Can you have an eating disorder without body image issues?

There’s a common perception that eating disorders always stem from body image issues. It’s true that in many cases, there is a link between disordered eating habits and how someone feels about their physical appearance. For example, a person might develop anorexia, in part, due to a desire to achieve an idealized body type or size. 

But you don’t have to be unhappy with your body to be at risk of an eating disorder. As we’ll explore below, there are several eating disorders that can negatively affect your health and well-being that don’t involve body image issues. By learning more about these conditions, we can broaden our understanding of eating disorders and be more informed about when it might be time to ask for help.  

Why body image often plays a part in disordered eating

Body image refers to how someone perceives and feels about their physical appearance. They can feel positively, negatively, or neutral about their appearance, and these feelings can shift and evolve over time. 

Body image can be influenced by culture, and it has four main components:

• Perceptual body image: This refers to how you visually perceive your own body. It encompasses the way you see your shape, size, and overall appearance, which can sometimes differ significantly from how others see you.
• Affective body image: This aspect involves your feelings and emotions about your body. It includes how you feel when you look in the mirror and how those feelings impact your overall self-esteem and confidence.
• Cognitive body image: This is about your thoughts and beliefs regarding your body. It includes any judgments you make about your appearance, like feeling that you need to change your body to fit societal standards or comparing yourself to others.
• Behavioral body image: This component covers how your body image affects your actions. For instance, it can influence how you dress, whether you participate in social activities, or if you engage in certain behaviors (like dieting or exercising excessively) in an attempt to change your body.

Research shows that body image issues are highly prevalent among people with eating disorders, especially in people with anorexia or bulimia. This is likely due to the presence of body dissatisfaction or negative feelings about one’s body image. Body dissatisfaction can cause people to engage in disordered eating and other potentially harmful behaviors to achieve their ideal body type or weight.

Lastly, when discussing body image and disordered eating, it’s important to mention the impact of technology. We live in an era when smartphones are nearly anywhere and everywhere. Almost everyone has constant access to imagery that can influence how we feel about our bodies. 

Young people are especially vulnerable to comparing themselves to others, especially those they see on social media. The cumulative effect of this exposure can take a toll on a person’s mental health and may put them at greater risk of developing an eating disorder. 

Underlying causes of eating disorders beyond body image

Body image issues can, in part, contribute to the onset of an eating disorder. But this isn’t the only risk factor. Eating disorders can occur due to a combination of genetic, environmental, and psychological factors, including:

• Having a pre-existing mental health condition, like depression or anxiety
• Having a family history of eating disorders or other mental health conditions
• Experiencing bullying related to weight or appearance
• Experiencing trauma or abuse
• Being someone who fixates on weight or thinness
• Feeling pressure from other people to have a specific body type
• Struggling with perfectionism
• Being from a culture or society with certain beauty standards
• Using substances in unhealthy or harmful ways
• Dieting and restrictive eating
• Experiencing major life transitions

There are also instances when a person may develop an eating disorder unintentionally. For example, a person who experiences a significant loss could go through long periods of suppressed appetite as they grieve. In addition, certain infections and medications can also impact appetite and eating behavior. 

But regardless of the underlying causes, anyone experiencing symptoms of an eating disorder should seek professional help to regain their health.

Recognizing an eating disorder without negative body image

Severe body image issues could signal the presence of an eating disorder. But there are other signs as well, including:

• Restricting food intake
• Purging after eating (either via vomiting or laxatives)
• Eating larger amounts of food than intended during a brief timeframe
• Intense fear of gaining weight
• Extreme weight loss that can’t be otherwise explained
• Brittle hair and nails
• Yellowish skin
• Breathing issues
• Fine-hair growth all over the body
• Fatigue or sluggishness
• Chronic sore throat
• Tooth decay
• Refusal to eat certain foods
• Extreme pickiness
• Gastrointestinal issues
• Loss of interest in food
• Obsession with only eating “clean foods”
• Eating non-food items

Eating disorders that aren’t driven by body size

There are a few forms of disordered eating that aren’t typically caused by body image issues. These include:

Avoidant/restrictive food intake disorder (ARFID)

ARFID is an eating disorder that typically shows up in childhood. It can cause difficulties with certain food textures, shapes, or colors and can create fears of trying new foods. Some people with ARFID lose interest in food, leading to malnutrition and other health risks. Others may refuse to eat because they’re worried they could vomit or choke. 

ARFID is a relatively new diagnosis, and we’re not fully sure what causes it. But it could be due to a combination of a child’s temperament, genetics, and life experiences (like surviving a life-threatening choking situation).

Orthorexia

While not an officially recognized mental health diagnosis, orthorexia is a condition that causes a fixation on the quality — as opposed to the quantity — of food a person eats. People living with orthorexia are obsessed with “clean” eating, meaning they won’t consume anything they deem unhealthy or impure. 

People with orthorexia often avoid things like additives or preservatives, along with whole categories of food, like dairy or gluten products. Unlike people who simply focus on healthy eating, people with this condition obsess and worry excessively about the ingredients in their food. This obsession can significantly interfere with their daily lives and relationships. There’s limited information available on the causes of orthorexia. But it may be related to an intense desire for perfection and control in one’s life.

Pica 

Pica is another eating disorder that usually arises in childhood. It causes a person to compulsively eat non-food items. People with pica may ingest things like dirt, chalk, paper, soap, hair, or feces, and this can lead to life-threatening health concerns. 

Pica is more prevalent among people living with conditions like schizophrenia, autism spectrum disorder (ASD), and intellectual disabilities. It’s thought to be caused by a combination of stress, traumatic childhood experiences, medical issues, or nutritional deficiencies. Pica can also be a learned or cultural behavior.

Find care with Rula

Many people assume that body image issues and eating disorders go hand in hand, and they’re not entirely wrong. Conditions like anorexia and bulimia are linked to negative thoughts and feelings about one’s body. However, there are forms of disordered eating — like pica, ARFID, and orthorexia — that don’t involve body dissatisfaction. 

If you’re living with one of these conditions, know that you’re not alone and recovery is possible. At Rula, we’re committed to making therapy more accessible, no matter the mental health concern you’re facing. In just a few minutes, you can use our therapist-matching program to find a provider who takes your insurance. When you’re ready, you can make your first appointment as early as this week and take the first step.

Get started with Rula today