Low Self-Esteem and Eating Disorders: A Vicious Circle
Although eating is an essential part of living, not everybody finds it easy. Disordered eating affects a growing number of people. Researchers have long hypothesized that low self-esteem is an important risk factor for eating disorders. Individuals with low self-esteem often evaluate their bodies in an overly self-critical way, which influences their eating behavior. For example, they may perceive their weight and shape in distorted ways, leading them to use strict dieting and other weight control behaviors that may contribute to the development of anorexia, bulimia, or binge eating disorder.
At the same time, suffering from an eating disorder could be detrimental to people's self-worth. Many individuals who show disordered eating feel disgusting and undesirable to others, and tend to socially withdraw and isolate themselves, which is toxic for maintaining social relationships. The resulting lack of social inclusion and social support may damage the individual's self-esteem.
Taken together, there is reason to believe that low self-esteem may lead to the development of eating disorders, and that disordered eating may lead to lower self-esteem. Importantly, the two directions of effects are not mutually exclusive. Both could be true at the same time.
Putting All the Research Together
To gain better insights into the relationship between low self-esteem and eating disorders, we collected all the studies that had followed people over time.
We found 48 studies with data from over 19,000 individuals. The majority of participants were female and ranged from 7 to 48 years old. Most groups were from Western cultural contexts and were predominantly White/European. The time intervals between the assessments were about one year on average.
Low Self-Esteem Leads to Disordered Eating and Vice Versa
It was true that low self-esteem makes people more vulnerable to developing an eating disorder, but also that suffering from an eating disorder harms the individual's self-esteem. This was true for almost all kinds of eating pathology, regardless of whether we looked at behavioral symptoms such as restrained eating, bulimic behavior, and binge eating, or at affective symptoms such as eating concerns, negative body image, and drive for thinness. The effects also held across age and gender.
Thus, we see a positive feedback loop for people with high self-esteem and healthy eating behavior and, simultaneously, a vicious circle for people with low self-esteem and problematic eating behavior.
The largest effect was for the impact of negative body image on self-esteem. Interestingly, this effect fits with existing research on self-esteem, which suggests that people's evaluations of specific aspects of their self (such as physical appearance) influence their global level of self-esteem.
The connection between low self-esteem and eating pathology was similar in strength to the connection between low self-esteem and depression, as well as between low self-esteem and anxiety. In future research, it would therefore be important to study the effects of self-esteem on other psychological disorders.
The reciprocal link between low self-esteem and eating pathology has important implications for prevention and treatment. Raising low self-esteem may be useful for reducing the risk of developing an eating disorder in the first place, and for improving treatment outcomes for individuals who suffer already from an eating disorder. At the same time, treating eating pathology, such as bulimic behavior, drive for thinness, and eating concerns, may be beneficial to the individual's self-esteem.
For Further Reading
Bardone‐Cone, A. M., Thompson, K. A., & Miller, A. J. (2020). The self and eating disorders. Journal of Personality, 88(1), 59-75. https://doi.org/10.1111/jopy.12448
Colmsee, I. S. O., Hank, P., & Bošnjak, M. (2021). Low self-esteem as a risk factor for eating disorders. Zeitschrift für Psychologie, 229(1), 48-69. https://doi.org/10.1027/2151-2604/a000433
Krauss, S., Dapp, L. C., & Orth, U. (2023). The link between low self-esteem and eating disorders: A meta-analysis of longitudinal studies. Clinical Psychological Science. https://doi.org/10.1177/21677026221144255
Samantha Krauss is a Postdoctoral Researcher at the University of Bern. Her research focuses primarily on self-esteem development over the lifespan.
Ulrich Orth is an Associate Professor of Psychology at the University of Bern. His main research interests are self-esteem and personality development.