Dr Stan Steindl, Clinical Psychologist
This week is Body Image and Eating Disorders Awareness Week in Australia. Many people I know have concerns about their body: how it looks, how it feels, how it moves and how it works. In fact, we can all relate to that feeling of self-consciousness, embarrassment, disappointment and frustration when it comes to our own bodies. Too tall, too short, too big, too small, too round, too flat..the list goes on.
Unfortunately, these body image concerns all too often develop into eating disorders and have a major impact on many Australians, both males and females of all ages. The National Eating Disorders Collaboration estimate that eating disorders affect approximately 9% of the Australian population. And the impact of an eating disorder on a person’s life can be devastating; including impaired relational, social and occupational roles, psychiatric and behavioural effects, medical complications, social isolation and an increased risk of death, including suicide.
Enormous efforts are being made to understand body image concerns and how they may develop into eating disorders, and one mechanism receiving specific attention over recent years is severe and harsh self-criticism.
Self-Criticism and Shame in the Development of Eating Disorders.
A 2008 study by Dr Silvana Fennig and her colleagues at Schneider Children’s Medical Centre of Israel found that self-criticism strongly predicted the severity of eating disorder symptoms in adolescent females. Canadian researchers, Dr Allison Kelly and Dr Jacqueline Carter, went on to discover in their 2012 study that this relationship between self-criticism and eating disorder symptoms is likely mediated through feelings of shame.
In other words, self-critical thoughts lead to feelings of shame, which in turn lead to disordered eating behaviours. Why might self-criticism and shame lead to eating disorders?
Well, to understand this, we turn to UK Professor Paul Gilbert’s Compassion-Focused Therapy model of affect regulation presented in his 2010 book The Compassionate Mind. According to Professor Gilbert, self-criticism is thought to activate an evolved threat system, yielding feelings of anxiety, anger and, in particular, shame. Feelings of shame then trigger self-protective, although sometimes maladaptive, behaviours aimed at reducing that shame.
With respect to eating disorders, Professor Gilbert and his colleague Dr Ken Goss suggested in a 2002 chapter they wrote for the book Body Shame that eating disorder symptoms, such as restrictive eating, excessive exercising, bingeing, and purging, might be self-protective attempts to regulate those underlying feelings of shame. And these symptoms are often effective at lowering the shame initially through distraction or temporary pride, however the feelings of shame return with a vengeance when the self-critical voice quickly escalates once again. An eating disorder is, in some ways, a representation of this vicious cycle.
Dr Goss, along with his colleague Dr Steven Allan, later suggested in their 2010 paper about compassion-focused therapy for eating disorders that the key to helping people with eating disorders change these maladaptive cycles and take steps towards recovery is self-compassion.
Self-Compassion as a Component of Eating Disorders Prevention and Treatment.
In a paper published earlier this year by another Canadian team of eating disorder researchers led by Dr Josie Geller, higher levels of self-compassion among a group of women was found to predict lower levels of concern about their body shape and weight, as well as less disordered eating. As such, targeting shame via self-compassion in eating disorders prevention and treatment is important. For example, programs presented to young people to develop practices in self-compassion may increase the likelihood of continued healthy eating.
But self-compassion is also proposed to be relevant in eating disorders treatment programs. A longitudinal study by Drs Kelly and Carter found that, across the timeframe of a treatment program, early increases in self-compassion predicted reductions in shame, and early reductions in shame predicted decreases in eating disorder symptoms.
Self-compassion seems to be somewhat of an antidote to self-criticism and shame, and therefore an important aspect of maintaining healthy eating. But what does this even sound like?
The Self-Talk of Self-Compassion
Imagine that a child you care about falls over and hurts their knee. What would you do to soothe or comfort them? Well, first let’s consider what you would NOT do. You would not scold, or belittle or humiliate them. You wouldn’t criticise them for being ugly, stupid or weak. What you would do is approach them, offer them physical comfort, and then, with a soft, kind, friendly voice, you would validate their feelings, reassure them that everything will be ok, and do something to make them feel better.
“Hey, come here darling,” you might say with a kind voice to a child you love. “Up you get. Oo, that looks sore! Can I kiss it better? You’ll be ok. Here, lets get you some ice for that bruise.”
And you know what? That’s exactly how to sound when you address yourself, especially when you are suffering! If you are feeling self-conscious, embarrassed, disappointed or frustrated about yourself, your body, or other aspects of your lives, then self-compassion is the very thing that can comfort you and motivate you to take positive steps.
“Hey, come here darling,” you might say with a kind voice to yourself, who you also love. “Things feel pretty tough right now! It’s hard to feel confident and good about yourself all the time. Everyone feels worried about how their body looks or feels at one time or another. It’s a real human thing. But you’ll be ok. You can do this! Let’s just breathe, relax under the tree and then focus on what’s important for you to do next.”
For more information on Dr Steindl and the team of Psychologists at Psychology Consultants visit http://www.psychologyconsultants.com.au