Bridget Engel, Psy.D., edited by Kathryn Patricelli, MA
Shame and Embarrassment
Behaviors associated with eating disorders that involve food restriction or purging often develop out of a sense of shame. Shame happens when someone is painfully aware that they have failed to meet a social standard, and have let people down. Shame is a social emotion. It reveals a deep need to meet social expectations. Individuals suffering with eating disorders cannot change or reset the culturally established standards to which they hold themselves. Because of this, their moods and level of shame depend on how well they feel they meet those standards.
Because there is shame attached to eating disorders, a sort of trap happens when people realize that their disordered behavior is no longer manageable. For fear of being judged, and to preserve their self-worth, they often avoid or reject assistance and help. When they are unable to help themselves, they feel ashamed and embarrassed to admit that they are out of control. They believe that asking for help would be telling others that they are a complete failure. This painful and shameful secret tends to keep their unhealthy behaviors going.
Psychologists know that dysfunctional thinking can affect a person's vulnerability toward development and continuing an eating disorder, as well as depression. One example of unhealthy thinking is learned helplessness. This is a psychological condition in which people learns to believe that they are helpless even when their situation is avoidable or changeable. People with eating disorders often believe that they have no control over:
the expectations placed on them
the behaviors used to meet those standards
the resulting pain and loneliness they endure
They believe that their situation is hopeless and anything they do is useless. They remain stuck in an unpleasant and even harmful situation.
Another unhealthy pattern of thinking often found in those with an eating disorder is body image distortion. This happens when people falsely see themselves as being different (generally heavier) than they actually are. People with eating disorders continue to see themselves as fat and unattractive, even when the people around them worry about their weight loss and body size. Because they see themselves as significantly different than others, they do not trust the opinions or advice of those around them. Body image distortion happens more frequently for women than for men. Teenagers may be particularly at risk for developing body image distortion during puberty. The rapid changes in body size and shape, as well as development of secondary sex characteristics (breasts, body hair, etc.) make them vulnerable to feeling awkward and large.