Don't worry, be happy - with your body

Beware the easy assumptions.

Of course body dissatisfaction is associated with later developing an eating disorder. 

Unfortunately, the 'of course' for me and the 'of course' for many others in the ED community is very different, I'm afraid.

Most say 'of course people feel bad about their bodies with all the obsession with thinness and the obesity crisis and skinny models and sexualization of women and all that pressure leads to people dieting and making themselves sick.' In other words, the amount of pressure leads to greater and greater symptoms and dissatisfaction. Therefore: prevent the dissatisfaction and help people feel better about themselves and eating disorders will be less severe or even prevented.

That's not my 'of course.' I see it as obvious that you'd see greater symptoms of body dissatisfaction in people who later go on to have eating disorders as an early symptom of a brain that is pre-wired to latch onto such messages and magnify them no matter what the level of pressure. I see certain people's brains as attracted to such messages and the real problem is that society has pretty much adopted the thinking of a severe mental illness as if it was healthy and normal.

That normalization of mental illness makes society toxic even for those without the brain problem: causing us to eat poorly, mistreat our bodies, and treat ourselves and others with disrespect and unkindness. That normalization of mental illness masks treatable illness, delays diagnosis, stymies treatment, and undermines recovery.  This misunderstanding about the nature of eating disorders leads to misguided treatment, misguided public awareness campaigns, misguided research targets, and bad healthcare policy.

In my perpetual quest for the illustrative analogy, let me try these:

Putting happy face stickers on everything doesn't prevent depression.

Telling people not to worry so much about germs doesn't prevent OCDs.

Helping people love their bodies doesn't prevent eating disorders. It's lovely, it's good, it's positive, and it should be done - but people don't get eating disorders BECAUSE they don't like their bodies and it isn't treatment to teach them to love their bodies. We all need to do that anyway. We do need to prevent DIETING, which is the gateway drug to mental illness for those with a predisposition, but it doesn't seem to matter if the initial restriction was a deliberate diet or a flu or an overzealous track season - and recovery isn't that much different regardless of the initial reason.

We would not be surprised to learn that people who have a history of being sad later develop depression. We wouldn't consider it a "risk factor." We would not try to prevent depression by assigning clowns to every streetcorner or banning obituaries. We wouldn't treat depression by surrounding the patient with happiness.

We need to re-think the "of course." We desperately need more and better public awareness but we don't need another generation of eating disorder patients deprived of the right support while we spend our time cheering for size 7 models instead of size 0 and we change the shape of the Happy Face stickers we're slapping up everywhere. All over the world today there are parents getting on the Internet to search for help for their newly diagnosed child. What they need to hear is not "love your body" it is "make appointments with evidence-based eating disorder specialists, cancel your plans for the next six months, and make dinner. It's going to be a bumpy night."


  1. If people with body image dissatisfaction are identified before full blown eating disorders emerge, there are interventions that can helpful. A cognitive dissonance program (Stice et al) was found effective in trials (moreso for bulimia than anorexia). IMO it's important work and not at all analogous to putting happy face stickers on everything.

  2. I'm not implying that you are implying that I think targeted prevention programs are a happy face sticker, but I'll address it anyway.

    A group of people who have body image issues already would include people who are predisposed and showing early signs of mental illness AND people who are simply responding to their environment. The intervention would certainly help those influenced by their environment to prevent some disordered behaviors and attitudes. It may even influence some of those who would be precipitated into self-perpetuating mental illness from doing so.

    The problem is the dieting, though, not the reason for it or the amount of pressure to do so.

    Getting our society to stop the thin idealization, or even reduce it, is important and necessary for ALL of us. It is even more important for those who are particularly at risk. But confusing eating disorders for a simple dose response to the environment is a dangerous mistake when it comes to diagnosis, treatment, and relapse prevention.

    The same would go for similar "prevention" efforts on OCD and depression.

  3. I think recovery IS different for those whose diet/weight loss which triggers the ED is due to body dissatisfaction/dysmorphia. And for those whose diet/weight loss is due to anxiety or depression (which often accompany the body image issues.) Those co-morbid issues or pre-existing conditions or whatever you want to call them do not disappear with weight restoration or with interruption of bulimic behaviors. I agree that dieting/weight loss is the ticket to the rabbit hole that is the ED but it does make a difference in terms of what led to the diet/weight loss. The response to it and the recovery from it must be different.

  4. To anonymous: recovery is different for everyone, because although the underlying biological mechanisms of EDs and many symptoms are shared, every person suffering from an eating disorder is an individual. No one said treatment had to be identical for everyone. But there ARE some aspects of treatment which are essential - weight restoration and/or behaviour cessation. After or alongside that, some people find therapy useful, some people use support groups, some people aren't all that bothered, some people like to get involved in body image awareness, and so on. My own recovery entailed gaining weight and learning to cope with anxiety.

    It's not like there are two categories of people with EDs - those with body dysmorphia and those without. There are many categories of people with EDs, and body dysmorphia occurs on a spectrum. But it doesn't cause EDs in the most literal sense of the word. Recovery is never the same for any two people, because we all have different genetic make up, physical health, co-morbid conditions, environmental circumstances, relationships, thought patterns and so on.

  5. I guess that is where we differ: I don't believe you can trigger this very serious mental disorder with body dissatisfaction.

  6. Anon #1 here again. Stice's work is worth a look. The idea is not to get society to stop idealizing thinness but a targeted approach for people who show risk. There are any number of prevention efforts that haven't been shown to be helpfulIt out there but the dissonance-based eating disorder prevention program that has been found to produce a 60% reduction in risk for future onset of eating disorders. There is real research on this that shows that it helpful. There are limitations--it seems helpful for bulimia but not anorexia. (Maybe bulimia is more socially influenced?)--but it would be a shame to ignore promising results in secondary prevention.

  7. It always bothers me when people think EDs are caused by an obsession with thinness. I didn't notice or care about those things until starving changed the way my brain worked.

    When I went in to seek treatment for my anxiety I clearly mentioned my ED, only to have it ignored by both the nurse and therapist. It really does seem to be treated as something normal, like it doesn't matter at all, probably because my weight is healthy now. It's frustrating trying to get help for one problem and having my ED triggered by their comments about my "nice figure" and "health". I've even been encouraged to exercise more and drink Crystal Light (no sugar!).

  8. I would LOVE to prevent eating disorders. I would like to see us prevent dieting and externally influenced body dissatisfaction wherever and whenever we can - and not just to prevent eating disorders.

    I believe most anorexia will happen even without environmental influences and we need to intervene and treat those early prodromal situations - I just don't call that "prevention." I think the jury is out on bulimia - it may be different.

  9. I love Katie's comment above :)

    I often have a moan about body image obsession in relation to EDs (especially AN, from which I suffered), because I didn't have body dysmorphia and my anorexic behaviours didn't relate to manipulating my body shape or weight. I had the urge to do anorexic behaviours irrespective of how I thought I looked - both to myself and to others.

    The number of times people would stand me in front of a mirror and say "can't you see how thin you are?" - with the assumption that if I could indeed see/perceive my thinness that I would stop over-exercising and restricting food. The point was that I could definitely see my thinness, I didn't think it looked nice and I wasn't 'proud' of it. But seeing my thinness didn't curtail my behaviours, because I didn't engage in these behaviours to become/remain thin! In the main, I over-exercised and restricted food to contain my anxiety.

    Having said that, I know that some people with EDs do have body dysmorphia and/or body dissatisfaction - and that they feel that their body dissatisfaction underpins their ED behaviours.

    About 3 years ago I made a video on YouTube (now deleted) wherein I asked people whether they would engage in ED behaviours if they were happy with their weight and shape (and also if they were confident that their weight and shape wouldn't change against their will). I received many responses and many (though not all) people who responded said that they would engage in ED behaviours irrespective of their weight and how they felt about their bodies.

    I agree with what you write in this post Laura.

  10. Great, important post, Laura.
    This one needs to go to the next level, too. Huffington Post? Your introduction of other disorders and how to/not to approach them was quite thought provoking (for me anyway). Thank you.

  11. From my experience with my daughter, I think that her underlying anxiety is the culprit behind eating disorders but values and cultures can help her find reasons for her anxiety. In a highly religious culture where fasting was the norm, the manifestation might have been that people with AN felt driven to fast to purify themselves to relieve the anxiety. But in our society, it turns into a diet to make our lives right by losing a few pounds.

    For my daughter, as she has gotten better, she has seen that her anxiety about food doesn't make sense but yet she also sees that it still happens. I think that as a matter of survival, the brain needs to find reasons for anxious feelings. The "flight or fight" response was set up for survival of the species. We have learned to pay attention to those feelings and to look for reasons and to avoid what makes us anxious.

    I think Laura is right about the happy face stickers and even in another culture, we will still have to deal with eating disorders because the anxiety traits that are associated with eating disorders will still be there. And there will be another or different reason for not eating.

    On the other hand, I'm sick of the science project of everyday life! I don't want to think about my food, I want to eat it naturally because I am hungry and it tastes good. I don't want processed diet food or even "healthy" granola bars. I want my body to be as it should be and not have to figure out a certain BMI and fat percentage and I don't want my body proportions being analyzed as good or bad and I don't want to decide which fats really are good for you after all (which changes every 4 days). It would be nice to go back to a simpler lifestyle....and relaxed attitude about eating and bodies in general


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