In working with eating disorders, it is hard to miss the inherent goals of “getting and remaining small.” Sometimes this is a literal small and clients begin dieting to change their bodies but what tends to be universal is the unconscious desire for folks with eating disorders to remain small—figuratively.
What does it mean to stay small in a figurative manner? This can look like choosing not to ask for a sick day, not sharing that today is your birthday when your friends made plans, and remaining quiet instead of asking what your salary is before starting a new job. There is a tremendous amount of withholding when we stay small. I have heard each of these scenarios in my work as an eating disorder therapist and I have found it helpful to classify these experiences as “remaining small.” A goal within the eating disorder work I do with clients is to help them work toward taking up space. Assertiveness can help break out of the pattern of remaining small.
Often assertiveness does not come with a positive connotation, especially for women. The sense of sticking up for one’s self is scary and aggression can be confused with assertiveness. Historically, women have contended with limiting gender roles that promote remaining quiet and complacent. Additionally, people-pleasing, knowing your own inherent value, and fears of coming across as entitled are barriers to assertiveness.
Ending the people-pleasing and believing you are worthy of asking for things in life that you need and desire is a huge challenge. How does one begin to chip away at these obstacles of taking up space and becoming more assertive?
I often talk to my clients about building awareness around the urge to remain small (figuratively). Asking questions about when this happens most is a good starting point. Folks will often describe the difficulty in taking up space in their relationships. I advocate for testing out the dialectical behavioral therapy skill “opposite action,” which suggests we engage in the opposite behavior of what we typically would do with trusted people around us. This experience could look like noticing that you feel ashamed in a certain moment and working on not hiding but remaining engaged in the conversation. The ultimate goal is slowly building towards staying present and not shrinking away.
Additionally, I often talk to my clients about the paradox of healthy entitlement. Those with eating disorders can be exceptionally fearful of coming across as anything other than amenable to people and their needs. Because people-pleasing is so central to the fear of sharing your own opinions—it can be worth sitting with the idea that as humans we are all entitled to have our thoughts and feelings and we get to choose how to present these. If we are intentional and mindful of others we do not have to fear being seen as rude or entitled. While becoming disrespectful is never the goal, internalizing the paradox of healthy entitlement can help build assertiveness skills, for example, the message becomes, “I am entitled to be respected, seen, and heard.”
The more one can reduce the barriers to assertiveness, the more one can take up space and move through eating disorder recovery.
References
Linehan, M. (2014.). Opposite action skill. Dialectical Behavior Therapy (DBT) Tools. https://dbt.tools/emotional_regulation/opposite-action.php
What is a people pleaser?. Medical News Today. (2023). https://www.medicalnewstoday.com/articles/people-pleaser
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