In honor of this year’s message, “It’s your time,” I want to draw attention to the link between how we see ourselves and how we treat our bodies.

Currently, 80 percent of women in the U.S. are dissatisfied with their appearance. And more than 10 million are suffering from eating disorders.

So the question I have to ask, Why all the self-hatred?

Body Image and the Media

Historically, the ideal female body was strong and full-figured, as seen in icons such as Marilyn Monroe. Yet even as early as the 1800s, when painful, health-impairing corsets were used to accentuate the breasts, hips and buttocks, women were expected to strive for a specific ideal of beauty.

In the 1900s, the American public became more consumed with the thin, boyish physique, viewing full-figured women as indulgent and lacking in self-control – a trend that grew exponentially by the end of the century.

In modern times, we’ve witnessed a “thin at all costs” movement that now defines Western culture. The U.S. has the highest rates of obesity and eating disorders in the world. As a melting pot of people from all backgrounds, there is no genetic reason that explains this increased vulnerability to weight, body and food issues. Instead, we have to look at the messages our society sends about how we value our citizens.
From a young age, women aspire to Barbie-like measurements that are physiologically impossible without surgery and/or starvation:

• According to the National Eating Disorders Association, 42 percent of first- to third-grade girls want to lose weight, and 81 percent of 10-year-olds are afraid of being fat.
• According to a study in Pediatrics, about two-thirds of girls in the 5th to 12th grades said that magazine images influence their vision of an ideal body, and about half of the girls said the images made them want to lose weight.
• By adolescence, studies show that young people are receiving an estimated 5,260 “attractiveness messages” per year from network television commercials alone.
• According to Teen magazine, 35 percent of girls ages 6 to 12 have been on at least one diet, and 50 to 70 percent of normal-weight girls think they are overweight.

Over time, models have gone from thin to emaciated, which has been mirrored by a growing problem of eating disorders and body image dissatisfaction. In 1975 most models weighed 8 percent less than the average woman; today they weigh 23 percent less. Compared to the Playboy centerfolds and Miss America winners from the 1950s, at least one-quarter of present-day icons meet the weight criteria for anorexia. Meanwhile, the average woman’s weight has increased.

Today, the media is a far more powerful influence than ever before, sometimes taking precedence over friends, family or other real women. Whereas women used to look at role models who were average-sized, women are now comparing themselves with images (some of which are merely computerized conglomerations of body parts) that are unrealistically thin. In the old days, a young girl grew up wanting to look like her mother or best friend. Now she wants to look like Angelina Jolie.

Herein lies the real damage. The more an individual is exposed to the media, the more he or she believes it is reflective of the real world. What most people still don’t realize is that the majority of the pictures they see in magazines are altered in some way and that looking like their role models is physically impossible. It is a setup for self-hatred.

Genetics and Thin-Heritance

As a result of both genetic and environmental factors, body image issues and eating disorder behaviors may be passed down from generation to generation. This concept, recently labeled “thin-heritance,” explores how a mother’s views about food, dieting practices, and negative attitudes and comments about her own body or her child’s appearance increase her children’s risk for poor body image and eating disorders.

Cultural Messages

Body image also stems from cultural messages. For example, in Polynesian culture, bigger once meant being healthier and stronger. In a landmark 1998 study of girls in Fiji, Harvard researchers demonstrated how the introduction of television contributed to dramatic increases in eating disorders over a three-year period. In a culture that once valued a healthy, robust physique, girls began viewing themselves as fat, going on diets and feeling depressed about the way they looked, all in an effort to look more like the Western women they saw on shows like the original “Beverly Hills 90210.”

After three years, 74 percent of Fijian teenage girls described themselves as too fat. Those who watched TV three or more nights a week were 30 percent more likely to go on a diet than their peers who watched less TV. Being called “skinny” went from a cultural insult to a worthy life goal.

Similarly, African-American culture is beginning to see a shift. While there used to be greater acceptance of women who were full-figured, now the younger generations are buying into the thin ideal, and we’re seeing famous African-American singers and actresses advertising dramatic weight losses.

Relationships

In all relationships, whether a boyfriend, spouse, peer, coworker, sibling or parent, people look for acceptance and validation. When they receive criticism, rejection or judgment instead, they are at increased risk of a number of mental health issues, including poor body image and eating disorders. Troubling behaviors range from a dirty look when taking a second helping of food at the dinner table to persistent weight-related bullying by one’s peers. All of these exchanges, no matter how subtle, can have a lasting impact.

A Glimmer of Hope

Amidst all of the negative media messages, there have been a few glimmers of hope in the past decade:

• In an effort to become ambassadors for the message of healthy body image, Voguerecently announced that it would no longer feature models under age 16 or those who appear to have an eating disorder.
• Fashion organizations in Spain and Italy have specified a minimum healthy body mass index for models.
• Israel’s government recently passed a law that requires a healthy body mass index for models as well as full disclosure if fashion media and advertising use Photoshop to change a model’s figure.
• Dove has been leading “real beauty” empowerment campaigns and taking a stand against Photoshopping for almost a decade.
• In 2002, actress Jamie Lee Curtis posed for a magazine both “glammed up” and in “real life” fashion to bring awareness to the way media images are digitally altered.
• Social media websites such as Facebook, Tumblr and Pinterest are increasingly banning pro-anorexia and pro-bulimia messages. At the same time, there are a growing number of websites dedicated to healthy portrayals of real women, including the I Am That Girl blog.

In spite of these trailblazing changes, a lot of progress has yet to be made. The majority of magazines and other media have not replaced unrealistic images with normal, average-sized people. Although awareness is growing, parents and other authority figures can do more to model healthy self-image and diet, limit exposure to media, openly talk about media messages and share daily family meals. What we need is a broad-scale cultural shift that will only come about when we start demanding it.

So what constitutes trauma?

Trauma comes in many forms, including childhood abuse or neglect, growing up in an alcoholic or dysfunctional home, environmental catastrophes such as Hurricane Katrina, a serious accident, loss of a loved one, and violent attacks such as rape and sexual assault. What all of these experiences have in common is that they leave the individual feeling helpless and out of control.

Trauma isn’t the same as having post-traumatic stress disorder (PTSD). PTSD is a specific diagnosis with distinct criteria, involving a serious or life-threatening experience that results in nightmares, flashbacks, attempts to avoid situations similar to those that led to the trauma and a hyperactive startle response, among other symptoms.

How Trauma Contributes to Eating Disorders

An eating disorder may develop in an attempt to cope with the trauma, suppress painful emotions or to regain a sense of control. Here are a few examples of how trauma manifests in eating disorders:

• Example 1:After the death of a parent, a child is sent to live with a grandparent who isn’t as loving and kind as her mother. She had pleasant memories around food, cooking and eating as a family, and used food to comfort herself through the sadness of losing her mom. After bingeing, she feels consumed by guilt and self-loathing and begins purging through self-induced vomiting, use of laxatives or excessive exercise.
• Example 2: A young adult woman was raped in college. Because she was powerless to prevent the attack, she began restricting her food intake to feel a sense of control over her body. Losing weight became a way to disappear or to appear childlike so she could be cared for by others or appear less attractive to men. Others who have been sexually abused or traumatized by the men in their lives may overeat, using their weight as a protective mechanism to avoid being hurt again.

Treatment for Trauma and Eating Disorders

Individuals with a history of trauma may not fully recover from an eating disorder, or may experience chronic relapse from their eating disorder, until they address the underlying trauma. As part of an integrative approach to eating disorder treatment, patients may participate in the following interventions.

Somatic Experiencing

Trauma is held in the body and often can’t be resolved solely with intellectual processing. Somatic experiencing is a body-awareness technique that was developed by Peter Levine, PhD. With guidance from a therapist, patients explore the sensations in the body as they work to recognize and regulate their feelings of distress.

Eye Movement Desensitization and Reprocessing

In EMDR, the patient focuses on past memories, present triggers or experiences they anticipate in the future while focusing on an external stimulus (e.g., eye movements, tones or taps). For example, the patient may be asked to focus on a particular thought or bodily sensation while simultaneously moving their eyes back and forth, following the therapist’s fingers as they move across the patient’s field of vision for about 20-30 seconds. Each session is guided by a therapist to help the patient develop new insights or associations surrounding their experience of trauma.

Cognitive-Behavioral Therapy

Individuals who have experienced trauma often struggle with self-blame or feeling responsible for what happened to them. This maladaptive thought process may follow them into adulthood. Trauma victims may recreate the trauma in some form for themselves or by perpetrating the act of their abuser on others.

Cognitive-behavioral therapy helps patients work through anger, shame, guilt and other emotions by replacing negative thought and behavior patterns with new skills and problem-solving strategies. It is backed by extensive scientific research and is widely used to treat trauma, eating disorders and a variety of other mental illnesses. In a safe, supportive therapeutic setting, patients are able to openly talk about their traumatic experiences and disordered eating behaviors.

Coping Skills Training

Eating disorders frequently develop as a way to cope with trauma. If trauma occurs at a time in life when the individual lacks the coping mechanisms to process it, they may use food to feel a sense of control.

Rather than judging the coping mechanism as good or bad, the therapist helps the patient identify the purpose the eating disorder has served and recognize that it has begun to cost more than it helps. As an adult, the patient can develop more mature coping strategies and call upon different skills than they could at the time of the traumatic event.

Dialectical-behavior therapy helps trauma sufferers build the skills of mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness to improve body image, manage painful feelings associated with trauma and guard against relapse. Learning how to trust and express anger in a healthy way are other important recovery tools.

Self-Help Support Groups

Social support is a major determinant of successful coping. A number of 12-step support groups exist for those suffering from an eating disorder, including Eating Disorders Anonymous, Overeaters Anonymous, and Anorexics and Bulimics Anonymous. Many eating disorder treatment programs invite family members to be part of the treatment team and to address their own emotional and psychological issues while their loved one is in treatment.

Nutritional Therapy

Beginning to address trauma can lead to an increase in eating disorder behaviors. By educating patients about nutrition and fueling the body with wholesome foods, patients can practice healthier patterns and boost their energy and mood.

Exercise

When a patient is working to manage their anger, certain forms of exercise may be a tool for healthy release of anger.

Nutraceuticals

Use of nutraceuticals – amino acids, nutrients and dietary supplements that improve overall health – can decrease distractions from trauma work and reduce some of the physical complaints of eating disorder recovery, such as bloating and constipation. Certain supplements and herbal remedies may also assist with symptoms of depression and co-occurring mood disorders.

Mind-Body Therapies

A number of mind-body therapies can aid in stress management and boost mood and memory. Meditation, acupuncture, yoga, massage, energy healing, self-hypnosis and breath work are a few examples of therapies that have been helpful in treating eating disorders and trauma.

The human mind is complex. A traumatic experience in childhood can manifest as an eating disorder years later. Both trauma and eating disorders can have profound, long-term consequences that make recovery challenging. Once the issues have been identified and are being treated simultaneously by a multidisciplinary team of professionals, lasting recovery is possible.

Complementary and alternative therapies used in integrative medicine can include acupuncture, chiropractic, herbal medicine, dietary supplements and others that give the clinician a wide array of treatments for difficult conditions. This is particularly true in the integrative medicine approach to eating disorders.

Eating disorders have been documented in adolescents and adults for many years. More recently, there is evidence that these disorders can also affect young children.

The cornerstones of an integrative medicine model for eating disorders includes some components that are found in every approach to the treatment of eating disorders, but may be used in a unique manner. Others are more specific to the use of complementary and alternative medicine (CAM) therapies. The most important difference in this model when compared to other treatment strategies is the philosophical underpinning of integrative medicine — that is, the belief in the self-healing nature of body, mind and spirit.

The integrative medicine philosophy holds that the body, mind and spirit are able to heal with support from conventional and alternative therapies, given needed changes in lifestyle. These changes happen in concert with the therapeutic relationship the patient has with his or her therapist, physician or other healer.

The cornerstones of this integrative medicine approach can include:

• Medical treatment that focuses on reducing the risk of, detecting and treating complications of the disease and on improving overall health status.

• Nutritional therapies to improve nutritional status, help women improve their relationship with food, and improve digestion and absorption of needed nutrients.
• The use of botanical therapies to reduce side effects of pharmacological therapies.
• Body movement to help patients get back in touch with physical cues and learn healthy behaviors.
• Psychological testing to identify co-occurring diagnoses, including mood and personality disorders, and inform treatment strategies.
• Skills training, which may include the use of cognitive behavioral therapy or dialectical behavior therapy, to enable patients to cope more effectively with stressors in their lives and with situations and emotions that may trigger relapse.
• Complementary and alternative therapies, which may include massage, mind-body, chiropractic, acupuncture and energy medicine therapies.
• Prescription medications, which are used cautiously in children and adolescents and should be prescribed only to manage behavior that is life-threatening or therapy interrupting.

Eating disorders comprise a spectrum of disorders that are difficult to treat and have a high risk for morbidity and mortality. The integrative medicine approach offers many options to explore. While research into these therapies is still in the early stages, the benefit-to-risk ratio is favorable. Recovery from eating disorders is possible and the earlier they are treated, the better the prognosis.