Body image is one’s perception of their body type or body size (Logio, 2008). Negative body image often correlates with body dysmorphic disorder (BDD), and thereby eating disorders (such as anorexia nervosa, bulimia nervosa, or binge eating disorder (BED)) (Zahn, 2013). BDD is a psychiatric disorder that produces preoccupation with imagined defects in physical appearance, which impairs social functioning (Zahn, 2013). Eating disorders classify a group of conditions characterized by disordered eating patterns, preoccupation with body size/weight, and distorted body image (often involving biological, psychological, and societal factors) (Bell, 2013).
When disagreement exists between actual and perceived body image, then disordered eating behaviors may ensue (Logio, 2008). Refusal to maintain normal body weight, extreme fear of being fat, and relentless pursuit of thinness characterizes anorexia nervosa (Bell, 2013). Anorexia entails either extreme restriction (fasting, meal skipping, or dieting) or bingeing and purging (distinct from bulimia, as one maintains a low body weight) (Bell, 2013).
Eating Disorder/BDD Descriptions
Recurrent binge eating, followed by purging (or other efforts) to avoid weight gain, typically describe bulimia (Bell, 2013). Bingeing entails eating drastically more food (in a limited time) than most people would under similar circumstances, and is typically accompanied by guilt, self-disgust, or depression (Bell, 2013). BED differs from bulimia because it does not involve efforts to avoid weight gain (i.e. purging/fasting), but it similarly entails bingeing (consuming thousands of calories in a period of hours) (Bell, 2013). While BDD differs from disordered eating (Zahn, 2013), distorted body image partially constitutes an eating disorder (Bell, 2013), so the two usually relate (Logio, 2008).
Percentage of Populations Impacted (2013)
Approximately 1% of the adult population suffers from BDD, with women and men equally affected (Zahn, 2013). Interestingly, women are more likely to experience disordered eating than men, as 90% of disordered eaters are female (Bell, 2013). Roughly 4% of females have eating disorders, while many others (male and female) meet some of the diagnostic criteria (Bell, 2013). Issues with body image or disordered eating can produce numerous psychological and physiological health problems for those affected (Bell, 2013; Logio, 2008; Zahn, 2013).
Potential Causes of BDD
While BDD’s cause has not been identified, models suggest that interactions between societal emphasis on physical appearance, low self-esteem, brain neurotransmitter abnormalities, and genetic predisposition to anxiety-related disorders all contribute to BDD (Zahn, 2013). Similarly, there is no precise cause for disordered eating, however numerous biological, psychological, and social variables may contribute to these conditions (Bell, 2013).
Potential Causes of Eating Disorders
The primary biological influence on eating disorder is hunger/starvation, thus anorexia nervosa, bulimia nervosa, or binge-eating disorder may develop after periods of food restriction (dieting; perhaps with a goal in mind) (Bell, 2013). Psychological factors identified to cause eating disorders include phobic responses to food or weight gain, conflicted feelings over adolescent development or sexual maturity, and compensation for perceived ineffectiveness by “controlling” hunger and the body (Bell, 2013).
Additionally, cognitive distortions may degrade one’s body image, causing undue concern for appearance that contributes to disordered eating (Bell, 2013). Irregular serotonin levels can cause the irresistible urges to eat and subsequent purges (to alleviate anxiety) exhibited by those with bulimia (Bell, 2013). BED’s causes are not clear, but BED correlates with a past of excess adiposity (Bell, 2013). Further, depression seems to contribute to all eating disorders (especially among the elderly), as those affected are often trying to reduce anxiety or exert control over their lives (Bell, 2013).
Traits/Behaviors Observed in BDD
Differences in body image and personality traits may alter which (if any) disordered eating behaviors manifest (Logio, 2008). For example, those with BDD exhibit exaggerated concern over perceived bodily defects (perhaps in their face, skin, penis, muscles, breasts, or buttocks) (Zahn, 2013). Stress over these perceived flaws often interferes with social or occupational functioning (Zahn, 2013). As such, one’s proneness to worry over appearance influences their susceptibility to BDD.
Traits/Behaviors Observed in Eating Disorders
Similarly, individuals with anorexia often display a lack of confidence or low self-esteem, causing them to adopt goal-driven, perfectionistic, or hyper-industrious behavior at work/school (Bell, 2013). A rigid (“all or nothing”) mindset can drive these individuals to fatigue or depression, which erodes their self-perception and impedes their performance in work/school (Bell, 2013).
Like those with BDD, people with bulimia strongly emphasize appearance, and their mood or self-esteem depends greatly on their weight/shape (Bell, 2013). Bulimia nervosa often results from restrictive dieting, which induces behavioral changes similar to those observed with anorexia (i.e. secretive behavior, obsession with food, food hoarding, anxiety, or depression) (Bell, 2013). Contrastingly, while those with anorexia may be introverted, people with bulimia worry more about socializing and how others perceive them (Bell, 2013).
BED is a newer disorder, yet it’s the most prevalent eating disorder in the U.S. (Bell, 2013). Like those with anorexia/bulimia, those with BED exemplify secrecy around and fixation over food, then experience mood/self-esteem shifts based on their weight/size (Bell, 2013). Again, depression and anxiety persist, but specifics differ, as those with BED are typically overweight and unhappy with their appearance/shape (whereas individuals with other eating disorders are less likely to be overweight) (Bell, 2013).
Low self-esteem and/or negative body image are thus commonly exhibited across eating disorders (Bell, 2013; Logio, 2008; Zahn, 2013). It seems media depictions of “ideal” bodies for men and women contribute to poor self-image among many (Logio, 2008; Kylie and Kenardy, 2002). Tragically, an estimated 60% of those suffering from BDD also suffer from depression (Zahn, 2013). As such, it seems that failing to meet others’ perceived standards culminates in depressive symptoms and feelings of inadequacy.
For example, those with body image disorders often struggle to socialize and grow housebound, spending hours each day looking in the mirror/trying to correct their appearance (Zahn, 2013). It thus seems there’s a large social component to these disorders, since those with bulimia worry about how others perceive them, and those with anorexia often avoid social gatherings altogether (Bell, 2013).
Associated Social Characteristics
Relatedly, BDD and eating disorders each correlate with physical activity (Bell, 2013; Logio, 2008; Kylie and Kenardy, 2002). For example, research has observed greater susceptibility to BDD or eating disorders among athletes (Morteza et al., 2017; Goldfield et al., 2006; Anderson et al., 1995). Specifically among bodybuilders, researchers observe many disordered eating behaviors/body image issues (Goldfield et al., 2006; Anderson et al., 1995; Mangweth et al., 2006). This makes sense, since bodybuilding involves dieting (which can yield an eating disorder) (Bell, 2013) to match others’ standards of the “ideal appearance” in competition. Social influence and one’s own negative self-image may therefore prompt sporting participation among those susceptible to dieting/disordered eating behaviors.
Peer/media influence can also manifest in isolation from society, impulsive misconduct, or other irregular social behaviors (Bell, 2013, Zahn, 2013). For example, those with anorexia may conduct exercise privately, take extreme efforts to maintain their diet’s secrecy, or avoid social gatherings/family meals (Bell, 2013). Additionally, those with bulimia are often prone to impulsive behavior (such as substance abuse or shoplifting (Bell, 2013)), perhaps due (in part) to their desire for social acceptance. Further, those with BDD often stress and struggle to maintain relationships, exemplified as ¾ of this population are unmarried (Zahn, 2013). All considered, a negative body image may indicate increased susceptibility to disordered eating, depression, anxiety, low self-esteem, and irregular social behavior.
Luckily, treatments are established for BDD and eating disorders. BDD, though often misjudged/misdiagnosed, can be treated with high-dose selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioral psychotherapy (Zahn, 2013). The combination of these 2 treatments is currently deemed the most effective approach, while cosmetic procedures rarely correct problems, and should thus be avoided (Zahn, 2013). SSRIs are thought to help symptoms given their influence on neurotransmitters, while cognitive behavior psychotherapy might improve one’s self-esteem/body image, especially if the subject’s loved ones are educated about the therapy (Zahn, 2013). However, BDD requires ongoing care, as a patient often relapses once therapy ceases (Zahn, 2013).
Anorexia’s treatment may require hospitalization, but most who are willing to eat/haven’t lost significant body weight can seek either individual or familial cognitive therapy (Bell, 2013). Those with bulimia/BED rarely require hospitalization, while outpatient treatments involve individual psychotherapy, family therapy, and pharmacotherapy (Bell, 2013). Therapy for these issues typically addresses cognitive distortions toward appearance, behaviors/thoughts/emotions that led to issues, and healthy eating behaviors (Bell, 2013). Given the tremendous harm that eating disorders/BDD can induce, those at risk/affected should certainly seek treatment.
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Ball, Kylie, and Justin Kenardy. “Body Weight, Body Image, and Eating Behaviours.” Eating Behaviors, vol. 3, no. 3, 2002, pp. 205–216., doi:10.1016/s1471-0153(02)00062-4.
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- EBSCOhost, lib1.lib.sunysuffolk.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ers&AN=86193940&site=eds-live&scope=site.