Eating disorders

The body and body-image

People often think that eating disorders develop because people are worried about their weight or unhappy with how they think their body looks (negative body image). In fact, eating disorders develop for psychological reasons  such as difficulty coping with negative thoughts and emotions and low self-confidence. People can focus on the way they look later on and a negative body image can keep an eating disorder going once it has developed. Overcoming negative body image is often the last challenge in recovery.

Meanings of body and weight
Only a few people we spoke with felt that their eating disorder had started off as wanting to lose weight, be more “slim”, “toned” or “muscular”. This often changed as people became more ill: weight loss became an obsession or habit and some people who hadn’t been aware of their bodies before, became more body-conscious.

People had sometimes come across health professionals and services who wrongly thought that eating disorders were caused by a person’s desire to be thin, with weight loss as the only sign that they had the condition. Some people had not been able to get help from eating disorder services because the service based their entry criteria purely on weight. 
 
Even for those who said they had been driven by weight loss or appearance, the main motivation could often be a desire to change themselves. People had learnt to connect particular values to different weights. They described how they associated being overweight with 'laziness' or 'failure' and being thin with 'being happy', 'successful' or 'achieving things'.
 
The way people thought about their body image could change over the course of the illness. When people had been ill with an eating disorder for a while, weight loss could become an obsessive habit and about achieving a certain number rather than about the weight or the way they looked. An eating disorder was described as a “numbers game” where all that mattered was getting to the right number, but the goal posts could move and the target number would always get smaller.
 
Body and self-confidence
Body-image, or the way people think about their physical appearance, was closely linked to self-confidence and how people felt about themselves more generally. Some had felt “ugly” or “fat” and that they couldn’t look themselves in the mirror. A negative body-image was commonly tied up with an overall feeling of being “undeserving” or “a failure”.
 
People described how they viewed themselves and their bodies often in comparison to other people. They described comparing themselves to others, “not fitting in” and feeling “inferior to peers”. Laura was always very self-conscious and aware of how others viewed her. Often unintentional comments from others that people interpreted negatively could start a cycle of weight loss. Later on, positive comments about weight loss could encourage people to keep losing weight and make weight loss seem ‘desirable’. David could remember a jibe about his body that triggered him to lose weight. Later on, as people became more ill and lost more weight, comments from others turned to concern. At this point, people were often too ill to believe them. Emily felt that the media promotes the view that “skinny is better”. Ewan said he used to read a lot of men’s health magazines which promoted a narrow view of an acceptable body.
 
Body-confidence was especially important in intimate and physical relationships. If people felt negatively about their bodies, it could be difficult to feel comfortable being naked with a partner or even hug them. Laura felt “too self-conscious to even bother” with intimacy. Katherine said that while she was ill with anorexia nervosa she was never interested in boys but later on, compliments from them were reassuring. 
(For more see Friends and relationships’).
 
How people think about their bodies
People’s view of their body could be different from the way others saw them. People’s view of themselves could become highly inaccurate. Some people had body dysmorphia' an anxiety disorder where people have a distorted view of their appearance and worry excessively about it. . When ill, some people struggled to believe it when people told them that they were underweight or looked “ill”. David recognised he had a “warped” self-image and Fiona-Grace knew her view of herself was “unrealistic”. Others had always known that they were underweight' Felicity says she never had “a distorted” view of herself and knew when she was too thin.
 
A few people said they had never particularly struggled with body-image or had come to terms with their body issues over time.
 
Body-image in recovery and beyond
People had addressed their body issues through counselling, therapy and workshops. Often their body-image started to improve as people were recovering and feeling better about themselves overall. This often remained the last challenge to overcome after their weight was at a healthy level and people’s mindset and thought patterns started to change.
 
Initially, gaining some weight could be difficult. People said it was important to look past that and work on developing a different mindset. People said they had to first learn to value health and then to relearn what ‘healthy’ actually meant. Fiona-Grace said she learnt to prioritise a healthy body, rather than what she looked like.
 
“It is possible to recover no matter how much of your life is taken up…You’ve just got to persevere… I mean every day I still wake up and I hate my body but… it will get easier in the future but I wouldn't let that put anyone off with recovery because there’s so much more to life than eating disorder.” -Fiona-Grace
 
Rachel described how she learnt to like her “curves”. She learnt to view her body differently and change her view of what “thin” meant to something desirable from “ugly and dangerous”. David said that after he lost weight, he wasn’t fully comfortable with his body. He felt guilty over the “unhealthy means” of bingeing and purging by which he had lost weight. Even if people still struggled with their body-image, they often said they had learnt to prioritise their long term health or wellbeing. For Rob, improved body-confidence was linked to an improved view of himself and learning to be less critical of what he did, was or looked like.
(For more about how people got better see ‘Working towards recovery’.)

Last reviewed July 2015.

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