Shame and eating disorders

The experience of shame is a part of the human condition: we all eat the apple from the garden of Eden at a very young age. Children experience shame of their bodies or their behavior without the perspective to comprehend what it means. This shame--in its primal form--is deeply buried within an eating disorder. The obvious shame of being sick is one facet, but at the center is something truly existential. People with eating disorders feel like there is something really wrong or even, in the most simplistic term, bad at the core. The irrefutable existence of this badness makes the eating disorder feel like a just punishment. The problem in treatment is that the source of shame is both fully accepted by the patient but also completely elusive. There is nothing to point to or home in on because--and this is where the logic of the eating disorder becomes a house of cards--there is nothing there. The shame and the central badness are one and the same. Rather than searching for a source for the shame, the therapy needs to find out why and how the shame took over in the first place and then expose it to the patient. If the shame was planted there first, then the patient unknowingly created a world to justify her false reality. Recovery can feel like a complex knot to untangle.

In treatment, shame creates a barrier which stops the patient from being able to talk freely and to be herself. Everyone knows what it's like to feel inhibited. Imagine having a secret so large, so abhorrent that revealing anything about oneself will lead to catastrophe. Imagine not knowing exactly what that secret is except that letting one's guard down will without a doubt reveal everything to the world. Imagine knowing that one is an absolutely awful person but pretending to be someone else will keep the charade of life going. Imagine always feeling like you're one step from losing everything. Living in such a precarious world can--too most people--seem surreal: constantly putting on an act, being terrified of being found out, never being yourself and never-ending shame. But this is the world that traps someone with an eating disorder. Under these circumstances, the punishing eating disorder completes the circle and feels like just retribution for just being allowed to live.

The first step towards addressing the shame is to break the almost delusional cycle. Even though the logic of the eating is precarious, the shame and punishment feel completely deserved. The therapist can start to question these deeply-held beliefs. What makes you so bad? What are you being punished for? What makes you different from everyone else? By gently probing the thought process, the therapist pokes holes in the eating disorder mantle. Patients have never spoken about the shame with anyone so it can be a revelation to actually question the eating disorder in any way. Often the effect is surprisingly brisk and empowering.

But the shame cannot instantly wash away and leave good self-esteem and well-being in its wake. Once the logic breaks down, patients are confused that the shame lingers and are furious that the requisite punishment continues. Eating the forbidden fruit may have shattered eternal bliss, but the process doesn't happen in reverse. The work in therapy involves looking for a new reflection of oneself. With no other way to process thoughts and feelings in the world, we all revert to the default self-image. The long-term goal is to build a structure that explains how to live in a world not dominated by shame.

The bigger revelation is that the shame was never warranted, and years were spent enduring an illusory punishment. Many people, faced with this shock of reality, find themselves quickly hidden behind the shame and the eating disorder again. The process of nurturing a new self-image necessitates intense feelings of vulnerability and discomfort--experiences that until now were avoided at all costs. Trust in oneself and in the treatment is crucial to take the first steps away from shame and from this badness. This post highlighted several important issues in eating disorder ecovery related to shame--namely feeling special and trust--and these will be further discussed in upcoming posts. But for a new way of seeing oneself in the world to fully take, the next step is forgiveness. That will be the topic of the next post.