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Outlining the Ways Bulimia Nervosa Is Affected by Body Image

Bulimia nervosa is a very well-known eating disorder that affects millions of people of all genders, but the factors that trigger its development still aren’t completely understood. Even though almost everyone has met or personally known someone with this dangerous purging-type disorder, but very few people are familiar with the way media and parenting, as well as genetic factors, influence its development. One of the main causes of most eating disorders is an irrational sense of being “too fat” or self-criticizing other flaws in their appearance, real or not. This is known as a distorted body image (AKA body dysmorphia), and it’s one of the most prominent developing factor in bulimia nervosa.

In the DSM-V, bulimia nervosa is listed as

  • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
  • Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
  • A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).
  • Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
  • The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
  • Self-evaluation is unduly influenced by body shape and weight.
  • The disturbance does not occur exclusively during episodes of anorexia nervosa.

Along with these symptoms, a negative or distorted body image almost always accompanies the onset of bulimia nervosa.

Adolescence Is The Most Common Point of Onset

In most cases, although not all, the average age where bulimia nervosa begins is 16 – 18, which means a statistically significant number of people with the disorder are in their vulnerable teenage years. Usually, the individual with bulimia nervosa has been expressing dissatisfaction with their body or weight for a while before the disorder manifests. This dissatisfaction with their weight or negative self-image classmates, is often due to a combination of parental pressures, media imagery, cultural norms, and co-occurring disorders like anxiety or depression.

Although the average onset is later, recent reporting has seen an increase in cases of bulimia nervosa in children as young as age six to twelve.

Every age from young childhood to young adulthood is critical in a person’s development physically and mentally. As we’ve seen,bulimia nervosa normally begins at a universally critical time in human development – adolescence. Aside from the physical changes and sexual maturation a person experiences in adolescence, it’s also a critical time in the development of a person’s self-image. During this impressionable time, a person may experience a separation between the body they have and the body they want. When that body is unrealistically influenced by the unattainable example set by media imagery, disordered eating behaviors may sink in.

What We Have Learned About Body Image and Bulimia Nervosa

At bulimia nervosa treatment centers and in the psychiatric community, decades of shared experience have allowed us to better understand how body image influences the development of eating disorders. There are several prominent factors that might lead to an eating disorder such as bulimia nervosa, anorexia nervosa, binge eating disorders, ARFID, exercise addiction, or others.

Here are some of the main factors in the development of negative body image and related eating disorders.

  1. Peer Pressure

According to academic studies, 40% of the 5th grade female students who were interviewed felt that they didn’t like or weren’t satisfied with their bodies. Think about that – these are children who are 10 or 11 years old and already they are worried about their weight. At a developmental stage of life as turbulent as the ten to thirteen years old range, children’s bodies begin to change quickly, and they often begin to compare themselves to their peers, or to kids just a little bit older than them. When added to the intense emotions of adolescence, this becomes an extremely risky time for being influenced by others. Additionally, this is a time when bullying is most common, and it often centers around a child’s appearance or weight.

Virtually everyone has an experience, witnessing or personally suffering, of a child being mocked for their weight.This, of course, can cause intense feelings of self-loathing and shame in the target. If mocked for being overweight, this sends the child’s body image into a spiral. This, unfortunately, can lead to the sense the individual is “fat” or otherwise unattractive, even when medically deemed underweight, a classic symptom of bulimia nervosa. They may then begin to take extreme weight loss measures, including extreme dieting and disordered eating behaviors to make sure their weight is not mocked again.

Peer pressure does not necessarily entail the kind of in-your-face bullying you might be imagining. Although cruel taunts and public mocking certainly do happen, peer pressure can have more subtle effects on teenagers as well as being far more common.Sometimes, a child doesn’t experience bullying or taunting at all and still develop a distorted body image.

As an example, a child’s friend may mention they’ve been eating a lot of pizza lately, and ask, “Don’t you worry about getting fat?” This kind of interaction, while not mocking, can still serve as a subtle form of “fat-shaming.” This may cause disordered thoughts to begin stirring and lead to both disordered eating behaviors and a distorted body image.

  1. Parental Pressure and Genetics

The “nature versus nurture” discussion is central to our understanding of how eating disorders like bulimia nervosa develop. Most experts in the field of eating disorder treatment agree there is a genetic component to these disorders,because development of eating disorders is more common in people whose parents also had an eating disorder. This is similar to the inherited nature of other mental health disorders such as OCD or depression. Although genetic lineage doesn’t guarantee that a mental health disorder will present, it increases the risk factor.

Aside from genetic factors, parenting can influence a person’s self-image. A distorted body image can be imparted (often unknowingly) by parents. This is especially common when parents focus on a child’s weight or impose dieting at a young age, or focus on weight-focused activities. Example of this can include ballet, swimming and diving, wrestling, beauty pageants and other activities that put a focus on weight.

These activities don’t necessarily cause an eating disorder, of course, and parents should encourage their children’s participation in them if the child shows an interest. It is important to allow children to explore their interests and passions as they develop into adults.

If they are involved in these types of activities, parents should be aware of the risk factors imposed by that kind of focus on weight and “beauty.”They should also provide reminders that self-acceptance of one’s body is a key to emotional balance, and that people are healthiest when they eat naturally and when they need to. This can go a long way to alleviating the pressures caused by both genetic and activity-based pressures.

  1. Traditional Media

Ever since people have been making art, presentations of a society’s “ideal body” have been put out before the public. Since advertising and films, TV, and print magazines, however, it’s been accelerated.We are all bombarded daily with bikini models and muscle men on TV and in movies, on the sides of buses and on billboards, and so on.These images present “ideal” and “attractive” bodies that are simply not realistic for most people to attain – in Western culture,unfortunately, “attractive” all too often means “skinny.”

Of course, it’s completely natural to see these idealized bodies and compare your own to them. The issue comes to a crisis point when an individual’s self-worth deteriorates when trying to diet or purge to reach that idealized body.Traditional media can cause people to set a goal for themselves which isn’t possible; it’s not the only factor in eating disorder development, but it’s an important one.

  1. Social Media

Even more pervasive than traditional media in 2020, the relatively new phenomenon of social media platforms can combine the influence of peer pressure and traditional media. Young people today, at the highest risk for developing bulimia nervosa, have never lived in a world without Facebook or Instagram. In this medium, they see not only the photos hopped images and videos of celebrities (especially “fitness models” and “diet influencers”), but their own peers presenting the “best” versions of themselves.

People tend to post only the images and stories on social media that put them in the best possible light They might edit the images or suck in their tummies to make themselves look thinner, presenting yet another unattainable body image.

Many influences or social media have a vested interest in promoting diet culture and making their followers feel a need to lose weight.They may post images and descriptions of a diet program they are trying to sell (many of which promote an unhealthy relationship with food and eating in the name of “thinness”). Even worse, they may claim that they are being “body positive” while still promoting people to eat unnaturally or engage on diets or even fasting. While many people want to lose weight, people with body dysmorphia often internalize these messages negatively, and begin to engage in eating disorder behaviors.

Eating Disorder Treatment Can Rehabilitate a Distorted Body Image

Treatment at a bulimia nervosa treatment center usually includes a considerable focus on objectively rehabilitating a person’s distorted body image, since treating the root causes of a mental health disorder is always necessary for a full recovery. Part of this treatment normally involves talk therapy methodologies such as Cognitive Behavioral Therapy (CBT) and others to help normalize a more positive body image and greater self-acceptance.

A distorted body image can take years to recover from, but it is possible. Reach out to an eating disorder treatment center or a specialized therapist as soon as you can if you or a loved one is struggling with bulimia nervosa. Whether residential or outpatient eating disorder treatment is the best option for you, there are caring professionals waiting to help you back on your feet and lead a healthier, happier, recovered life.

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.