Links Between Body Image and Disordered Eating

Dr. David Wiss

February 25, 2022

Eating Disorders

Body image is a component of personal identity representing how we think, feel, and behave regarding our bodies. Body dissatisfaction, sometimes conceptualized as body image disturbance (or distortion), is a classic component of restrictive eating disorders, although not all eating disorders are driven by body image issues. 

Furthermore, many people have relentless body image issues but do not cross the threshold into clinically significant eating disorders. Even milder body image disturbances can significantly compromise quality of life [1]. They can point to underlying issues such as obsessive-compulsive disorder, trauma, or a compromised “sense of self” characterized by unworthiness.

Diet culture is the “pervasive belief that appearance and body shape are more important than physical, psychological, and general well-being.” Diet culture is a known contributor to body dissatisfaction. Are you ready to drop out? This can be the best way to combat weight stigma and internalized weight bias. 

It has been suggested that self-esteem issues may mediate the pathway from body dissatisfaction to disordered eating [2]. Traumatic life events can also shape body image over the lifespan, referred to as embodied repercussions of adversity [3]. Thus, body dissatisfaction is one mediator in the established link between early life adversity and disordered eating, among others [4]. 

Trauma-informed approaches to treating eating disorders are only beginning to become mainstream. Still, more research is needed to understand how these models vary across the continuum of eating disorders, including food addiction [5]. Experts agree that treatment models for disordered eating must be trauma-informed [5,6].

Meanwhile, it is well established that individuals with binge eating disorders who have heightened body image disturbance are more likely to engage in dietary restraint [7]. Dietary restraint (synonymous with restrained eating or chronic dieting) can be defined as the cognitive effort to restrict food intake for various reasons, but most commonly for weight loss [8]. It is the intention to restrict food rather than the actually sustained restriction [9]. Dieting is considered a major risk factor for the development and progression of eating disorders; however, not all eating disorders stem from restrained eating.

In the context of mental health more broadly, dietary restraint can be seen as one form of disturbed eating, often driven by body dissatisfaction. Meanwhile, it is crucial to clarify the form of dietary restraint when investigating the effects of “dieting” on the development of disordered eating. It is not clear whether deliberate efforts to eat differently (focusing on dietary quality such as reduced exposure to highly palatable foods rather than on quantity) should be classified as pathological restraint [10]. However, suppose dieting stems from persistent body image issues and leads to erratic eating patterns characterized by bingeing. In that case, it is a problem worthy of attention. There are specialists who can help you, including registered dietitian nutritionists, and mental health professionals. 

Body dysmorphic disorder is a growing phenomenon characterized by obsessive thoughts about one or more perceived defects or flaws in appearance. This can lead to compulsive body checking (e.g., mirror-checking) and avoidance of social situations based on shame and anxiety. There are evidence-based approaches for the treatment of body dysmorphic disorder, including cognitive behavioral therapy (CBT) [11].

Recent research has shown that social media engagement (including exposure to body-related content) may exacerbate the relationship between body image and dietary restraint [12]. Higher levels of body dissatisfaction, including the internalization of weight stigma, consistently associates with weight-related behaviors [13,14]. 

Among women in midlife, greater levels of body dissatisfaction are associated with greater levels of dietary restraint, which in turn predict more significant psychological distress [15]. While internalization of body shape ideals and body dissatisfaction are more common in the female gender, a recent systematic review and meta-analysis found this phenomenon to be broadly similar among men [16]. Meanwhile, social context suggests that the burden of weight stigma is higher in women than men [17]. Feelings of rejection associated with weight stigma and disordered eating are additional stressors perpetuating a negative cycle [18,19]. Is it time to break the cycle?

Making peace with your body is essential to the quest of making peace with food. If body images persist, you will likely be tempted to engage in dieting behaviors, which may progress into an eating disorder and create significant impairment and distress. We want to help you avoid this pitfall. 

At Wise Mind Nutrition, we are here to help you engage in a meaningful healing journey that goes beyond food, incorporating recovery principles that will help you feel more at home in the body that you live in! If you have been searching for the right eating disorder help, you may have just found it! 

References

1. Nayir T, Uskun E, Yürekli MV, Devran H, Çelik A, Okyay RA. Does Body Image Affect Quality of Life?: A Population Based Study. Plos One. 2016;11(9):e0163290.

2. Brechan I, Kvalem IL. Relationship between body dissatisfaction and disordered eating: Mediating role of self-esteem and depression. Eat Behav. 2015;17:49–58.

3. Clarke LH, Griffin M. Body image and aging: Older women and the embodiment of trauma. Women’s Stud Int Forum. 2008;31(3):200–8.

4. Rabito-Alcón MF, Baile JI, Vanderlinden J. Mediating Factors between Childhood Traumatic Experiences and Eating Disorders Development: A Systematic Review. Children. 2021;8(2):114.

5. Wiss D, Brewerton T. Separating the Signal from the Noise: How Psychiatric Diagnoses Can Help Discern Food Addiction from Dietary Restraint. Nutrients. 2020;12(10):2937.

6. Brewerton TD. An Overview of Trauma-Informed Care and Practice for Eating Disorders. Journal of Aggression, Maltreatment & Trauma. 2018;28(4):1–18.

7. Andrés A, Saldaña C. Body dissatisfaction and dietary restraint influence binge eating behavior. Nutr Res. 2014;34(11):944–50. 8. Lowe MR, Whitlow JW, Bellwoar V. Eating regulation: The role of restraint, dieting, and weight. Int J Eat Disorder. 1991;10(4):461–71.

9. Bottera AR, Kambanis PE, Young KPD. Persistence: A key factor in understanding the circumstances under which dietary restraint predicts restriction of caloric intake. Eat Behav. 2021;101563.

10. Wiss DA, Avena N, Gold M. Food Addiction and Psychosocial Adversity: Biological Embedding, Contextual Factors, and Public Health Implications. Nutrients. 2020;12(11):3521.

11. Castle D, Beilharz F, Phillips KA, Brakoulias V, Drummond LM, Hollander E, et al. Body dysmorphic disorder: a treatment synthesis and consensus on behalf of the International College of Obsessive-Compulsive Spectrum Disorders and the Obsessive Compulsive and Related Disorders Network of the European College of Neuropsychopharmacology. Int Clin Psychopharm. 2021;36(2):61–75.

12. Rounsefell K, Gibson S, McLean S, Blair M, Molenaar A, Brennan L, et al. Social media, body image and food choices in healthy young adults: A mixed methods systematic review. Nutr Diet. 2020;77(1):19–40.

13. Nakhoul TB, Mina A, Soufia M, Obeid S, Hallit S. Restrained eating in Lebanese adolescents: scale validation and correlates. Bmc Pediatr. 2021;21(1):257.

14. Bidstrup H, Brennan L, Kaufmann L, Garcia X de la P. Internalised weight stigma as a mediator of the relationship between experienced/perceived weight stigma and biopsychosocial outcomes: a systematic review. Int J Obes 2005. 2021;1–9.

15. Hockey A, Barlow FK, Shiels AL, Donovan CL. Body dissatisfaction in midlife women: The applicability of the tripartite influence model. Body Image. 2021;39:202–12.

16. Paterna A, Alcaraz‐Ibáñez M, Fuller‐Tyszkiewicz M, Sicilia Á. Internalization of body shape ideals and body dissatisfaction: A systematic review and meta‐analysis. Int J Eat Disorder. 2021;

17. Sattler KM, Deane FP, Tapsell L, Kelly PJ. Gender differences in the relationship of weight-based stigmatisation with motivation to exercise and physical activity in overweight individuals. Heal Psychology Open. 2018;5(1):205510291875969.

18. Tomiyama A. Stress and Obesity. Annual review of psychology. 2019;70:703–18.

19. Chami R, Monteleone A, Treasure J, Monteleone P. Stress hormones and eating disorders. Molecular and Cellular Endocrinology. 2018;(Physiol. Behav. 91 2007).