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The Connection Between Body

Image and Eating Disorders
By Lauren Muhlheim, PsyD, CEDS Updated on January 05, 2021

Medically reviewed by Rachel Goldman, PhD, FTOS

Table of Contents

What Is Body Image?

Negative Body Image

Body Image Issues in Eating Disorders

Negative Body Image and Other Disorders

Body Dysmorphic Disorder

VIEW ALL

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?

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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 has an impact on our health, our
mental health, and 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.

Negative Body Image

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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 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.

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 percent were
dissatisfied with their body weight and over 71 percent thought they needed to lose weight.

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Even though 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. 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.

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. Patients with the eating disorder avoidant restrictive food intake disorder
(ARFID) do not typically experience any preoccupation with shape and weight at all.

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Related: How the Media Effects Body Image

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 als
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 who have BDD are preoccupied with one or
more nonexistent or slight defects or flaws in their physical appearance, which can include body
shape.

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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 not uncommon 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.

Related: Body Dysmorphic Disorder

Treatment for Negative Body Image

Research shows that body image is often one of the last symptoms of an eating disorder to
improve during treatment.Even accounting for different treatments and symptoms between
patients, 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 of an
eating disorder since it is not normal for people in our society to be entirely free of body image
concerns.

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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.

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 self-monitoring, cognitive
restructuring, body size estimation training, exposure to triggers, and mirror exposure. 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 exercise 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 body 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
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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. 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. We are all barraged on a daily basis with images and
messages emphasizing thinness and/or the attainment of an ideal physique. To counteract
these messages, it is important to find messages that support body acceptance and the

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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 basic items that fit now and
that makes you feel good. Most people find that this leads them to 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
a variety of 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 gradually cut that back. Exposure can also be gradual.
For example, one can first wear sleeveless shirts around the apartment for increasing
lengths of time before eventually venturing outside wearing them.

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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 are in conflict, a person
experiences discomfort and tries to align attitudes with behaviors. Individuals 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 that encourages 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 that explains why that bothers you.
Change negative body language. Engaging in typical “fat talk” – negative and judgmental
comments or conversations that are 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 to not engage in fat talk.

Press Play for Advice On Dealing With Body Image Issues

Hosted by Editor-in-Chief and therapist Amy Morin, LCSW, this episode of The Verywell Mind
Podcast, featuring model Iskra Lawrence, shares how to be more comfortable in your body an
with the way you look. Click below to listen now.

Follow Now: Apple Podcasts / Spotify / Google Podcasts / RSS

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 is not likely to improve without effort, and the activities above
need to 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.

Read Next: How to Manage the Negative Thoughts That Accompany Disordered Eating

12 Sources

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Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within
our articles. Read our editorial process to learn more about how we fact-check and keep our content
accurate, reliable, and trustworthy.

1. Vannucci A, Ohannessian CM. Body Image Dissatisfaction and Anxiety Trajectories During
Adolescence. J Clin Child Adolesc Psychol. 2018;(47)5:785-795.
doi:10.1080/15374416.2017.1390755

2. Matthiasdottir E, Jonsson SH, Kristjansson AL. Body weight dissatisfaction in the Icelandic adult
population: a normative discontent?. Eur J Public Health. 2012;(22)1:116-21.
doi:10.1093/eurpub/ckq178

3. Sockalingam S, Hawa R, (Editors). Psychiatric Care in Severe Obesity: An Interdisciplinary Guide to

Integrated Care. Springer. 2017.

4. Malcolm A, Labuschagne I, Castle D, Terrett G, Rendell PG, Rossell SL. The relationship between
body dysmorphic disorder and obsessive-compulsive disorder: A systematic review of direct
comparative studies. Aust N Z J Psychiatry. 2018;52(11):1030-1049.
doi:10.1177/0004867418799925

5. Murray SB, Rieger E, Karlov L, Touyz SW. Masculinity and femininity in the divergence of male body
image concerns. J Eat Disord. 2013;(1):11. doi:10.1186/2050-2974-1-11

6. Cash TF. The Body Image Workbook: An 8-Step Program for Learning to Like Your Looks (2nd ed.).
New Harbinger Publications. 2008.

7. Lewer M, Kosfelder J, Michalak J, Schroeder D, Nasrawi N, Vocks S. Effects of a cognitive-behavioral

exposure-based body image therapy for overweight females with binge eating disorder: a pilot study.
J Eat Disord. 2017;(5):43. doi:10.1186/s40337-017-0174-y

8. Alleva JM, Sheeran P, Webb TL, Martijn C, Miles E. A Meta-Analytic Review of Stand-Alone
Interventions to Improve Body Image. PLoS ONE. 2015;10(9):e0139177.
doi:10.1371/journal.pone.0139177

9. Beresin EV, Olson CK. Child and Adolescent Psychiatry and the Media. Elsevier. 2018.

10. Smith-Jackson T, Reel JJ, Thackeray R. Coping with "bad body image days": strategies from first-
year young adult college women. Body Image. 2011;(8)4:335-42. doi:10.1016/j.bodyim.2011.05.002

11. Wolfe WL, Patterson K. Comparison of a gratitude-based and cognitive restructuring intervention for
body dissatisfaction and dysfunctional eating behavior in college women. Eat Disord. 2017;(25)4:330-
344. doi:10.1080/10640266.2017.1279908

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12. Goldschmidt AB, Wonderlich SA, Crosby RD, et al. Latent profile analysis of eating episodes in
anorexia nervosa. J Psychiatr Res. 2014;53:193-9. doi:10.1016/j.jpsychires.2014.02.019

Additional Reading

Alleva JM., Sheeran P, Webb TL, Martijn C, & Miles E. “A Meta-Analytic Review of Stand-Alone
Interventions to Improve Body Image.” 2017. Plos One.

Matthiasdottir E, Jonsson SH, and Kristjansson AL. 2012. “Body Weight Dissatisfaction in the
Icelandic Adult Population: A Normative Discontent?” European Journal of Public Health 22 (1): 116–
21. doi:10.1093/eurpub/ckq178.

Paxton, SJ, Neumark-Sztainer, D, Hannan PJ, & Eisenberg ME. Body Dissatisfaction Prospectively
Predicts Depressive Mood and Low Self-Esteem in Adolescent Girls and Boys, Journal of Clinical
Child & Adolescent Psychology: Vol 35, No 4. 2017.

Cash, T.F. (2008). The Body Image Workbook: An 8-Step Program for Learning to Like Your Looks
(2nd ed.). Oakland, CA: New Harbinger Publications.

Clausen, L. 2004. “Time Course of Symptom Remission in Eating Disorders.” The International
Journal of Eating Disorders 36 (3): 296–306. doi:10.1002/eat.20043.

Grilo, CM., Crosby RD, Masheb RM, et al,. 2009. “Overvaluation of Shape and Weight in Binge
Eating Disorder, Bulimia Nervosa, and Sub-Threshold Bulimia Nervosa.” Behaviour Research and
Therapy 47 (8): 692–96. doi:10.1016/j.brat.2009.05.001.

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