Eating Disorders: When Body Dissatisfaction leads to Unhealthy Behaviours

04 January 2020 / By Social Media

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. Body image is mental and emotional: it’s both the mental picture that you have of your body and the way you feel about your body when you look in a mirror. The way we see ourselves and our bodies has an impact on our health, on our mental health, and on our relationships.

A healthy body image involves having an objective perception of one’s appearance and an ability to separate one’s value as a person from the way one looks. It is more than simply tolerating what you look like or “not disliking” yourself. A healthy body image means that you truly accept and like the way you look right now, and aren’t trying to change your body to fit the way you think you should look. It means recognizing the individual qualities and strengths that make you feel good about yourself beyond weight, shape or appearance, and resisting the pressure to strive for the myth of the “perfect” body that you see in the media, online, in your communities.

A negative body image, on the other hand, involves a distorted perception for one’s shape. Negative body image (or body dissatisfaction) involves feelings of shame, anxiety, and self-consciousness. People who experience high levels of body dissatisfaction feel their bodies are flawed in comparison to others, and these folks are more likely to suffer from feelings of depression, isolation, low self-esteem, and eating disorders. While there is no single cause of eating disorders, research indicates that body dissatisfaction is the best-known contributor to the development of anorexia nervosa and bulimia nervosa (Stice, 2002).

Studies show that approximately 50 percent of preadolescent girls and 30 percent of preadolescent boys dislike their body and that 60 percent of adult women and 40 percent of adult men have a negative body image.

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, which is characterized by an extreme fear of gaining weight and these individuals actually perceive their bodies as larger or “fat” even though they are grossly underweight or bulimia nervosa in which individuals are very dissatisfied with their bodies and have extreme concern with body weight and shape. A diagnosis of anorexia nervosa is additionally consistent with a disturbance in the way one’s body weight or shape is experienced or an inability to recognize the seriousness of the current low body weight.

People with Anorexia Nervosa place a high value on controlling their weight and shape, using extreme efforts that tend to significantly interfere with their lives. To prevent weight gain or to continue losing weight, people with anorexia usually severely restrict the amount of food they eat. They may control calorie intake by vomiting after eating or by misusing laxatives, diet aids, diuretics or enemas. They may also try to lose weight by exercising excessively. No matter how much weight is lost, the person continues to fear weight gain.

People with Bulimia Nervosa may secretly binge — eating large amounts of food with a loss of control over the eating — and then purge, trying to get rid of the extra calories in an unhealthy way. To get rid of calories and prevent weight gain, people with bulimia may use different methods. For example, regularly self-inducing vomiting or misusing laxatives, weight-loss supplements, diuretics or enemas after bingeing. Or using other ways to rid yourself of calories and prevent weight gain, such as fasting, strict dieting or excessive exercise.

Over-evaluation of shape and weight is not a required feature of binge eating disorder (BED), the most common eating disorder. Research indicates that only about 60 percent 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.

Body dysmorphic disorder (BDD) is another psychiatric disorder, classified as a type of obsessive-compulsive and related disorders. People who have BDD are preoccupied with one or more nonexistent or slight defects or flaws in their physical appearance, which can include body shape.

In order to be diagnosed with BDD a person must engage in repetitive behaviors (such as checking or reassurance-seeking) related to the preoccupation and it must cause 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 quite common for patients to have both an eating disorder and BDD (the latter focusing on concerns other than weight or body fat).

Body weight and size dissatisfaction have long been recognized as an issue among females, but it has in recent years been identified as an increasing problem among males. One type of body dysmorphic disorder, muscle dysmorphia, affects primarily males who desire to be more muscular. Because many patients 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.

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, treatments incorporate more than one category of intervention. For example, cognitive-behavioral treatments and media literacy programs often include psychoeducation. Efforts are improving, but there is a lot of work left to be done in this area.

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References:

Battling Our Bodies: Understanding and Overcoming Negative Body Images (2014). Center for Change, Incorporated. Link

Body Image and Eating Disorders. (2018). National Eating Disorders Association. Link

Canadian Mental Health Association, BC Division. (2015). Body Image, Self-Esteem, and Mental Health. Link

Muhlheim, L. (2019). The Connection Between Body Image and Eating Disorders.

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