What is going on with our girls, teens, and women? Why are eating and weight such hot topics? Why do so many females feel that dieting and losing weight are such major accomplishments? I am referring to females of all ages who engage in the relentless pursuit of thinness and take pride in dietary restraint. Being a healthy weight is certainly important, but focusing on dieting and restraining food intake does in many cases lead to eating disorders like anorexia nervosa which are extremely resistant to treatment. In addition, they are associated with depression, isolation, and health problems.
The thinking among professionals who are treating females with eating disorders seems to be concentrated on the treatment of depression and anxiety while also working on cognitive restructuring, particularly around such negative thoughts as, "I will be seen as a glutton if I gain a pound." Therapists also tend to work in conjunction with nutritionists who aim to normalize healthy eating habits to restore body weight. Additionally, the therapy often includes a physician who monitors physical health.
More recent research particularly that of Howard et al. (2023) has had a very interesting and unique focus. I found this research particularly refreshing because it adds an additional lens from which to view anorexia nervosa and dietary restraint in general. I think this perspective has been largely overlooked in the treatment of females with eating and body image issues. Howard et al. (2023) interviewed 11 females over the age of 18 who were receiving outpatient treatment for anorexia nervosa in a community eating-disorders service. They were assessed with the Eating Disorder Examination Questionnaire, a demographics questionnaire, and a face-to-face interview.
The focus of the study was on the relationship between anorexia and the self-conscious emotions of shame and perfectionism. The findings indicated that anorexia was clearly driven in part by the vicious cycle of shame and perfectionism. The relationship was as follows: Anorexics tend to deal with their feelings of shame by striving for perfectionism. It is not entirely clear why these women were so full of shame, although those who had a history of trauma reported experiencing shame prior to perfectionism. The women who did not report a history of trauma were either unsure of which feeling came first or sometimes reported that perfectionism preceded shame. Regardless of the directionality of these two self-conscious emotions, they coexisted to form a vicious cycle for these women. Many reported trying to minimize feelings of shame by setting high standards for themselves. In this group, perfectionism was centered around the body and dietary restraint. They were striving for the perfect body by controlling their eating. And recovery was particularly difficult for several reasons, including the need to be perfect at recovery.
While the findings may have implications for the successful treatment of anorexics, there are several limitations of this study. The sample size was small. We also do not know if the same degree of shame and perfectionism would be found in younger and older females who are not in treatment or who are at different stages of their eating disorder. The most important question is whether or not the shame-perfectionism cycle precedes the development of body image and eating issues or if this cycle is preceded by the development of full-blown anorexia nervosa. We could learn the answers to these questions by replicating this study with both a large control group and a large number of females of all ages pretreatment, during treatment, and during recovery. In the meantime, issues of shame and perfectionism should be addressed with females who present with body image issues and eating/dieting issues.
References
Howard,T.L.M.,Williams.M.O.Woodward.,D.&Fox, J.R.E. (2023)The relationship between shame, perfectionism, and Anorexia Nervosa:A grounded theory study. Psychology and Psychotherapy:Theory, Research, and Practice, 96,40-55.
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