What is the relationship between body image issues and eating disorders?

By Rachel Matthews, Hospital Manager, Newbridge House

Body image is defined as the perception a person has about their own body and the thoughts and feelings arising from that perception. Body image issues are very common, manifesting in different ways: for example, a person may be under-weight but believes they are fat. Very commonly, people have body image issues expressed in high levels of self-criticism of their physical appearance and distress when they see themselves in photographs.

In this article, we will consider the following questions and themes around body image issues:

  • What can cause body image issues?
  • Signs of body image issues
  • Body image issues and mental health
  • The relationship between body image issues and eating disorders
  • Getting support

What can cause body image issues?

The precise interaction of causal factors and body image issues will vary for each person. We know, however, there is a close relationship between body image and self-esteem, body image and the media and body image and mental health. These are some of the risks and triggers that are closely associated with body image issues

  • Having a close relative with body image issues or an eating disorder is known to increase an individual’s own risk. For example, if a girl has a mother who is highly self-critical and anxious about her own appearance, there is an increased risk of her daughter developing body image issues herself
  • There is a relationship between anxiety and body image issues: an individual who may have shown higher levels of anxiety in early childhood may focus their anxiety on body image as they reach adolescence when physical appearance is under greater scrutiny
  • A history of being teased or bullied about your appearance and perceived attractiveness
  • A history of frequent dieting
  • Some people are more susceptible to idealised images of body perfection in the media and/or frequently compare themselves to their peers, evaluating themselves negatively

Signs of body image issues

  • Mirror checking is a recognised sign of body image issues, but how do we know the difference between a normal level of scrutiny and something which is unhealthy and obsessive? Mirror checking may become excessive if: you find you are spending increased time repeatedly throughout the day in front of the mirror, you have difficulty leaving the house without returning to the mirror to frequently check body image, there is an overwhelming focus on perceived flaws.
  • Frequent comparison with other people’s bodies is another sign of possible body image issues. Comparison may be with celebrities or peers or both and the key characteristic will be the affected individual feeling they compare poorly with others
  • An individual with body image issues is likely to make frequent and negative comments about their own body. They may be overwhelmingly focused on a perceived flaw. They may talk frequently and obsessively about their body image.

Body image issues and mental health

Body image issues and mental health are very closely related. A person who is experiencing mental health difficulties may develop body image issues: for example, if a teenager is depressed or has poor self-esteem, they will be at an increased risk of developing a poor body image.

Equally, body image issues are harmful to mental health: obsessive mirror checking increases anxiety levels; the perception that you are unattractive to others will damage self-esteem. People with body images issues and mental health difficulties can become locked in a cycle where they are overwhelmingly focused on their perceived appearance but evaluate themselves negatively for that appearance. It is important to recognise how intractable this can feel for the affected individual; it is not possible for them to simply ‘stop worrying about your appearance’.

The relationship between body image issues and eating disorders

Body image issues are closely related to eating disorders, both as causal factors triggering the disorder and once developed, as a maintaining factor, enabling the disorder to persist. Body image issues usually contribute in the three main types of eating disorder: anorexia nervosa, bulimia nervosa and binge eating disorder. A person with anorexia is likely to have a very distorted body image, believing they are fat when they may be dangerously underweight. For those affected by bulimia or binge eating disorder, the binge behaviour may be triggered by difficult emotions around their body image: for example, distress at seeing an image of themselves or comments made about their appearance.

When a person is experiencing body image issues and eating disorders, it is very important that treatment includes an effective focus on their body image issues. This is because body image issues can remain difficult after other symptoms have been addressed. For example, a person with anorexia may improve their food intake to restore weight and develop better ways to deal with distress but body image issues may remain. If this is the case and body image issues are not addressed in treatment, the individual may be at an increased risk of a future relapse. Body image interventions within eating disorder treatment programmes seek to reduce distress around body image, challenge perceptions and reduce mirror checking and anxiety.

Getting support

If you or a loved one has an eating disorder (or you think there may be an eating disorder), it is very important to get a specialist opinion and commence treatment as soon as possible. Left untreated, eating disorders become increasingly intractable, difficult to treat and therefore longer-term outcomes can be poorer.

If you are affected by body image issues, you may need to seek help and support, especially if your body image issues are affecting what you eat and/or starting to dominate your life, causing high levels of anxiety and obsessive behaviour.


Outpatient clinic

We have an outpatient clinic for adults as well as young people, treating eating disorders including bulimia and binge eating disorder.

Our outpatients’ clinic remains open, including to new requests for advice and support. We are following the Department of Health and Public Health England Coronavirus guidelines and all our consultations are being conducted by video conference or telephone. You are welcome to contact us to discuss your needs. Please be assured, we continue to support and offer outpatient programmes via digital and telephone communications.

Find out more about our outpatient clinic

Eating disorders help: our services in London and York

Newbridge House is part of the Schoen Clinic group, 26 high quality hospitals and services across Germany and the UK. Schoen Clinic Chelsea provides private outpatient and day treatment for adults, adolescents and children with eating disorders, anxiety and depression. You can self-refer to our service in Chelsea. Additionally, Schoen Clinic York is an adult inpatient service for adults with eating disorders and complex personality disorders.