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According to the American Academy of Child and Adolescent Psychiatry, in the USA as many as 10 out of 100 young girls and women have received a diagnosis of an eating disorder. The true number, including boys and non-gender-conforming people, may be much higher as those groups tend to underreport eating disorders.While there are varied causes of disordered eating behaviors, including genetic factors and family environment, body dysmorphia (AKA disordered body image) is nearly always present.

Eating disorders come in various forms, and although their specific symptoms vary, from the definitive binge and purge cycle of bulimia nervosa to the avoidance of certain foods in ARFID, a troubled relationship with self-image, food, and eating is constant. Eating disorders can affect people regardless of age, ethnicity, gender, or any other demographic.

A simple way to define body image is “the way a person sees themselves.” While everyone struggles with negative body image sometimes, a persistent negative or distorted teen body image causes an irrationally unrealistic perception of how they look. The idea of being flawed or overweight can then lead to dieting and also more dangerous eating behaviors.

Why Body Image Is in Flux During Adolescence

With exceptions, most clinical studies indicate that negative body image is a contributing factor to the development of eating disorders. Not coincidentally, most eating disorders develop for the first time in early to middle adolescence. During puberty, most children begin to reassess their feelings about their bodies as they rapidly change. Also important is the beginning of sexuality in early adolescence, which influences feelings of attractiveness and a desire to appeal to peers.

The mental health community has proven in various studies over the years that adolescence is the most common period for psychiatric and behavioral disorders to start. Parents and caregivers should be aware of these signs distorted body image in tweens and teenagers:

  • Feeling jealous about other people’s body shape
  • Complaining about their weight or body shape
  • Frequently comparing their body to others
  • Experimenting with diets
  • Expressing feelings of being ugly or fat
  • Cutting or other forms of self-harm

Signs and Symptoms of Eating Disorders

Some of the common symptoms of eating disorders (specific symptoms’ disorder listed in italics) include:

  • Avoiding meals or other socializing with food involved
  • Hoarding food (binge eating and bulimia nervosa)
  • Going to the bathroom directly after meals (BN)
  • Anxiety
  • Depression
  • Fainting, anemia, tiredness (anorexia nervosa)
  • Disruption or cessation of menstruation
  • Frequent or obsessive dieting
  • Excessive exercise
  • Abusing laxatives or diuretics (all types, but commonly bulimia nervosa)
  • Restricting certain food groups (common in ARFID and orthorexia nervosa)
  • Food rituals (eating foods in a certain order, not letting foods touch on the plate, excessive chewing, etc.)

One by one, these symptoms bight me easy to overlook or ignore – people’s bodies, personalities, and actions certainly change in adolescence and parents might thing these behaviors are passing. However, since the overwhelming evidence shows that this time in a person’s life can set the course for later, adult eating behaviors, parents should be aware of them and ready to respond. Professionals and treatment centers put great importance on honest, non-judgmental communication during this time.

How Common Is a Disordered Body Image?

Body image distortions are more common than most laypeople think, although they certainly don’t always lead to eating disorders. When they do lead to eating disorders such as anorexia nervosa or binge eating disorder, the disordered eating behavior is normally a response to these perceived flaws.

These compensatory behaviors can range from dieting and fasting to avoidance behaviors or binge eating and purging. Negative body image can develop even before puberty, with half of pre-teen girls and about 30 percent of boys expressing a lack of satisfaction with their bodies. It can carry on for years, with around 60 percent of adult women and 40 percent of adult men experiencing body-image negativity.

Does a Negative Body Image Always Cause Eating Disorders?

Definitely not. However, while not every case of negative body image causes an eating disorder, almost every eating disorder comes with it a sense of body dissatisfaction. Eating disorders are extremely complex mental illnesses that normally have more than one causative factor, of which a negative body image in adolescence is only one of the causative factors.

However, parents and families should be aware of the pitfalls of ignoring body image challenges in teenagers. As adolescence continues, more pressure is put on teenagers to conform to society’s ideals of what a “beautiful” or “healthy” (a word that’s too often weaponized to shame overweight people) body is. Their focus on weight and the shape of their body may become overwhelming.

What Factors Influence Body Image in Teenagers and Pre-Teens?

The process of transitioning from childhood to adulthood is never easy; it’s a time of uncertainty and finding one’s self. Puberty causes dramatic changes in a person’s size and shape, and of course acne and new body hair cause some people to feel shame and confusion.There are also hormonal changes, such as testosterone and estrogen, that affect brain chemistry and mood.

In addition to their changing bodies and brain function, adolescents have to cope with more pressure academically new responsibilities, and new pressure to “fit in” to society – all of which cause stress. Three of the most common factors in adolescence that can influence body image negatively include:


A major factor in a person’s self-esteem is how attractive they seem to potential dating partners. During the beginning of an adolescent’s dating life, they may develop an unrequited crush or be rejected, sending them into a shame spiral. They may come to doubt their own attractiveness, and those feelings can become obsessive and center around weight and body shape. They may feel they need to go on a crash diet or purge to attain a “better” body.When discussing dating and sex with their adolescent kids, parents should be sensitive to potential body image issues and supportive of HAES (Health At Every Size) to prevent disordered eating behaviors and foreground the importance of embracing one’s own beauty.

Athletics and Other Activities

Sports and other forms of athletic or performative activities form a major part of many teenagers’ lives. They can help form the values of teamwork, perseverance, leadership, and other qualities as they grow into adulthood, and that leads many parents and educators alike to think of sports as valuable activities. However, many activities, from wrestling to ballet, swimming to distance running place a high priority on weight control and repetitive, obsessive exercising.

Putting a premium on a specific weight can wreak havoc on the mindset of a person who already feels overweight (even if they are not). Parents may want to consider encouraging activities that don’t require revealing outfits or have specific weight restrictions, as these can worsen existing body image difficulties and disordered eating behaviors.

Media, Both Traditional and Social

Social media has infiltrated every aspect of most people’s lives, especially teenagers. Using Facebook, Instagram, TikTok, Twitter, and so on, teenagers are exposed to both their peers and various celebrities, models, and “fitness” or “beauty” professionals, all pushing a certain body ideal that may not be possible to attain.This doesn’t preclude the continued existence of traditional media like TV, movies, and print, which also tend to feature only thin women and muscular men. Since comparing one’s body to others’ is a common form of body dysmorphia, both social and traditional media can act as a further trigger for disordered eating behaviors – driving still-impressionable teenagers to try to lose weight in a futile attempt to match what they see.

Starting a HAES Approach Early Is Key

If parents believe they are seeing the signs of body image problems, it is best to act quickly. Even before reaching out to an eating disorder treatment center, there should be a frank and non-judgmental discussion about how he or she is feeling regarding their weight and body. While this may be a difficult conversation to have it is necessary to provide teens every tool to build a healthy life as they navigate this difficult stage. The first rule of thumb is to stress the importance of self-acceptance and HAES – the idea that a body can be healthy and beautiful in its natural state.

Outlining Treatment Options

Although it may be tempting to try and handle your teenager’s body image challenges or eating disorder by yourself as parents, it should be clear that professional help is often needed. The first step should always be to consult your family doctor. Although general practitioners normally don’t specialize in treating EDs or other behavioral health disorders, they will have the resources to point you in the right direction.

There are a few avenues of treatment available for eating disorders, and finding the right course is a matter of determining the severity of the disorder, any medical or psychiatric conditions that need treatment, and availability.

Some of the main treatment options for eating disorders include:

  • Residential Treatment:This is the most intensive form of eating disorder treatment, in which a client stays at a treatment facility for an extended period, typically 30-45 days to start. Residential treatment begins with medical stabilization and offers 24/7 coverage. Typical activities include cognitive retraining, groups, and individual sessions, mindful movement classes, and a team of nutritionists and dieticians to re-establish the client’s relationship with food and eating.
  • Partial Hospitalization: This type of treatment is ideal for those who are medically and psychiatrically stable but may still benefit from a supportive program that can help them transition back into a regular routine. Sometimes referred to as “full-day outpatient care,” teens may find this is a great continuing treatment option before returning to school.
  • Outpatient or Day Treatment:This is ideal for people stepping down from residential treatment, and for less-severe cases. Day treatment is also perfect for students who cannot take time off school for residential treatment. These are normally sessions of therapy in a group or individual setting performed several times a week, or even daily.


Melissa Spann, PhD, LMHC, CEDS-S

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.