Body image violence breaks self-esteem

A call to see the unseen pain of eating disorders

By Marlene van den Berg, therapeutic programme manager

and occupational therapist at Netcare Akeso Montrose Manor 

Tuesday, 18 February 2025: Imagine a world where emotional pain was visible, but no one paid any attention to the bleeding wounds. This sounds unthinkable, yet it is the reality we live in every day.

In South Africa, one in four teenage girls is estimated to suffer from an eating disorder. A 2021 study reported that 22% of adolescent females in Johannesburg bear the burden of disordered eating, while 9% of adolescent males are similarly affected. Society often reinforces unrealistic body standards for young people, leading them to believe and internalise these as “normal” expectations.

Instead of expressing concern at potential warning signs of eating disorders and unhealthy relationships with food, mainstream global media continues to normalise these patterns. They hold up painfully thin icons of popular culture as examples to emulate.

Eating disorders are not confined to any single demographic. They are increasing across all racial and socioeconomic groups, thriving in a culture that often fails to recognise the silent suffering. One of the greatest barriers to seeking treatment for eating disorders is this lack of recognition.

The warning signs are frequently dismissed, or worse, praised as positive traits. Children are often commended for their discipline when they follow rigid meal plans or exercise obsessively. A competitive sports culture encourages young people to push their bodies beyond healthy limits, while concerns about restrictive food choices or aesthetic weight loss are comparatively deafening in their silence.

Many parents unknowingly reinforce disordered habits through their own orthorexic behaviours, which include obsessing over so-called ‘clean’ eating, equating thinness with health, or making dieting a family activity.

The truth about eating disorders is that they are not about vanity, food, or even weight. They are manifestations of deep psychological wounds – unprocessed trauma, emotional distress, and unmet needs that manifest as obsessive behaviours. Anorexia, bulimia, binge eating disorder, and avoidant/restrictive food intake disorder (ARFID) all carry the same underlying message: an individual who is struggling to express pain in any other way.

The South African Journal of Science highlights that these illnesses are too often seen as personal choices rather than the complex mental health conditions they truly are. This common misconception prevents people from receiving the help they need, allowing the disorder to tighten its grip on their lives.

We must extend our focus beyond those who are actively struggling with eating disorders to challenge the societal norms that normalise disordered behaviours.

We need to reconsider what it truly means to be healthy and recognise the fine line between encouragement and obsession. We have to look at our own families with fresh eyes, or we could be unknowingly reinforcing harmful habits.

This is a call to see the unseen, an opportunity to recognise that the wounds of eating disorders are not always easily visible but are no less real. Our children are asking us to notice, to listen, and to act before it is too late.

Recognising eating disorders

Symptoms of eating disorders vary but often include:

• Drastic changes in eating habits, such as severe restriction, binge eating, or secretive food behaviours.
• Obsession with body size, shape, and weight is often coupled with excessive exercise.
• Avoidance of social situations involving food leads to isolation.
• Physical symptoms include extreme weight fluctuations, dizziness, hair loss, and digestive issues.
• Emotional distress, including depression, anxiety, and feelings of inadequacy.

For assistance in a psychological crisis, call 0861 435 787, 24 hours a day for emergency support from Netcare Akeso.