Imagine this: You’re getting ready in the morning, running late for school or work, when you catch a glimpse of yourself in the mirror. Maybe it’s the curve of your stomach, the angle of your jaw, the way your clothes fit. In seconds, your mind floods with harsh judgments — too soft, too big, not enough. That split second isn’t just about your reflection. It’s about body image: how you see, think, and feel about your body.
Clinicians and researchers describe body image as a multi-layered perception: it’s the mental “picture” you have of yourself, the emotions it stirs, and the thoughts it shapes (Cornelissen et al., 2024). And it’s not static — it’s influenced by culture, relationships, and even the mood you’re in when you wake up in the morning. In body image disturbance, your relationship with your body becomes persistently inaccurate and distressing. It can drive a wide range of behaviors, from subtle daily habits to more extreme actions that affect health and quality of life.
What You See in the Mirror: Understanding Body Image
Body image is a multidimensional construct that describes how you perceive, think about, and feel toward your body. Researchers note that body image is shaped by both internal and external influences, including genetics, personality traits, personal history, sociocultural ideals, media exposure, and interpersonal relationships (Cash & Smolak, 2011; Grogan, 2021).
Explore a breakdown of the main aspects of body image and what shapes them below:
The components of body image
and how they’re shaped
1. Perceptual (Physical) Aspect
How You See Your Body
What it is: How accurately — or inaccurately — you see your body’s size, shape, and proportions.
What Shapes It?
Sensory input: Vision, touch, and proprioception (how you sense your body’s position in space).
Neurological factors: The way your brain processes body‑related information. Research shows altered activity in visual and parietal brain regions in individuals with eating disorders (Paulino de Carvalho et al., 2024).
Comparisons: Seeing others in person or online can distort your reference point for what is “normal” or “ideal” in terms of appearance.
2. Cognitive Aspect
What You Think About Your Body
What it is: The thoughts, beliefs, and attitudes you hold about your body’s appearance and value.
What Shapes It?
Cultural ideals: Societal standards of beauty, often gender‑specific (thinness for women, muscularity for men).
Family and peer messages: Comments about weight, shape, or eating habits during childhood and adolescence.
Internalized standards: Over time, external ideals can become self‑imposed rules (e.g., “I must be under X pounds to be attractive”).
3. Affective Aspect
How You Feel About Your Body
What it is: The emotional responses (positive or negative) that your body image triggers.
What Shapes It?
Personal experiences: Compliments or criticisms, teasing, trauma, or achievements related to appearance.
Social media engagement: Exposure to idealized images can heighten dissatisfaction and shame.
Life transitions: Puberty, pregnancy, aging, and illness can alter your emotional connection to your body.
4. Behavioral Aspect
What You Do Because of Your Body Image
What it is: Actions you take in response to how you see and feel about your body.
What Shapes It?
Coping strategies: Body checking, frequent weighing, avoiding mirrors, restrictive dieting, and excessive exercise.
Reinforcement loops: If a behavior temporarily reduces body‑related anxiety (e.g., skipping a meal), it can become habitual.
Social modeling: Observing how friends, influencers, or family members manage their body concerns.
How the Aspects of Body Image Interact
These four components of body image are interdependent:
A distorted perception (“I look bigger than I am”) can influence thoughts (“I need to lose weight”), which trigger emotions (shame, anxiety), leading to behaviors (skipping meals, avoiding social situations).
Over time, this cycle can solidify and, in some cases, develop into disordered eating patterns or clinical eating disorders.
The Body Image Spectrum
Whether we think about it often or not, every individual has a body image. It changes over time with age, life events, health changes, and shifting cultural influences, but it’s not something you can opt out of. Even if your appearance isn’t a significant concern for you, your mind still maintains an internal “map” of your body that influences your daily experiences — from the clothes you choose to how comfortable you feel in a room full of people.
It's Dynamic, But It Has Core Features
Body image typically shifts over time. For example:
A teenager’s body image may be strongly shaped by peer comparison.
During pregnancy, individuals may experience both appreciation and discomfort as their bodies undergo changes.
With age, priorities may shift toward function and health over appearance.
Despite these changes, certain features tend to remain relatively stable for each person over the long term:
Perceptual baseline: A general sense of how your body looks and feels in space.
Core beliefs: Underlying attitudes about weight, shape, and appearance that develop early in life.
Emotional tone: The overall emotional “set point” toward your body — whether more accepting, neutral, or critical — often remains consistent, even if day‑to‑day feelings fluctuate.
Behavioral patterns: Habits related to appearance, such as clothing choices, grooming, or preferred activities, may evolve but usually reflect your underlying level of comfort with your body.
What is a Healthy or "Normal" Body Image?
In a typical, healthy body image, perceptions are generally accurate. You may notice changes in weight or shape, but these observations don’t dominate your thoughts or control your self‑worth.
Emotional reactions — whether positive, neutral, or mildly negative — are proportionate. You might dislike certain features at times, but these feelings don’t consistently disrupt daily life or lead to harmful behaviors.
Body‑related thoughts and actions (e.g., choosing clothes, exercising) are flexible and not rigidly tied to appearance alone.
A balanced body image is a clear, realistic view of your body that’s grounded in how it actually looks and feels, where your sense of self‑worth isn’t ruled by appearance and you can appreciate your body as just one part of who you are.
Body Image Disturbance: More Than Not "Liking" Your Body
When an individual has a healthy body image, they may notice when they gain or lose a few pounds, but it doesn’t dominate their thoughts or have a significant impact on how they see, think about, or regard their body.
When an individual’s body image is distorted, their perception can become so skewed that they see “flaws” no one else notices — or they misjudge their body’s size and shape entirely. This isn’t about vanity; research shows it’s tied to differences in how the brain processes visual and emotional information about the body (Paulino de Carvalho et al., 2024).
Body image disturbance is a persistent and distressing mismatch between how a person actually looks and how they perceive or feel about their appearance. It’s not just “disliking” certain features or wishing you looked different. It’s a deep, ongoing disruption in the way the body is experienced mentally, emotionally, and behaviorally.
Clinically, body image disturbance is considered multidimensional, meaning it presents in four interconnected ways.
The dimensions of
body image disturbance
1. Perceptual Distortion
Seeing your body inaccurately
How it manifests: Consistently misjudging your body’s size, shape, or proportions — often seeing yourself as larger or differently shaped than you actually are.
What research says: Research shows that the brain can misinterpret visual information about the body, so what the person sees and what is objectively true don’t match (Paulino de Carvalho et al., 2024).
2. Cognitive Overvaluation
Basing too much of your self-worth on how you look
How it manifests: Placing so much importance on weight or shape that it overshadows other qualities, achievements, or parts of your identity.
What research says: Research shows that when appearance becomes the dominant measure of self‑evaluation, it reinforces disordered eating behaviors such as restrictive dieting and compulsive exercise. It is also associated with more severe conditions, poorer treatment response, and higher relapse risk, because any perceived change in weight or shape — real or imagined — can trigger intense distress and maladaptive coping behaviors (Fairburn, Cooper, & Shafran, 2003).
3. Emotional Distress
Feeling intense negative emotions about your body
How it manifests: Frequent, overwhelming feelings like shame, anxiety, or disgust when thinking about, seeing, or talking about your body.
What research says: Brain scans show that when individuals with body image disturbance look at their own bodies, the areas of the brain that handle fear, threat detection, and internal body awareness — the amygdala and insula — become more active than in those without the disturbance. This means their brains are reacting as if something is wrong or threatening, even though nothing dangerous is happening in the moment (Friederich et al., 2010).
4. Maladaptive Behaviors
Engaging in harmful actions to change or hide your body
How it manifests: Extreme or rigid behaviors — like restrictive eating, over‑exercise, body checking, or avoiding social situations — meant to control or conceal your appearance.
What research says: Studies have shown that frequent body checking is associated with greater body dissatisfaction, increased anxiety, and more severe eating disorder symptoms. Likewise, avoidance behaviors may temporarily reduce distress, but maintain the disturbance by preventing individuals from confronting and recalibrating distorted body perceptions. Over time, both types of behaviors contribute to poorer treatment outcomes and a greater risk of relapse in eating disorders (Shafran et al., 2004).
The Connection Between Body Image + Eating Disorders
Body image plays a central role in the development, severity, and recovery of eating disorders. In fact, for conditions like anorexia nervosa and bulimia nervosa, two features — distorted body perception and placing excessive importance on weight or shape in self‑evaluation — are part of the official diagnostic criteria (American Psychiatric Association, 2013).
How Body Image Disturbance Influences Eating Disorders
Research shows that the relationship between body image distortion and eating disorders can work both ways. Often, it’s more of a two‑way street than a one‑direction cause‑and‑effect.
For some, body image disturbance is the initial issue. Persistent dissatisfaction, distorted perception of size or shape, or placing excessive value on appearance can trigger unhealthy eating behaviors that eventually develop into a diagnosable eating disorder. This is supported by longitudinal studies showing that body dissatisfaction in adolescence increases the risk of developing an eating disorder later (Stice & Shaw, 2002).
For others, the eating disorder develops first, and body image disturbance follows. For example, someone might start restricting food for reasons unrelated to body image (e.g., a desire for control, stress relief, or athletic performance). Still, over time, the physical and psychological effects of restriction (combined with constant attention to weight and shape) can distort how they see and evaluate their body.
Most often, once both are present, they reinforce each other. The eating disorder behaviors (like restriction, body checking, or binge/purge cycles) keep attention locked on the body, while the distorted perceptions and overvaluation of appearance fuel the behaviors, making each harder to treat without also addressing the other (Fairburn, Cooper, & Shafran, 2003).
How Distorted Body Image Can Reinforce an Eating Disorder
Body image disturbance isn’t just something that happens alongside an eating disorder — it can actually help keep the disorder going.
Even when an individual begins treatment and changes their eating habits, a distorted view of their body or an extreme focus on appearance can continue to fuel unhealthy behaviors. For example, if a person still believes they are “too big” despite being medically underweight or normal weight, they may return to restrictive dieting or over‑exercise to “fix” what they see. This is what researchers mean when they call body image disturbance a maintaining mechanism — it reinforces the thoughts, feelings, and behaviors that drive the eating disorder (Fairburn, Cooper, & Shafran, 2003).
Studies show that individuals with persistent body image disturbance are more likely to relapse after eating disorder treatment and often have more severe symptoms overall. In other words, if the distorted perception and over‑critical self‑evaluation aren’t addressed directly, the eating disorder has a stronger hold and is harder to fully recover from (Cash & Deagle, 1997).
Addressing Body Image Distortion in Eating Disorder Treatment
Treating an eating disorder isn’t just about changing eating habits — it’s also about reshaping the way an individual sees and evaluates their body. Because body image distortion can help maintain the disorder, effective treatment often includes targeted strategies to address it directly.
1. Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy — especially the enhanced form known as CBT‑E — is one of the most effective, research‑supported treatments for eating disorders, as it specifically targets body image distortion alongside disordered eating behaviors.
It works by helping individuals identify and challenge unhelpful beliefs about their body, reducing the extreme importance placed on weight or shape in self-worth, and broadening their self-evaluation to include other qualities and values (Fairburn et al., 2003).
2. Perceptual Retraining
Some interventions focus on correcting perceptual distortion, or the inaccurate mental image of the body. This can involve:
Mirror exposure therapy: Gradually increasing comfort with seeing one’s body in a mirror while challenging distorted perceptions.
Video feedback: Viewing recordings of oneself to compare perceived and actual appearance.
Body‑size estimation tasks: Structured exercises that help recalibrate internal body size perception (Jansen et al., 2016).
3. Emotion Regulation Skills
Since emotional distress often fuels avoidance or harmful behaviors, treatments frequently include skills from dialectical behavior therapy (DBT) or acceptance and commitment therapy (ACT) to help individuals tolerate and manage body‑related emotions without resorting to restriction, bingeing, or purging.
4. Reducing Maladaptive Behaviors
In eating disorder treatment, therapists work with clients to gradually reduce body checking (frequent weighing, measuring, mirror use) and body avoidance (covering up, avoiding social situations). This exposure helps weaken the link between perceived flaws and resulting distress, breaking down the cycle that keeps the distortion in place (Shafran et al., 2004).
5. Compassion-Focused + Mindfulness Approaches
Mindfulness and self‑compassion interventions can help replace harsh self‑criticism with a kinder, more accepting stance toward the body. This doesn’t mean an individual has to “love” their body — it’s about reducing the intensity of negative thoughts and feelings so they no longer dominate daily life.
Body image disturbance can feel like a lens you can’t take off — one that distorts how you see yourself and keeps you trapped in the cycle of self-hatred, shame, isolation, and disordered eating behaviors. But that lens isn’t permanent. With the proper treatment, compassionate support, and ongoing recovery work, it’s absolutely possible to see your body more clearly, relate to it with greater kindness, and break free from the thoughts and behaviors that have held you back.
At Aster Springs, we offer specialized treatment for eating disorders and body image issues across multiple levels of care, including residential treatment, partial hospitalization, and intensive outpatient programs. Our expert team utilizes evidence-based therapies, such as CBT and ERP, within a compassionate and individualized framework that respects your unique experiences and recovery goals.
Healing takes time, and it looks different for everyone. Still, many individuals find that as their relationship with their body shifts, so does their freedom to live fully, connect deeply, and focus on the parts of life that truly matter.
BDD + Eating Disorders
Key Differences, Important Similarities
Core Concerns
Body Dysmorphic Disorder
Specific perceived physical flaw(s) (e.g., nose, skin, hair, body shape)
Eating Disorders
Body weight, size, shape, and control over eating
Shared Features/Symptom Overlap
Distorted body image and intense appearance-related anxiety
Focus of Obsession
Body Dysmorphic Disorder
Facial features, skin, hair, body asymmetry, muscularity
Eating Disorders
Weight, calories, fatness, thinness, eating rituals
Shared Features/Symptom Overlap
Appearance-related preoccupation and dissatisfaction
Behaviors
Body Dysmorphic Disorder
Mirror checking, skin picking, excessive grooming, avoiding mirrors, seeking cosmetic procedures
Eating Disorders
Food restriction, bingeing, purging, excessive exercise, body checking
Shared Features/Symptom Overlap
Ritualistic or compulsive behaviors tied to body image
Fears/Beliefs
Body Dysmorphic Disorder
“This part of my body is deformed or ugly.”
Eating Disorders
“I’ll gain weight if I eat" or "This food is unsafe."
Shared Features/Symptom Overlap
Belief that appearance determines self-worth
Body Image
Body Dysmorphic Disorder
Negative perception of specific body parts despite normal appearance
Eating Disorders
Distorted perception of entire body or body weight
Shared Features/Symptom Overlap
Deep discomfort with body and appearance
Insight
Body Dysmorphic Disorder
Can range from good insight to complete delusional belief
Eating Disorders
May also range, though often some awareness of disordered behaviors
Shared Features/Symptom Overlap
Difficulty seeing appearance accurately
Motivation Behind Behaviors
Body Dysmorphic Disorder
Reduce shame, fix or hide the “flaw,” feel normal or accepted
Eating Disorders
Achieve thinness, control body, cope with anxiety or trauma
Shared Features/Symptom Overlap
Attempts to reduce distress and feel better about oneself
Medical Risks
Body Dysmorphic Disorder
Self-harm from picking or cosmetic procedures; depression, anxiety, suicidal ideation
Eating Disorders
Malnutrition, electrolyte imbalance, organ damage, mortality risk
Shared Features/Symptom Overlap
High emotional distress and co-occurring mental health issues
Common Co-Occurring Disorders
Body Dysmorphic Disorder
OCD, social anxiety, depression
Eating Disorders
Anxiety disorders, depression, trauma-related disorders
Shared Features/Symptom Overlap
Depression, anxiety, low self-esteem, perfectionism
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Cash, T. F., & Deagle, E. A. (1997). The nature and extent of body-image disturbances in anorexia nervosa and bulimia nervosa: A meta-analysis. International Journal of Eating Disorders, 22(2), 107–125.
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41(5), 509–528.
Stice, E., & Shaw, H. E. (2002). Role of body dissatisfaction in the onset and maintenance of eating pathology: A synthesis of research findings. Journal of Psychosomatic Research, 53(5), 985–993.
- Jansen, A., et al. (2016). Mirror exposure to increase body satisfaction: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 84(6), 471–481.
