Piecing together the broken reflection

Eating disorders, body image, and the digital age

We often think of mirrors as bright surfaces– they reflect light, after all. We’ve learned to trust the gleaming images they send back to us as accurate and reliable. 

But mirrors have a dark side. 

An old Roman legend tells that shattering a mirror will lead to seven years of bad luck. In the Victorian era, people began covering mirrors after a death to prevent the spirit of the deceased from being trapped. And for centuries, children have huddled around mirrors in the dark trying to summon Bloody Mary. 

We aren’t children anymore. We may no longer believe in trapped souls or otherworldly portals over our bathroom sinks, but new monsters sometimes appear in the reflective surfaces, ones that follow us even after we tear our eyes away. 

We have a tendency to berate, detest, and attempt to alter the image we see in the mirror. Over time, this repeated self-criticism can spiral into dangerous and disordered habits.

Eating disorders account for some of the deadliest psychiatric disorders. According to a meta-analysis of 36 studies on the mortality rates of eating disorders, anorexia nervosa increases the risk of death by 5.86-fold, bulimia nervosa by almost 1.93-fold, and other unspecified eating disorders increase the risk of death by 1.92-fold.

Despite common and often exclusive recognition of anorexia nervosa and bulimia nervosa, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) recognizes a vast range of other common eating disorders such as avoidant/restrictive food intake disorder, binge eating disorder (BED), pica, and rumination disorder. Individuals may exhibit traits of multiple specific disorders and often grapple with a unique mixture of disordered habits.

“BED is the most common eating disorder in the United States,” National Eating Disorder Association Communications Manager Chelsea Kronengold said. “However, it is often less talked about than anorexia or bulimia. One reason is that BED is one of the newest eating disorders formally recognized in the latest edition of the Diagnostic and Statistical Manual. Before the most recent revision in 2013, BED was listed as a subtype of Other Specified Feeding or Eating Disorder.”

 While the aforementioned disorders are all enumerated in the fifth edition diagnostic and statistical manual, the list is far from exhaustive. The medical community has begun to consider the possibility of other disorders such as orthorexia, an obsessive form of healthy eating, which is currently unrecognized by DSM. 

 “Without formal diagnostic criteria, it’s difficult to get an estimate on precisely how many people have orthorexia, and whether it’s a stand-alone eating disorder, a type of existing eating disorders like anorexia, or a form of obsessive-compulsive disorder (OCD),” Kronengold said.

 BALANCE Eating Disorder Treatment Center, a nationally recognized treatment center located in New York City, treats clients who present symptoms outside of manual-enumerated disorders. 

 “We see eating disorders as being part of a broad spectrum ranging from mild disordered eating to acute eating disordered behavioral syndromes. Not every person fits into a defined diagnostic ‘box,’ as symptoms overlap and often shift. There are a number of clients we evaluate who have an orthorexic presentation without manifesting pronounced eating disorder symptoms that fit a classical DSM diagnosis. This might include obsessive thinking about ‘clean eating’, compulsive exercise, a persistent ‘diet mentality’, food rituals and rigidity around food and exercise,” Clinical Outreach Coordinator for BALANCE Treatment Center Leslie Davenport said.

 Although genetics and a few medical conditions, including Type-1 Diabetes and Polycystic Ovarian Syndrome, can predispose individuals to disordered eating, psychological and social factors are often major contributors. This diverse range of causes makes it impossible to judge whether or not someone has an eating disorder from outward appearance alone.

“You cannot tell if a person has an eating disorder based on their age, race, gender, socioeconomic status, or even weight. Any person in any sized body can have any eating disorder,” Kronengold said. “Misconceptions about who eating disorders affect have real consequences, leading to fewer diagnoses, treatment options, and pathways to help for those who don’t fit the stereotype.”

 Stress, pressure, or change can contribute to the onset of an eating disorder.

  “It started freshman year, with the transition to high school and taking on a new sport, cross country,” said Acalanes Student One, who wishes to remain anonymous. “There was also family stuff going on at the time, and stress to fit in which worsened it. I felt that everyone around me was naturally able to be so skinny and that by not eating I would be able to ‘fit in,’”

Eating disorders often accompany other mental health issues, such as depression, anxiety, OCD, and ADHD, leading to additional challenges in daily life. 

“Stress and psychological distress can have a major impact and particularly if there has been conflict in the family, early childhood trauma, and relational discord. Anxiety and depression are major contributing factors to an eating disorder as are chronic feelings of low self-esteem or inadequacy,” BALANCE’s Davenport said.

Davenport, who is also a licensed clinical social worker and trained psychotherapist, noted that eating disorders can quickly become coping mechanisms. 

“The attempt to use food and to control one’s eating in order to cope with feelings and emotions becomes the mode of operation for dealing with stress and unhappiness. For some, dieting, binging, purging and other behaviors may begin as a way to manage painful emotions and to gain a sense of stability and control over one’s life. Eventually the solution to feeling a sense of control becomes the very problem itself as the eating disorder takes over and wreaks havoc causing damage to the person’s physical and emotional health,” Davenport said. 

This can create significant difficulties for students dealing with multiple issues.

“I have severe ADHD so I wasn’t really able to pay attention before I got medicated,” Acalanes senior Jack Page said. “Mix that with anorexia and all your energy is taken away, making it hard to focus and making me always distracted.”

Eating disorders accompanied by other mental health issues are considered co-occurring conditions.

“It is rare that an eating disorder exists as a distinct diagnostic entity without being accompanied by another mental health condition. Eating disorders have a high comorbidity rate with other mental health and substance use disorders,” Davenport said. “Anxiety and depression can be co-occurring conditions at a rate as high as 70-80 percent and substance use can be found to co-occur at a rate of between 25-50 percent. In addition, many persons struggling with eating disorders have some experience of trauma in their histories. Trauma can occur at a rate of 50-80 percent, which is pretty staggering in terms of numbers.”

These issues may quickly create a vicious cycle “It might be self harm. It might be really heavy thoughts about themselves. And it might be thoughts of suicide,” said Acalanes Wellness Coordinator Allen Choi, who has also worked as a social worker and therapist.

Although staff members like Choi work to support students, there is a limit to how much they can help in the realm of eating disorders. 

“If I see that there is a longer term problem that requires addressing, if I’m not the right person, it’s really working with them to maybe work with their parents and work with [an] outside provider,” Choi said.

Acalanes Human and Social Development classes, however, hope to provide information and start more conversations about body image in a school setting. 

   “There are a lot of misunderstandings about bodies, dysmorphia, anorexia, bulimia, and all eating disorders and body image issues in general. I think that people don’t understand that it is a real mental health issue,” human and social development teacher Monika Voellm said. “The person who is experiencing these feelings doesn’t necessarily want to be ‘right,’ but that they are suffering a mental health crisis.”

One major misunderstanding when it comes to eating disorders is their prevalence amongst males.

“Historically, eating disorders among men have been stigmatized. Therefore, boys and men suffering from eating disorders have been overlooked and have ‘flown under the radar’ so to speak, for quite some time. Until recently, boys and men were either under diagnosed or not diagnosed at all. Therefore, when they do present for treatment their eating disorders are sometimes more advanced and at higher levels of acuity,” Davenport said. 

Similarly, Davenport noted a high prevalence of disordered eating among nonbinary and transgender individuals.

“The Journal of Adolescent Health sampled nearly 300,000 U.S. college students about their self-reported eating disorder behaviors. The researchers found that 15 percent of the transgender people surveyed reported an eating disorder diagnosis within the year prior to the survey. Transgender students self-reported higher rates of an eating disorder diagnosis as well as higher rates of using compensatory behaviors such as diet pills, vomiting, and laxatives,” Davenport said. 

Eating disorders are accompanied by a slew of damaging physical and mental effects, including digestive, cardiovascular, neurological, and endocrinological issues.

“I would have to get to the point of thinking I was gonna fall down or that I was going to have to rush somewhere to think, ‘OK,  now I’ll eat’. And then I would eat and for like a split second I’d realize it gave me energy pretty quick,” Acalanes’ Page said. “But then I’d go on the scale. And then I’d be peeved by the weight the food gave me really quick too, even though that’s not real weight.”

The physical consequences of disordered eating can also distract from academic performance.

There were many times during tests that I was scared the entire class could hear my stomach growling because it was so loud to me and the room was so silent,” said Acalanes Student Three, who wishes to remain anonymous.

Eating disorders, which can spread to rule a person’s every action or thought, also take a drastic toll on mental health. 

“If I drank a cup of water or took a five minute walk I immediately had to go see the number on the scale,” Page said.

Obsessive behaviors like this tie into feelings of guilt or shame associated with food. 

“I also grew up in a pretty controlling household when it came to food, so I don’t think that helped. My family keeps unhealthy food in a separate spot so that we can keep track of the rate at which it gets consumed… I don’t really blame them, it did make me aware of healthy eating, but I also now have a serious guilt complex when it comes to eating out of schedule or eating something that isn’t on the menu,” said Acalanes Student Two, who wishes to remain anonymous.

Davenport emphasizes the importance of the household in the development and treatment of eating disorders. 

“The family system can be influential and serve to enhance one’s chances of developing an eating disorder. If the family places a strong emphasis on external beauty, achievement and success as the primary means to be loved and accepted this can have an influence on an individual developing an eating disorder,” Davenport said. 

The home isn’t the only place where issues take root. Body image issues may develop in a school setting as well. Senior Riley Hawkins recalls beginning to feel self conscious in second grade.

“I thought I wasn’t as skinny as the other girls,” Hawkins said. 

Although unhealthy comparisons should not burden childhood, children often begin to dwell on their appearances at young ages, especially if they encounter teasing or bullying. 

“The first time I became self conscious of my body was probably in fourth or fifth grade when girls started really comparing themselves to each other and dressing differently based on their body types. This made me think that you had to look a certain way to wear certain clothes,” junior Natalie Cohen said. 

Many young women feel pressure to be slim while still having curves, an often impossible standard. Boys can also face hurtful comments and toxic expectations from an early age.  

“If we’re born in a society that tells us that we have to look a certain way — it could be race, gender, body size — and we don’t fit that mold, there’s a lot that we have to overcome in addition to all the other facets of our lives,” Choi said. 

The competitive nature of sports sometimes largely influences body image by creating additional molds.

“Weight was just always thrown out there and compared,” Page said. “If I beat someone in a race or something, they might still say, ‘Oh, well, you’re still bigger than me.’”

When every athlete is wearing the same uniform, comparison is inevitable. Tight or revealing uniforms often exacerbate this.

“Wearing skin tight spandex was not my favorite,” Acalanes Student Two said. “All I could think about was what my thighs and waist looked like.”

The tendency to compare oneself to others is seldom healthy, especially due to natural genetic variation. Social media, unfortunately, makes these comparisons and expectations commonplace. 

“I think that guys should know that the things they see on social media of perfect girls are unrealistic, and we can’t possibly look like that. I know that a lot of guys think that skinny girls on social media work out perfectly, and eat super healthy and that everyone else just must not care about health. I just want them to know that only praising girls with ‘perfect’ bodies creates such an impossible, toxic standard,” Cohen said. 

Social media often revolves around models, celebrities, fitness influencers, and other prominent figures. The ever-growing platforms that promote their content also create space for people to criticize others’ bodies. This can push people to seek “better” figures in order to avoid similar criticism. 

“Society constantly makes comments about what they look like, how their body appears. If they’ve gained weight, if they’ve lost weight. When somebody becomes famous, it’s like they’re no longer humans,” Voellm said. “That creates a culture of people expected to look perfect and the minute that somebody thinks they don’t look perfect anymore then it’s open game to just make fun of them.”

According to Davenport, the rise of social media directly correlates with the rise of teenagers receiving treatment. 

“We have definitely seen an increase in the number of teens coming into treatment and we are seeing a striking number of younger teens or pre-teens as young as 12 presenting with serious eating disorder symptomatology. There seems to be a high correlation with social media which has only increased during the pandemic with many young people isolated at home in front of computer screens for the majority of the day,” Davenport said. 

On top of providing space for harmful comparisons and toxic criticism, social media also gives a platform to people who may promote disordered habits. 

“In social media we often see a romanticisation of eating disorders and disordered eating behaviours. You have to be really careful who you follow because many people actually promote disordered eating and label it as a ‘lifestyle’ or ‘fitness journey,’ ” Instagram blogger @agooddaytogrow said.

Accounts like @agooddaytogrow attempt to counter this with positive content. Dutch blogger Dionysia, who runs the pro-recovery Instagram account @idontneedana, also uses her platform to educate and encourage.

“By sharing my point of view … on harmful content on social media, I try to stimulate people to listen to their own bodies instead of the things society teaches us. I also gather recommendations, like videos, other helpful accounts or YouTube channels, for people to educate and inspire themselves. By setting up challenges, I try to motivate others to challenge their fear foods, which I always join as well,” Dionysia said.

Many bloggers and influencers also work to bring light to tangential social issues. 

“I like to use my social media to share my own story as well as to educate others on the dangers of ED’s and the toxic traits, such as fatphobia and racism, that come into play as well,” @agooddaytogrow said. 

@agooddaytogrow also uses her account to inspire dialogue around topics like stigma and other challenges that people in recovery face. 

“I hope that my online presence has helped to destigmatize mental illness and eating disorders and show that you can’t tell who has an eating disorder simply by looking at them. I also want to show everyone that it’s possible to recover without having access to top quality resources and that recovery truly is for everyone,” she said.

Recovery often consists of a five step process starting with acknowledgment of the issue. It requires significant time, support, and patience.     

BALANCE applies a variety of treatment approaches that follow a similar track. 

“There are many treatment approaches and strategies such as Family Based Therapy, Acceptance and Commitment Therapy , Exposure and Response Therapy and so on,” Davenport said. 

As it’s often difficult for individuals to acknowledge their disordered habits, outside influences often spur on the recovery process. At Acalanes, the Wellness Center occasionally plays a role in this step.

“One of my goals is to actually work with [students] and help them identify, ‘Hey, this is time for you to make a change, and maybe get some outside help,’ ” Choi said. 

Eating disorder recovery varies greatly on an individual basis. 

“One treatment modality may be successful for one client but prove ineffective for another. There is no ‘one size fits all’ when it comes to eating disorder treatment. Most often a combination of treatment approaches and techniques tailored to the individual client’s needs is shown to be most effective. At our treatment center each client has a specific customized plan and we are always seeking to integrate new forms of therapy based on the latest research in our field,” Davenport said.

The admin of @agooddaytogrow emphasizes this variation.

“Every individual’s recovery looks different! Everyone has different factors that come into play. Are they able to access treatment? Do they have a support system? Are fatphobia and racism coming into play? Everyone is going to have different lived experiences and no two individuals are going to have the same recovery process,” she said. 

The length of recovery also varies from person to person. 

“Treatment takes time and often clients and families falsely believe that one is simply ‘cured’ once weight is restored. This is only the first step as it takes time for the brain to return to full functioning and for the body to restore itself to maximum health. In addition, ingrained and entrenched behaviors need to change. Some reports of anorexic clients that have fully recovered indicate that it can take up to seven years or longer to get well and to establish stability in recovery,” Davenport said. 

Access to recovery is often inconsistent across ethnic and racial lines as well. A 2003 study by the National Eating Disorders Screening Program found that doctors are less likely to ask people of color about eating disorder symptoms than their white peers despite similar rates of symptoms. 

Although recovery is a difficult process, it can allow a person to cultivate new interests. Dionysia found motivation to create her Instagram account while in recovery herself. 

“In the beginning of my recovery, I wasn’t allowed to do anything. I couldn’t go to school, I couldn’t hang out with friends, I couldn’t even go for a walk. I needed a new hobby, something I’d be passionate about,” Dionysia said.

“Meanwhile, I was very motivated to recover, and so I decided to share my tips and experiences with those who are struggling with the same things as I do. I’ve always loved helping others and I wanted to create a safe space that would give people the feeling they’re not alone.”

During this process, the everyday support of family and friends as well as trained professionals is essential. 

“When we eat together I try to take the first bite, have a larger portion than them, and keep eating long enough that they’re never the last or only person eating. If we’re eating from a package sometimes I’ll position it so the nutrition label is pointed away from them,” Acalanes senior Megan Baginski said. 

Supporting friends, even through little actions, can often alleviate the stress of eating.

“Even if we’re just going into a gas station and I see they’re not getting something I’ll be like, ‘Hey, I can get you something, what do you want?’” Page said. “It’s better than always telling someone ‘you have to eat.’ That’s insensitive.”

This support is especially vital in the case of relapses, which are common. 

“Relapses are common and are a reality that one must confront in the process of recovery. Relapses often occur if a patient does not have an adequate support system and if treatment is not comprehensive or extensive enough. Treatment must be high quality delivered by trained, experienced eating disorder professionals and the level of care must be carefully chosen to address the degree of acuity of a given patient’s condition. Some patients relapse in outpatient care because they have not had the opportunity to receive extensive treatment including proper weight restoration and re-nourishing that can take place in an inpatient or residential setting,” Davenport said. 

Relapse, much like the initial development of an eating disorder, can be the result of myriad factors.

“There can be many ‘triggers’ to increase one’s chances of relapse. These can include an unsupportive home environment, especially if parents or other figures are manifesting their own eating disorder behaviors, stress, trauma, co-occurring conditions such as depression, anxiety or substance use, and finally vulnerability to the influences of advertising and social media,” Davenport said. 

These triggers can even be offhand comments, which Voellm recommends avoiding by redirecting language. 

“Commenting about people’s bodies, like their size when they’ve lost weight, can cause more harm than people might realize,” Acalanes’ Voellm said. “A better comment might be along the lines of, ‘that’s a cool shirt you have on.’”

When trying to improve their body image, some students take a stance of gratitude.

“I sometimes think of the people out there who are limited in what they can do because of a medical problem, like some people can’t walk and I’m over here complaining about my body even though I’m capable of so many things. An ounce of fat on my stomach isn’t going to restrict me from doing anything,” Cohen said.

Many also encourage setting goals and focusing on the future. 

“Find out what motivates you. Think about your goals and your purpose in life. Keep reminding yourself of these things and believe in yourself. You’re capable of achieving amazing things. Recovery is so possible and you’re so much stronger than you think you are,” Dionysia said.   

“Whatever you’re struggling with, your struggles matter and you deserve the help and support you need to get back your life. It’s so worth fighting for. And you don’t have to fight alone.”

It is also beneficial to remember the negative consequences of disordered eating while struggling with body image issues. 

“When I begin to have more of the eating disorder thoughts again, I tend to try to remember what it was like when I let them win. It was a very unhappy and taxing state, both mentally and physically,” Acalanes Student Three said.

To increase awareness, it is vital to discuss and reduce stigma around eating disorders.

“You shouldn’t feel like you’re a bad person because it affected you. When we take away the shame, the stigma, more people will get help,” Voellm said.

It can be difficult to know where to turn when you find yourself standing amidst broken glass. Remember that you are not consigned to cleaning it up alone.

It may take time, and we may get cut along the way. 

But piece by piece and shard by shard we put our reflections back together. We regard that illusion of self that stares back at us. And we let it go.