusal to swim because of anxiety over wearing a swimsuit) or complete avoidance of doctors who might weigh them.
Body checking is the repeated checking of one’s shape and weight and takes various forms, from repeated weighing, measuring (with a tape measure or by touch), or obsessive checking in the mirror.
Avoidance and body checking only perpetuate anxiety. The goal should be moderation. Those who avoid should practice exposure, and those who obsessively check should stop.
If checking is an issue, try keeping track of the number of times you check and then try to cut that back gradually. Exposure can also be gradual. For example, wear sleeveless shirts around the apartment for increasing periods before eventually venturing outside wearing them.
Act Out Against the Thin Ideal
Some of the most effective eating disorder prevention programs, such as The Body Project, are based on the principle of cognitive dissonance. Cognitive dissonance is the idea that when attitudes and behaviors conflict, a person experiences discomfort and tries to align attitudes with behaviors.
People are encouraged to engage in activities that actively resist cultural pressures toward the thin ideal. Such activities include writing a peer or young girl a letter encouraging her to embrace a more diverse range of beauty or writing a company that has engaged in fat-shaming or thin-centric behaviors a letter explaining why that bothers you.
Change Negative Body Language
Engaging in typical “fat talk” – negative and judgmental comments or conversations focused on weight and appearance – is detrimental to body image. Avoiding such judgments (e.g., “I’m so fat!”) can improve body image. Consider taking a pledge not to engage in fat talk.
A Word From Verywell
There are numerous movements suggesting people should aim to love their bodies. This may not be possible. A more reasonable goal for some might be to work toward appreciating and accepting their bodies.
Body image will not likely improve without effort, and the above activities must be performed over time. Improving body image is an appropriate goal for therapy, whether or not an individual is experiencing disordered eating.
If employing these strategies independently is not helping over time and body image is having a negative effect on overall well-being or daily functioning, don’t hesitate to seek help from a professional.
