-Teresa Jacobson, DBH, LPCC-S, NCC
November 30, 2022
Eating disorders have increased in prevalence in the last decade, and in particular they have increased exponentially with the COVID-19 pandemic. These are alarming truths because eating disorders are serious and can be fatal.
With the COVID-19 pandemic unleashing stress and anxiety in the world, it has been acknowledged that individuals with binge eating disorder and anorexia have experienced worsening symptoms, and all eating disorders are on the rise (Graber, 2021). "Eating disorders are among the deadliest mental illnesses, second only to opioid addiction, resulting in approximately 10,200 deaths each year."
Described as persistent disordered eating patterns that interfere with daily social and psychological functioning, eating disorders are "physically, mentally, and socially disabling, and are associated with the highest rates of cause-specific mortality among mental disorders" (Santomauro, Melen, Mitchison, Vos, Whiteford, & Ferrari, 2021).
Common eating disorders include binge eating disorder, which is most prevalent in the United States, bulimia nervosa, and anorexia nervosa which has the highest mortality rate.
Binge Eating Disorder is defined by recurring binging episodes that include a person feeling a sense of lack of control and marked distress over his or her eating, and "eating an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances" within any 2-hour period (DSM-IV, 2013). These binging episodes are associated with three or more of the following: (a) eating much more rapidly than normal; (b) eating until feeling uncomfortably full; (c) eating large amounts of food when not feeling physically hungry; (d) eating alone because of feeling embarassed by how much one is eating; and (e) feeling disgusted with oneself, depressed, or very guilty afterward. Binge eating disorder does not include purging, excessive exercising or fasting.
Bulimia Nervosa includes recurrent episodes of binge eating as described above with a sense of lack of control, and recurrent compensatory behaviors in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise. In addition, the binge eating and inappropriate compensatory behaviors on average occur at least once a week for 3 months, and self-evaluation is "unduly influenced by body shape and weight" (DSM-IV, 2013).
Anorexia Nervosa is characterized by significant and persistent restriction of energy intake/food leading to extremly low body weight in the context of age, gender, developmental trajectory, physical health. It includes: (a) a relentless pursuit of thinness; (b) a distortion of body image; (c) an intense fear of gaining weight; and (d) an extremely disruptive eating behavior. The two types of Anorexia include restricting and a binging/purging type. "Many people with anorexia see themselves as overweight, even when they are starved or severely malnourished" (National Institute of Mental Health, 2022).
Should you or a loved one experience symptoms that parallel those above, professionals can help change the trajectory of these fierce disorders. If you recognize some of these tendancies in yourself or a loved one, one consideration to learn more about is the developmental theory of positive embodiment.
Positive embodiment can be described as a comfort and connection with one's body that embodies wholeness and promotes wellbeing. Positive embodiment is a psychological construct that has emerged from the eating disorders field and can guide all of us to a healthier experience in life and self-satisfaction. Growing research reveals a movement towards a positive embodiment in the future will be able to prevent eating disorders.
"We talk about embodiment, because this guides us to the subjective experience of how it feels to live inside our bodies and to identify with our own unique experience" (Scott, 2020). "Whereas body image is fundamentally dissociative." Viewing ourselves from how we believe the world to view us can lead to self deprecation, self-neglect, and self-shame which can lead to a multitude of unhealthy beliefs and behaviors. Positive embodiment can turn these maladaptive patterns around.
The work on embodiment offers an integrated perspective in protective as well as risk factors. Dr. Niva Piran (2022) is well-published in her 20 years of research on embodiment, as well as in her books and woorkbooks about the theory and implications of positive embodiment. The work of this research describes the experience of embodiment to include five key dimensions:
Body connection and comfort, described as quality in the body and the ability to engage in protective self-talk. "I still feel okay with my body though I see models that don't look like me."
Agency and functionality, which addresses agency and functionality in acting in the world both physically and through one's voice. This includes concepts like feeling empowered and self-confident.
Engagement in attuned self-care practices refer "to the degree of attunment and responsiveness to the embodied self and it's physical, emotional, relational, spiritual, inspirational, as we engage in the world." When we are aware and in harmony with ourselves and attend to our own self care, it leads to positive wellbeing.
Experience and expression of bodily desires, involves healthy attendance and responsibility to our own physical hunger or appetite, as well as healthy sexual desires.
Resistance to objectification which is being able to live in one's body subjectively, rather than through an objective lens from one's own eyes or from the vision of others.
Each dimension can be positive or negative and can be inter-correlated (Piran, 2022). The five dimensions of experience of embodiment are each on a spectrum from positive experiences of freedom, to negative experiences of being controlled.
"In correlational research, positive embodiment measures predicted a significant degree of variance in disordered eating, evidencing the benefit of a positive psychology lens in understanding and preventing disordered eating by fostering resilience, wellbeing, and self-identity" (Munroe, 2022). "Positive embodiment was also correlated with higher life satisfaction, especially for women, for whom positive embodiment was a significant predictor of life satisfaction."
Self-care is considered they key to experiencing positive embodiment. Specifically, yoga, physical activity, and mindfulness are all recommended as positive self-care activities to aid positive embodiment, as all involve the mind-body connection. "In cross-sectional studies, the value of yoga and attuned exercise for experiential promotion of positive embodiment is echoed with links made to its value in both treatment and prevention of eating disorders and the importance of joyful physical activity as a protective factor for positive embodiment" (Munroe, 2022).
In addition to the physical, mental and social benefits of yoga, mindfulness, and physical activity, positive embodiment involves listening and responding to internal cues emphasized "alongside the relationship between caring for the body, body acceptance, and self-acceptance" (Munroe, 2022). The purpose of these activities is for enjoyment and experience, not for "manipulating physique." The involvement of self compassion can help enhance acceptance reduce one's experience of shame.
The breadth of the embodiment movement for eating disorders involves the theme of moving away from appearance, objectification, and self-objectification, and more torwards cultivating positive embodiment and well-being.
With so much suffering in this world, the last thing we need to do is to cause ourselves more. Positive embodiment is a relatively "new" way of thinking and being, and yet it sure sounds like the way we were always meant to be.
Teresa Jacobson is a Doctor of Behavioral Health and Licensed Professional Clinical Counselor Supervisor who is counseling Ohio and Kentucky adults of all ages and life experiences via secure Telehealth/Video visits. A strength-based, person-centered multi-cultural counselor, with an existential philosophy, Teresa can be reached by emailing firstname.lastname@example.org, calling (513) 206-3026, or visiting https://www.steppingtowardserenity.org
Graber, E. (2021, February 22). Eating disorders are on the rise. American Society for Nutrition.
Munroe, M. (2022). Positive embodiment for wellbeing researchers and practitioners: A narrative
review of emerging constructs, measurement tools, implications, and future directions.
International Journal of Wellbeing, 12(2), 134-162. Retrieved from
National Institute of Mental Health (2022). Eating disorders. Retrieved from
Piran, N. (2020, April 27). The embodiment construct Part 1. ED Matters. Podcast Retrieved from
Santomauro, D. F., Melen, S., Mitchison, D., Vos, T., Whiteford, P, and Ferrari, A.J. (2021). The hidden burden
of eating disorders: An extension of estimates from the Global Burden of Disease Study 2019.
The Lancet, 8:4, 320-328. Retrieved from
Scott, E. (2020, September 27). Why we talk about "embodiment" instead of "body image" at The Body
Positive. Retrieved from https://thebodypositive.org/why-we-talk-about-embodiment-instead-of-body-image-at-the-body-positive/