Understanding Disordered Eating and Body Image

Body image and disordered eating are complex issues, with psychological, biological, social and cultural influences. This blog explores eating and body image struggles – what these may entail, where they may stem from, and the impact of weight stigma and societal influences. It’s an introduction to the topics so further reading, learning and training are suggested at the end.

This blog was inspired by a chapter I wrote for a book called “A New Introduction to Counselling and Psychotherapy” by Mamood Ahmad. I was delighted to contribute this topic as it is often left out of counselling studies, yet body image and eating problems are so prevalent, it is crucially important.

​Body Image

​Body image is heavily influenced by cultural and social beauty standards, as well as personal experiences, trauma and self-worth. Negative body image can take a serious toll on mental health, leading to anxiety, depression, eating disorders, self-harm and suicidal thoughts.

Our cultural heritage, childhood experiences, family and friends, and early developmental and attachment factors shape the way we see our bodies and how we eat. These are highly correlated with morality, e.g. “good” and “bad” foods, and the assumption that a thin body means healthy and therefore virtuous and good. Gender binaries also create pressures to conform, with a risk of social rejection and discrimination for those who may stray from the dominant norm.
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Media (e.g. TV/film, social media) also influences the portrayal of appearance ideals, with hundreds of adverts and images of “ideal” bodies every day, often without even consciously knowing it. This has a huge impact on our individual and collective psyche, normalising what we “should” look like. Many people face discrimination due to their appearance on a daily basis, which can be a traumatic experience. Body image issues aren’t just an individual problem, it’s a wider system problem as part of systemic inequalities.

Body Dysmorphic Disorder (BDD)

The difference between body image problems and Body Dysmorphic Disorder (BDD) is in the severity of thoughts and behaviours. BDD is categorised as an anxiety disorder alongside Obsessive Compulsive Disorder (OCD), with rituals and compulsive behaviours such as checking certain areas of the body, mirror checking, skin picking and excessive grooming (OCD UK, 2022).
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People may or may not find benefit in gaining a diagnosis; it can be validating for some and may lead to more support. Whether somebody has a label or not, similar to disordered eating and eating disorders, the label is not a sign of less distress, and all are worthy of help and support. 

​Early Roots of Body Image

Body image begins to form in childhood, with young children expressing dissatisfaction with their bodies. Experiences like bullying, exposure to dieting, family narratives about weight, and attachment/relationship dynamics can all impact how someone relates to their body. This can impact later relationships, careers and various aspects of life and relating to others, as people often carry shame and feelings of being unworthy and unlovable.

This can lead to dieting, cosmetic procedures and attempts to change appearance as a way to take control and feel happier. The diet and cosmetic industry play into this, pushing this idea of happiness and wellness, profiting off our body shame. These attempted changes, including dieting, often only work in the short term (if at all) due to the depth of the issue, especially if the person has also experienced trauma.
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Weight and appearance changes throughout a person’s lifespan and so isn’t a reliable base for self-worth. People can instead benefit from exploring underlying factors (in therapy) which impact self-esteem and self-worth, and process difficult emotions around their bodies and their identity, to help build self-acceptance and compassion toward themselves.

​Eating Disorders and Disordered Eating

Diagnostic criteria for eating disorders are based on frequency and severity of symptoms and behaviours. Diagnosis is given by a medical or psychiatric professional (not by counsellors or therapists).

Anorexia Nervosa - a formal diagnosis of anorexia will often rely upon the person engaging in restriction of food, fears of weight gain, and being classed as “underweight”, although there are subtypes which involve binging and purging (e.g. vomiting, laxative misuse).

Bulimia Nervosa - involves a cycle of restriction, binge eating and then purging, which can include vomiting, compensatory/over-exercising, and using diet pills, diuretics or laxatives.

Binge Eating Disorder (BED) - episodes of binge eating but without the purging. A binge is defined as “consuming excessive food in a discrete time, accompanied by a sense of loss of control” (NICE, 2024). BED is one of the most prevalent eating disorders, and is three times more common than anorexia and bulimia (Matz and Frankel, 2024).

Binge eating is not the same as “obesity” - this is a body size measure and is not an eating disorder, and people with BED may not be “overweight”.  Anyone of any size can struggle with any eating disorder, and it’s also important to note that even if somebody doesn’t have a diagnosis that doesn’t mean their struggle is any less, and they are still worthy of help.

The words describing body size in speech marks are used by the medical field but are increasingly seen as stigmatising due to the impact of weight stigma and anti-fat biases, plus the outdated nature of the Body Mass Index (BMI).

ARFID – Avoidant Restrictive Food Intake Disorder - Involves food aversion, sensitivity to smells and textures, and fear of foods/eating, contamination, or of becoming sick. This can have an overlap with neurodivergence, particularly autism, but there is an overlap with many eating disorders and neurodivergence. ARFID is often said not to involve body image or weight concerns, but all eating is in the context of living in a diet culture and weight stigma, so it is an important contextual consideration.

OSFED - Other Specified Feeding or Eating Disorder - the most prevalent eating disorder diagnosis - eating problems with “clinically significant distress” but do not fit the other categories. This is common as much disordered eating doesn’t neatly fit the boxes and criteria.
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An example of this is “Atypical anorexia”, deemed atypical due to not meeting the “underweight” criteria of anorexia (NICE, 2024). Atypical anorexia carries many of the same risks as anorexia and is arguably not “atypical” as there are many people in larger bodies engaging in restrictive behaviours. Due to assumptions and stereotypes about anorexia, and about bigger people, our society often has difficulty in understanding that people at higher weights can engage in such restriction. This is a prime example of how weight stigma and anti-fat bias are intrinsically linked to eating disorders. 

You can read more about atypical anorexia here.

Weight Stigma

Many people with eating disorders are at higher weights, contrary to the stereotype of thin young women with anorexia. People in larger bodies can be overlooked for disordered eating due to the normalisation of dieting and restriction in our society.
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Weight stigma is a major barrier to medical care. It reinforces shame, contributes to disordered eating, and can prevent people from accessing eating disorder services. To understand disordered eating and body image, it’s essential to recognise how weight stigma and anti-fat biases show up in our own assumptions and in the systems around us.

“Obesity” is often positioned as a disease to be “treated”, reinforcing the idea that larger bodies are “wrong”, increasing shame and self-blame. When “obesity” is presented as a problem to be fixed, this often involves advocating for the very behaviours (weight loss interventions) that risk leading to an eating disorder. What is often recommended to people at higher weights is deemed an eating disorder in thin people.
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Most diets do not lead to long-term weight loss as many regain the weight eventually. Diets are more likely to contribute to disordered eating and can hugely impact self-worth, especially when diet cycling or in a binge cycle – you can read more about this here. 

Neurodivergence

Society assumes a largely neurotypical lens, which leads to expectations, standards and “norms” which make life particularly difficult for neurodivergent people. Ideals around "healthy" and “normal” eating (often white Western ideals) can create pressure to conform and people can feel ashamed if they cannot comply with those rules and expectations.

Neurodivergent clients may rely on safe foods to feel comfortable and secure. Pushing them into “healthy” eating patterns without understanding their needs can be harmful. Exploring a person’s relationship with food means listening without judgement and respecting the meanings that food holds for them.
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When conditions of worth and love in childhood are based on pressure to “act normal” and “eat normally” it can feel as if it’s their own fault, that they are unlovable and are not accepted. 

Disordered Eating and Eating Disorder Therapy

Not all therapists feel confident working with eating disorders, and that is understandable. To work effectively and ethically with clients with eating disorders/disordered eating or body image problems, therapists need to examine their own relationship with food and their bodies. They need to challenge their assumptions and biases around eating disorders, body size and appearance, particularly to understand the harms caused by weight stigma, anti-fat bias and systemic inequalities.

Body image and disordered eating show up regularly in counselling, though may not be the intended area of focus, but all therapists benefit from a basic level of knowledge. Weight-inclusive training is vital, and knowing when to refer on and working within their competency and comfort is crucial.

Clients may arrive in therapy ashamed, anticipating judgement, or desperate for weight loss. Our role is not to collude with the thin ideal, nor judge weight loss attempts, but to create a space where the deeper struggles can be explored. That might mean processing painful memories, challenging internalised stigma, and gently nurturing self-acceptance and worth beyond appearance.

If you’re a professional looking for CPD in this area, check out my training/workshops page with links to Online Events recordings, and for further eating disorder training take a look at NEDDE.

I also have a reading and recommendations list with books, podcasts videos and blogs here.

If you’re reading this looking for help or support for yourself, feeling safe and comfortable in the counselling relationship is so important, so I offer a free 15-minute introductory call on Zoom. To find out more about my counselling service click here, or click the button to contact me to arrange an introductory call.

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"This is an essential read for anyone involved in therapeutic training and education. It offers a visionary and practical roadmap for embedding a deep understanding of individuals in their full, lived-in context—right from the start. By challenging isolated approaches to learning about "social context, culture, difference, and diversity," it provides a refreshing antidote to the "othering" of students, trainers, and clients alike while fostering a truly inclusive, equitable training experience."

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