Addressing Body Image in Eating Disorder Recovery



‘Body Positivity’ is what most of us have been taught we should strive for. That we should love our body and be confident in the way we look. It’s a lovely idea, right? Yet, we find, on a whole, society hasn’t come a long way when it comes to improving body image. Children are reporting body dissatisfaction from a younger age, the health and diet industries continue to capitalise on people’s low self-worth, and eating disorders appear to be increasing in presentations. So is body positivity the way to go, particularly when recovering from an eating disorder?

An eating disorder affects body image in multiple ways.

1. Your view of yourself may actually be inaccurate and distorted

Studies have shown that persons with eating disorders are incredibly poor at accurately representing their body shape, often seeing themselves as much larger than what they truly are. In a study where people were asked to walk through a doorframe, those with eating disorders started rotating their bodies “to fit” when the door opening was still 40% wider than their own shoulders, while healthy controls kept walking straight through until the doorframe was just 25% wider.

2. “I feel fat” starts to become your indicator of body size

Most people with eating disorders have a heightened sensitivity to fullness – both due to shrunken stomach sizes, but also due to the anxiety and hypervigilance involved in avoiding fullness when trying to restrict. Rather than having a comfortable feeling of satiation after a meal, persons with eating disorders truly believe that feeling full is the same as feeling fat, and that feeling fat is the same as being fat.

3. Your attitude towards your size becomes self-loathing

For any person their attitude towards their body will vary across a spectrum from “I love myself” to “I absolutely hate myself” based on how they perceive and judge their body. The middle of this spectrum is neutral territory – “I don’t have particularly strong negative or positive feelings about myself based on my body”. Body loathing may be the precipitator of an eating disorder, that is, “I’ll lose or control my weight in order to heal my negative attitude” – however, this is rarely an effective solution because your worth will always be based on something narrow and conditional to change (even weight ‘stable’ people have fluctuations in weight, and our bodies will always change one day).

So how does one address body image when recovering from an eating disorder? Here are some guidelines:

1. Don’t immediately aim for body positivity

Most people have things about their appearance they don’t like, and that’s ok. If we’re told we’ll only be happy when we’re totally body-confident it may feel like an impossible battle, and you may then feel like a fraud if you’ve recovered from your eating disorder behaviour but still have bad ‘body image’ days. Setting a goal for body neutrality or body acceptance, the idea of not having strong positive or negative attitudes about the way you look, is much more achievable. Your body is there to function for you, rather than to primarily provide aesthetic value.

2. Reduce your body checking

We’ve already talked about how your view of yourself may not be accurate when experiencing an eating disorder. When you check the mirror to see whether you’ve ‘gained weight’ you’re probably going to find evidence of that due to your anxiety and cognitive distortions. Try to reduce your checking wherever possible, and if you notice yourself internally scanning your fullness or natural body folds (yes, the body does do that for everyone), keep yourself occupied with an activity.

3. Replace “I feel fat”

Fat is not really a feeling. While you might “feel” fat, it might be more helpful to get in touch with your underlying emotions here. Do you feel shame because your critic is telling you you’re not lovable? Do you feel anxious because you feel you’ve lost control? Do you feel sad about losing your eating disorder? Try to figure out the real feeling and journal about what’s really going on.

4. Get political

Do your research on the socio-cultural factors that have led to you over-evaluating your weight and shape. You’re not being silly or vain – you were trained to do this! We live in a society that hyperbolizes an ‘acceptable body shape’ and demonises anyone that doesn’t fit that mould, and you can find evidence of that in the messages you may have been told as a child, the TV/movie icons you had growing up, the expansion of social media. In a wider sense the capitalist world wants you to feel bad so you’ll spend more money to counter that. Try to figure out what may have influenced you, and then adopt a self-compassionate “well, no bloody wonder!” attitude when you think about what shaped your body image.

5. Expand your view of what makes you great

It’s never good to have all your eggs in one basket. Even if you can start to have positive feelings about your body, you’re going to want to diversify your worth so it’s not conditional on one thing. If you think about the people you love the most, chances are their weight is the least interesting thing to you. Figure out what you care about, invest your time, effort and energy into it (the same intensity that you may have devoted to your eating disorder), and draw on many qualities when thinking about what makes you wonderful.

Jessica is a Clinical Psychologist with experience working in outpatient, inpatient and day program settings. She works with a range of presentations, including mood disorders, anxiety disorders, and trauma. Jessica has a special interest in working with children, adolescents and adults experiencing eating disorders and recently published an article on Family Based Therapy (FBT) for Adolescent Anorexia Nervosa in the Journal of Eating Disorders, which you can read here.


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