Shame and Eating Disorders: Breaking the Cycle with Dialectical Behavior Therapy

Shame and eating disorders are often inseparable.  In this article, I explain how to break the shame and eating disorder cycle using Dialectical Behavior Therapy.

Full Disclosure: I hate the scale.  Even more, I hate that weight is the metric we commonly use to determine our health, and to some extent, our worth.  Weight is a worthless metric in terms of health, and our quest to achieve an unrealistic ideal is hurting us physically, socially, and emotionally.

It’s rare that a person begins to exercise or change his or her diet for health. Rather, the motivating force is almost always to lose weight- usually to look better. People are obsessed!

It’s amazing that numbers on a scale are so important to so many.  And yet, few understand that those numbers have nothing to do with actual health. For our PE classes at Sunrise, I have to arrive early at the gym to move the scale.  Otherwise, the girls will try to weigh themselves when no one is looking.  They want to compare themselves to their perception of what they should weigh.  Some argue that results, not motivation, are all that matter when making positive health choices. I may have agreed with this position before learning about Dialectical Behavior Therapy.

I work with many girls that struggle with body image and I recognize their struggle.  I often worry about how it might affect my own daughter as she grows into her teenage years. When it comes to losing weight, I now understand that “why” is as important (if not more) than “how.” Too often, the real motivation for change is not vanity, but shame.

Connection Between Shame and Eating Disorders

Shame is a powerful emotion that affects each of us on some level and in different areas of our lives. Shame stems from comparing ourselves to a perceived standard. Sometimes we set that standard, and sometimes it is set by others, either consciously or not. Most eating disorder related shame is the indirect result of a societal expectation. This shaming cycle has become a regular part of life, without most of us being aware it is happening.

The Body Image Shame Cycle works like this:

  1. First, society establishes the ideal image of what a body should look like (not based on any health metric).
  2. This new ideal image is sold to the masses as the “norm” (also not based on any health metric).
  3. Programs on how to achieve the “ideal image” are created and sold to the public (again, not based on any health and wellness criteria).
  4. Since the ideal is not based on health and has no scientific basis or rationale, it is usually either unreliable, unrealistic or unsustainable.
  5. Because expectations of the ideal are unrealistic or unsustainable; failure to achieve the standard is inevitable.
  6. Feelings of guilt and unworthiness enter the psyche as a result of failing to meet the perceived ideal standards.  Guilt and unworthiness lead to shame.
  7. Feelings of shame drive us to mentally strive for the unrealistic standards, and the cycle starts over.

Shame and Eating Disorders Cycle | Sunrise Residential Treatment Center

This type of approach might work for businesses selling a product. But, when this model is coupled with an emotional response, the effect can be substantial and devastating. As a health and fitness professional, it drives me crazy to hear “colleagues” make unsubstantiated claims.  Many times they know these claims are misleading or outright lies! These claims bother me from the exercise-science point of view, but they bother me more as I begin to understand the extensive psychological toll on society. The damage is a deep-rooted shame.  Shame caused by the observable or quantifiable failure to physically meet unrealistic societal standards. 

To turn the corner and treat the real issue of shame, we need to start by examining what body image really is. Body image is just that- an image.  A representation of something else created in our minds, or ultimately something not real. We can’t begin to understand or treat shame unless we are willing to base our self-worth on something more than perception or expectation.

We need to recognize there is a difference between health and weight.  Health is a combination of our physical, social, and mental/emotional well-being.  Weight is not indicative of health, but due to the shame cycle mentioned above, gained weight communicates:

  • “Everyone thinks I’m ugly”
  • “Everyone thinks I’m lazy”
  • “I have no self-control”
  • “I don’t deserve the love of others”

It is easier for those of us who don’t struggle with eating disorders to recognize the fault of this type of black-and-white thinking.  But for some, the feelings are real and can’t just be shrugged off.

Breaking the Cycle with Dialectical Behavior Therapy

DBT skills can be effective in managing both shame and eating disorders. Three DBT skills, in particular, can help– Wise-Mind, Radical Acceptance and Opposite Action.

Wise-Mind

Wise-Mind helps us recognize that we think both emotionally and logically.  Developing a Wise-Mind means learning to balance the two. When we are critical of ourselves, especially of our perceived physical appearance, it is important to understand we are in an emotional state. In this emotional state of mind, we are less likely to make good decisions about our physical health. This emotional mind facilitates the shame cycle because we become more likely to buy into societal standards.   All of the diets, programs, and supplements tell us what we want to hear.

Learning to recognize our ‘emotional-mind’ helps us analyze health-related decisions before we act on them.  One way to balance emotion and logic is to use another DBT skill called Radical Acceptance.

wise-mind-sunrise-residential-treatment-center

Radical Acceptance

Radical Acceptance can be a challenging skill to apply in terms of body image, but it is probably one of the best. Radical Acceptance is allowing ourselves to accept our current situation (in this case our body) for what it is in this present moment. This acceptance needs to be non-judgemental and with an open (wise) mind.

We need to recognize that regardless of how the body looks, or how it is perceived to look, we still have life, and it is worth living.  We aren’t worth less or more as a result of the physical differences of our bodies. Radical Acceptance may feel impossible but can be made easier in utilizing the last DBT skill I want to mention: Opposite Action.

It is what it is Sunrise Residential Treatment Center

Opposite Action

Opposite Action is a mindfulness-based approach to dealing with negative body image.  Its practice is acting opposite to the negative emotions that are felt.

An example is society’s obsession with weight. Due to the societal emphasis placed on the scale, there is a direct correlation between feelings of guilt and shame. The more we focus on our weight, the more shame we carry.  Conversely, those who don’t associate weight with health, carry much less shame associated with body image.

Radical Acceptance and acting opposite to the emotions that make us feel shame force us to confront the issue by processing it in a healthy way.

An example of this might be:

Negative Emotion- You feel of shame after eating certain foods.

Opposite Action- You practice mindful eating.  This helps you focus on how the food empowers the body and provides nutrients that allow the body to function.

Another might be:

Negative Emotion- You find yourself focusing on weight or physical appearance.

Opposite Reaction- Mindfully contemplate all of the things your body is capable of doing.

Imagine if we obsessed over the things we loved about ourselves? Using opposite action empowers you to visualize the possible instead of dwelling on perceived weaknesses.

I would love to say:

  • “You are capable”
  • “You are enough”
  • “You are more than a number on scale”
  • “A six-pack is not a sign of health”

While true, these statements usually go through one ear, and out the other. However, mindful incorporation and practice of these DBT skills can help break the cycle of shame and eating disorders.  They will incrementally shift your focus away from unhealthy societal expectations.  They’ll empower you with lasting health, happiness and wellbeing.

___

Author’s Note: I have been fortunate to work in many different facets of the wellness industry.  I’ve worked as a teacher in both secondary and post-secondary environments.  I’ve led corporate health and wellness programs and worked as a personal trainer and exercise instructor.  I’ve worked with groups ranging from soccer moms to professional athletes. But please note, I am not a therapist.  My thoughts and ideas are based on knowledge I’ve gained working as a teacher in a treatment center that uses DBT.  If you have any suggestions on how to improve this article, please leave a note in the comments.