Eating Disorder Resource centre of Ireland

Self Esteem & Eating Disorders.

THE SELF – Image/Esteem/Worth

Self Esteem refers to the overall opinion we have of ourselves, how we judge or evaluate ourselves, and the value we attach to ourselves as people
Low Self esteem refers to a constant stream of value judgements (can be expressed as core beliefs) about the self.

Low Self Esteem or worth (based on core beliefs) can allude to (feelings) of
Helplessness - out of control, lacking skills
Hopelessness - no matter what you do things will never change
Worthlessness – You may feel you have useful skills, and life has much to offer but you simply feel you don’t deserve to succeed.

Self Esteem and Eating Patterns The Connection…

If a person feels helpless, hopeless, and worthless they may then nourish themselves with food, hence comfort eating has a purpose.

Alternatively a person may feel they would be approved of and more acceptable if they were thin , hence they may starve themselves and again starving has a purpose.

The core problems of eating disorders are described as an integral connection between beliefs, feelings, and idea’s about body shape, weight, and self esteem
Having a poor or absent self concept can be a risk factor for an eating disorder and a perpetuating factor.

When a person lacks a sense of self, they may try to control food, eating, or weight in order to achieve a sense of personal control
With anorexia this strategy is successful and serves to maintain (perpetuate) the eating disorder.

With Bulimia and Binge Eating Disorder, the breakdown of restraint leads to feelings of failure and fruitless attempts to regain control through restraint only serves to intensify the binge/purge cycle
In treatment of an eating disorder it is crucial to address self esteem as low self esteem acts as a negative motivator.

So What Influences Self Esteem ?

Self Esteem is influenced by such facets as
Beliefs / Cognitions/ Schemas / Values – Slim = good person, self hatred = food used for punishment
Endorphins – low endorphins confers low self esteem
Experiences – perceived or actual
Expectations of future – coping/performance

Family Influences
Guilt – projection into diet/binge cycle
Personality – perfectionist
Relationships with others
Role failure
Sense of non deserving – desire to then feed oneself
Self Dislike – desire for perfect body.

Experiences early in life, perceived or actual, have a profound effect on self esteem
Abuse, being the odd one out, coldness, disapproval, lack of warmth, neglect, rejection , all serve to create the core belief – I AM WORTHLESS, UNLOVABLE, BAD.

It can also confer core beliefs about others… People cannot be trusted or people cannot meet my needs
This results in self critical rules ….
Unless I put others first at all times I will be unloved… or
If I say what I think people will reject me.

Treatment Interventions for Low Self Esteem in Eating Disorders

Recovery from an eating disorder is paved with a rise in self esteem and seems to be a consequent upon self worth being enhanced, hence self esteem work is an integral part of eating disorder therapy
The extent to which this is necessary depends very much on each individual and their specific issues.

Self Esteem work starts with the therapist helping the client to become self aware
The client needs to be aware of the beliefs, thoughts, values etc. that are maintaining their self esteem issues
The client needs to become aware of their use or abuse of food to deal with these issues.

Awareness of current perception of self
Assertiveness Training
Cognitive Therapy
Develop New Sense of Self
Develop New System of Personal Reward
Develop Problem Solving Skills
Educate the client

Exercise ‘’One thing I think I have done wrong’’

Reframe information that is received in the above exercise as it may be therapeutic to clear out emotional baggage that may be perpetuating guilt and/or self-dislike

Self Care needs to be addressed to enhance sense of self.

The client needs to become aware of the impact low self esteem is having on their life
Thoughts (negative self talk)
Emotions
Behaviours
Body Image
Relationships /work leisure
Self care – control / neglect / attack.

Awareness of the clients current perception of themselves is done through the use of the lifeline and talking about the various life experiences to date that are perpetuating their self concept
Assertiveness Training is the next step in self esteem enhancement as the need for learning to be assertive is crucial in relation to eating disorders.

Lack of assertion is associated with…
Non establishment of personal boundaries
Feeling undeserving of having ones own needs and desires, and validating the needs in others
Manipulating behaviours such as people pleasing
Experiencing anger and resentment to the above
Feeling inconsequential resulting in poor self esteem.

Poor assertion may not cause an eating disorder, however it will maintain the disorder as the non assertive patterns are played out with the persons relationship with food !

People who attend to the needs of others, or who take on to much may find they neglect themselves and overeat to just keep going.

Assertiveness work is to help people become aware and to regain choices around what they do and who controls their lives, not only with food but with all interpersonal situations.
Assertiveness work involves the therapist introducing the notion of assertiveness and it’s implications in interpersonal situations
Next the client gets to acknowledge situations in which they do not assert themselves.

The Food Fight.....

There is a direct link between food and self esteem. The desire for the perfect body brings with it ideals of having more confidence, self worth, and respect from others. This can lead to a constant pressure that governs how you eat, and the belief that you will not be truly happy until you are slim.

We are constantly bombarded with images of slim people, who we subconsciously aspire to be like, and these external stresses are probably the first stage of affecting how we view ourselves, which in turn affects our food choices.

What we then eat is not based on nutritional requirements but is more about how we can attain the body that we feel we should and could have. What we don't realise is that most diets are so biologically flawed, that changes in brain chemistry can result, causing disordered thinking and cravings.

When you diet (note the first three letters die !) you are making a conscious effort to ignore the body's hunger messages. These are signals that you need to refuel, and by ignoring them you are denying yourself the nourishment that your body needs and running the risk of resorting to binge eating.

People who restrain their food intake often fall into the trap of starving and bingeing because of the physical and psychological consequences of dieting.
Crash dieting or low food intake will allow free radicals to proliferate, and this can have the effect of reducing the immune system, increase signs of ageing, and increase the risk of heart disease.

eating disorders Labelling food as ''good'' and ''bad'' sets us up for psychological failure. If we eat a good food then we feel good, but if it's a bad food this can lead to feelings of failure or feelings of ''I've blown it now so I might as well binge and start again tomorrow''. Everything in moderation is the key and while you may eat more of the previously forbidden foods initially, ''more is less eventually''. All foods have a place in a healthy, balanced diet, and ensuring yours is as wide ranging and unrestricted as possible is the first step to making friends with food.

Overeating isn't a character flaw or a sign of weakness, nor is limiting how much you eat a question of self control. Dieting sets up a binge cycle. When the body doesn't get enough nutrients, the blood sugar fluctuates. If your serotonin levels are too low you could also overeat as your serotonin controls your mood and curb cravings. Food is often a thinking rather than a behavioural problem. We've all experienced the saying ''I've blown it'' which usually makes us reach for that extra helping.

The good news is that you can control your eating habits. All you need are new skills and practice, practice, practice !

With a bit of planning you can free yourself from negative eating habits and enjoy a better relationship with food.

1) Identify triggers - few people overeat all the time, so determine the circumstances that are likely to trigger a binge. Once you have done this it enables you to come up with a game plan.

2) Food Free Socialising - in social situations everybody eats more if they see others doing it. Instead plan what you are going to eat and listen to your body i.e. eat when you are hungry and stop when you are full. If you do overeat don't try to cut down the following day to compensate, as this leads to the binge/starve cycle. Eat without reference to the past.

3) Become aware of why you are eating H.A.L.T. Is it Hunger, Anger, Loneliness, or are you just Tired ? . If you are in tune with your body then you only eat when hungry - this is real hunger whereas the others are false hunger.

4) Eat More Often - mini meals during the day not only raises the metabolic rate but it keeps the blood sugar level stable and as such maintains serotonin levels thus avoiding excessive hunger.

5) Don't Diet - Being too rigid about your eating is likely to make you feel deprived and feeling deprived leads to binges. Saying ''I shouldn't '' can cause you to rebel and end up eating more. You need to channel that rebellion into something positive. If all foods are allowed in moderation then you won't feel deprived.

6) Use the 10 Minute Rule - If you are not sure if it's hunger or another emotion influencing you to eat then stop and distract yourself for 10 minutes. If you still want to eat after the 10 minutes, then it's usually a signal that your body needs refuelling.

7) Find another outlet for the emotions other than hunger that influence your eating. Whether it's taking a long bath, meditating, chatting with someone or just sitting with the emotion and not using food to douse the signal. You need to replace the cycle of overeating and fasting with something more constructive. If you sit with the emotion sometimes they pass more quickly than you thought. Afterwards you'll feel better because you will have avoided another potential distress - losing control of your eating !.

Questions to help you identify your good points...

How to build self esteem and self confidence…

1. Stop criticising yourself.
A person who lacks confidence does so because he/she is always putting themselves down. He/she feels to fat, to old, to tall, to small… you know the drill ! stop this negative self talk now. The problem is when you start to hear something often enough, despite it being untrue, you start to believe it.

Appreciate that you are unique. You are doing the best you can with the awareness you have at present. When you are interacting with people don't sit in judgement afterwards…. I should have said that…. what did I say that for…. they aren't interested in my opinion,… etc. imagine a stop sign like the ones you see on the road and this will interrupt the thought long enough for you to become aware of what you are thinking. When you stop being so harsh on yourself then you have the objectivity to make changes more easily. Self acceptance is the key every time.

2. Build yourself up by acknowledging your values and virtues.
Make a list of your qualities, gifts, attributes, and traits. Are you loving, kind, sensitive, a good listener, an understanding spirit, and so on… start to feed your mind with positive thoughts. Repeat various affirmations to change your unconscious mind and reprogram what you want to think, not what is automatically being thrown at you due to existing distortions. Your thoughts never stand still so it is up to you to chose more positive empowering thoughts to replace disempowering negative thoughts.

3. Lighten up !
life holds many adventures and experiences for you and if you go with the flow then you have a better chance of riding the wave ! resisting, struggling, and giving into negativity can only lead to anxiety and stress which in turn affects every aspect of your being. Make the most of life and life's obstacles. Choose to learn from people and events and have them make you instead of break you.

4. Trust your higher power.
It takes a great leap of faith to believe in something greater than yourself, but when you do, oh the rewards ! relying on your higher power or spirit strength does not mean handing things over and making no effort to change. It simply means that if you do your best and have faith in the power of the universe, then you can harness the universal life force behind you and it will then be your driving force to. I have addressed this in chapter 5 - recovery on a spiritual level.

5. Take time out for ''you'' everyday.
Each day take the time to acknowledge the importance of being in your own space. By this I mean time on your own to relax, meditate, pray, chill, or simply be. This is valuable in your personal development as it helps you to get to grips with yourself and your purpose. We all have a life purpose handsome of us have a global purpose. Spending time out alone can enlighten you to this purpose, if you are not already aware of what it is. Any form of relaxation is enough to slow the mind down and open the channels to universal healing energy and inspiration.

6. Repeat positive affirmations daily.
These are invaluable in your reprogramming of the unconscious mind. Up to now you have programmed your unconscious with information based on lack of awareness and understanding. Affirmations are a way to re program what you want instead of what you got in the past. (See list of positive affirmations in chapter 2 - recovery on a mental level). repeat and see the difference it makes over 21 days.

7. See problems or obstacles as challenges or tests.
Obstacles are what we see when we lose sight of the goal. The goal is life ! live it ! instead of focusing on the problem, focus on how to solve it. Most situations can be improved upon when action is taken. All situations can get worse when no action is taken.

8. Get up and go !
get active - walking , swimming, or whatever sport you enjoyed not do something that bores you, otherwise it won't last. When you are active you release endorphins which are the body's natural relaxants. This deals with physical stress and allows you to calm down. It also raises your metabolic rate (the rate at which you burn food for energy). this is great for all who want to lose weight and keep it off. See activity as a way of life not a short term fix.

9. Surround yourself with positive people.
I feel there are two types of people - helpers and hinders ! the helpers support you, energise you, encourage you, and generally walk the path with you. Hinders hold you back, put you down, make you doubt, and generally create havoc on your path. While I do believe that everyone crosses your path to teach you something, that does not mean you have to stay around them. If you are surrounded by hinders then they should come with a health warning ! as they can ,if you let them do so much damage. Try and spot the helpers and spend as much time as possible around them. Then spot the hinders and choose to eliminate them from your circle or at least spend less time with them. If you cannot do either of these just acknowledge the impact they are having on you and try and learn not to absorb their energy. You choose what you absorb and what you deflect.

10. Make goals and focus on achieving them.
Making and achieving goals makes life interesting and creates a better future. Goals help you to move forward and develop. It can be personal or professional, either way you are going to grow and prosper when it is achieved. Decide what your goal is.. Believe you have the ability to achieve it.. Focus on achieving it, despite obstacles and setback… have a positive mental attitude towards who you are and what you want in life…

Affirm daily what you want to achieve… remember as you change, so do your goals and how you attain them.

Go for it !!!

Suzanne Horgan
director & founder
Certified Trainer in Practitioner Skills for Eating Disorders and Obesity

Eating Disorder Resource centre of Ireland

Self Esteem & Eating Disorders.

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