Towards an Understanding of Self-Esteem and Eating Disorders
During a session with a client who has long suffered with an eating disorder I was discussing what it would be like if she could feel positive about herself. I was shocked with the response she gave me. Instead of reporting a desire to feel better about herself, this client laughed at me and retorted, “Self-esteem is laughable to me. I hope to be rid of the disturbing behaviors of the eating disorder, but I know it’s asking too much to like myself.” This encounter has been as intriguing as it has been disturbing. In this interaction I believe I came to understand, in small measure, what many women who suffer from eating disorders must feel about themselves. And, I better understand that when therapists, dietitians, and other helpers meet these women, survival is often the goal rather than happiness or feelings of self-worth. This interaction has come to symbolize for me the lie of the eating disorder in that it so efficiently creates such hopelessness, self-hate, and shame in women.
RELATIONSHIP BETWEEN SELF-ESTEEM AND EATING DISORDERS
Anyone working with women with disordered eating recognizes that self-esteem is intricately connected, however just how the two are related is not entirely well-defined. Inevitably, any discussion of eating disorders and self-esteem leads to the question of the chicken and the egg-which came first: poor self-esteem which made an individual more susceptible to disordered eating or an eating disorder which wreaked havoc on an individual’s self-esteem? While there is no simple answer to this question, there is substantial research that has investigated the relationship between self-esteem and eating disorders, and provides interesting insights.
In a review of the literature, Ghaderi (2001) concluded that low self-esteem, along with other factors, not only puts women at greater risk for the development of disordered eating but also serves to maintain an eating disorder. Numerous reports support the contention that low self-esteem is often present before the development of disordered eating, and that low self-esteem is a significant risk factor for both bulimia and anorexia even in young, school-age girls (Ghaderi, 2001).
According to Robson (1989, as in Ghaderi, 2001), self-esteem is “a sense of contentment and self-acceptance that results from a person’s appraisal of their own worth, attractiveness, competence and ability to satisfy their aspirations.” Given this definition, it is clear to see that self-esteem is multifaceted. Similarly, the development and maintenance of eating disorders is complex, including such factors as family environment, cultural environment, history of dieting, genetic predisposition, history of abuse, age and developmental concerns, length of time in eating disorder, immediate factors such as support system, emotional factors, and spiritual factors, of which self-esteem is only one factor of many (Berrett, 2002). However, self-esteem appears to be a primary risk factor that may contribute to the development of other risk factors for eating disorders. For example, three separate research studies found that development of bulimia is predicted by 먹튀검증사이트 perfectionistic tendencies and body dissatisfaction only among low self-esteem women, whereas women with higher self-esteem did not have these risk factors and accordingly did not develop bulimia (Vohs, Voelz, Pettit, Bardone, Katz, Abramson, Heatherton, & Joiner, 2001; Vohs, Bardone, Joiner, Abramson, & Heatherton, 1999; Joiner, Heatherton, Rudd, & Schmidt, 1997).
Identity formation is an area of focus when discussing eating disorders and self-esteem. Attention has been given to the parent-child relationship and how parents’ perfectionistic expectations work to limit the child’s development of autonomy, consequently creating an environment where the child is reliant on parental expectations rather than on individual needs and desires (Stein, 1996). Bruch (1982) posited that as children attempt to meet unrealistic parental demands, they often develop a sense of being “nothing.” As these children grow into adolescence they may turn to an eating disorder as a way of defining self and establishing a sense of self-control (Stein, 1996).