Top Signs of a Body Image, Self-Esteem or Disordered Eating Problem… and How to Help

In the age of high-def images and the celebrated attainment of physical perfection, we all can find things about our own bodies that we don’t like. How do you know, though, when you, your friend or loved one has veered into a danger zone, one that can have serious consequences on your wellbeing? How do you know when it is time to be concerned about his or her negative body image, low self-esteem or disordered eating behaviors? And, once you have decided that you need to do something to help this person, what do you do?

All of these questions are difficult, trying and scary. Knowing that your friend or loved one is hurting and that his or her body image, self-esteem and eating habits are not healthy is overwhelming. I often have patients’ loved ones tell me that all they want to do is help but that they do not know how. Below, I list some general signs of a person who is struggling with body image, self-esteem or eating problem, and some of the best things you can do to help that person.

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1. Poor Body Image. Notice if the person often engages in negative self-talk such as “I’m so fat” or “I have no self-control.” Notice if the person consistently interprets others’ comments as negative judgments of him or herself. Negative or obsessive thoughts about body size and body insecurity are important signs to look for.

2. Wanting to Eat Alone. If your friend or loved one has a fear of eating in public, it is important to question why this fear exists. Is the person self-conscious about food intake in relation to his or her body? What is underlying the person’s anxiety? For people struggling with disordered eating, food in and of itself can provoke anxiety, so eating in public is even more anxiety provoking than eating alone.

3. Focusing on ‘Safe’ Foods. Does your friend or loved one label foods? Are certain foods ‘healthy’ and others ‘bad’? If you have a sense that your friend or loved one has labeled foods as ‘safe’ or ‘unhealthy’ then it is important to consider where these labels came from. Notice whether your friend or loved one connects the category of food (good versus bad) with his or her self-worth e.g. “I was bad today because I ate a bad food.”

4. Excessive exercise. This one is difficult because defining what ‘excessive’ is can be tricky, especially when talking about active adolescents and athletes. The key questions to ask yourself are: Does my friend or loved one panic if he or she misses a day of exercise? And, will he or she exercise even when sick or injured? Exercise can be a compensatory behavior in response to food, so noticing the role that it plays in your friend or loved one’s life is important.

5. Eating Rituals. Does your friend or loved one approach every meal in a regimented way? Does he or she cut food into very small pieces? Arrange items on a plate in a certain pattern? Always leave the same item uneaten? Eating rituals can indicate attempts to eat less as well as obsessive food related behaviors.

6. Feeling Cold and Fine Body Hair. Feeling cold is often a symptom of low body fat and malnutrition. Choosing to wear heavy sweaters on warm days and always wanting to keep a jacket on inside the house are common indicators that a person’s body is having difficulty maintaining warmth. Additionally, people who are restricting their caloric intake often develop a thin film of hair that is soft and downy on his or her arms and other parts of the body. This hair is known as lanugo and emerges after extended periods of malnutrition.

THE STEPS. If you notice any of these signs of a body image, self-esteem or disordered eating problem, here are some helpful ways to approach it:

1. Trust Your Gut. If you are concerned, listen to yourself. You might not have clarity on what exactly feels unhealthy about your friend or loved one, but if you are worried, do not ignore that feeling.

2. Educate Yourself. Learn as much as you can. Read books, articles, and brochures. Try your best to distinguish facts about your friend’s disordered eating with inaccurate ideas that he or she has.



3. Be Honest, Caring and Firm. The best thing that you can do for your friend or loved one is to talk openly with him or her about your worries. Your sharing your concerns indicates how much you care for him or her. You do not need to police the person or try to take responsibility for his or her actions. Instead, compliment the person’s personality, accomplishments and successes while also expressing to him or her what you have observed and why you are worried.

4. Seek Help. No one can force someone else to change his or her attitudes and behaviors or to engage in help. Once you have openly and honestly shared your concerns with your friend or loved one, tell someone else. Ask others in this person’s life to support you and this person in taking the problem seriously and addressing it. If you can, seek the help of a professional who has experience working with others with negative body image and self-esteem. Asking the professional to speak to your friend about your concerns might help the person to take your worries more seriously.



Rebecca Glavin, MBA, MSW, LCSWA is a therapist in Charlotte who specializes in working with women with body image and self-esteem concerns as well as eating disorders. Rebecca also works with women who struggle with infertility and miscarriages. Rebecca lives in the Cotswold area with her husband and young daughter. To learn more about Rebecca, visit her website, or find her profile and information on the Psychology Today website here.