2. Body Image
• Body image refers to an individual’s perceptions, emotional attitudes, and beliefs
about their own body, including their own attractiveness.
• Positive body image is an understanding that one’s own value as a person is not
defined by their appearance; an individual with positive body image typically accepts
and appreciates their body for what it can do, as well as how it looks.
• An “idealized body type” or “body image ideal” refers to a body type set forth by
social and cultural institutions (e.g. family, media, the government, learning
institutions like medical schools, etc.) as one that individuals should strive to achieve.
What is considered “ideal” changes over time and varies by culture (see Fraser).
• Body image distortion refers to a deep misperception about one or more features of
one’s own body. Someone with distorted body image may see their body in a mirror
in ways that are not factually accurate, e.g. waist size, or not likely to be shared by
another person. Distorted body image is common in patients with eating disorders,
particularly anorexia and bulimia.
3. Eating Disorders (EDs)*
• Psychiatric illnesses “characterized by a persistent disturbance of eating
patterns that leads to poor physical and/or psychological health.”
• Causes are “multiply influenced and complex,” and may include
environmental, biological, and cultural factors that remain unclear.
• May “be caused by feelings of distress or concern about body shape or
weight” – seemingly minor changes or adjustments in behavior pertaining to
food and eating “can spiral out of control and the maladaptive patterns of
eating take on a life of their own.”
• Often occur together with illnesses such as “depression, substance abuse, or
anxiety disorders” [simultaneous conditions known as comorbidities].
• In the long-term, EDs can cause serious damage to the heart and kidneys,
and may be fatal.
• Reproductive capacity may also be severely diminished or otherwise
affected, esp. among those with anorexia or bulimia.
*Unless otherwise indicated, all info on these slides is drawn from “Eating Disorders,” Psychology Today (2019).
4. Anorexia Nervosa
• Food intake is severely restricted, leading to below “minimally normal” body
weight for patient’s age and sex.
• Characterized by intense fears of weight gain or becoming “fat.”
• Distorted perceptions of one’s body, e.g. believing oneself to be “fat” even when
clinically underweight.
• Weight loss may occur by dieting, fasting, or exercising to excess.
• Associated behaviors:
• Avoidance of what is perceived to be “high caloric food and meals, picking out a few foods
and eating only these in small quantities, or carefully weighing and portioning food.”
• Frequent weighing of one’s body; excessive exercise; use of laxatives, diet pills, or diuretics.
• Preoccupation with avoiding food may become obsessive.
• May lead to osteoporosis, cardiac problems, infertility, depression, relationship
difficulties, suicide, and death from medical complications.
• Adolescent females may experience delayed onset of menstruation. Adult females
may experience cessation or irregularity of menstruation.
• Affects ~0.9 percent of females and ~0.3 percent of males in U.S.
5. Bulimia Nervosa
• Engagement in cycles of binging and purging:
• “Recurrent and frequent episodes of eating unusually large amounts of food…followed by some type of
behavior that compensates for the binge.”
• Compensatory behaviors may include purging (vomiting); excessive exercise; abuse of diet pills,
laxatives, or diuretics.
• Characterized by a sense of being out of control to stop eating or change what or how much is consumed.
• Those with bulimia are generally at or around normal body weight but often have a preoccupation with losing
weight and/or distorted body image.
• Behaviors are often surrounded by feelings of shame and guilt and/or feelings of relief; binging and purging
are often done in secret.
• In additional to triggers such as trauma, stress, or low self-esteem, behaviors may be learned, esp. from family
members also suffering from an eating disorder.
• Indicators include: poor dental health (tooth decay or worn enamel), swollen glands in neck and jaw,
chronically inflamed or sore throat, acid reflux disorder, severe dehydration, intestinal disorders, and kidney
problems.
• Affects ~1-4 percent of females in the U.S. as some point in their lives; much less common among males.
6. Binge Eating Disorder (BED)
• Individual engages in “recurrent binge-eating episodes” characterized by feeling a
loss of control, which causes distress rather than pleasure.
• Binges involve consuming large amounts of food very quickly, sometimes to the
point of physical discomfort and sometimes when not physically hungry.
• Unlike with bulimia, binging episodes are not followed by compensatory
behaviors like purging, excessive exercise, or abuse of laxatives.
• Those with BED are generally overweight or obese and often eat alone due to
feelings of embarrassment, shame, depression, or self-disgust.
• Related medical conditions may include diabetes, high blood pressure or
cholesterol, gallbladder disease, and some types of cancer.
• May be the most common ED in the U.S., affecting ~four million people (most
commonly women) and nearly 15 percent of people on a weight-loss diet.
7. Other Eating Disorders
• Avoidant/Restrictive Food Intake Disorder (ARFID)
• Lack of interest in eating or food, sometimes based on past negative experience – sometimes
thought of as “picky eating.”
• Often develops in infancy or early childhood or among people with sensory sensitivities
related to autism.
• Rumination Disorder
• Repeated regurgitation of food into mouth and re-chewing of food without signs of nausea or
disgust – may be self-soothing or self-stimulating behavior.
• After regurgitation, food may be re-swallowed or spit out.
• Marked by weight loss and malnutrition.
• Pica
• Consumption of non-nutritive, nonfood substances, e.g. paper, hair, gum, paint, pebbles, coal,
chalk, etc.
• May causes bowel problems, intestinal obstruction, or infections.
• More prevalent among people with developmental disabilities and some pregnant women (is
not diagnosed among children under two).
9. Causes
• Onset of an eating disorder may be triggered by:
• Trauma, e.g. sexual or physical assault or abuse, bullying.
• Stressful life event, e.g. divorce of parents or own marriage, end of personal romantic
relationship, moving away from home, starting a new job.
• Tendencies towards perfectionism and other obsessional traits in childhood.
• Potentially influenced by biology and heredity. (E.g. Higher incidences of
first-degree relatives and identical twins with same disorders.)
• Environmental, social, and cultural factors: More likely to develop among
individuals from cultures that value thinness or are specifically concerned
with weight and body image as determiners of self-worth and social
standing.
12. Treatments
• A treatment plan may require full or partial-hospitalization and
typically requires a team of professionals:
• Medical practitioner (M.D. or N.P.)
• Dietician
• Therapist
• Treatment approaches may include:
• Medical interventions, e.g. medication management for depression or anxiety.
• Nutrition counseling, e.g. detailed meal plans, exposure therapy, supervision of
meal preparation.
• Mental health counseling/therapy, esp. psychotherapy and cognitive behavioral
therapy (CBT).
Editor's Notes
risky medical conditions, such as diabetes, high blood pressure, high cholesterol, gallbladder disease, heart disease, and certain types of cancer.
