A-Z

Eating disorders (young people)

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.

 

For James developing anorexia nervosa had nothing to do with his body-image. He thinks it's a...

For James developing anorexia nervosa had nothing to do with his body-image. He thinks it's a...

Age at interview: 21
Sex: Male
Age at diagnosis: 20
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When I sort of became full blown with my disorder I never really I didn’t have this sort of image problem I guess. I never looked at magazines and wanted to look like somebody. Because I was always sort of exercising anyway so I knew what I could do. But I really, it’s really hard to see it as a guy now because a lot of people like when they talk to me, when I go home and stuff like that, but a lot of people don’t understand this illness. Quite a lot and they think that ‘Oh, wait a minute, you know you just want to look like so and so in the papers’, and it’s like, it’s completely nothing like that you know. So and so in the papers, and it’s completely nothing like that you know. And it’s, even about anorexia it’s not about food, it’s about feelings. You know and it is true, it’s completely about the way I felt.

 

Laura became aware of her body and weight only after she had developed an eating disorder.

Laura became aware of her body and weight only after she had developed an eating disorder.

Age at interview: 18
Sex: Female
Age at diagnosis: 18
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How much do you think originally restricting food and exercising was to do with body-image and wanting to lose weight? Or how much of the issues that you’re dealing with at the moment are to do with body-image or body? 
 
I think originally it wasn’t something that was a big thing, but as I started losing weight I became more aware because beforehand I’d, I’d never really known what my weight was and I didn’t really care, and like everything like that. But as soon, yeah when things developed I did become more aware and more conscious of my body and that is a big thing now, I am very kind of self-conscious with my body-image and how I seem to myself and to others.
 

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. 
 

David feels self-conscious of his body. He worries other people could find it a turn off when he...

David feels self-conscious of his body. He worries other people could find it a turn off when he...

Age at interview: 22
Sex: Male
Age at diagnosis: 19
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I don’t think highly of myself all the time. And so I find it, I think in my head find it hard to believe it when someone’s being compliment; you know paying me a compliment. And I think that can be, you know in a romantic sense, or in a meeting someone sense, that in itself can be a big turn off. You want to be able to compliment someone without them turning round and saying, “Don’t compliment me,” or “Don’t,” or you know, or disagreeing with you. Because I know what it’s like if I say it to someone and they don’t, they disagree back. Yeah if I think about it it’s exactly how I am every time someone tries to pay me a compliment.
 
So yeah in a physical aspect I’m not entirely comfortable with my body, and so I’m very conscious, perhaps it isn’t as bad if I’ve been drinking, but if I haven’t been drinking then I’m very conscious of my body and stuff. And that, that’s a big thing I think for some people. They want you to feel comfortable with them and my image of myself means that I’m not. 
 
 

Hearing compliments from guys at university gave Katherine confidence that she’d not had before.

Hearing compliments from guys at university gave Katherine confidence that she’d not had before.

Age at interview: 19
Sex: Female
Age at diagnosis: 11
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I’ve always, a in my previous kind of long term relationship that was never an element of it, but also because I don’t think of myself in that way. I don’t, and it’s only, it’s literally only been since coming to Uni that kind of other guys have started to comment on my appearance, and you kind of think, “Oh maybe I’m not actually horrifically unattractive, you know.” And it’s reassuring that kind of there is, you know people see you in that kind of positive light. That you, I just didn’t think that people did at all, and it’s not how I thought about myself. So it’s kind of only impacted positively really. And also like having someone else there who you know finds you attractive and you know, in terms of your personality and your looks, kind of gives you the confidence to take those like big jumps that you need to sometimes with food.

(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.
 

Rebekah worked on her body-image in workshops and by building her self-confidence. Restoring a...

Rebekah worked on her body-image in workshops and by building her self-confidence. Restoring a...

Age at interview: 18
Sex: Female
Age at diagnosis: 16
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Even now it’s hard, like look in the mirror because I find it really difficult but I’ve worked on that with like my whole body-image and workshops so I guess and I think, like that was in , when I was in hospital they do, they have like body-image workshops, creative and self-esteem and mindfulness. And I think it was really great, especially when you’re just, like your weight’s restoring and it’s getting to that healthy weight, and you’re feeling like really great about yourself.

(For more about how people got better see ‘Working towards recovery’.)

Last reviewed October 2018.
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