Symptoms of Bulimia Nervosa | Body Image Negativity

Body image is an important aspect of how we see ourselves and can contribute significantly to our mental and emotional well-being.

Author | Bridget Clerkin

6 sources cited

Body image

Unfortunately, developing a negative body image is a common experience for many people, mainly thanks to a long tradition of unrealistic beauty standards and advertisements targeted to make people feel worse about themselves.

Body image also plays a crucial role in a number of eating disorders, including bulimia nervosa (BN). Understanding more about the connection between body image and bulimia can help you develop a deeper understanding of the eating disorder and look out for subtle signs that something may be wrong.

What is Body Image?

Body image is broadly a combination of our thoughts and feelings about our bodies and appearance. Four major aspects contribute to this perception, including:1

  • Perceptual body image: the way we see our body
  • Affective body image: the way we feel about our body
  • Cognitive body image: the way we think about our body
  • Behavioral body image: the way we act as a result of how we perceive our body

Body image can be positive, negative, or neutral, a designation based on a number of factors. And body image is not fixed. Someone can go from having a positive body image to a negative body image to a neutral body image any amount of times, in any order.

When someone has a negative body image, it’s due to having a negative outlook about at least one (but usually more) of the above types of body image. And when these types of thoughts become a fixation or start impacting daily life, it can lead to disordered eating patterns and other serious concerns.

What Does Negative Body Image Look Like?

When someone experiences negative body image—sometimes also called body dissatisfaction—it can manifest in various ways and have many consequences on mental, emotional, and physical health.

Someone struggling with body image issues may:1,2

  • Constantly check themselves in the mirror
  • Actively avoid mirrors or opportunities to look at themselves
  • “Hide” their body in baggy or oversized clothes
  • Wear excessive makeup or not leave the house without makeup
  • Use harsh or unkind words to describe themselves or their body
  • Weigh themselves excessively
  • Closely examine certain body parts
  • Fixate on their body shape and size
  • Frequently compare their appearance to those around them

Overall, someone struggling with negative body image will tend to base their self-worth on their physical appearance, body shape, or size. This is part of what feeds the fixation on achieving a “perfect” or “ideal” body.

What Causes Negative Body Image?

Unfortunately, there are a variety of factors that can lead to developing a negative body image.

The “body ideal internalization,” or tying of personal worth to physical appearance, is one of the most common and damaging causes of negative body image. The concept may be developed through pressure to fit in with peers or taken from how people are depicted in media and advertising, among other sources.3

In general, the biggest sources of body dissatisfaction tend to be:3

  • Media representations
  • Social media
  • Friends
  • Family members
  • Peers

40% of teenagers said social media images made them worry about their bodies.3

Social media is one of the newest contributors to negative body image, but it’s already among the most powerful. One survey of young and teenage children found that up to 40% said social media images caused them to worry about their bodies.3 Constant comparisons with others are thought to be the primary reason for these feelings.

Numerous studies have also been done on the impact of traditional media on body image and mental health, with many finding a strong negative connection between media exposure and self-esteem.4

And peers, friends, or even family members can encourage this thinking. Bullying or teasing about weight or appearance has been found to have a particular impact on someone’s body image, and children are also susceptible to the thoughts and behaviors modeled by their parents and family members, whether negative, positive, or neutral.3

Effects of not eating

Body Image and Bulimia: What’s the Connection?

Body image issues also play an essential role in developing or maintaining bulimia nervosa and other eating disorders. Across the board, body image concerns, especially those targeted around weight, are considered major risk factors for developing an eating disorder.4

When someone is unhappy with their body shape or size and fixated on this fact, it can lead to behaviors like excessive exercise or frequent dieting to achieve the “ideal” shape.4 If the fixation continues over time, more extreme measures, like diet pills, laxative abuse, and other unhealthy weight control behaviors, may be used. Someone may also develop an extreme fear of gaining weight, which can lead to or further empower eating disorder behavior.

Yet, the “ideals” people are working toward are hardly—if ever—realistically attainable. Advertisements, movies, and even social media posts can be, and frequently are, heavily edited to make their subjects look better. Chasing this impossible goal can lead to feelings of frustration, guilt, or shame, which only work to power the eating disorder. Self-esteem can continue to plummet as people feel they’re not reaching their goals.

Other Common Bulimia Symptoms

The symptoms of negative body image are often warning signs that someone is struggling with BN or another eating disorder. But there are other common bulimia nervosa symptoms that can point to a problem, including:5,6

  • Strange or specific eating habits or rituals
  • Using the bathroom immediately after meals
  • Mood fluctuations
  • Anxiety and/or depression
  • Lethargy
  • Dental or oral health problems such as tooth decay
  • Frequently sore throat
  • Low self-esteem
  • Frequent acid reflux, constipation, or other GI problems
  • Scars or calluses on the knuckles or hands
  • Puffy cheeks caused by inflamed salivary glands
  • Weight fluctuations

Bulimia nervosa is a serious illness comprised of cycles of binge eating and purging. Self-induced vomiting is the most recognizable form of purging, but people with BN may also use fasting, excessive exercise, or laxative misuse to “compensate” for binging behavior.

Types of Treatment for Negative Body Image

Negative body image may be a damaging state of mind, but it’s far from a permanent way of being. Several types of treatment or self-help strategies can help reduce the impact of negative body image.

Cognitive behavioral therapy (CBT) is among the most effective therapeutic techniques for changing people’s unhelpful thoughts and behaviors. Through this type of treatment, patients learn to recognize their unhelpful thoughts and redirect them, with the hope of eventually eliminating them altogether.

You can also try some at-home tips to improve self-esteem, including:1

  • Using positive mantras or saying positive things to yourself every day
  • Focusing on your skills, talents, and other sources of worth that aren’t connected to appearance
  • Having gratitude for what your body can do rather than what it looks like
  • Clearing out your social media feed of toxic, triggering, or otherwise unhelpful accounts
Treatment for bulimia

When to Get Help

Negative body image can have many detrimental effects on mental, emotional, and physical health. Working toward building a better and healthier relationship with yourself is an important way to minimize or reverse these effects.

Interested in a virtual option?

Within Health provides a streamlined experience with an industry-first treatment app.

Attend individual and group sessions, connect with your care team, submit weights and vitals via a numberless scale that is provided to you, receive meal support along with meal kit deliveries, access check-ins and recovery-focused tools for use between sessions

Call for a free consultation

If you or a loved one are consistently talking and/or thinking about physical appearance or aspects of your body weight, shape, or size, it might be a sign that it’s time to seek help. And if you’re already using or observing certain behaviors to specifically control or lose weight, it’s another sign.

If you notice any of the symptoms of negative body image or bulimia nervosa symptoms in yourself or others, you should speak with your primary care doctor or therapist for more specific advice on the best next steps. Remember: Treatment is always available, and it’s never too late.


  1. Body Image. (n.d.) National Eating Disorders Collaboration. Accessed June 2024.
  2. Stanborough R. (2020, November 25). What to Know About a Negative Body Image and How to Overcome It. Healthline. Accessed June 2024.
  3. Body Image in Childhood. (n.d.) Mental Health Foundation UK. Accessed June 2024.
  4. Morris AM, & Katzman DK. (2003). The impact of the media on eating disorders in children and adolescents. Paediatrics & Child Health; 8(5):287–289.
  5. Bulimia Nervosa. (n.d.) Johns Hopkins Medicine. Accessed June 2024.
  6. Bulimia Nervosa. (n.d.) Mayo Clinic. Accessed June 2024.

Last Update | 07 - 10 - 2024

Medical Disclaimer

Any information provided on the is for educational purposes only. The information on this site should not substitute for professional medical advice. Please consult with a medical professional if you are seeking medical advice, a diagnosis or any treatment solutions. is not liable for any issues associated with acting upon any information on this site.