The Perfect Storm. Bullying and Eating Disorders: Is There a Link?
A Guide for Teens and Families
Bullying is harmful. Whether your child is in pre-prep or at university, the immediate and longer-term harm caused by bullying is well documented.
Is There a Link Between Bullying and Eating Disorders?
The short answer is ‘yes’. There is significant research that indicates that bullying and the associated short- and long-term effects of bullying can be associated with eating disorders of all types.
Does Bullying Cause Eating Disorders?
There is no single cause of eating disorders or definitive answer, but bullying can be a strong factor in the development of an eating disorder. Genetics, environment and trauma can also all play a part.
The Perfect Storm
Some children, teenagers and young people may be more at risk of developing an eating disorder, such as Anorexia Nervosa, Bulimia Nervosa or Binge Eating Disorder.
These young people may have a unique combination of biological, social and psychological markers that create what professionals often refer to as ‘The Perfect Storm’.
- Having a family history of eating disorders or body image disturbance.
- Having a family history of psychiatric illness.
- Being premature at birth, low birth weight or being a twin.
- Having a previous diagnosis of ADHD, Bipolar Disorder, Borderline Personality Disorder or a history within the family.
- Growing up in cultures where ‘thinness’ is idealised and valued, and in families/societies who regularly diet or ‘watch their food’ to maintain the ‘ideal’ body weight/shape/size/look.
- Growing up in a household where food groups are restricted for weight maintenance (e.g. carbs, proteins, sugars, fats).
- Beginning to restrict food groups at an early age (vegetarianism).
- Having family members who regularly ‘diet’.
- Being in families who regularly comment on children and teenagers ‘looking good’ when they reach a lower body weight/shape/size.
- Having a highly sensitive nature.
- Difficulty controlling big feelings or emotions.
- Having depression, anxiety, mood disorders, cognitive distortions, low self-confidence.
What is Bullying?
Bullying is the intentional, persistent and repeated threat of aggressive physical behaviour or verbal abuse. It can also involve social behaviour that intends to cause physical, social and/or psychological harm.
It can involve an individual or group who misuse power (or perceived power) over one or more people who are seen to be at a situational disadvantage. Bullying can be in the open or hidden. It usually involves a real or perceived power imbalance, for example: social, age, size, disability, popularity or academic standing.
Bullying can happen in person or online. Bullying is not a disagreement or a clash of personalities. Bullying is not a ‘usual’ fall out between friends.
Bullying Affects 1 in 4 Children Globally
Bullying affects approximately 25% of children at any one time. International and national statistics vary, with bullying in the UK coming out near the top of the list. Just over 39% of children and teenagers in the UK report being bullied on one or more occasions.
Bullying and Eating Disorders
Over 65% of children and teenagers diagnosed with an eating disorder (Anorexia Nervosa, Bulimia Nervosa, ARFID and Binger Eating Disorder) believe that being bullied contributed to the later development of their diagnosed eating disorder.
Children in Larger-Sized Bodies
Children in larger-sized bodies are 63% more likely to be bullied than their peers. Weight stigma and weight shaming can begin at home. 40% of children later diagnosed with an eating disorder report being teased at home and school about body size and weight-related issues.
What is Weight Stigma?
Weight stigma or weight bias (sometimes referred to as weight discrimination) involves stereotyping or discrimination based on a young person’s weight or size. This includes holding beliefs about a person’s characteristics, personality, ability or disability based purely on their shape and/or size.
Weight stigma can lead to teasing, belittling and bullying.
Weight stigma, shaming, teasing, and bullying are leading causes in the development of eating disorders in children, teenagers and young adults.
Children and teenagers who are victims of weight-based stigmatisation are more likely to:
- Develop symptoms of Binge Eating Disorder (BED).
- Engage in frequent binge episodes.
- Be at high risk for diagnosis of eating disorders across their lifespan.
Asia and Weight Stigma
Children and young people in Asian countries are often subject to cultural messaging, which reinforces weight bias. Food, weight and eating are intertwined, leaving young people open to developing eating disorders at an alarming rate. Eating disorders in Malaysia, Hong Kong, Singapore and Japan are increasing in both numbers and severity.
Doctors, teachers, parents and extended families can contribute to the shame felt by children, teenagers and young adults in relation to their developing bodies. Research indicates that physicians and family members are the most common source of weight bias that young people in Asia encounter.
Eating disorder education for professionals in South East Asia is minimal, even in the field of nutrition and dietician education.
The Wave Programs are the only dedicated programs for teenagers and young adults in the Asia Pacific Region.
The Impact of Weight Stigma on Children and Teenagers
Being bullied or subject to weight-related discrimination is known to have far-reaching physical and psychological effects on young people and is linked to depression, body image concerns and Body Dysmorphic Disorder, low self-confidence, anxiety, and eating disorders.
Other Types of Bullying
Bullying transcends gender, age and culture. It is our role as parents, educators, families, brothers, sisters, teachers and professionals to ensure that bullying is not happening in our systems; at home, school or work.
There are three main types of bullying: verbal, social and physical.
Verbal Bullying involves saying, writing or sharing unpleasant, mean or cruel comments, for example:
- Teasing and taunting
- Name-calling or refusing to use the correct name of the victim
- Inappropriate gender, sexual or ability-related remarks
- Threatening to cause harm to the victim or those they love and causing fear in doing so
- Writing untrue and unkind articles, notes, reviews in order to cause embarrassment, harm or injury
- Using harmful words linked to perceived inequality to cause shame
- Shouting/swearing with the intention of causing fear.
Social Bullying or Relational Bullying involves intending to cause harm to the victim’s relationship with others, for example, by harming the victim’s reputation, inciting mistrust or dislike by others, causing damage to the victim’s relationships and/or support system. The actions are taken with the intention of causing the victim to be ostracised or isolated and include:
- Leaving someone out intentionally (parties, gatherings, group chats)
- Spreading rumours about them
- Causing embarrassment, teasing or belittling in public
- Telling others not to be friends with the victim
- Leaving young people out of team games, lunch or other group activities repeatedly
- Telling victims that they are not good enough/sporty enough/able enough to join in team activities or sports
- Highlighting ability or disability in order to exclude
- Threatening to leave out/withdraw or cause harm in social situations
- Holding the victim up or derailing their plans to cause them distress or harm (making them late, preventing attendance, missing opportunities).
Physical Bullying involves causing intentional harm to the victim or their possessions, for example:
- Spitting and/or breathing in the victim’s face
- Tripping/nudging/bumping into
- Taking or breaking the victim’s belongings or threatening to do so
- Threatening the victims, their family or their animals
- Stealing or hiding the victim’s belongings without consent
- Damaging clothes/toys/stationery
- Defacing articles belonging to the victim.
There are many other examples. Listen to your child or teenager. If it sounds unpleasant or unkind, it could be a form of bullying.
Physical and Psychological Harm
Children and teenagers who are bullied describe a loss of confidence in themselves. They describe feeling ‘not good enough’, ‘a failure’, or an increased need to ‘be perfect’. This system of negative core beliefs can directly impact the development of maladaptive or disordered behaviours.
Young people may experience feelings of guilt, shame, fear and sadness. These are the same feelings that are prevalent in eating disorders.
Perfectionism is a character trait seen in many young people who go on to meet the diagnostic criteria for eating disorders.
Children and teenagers who have been bullied have more frequent somatic complaints than children who have not been subject to bullying. Somatic complaints may include headaches, stomach pain and sleep disturbances.
Bullying can lead to later diagnosis of anxiety, depression, self-harm, PTSD, C-PTSD and ultimately bullying can lead to young people considering ending their life. The sad fact is that bullying is responsible for death in children, teenagers, and adults worldwide.
Bullying at School
Bullying at school can begin at any age. Younger children, Upper Primary, Middle and Secondary school children report being bullied in schools.
The sad reality is that many children will not discuss bullying with their teachers. Those who do reach out may not fully disclose the extent of the situation.
Recent research in Australia has shown that, where bullying is less severe, good school management can reduce incidents by up to 50%. However, in more severe cases informing teachers actually saw an increase in further incidents.
Let’s start a conversation.
Let’s talk about bullying.
Let’s talk about weight stigma and weight bias.
Let’s highlight our own bias as parents, teachers and mental health professionals.
Together, let’s end weight-based discrimination.
Together let’s take a stand against bullying.
The Wave Programs are aligned with Health At Every Size principles and values. The Wave is committed to ending bullying at home, at school and online. The Wave is proactive in ending weight-related stigma and bias in our communities and, particularly in South East Asia, our adopted home. We will strive to do our part to keep learning in the hope of increasing education and resources for parents, teachers and professionals on subjects related to eating disorders and disordered eating.
Fiona Yassin is the International Clinical Director at The Wave Clinic in Kuala Lumpur. Fiona is a member of The Association of Child Protection Professionals and has a personal interest in bullying and psychiatric disorders for women across the lifespan. Fiona is a UK Registered Psychotherapist and Clinical Supervisor (MICP #361609) and member of The International Chapter of the IAEDP. Trained in EMDR (EMDRIA Registered), FREED (King’s College, London), CBT-E (CREDO, Oxford) and trauma-focused approaches to eating disorders.
For information on programs at The Wave, Kuala Lumpur, please contact firstname.lastname@example.org
Fiona runs a small private eating disorder practice for international families. To find out more, please contact +60125227734