How do you help someone with an eating disorder improve their self-esteem? It is not as easy as you might think. Dr. Smith provides some insights below.
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While self-esteem is a significant risk factor for eating disorders, one research team found body dissatisfaction to be the single strongest predictor of eating disorder symptoms (Button, Sonug Barke, Davies, & Thompson, 1996). Therefore, in targeting body dissatisfaction, therapists do well to attend to improving self-esteem, a major determinant of one’s body image. For instance, one study found that assisting adolescents in recognizing what is positive about their bodies and physical appearances while at the same time increasing their sense of personal competence leads to less internalization of sociocultural norms idealizing thinness (Phelps, Dempsey, Sapia, & Nelson, 1999). This resulted in significantly less body dissatisfaction, which in turn meant less eating disorder behavior among the adolescents (Phelps et al., 1999). Improving self-esteem is a challenging task for women with disordered eating. Often, their negative thoughts and beliefs are deeply entrenched and consequently difficult to give up. Once negative thoughts are established they serve to maintain low self-esteem and an eating disorder.
A critical intervention for women with anorexia, bulimia, or compulsive eating is to begin challenging the deeply held negative beliefs. For example, most women with disordered eating equate their worth with their weight, dress size, or shape. The sooner a woman can let go of these negative self-evaluations and replace them with more meaningful alternatives, the sooner she can be on the road to recovery. This may include exploring questions such as, “What do you want for your life, your future, your loved ones?” Answering these questions may be difficult and could result in significant shifts in an individual’s vocational roles, leisure activities, and relationships (Ghaderi, 2001). Therapists can assist women in identifying and building upon positive sources of self-definition. The eating disorder functions to limit an individual’s resources, yet through therapy women can be challenged to try on new roles and pursue activities where they can gain confidence.
Too often, individuals with eating disorders make themselves the exception in life. They believe that others deserve happiness, love, and joy, but that they themselves deserve sorrow, disappointment, and punishment. One of the first challenges therapists can give to the eating disorder is to begin disputing these false beliefs. Therapists can begin pointing out how the client has made herself the exception, and can then begin exploring where these false beliefs come from, whether they be from past abuse, negative family interactions, childhood teasing, or other difficult experiences. Teaching the client that she is worthy of love and acceptance, and that there are no conditions to her worth can prove essential to improving self-esteem.
It is important to keep in mind that, at least initially, these types of interventions, along with the therapist, will likely be rejected by women struggling with anorexia, bulimia, or compulsive eating. Challenges to the negative mind-set do not fit with what many of these women believe is true of themselves. However, with persistence, patience, and continuing acceptance, therapists can help clients to recognize their value and may help to create hope – one of the most critical components of overcoming anorexia, bulimia, or compulsive eating.
DR. SMITH’S REFERENCES
Berrett, M. E. (2002). Factors contributing to development and maintenance of an eating disorder: A clinician’s view. Handout from Treating Teens: from Self-esteem to Eating Disorders. Center for Change, Orem, UT.
Bruch, H. (1982). Anorexia Nervosa: Therapy and Theory. American Journal of Psychiatry, 139, 1531-1538.
Button, E. J., Sonug Barke, E. J., Davies, J., & Thompson, M. (1996). A Prospective Study of Self-esteem in the Prediction of Eating Problems in Adolescent Schoolgirls: Questionnaire Findings. British Journal of Clinical Psychology, 35, 193-203.
Ghaderi, A. (2001). Review of Risk Factors for Eating Disorders: Implications for Primary Prevention and Cognitive Behavioural Therapy. Scandinavian Journal of Behaviour Therapy, 30 (2), 57-74.
Gross, J. & Rosen, J. C. (1988). Bulimia in Adolescents: Prevalence and Psychosocial Correlates. International Journal of Eating Disorders, 7 (1), 51-61.
Joiner, T. E., Jr., Heatherton, T. F., Rudd, M. D., & Schmidt, N. (1997). Perfectionism, Perceived Weight Status, and Bulimic Symptoms: Two Studies Testing a Diathesis-stress Model. Journal of Abnormal Psychology, 106, 145-153.
Phelps, L., Dempsey, M., Sapia, J., & Nelson, L. (1999). The Efficacy of a School-based Eating Disorder Prevention Program: Building Physical Self-esteem and Personal Competencies. In N. Piran, M. P. Levine, & C. Steiner-Adair (Eds.), Preventing Eating Disorders: A Handbook of Interventions and Special Challenges. MI: Brunner/Mazel.
Stein, K. F. (1996). The Self-schema Model: a Theoretical Approach to the Self-concept in Eating Disorders. Archives of Psychiatric Nursing, 10 (2), 96-109.
Vohs, K. D., Voelz, Z. R., Pettit, J. W., Bardone, A. M., Katz, J., Abramson, L. Y., Heatherton, T. F., & Joiner, Jr., T. E. (2001). Perfectionism, Body Dissatisfaction, and Self-esteem: an Interactive Model of Bulimic Symptom Development. Journal of Social and Clinical Psychology, 20 (4), 476-497.
Vohs, K. D., Bardone, A. M., Joiner, T. E., Jr., Abramson, L. Y., & Heatherton, T. F. (1999). Perfectionism, Perceived Weight Status, and Self-esteem Interact to Predict Bulimic Symptoms: a Model of Bulimic Symptom Development. Journal of Abnormal Psychology, 108, 695-700.