Do you sometimes wonder if your relationship with food is “normal”? Maybe you’ve caught yourself thinking your eating habits aren’t disordered enough to matter, or that you don’t look like someone who would have an eating disorder. If these thoughts sound familiar, you’re not alone and understanding common eating disorder myths can help you discover the truth about your experience.

Eating disorder myths remain some of the most dangerous misconceptions in mental health. Despite decades of research, these harmful eating disorder myths continue to shape how we think about these serious illnesses, creating barriers that prevent millions of people from seeking the help they need and deserve.

As a therapist specializing in eating disorders and OCD, I see firsthand how misinformation impacts clients. The reality is that eating disorders are complex, deeply individual experiences that cannot be reduced to stereotypes. It’s time to challenge these misconceptions and replace them with truths that support healing, autonomy, and justice.

The Hidden Impact of Eating Disorder Myths

Before we dive into specific eating disorder myths, it’s important to understand why these misconceptions are so dangerous. Eating disorder myths don’t just spread misinformation, they:

• Delay diagnosis and treatment by making people question whether they’re “sick enough”
• Perpetuate shame and stigma around seeking help
• Lead to inadequate or harmful care from uninformed healthcare providers
• Prevent early intervention when treatment is most effective
• Reinforce harmful stereotypes that exclude marginalized communities

If you haven’t felt valid in your struggle with food and body image, these myths may be the reason why. Let’s debunk them once and for all.

Myth #1: Eating Disorders Have One Clear Cause

The Truth: Eating disorders are complex, multifactorial illnesses with no single cause.

There’s no simple explanation for why eating disorders develop. Genetics, biology, environment, attachment trauma, cultural pressures, and systems of oppression all interact in unique ways for each individual.

Simplifying eating disorders to “a diet gone too far” or “control issues” erases the very real intersection of personal history and systemic forces that contribute to their development. In my practice, I typically work with people who experience a “perfect storm” of triggers, perhaps a genetic predisposition combined with major life stressors or trauma.

For example, research shows that growing up with food insecurity can lead to a full-blown eating disorder even without a family history, while others may have genetic vulnerability that only manifests under specific environmental conditions.

Myth #2: Everyone With an Eating Disorder Is Underweight

The Truth: Only 4% of people with eating disorders are underweight.

This is perhaps the most dangerous myth of all. The stereotype of the emaciated person not only misrepresents reality, it actively harms those in larger bodies or at “average” weights, who may be dismissed by healthcare providers and even themselves.

This misconception delays or prevents access to treatment, leading to more severe medical and psychological complications. Some research shows that “atypical anorexia” can be just as deadly, if not more deadly, than typical anorexia.

The reality: Eating disorders affect people in every body size, and body size alone tells us nothing about the severity of the illness or the person’s need for support.

Need Help Understanding Body Image Issues? If you’re struggling with how you see your body or wondering if your concerns are valid, explore our comprehensive guide on body image therapy and what it can do for you. Remember: every body deserves compassion and care.

Myth #3: Hospitalization Is Required for All Eating Disorder Treatment

The Truth: Healing looks different for every person, and many paths lead to recovery.

While some people benefit from inpatient or residential treatment, many find healing through outpatient therapy, support groups, or community-based care. One-size-fits-all approaches ignore the diversity of recovery paths and can be inaccessible for those who cannot afford or take time away for higher levels of care.

For those who don’t have access to traditional healthcare, the notion that you must go through formal treatment levels might prevent you from seeking any help at all, which is far worse than seeking alternative support.

If you can’t afford paid help, there are options:

• Free support groups at ANAD
• Free recovery peer mentors at MEDA
• Treatment scholarships through Project HEAL

That said, if you can access healthcare, it’s highly recommended to work with a medical doctor, registered dietitian, and specialized therapist.

Myth #4: Eating Disorders Are Personal Character Flaws

The Truth: Systems of oppression significantly influence eating disorder development.

Diet culture, anti-fat bias, racism, ableism, transphobia, and other systemic injustices all contribute to the onset and maintenance of eating disorders. These aren’t simply individual “choices”—no one chooses an eating disorder.

They’re often shaped by living in a society that upholds harmful ideals about bodies, worth, and belonging. For example, for a BIPOC person, body restriction might serve as a protective strategy against white supremacy culture, though it remains harmful nonetheless. Research shows how racial discrimination directly impacts eating behaviors.

Healing from racial trauma and other forms of oppression must be central to eating disorder recovery.

Wondering If Your Struggles Are Valid? Many people struggle to identify the difference between a “Diet” and an eating disorder. Learn more about the thin line that differentiates them.

Myth #5: There’s Only One “Right” Way to Recover

The Truth: Recovery is not a rigid checklist, you can define your own healing path.

What matters isn’t meeting someone else’s standard of what “recovered” should look like. Instead, recovery is about reclaiming your agency, safety, and connection to your body in ways that work for you.

Of course, being medically and psychologically stable is important for everyone’s recovery, but the steps you take to get there can be unique to your life circumstances and needs. This might include exploring harm reduction approaches that meet you where you are in your journey.

Myth #6: Eating Disorders Only Affect Young, White Women

The Truth: BIPOC and transgender individuals have some of the highest rates of eating disorders.

White-centered portrayals of eating disorders erase the experiences of Black, Indigenous, Asian, Latinx, mixed-race, and transgender communities, many of whom experience eating disorders at equal or higher rates than their white cisgender peers.

These groups also face greater barriers to diagnosis and care due to systemic racism, transphobia, and medical bias. Research shows that eating disorders are far more prevalent than many assume, affecting 10 million men and 20 million women at some point in their lives.

When we overlook marginalized communities, we perpetuate systemic oppression and harm. Instead, we must work to dismantle these barriers and create inclusive spaces for all bodies in eating disorder recovery.

Myth #7: People With Eating Disorders Are “Control Freaks”

The Truth: While some may seek agency due to trauma, eating disorders aren’t inherently about control.

Many clients describe using food and body behaviors to cope with overwhelming powerlessness or pain. Framing eating disorders solely as “control issues” oversimplifies and stigmatizes a deeply complex experience.

Someone needing a sense of control has likely faced circumstances where they had none, leaving them feeling powerless. Seeking autonomy is a basic human need and drive, very different from being “born a control freak.”

Feeling Overwhelmed by Food and Control Issues? If you’re using food to cope with difficult emotions or trauma, you’re not alone. Discover how trauma and eating disorders are connected and find healthier ways to regain your sense of power.

Myth #8: Recovery Is Purely a Matter of Willpower

The Truth: Access to recovery requires resources, not just willpower.

Yes, recovery involves intention and choice. But it also depends on access to supportive care, financial stability, safe housing, and affirming relationships. Telling someone to “just choose recovery” ignores the structural realities that make healing possible.

For example, the average cost per day at a residential eating disorder program is upwards of $2,000, clearly beyond many people’s reach.

Myth #9: Harm Reduction Enables Eating Disorders

The Truth: Harm reduction is lifesaving and honors autonomy.

Meeting people where they are, rather than demanding immediate, complete cessation of harmful behaviors, can keep them alive and engaged in care. Harm reduction is rooted in respect for autonomy and recognition that healing is rarely linear.

Harm reduction for eating disorders might include gradually reducing behaviors or agreeing to minimum nutritional intake that sustains life while building coping skills. It’s about keeping people safe and alive while they work toward recovery at their own pace.

Ready to Explore Your Treatment Options? Recovery doesn’t have to be all-or-nothing. Learn about different approaches to eating disorder treatment and find the path that feels right for you, whether that’s traditional therapy, harm reduction, or something in between.

Frequently Asked Questions About Eating Disorder Myths

Q: How do I know if my eating behaviors are disordered enough to seek help?

A: If your relationship with food or your body is causing distress, interfering with your daily life, or feels out of control, you deserve support, regardless of your weight, symptoms, or how you compare to others. There’s no “sick enough” threshold for getting help.

Q: Can eating disorders develop at any age?

A: Yes, eating disorders can develop at any stage of life. While they often begin in adolescence or young adulthood, they can also emerge in midlife or later, especially during major life transitions or stressful periods.

Q: Are eating disorders genetic?

A: Genetics play a role in eating disorder risk, but they’re not destiny. Having a family history increases vulnerability, but environmental factors usually serve as the “trigger” for symptoms to develop.

Q: Can you fully recover from an eating disorder?

A: Yes, full recovery is possible for many people. However, recovery looks different for everyone and may take time. Some people achieve complete freedom from symptoms, while others learn to manage their condition effectively with support.

Q: Do men get eating disorders?

A: Absolutely. While eating disorders are more commonly diagnosed in women, men account for about 25% of people with anorexia and bulimia, and about 40% of those with binge eating disorder. Men may be underdiagnosed due to stigma and different symptom presentations.

Q: Is it possible to have an eating disorder without extreme weight loss?

A: Yes. Most people with eating disorders don’t experience dramatic weight changes. Eating disorders can occur at any weight, and psychological symptoms often precede or occur without significant physical changes.

Ready to Take the Next Step?

If you or someone you love is struggling with an eating disorder, know this: Your experience is valid. Your body is not the problem. And recovery is possible.

Every person deserves compassionate, informed care that honors their unique journey. Whether you’re just beginning to question your relationship with food or you’ve been struggling for years, support is available.

Find Your Local Support Explore the GoodTherapy therapist directory to connect with qualified eating disorder specialists in your area who understand the complex nature of these conditions.

Additional Resources for Support:

• Body image therapy and support
• Understanding eating disorder treatment options
• The role of trauma in eating disorders

Remember: Healing is not a destination but a journey, and you don’t have to walk it alone. There is hope, and there is help.

References:

Becker, C. B., Middlemass, K., Taylor, B., Johnson, C., & Gomez, F. (2017). Food insecurity and eating disorder pathology. International Journal of Eating Disorders, 50(9), 1031–1040. https://doi.org/10.1002/eat.22735

Beck, A. R., & Saucedo, J. C. (2019). Food insecurity and eating disorders in college students. Journal of American College Health, 67(7), 662–667. https://doi.org/10.1080/07448481.2018.1499652

Brown, K. L., Graham, A. K., Perera, R. A., & LaRose, J. G. (2022). Eating to cope: Advancing our understanding of the effects of exposure to racial discrimination on maladaptive eating behaviors. International Journal of Eating Disorders, 55(12), 1744–1752. https://doi.org/10.1002/eat.23820

Hassan, S. (2022). Saving Our Own Lives: A liberatory practice of harm reduction (Foreword by A. M. Brown; Introduction by Tourmaline). Haymarket Books.

Nineteen years ago, I made a decision that changed my life: I had gastric bypass surgery. At the time, I weighed 365 pounds, and my relationship with food, my body, and even my self-worth was deeply complicated. Today, I’ve lost and maintained a weight loss of 230 pounds, but what I’ve learned about the weight loss mental health connection has been even more transformative than the physical changes. While the surgery was a powerful tool, the real work, the kind that often goes unnoticed, has been mental, emotional, and deeply personal.

In the last two years, I added a GLP-1 medication to my routine, which has helped support my continued progress. Make no mistake: medication and surgery are not shortcuts. They are tools, and the real, lasting transformation has come from reshaping my mindset and prioritizing my mental health.

The Mental Side of Weight Loss No One Talks About

We often hear about diet plans, workout regimens, and before-and-after photos. What’s less visible is the emotional and psychological journey that runs alongside the physical one. For me, this was the hardest part.

Research consistently shows that bariatric surgery affects mental health significantly, with studies indicating both positive and negative psychological changes post-surgery. Before surgery, food was more than just fuel; it was comfort, distraction, and a coping mechanism. After surgery, I had to relearn how to eat, but even more importantly, I had to relearn why I eat. That’s where mental health came into play.

Healing My Relationship With Food: A Weight Loss Mental Health Journey

Gastric bypass changes your anatomy, but not your mindset. I had to face the habits and beliefs I carried with me for years. I had to confront emotional eating patterns, self-sabotage, and a negative internal dialogue that often told me I wasn’t “good enough” or that I’d always struggle.

Research demonstrates that psychological interventions targeting emotional eating can be highly effective, with cognitive behavioral therapy, mindfulness-based treatments, and acceptance-based therapies showing significant improvements in both emotional eating behaviors and weight outcomes.

Therapy, journaling, support groups, and self-reflection became just as important as meal planning and exercise. I learned to check in with myself emotionally before meals. Was I really hungry? Or was I stressed, bored, anxious, or sad?

Mindset: The Hidden Engine Behind Success

Losing weight and keeping it off for nearly two decades has taught me that mindset is everything. I’ve had to be patient when progress slowed. I’ve had to stay grounded when the scale didn’t move, and I’ve had to keep showing up for myself, even when it felt hard.

A growth mindset, believing that I can change, adapt, and grow, has carried me through setbacks and plateaus. Stanford psychologist Carol Dweck’s research demonstrates that individuals with a growth mindset consistently outperform those with a fixed mindset, particularly when facing challenges.

I stopped seeing challenges as failures and began to see them as part of the journey. This shift in perspective has been crucial to my resilience and long-term success.

The addition of GLP-1 medication over the past two years has given me another helpful tool, especially when it comes to appetite regulation and managing food cravings. The medication didn’t erase the need for mindful eating, therapy, or self-care. If anything, it amplified the importance of those things.

Nutrition Isn’t Just Science—It’s Personal

Nutrition advice is everywhere, but what works for one person may not work for another. I’ve had to learn what my body needs, how to listen to its signals, and how to feed it with both nutrition and self-compassion. Some days I eat to nourish, other days I eat for joy. I’ve learned that both are okay, and balance, not perfection, is the key to sustainable health.

Understanding that weight loss can be difficult helped me set realistic expectations and develop patience with the process. This acknowledgment actually improved my long-term success rather than hindering it.

Final Thoughts

Today, I live in a body that feels strong and capable. More importantly, I live with a mind that’s kinder, more resilient, and more aware. My journey hasn’t been linear or easy. It’s been filled with detours, lessons, and growth. Through it all, the most significant transformation hasn’t just been what I see in the mirror, it’s how I see myself.

If you’re on your own weight loss or health journey, know this: your mindset matters. Your mental health matters. You are so much more than a number on the scale. Consider focusing on positive behavioral changes rather than just the number on the scale, this approach often leads to more sustainable, lasting results.

The Mayo Clinic emphasizes that gaining control over emotional eating requires addressing both the psychological triggers and developing healthier coping mechanisms. Remember, if you’re struggling with emotional barriers to weight loss or need support on your mental health journey, consider reaching out to a qualified therapist who can help you develop the tools and mindset for lasting change.

Let’s be honest: Reality television has become America’s not-so-secret obsession. Whether it’s your guilty pleasure after a long day, the background noise while you’re scrolling your phone, or something you swear you’d never watch (but somehow know all the contestants’ names), there’s no denying we’re consuming more reality TV than ever before.

From the drama-filled villas of Love Island to the backstabbing brilliance of The Traitors, from the soaring vocals on The Voice to the rose ceremonies on The Bachelor — these shows have us hooked, and they’re undeniably entertaining. Still, researchers and mental health professionals are increasingly worried about the impact this “harmless” entertainment might be doing to our mental health, especially as it relates to body image.

If you’ve ever felt a knot in your stomach after watching impossibly perfect people find love on a tropical island or noticed your mood dip after a reality TV binge, you’re not alone. These shows are messing with our minds in ways we’re only beginning to understand, and the impact on how we see ourselves, especially our bodies, is becoming impossible to ignore.

Take Love Island USA, for instance. This longtime fan favorite has been called out for years over its harmful body image messaging, yet the most recent season (which premiered June 3rd, 2025) serves up more of the same. It might be your go-to guilty pleasure, but it’s worth asking: What’s the real cost of the “Love Island Effect” on our mental health?

Below is a deeper dive into the show’s impact on our mental health — from the show’s impossible beauty standards to the direct psychological toll it takes on us — plus some practical ways to enjoy your reality TV fix without letting it mess with your self-worth.

Negative Body Image and Mental Health: Understanding the Connection

When it comes to what shapes your mental health, body image plays a bigger role than you may realize. The way you see yourself in the mirror isn’t just about vanity: it’s deeply connected to your overall well-being and self-worth. When those thoughts are persistently negative, your mind can suffer.

Poor body image can trigger or worsen a number of conditions or symptoms: 

• Anxiety and depression 
• Body dysmorphia 
• Eating disorders like anorexia and bulimia 
• Feelings of shame and guilt 
• Self-esteem 
• An unhealthy obsession with body type

Learning how body image affects mental health isn’t just important: it’s essential if you want to take care of yourself, feel better in your own skin, and help others do the same. There are four components to body image you should know: what you see when you look at yourself (perceptual), how that makes you feel (affective), what you think about it (cognitive), and what you do as a result (behavioral).

Here’s the kicker: Reality TV and social media can mess with any or all of these layers, creating a perfect storm for mental health struggles.

The good news? If you’re battling negative body image, you don’t have to go it alone. Therapy professionals are specially trained to help you spot reality TV’s toxic influence and flip the script on how you see yourself. They can even coach you through tough conversations about body image with friends and family, helping curate a more positive message to the people you care about.

Read More: Wondering How to Talk to Your Child About Their Body? Start Here 

The Popularity of Reality TV

Despite all the hand-wringing about reality TV’s impact on our mental health, we’re watching more of it than ever. In fact, reality shows now make up a staggering 57% of all available TV programming. The message is crystal clear — reality TV isn’t just a guilty pleasure anymore: It’s become part of our daily media diet.

How Reality TV Impacts Body Image

You’ve probably encountered at least one of the Love Island franchises, whether it’s the UK, Australia, France, Germany, or USA version. Yet, what stays consistent across every beach and villa is the show’s basic formula of putting conventionally attractive twenty-somethings in swimwear and watching them compete for love — and the troubling impact it has on how we see ourselves.

The numbers are pretty sobering. New research from the Mental Health Foundation reveals that nearly 25% of 18-to-24-year-olds say reality TV makes them worry about their body image. The newest debut of Love Island USA, season 7, exacerbates this widespread concern. The cast is another lineup of people who fit that narrow definition of “beach body ready” and have likely had cosmetic work done.  Love Island is certainly not alone in promoting unhealthy body standards, but researchers are particularly worried about the show’s so-called “Love Island Effect”: when viewers don’t just watch the show but also start questioning their own appearance and considering cosmetic procedures.

Despite the show’s lack of body diversity and some franchise changes, like offering mental health support for contestants after the show, Love Island USA celebrates the same, negative idea about body image: that true physical beauty does not include plus-sized bodies and only celebrates those with toned physiques and cosmetic enhancements.

Understanding how your TV habits affect your mental health is just the beginning. Actually building a positive body image, though, is the real work. Learn some concrete steps you can take to reset your perspective and find the support you need to feel good in your own skin.

How to Develop a Positive Body Image

As you grab the remote this week to turn on your favorite reality TV show, stop yourself and remember this key fact: the people you see on TV both represent skewed body ideals and likely struggle with body image issues themselves. 

While GoodTherapy’s expert therapists are ready to help you tackle any body image challenges head-on, you can start protecting your mental health right now with these three game-changing strategies:

1. Set Boundaries: Think of boundaries as your personal protection measures — whether physical, mental, or emotional. They’re your first line of defense in protecting your peace of mind.
2. Fight Back With Cognitive Dissonance: Recognize and combat toxic beauty standards. See something unrealistic? Call it out. Challenge it verbally or take action against it.
3. Remember the Ultimate Goal: Self-love isn’t one-size-fits-all. What works for your best friend might not work for you, and that’s okay. The freedom that comes with genuine self-acceptance? That’s universal.

These are the big-picture strategies, but let’s get practical. Here are some small but mighty actions that can transform how you see yourself:

• Start your day with positive affirmations (yes, they actually work) 
• Chase health, not a number on the scale 
• Spread compliments freely to others and yourself 
• Make a list of what you love about yourself (and read it often) 
• Catch yourself comparing and shut it down 
• Notice when your inner critic gets loud and stop it in its tracks 
• Remember you’re more than just a body: you’re a whole person

Fighting back against TV’s toxic body standards doesn’t mean you have to give up Bachelor in Paradise or stop rooting for your favorite Survivor contestant. It just means watching with your eyes wide open and recognizing your triggers so you can practice foundational skills in cognitive behavioral therapy (CBT). When you notice yourself making comparisons while watching Love Island, that awareness itself is the first step toward change.

Read More: Want to Learn About the Importance of CBT? Start Learning Now

How You Can Watch Love Island and Protect Your Mental Health 

You don’t have to navigate this mental health journey solo. GoodTherapy’s trained professionals understand how reality TV affects mental health. They’re equipped with tools and strategies to help you build a healthier relationship with your body image.

With the right support, you don’t have to break up with Love Island USA this summer. You can absolutely keep up with all the villa drama while also working on rebuilding your confidence and protecting your mental health. It’s not about choosing between entertainment and self-care: it’s about finding that sweet spot where you can enjoy both.

Ready to take that first step? Find the right therapist for you, today!

Sources:

Multidisciplinary Digital Publishing Institute: Body Perceptions and Psychological Well-Being

Reality TV Statistics by Shows, Franchise, Demographics and Popularity

Which American Genres Have the Highest Global Demand?

Popularity of Reality TV as Online Video Content Genre in the U.S. 2019-2023 as of June 2024, by Quarter

Mental Health Foundation Raises Fears About Impact of Reality TV on Young Viewers

The Issue of Diverse Body Representation on Reality TV Goes Way Beyond Love Island

Reality TV Fuels Body Anxiety in Young People, Survey Says

Very few people are one hundred percent happy with their physical appearance. Most of us have something about ourselves that we would like to change in some small way.

But for most of us, our perceived flaws do not interfere with our happiness or daily functioning. For those who have body dysmorphia, or body dysmorphic disorder (BDD), however, a small flaw—either real or imagined—can substantially reduce their quality of life. They may obsess and worry about the flaw for hours every day (Anxiety and Depression Association of America, n.d.). BDD is a serious mental health issue that can lead to suicidality and significant social and occupational dysfunction. Both men and women can experience BDD (Phillips & Castle, 2001).

People with BDD are often extremely preoccupied with their physical appearance and can become deeply upset over minor flaws that wouldn’t even be noticed by others. The person’s perception of the flaw, however unrealistic, often causes intense emotional distress and can trigger avoidance of social situations.

The preoccupation and obsession with flaws that comes with body dysmorphia can take away the ability to experience joy and healthy relationships. Some people with BDD undertake multiple cosmetic procedures to correct the flaw. Unfortunately, relief is likely to be short-lived at best. The root issue is not the flaw, which may be minor or even imagined. After the cosmetic procedures, the individual with BDD may simply focus on a different or “new” flaw.

The preoccupation and obsession with flaws that comes with body dysmorphia can take away the ability to experience joy and healthy relationships.

Emotional Neglect and Body Dysmorphia

Emotional neglect can be understood as a pattern in a parent-child relationship where the child’s needs are consistently ignored, disregarded, or devalued by the parent. Emotionally neglected parents often feel ambivalent towards their children’s emotional needs, particularly when they are distressed and crying (Didie et al., 2006). The parent may feel the child is impossible to please and—out of frustration—simply ignore and reject the child when they are upset. In this cycle, adults who were emotionally neglected as children tend to become emotionally neglectful as parents.

Emotional neglect is commonly found in both males and females diagnosed with BDD (Carey, Crocker, Elias, Feldman, & Coleman, 2009).

Emotional Neglect as Trauma

The body and the nervous system experience neglect in a way that is similar to abuse. The child who is not nurtured and cared for emotionally may experience continuous high levels of stress and sadness with no one to turn to for comfort. Over time, this can take a serious toll on the ability to develop resilience as the child matures into adolescence and adulthood.

Adults with histories of neglect often develop a range of emotional and mental health issues, including depression, low self-esteem, hyperactivity, and aggression. Neglect often leads to the child feeling unwanted and unloved, and it can lead to a distorted perception of the self.

In the case of BDD, emotional neglect may foster a distorted self-perception in terms of physical appearance. The individual with BDD may believe they are deeply flawed and unacceptable to others as a result of their physical appearance.

Developmental Timing and Neglect

The impact of physical and emotional neglect may be influenced by when it occurs during the child’s development. A child who is neglected during the early years of development can miss out on crucial opportunities for social, emotional, and cognitive development. An important factor that underlies each of these aspects of childhood development is the ability to develop resilience and cope with stress (Cicchetti & Toth, 1995).

Very young children and infants are not biologically capable of reducing the autonomic stress response once it is activated. During times of heightened emotional upset or fear, increased levels of stress hormones begin to circulate in the brain and nervous system. A child without comfort and guidance from an adult is forced to expend all of their energy in bringing the body and mind back to a balanced state. When the child is put in the position of having no help or comfort, all resources are expended and the child has little left for anything else. In this way, opportunities for development in other areas such as social and cognitive learning are lost.

As the child gets older, it is understandable why neglect can lead to intense feelings of shame and a distortion of body image. Body image is connected to self-esteem. When children grow and develop in circumstances that teach them they are unworthy of love and even send messages that there is something wrong with them, the child is likely to internalize these perceptions as they grow.

Therapy for Trauma and Body Dysmorphia

Exposure therapy (Neziroglu & Yaryura-Tobias, 1993; Linde et al., 2015) and cognitive behavioral therapy (CBT) can help some people process and heal the effects of past trauma and neglect. Cognitive behavioral therapy may be helpful for BDD because it helps the person discover the source of distorted and unrealistic perceptions. Once it’s understood where the negative thought patterns are coming from, CBT teaches us how to correct these patterns and then move into a more realistic and healthy way of thinking (Neziroglu & Khemlani-Patel, 2002). In this way, CBT can be effective in treating distorted perceptions of the body. At the same time, CBT can help in developing healthier thinking patterns that address depression and anxiety, which often co-occur with trauma and BDD.

If you think childhood emotional neglect or body dysmorphia are issues that could be impacting you, support is available. Reach out to a licensed and compassionate therapist.

References:

1. Body dysmorphic disorder (BDD). (n.d.). Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/body-dysmorphic-disorder-bdd
2. Carey, W. B., Crocker, A. C., Elias, E. R., Feldman, H. M., & Coleman, W. L. (2009). Developmental-Behavioral Pediatrics E-Book. Philadelphia, PA: Elsevier Health Sciences.
3. Cicchetti, D., & Toth, S. L. (1995). A developmental psychopathology perspective on child abuse and neglect. Journal of the American Academy of Child and Adolescent Psychiatry, 34(5), 541-565. doi: 10.1097/00004583-199505000-00008
4. Didie, E. R., Tortolani, C. C., Pope, C. G., Menard, W., Fay, C., & Phillips, K. A. (2006, September 26). Childhood abuse and neglect in body dysmorphic disorder. Child Abuse & Neglect, 30(10), 1105-1115. doi: 10.1016/j.chiabu.2006.03.007
5. Linde, J., Rück, C., Bjureberg, J., Ivanov, V. Z., Djurfeldt, D. R., & Ramnerö, J. (2015). Acceptance-based exposure therapy for body dysmorphic disorder: A pilot study. Behavior Therapy, 46(4), 423-431. doi: 10.1016/j.beth.2015.05.002
6. Neziroglu, F., & Khemlani-Patel, S. (2002). A review of cognitive and behavioral treatment for body dysmorphic disorder. CNS Spectrums, 7(6), 464-471. doi: 10.1017/s1092852900017971
7. Neziroglu, F. A., & Yaryura-Tobias, J. A. (1993). Exposure, response prevention, and cognitive therapy in the treatment of body dysmorphic disorder. Behavior Therapy, 24(3), 431-438. Retrieved from https://psycnet.apa.org/record/1994-26859-001
8. Phillips, K. A., & Castle, D. J. (2001, November 3). Body dysmorphic disorder in men: Psychiatric treatments are usually effective. The BMJ, 323(7320), 1015-1016. doi: 10.1136/bmj.323.7320.1015

Body dysmorphic disorder (BDD), or body dysmorphia, is a condition in which a person thinks their body is severely flawed. The flaw is either imagined or real but minor. For example, a person may have a small skin blemish that others hardly notice, but they develop a preoccupation with and an exaggerated perception of the flaw.

Typically a person’s focus is on their face, head, or the shape of their body. Excessive mirror-checking, grooming, or exercising can all be signs of BDD. The condition is closely related to obsessive compulsive disorder (OCD).

BDD usually begins to develop in adolescence. The average age of onset is 17 years, and studies have shown prevalence begins to drop off after age 44. Body dysmorphia is more common than one might think, occurring in around 2% of the population.

Symptoms of Body Dysmorphia

The following are common signs of body dysmorphia:

1. Extreme preoccupation with a physical flaw that is minor or can’t be noticed by other people.
2. A strong belief that said flaw makes you ugly or unattractive, no matter what the rest of your body looks like.
3. A belief that others take notice of the flaw or flaws in your appearance.
4. Constantly comparing your appearance to others.
5. Avoiding social situations due to shame about your appearance.
6. Always seeking reassurance about your appearance.

We live in a society that places much emphasis on beauty and youth, so it is normal to be concerned about our appearance. However, if your concern over how you look becomes obsessive, begins to interfere with your daily functioning, and/or causes significant distress, you may have BDD.

What Causes Body Dysmorphia?

A survey of individuals with body dysmorphic disorder found a significant association with child maltreatment. Specifically, 78.7% of individuals diagnosed with BDD reported early-life abuse, including:

• Emotional neglect (68.0%)
• Emotional abuse (56.0%)
• Physical abuse (34.7%)
• Physical neglect (33.3%)
• Sexual abuse (28.0%)

A child raised by a neglectful parent is unlikely to have had the opportunity to develop good coping skills. For some individuals with BDD, it seems that as a result of maltreatment, they may internalize grief and pain. In time, the individual comes to believe that there is something wrong with them or their body.

Researchers have found that individuals suffering from BDD have abnormal brain network organization. The greater the symptom severity, the greater the disturbances in functioning and organization compared to people without BDD. Researchers also found evidence of abnormal connectivity in visual regions and emotional processing, indicating a deficit in information processing within these brain regions.

Treatment and Outcomes for Body Dysmorphia

Body dysmorphia is a serious issue and should not be treated as simple vanity. Individuals experiencing BDD have a higher risk of suicide as well as impeded social and occupational development. BDD often does not go away without treatment. If left untreated, body dysmorphic disorder can lead to depression, anxiety, and extensive medical expenses.

Body dysmorphia is a serious issue and should not be treated as simple vanity. Given the long-term course of BDD and the significant impact on quality of life, it is important for affected individuals to seek treatment. While there are neurological differences in patients with BDD, it is possible to effect changes in neurological functioning. The brain is plastic and retains the ability to change throughout the entire lifespan.

The most common forms of treatment for BDD are cognitive behavior therapy (CBT) and pharmacotherapy. In a recent study, the medication of choice was a selective serotonin reuptake inhibitor (SSRI). Investigations examining the use of pharmacotherapy and CBT in tandem have found combined therapy to be effective.

BDD may require long-term therapy, and many patient populations are not willing or are unable to take SSRIs, such as pregnant women. However, CBT has been shown to be very effective and is often a preferred course of treatment. CBT has been shown to improve outcomes both when it is the only treatment and when it is combined with medication.

If you or a loved one is experiencing body dysmorphia, you can find a therapist here.

References:

1. Arienzo, D., Leow, A., Brown, J. A., Zhan, L., GadElkarim, J., Hovav, S., & Feusner, J. D. (2013). Abnormal brain network organization in body dysmorphic disorder. Neuropsychopharmacology, 38(6), 1130-1139.‏ Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3629399
2. Bjornsson, A. S., Didie, E. R., & Phillips, K. A. (2010). Body dysmorphic disorder. Dialogues in Clinical Neuroscience, 12(2), 221-232. Retrieved from ‏ https://www.ncbi.nlm.nih.gov/pubmed/20623926
3. Buhlmann, U., Marques, L. M., & Wilhelm, S. (2012). Traumatic experiences in individuals with body dysmorphic disorder. The Journal of Nervous and Mental Disease, 200(1), 95-98. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22210370
4. DeVos, K. (2017, September 5). Examining the link between body dysmorphia and PTSD. Retrieved from https://www.eatingdisorderhope.com/blog/examining-body-dysmorphia-ptsd
5. Hong, K., Nezgovorova, V., & Hollander, E. (2018). New perspectives in the treatment of body dysmorphic disorder. F1000Research, 7.‏ Retrieved from https://f1000research.com/articles/7-361/v1
6. Koran, L. M., Abujaoude, E., Large, M. D., & Serpe, R. T. (2008). The prevalence of body dysmorphic disorder in the United States adult population. CNS Spectrums, 13(4), 316-322.‏ Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/18408651
7. Vitiello, B. (2009). Combined cognitive-behavioral therapy and pharmacotherapy for adolescent depression. CNS Drugs, 23(4), 271-280.‏ Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671638

Adolescence is well known to be a challenging time. Much has been written about the difficulties of early adolescence, especially as it relates to the development of girls. Dr. Mary Pipher’s 2005 book, Reviving Ophelia: Saving the Selves of Adolescent Girls, written from her years of experience working with young women in therapy, is an exploration of her discovery that the process of developing into women is painful for many girls. Development in young women, she found, often involves the loss of self, which happens as girls internalize the pressure to be in service to others by becoming what other people seem to expect of them. In this way, they are fulfilling the desires of others. These pressures can manifest in many ways. The onset of negative body image or eating disorders are just two examples.

In my practice I have seen this loss of identity myself, in people who have struggled for years with disordered eating and poor body image. Many young women make an effort to control and hide their emotions by over-focusing on the body, hoping to earn back a sense of stability by attaining a certain ideal. But when attempts of trying to cope with difficult feelings and social pressures are externally focused, girls can end up losing who they are in the struggle.

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Rather than determining on their own who they are and how they want to navigate adulthood, many girls don’t know how they feel about anything, independent of the opinions of others. They cannot identify their likes or dislikes, and they no longer know what they stand for anymore. Sometimes they are unable to determine whether they are angry, bored, or hungry. They talk about feeling lost. I have found that the more time girls have spent fixated on the body and the way they look, the more work they often have to do to reclaim their sense of self.

Recently, researchers have been studying how social media affects the development of young women today. Consumption of social media can contribute to poor body image. One study found an overwhelming majority of girls had both home internet access and social media accounts. The time they spent online “significantly related” to unhealthy body monitoring and the internalization of the thin ideal. Further, the girls who used Facebook scored higher on all body image concern measures than those who did not use Facebook (Tiggermann &  Slater, 2013).

In another study, girls who had positive body images tended to be critical of the body ideals presented to them on social media and had a more complex and personal view of beauty. The authors discussed the importance of teaching media literacy and feminist theory to create more resilience in young women faced with societal pressure to achieve and maintain a certain type of body or appearance.

Helping Young Women Develop Strong Selves

We often cannot prevent the young women in our lives from being exposed to pressures such as the thin ideal, but we can protect them. Specifically, we can help girls increase their resilience by encouraging the growth and sustenance of a strong sense of self.

• Open discussion of the ways society pressures girls to please others and conform to certain standards of beauty can help them understand how and why these standards are flawed. Talk openly at home with young teens about their social experiences. Do they feel pressured to fit in by conforming to the expectations of others? Encourage them to question how they can grow their strongest sense of internal self if they focus on external aspects.
• Avoid focusing on body size or shape. Encourage them to give time and attention to interests that are not about the body or appearance. Encourage nutritious food choices and physical activity in addition to other healthy habits, but avoid “diet talk” and discussion of size or weight (your own as well as theirs—if you disparage your own body, your child is likely to absorb this language and behavior). Speak of food in terms of the energy it provides and how it fuels the body, not in terms of how it affects size.
• Encourage them to critically reflect on gender role expectations, especially with regard to their bodies. Is their body for strength, movement, their own enjoyment—or is it there for the pleasure of others? Does it matter to them what others think of their body? If so, why? What do they personally see as an ideal body? Where did they get that idea from?
• Encourage them to think critically about the ideas they encounter. If they show you a photo of a friend on Facebook and comment on the person’s appearance, or compare their own, take the opportunity to discuss their thoughts (without criticizing them). Ask why they feel the way they do. Ask how the images they see online make them feel. You might share how how social comparison in general makes you feel, and ask how it makes them feel.
• Allow for a full range of expressed emotion. We learn about boundaries and self-regulation through expression. Allow your children to (safely) be happy, sad, angry, excited, or anything else. Encourage them to explore healthy coping methods for difficult emotions, and help them learn to practice self-regulation so they do not feel the need to conceal, suppress, or escape their feelings.
• Be a good role model for emotional self-acceptance and self-care. Showing your own acceptance of and love for all aspects of your body is one of the most effective ways to help your children learn to love and accept their own bodies. Devote regular time to self-care, and encourage your child to do the same.

If you are unsure of how to begin exploring any of the above issues with your child, the support of a compassionate, qualified therapist or counselor may be of benefit. You might also consider seeking professional help if you struggle with your own emotions or sense of self or if your daughter is preoccupied with her weight or body and these conversations do not seem to helping.

We recognize the many challenges of adolescence, especially those related to body image and social pressures, are not specific to girls and young women. While this article focuses on the experience of young women, individuals of any gender may experience body image issues and disordered eating. If you (or your child) are struggling, we encourage you to seek support from a counselor. Help is available for all. 

References:

1. Pipher, M. (2005). Reviving Ophelia: Saving the selves of adolescent girls. New York, NY: Riverhead Books.
2. Holmqvist, K., & Frisén, A. (2012). “I bet they aren’t that perfect in reality:” Appearance ideals viewed from the perspective of adolescents with a positive body image. Body Image, 9(3), 388-395. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22542634
3. Santa Cruz, J. (2014, March 10). Body image pressure increasingly affects boys. The Atlantic. Retrieved from https://www.theatlantic.com/health/archive/2014/03/body-image-pressure-increasingly-affects-boys/283897
4. Tiggermann, M., & Slater, A. (2013). NetGirls: The internet, Facebook, and body image concern in adolescent girls. International Journal of Eating Disorders, 46(6). 630-633. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23712456

How many of us struggle with weight loss, frustrated when we achieve less than our desired results? Assuming you have ruled out possible medical causes contributing to difficulty with weight loss, some of the most powerful forces that can inhibit weight loss are the barriers that exist in our heads.

That being said, many of the emotional barriers to weight loss are not initially obvious, so it is important to identify common emotional barriers and be honest with yourself about how they might be affecting you. Once you better understand any psychological factors that may be holding you back, you may be better able to tackle them.

Several common emotional barriers are described below.

How We Think About Weight Loss

If we think we’re going to fail, we are more likely to fail. Less-than-successful weight loss attempts in the past can contribute to self-defeating thoughts and/or the belief that we lack willpower. This may create the (false) belief that our destiny is to be stuck where we are now.

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If you don’t believe you can lose the weight you want to lose, it will be extremely hard to do so. Skepticism and self-doubt can easily stand in the way of making lasting, positive lifestyle change.

All-or-nothing thinking

Many people attempting to lose weight focus solely on results, look for immediate progress, and tend to view any setbacks as failures (disproportionate to how others may view the setback in question). Sometimes setbacks experienced may lead people to abandon the healthy changes they are trying to implement. The pattern of thinking often becomes, “If I can’t do this exactly the way I want to do it, what’s the point of doing it at all?”

Not prioritizing the changes we want to make

Many of us are busy and have many things demanding our attention and time. We may be regularly spread in multiple directions. But people who want to lose weight may, as a result of lacking the time or resources to plan nutritious meals, exercise, get enough sleep, and so on end up making choices that do not further this goal.

By sending ourselves the message, however unconscious it may be, that we don’t have time to address weight loss and other health goals, we are making it more challenging to find or set aside time to achieve these things. If we move this item up on our to-do list, we are more likely to remain aware of our desires and goals and less likely to make choices that will sabotage them.

How We Think About Ourselves

Negative body image

Adopting a positive body image is a challenge for many people. Though some may recognize they harbor a negative body image, they may not recognize how this is holding back their weight-loss attempts. Some may attempt to shame themselves into losing weight by repeating negative messages about how they look, but these internalized messages are generally more likely to frustrate a person and disrupt weight-loss attempts even more. Consequently, people then struggle to overcome these negative messages while also attempting to lose weight.

Ourselves vs. others.

You are you. Your body is yours. Someone else’s body or weight-loss journey is their own. It may seem motivating to compare ourselves with others, but all too often this can lead to feelings of failure when we fall short in comparison. What works for one person might not work for another. Recognize that your weight-loss journey is yours alone. Your plan of action is yours alone.

It can also help to keep in mind that bodies come in all shapes and sizes, and some desired sizes and shapes may simply be unattainable for certain body types.

Stress and Emotional Health

Life (or daily) stress

It may come as no surprise that, when we are going through a challenging time, the associated stress can affect both our appetite and how we typically respond to stress. Through past experiences, we have learned eating can often  bring comfort. While “emotional eating” and “comfort foods” often do make us feel good, eating in response to emotional cues or even simply out of habit can have the effect of reinforcing the patterns we are trying to overcome. Breaking these patterns can be much harder than we realize.

The goals that are most conducive to success are those that are realistic, specific, and attainable. If we want to see results, it is far better to adapt our ideal goals to fit these parameters than to wish for something that is abstract or unrealistic. By doing so, we are more likely to succeed. 

Mental health status

Similarly, many mental health conditions, depression among them, can affect both appetite and subsequent eating behavior. Depression is also often associated with decreased motivation, decreased self-efficacy, and lack of interest, all of which can negatively impact the ability to achieve goals. While depression (or stress, for that matter) may be associated with weight loss in some individuals, these changes may not be sustained, since they have not been achieved mindfully.

Overcoming Barriers to Weight Loss

Learn how to set goals that work for you.

The goals that are most conducive to success are those that are realistic, specific, and attainable. If we want to see results, it is far better to adapt our ideal goals to fit these parameters than to wish for something that is abstract or unrealistic. By doing so, we are more likely to succeed.

Make yourself accountable.

After you make a commitment to yourself, share your plan with someone else. Articulating a plan to others can reinforce the level of commitment to the plan while also introducing social motivators. Setting reminders with digital technology or hanging up a motivating sign at home or in the office can also help us keep our goals in mind.

Modify your thinking.

Pay attention to the messages you’re telling yourself, honing in on any negative or unproductive thoughts. Then consciously challenge these thoughts, replacing them with messages that reflect greater self-compassion. This is important to do in so any realm of personal thought, but particularly around weight management and body image. Our behaviors play a large role in weight loss, and our thinking really does help drive our behavior.

Learn to regularly manage stress.

Ideally, stress management techniques will be a part of your daily routine. Developing healthy coping responses to stress can be helpful for many reasons, reducing emotional eating among them. Prioritizing regular self-care can be one way to help manage stress.

Educate yourself about weight loss.

Many of us want to lose weight. When we struggle, when our attempts fail, or when we gain back weight we have lost, we may wonder what we are doing wrong. But knowledge is power, and making a plan based on misleading information is likely to inhibit progress.

Weight loss does not have to cost a lot of money, nor does it require a gym membership. There is a lot of data that supports the type of approaches that can be effective—and those that are often less effective. Trending diets, expensive meal plans, and other fads may seem to yield results for others, and they may indeed yield results for anyone at first, but they are less likely to lead to lasting behavioral change.

Seek outside support.

There is help out there. An entire industry, in fact. A variety of professionals can help you meet your weight-loss goals, not just for the immediate future, but for the long term. Many of these professionals also have a solid understanding of the role that emotions can play in weight management and/ or obesity. Finding a professional you enjoy working with, and/or a program or group you enjoy participating in, can make all the difference to your goals.

Talk it out.

If you struggle to lose weight, consider speaking to a therapist about any emotional causes that may be contributing to these challenges. Many therapists or other trained professionals can help provide support and education to help identify and explore barriers that may be holding you back.

As an eating disorder therapist, I work with people in all stages of their recovery journey. One question I am often asked is, “How do I move from body dissatisfaction to body acceptance?”

To answer, I often remind the person I’m working with to focus on the function of the body instead of its form. I remind them to take note of—and express gratitude for—the everyday motions and actions that are feasible because of their body.

We can all benefit from learning to relish the genuine sparks of affection and admiration we have for ourselves when we get a new haircut, put together a fresh outfit, or put on that one pair of pants we know really make our butt look great. With time and practice, these moments of self-admiration can lead to an internal dialogue that is centered on appreciation and gratitude for our bodies instead of a dialogue that is judgmental and focused on finding our flaws.

While some may have been told to spend time engaging in positive affirmations, forcing ourselves to repeat “I am beautiful” often falls flat. There is certainly a time and a place for positive affirmations, but without a dedicated practice through which we train ourselves to think differently about our bodies, those affirmations are not likely to take us very far. [fat_widget_right]

The ‘Appearance Ideal’ and Cognitive Dissonance

I recently read through The Body Project’s structured group manual, which aims to decrease body dissatisfaction and harmful eating behaviors by increasing cognitive dissonance around the “appearance ideal.” The appearance ideal describes the widely accepted portrayal of the “perfect” female body: a figure that is slim and toned but still curvy (breasts and buttocks). The Body Project intervention, which challenges this ideal through cognitive dissonance, is a fascinating concept that has been tested rigorously over the years with overall positive results. According to the National Eating Disorders Association, this intervention can reduce the risk of eating disorders.

We can all use cognitive dissonance concepts and activities (these might range from verbally combating the appearance ideal to taking personal action against it) in our everyday lives. It is my belief that doing so can do a great deal to help us find that body acceptance we are striving for.

The cover image I see doesn’t depict a person as they are in reality. Rather, it illustrates what society tells me I should look like, despite the fact that such a goal is not realistic or healthfully attainable. By reminding myself of this, I am increasing my cognitive dissonance and ultimately challenging the unspoken belief many of us have unwittingly bought into—the idea that we must look a certain way or, at the very least, be striving to change ourselves, in order to be accepted by society.

Let’s begin by verbalizing statements that counter the appearance ideal. For example, we might maintain an internal dialogue as we confront the daily barrage of advertisements, TV shows, and even people we see who spark that societal idealization of thinness. I have found the checkout line in the grocery stores to be a perfect space for this, as any number of magazines featuring ultra-slender models staring at me (and my cart full of groceries) can usually be found here. When I see these magazines, I find it helpful to remind myself of the amount of effort it likely took to portray those (frequently female) models in that way. “How costly were the clothes?” I might ask myself. “How many pins did it take to make them lay just so?” “How much photo editing went into making sure no creases, dimples, or freckles were visible?”

I then take a deep breath and verbalize what I know is true: The magazine serves no other purpose than to sell itself. The cover image I see doesn’t depict a person as they are in reality. Rather, it illustrates what society tells me I should look like, despite the fact that such a goal is not realistic or healthfully attainable. By reminding myself of this, I am increasing my cognitive dissonance and ultimately challenging the unspoken belief many of us have unwittingly bought into—the idea that we must look a certain way or, at the very least, be striving to change ourselves, in order to be accepted by society.

We can also take action to increase that cognitive dissonance within ourselves. The Body Project’s manual describes an activity that might be a good place to start!

• Stand in front of a mirror, naked or minimally clothed. Study yourself and list 10 things you like about yourself. You can choose qualities that are emotional, intellectual, or social, but some of them should also be physical attributes. The activity has no other limits.

Many find the above exercise to be helpful and empowering, but it can be difficult to enter this space with ourselves. The activity requires women in particular to challenge many social norms, beginning with ideas that women should be modest or humble. Many women may never have been encouraged to (and may have been actively discouraged from) calling attention to things they like about themselves.

If you’re familiar with the movie Mean Girls, this may call to mind the scene where the three friends (Regina, Gretchen, and Karen) dutifully observe and call out their flaws to one another and seem shocked when Cady, the newcomer, struggles to find something negative to say about herself. Developing a vocabulary of positive attributes associated with our bodies tends to make it more difficult to fall into an automatic flaw-finding mentality. Again, this takes practice. I encourage you to try it once a week and see how your list might change. Stop yourself and breathe if you notice only negative attributes, and challenge yourself to see function over form. For example, you might think of your feet as just feet. But consider what purpose they serve in your life. If it feels too daunting to identify 10 items at first, start with one and slowly build up from there.

Maintaining a Practice of Gratitude in Public

It’s one thing to be able to privately have these empowering conversations with ourselves. But it can be quite another to bring these ideas into the light. How can we strive to maintain our practice of gratitude toward our bodies in the public arena? My personal challenge is to change the dialogue if I notice friends getting sucked into “diet” talk or if I hear them highlighting aspects of their bodies they want to change.

I have found that sharing a personal belief, such as “All foods are good foods in my book” can help to shift the conversation into less negative territory. Another tactic you might try is sharing your personal gratitude for your body with others. Notice how amazing it is that your legs can carry you on walks or hikes with friends, or appreciate the dexterity of your fingers as you maneuver chopsticks.

It can also be helpful to publicly state your boundaries around body talk. For example, you might say there’s no negative body talk allowed in your home. Follow through with these boundaries by reinforcing positive body talk and redirecting conversation in a way that challenges the appearance ideal.

These concepts and practices can help us build ourselves up through positive body talk and combat the appearance ideal found in the media and daily life. Ultimately, they can also help us find a path to greater body acceptance. By continuously challenging our society’s unrealistic body ideals, we can internally shift our dialogue about our own bodies and ultimately the environment we find ourselves in.

If you or someone you know is struggling with body image, consider speaking to an compassionate and qualified therapist or eating disorder specialist in your area.

References:

1. Home/Get involved: The body project. (2016). National Eating Disorder Association. Retrieved from https://www.nationaleatingdisorders.org/get-involved/the-body-project
2. The body project. (n.d.). Retrieved from http://www.bodyprojectsupport.org
3. Stice, E., Shaw, H., & Rohde, P. (n.d.). Body acceptance class maunal: Enhanced-dissonance version. Retrieved from http://www.bodyprojectsupport.org/assets/pdf/materials/bodyproject4sessionscriptandhandouts.pdf

“If you try to lose weight by shaming, depriving, and fearing yourself, you will end up shamed, deprived, and afraid. Kindness comes first. Always.” —Geneen Roth

Fat.

Adipose. Flesh. Avoirdupois. Chub. Paunch. Flab. Corpulence.

It’s difficult to think of an aspect of the human body more complex and controversial than fat, aside, perhaps, from sexuality. During medieval times, when famines could and did occur, corpulence was valued because fat symbolized wealth, or the possession of resources that conveyed invulnerability to life’s ups and downs. As such, it was seen as if not desirable, then at least neutral (Vigarello, 2013). For peasants and members of agricultural societies, obesity was practically unheard of.

In modern Western culture, however, the tables have (mostly) turned. Today, for the most part, wealthier people tend to have access to healthier, more nutrient-dense foods. The higher nutrient density keeps total calorie intake much lower, since more nutrients and fiber satiate the body quickly with fewer calories (Furman, 2011).

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Less economically fortunate people, on the other hand, tend to not have much fresh, healthy food available in their neighborhoods. Even when fresh food is available, they may lack sufficient income to purchase it. Social justice activists have coined a term for when a community lacks access to healthy food: “food desert”. With fast food or junk food being much more economical and widely available to people living near or below the poverty line, it may be easier for people living in poverty to put on pounds.

The issue remains complex, with many different variables. As far as modern social attitudes towards extra fat go, many dislike it, even loathe it. Certainly, many people don’t like it on their own body, but some even become angry when they see abundant adipose tissue on someone else’s body. For some, fat is part of a truly vicious cycle of self-loathing. Geneen Roth writes that when she was in her twenties, she hated her fat so much, she wanted to slice it off with a knife. Then she would have been standing there, trembling and bleeding, but at least she would be thin.

As far as modern social attitudes towards extra fat go, many dislike it, even loathe it. Certainly, many people don’t like it on their own body, but some even become angry when they see abundant adipose tissue on someone else’s body. For some, fat is part of a truly vicious cycle of self-loathing.

Others passionately defend fat and its hosts. The fat acceptance movement has risen to defend people from fatphobia, or the unwarranted ostracism, contempt, and bullying frequently experienced by heavier people. Still others may fetishize fat, forming a subculture around the care and feeding of those too large to get out into the world and fend for themselves.

Medically speaking, fat tissue has been implicated in its associations with cancer, heart disease, diabetes, arthritis and other inflammatory diseases. Some people debate the validity of these assertions, pointing to research showing that in some cases, being what’s considered “slightly overweight” may in fact lower mortality rates. Further, movements such as the Health at Every Size movement point out that body shapes and sizes are diverse, describe the harm restrictive dieting can cause, and work to promote health without focusing on weight loss.

The Issue of Fat

As you can see, the issue of fat is very complex. In this article I am emphatically not taking any position as to the goodness or badness, nor as to the beauty or ugliness, of this embattled tissue. Rather, I want to explore: What is fat, and what is it doing for us? There are high levels of vehemence, vitriol, and medical admonishment against fat, yet many people carry what is considered by current medical standards to be excess poundage. There must be some function or functions powerful enough to override the tremendous social forces against it. What is going on here?

First, let’s look at the overall somatic context. The human body consists of multiple types of tissues, which tend to occur in layers.

Muscle tissue comes in two types: smooth (usually involuntary, like intestines or uterus) and striated (voluntary skeletal muscles that move our limbs and support our core).

Bone, though often ignored or underrated, is an amazing part of our bodies. Living bone has a pinkish tinge and is more flexible than the rigid, white bone that comes more readily to mind. It gives structure and support, and provides “spacers” for the muscular system (without it, the muscles that attach to and move the bones would contract into tight little balls). The marrow of bones produces blood and immune cells.

Our skin (which itself comes in several layers) is a vital part of our sensory system. It blocks water loss, UV rays, and germs; regulates temperature; and provides a boundary between our bodies and the greater world.

The fascia is a connective tissue that penetrates all other tissues and binds us together. Muscles slide over its smooth surfaces, and it prevents our organs from sloshing around inside us like a big bag of goo.

Our nervous system (brain, spinal cord and peripheral nerves) controls the body via nerve impulses and signals to release hormones.

Our fluid system includes blood, lymph, digestive fluids, and interstitial (between-cell) fluids. It transports oxygen, cellular wastes, hormones, glucose, and other nutrients.

And then there is fat.

Fat does many things for its host organism. As most people know, it can be considered a kind of “energy savings account” in case of famine or illness. Fat provides insulation, particularly against cold, and padding, so our bones don’t grind on the surfaces we sit or lean on. Fat forms part of the breast tissue, allowing mothers to feed their infants, and is also involved in hormone production

Some believe fat stores toxins in a way that makes them inert, or prevents them from damaging the vital organs, though I must point out that I don’t know whether this claim is backed by scientific evidence. I do recall a long-ago evening in which a friend and I took a long walk (of about three hours) to the beach. He had recently quit using marijuana and hadn’t used any at all for several months. The walk was long enough that metabolically, we both switched from running on blood glucose to primarily burning accumulated fat stores. By the time we got back to my house, he was, as they say, high as a kite—without having taken a single hit of marijuana.

And then there is another function of fat, one that’s not so commonly discussed. I don’t know whether or not it has been demonstrated in any medical literature, but eating disorder therapists (and many who overeat, binge eat, or experience a related type of disordered eating) will know this one: Fat is an emotional insulator.

How Fat Can Help Insulate Us from Emotions

Having extra fat on the body can help protect against feeling the intensity of unprocessed emotions. It’s like a thick coat of insulation on an extremely high-voltage wire. In this regard, it helps keep us in some semblance of balance, able to exist and function without becoming completely obliterated by our own emotional charge.

We have to live life on life’s terms, and these terms are not always kind. At any moment, even when we are young and vulnerable children, life can hand us events that are just too big for us to deal with in an efficient or comfortable manner.

We have to live life on life’s terms, and these terms are not always kind. At any moment, even when we are young and vulnerable children, life can hand us events that are just too big for us to deal with in an efficient or comfortable manner. The emotional aspect of our survival energies tends to be unbelievably strong. Repression may cut us off from old, unprocessed emotions, but blocking or repressing emotions may only work up to a certain extent.

What might happen if a person carries such large emotional charges without insulation of some sort, or other cut-off strategies such as substance abuse? I have heard many people making statements similar to these:

• “You know those cables that come out of the big power plants? Well, I felt like I was plugged into one of those. Or riding a lightning bolt. I just couldn’t shut it off.” (Note that the relationship between trauma and bipolar is sometimes murky; experiencing a state such as this does not necessarily mandate a diagnosis of bipolar.)
• “I couldn’t move. I couldn’t get out of bed. I tried. It was like when you push the gas pedal in your car, but nothing happens.”
• “I just felt awful. It was like wave after wave of the worst, cruddiest feeling was washing over me.”
• “When I lost weight, I constantly felt vulnerable. Like everyone was looking at me and could see right to my core. When I’m fat, I’m invisible.”

Still others have talked about the sense that their experience with psychosis or other mental health issues began in part because their systems just couldn’t contain the terrible traumas they had experienced. I believe this sheer intensity is the true meaning of the word overwhelmed and, in my experience, sufficient to explain why some people find themselves overweight.

These days, many people are talking about the Adverse Childhood Experiences study. A physician treating obesity at Kaiser noticed that his most successful patients—those who had lost the most weight—were dropping out of his program. Intrigued, he arranged for follow-up with the ex-participants, who shared that their weight loss brought up old traumatic emotions from childhood. It was easier to live life with morbid obesity, despite any pain and inconvenience it might cause, than it was to face those old feelings.

That is testament to the power of old trauma, and of fat as a semi-conscious strategy to help contain it.

Certainly, the issue of excess body fat is very complex, and so are the people who carry it. Genetics undoubtedly play some role in a person’s predisposition to weight gain. Others may live in food deserts or, out of choice or necessity, fall into habits that support weight gain. Athletes who get injured and don’t change their food intake are prone to gaining weight. Some people also tend to overeat as a way of bolstering their overall energy when tired (Dr. Judith Orloff calls this “energy defensive eating”).

In short, if you have a lifestyle where you are constantly running on fatigue and overwhelm and/or neglecting your own needs for the needs of others, it can be easy to gain weight—particularly if you have a “sit-down” job. Researchers and medical experts have begun to point out that sitting for long periods of time can negatively impact health. Some have even called it the “new smoking.”

Society exerts tremendous pressure to conform to a thinner body standard. This social pressure often contributes to internal pressure. But all people, regardless of their size, deserve compassion and kindness—from themselves as well as from others—not judgment or ostracism. If someone is insulating their feelings with a layer of fat, then the more cruelty they experience, the more entrenched their defenses are likely to become. Even if their size causes them distress, they may find it all the more difficult to lose weight.

Our bodies come in all shapes and sizes, and we cannot completely control the way they look. We really never know what life will end up bringing us, and to some extent, we must accept what life has already handed us. As with any aspect of the human condition–there but for the grace of luck, circumstance, and the genetic lottery, go all of us.

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Those who struggle with difficult emotions and/or overwhelm and desire to lose weight but haven’t been able to (in other words, if this article speaks to you) might consider working with a compassionate therapist trained in helping people increase affect tolerance and move gently into and out of old feelings.

“Fat-bashing in all its varied forms–criticism, exclusion, shaming, fat talk, self-deprecation, jokes, gossip, bullying–is one of the last socially acceptable forms of prejudice. From a very young age, before they can walk away or defend themselves, women are taught that they are how they look, not what they do or what they know.” —Robyn Silverman, Good Girls Don’t Get Fat: How Weight Obsession Is Messing Up Our Girls and How We Can Help Them Thrive Despite It

References:

1. Afzal, S., Tybjaerg-Hansen, A., Jensen, G., & Nordestgaard, B. G. (2016). Change in body mass index associated with lowest mortality in Denmark, 1976-2013. JAMA. doi:10.1001/jama.2016.4666
2. Brown, H. (2015, November 17). The obesity paradox: Scientists now think that being overweight can protect your health. Quartz Media. Retrieved from https://qz.com/550527/obesity-paradox-scientists-now-think-that-being-overweight-is-sometimes-good-for-your-health
3. Furman, J. (2011). Eat to live: The amazing nutrient-rich program for fast and sustained weight loss. New York, NY: Little Brown and Co.
4. Gerstacker, D. (2014, September 5). Sitting is the new smoking—7 ways a sedentary lifestyle is killing you. The Active Times. Retrieved from https://www.theactivetimes.com/sitting-new-smoking-7-ways-sedentary-lifestyle-killing-you?utm_source=huffington%2Bpost&utm_medium=partner&utm_campaign=sitting
5. Roth, G. (2011) Women, food, and God. New York, NY: Scribner.
6. Scutti, S. (2017, September 22). Yes, sitting too long can kill you, even if you exercise. CNN. Retrieved from https://www.cnn.com/2017/09/11/health/sitting-increases-risk-of-death-study/index.html
7. Vigarello, G. (2013). The metamorphoses of fat: A history of obesity. New York, NY: Columbia University Press.

Most people would agree the media today is inundated with unrealistic portrayals of women’s bodies. Because of practices such as choosing primarily thin, young, white women to sell products and using Photoshop to erase natural “flaws” and “imperfections,” to name a few, we are not exposed to a diverse (one might also say realistic) array of people. Consequently, generations of people grow up believing their appearance is inferior because it is not widely represented or considered to be “ideal.”

In my practice, I frequently work with women who are struggling with anxiety. Concerns related to weight and body image almost always come up as a contributing fact—in no small part, I believe, due to the media messages regarding the “ideal” body. Many people today have a tremendous fear of being judged for weight gain or their size. Fears and insecurities surrounding the body may take many forms. Some may fear being passed up for promotions or being looked down on at work due to weight stigma or sizeist stereotypes. Other individuals might fear never having a romantic relationship because potential love interests consider their size unacceptable.

Fears contributing to general feelings of anxiety may not always be rational, but unfortunately, weight stigma is a real concern in our society. The size-based discrimination and prejudice many people experience is likely to contributes to or exacerbate feelings of anxiety, depression, and other mental health challenges. Thus, these feelings of anxiety in particular may be more difficult to address. Further complications often result when, in an effort to achieve what societal messages suggest to be an “ideal” body, people develop unhealthy relationships with food and their bodies to achieve this ideal. [fat_widget_right]

From one fad diet to the next, the message is often the same: restricting food and ignoring the body’s natural hunger cues will lead to perfection. Instagram and other social media platforms are filled with pictures of plates of vegetables and videos of workouts meant to inspire. Whether a diet is low-fat, low-carb, or sugar-free, it does not often promote the development of a healthy relationship with all foods.

Take the current trend of clean eating as an example. Clean eating moralizes and judges foods by designating some as “clean” (and therefore acceptable to eat) and implying that consuming foods not considered clean results in the ingestion of dirty or toxic substances. Cleanses, or highly restrictive fasts meant to rid the body of perceived impurities, are increasingly popular, and people talk about “cheat days” as if they are committing a crime by eating sweets or processed foods. It is common to see posts in which people apologize for eating “unclean” foods or say they are being “bad” for eating them.

Clean eating has become prevalent enough that the term orthorexia nervosa was developed to help describe it when taken to an extreme. Though orthorexia is not currently listed in the Diagnostic and Statistical Manual, it bears similarities to other eating disorders. People with symptoms of orthorexia are often so fixated on living a “clean life” that they restrict their food intake to certain items and exercise excessively for purported health reasons. This fixation can have a serious impact on a person’s mental and emotional well-being as well as their physical health and social life.

This may seem like a radical idea, but you are perfect just the way you are, regardless of your size. Your worth is not determined by a number on the scale or a size of clothing. Focus on the beauty and strength you find in yourself and build on those aspects.

Of course, there is nothing wrong with wanting to include nutritious foods into our diets or making sure we exercise to keep our heart and bodies healthy. But somewhere along the line, eating became an act that was no longer intuitive. Years of yo-yo dieting, eating on prescribed schedules, or restricting entire food groups has taken its toll on our physical and mental health, to the point where we no longer trust our own bodies to tell us what, when and how to eat. Movement and physical exercise are no longer simply enjoyable activities, but rather the means to a thin end.

So, what is the answer? How can a person combat body anxiety amid internal and external pressures and messages faced on a daily basis?

The following five ways can help you begin to let go of anxiety and become better able to practice self-love.

Start to build trust in yourself.

Instead of constantly fighting your body, learn to trust it. Intuitive Eating is a philosophy that focuses on teaching people to trust their food desires and hunger cues. Many dietitians are teaching the people they work with to listen to the body’s messages, whether they desire “good” food or “bad” food. It is often a long process, but once your body learns you will no longer restrict certain foods or allow it to go hungry, it will tell you exactly what nutrients and type of food it needs.

Embrace yourself as you are today.

So many people put off adventures, shopping, and life events because they are waiting until they reach a certain weight or body shape. Let’s instead learn to love ourselves just as we are today. This may seem like a radical idea, but you are perfect just the way you are, regardless of your size. Your worth is not determined by a number on the scale or a size of clothing. Focus on the beauty and strength you find in yourself and build on those aspects.

Know your triggers.

Just like any other form of anxiety, body anxiety can be triggered by certain words, people, or actions. Become familiar with who or what sends your anxiety about your body skyrocketing, and then develop a plan. Avoid unnecessary triggers and be prepared for those that are unavoidable.

For instance, if you avoid going to the doctor because you become anxious when you are weighed, let the staff know ahead of time that you do not plan on stepping on the scale. If you have family members who make it their business to comment on what you eat or how you look, prepare a response for them and have it ready so you are not flustered or too embarrassed to address their remarks. By taking these actions you can be more proactive in reducing your anxiety.

Change your feed, not your food.

It can feel overwhelming when you are constantly confronted with images of the “ideal” body type or when all you seem to see in your social media feeds are posts about diets and weight loss. But remember, you have the right to remove anything that feels shaming (this includes people who make you feel ashamed!) from your social media feed and replace them with people and messages that inspire you to love yourself just as you are. Consider following body acceptance advocates and people who demonstrate that fitness and self-love do not come in the form of one body shape, size, color, or age. Doing this can help you feel more positive and inspired when you look at Instagram and other social media apps.

Find the right therapist.

If you are seeking help to change the way you perceive your body and reduce body anxiety, the right therapist is essential. It is important to find a therapist who is educated about Health At Every Size (HAES), a movement that encourages people to work on their physical and mental health without focusing on body size. Therapists are people, after all, and they are not immune to the outside messages about what “health” looks like. Mental health professionals may come into sessions with their own implicit biases about weight and food, so finding a therapist who supports your journey to self-love and acceptance without making it about weight loss is instrumental as you work toward these goals.

References:

1. Bates, L. (2014, October 14). Why is women’s body image anxiety at such devastating levels? The Guardian. Retrieved from https://www.theguardian.com/lifeandstyle/2014/oct/14/women-body-image-anxiety-improve-body-confidence
2. Bell, L. (2015, July 1). Body image and social anxiety. Eating Disorder Hope. Retrieved from https://www.eatingdisorderhope.com/treatment-for-eating-disorders/co-occurring-dual-diagnosis/anxiety/body-image-and-social-anxiety
3. Get the facts on eating disorders. (2016). NEDA. Retrieved from https://www.nationaleatingdisorders.org/get-facts-eating-disorders
4. Kratina, K. (n.d.). Orthorexia nervosa. NEDA. Retrieved from https://www.nationaleatingdisorders.org/orthorexia-nervosa
5. Multiple anxiety disorders share an elevated concern over physical appearance. (2015, November 4). Anxiety.org. Retrieved from https://www.anxiety.org/body-image-a-common-source-of-anxiety
6. Orthorexia symptoms and effects. (n.d.). Timberline Knolls. Retrieved from http://www.timberlineknolls.com/eating-disorder/orthorexia/signs-effects/
7. Puhl, R. (2015, December 11). Stigma and ‘fat shaming’ can fuel depression and increase obesity. WBUR. Retrieved from http://www.wbur.org/hereandnow/2015/12/11/obesity-stigma-fat-shaming