Eating disorders and body image

An eating disorder like anorexia, bulimia or binge eating disorder is a serious mental health condition that can have a lasting impact on your health.

People with low self-esteem or a negative body image tend to be more likely to develop an eating disorder, however, there is no single reason why a person develops an eating disorder. It is usually caused by a combination of factors. It may be that someone has a difficult situation or problem that they are struggling to cope with, but sometimes it is not obvious what the trigger is.

Eating disorders are not about food. An eating disorder develops as a way for the person to cope with or avoid difficult feelings. People do not choose to have an eating disorder and it is NOT a way of seeking attention. An eating disorder can make the person feel very alone and out of control. It can make someone difficult to talk to or spend time with, and it can make it difficult for them to let anyone know what is going on for them.

RECOVERY FROM AN EATING DISORDER

The first thing to remember is that recovery is possible. Many people fully recover from eating disorders and go on to live healthy and happy lives. The first step towards recovery is to talk to someone you feel you can trust and finding out about support options which are available in your local area and online at this time. You will find useful supports at the end of this page to guide you in your choices.

Learning to trust your body

Establishing a positive supportive relationship with your body is important to successfully overcoming an eating disorder. Food and our bodies are central to our overall well-being. In overcoming an eating disorder it is important to step away from using food and exercise as a way of measuring your worth, punishing yourself or controlling your life. Living in a way that is free from the eating disorder and which enables you to truly move on with your life involves changing your relationship with food, exercise and your body in a way that supports your overall well-being. To be truly free of the restrictive hold of the eating disorder on your thoughts and actions, you will need to slowly build a supportive relationship with your body. This involves making an effort day by day to choose patterns of behaviour which support your well-being. These patterns will not form overnight, it will take time and consistent effort to step away from the eating disorder behaviours and it is important to go gently while you make these changes.

It is possible for a person to fully recover from an eating disorder and to learn to develop a positive and supportive relationship with their body. People who have successfully recovered indicate that although these changes take time, they are worth it and lead to overall well-being, increased happiness and enable a quality of life and ability to enjoy life and all that it brings in a way they would never have dreamed possible when in the throes of their disordered patterns.

If you are recovering from an eating disorder, go gently, remind yourself that changing patterns can sometimes mean days when things don’t go so well. Allow for these ups and downs and support yourself in starting anew on the path to self acceptance and a happier life. The information on ‘checking in’ with your body, self-compassion and the mind-body connection in Improving Body Image Part 2 here may be beneficial in building a supportive relationship with your body and learning to accept your body and yourself as you are. You may also find it helpful to note your strengths and achievements and to acknowledge any small steps your take on the road to recovery to support yourself on your journey.

WHAT CAN YOU DO IF A FRIEND HAS AN EATING DISORDER?

• Find out more about eating disorders and services so you can understand more and be ready to help.

• Talk to them and let them know you’re concerned and why.

• Don’t be surprised if they deny that there is a problem.

• Encourage them to talk to an adult they trust.

• If they won’t tell someone, even if it seems like a bad thing to do, it would be a good idea if you could tell someone. Although your friend may be angry with you at first, it may be the first step towards getting them the help they need.

• Don’t change your own eating habits.

• Let them know you’re there for them.

Body dysmorphic disorder 

Body dysmorphic disorder (BDD) or body dysmorphia is a mental health condition which causes the individual to obsessively worry about aspects of their physical appearance. It involves a fixation on their perceived flaws, which causes the individual a great deal of anxiety and distress. It is often seen as a subcategory of obsessive-compulsive disorder (OCD). BDD can have a very significant impact on someone’s well-being and their day-to-day functioning and has been linked to depression, self-harm and suicide. Someone with BDD may avoid social situations as they predict that they will be judged harshly by others. Their preoccupation with their perceived flaws often causes them to fear intimacy with others for the same reason. The behaviours that the person engages in as a result of BDD can negatively impact relationships with friends and family when the condition is not well understood.

Someone with BDD may spend a lot of time checking their appearance in the mirror and comparing themselves to other people. Alternatively, they may avoid looking in a mirror to prevent the onset of negative thoughts and feelings about their appearance. BDD often results in someone trying to ‘fix’ the parts of themselves that they deem unacceptable. This may involve attempts at concealing perceived flaws by spending long periods of time applying make-up or choosing what to wear, and ‘DIY’ attempts to alter aspects of their appearance. Some individuals seek cosmetic surgery to permanently alter their appearance. However, often the results of surgery do not match the individual’s expectations and even if they do, the person can often develop a fixation with another aspect of their appearance.

There is some overlap between BDD and eating disorders like anorexia, bulimia and binge eating disorder but they are not one in the same. In the instance of BDD, the individual can be preoccupied with a specific body part such as the nose, which is unrelated to shape and weight and does not result in any eating disorder behaviours. Similarly, not every person who has an eating disorder has BDD. However, individuals with eating disorders can be diagnosed with BDD as well and there can be an overlap in symptoms, e.g. extreme dieting and weight control behaviours, body dissatisfaction, and appearance comparison tendency.

Self-image amongst those with BDD may relate to early stressful experiences in childhood. BDD is often hidden as people tend not to seek professional help, and those that do, may be reluctant to discuss their difficulties. Some may report misdiagnosis before finding appropriate treatment. BDD often co-exists with other disorders, with depression being the most common. Others include social phobia, obsessive compulsive disorder (OCD) and generalised anxiety disorder. If a person is suffering with BDD, they should seek help by attending their GP. Various psychological therapies including Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT) have been found to be effective in treating BDD. Treatment for BDD can vary from psychological therapy, medication, or a combination of the two. If you are engaging in self-harm or experiencing suicidal thoughts contact Pieta house on 1800 247 247. You may find some useful resources relating to BDD on the Body Dysmorphic Disorder Foundation website.

Muscle dysmorphia

Muscle dysmorphia involves a preoccupation with levels of muscularity and leanness. It is a form of body dysmorphic disorder (BDD) whereby the individual perceives themselves to be ‘too small’ or thinks that they do not have enough lean muscle, and is fixated on this aspect of their appearance. In actual fact, the individual's build is normal or even exceptionally large and muscular already. Muscle dysmorphia is sometimes referred to as reverse anorexia, megarexia or bigorexia. It involves a specific dissatisfaction with muscularity rather than the body as a whole. The person experiences a compulsion to achieve greater levels of muscularity and leanness and may invest significant amounts of time in pursuit of increasing muscle mass. 

Someone with muscle dysmorphia engages in behaviours such as exercising excessively, lifting weights and body-building, misusing muscle building drugs and/or steroids, fixating on diet and in particular protein consumption, and spending excessive amounts of time at the gym. The preoccupation causes a great deal of distress and can have a severe impact on relationships as the person’s life becomes restricted due to the pursuit of an unattainable ideal body. Muscle dysmorphia can affect anyone but typically it affects males more often than females and more often than not, the individual is not small or lacking in musculature.

A person with muscle dysmorphia will often require professional treatment to overcome their condition. A positive first step on the road to recovery is acknowledging that this is an issue which may be holding them back in life and taking steps to find out what treatment options are available in their local area. They may benefit from talking to their GP to establish what options are available. A significant part of their recovery will also be in building a positive supportive relationship with their bodies and the information on building the mind-body connection and self-compassion in Improving Body Image Part 2 may be helpful. For more information about muscle dysmorphia, check out this TED talk by researcher, Dr. Scott Griffiths.

Further information

You will find additional information about eating disorders on the Bodywhys website.

You will find some resources on the Body Dysmorphic Disorder Foundation website.

Bodywhys support services

Bodywhys provide a range of support services to support people affected by eating disorders. These include the Bodywhys helpline, support groups, email support and online support groups. See the support section of the Bodywhys website for more details about the support services Bodywhys offer.