(Summary from The Parent's Guide to Eating Disorders)

Body image is both the mental picture one has of one's body and the feelings one has about her/his body.  Although body image is based on the body's actual characteristics, it can be affected by past experiences, moods, and feedback from others.  So while there is a degree of objective truth, there is also a subjective element to it, often revealing how happy or unhappy the person is with herself in general.

The more disordered the eating, the less objectivity.

Most people with good body image usually see themselves accurately and do not tie their sense of self esteem to their body weight.  No matter whether they love their appearance, are accepting of their appearance, or resigned to their appearance, they keep their assessment of their body separate from their sense of self esteem.

People with eating disorders nearly always have body image distortion.  (An exaggerated view of size and shape).  People without eating disorders have a variety of ways to feel good about themselves.  Often times the eating disordered person has just one:  self-evaluation of body and the score is always poor.  For anorexics, losing weight often magnifies the body image distortions.  Fortunately, when an anorexic restores her weight, she is able to re-gain the ability to accurately assess her body size and shape.  When she normalizes her eating  and her body weight, she starts to feel more in control, more confident, and more hopeful.  This is true for those with bulimia and compulsive eating, as well.  The body-image problems improve when the person puts a healthy program into place on a consistent basis.

Girls often learn from their mother's attitudes and comments, from other women in the family and in their life, as well as from cultural messages.  They may learn that the female body is something to be watched, dieted, and exercised in order to keep it acceptable.  Negative comments or criticism from many places can cause a child to feel judged and shamed. If these messages come from important people in her life, it is that much more powerful.  Self-loathing can begin early.  Part of treatment is to learn to set boundaries around any current comments about one's body from others.  Treatment also helps the person with disordered eating to become aware of the internal voice or eating disorder voice and to learn to take charge of it.  

Many times a girl will project any negative feelings she has about anything onto her body.  For example, she may be disappointed in her SAT scores, or she may feel inadequate in a particular social situation, or she may be angry at her parents for divorcing.  She can't change these things, but decides she can change her body.  So instead of learning how to employ healthy coping mechanisms, the child turns to disordered eating behavior to assuage disappointment, inadequacy, or anger.

Children as young as kindergarten age already have negative attitudes toward fat in themselves and others.  Children as young as third grade are knowledgeable about dieting.  In one study, half of children between third and sixth grade said they wanted to weigh less.  Over a third wanted a thinner shape.  Parental voices that are respectful of a variety of body sizes and shapes can help children develop respectful inner voices.   

Size and shape are primarily genetically predetermined.  To work with oneself on good healthy eating and on acceptance of ones natural body shape and weight is part of the recovery from body image issues.  Also, developing a self-concept based on personal qualities such as patience, kindness, and on achievements, rather than on appearance is part of healing.