The Elephant in the Room: What the struggle with body image tells us about the psychology of eating disorders, and their real causes

If you are struggling with an eating disorder, this article might present triggers. Please think carefully before reading it. It is intended to help people with and without eating disorders to better understand the psychology behind eating disorders and the struggle with body image. 

Until now, I have been reluctant to write about body image. Firstly, because too much attention is given to the relationship between eating disorders and how we feel about our bodies, which unfairly simplifies people’s understanding of the illness. The first article I posted was about how eating disorders are about far more than just food and body image. Secondly, I personally still find it a difficult subject to talk about. It’s a very private subject at the best of times, and it remains a sore issue that I find uncomfortable to think about.

But that’s exactly why I should talk about it. And even though I don’t agree that most media attention regarding eating disorders tends to centre around body image pressures, I can’t deny that they do play a role in how an eating disorder manifests (but not, I must highlight, in causing the eating disorder in the first place).

sad eephant

So it’s time to address the elephant in the room (bad pun, sorry!). Difficulty with body image is an important part of an eating disorder, and the struggles associated with it can reveal a lot about the psychology behind the illness.

The first thing I have to say is that body image, dissatisfaction with how you look, an irrational fear of weight gain are all SYMPTOMS of an eating disorder. They are not the internal cause of the illness, and social pressures regarding body image cannot be said to lead directly to eating disorders. To say so would be to belittle the illness, its complexity, and the distress and suffering that it causes. What turns body image into such a painful part of the illness can help us to understand the psychology of eating disorders and to begin to unravel how to recover.

Before I go any further, I need to state that everyone’s eating disorder is different and therefore everyone’s experience with their body image will be different. I’m basing this on my own experience and hearing from others throughout recovery. Also, the struggle with body image may be different depending on the type of eating disorder you have – anorexia, bulimia, or another diagnosis. My fight was with anorexia. But there are key themes and similarities that need to be better understood. Please don’t take this article as the final say on body image and eating disorders.

Mirror, Mirrormirror

So what do I mean by ‘body image’? And what does it mean in the context of an eating disorder? Body image is how you perceive yourself when you look at an image or reflection of yourself, or visualise yourself mentally. It is not how you objectively look. Taken from the National Eating Disorder Association, body image encompasses:

  • What you believe about your own appearance (including your memories, assumptions, and generalisations).
  • How you feel about your body, including your height, shape, and weight.
  • How you physically experience or feel in your body.

Notice how all of the above are subjective experiences. That’s important. Everyone, whether you have an eating disorder or not, has a different image and interpretation of their body. Sadly, we live in a society where millions of people are dissatisfied with their bodies (and yet notice how all those millions of people don’t develop an eating disorder – the relationship is not causal). 91% of women state that they are dissatisfied with their appearance; only 2% of women would describe themselves as beautiful. 29% of men think negatively about their body at least five times a day. These are sad statistics.

91% of women are dissatisfied with their appearance

Body image distortion is a key diagnostic factor in eating disorders, of whatever category or type. In technical talk, they speak of a ‘disturbance in the way in which one’s body weight, size or shape is experienced, undue influence of body shape and weight on self-evaluation, or denial of the seriousness of low body weight’. People with eating disorders frequently believe themselves to be ‘bigger’ than they really are and are blind to the fact that in reality they are putting themselves in danger (whether through restriction or through binging and purging).

The eating disorder forces you to make an inaccurate assessment of yourself through judgements about your appearance that you would never apply to someone else. One of the most frustrating things for me whilst fighting the illness was the hypocrisy: I would say I was ‘fat’, ‘disgusting’, ‘dirty’, a ‘terrible person’ for putting on weight, but I would never judge anybody else on their appearance. I’ve always believed that it’s the person inside that counts. And yet there I was, unable to apply that philosophy to me.

It’s the person inside that counts

From my own experience, I was not that concerned with my body image until I started the process of recovery and my body began to change. I was underweight, so any changes felt drastic and at times, I didn’t think I would be able to cope. The struggle with body image is one of the most difficult and painful aspects of recovery. Before recovery, I was less concerned by my size and shape than by the number on the scale and the sense of control that I gained from monitoring it daily (but more of that to come). During recovery, just looking in the mirror was a distressing act and something I tried to avoid at all costs so as not to feel that stinging sense of shame and disgust. Even though I knew through my numerical weight and BMI that I was still underweight, what I saw in the mirror was entirely different. There was an elephant in the mirror, and, in my mind, in the room: it was me.

Here’s something I wrote down in my journal one day when the eating disorder was especially making me hate my body after eating a challenging meal:

“I have just had mushroom and leek pasta followed by ice cream sundae. I feel horrendous, I want to tear my body open and spew it all out. My brain is telling me that I shouldn’t have eaten that, that I am losing control. I am getting fat and dirty, I am a bad person and I don’t want or deserve to get better. I don’t want to do this anymore”.

What I wrote that day reveals a lot about the psychology behind the struggle with body image, and about how the illness distorts your perception so much that you cannot see the truth: that what you are doing in recovery is not becoming fat (as I so often feared), but becoming healthy. Getting ‘fat, dirty’, becoming a ‘bad person’ – those words show that body image is less about how you look, than how you feel about yourself. That’s the important message to take away from this.

Body image is less about how you look than how you feel about yourself

Notice how when I was writing about how I felt, I immediately jumped from ‘fat’ to feeling ‘dirty’ and like a ‘bad person’, and how putting on weight was associated with ‘losing control’. Those descriptions go far beyond the valuation of appearance, to saying something more profound about how you feel about yourself as a person. This demonstrates how the illness isn’t really about weight or food or body size and shape: it’s about deeper feelings about yourself. It’s about control. It’s about a crippling perfectionism. It’s about a sense of self-dislike that leads to dangerous self-denial and self-neglect.

The Deeper Meaning

CatAndMirror111Our body image is directly related to our self-esteem and how we think about ourselves. The more negative our perception of ourselves, the more negative we feel about our bodies. In some ways, starving yourself or binging and purging behaviours are a form of self-harm, of punishment. Hating your appearance becomes another stick to beat yourself with.

I didn’t develop an eating disorder because I didn’t like the way I looked. I developed an eating disorder because I didn’t like who I was. I believed that I was a bad person, that I didn’t deserve the life I had been granted. My self-esteem was at rock bottom, which led to self-neglect and self-denial, which manifested itself (for me) in restricting my food intake. I didn’t deserve to eat.

That same low self-esteem, piercing dislike of who I was, and belief that I was a bad person contributed to a compulsion to control myself and the world around me. I had to control myself so that other people didn’t realise how bad I was, and so I could protect them from myself, and protect myself from their judgements. Earlier in life I had achieved this through controlling work and money, and then something else came along: weight and food. I stated before that in the beginning, it wasn’t about how I looked, but about controlling the number on the weighing scales. That came to mean ensuring that that number was going down. This need for control grew into a dangerous and false sense of achievement whenever the number fell.

There is no such thing as the perfect body or the perfect weight

no body perfectAnd that fed into another psychological mechanism which fuels eating disorders: perfectionism. Nothing was ever good enough. Perfectionism, for me, helped me to control who I was. If I was ‘perfect’, no one would see who I really was. But perfection is impossible. There is no such thing as the perfect body or the perfect weight – but I didn’t realise that at the time. Perfectionism is a key trait of many people who suffer from an eating disorder and can manifest itself in many ways, for example, in social interactions, in painting or drawing, in music, in academic achievement. Perfectionism is not healthy. It is exhausting and dangerous. For me, it took me into hospital.

What do you mean when you say ‘fat’?

So, when I said I was ‘fat’ (as I did countless times to the mental health workers helping me in my recovery), what I actually meant was that I feared I was losing control, that I was a bad person, that I was not good enough, that I was letting myself go, that I hated myself. What I saw in the mirror was not an accurate reflection of what I looked like, but a reflection of how I felt about myself as a human being. That’s what body image is about in eating disorders: the discomfort and distress caused by weight gain or not purging after binging is not a result of accurate judgements about your appearance itself. You have to look at what lies behind that little word: ‘fat’.

The Role of Society and Social Media

Right, I hope that makes sense. But what about the role of society and social media? It is a good question, and it is relevant, but the role of culture, media and social expectations is overstated. Every time I hear eating disorders being discussed in the media, the commentators almost always start talking immediately about the pressures on young people regarding how they look from social media and our seemingly unavoidable diet-culture.

social media.jpgOf course, our beliefs about body shape and size are influenced by culture, media, social expectations and, increasingly, social media. You can’t escape the the constant body shaming in the press, the ‘summer body’ preparation workouts and diets plastered across our screens and billboards, the constant valuation of celebrities on their appearance. Facebook and Instagram are full of people telling you to ‘get the glow’ or to get slim quick, to avoid sugar and chocolate and crisps and ice cream and all things nice! The news is constantly telling us we have an obesity problem, that we should limit our sugar and fat and protein and processed foods and so on and so on. Every film shows the buff guy and the slim girl finding happiness and running off into the sunset. Where are the ‘normal’ people finding their happy-ever-afters?

We are constantly bombarded with messages about how we should look and how we should eat. So it’s not surprising that more and more of us are dissatisfied with how we look. For someone in an eating disorder mindset, all these messages are internalised and become ammo for attacking yourself and rules for which you can feel a false sense of control in this unsettled and uncertain world.

These social pressures do not cause eating disorders. As I have said before, if that were the case, everyone would have an eating disorder, or no one would. But they do feed into the psychological belief systems and thought processes which fuel eating disorders. Personally, I think eating disorders would still exist in a world without social media or in a society that was not so obsessed with appearances.

Body image is not about how you really look, but about how you feel.

Body image is not about how you really look, but about how you feel. Negative body image feeds into eating disorders and is a result of the same illness. I became far more obsessed with how I looked after I started the road to recovery than I was before, because it was a way for the illness to cling on and keep control over me. I still struggle with body image, but in a way that most people without an eating disorder do. I no longer want to skip meals or restrict my carb intake or go on an exhausting run just because I caught a glimpse of myself in the mirror. In fact, looking in the mirror is getting easier: most days, I no longer hate the person behind the glass. The next step, is to try to like it, and that means trying to like myself.

If you or someone you know may be suffering with an eating disorder, here are some links to find out more information about the illness and treatment. Please don’t think you’re not ‘ill enough’: if you need help, ask for it…

Recovery information from Beat, including helplines

NHS information about different types of disorders and how to find help

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