How Are Eating Disorders And Body Image Related?

According to the American Psychiatric Association, eating disorders affect up to 5% of the population. While they may often be thought of as disorders that exclusively affect young people or women, they can affect individuals of all ages and genders. 

Eating disorders tend to have a strong connection to ideas of body image and self-worth. Below, we’ll explore the connection between eating disorders and body image and look at some ways to get help.  

What is body image?

What are eating disorders?

The American Psychiatric Association defines eating disorders as “behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions.” Some of the most common eating disorders that are often related to body image concerns are bulimia nervosa and anorexia nervosa. 

About bulimia nervosa

Bulimia nervosa is characterized by episodes of binge-eating and subsequent compensatory behaviors to avoid weight gain. To be diagnosed with bulimia nervosa, a person must meet the following criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5):

1. “Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
2. Eating, in a discrete period of time (e.g., within any two-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
3. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
4. 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
5. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months
6. Self-evaluation is unduly influenced by body shape and weight
7. The disturbance does not occur exclusively during episodes of anorexia nervosa.”

The DSM-5 also includes four levels of severity of bulimia symptoms: mild, moderate, severe, and extreme. A person who engages in episodes of compensatory behaviors one to three times per week is considered to have a mild case, whereas someone who engages in 14 episodes of compensatory behaviors per week is considered to have an extreme level of current severity. 

About anorexia nervosa

Anorexia nervosa is an eating disorder characterized by fear of gaining weight and restriction of food intake accordingly. To be diagnosed with anorexia, a person must meet the following criteria from the DSM-5:

1. “Restriction of energy intake relative to requirements, leading to a significantly 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.
2. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
3. 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 current low body weight.”

The DSM-5 goes on to state that there are two types of anorexia. In the restricting type, a person mainly uses fasting or extreme exercise as a mechanism of weight loss, with no recurring binging or purging episodes in the previous three months. In the binging/purging type, individuals typically engage in purging after eating, such as through self-induced vomiting or the use of laxatives, enemas, or diuretics. 

What about binge eating disorder?

Binge eating disorder (BED) may not include body image concerns among the criteria for diagnosis. However, according to the National Eating Disorders Association (NEDA), “studies have found that body dissatisfaction is higher among those with BED than those without BED.” NEDA also states that “those who have experienced weight-based stigmatization report more frequent binge eating behaviors, are at an increased risk for developing an eating disorder, and are more likely to have a diagnosis of BED.”

Mental health support for those with an eating disorder

Treatment is available for eating disorders related to body image concerns, often in the form of talk therapy. A therapist may use an approach like cognitive behavioral therapy to help individuals identify and challenge inaccurate thoughts about their body and build a healthy level of self-esteem and strong coping mechanisms. Working with a doctor and a nutritionist to address physical effects of symptoms and build healthier eating habits may also be part of treatment. Medication and support groups may be recommended in some cases as well.

Online therapy for eating disorder symptoms

Although seeking the support of a mental health professional can be an important next step for people who are experiencing signs of an eating disorder, commuting to and from regular in-person appointments isn’t feasible for everyone. In cases like these, it may be beneficial to explore online therapy as an alternative. Online therapy allows individuals to connect with a licensed mental health professional via phone, video call, and/or in-app messaging from anywhere they have an internet connection. 

Does online therapy work for eating disorders?

In recent years, numerous peer-reviewed studies have suggested the effectiveness of online therapy for treating many types of mental illnesses, including eating disorders. For example, one study published in Eating and Weight Disorders indicates that online cognitive behavioral therapy may help participants with body dissatisfaction and eating disorder psychopathology.