Is it an Eating Disorder or Body Dysmorphic Disorder?

I stared in the mirror and obsessed about whether a space existed between my thighs. Sometimes referred to as the “thigh gap,” I did my best to stand at specific angles that might create such a space. When I couldn’t achieve this so-called ideal after a considerable amount of effort, I wore baggy clothes to hide the perceived flaw. I stayed in—again—instead of hanging out with friends.

My body was my prison.

Does your body keep you from engaging in life? If so, you may have wondered if you have a problem. Well, maybe you haven’t.

But if you’re obsessing about your shape, it’s important and really helpful to know the difference between two very serious mental illnesses: eating disorders and body dysmorphic disorder. It can be really confusing to tell these two disorders apart.

People living with an eating disorder or body dysmorphic disorder (BDD) might relate to the behaviors described above (excessive mirror gazing, wearing baggy clothes or avoiding going out with friends). If this is you, you might also feel the need to seek reassurance about your physical appearance from friends and family.

Eating disorders and BDD are similar in these ways. Sadly, both disorders are also associated with depression and low self-esteem.

So, what’s the difference between an eating disorder and BDD?

What I didn’t share in my story above is a point that illuminates one key difference between eating disorders and BDD:

After my depressing experience in front of the mirror, I refused to eat that day.

This is an important difference between an individual struggling with an eating disorder and someone with BDD. To be diagnosed with an eating disorder (this might sound obvious), eating must be impaired.

Also, compared to BDD, which tends to be focused more on a specific part of the body like one’s nose or hairline, the preoccupation with the body in an eating disorder is more generalized to shape and weight concerns.

Don’t get me wrong: for a long time while I struggled with an eating disorder, I didn’t like my nose, and I hated the blemishes on my chin. But these things never kept me from engaging in life. Concerns about my shape and weight are what kept me from engaging.

Above, I did describe an obsession with a specific body part: my thighs. Yet, importantly, this preoccupation with the thigh gap was a part of my larger concern about shape and weight.

Can I have both an eating disorder and BDD?

Yes, some people are living with both BDD and an eating disorder — like my friend, Matt. Years ago, in an eating disorder therapy group, Matt spoke about feeling obsessed with both “feeling fat” as well as a tiny acne scar on his nose, which he described as being “huge and disgusting.” No one else in the group even noticed the scar until he pointed it out one day.

Because Matt was intensely preoccupied with a perceived defect beyond just shape and weight, he was also diagnosed with BDD.

Yes, people with BDD can have both shape and weight concerns. But, remember: if the weight or shape preoccupation leads to disordered eating, an eating disorder diagnosis might be more likely.

Why does any of this even matter?

It’s important to know the signs and symptoms of both BDD and eating disorders. These illnesses are complicated, terrifying, and real. And these illnesses cause millions of people to lead lives filled with a great deal of pain and suffering.
 
A thorough assessment and correct diagnosis can make all the difference by helping individuals find the most effective treatment options available to them. A correct diagnosis ensures that someone suffering with an eating disorder without BDD follows an appropriate (and possibly different) treatment path compared to a person with an eating disorder plus BDD. And, the individual with BDD and no eating problems might follow a different therapeutic journey altogether.

Recovery for both eating disorders and BDD

Surprisingly, thanks to the gift of recovery, many of us, including Matt, are now in a place where our attitude about our bodies is healthier than the average person! Like many things in life, our struggles ended up making us stronger.

If your body makes you feel like you are in a prison, have hope that things can get better. Make an appointment with a mental health counselor (if you aren’t currently in treatment). And, if someone you care about is struggling with issues related to body image or eating, please share this post with them and encourage them to get help.

A body doesn’t have to be a prison. Instead, our bodies can be precious vehicles for life. We can heal from both eating disorders and BDD. With treatment, effort, and persistence, people do get better. I know this firsthand!

In partnership with Insight Behavioral Health Centers (877-737-7391), Eating Recovery Center (877-957-6575) provides specialized treatment for eating disorders as well as related disorders, including BDD.

Jenni Schaefer is a bestselling author and popular speaker on eating disorders and related disorders, including PTSD. 

References:

• Hartmann, A.S, Thomas, J.J., Greenberg, J.L., Matheny, M.L., Wilhelm, S. (2014). A comparison of self-esteem and perfectionism in anorexia nervosa and body dysmorphic disorder. The Journal of Nervous and Mental Disease, 202(12), 883-888.
• Rabe-Jablonska Jolanta, J., & Sobow Tomasz, M. (2000). The links between body dysmorphic disorder and eating disorders. European Psychiatry, 15(5), 302-305
• Ruffolo, J. S., Phillips, K. A., Menard, W., Fay, C., & Weisberg, R. B. (2006). Comorbidity of body dysmorphic disorder and eating disorders: Severity of psychopathology and body image disturbance. International Journal of Eating Disorders, 39(1), 11-19.