How Body Image Plays a Part in Eating Disorders

A young woman who broke up with her boyfriend because she found out he was dating other girls cut down on eating without conscious effort. She was taking an exercise class through the college she was attending and noticed the other girls in the class were whispering and pointing at her. She heard one of the girls say, “She has anorexia.” Did she begin eating healthier? No! Her undiagnosed eating disorder worsened.

A young man who loved playing his trumpet in the school band left his trumpet on the school grounds one day on his way home from school and told his parents he lost his trumpet. He was teased for playing in the band and bullied by his peers. They called him a fat geek. In his eyes, the boys who played sports were more popular.

One author notes, “Body image is how I look at myself in my mind’s eye, how I believe others perceive me and how I feel living in my body” (Bruch, 1962).

Another notes, “As early feminist Simone de Beauvoir said in the 1940’s, “To lose confidence in one’s body is to lose confidence in oneself” (Conner-Green, 1993).

Negative Self-Talk, Negative Thinking, Fear, and Feeling Out of Control

Unrecognized negative self-talk can begin the journey of an eating disorder. “I’m eating less so I will be accepted by my peers.” You might starve yourself, not realizing you are not being accepted anymore than you were before. “I had more friends and boyfriends when I dieted.” “When I look in the mirror, I look fat and ugly.”

Through this process you might not realize you are causing yourself physical, spiritual, and psychological danger.

In the 2012 Never Enough Workbook, Nina Bingham reports, “Negative thinking is a serious block to our happiness. We become hopeless, which leads to loss of confidence, causes anxiety, or even depression.”

How Fear Contributes to Eating Disorders

Fears can provide a powerful influence on someone who has an eating disorder. Fears can take on many forms and are caused by distorted thoughts. Thoughts cause an emotional reaction. When the distorted thoughts continue and are held onto, the fears grow.

Fears can control your eating disorder. Shure & Weinstock (2009) noted, “Fear of rejection or humiliation at being singled out adds to the likelihood of conforming to body standards in order to avoid being shamed or in an attempt to distract oneself from emotions difficult to tolerate.”

Sometimes our lives feel out of control. Maybe you feel you have a lack of control over your life due to maybe a past history of trauma, as just one example. Sometimes those who struggle with feeling like they have no control in their lives restrict the food they eat to feel like they are in control, which may lead to an eating disorder.

Kleinman & Hall (2006) noted, “The body is seen as an object needing to be controlled. Clients will often refer to their bodies as ‘it,’ indictive of something outside of themselves.”

Types of Eating Disorders

Anorexia, Bulimia Nervosa, and Binge Eating Disorder are three eating disorders listed in The American Psychiatric Association, excerpted from the Diagnostic and Statistical Manual of Mental Disorders in Fifth Edition DSM-5 dated 2013. Diagnostic Criteria for these disorders include the following:

Anorexia Nervosa

• Restriction of energy intake relative to requirements, leading to a significant low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.
• Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
• Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the low body weight.

Bulimia Nervosa

1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

a. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.

b. A sense of lack of control over eating during the episode (e.g., a feeling that on cannot stop eating or control what or how much one is eating).

2. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.

3. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.

4. Self-evaluation is unduly influenced by body shape and weight.

5. The disturbance does not occur exclusively during episodes of anorexia nervosa.

Binge Eating Disorder

• Recurrent episodes of binge eating (see #1 under “Bulimia Nervosa” above).
• The binge-eating episodes are associated with three (or more) of the following:

• Eating much more rapidly than normal.
• Eating until feeling uncomfortably full.
• Eating large amounts of food when not feeling physically hungry.
• Eating alone because of feeling embarrassed by how much one is eating.
• Feeling disgusted with oneself, depressed, or very guilty afterward.
• Marked distress regarding binge eating is present.
• The binge eating occurs on an average, at least once a week for 3 months.
• The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

The journey of an eating disorder does not discriminate among those of age, male or female.

Eating Disorders Statistics

In her article, “The Complexity of Body Image,” Adriene Ressler, LMSW, CEDS   notes, “Body image, dissatisfaction, and distortion are key issues for most women and girls (and an ever-increasing number of boys and men).”

Marla Sanzone, P.h.D. reported in an article titled, “Why Are an Increasing Number of Boys Developing Eating Disorders?” that she is “witnessing a disturbing new trend: more boys are now developing eating disorders. The perfectly shaped bodies once expected of females in ads and on TV are now expected of males too.”

She goes on to say, “As a general rule, anxiety and depression make boys susceptible to eating disorders. Statistics reports that an estimated 10-15% of people with anorexia or bulimia are males. Clinicians believe the figure is understated.” The report goes on to say that “40% of 131 males engaged in eating disorders on the Cornwall University football team.”

A study by Tiggemann and Lynch (2001) suggests that women (ages 20-84) continue to struggle with issues related to changing shape and size throughout the life cycle.

Maine (2010) notes, “While males may have some overlap with these concerns, with age may come the pressures to be at the top of their game — both professionally and socially. In a competitive male world, there are always younger contenders with abundant energy, knowledge of the latest technological gadgets, and a lifetime contract with the local gym. While men’s concerns center more on muscularity than thinness, issues of sexual performance and hair loss are often the focus of insecurity and anxiety.”

Dr. Rebecca Puhl, Deputy Director of the UConn Rudd Center on Food Policy and Obesity reported that 64% of students enrolled in weight-loss programs reported experiencing weight-based victimization. One-third of the girls and one-fourth of the boys reported weight-based teasing from peers, but prevalence rates increased to approximately 60% among the heaviest students. Puhl’s research on obesity and weight stigma also found that adults who “live in larger bodies” are often excluded and discriminated against and are often victims of vicious public “fat” shaming.

Treatment Methods

Through training, experience, and practice as a clinician I have witnessed clients finding hope and success through the utilization of Cognitive Behavioral Therapy (CBT) in exploring and identifying fears, negative thoughts, distorted thoughts, and negative self-talk which lead to their eating disorders. Clients have also disclosed issues with control due to past trauma and neglect.

Past clients have completed exercises daily in identifying fears, negative self-talk, and distorted negative thoughts. They identified and shared how these fears, negative self-talk, and distorted negative thoughts controlled their behaviors. Clients were able to develop a plan as to how to dispute their fears, change their negative self-talk to positive self-talk, and dispute their negative distorted thoughts that caused the negative behaviors which lead to an eating disorder.

Informed Trauma Therapy can be utilized as well to address trauma with a strength-based, client-centered approach with the utilization of a team approach in working with a medical provider and a provider who prescribes medications.

According to Anne Marie O’Melia, MS, MD, FAAP, Bulimia Nervosa is best treated with a multidisciplinary, multidimensional approach to include nutritional rehabilitation and psychotherapy. She notes, “Nutritional rehabilitation, Cognitive Behavioral Therapy, and medication management with anti-depressants are most effective when combined.”

Last but not least, I believe it is important to also gain an understanding of how clients of different genders look at and feel about their eating disorders. This could open a door to building the therapeutic relationship.

Additional Support

Family, outside support, and parental support are so important, both for the person with the eating disorder and for family members.

It can be so scary and frustrating to see a child, adolescent, or adult family member disappear before our eyes. The experts say stay calm with compassion, unconditional love, and acceptance. Probably easier said than done, right?!

The child, adolescent, or adult with the eating disorder most likely feels as though they don’t deserve compassion, unconditional love, or acceptance from anyone, including themselves.

There are wonderful support groups available for family members to attend that are free of charge. There are also free support groups available for a person with an eating disorder to attend to receive additional support. It can be very comforting to be with a group of people in a safe setting where you can talk to and learn from those who have the same issues in common, without judgement. Others in the support group setting can also provide valuable information concerning treatment availability.

A website called Edcatalogue.com also contains valuable information, resources, and a directory of providers for eating disorders. Eva Musby, in her article, “Love No Matter What,” says, “Humans need their souls nourished, too.” She further states, “Our love heals their battered self-esteem, counteracts their self-hate, and guarantees that we will not abandon them.” Eva goes on to say, “Nurturing our connection with our child is a powerful weapon against an eating disorder. It’s also what family is all about.” Profound words.

Conclusion

In his article, “Listening to and Following the Heart,” Michael E. Berrett, PhD notes, “Guidance may come from a ‘higher power’ — a spiritual source of strength, power, beauty, wisdom, goodness, and peace beyond our own.”

I would cherish the opportunity to guide those with eating disorders to explore a relationship with their higher power and toward a place of finding self-love, peace, and happiness.

My hope and prayers for my clients, their families, and their close acquaintances are to gain hope and faith in our Lord and Savior Jesus Christ.