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Body image and eating disorders

Exploring the complex relationship between body image, self-esteem, and eating disorders and providing counseling support to individuals struggling with these issues.

Self-esteem is our self-perception or our values, opinions, and beliefs about ourselves. We can also say self-image is the confidence in one’s personal worth. In Abraham Maslow’s theory of the hierarchy of needs self, self-esteem needs come after belongingness needs. High self-esteem leads to success in academics as well as career, betterment in relationships with families, friends, and relatives, role-playing, fulfillment of responsibilities as well as developmental tasks, age-appropriate behavior, high emotional intelligence, and it is good for mental health and physical health as well. High self-esteem does not reinforce anti-social activities or other mental health issues like depression, anxiety, impulsivity, and reduced self-confidence, along with other conditions. Low self-esteem is detrimental for adolescents as well since it can result in feelings of inferiority complex, social isolation, difficulties in career selection, formation of relationships, and maintaining them. Factors like genetics, personality, home environment, noncordial relationship with family members, childhood experiences of trauma and abuse, age, health, social circumstances, and parenting style are responsible. 

Maria Fabrizio for NPR

According to the American Psychology Association body image is the mental picture one forms of one’s body as a whole, including its physical characteristics and one’s attitudes toward these characteristics. 

During adolescence, which is a difficult phase of life, chances of weight gain are present, which may lead to eating disorders as well, so body image is important in weight control, eating disorders, and other mental health issues. Moreover, when our body image is negative, it leads to poor coping strategies like dieting without consulting expertise or a dietician, exercise, and overthinking about body image issues, and also increases the risk of eating disorders. It can also lead to difficulties in relationship, mood disorder and self harm tendency. 

Eating disorder – Eating disorder is mentioned in ICD -10. According to ICD 10, the Eating disorder is a broad group of psychological disorders with abnormal eating behaviors leading to physiological effects from overeating or insufficient food intake. 

Eating disorders are serious behavior problems that include anorexia nervosa, bulimia nervosa, and binge eating.  

Anorexia nervosa – people desire to become extremely thin and stop eating as they feel they are overweight.

Bulimia nervosa – It involves periods of overeating that are followed by purging. Purging is done by self-induced vomiting as well as using laxatives.

Binge eating –  it involves consumption of large amount of food frequently without any control and unable to stop consuming it. 

Indian studies have indicated the relationship between self-esteem, body image, and eating disorders. According to Indian research, Body dissatisfaction is a pressing public health issue affecting adolescents globally, which predicts the onset of eating disorders, unhealthy weight control practices, low self-esteem, depression, self-harm, smoking, high-risk drinking, and drug use. Whilst some body image concerns of Indian adolescents, such as weight and height, are relevant to those in high-income countries, others are unique to this group, including skin color and body hair dissatisfaction. The latter is particularly salient to Indian girls, who are concerned with hair covering different parts of the body. In addition to the adverse effects on physical and mental health previously discussed, body image concerns in India are also associated with the use of harmful skin-lightening products. Not only does this have dangerous physical side effects, but it also perpetuates established social inequalities due to skin shade being considered a currency of cultural capital in the country. Indeed, deepened by historical colonial rule, there are strong connections between skin colour and caste, class, occupation status, and marital prospects. This highlights body dissatisfaction as a public health and social justice issue for Indian adolescents. Further, late adolescence is a peak time for the emergence of mental health difficulties, including threshold eating disorders and their clinical symptom. Indeed, research indicates that approximately a third of Indian adolescents are at risk of developing an eating disorder. Overall, this reinforces the need to develop preventative interventions for mental health issues, and particularly in relation to body dissatisfaction. Finally, there have been calls from the Indian government, teachers, school counselors, parents, and students for the provision of mental health education via schools.  In a study conducted by Nivedita N, G Sreenivasa, and Mullini S in 2018 in Mysore, It was found that 26.06% of participants were prone to ED due to their abnormal eating attitudes. According to research, the prevalence rates for binge-eating disorder, bulimia nervosa, and anorexia nervosa are 0.48%, 0.51%, and 1.12%, respectively. Indian studies have also found A positive association between overweight and obesity with disturbed eating behaviors and attempts to change the body weight resulting in mental disorders, of which eating disorders (EDs) being one of them have been reported. Body image dissatisfaction may also further lead to EDs such as anorexia nervosa and bulimia nervosa and can cause distortions in cognition, affect, perception, and behavior related to body weight or shape among adolescent girls and women. All adolescents do not suffer from eating disorders, but when their self-esteem becomes poor, their perception of their own body image becomes poor or negative as well. Self-esteem can influence interpersonal relationships and academic performance positively when it is high but can have dangerous outcomes or consequences when it becomes low. Low self-esteem helps to develop feelings of helplessness, worthlessness, guilt, and incompetence too. It makes one feel like a failure too and reduces self-confidence, which may negatively impact future career as well. High self-esteem leads to feelings of satisfaction and helps to fulfill needs for achievement and affiliation confidently. Children, adolescents, and people with negative body image may have low self-esteem and feelings of inferiority, which may further help to develop other mental health conditions like depression, anxiety, and eating disorders. Though clear-cut causes are not known for eating disorders, research studies indicate that media plays an important role in the development of eating disorders among adolescents. Exposure to and pressure exerted by media increases body dissatisfaction and disordered eating. Over 80% of Americans watch television daily. Also, research highlights the high level of concern about weight, dieting, and a desire to look like models or celebrities, which may contribute to an increased risk for all eating disorders.  During adolescence, children want to look desirable in choosing their partners as well and do not want to get rejected from their groups.  Eating disorders may be a result of low self-esteem and negative body image, but studies have also shown that there is a huge gap in treatment procedures for eating disorders. Though treatment procedures are available, people do not avail of them due to deficits in awareness. They do not even know nor do they have any knowledge about the treatment facilities available and their beneficial consequences. It might take time to recover but better late than never. 

Treatment plans for eating disorders 

Treatment plans for eating disorders may not only include a psychotherapist or psychologist. It may also need a registered dietitian, medical professional, and family members as well. Management of eating disorders is not easy. Rather, it is time-consuming and can be a long-term challenge, too. Patients and professionals have to set long-term goals to recover. Also continuous reinforcement and information about progress motivates the patients to recover. Eating disorders can also lead to physical health problems like digestive issues, dental problems and many more. 

Though psychological therapy is of utmost importance in treating eating disorders, it may continue for months to years. Patients and their family members should not miss appointments with mental health professionals, and treatment adherence also matters for improvement and recovery. Poor compliance with treatment may be detrimental to patients and their families, too. Psychotherapy can help patients to normalize their eating patterns, exchange unhealthy eating habits with healthy ones, develop proper coping strategies to deal with low self-esteem and negative body image as well as other mental health condition, self-monitoring of mood and eating habits, bring improvement in the execution of tasks and relationships as well. It may involve cognitive behavior therapy, family therapy, and mindfulness therapy as well.

Cognitive behavior therapy helps to challenge the cognitive errors present in the minds of patients or adolescents, which affect their behavior negatively. It also helps to deal with negative automatic thoughts and brings improvement in behavior. It also identifies thoughts, feelings, and behaviors that are leading to eating disorders to bring positive changes and improvements in the behavior of people suffering from eating disorders.

Family therapy is also helpful to treat eating disorders as family members learn how to deal with their children and further they can help them to restore healthy eating habits while changing the unhealthy ones. They can also use principles of behavior therapy like reinforcement, which would be helpful in recovering.

Mindfulness helps our mind and body to calm down and relax. It helps us be non-judgmental, helps in emotional regulation and distress tolerance, and improves interpersonal skills effectively, which are impaired in eating disorders and other mental health conditions. Mindfulness helps us to be aware of the present moment with a sense of curiosity and openness and without being non-judgmental. In eating disorders, after prolonged restrictions on food consumption, human bodies cannot send hunger cues properly anymore. So, in this case, practicing mindfulness can improve our ability to identify, access, understand d, and respond to our body’s internal signals like hunger, thirst, and physical processes that come with stress, like palpitations, excessive sweating, and shaky hands. Mindful breathing and focusing on the tangible sensations of the moment while thinking about food and eating can help us understand when people understand their hunger and the satisfaction of hunger.

Group therapy can also help in dealing with eating disorders, where a mental health professional deals with multiple people suffering from eating disorders. Group therapy does not let people feel that they are suffering alone. People do not have any problems sharing their thoughts, feelings, and emotions with each other, which helps them to deal with their problems confidently. It also helps them to interact with each other, leading to better communication and improved relationships. They can also learn skills to deal with their struggles.

Along with the above-mentioned therapies, from my point of view, to prevent disorders, schools should keep school counselors or school psychologists who can help teach parents, teachers, and students healthy coping strategies to deal with mental health conditions. It becomes easier for schools to conduct awareness programs with the help of psychologists. 

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