Why?  Why does she think that losing weight is more important than anything else, even her health?  Why doesn’t she see herself as the bright, talented, athletic, attractive young woman that others see?  These are among the questions most frequently asked by family members of a young woman with an eating disorder. A large part of the answer to these questions can be found in understanding the emotion we call shame, and its relation to self image.

          Self image can be thought of as a set of beliefs about yourself that are formed over time through a process of repetition and emotional reinforcement.   These beliefs may be accurate or mistaken, rational or irrational, but we trust them as true guides to our choices or behavior even when they tell us something feels bad.  In particular, beliefs about something being dangerous or unpleasant are usually more important to remember and therefore more strongly held than beliefs about things that are pleasant or neutral.   The more intense the emotional reinforcement, the less repetition it may take to establish a belief.  One vicious dog bite may be sufficient to establish the belief that all dogs are dangerous.   When the emotional voltage is low, however, repetition can be a powerful factor in shaping belief. The persistence of rumors and the effectiveness of repetitive advertising demonstrate this.  Because beliefs concerning self image are private, internal matters, it is entirely possible to repeat to yourself over and over again, a mistaken and emotionally charged assumption until it becomes a strongly held generalization, a  misguided belief.  A strongly held belief about something personal and dangerous is highly resistant to change.

          The emotion we call shame has certain characteristics that make it uniquely powerful in shaping beliefs about the self.   Shame is the affect associated with surrender and defeat.  It is a powerful basic emotion because it has survival value.  The defeated dog that slinks away after the fight is demonstrating the posture of shame, and its abject posture prevents it from being killed by its enemy.   It is an intensely uncomfortable affect,  experienced internally as "the agony of defeat,"  but it can be triggered in a young child by almost any scolding or rejection on the part of parents, older siblings, or other important figures in the child’s life.   Any parent who witnesses the torrent of tears from a young child in response to one sharp word or disapproving look is witnessing the anguish that follows the shame response.   [Fortunately,  there is an antidote for these early agonies in the reconciling hug and reassurance of parental love.]    The first instinctive response to shame is to withdraw or hide.  This is why public humiliation is so punishing and why children lie to hide their mistakes.  The second instinctive response to shame is a surge of aggression [once the danger is past] that serves as an explanation for the "pecking order" in animals or in sibling rivalry.   This surge of aggression can be problematic in itself, depending on the circumstances.  If it is unsafe to act on the aggressive surge, the aggression may be turned inward, forming the core of a secret angry grudge against another or against the self.  Secret shame is privately revisited over and over in an attempt to deal with the pain,  and becomes fertile ground for distorted beliefs highly charged with a painful emotional tag.   Repeated often enough and painfully enough, this can be the root  of  "Toxic Shame,"  a kind of hypersensitivity to possible failure and rejection that is referred to by some addictions experts as central in the development of compulsive disorders, including eating disorders such as anorexia, bulimia, or binge eating disorder.

          A strong learned association similar to a phobia can develop between the affect of  shame and any perception of body fat or weight gain. The origins of such a hypersensitivity to shame can be dramatic or subtle.   A child may experience a terrible loss, defeat, or even abuse, and be too ashamed to tell anyone about it.  Unless memories of such an event are reviewed and placed in a healthy supportive perspective, it can be a kind of emotional dog bite leading to a painful mistaken belief about the self.   Or early success by a bright or talented child may lead to a subtle fear about the possibility of failure that becomes exaggerated through repetition.  Weight or body fat can become a shame issue easily enough.  [ See the article on "A Pound of Prevention" in February Issue]  For some, it may be the shame associated with peer ridicule or parental disapproval.  For others it may be the shame issues raised by emerging sexuality associated with body fat. Once the association between between body fat and  intense shame is established,  it can escallate by secret repetition.  Weight loss or control may be seen as a source of relief from shame; failure at weight loss another source of shame.  Eventually, any weight gain, including normal weekly or monthly fluctuations in weight, will be experienced with intense shame.   And if the association continues to develop, any trigger for shame will remind her of the thing most associated with shame: fat.  Individuals with this kind of eating disorder will often report "feeling fat"  immediately after a disappointment, rejection, or any stressful adversity, even if the scale indicates a weight loss. 

          It must be noted here that a genetic or biological predisposition toward depression or anxiety often  plays a role in an individual’s vulnerability to developing a sensitivity to shame and the resulting association between shame and body fat.   But all of the self image beliefs built up over years do not change immediately with a positive response to medication, and effective means of challenging distorted self image requires some approaches based on an understanding of the emotional origins and reinforcers of those beliefs.

          Understanding the nature and dynamics of emotions such as shame and toxic shame, and their powerful influence on our self image and behavior gives us important leverage in dealing with them.   Techniques for managing these emotions are teachable and learnable skills that are important elements of therapy when a shame based disorder has already developed.   These techniques and skills  also provide a foundation for healthy  parenting approaches.

          Shame interferes in another way.  When serious emotional problems such as eating disorders are diagnosed,  parents often feel the stab of shame.  Intense guilt and feelings of helplessness are triggered and evoke the patterns of  avoidance and anger characteristic of shame.  It is natural to feel some shame when you have to show up at the principal’s office or the therapist’s office, and it is equally natural to want to hide that feeling and experience some anger in response.   These feelings, often misinterpreted by the child as blaming,  can be barriers to clear parent/child communication and problem solving in a crisis.

          We don’t understand shame very well because we don’t talk about it very often or very clearly.   Perhaps the confusion about guilt and morality keep us from talking about it clearly.     Excessive shame traps the rape victim, the child with the learning problem, the child of the alcoholic parent,  the awkward adolescent with the rapidly changing body, and many others in a lonely cell of self torture that can lead to painfully distorted self image with long term consequences such as eating disorders.  We need to understand shame better  to help prevent and solve such problems.  Brock Hansen, LCSW, is a Licensed Clinical Social Worker with offices in Northwest Washington, DC.  He conducts groups and  workshops on topics of Shame, Anxiety, Anger, Eating Disorders, Criticism, Depression, and Family Communication Strategies .