Understanding The Connection Between Eating Disorders And Self-Esteem
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Eating disorders (EDs) are complex mental health conditions that can significantly interfere with a person’s sense of self, often stemming from deep-seated feelings of inadequacy, negative self-perception, and unrealistic standards fueled by internal and external pressures. Low self-esteem is a hallmark characteristic of several different eating disorders as well as a major risk factor in their development.
Here, we’ll explore the relationship between EDs and self-esteem, including key takeaways from the current research, causes and risk factors, and tips for boosting self-esteem in recovery. With this guide, you may be better equipped to understand the complex dynamics between self-esteem and eating disorders and how addressing these issues can play a crucial role in recovery.
Understanding self-esteem and eating disorders like anorexia nervosa
Breaking this cycle of negativity is an essential component of treatment, and mental health professionals specializing in eating disorders often focus on exercises for building self-esteem and promoting healthier thought patterns. Building self-esteem at each stage of development can also be an effective way for caregivers, educators, and others to help mitigate the risk of eating disorders in children and teens.
Eating disorders and self-esteem: What the research says
Peer-reviewed research suggests a strong connection between eating disorders and self-esteem levels that are low. This may be because low self-esteem can cause a person to adopt certain distorted thought patterns, which can in turn trigger disordered eating behaviors. Here are a few key takeaways from recent studies:
Low self-esteem is a significant risk factor for eating disorders
One major study combined results from multiple sources, its findings suggest that people—especially young women and girls—with lower self-esteem are more likely to develop eating disorders. This link is consistent, suggesting that low self-esteem is a significant risk factor for various eating disorders.
Low self-esteem and eating disorders often exacerbate each other
Another important finding is that low self-esteem and eating disorders seem to often exacerbate each other. Low self-esteem can lead to unhealthy eating behaviors, and those behaviors can, in turn, further lower self-esteem. Boosting confidence and self-esteem through therapy can be a way to break this cycle, helping to prevent or reduce the severity of eating disorder symptoms.
Younger women and girls with low self-esteem and low life satisfaction are at higher risk
Younger women and girls with low self-esteem and life dissatisfaction may be at higher risk of developing eating disorders. While men generally report higher satisfaction with their weight and appearance, the opposite is true for women; they are more likely to experience body dissatisfaction and related eating disorders. Lower life satisfaction further elevates the likelihood of developing eating disorders.
Causes and risk factors for low self-esteem and eating disorders
Self-esteem issues and other related challenges don’t typically arise in isolation, so it can help to understand the underlying factors that might make a person more susceptible to low-self esteem and eating disorders. Here are some causes and risk factors that can influence self-esteem and potentially contribute to the development of an eating disorder.
Co-occuring mental health disorders
Eating disorders often occur alongside other mental health conditions. Anxiety and mood disorders like depression are particularly prevalent among those with EDs, and they can also negatively impact self-esteem. Obsessive-compulsive disorder (OCD) is another risk factor for developing eating disorders, as the compulsive behaviors and obsessive thoughts can contribute to unhealthy eating patterns and negative body image.
Personality traits
Certain personality traits like perfectionism and neuroticism can put a person at greater risk of developing an eating disorder. Those with perfectionist tendencies often set unattainable standards for themselves, inevitably leading to self-criticism and low self-esteem. Neuroticism can also make individuals more vulnerable to stress and negative self-perception, further fueling eating disorder symptoms.
Psychological factors
Certain cognitive biases can impact self-esteem and contribute to unhealthy attitudes toward food. Attentional bias, for example, may make an individual focus excessively on food-related stimuli or body image concerns. Memory bias could cause a person to selectively recall incidents that reinforce negative self-esteem. Judgment bias might lead to distorted evaluations of one’s body or eating habits.
Adverse childhood experiences
Research suggests that adverse childhood experiences such as abuse, neglect, and other forms of trauma are strongly linked to the development of low self-esteem and eating disorders later in life. These early experiences can lead to deep-seated feelings of worthlessness and a distorted sense of self, making individuals more susceptible to disordered eating as a coping mechanism.
Peer pressure
Peer pressure, especially during adolescence, can play a crucial role in the development of low self-esteem and eating disorders. The desire or pressure to fit in or meet societal standards of beauty can lead individuals to engage in unhealthy eating behaviors. Constant comparison with peers can exacerbate feelings of inadequacy, driving disordered eating patterns.
How to improve self-esteem and body image in recovery
Enhancing confidence, self-esteem, and body image can be key to ED recovery. Here are some tips that may help, in conjunction with seeking professional treatment:
Engage in confidence-building activities
While an eating disorder can make it feel like high self-esteem is tied to appearance, we generally value ourselves more for our achievements, life successes, and positive traits. When addressing body image issues, it can help to engage in activities that make you feel good about yourself, such as by partaking in hobbies or challenging yourself in new ways.
Learn to “change the channel”
A common technique used in ED treatment is called “changing the channel.” When you notice a negative thought arise, try replacing it with a more positive thought instead—just as you would change the channel on the TV. For example, rather than dwelling on a meal you had that brings up feelings of guilt, you might choose to focus instead on the healthy meals you have planned for the upcoming week.
Use positive affirmations
Positive affirmations are another method that may help in overcoming negative thoughts and boosting self-esteem. Try repeating positive statements to yourself or posting written versions where you’ll see them regularly. To create positive affirmations that work for you, try turning self-criticism into praise. For instance, you might write down “I love my body for what it can do” to replace an unhealthy thought about your appearance.
Find new ways to nurture your body
Just as you replace the unhelpful thoughts that drive the ED, it’s just as important to replace unhealthy behaviors. Consider how you might find new ways to nourish and thrive in your body, such as joining a sports league, trying a new exercise class, or learning a new way of cooking. Talk to your therapist about ways to improve your relationship with your body in ways that align with your recovery.
Tap into your support system
If you’re feeling nervous about the challenges of recovery, it can help to ask someone within your support system to assist or accompany you. For example, you might ask a friend to come with you to a restaurant or ask a family member if they can help you prepare a meal. While taking these steps alone can feel daunting, your support system can be a source of motivation and encouragement.
Effective therapies for eating disorder recovery
Eating disorder treatments often focus on addressing the underlying psychological factors that contribute to disordered eating behaviors. Cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and family-based therapy (FBT) are three well-established approaches that have shown significant success in helping many individuals recover by targeting thought patterns, emotional regulation, and family dynamics.
- Cognitive behavioral therapy for eating disorders (CBT-ED): This specialized form of CBT focuses on helping individuals recognize and reframe the negative thought patterns fueling body image issues and disordered eating behavior.
- Dialectical behavior therapy (DBT): DBT is another form of CBT that can help treat EDs. It incorporates mindfulness practices to help boost emotional regulation, reduce impulsivity, and strengthen relationships.
- Family-based treatment (FBT): FBT is often used in situations when a child or adolescent has an eating disorder. It involves the family in the treatment process, helping inform and guide them as they support their loved one through recovery.
Before recommending one of these, a mental health professional will typically make a diagnosis, if applicable. This will help them decide on the appropriate course of treatment. They may use a variety of diagnostic tools to do this, such as the Eating Attitudes Test, and may do a comprehensive mental health evaluation in this process. They may request or recommend the individual receive a medical evaluation as well.
Online mental health support for eating disorders
Eating disorders tend to not resolve without professional treatment. If you’re experiencing signs of an eating disorder, it’s recommended that you seek mental health support as soon as possible. While many eating disorder cases may require the in-person support of a doctor, nutritionist, and/or other providers, seeking mental health therapy virtually can be a useful and convenient addition to the treatment plan.
With BetterHelp, you can match with a licensed therapist and attend weekly online sessions from the comfort of home or anywhere you have an internet connection. Research suggests no significant difference between online and in-person therapy, and many find the convenience, flexibility, and cost-effectiveness of teletherapy preferable to that of face-to-face sessions.
Takeaway
Is self-esteem the primary predictor of eating disorders?
While it may not be a primary predictor, a broad scope of research shows a robust bi-directional relationship between self-esteem and eating disorders. For example, a study published in the journal Nutrients investigated low self-esteem and life satisfaction as risk factors for eating disorders among adolescents. Researchers administered the Eating Attitudes Test-26 (EAT-26), the Self-Esteem Scale (SES), and the Cantril Scale to survey the participants' recent feelings and behaviors across areas of dieting, bulimia, and food preoccupation over six months. The participants also provided height and weight, both actual and desired, to calculate body mass index (BMI) and compare against World Health Organization (WHO) charts.
Statistical analysis of the results was conducted via non-parametric tests using descriptive statistics (mean, median, quartiles, etc.) for numerical data. The Mann–Whitney U test assessed differences between groups, while Spearman’s rank correlation analyzed correlations for non-normally distributed variables. The results revealed a few points:
- Compared to the male group, the females showed lower self-esteem and a higher risk of eating disorders. The males in the group reported higher self-worth and greater satisfaction levels with their body weight, appearance, and lives.
- The youngest participants were at the most significant risk for developing eating disorders.
- Participants with low self-esteem were more likely to lose weight significantly, have more frequent uncontrollable binge eating episodes, and exercise more than one hour daily to influence appearance and body image.
Another meta-analysis published in Sage Journals also found a strong correlation between low self-esteem and the development of eating disorders. The paper’s findings reveal that individuals with low self-esteem were more likely to experience eating disorder symptoms over time, low self-esteem leads as a statistically significant predictor of future eating disorders, and while low self-esteem is a major factor, it interacts with other variables that also influence the development of eating disorders. These may include:
- Genetic predisposition and neurobiological influences
- Psychological factors such as perfectionism, impulsivity, and body dissatisfaction
- Social and cultural influences, particularly in cultures that idealize thinness
- Family dynamics, such as overprotectiveness, critical environments, or a family history of eating disorders
Can you have an eating disorder without body image issues?
The Merck Manual’s Introduction to Eating Disorders lists six types: anorexia nervosa, avoidant/restrictive food intake disorder, binge eating disorder, bulimia nervosa, pica, and rumination disorder.
While body image concerns are a central feature in many eating disorders—not all individuals with eating disorders experience these concerns. For example, some individuals with binge eating disorder BED may focus primarily on the emotional or psychological comfort they get from food. They may experience distress about their eating behaviors and the feeling of losing control rather than about their body shape or weight.
In some cases, such as for those with avoidant/restrictive food intake disorder (ARFID), individuals may have limited eating patterns due to an aversion to certain textures or tastes, fear of choking, or a general lack of interest in food rather than out of body image or weight loss concerns. Additionally, some individuals might develop disordered eating patterns as a coping mechanism for trauma, stress, or other emotional issues, with minimal connection to body dissatisfaction. Their behavioral symptoms may be driven by a need to manage or numb emotions rather than by body image concerns.
While there are several reasons one might have an eating disorder absent of body image issues, research shows a strong connection between the two. One cross-sectional study published in the International Journal of Environmental Research and Public Health (Journal Environ Res Public Health) and distributed to other research publications under a Creative Commons Attribution license examined the relationship between body image perception, eating disorder behavior, self-esteem, and quality of life. The study’s findings revealed that, among a sampling of female medical college students in India, elevated BMI and a greater degree of body shape concern led to a lower quality of life, self-esteem, and body image satisfaction—leading to an increased risk for developing eating disorder behaviors.
Is anorexia nervosa linked to low self-esteem?
To understand the role of self-esteem in anorexia, it may be helpful to understand the official definition and diagnostic criteria. According to The Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5-TR), anorexia nervosa is characterized by:
- A 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 (less than minimally usual/expected)
- Intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain.
- Distress over one's body weight or shape, self-worth influenced by body weight or shape, or persistent lack of recognition of the seriousness of low body weight.
The American Psychiatric Association recognizes two subtypes of anorexia nervosa: the restricting type, characterized by behaviors like extreme dietary restraint, fasting, or excessive exercising, and the binge-eating/purging type, which adds intermittent binge eating and purging behaviors to the list of symptoms.
Like many other eating disorders, anorexia and core low self-esteem seem to share a bi-directional relationship. To highlight this relationship, a group of researchers compared treatment outcomes between a standardized plan and an augmented plan targeting self-esteem in child and adolescent girls treated for anorexia at an inpatient facility. The clinicians received informed consent to distribute self-assessment questionnaires measuring adolescent self-image, self-esteem levels, and other progress markers—finding significant levels of improvement in the augmented plan group compared to the control. The study's authors recommend future research on mechanisms by which self-esteem affects eating behavior and the development of self-esteem-boosting interventions as preventive measures.
How do eating disorders affect self-esteem?
Eating disorders often have a profound impact on self-esteem, creating a cycle where low self-esteem and disordered eating behaviors reinforce each other. Some people with eating disorders equate self-worth with weight, body shape, or control over food. Others might experience inadequacy and self-criticism when they have feelings of “failure” related to their eating behaviors or physical appearance.
Further, disordered eating behaviors can lead to social isolation, as individuals may avoid situations involving food, heightening feelings of loneliness and undermining self-worth. Some individuals with eating disorders experience cognitive distortions—like all-or-nothing thinking or overgeneralization—that can erode self-esteem over time, as individuals view themselves as fundamentally “flawed.” Additionally, some eating disorders foster a sense of control that, when lost (such as in a binge eating episode), might create feelings of intense guilt and shame that negatively impact self-esteem.
How do eating disorders affect a person's life?
Eating disorders can have a significant, far-reaching impact—from individual to community to a global burden. Here are a few examples of ways that eating disorders can affect one’s life:
Physical health
Physical health consequences from restrictive eating, such as malnutrition, can affect everything from skin, hair, and nails to essential organ functions. All eating disorders can impact organs like the heart (leading to irregular heartbeats or heart failure), kidneys (due to dehydration), and the digestive system (like gastroparesis or constipation).
Conditions like amenorrhea (loss of menstrual cycle) and bone density loss (increasing the risk of osteoporosis) are common, particularly in those with anorexia. Frequent vomiting in bulimia can erode tooth enamel and lead to stomach problems like acid reflux. Such conditions can cause severe fatigue, weakness, and increased susceptibility to illness. When unaddressed, eating disorders can have long-term impacts, like osteoporosis, heart damage, and digestive issues—sometimes even after recovery. Eating disorders, especially anorexia, have among the highest mortality rates of all mental health disorders. This is due to both physical complications and the increased risk of suicide.
Mental health
Eating disorders often co-occur with mental disorders like depression, anxiety, and obsessive-compulsive disorder (OCD). They can worsen these symptoms, making recovery more challenging. Disordered eating patterns can reinforce negative self-image and feelings of shame, creating a cycle of low self-esteem and self-critical thoughts. Malnutrition may also affect cognitive functioning, leading to difficulties with concentration, memory, and decision-making, impacting academic or job performance.
Social life and relationships
Some individuals with eating disorders withdraw from social activities, especially those involving food, to avoid judgment or discomfort. This isolation often leads to loneliness and loss of social support. Family and friends may find it difficult to understand or cope with the person’s behaviors, leading to tension, frustration, or conflict within relationships. Eating disorders can also affect family dynamics, as loved ones may worry or feel helpless.
Daily life and overall well-being
The cognitive impairments, low energy, and emotional struggles that accompany eating disorders can affect academic and work performance, potentially leading to absenteeism, reduced focus, and decreased productivity. In severe cases, people may have difficulty holding jobs, leading to financial strain and instability.
For many, the eating disorder becomes a core part of their identity, overshadowing other aspects of their personality. This preoccupation can make it challenging to envision a life without the disorder. Body dysmorphia or extreme self-criticism can make individuals feel disconnected from their sense of self-worth and make recovery more complex.
In a paper published in the International Journal of Environmental Research and Public Health (Journal Environ res public health), researchers stress the importance of eating disorder education and early intervention strategies in helping reduce or eliminate such impacts. The average age of onset for most eating disorders is between 12 and 25. Findings from many systematic reviews indicate a considerable global prevalence of eating disorders in young people, the statistical significance of which underscores the importance of early recognition.
How do people with eating disorders feel about themselves?
People with eating disorders often experience profoundly negative feelings about themselves, which can vary depending on the type of eating disorder and individual experiences. Some common patterns include low self-esteem, poor body image, and feelings of inadequacy when individuals tie their self-worth to body shape, weight, or appearance.
Perfectionistic tendencies are common, leading individuals to set unrealistic standards around weight, appearance, and physical fitness. When these standards aren’t met, they may experience intense self-criticism, guilt, and shame about their bodies or eating behaviors. Some individuals with eating disorders draw negative comparisons between themselves and others, leading to feelings of inferiority, which can worsen body dissatisfaction and negative self-perceptions.
Eating disorders sometimes come with feelings of shame and a desire to keep behaviors secret, leading to social withdrawal. This isolation can reinforce negative self-perceptions, and people may feel that no one else could understand or accept them. Additionally, people with eating disorders are sometimes aware of societal stigma around their condition, which can worsen self-blame and secondary self-criticism. This can create a vicious circle where they see their disorder as a personal failure rather than a mental health issue—perpetuating eating disorder behaviors.
What is the self-help group for individuals with eating problems?
The National Association of Anorexia Nervosa and Associated Disorders (ANAD) offers free peer support resources for individuals with eating disorders, as does The National Eating Disorders Association (NEDA) and The National Alliance for Eating Disorders (NAED). All of these organizations are committed to increasing awareness of EDs, particularly in children, adolescents, and young adults, through community support initiatives and the normal distribution of psychoeducational materials.
How does food affect self-esteem?
How food affects self-esteem can be complex, involving physical and psychological factors and direct and indirect mechanisms. Eating well can support positive self-esteem, while disordered eating, restrictive diets, or poor nutrition can often undermine it. Food often influences our mood and energy levels, social connections, and physical appearance—factors that greatly influence how we see ourselves. Cultivating a healthy relationship with food can be a powerful way to support and improve self-esteem, especially when paired with self-acceptance and self-care practices.
Do people with eating disorders have high self-esteem?
Self-esteem and eating disorders are strongly related. People with eating disorders (and many other types of eating pathology) typically don’t have healthy levels of self-esteem.
How do eating disorders affect social life?
Eating disorders can have a significant impact on a person’s social life, often creating barriers to connection and leading to interpersonal problems. Here are several ways eating disorders affect social interactions and relationships:
Social isolation and withdrawal
Some people with eating disorders avoid social situations that involve food (like family meals, parties, or dining out) to avoid discomfort or judgment. This avoidance can lead to increased isolation, reducing opportunities for bonding and support from friends and family. Intense body image issues and self-criticism can lead to a lack of self-confidence and a tendency for individuals to compare themselves with others or feel inferior in social settings. This self-consciousness can make them uncomfortable in group settings, and they may withdraw to avoid these feelings.
Conflict and misunderstandings with loved ones
Loved ones may struggle to understand the disorder, leading to frustration, worry, or even conflict. Friends and family may feel hurt if the person with an eating disorder withdraws or refuses invitations, or they may feel helpless and unsure of how to support them. Additionally, eating disorders can create secrecy around behaviors, such as hiding or lying about eating habits, which can damage trust within relationships. In romantic relationships, eating disorders can affect intimacy and emotional connection as individuals may struggle with body image, low self-esteem, and trust issues. They may also avoid romantic situations involving meals, which are often important for bonding or may feel uncomfortable being physically close.
Reduced enjoyment of social activities
People with eating disorders may feel too anxious or preoccupied with thoughts about food, appearance, or weight to enjoy social activities fully. The disorder's constant mental and emotional burden can reduce the person’s capacity for genuine connection and shared experiences, affecting the quality of their relationships. This “hijacking” of an individual’s time and focus may also cause them to lose interest in previously enjoyed hobbies or activities. This shift can strain friendships based on shared interests and may reduce motivation to participate in group activities.
Negative impacts on peer relationships and support
Eating disorders can affect work and academic performance, reducing a person’s participation in social or team-based activities within these environments. They may avoid office gatherings, group study sessions, or lunch breaks with coworkers, leading to missed networking or socializing opportunities. Finally, social isolation can make it difficult to reach out for support when help is needed. This lack of connection can worsen feelings of loneliness and reduce access to the emotional and practical support necessary for recovery.
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