Eating Disorder Recovery: Asking for Help Can Be Challenging
By Kathryn Cortese, LCSW, ACSW, CEDS
Asking for help can take many different forms and can be quite challenging. When struggling with an eating disorder, taking this action can be more complex than a simple, straightforward request. What are some of the reasons why asking for help can be so difficult? Why do “cries for help” appear in disguise? And what about these two questions can be specific to eating disorder recovery?
This article uses the term, eating disorders, to refer to anorexia nervosa, (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified feeding or eating disorder (OSFED). Three factors that are active in eating disorders, complex on their own, as well as elaborately entangled are shame, internal criticism, and diminished self-worth.
Shame is a strong and distressing human feeling. As defined by Nikki Rollo, PhD, shame is “an acute response to an unacceptable view of ourselves.” (1) This experience of shame in the eating disorder thrives on degradation, self-disgust, embarrassment, and a sense of defectiveness and inadequacy that can internally cripple an individual. To experience the depth of shame that accompanies an eating disorder contributes to secrecy, fear, and disconnection from self and others. In their work with Compassion Focused Therapy (CFT) in eating disorders treatment, Allison C. Kelly, PhD, Jacqueline C. Carter, DPhil, and Sahar Borairi remind us “shame may contribute to the maintenance of eating disorders.”(2) To then speak from this “place” imposes a threat on the being and bearing of the individual, amplified by accompanying self-criticism and low self-worth.
The internal critic is typically present with an active eating disorder. Translated, the internal critic is a master with words of self-derision. “I can’t believe you plan to wear that.” “You are ugly.” “You won’t fit through the door.” “How can you show your face!” “You know what you have to do now that you ate that.” These are only a few of the confrontational attacks the internal critic discharges. This persistent abasement can often drive anxiety in an already anxious person and filter out anything positive that may be active in the eating disordered individual. Some categories of negative self-talk in eating disorders include “Threats,” “Cautions regarding eating,” “Self-abuse,” “Self-punishment,” “Self-criticism,” “Comparisons,” and many more. (3) Ilene Fishman, LCSW, takes this concept further with her term “internal tyrant.” She notes this tyrant’s style is “I’ll get me before you get me because what ends up happening is a self-protective I’ll get me first. So anything that you might see that’s wrong with me, I’ll be first to figure out everything that’s wrong with me so that I can protect myself from failing to be perfect or opening myself up to criticism so I’ll be first to criticize myself.” (4)
Woven together with the impact of shame and internal criticism, the person with the eating disorder inevitably suffers from diminished self-worth. As defined by James E. Maddux, PhD, self-worth “refers to valuing one’s self and viewing one’s self as having worth.” (5) A vibrant sense of self-esteem is tested and denounced by the active mechanisms of any eating disorder. The further diminished one’s sense of self worth becomes, the more vulnerable is the core of the individual self.
Evaluating the impact of these three factors – shame, the internal critic, and low self-worth – helps us appreciate why asking for help when experiencing an eating disorder becomes a looming proposition. How does one override or at least temporarily neutralize the assaults on the self in order to have the triumph of asking for help? As treatment providers, parents, loved ones, or carers, we need to fully appreciate the many components which lead to requests for help manifesting as awkward, subtle, disguised, confusing, mixed, non-verbal, or cryptically coded. One of the skill sets individuals in recovery learn is to speak clearly, directly, and assertively. The outcome becomes a greater likelihood that one’s actual needs will be met. Yet, one can see the dilemma – if a person does not believe their needs matter, serve a purpose, or have any value, how can one voice them?
I hope that all concerned can offer compassion, understanding, and support when an individual struggles to ask for help and then have a fuller appreciation of why asking for help can be so difficult. Perhaps this information can provide an answer for this and also, in part, to that thornier question, “Why does the process of recovery take so long”?
About the author:
Kathryn Cortese, LCSW, ACSW, CEDS, began working with individuals with eating disorders in 1989. She is committed to the beliefs that recovery is real, support is essential, and hope matters. In 2013, along with her son, Michael, Kathy purchased the Gürze Catalogue. They offer the annual Gürze/Salucore Eating Disorders Resource Catalogue, a monthly ENewsletter featuring articles specifically written for this as well as a Book Interview, the edcatalogue.com website, EatingDisordersRecoveryToday.com, the ED Pulse, and podcast series, ED Matters.
(1) Rollo, Nikki, PhD. (interviewee). (2017, April 10). Eating Disorders and Shame Audio podcast retrieved from https:www.edcatalogue.com/episode-29-dr-nikki-rollo-eatingdisorders-shame/
(2) Kelly, Allison C., Carter, Jacqueline C. and Borairi, Sahar. (2014), Are improvements in shame and self-compassion early in eating disorders treatment associated with better patient outcomes?. Int. J. Eat. Disord., 47: 54–64. doi:10.1002/eat.2219
(3) Scott, Ned, Tanya L. Hanstock, and Chris Thornton. “Dysfunctional Self-talk Associated with Eating Disorder Severity and Symptomatology.” Journal of Eating Disorders 2.1 (2014): 14. Web.
(4) Fishman, Ilene, LCSW. (interviewee) (2016, November 11). Wellness Audio podcast retrieved from https:www.edcatalogue.com/3-ilene-fishman-wellness/
(5) Maddux, James E. “Mental Health and Self-esteem.” The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society. N.p.: n.p., n.d. 1525-528. Print.