The Role of Confidence in Eating Disorder Treatment

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A glaring theme across my therapy sessions with clients suffering from eating disorders is the self-esteem struggle they often experience. Eating disorders are generally understood to be associated with a sense of self that is highly dependent on external evaluation.

It's also well understood that patients with these disorders broadly define themselves by their body shape and weight. So it is no wonder that treatment focuses on rebuilding a sense of self that promotes looking at internal attributes versus external ones.

One main goal of therapy is to bolster the client's self-esteem so that their physical appearance ceases to be their primary source of self-worth and self-evaluation. A secondary goal of treatment is to find out why this evaluation pattern emerged in the first place.

• Was it a series of events in childhood and adolescence that led to a desire to receive approval from others, leading to engaging in behaviors that would accomplish this?
• Was it that one visit to the doctor's office during which weight was mentioned led to feelings of inadequacy and failure, thereby causing a series of events that led to restrictive eating?
• Was it comments made by others coupled with an over-sensitivity to criticism?
• Or was it a harsh internal superego (that voice in our heads that beats us up when we do something short of our high expectations of ourselves)?

Whatever the reason, therapy's role is to find this source and air it out to the individual so that this insight can propel them toward healing.

Rebuilding self-esteem comes from this process–from figuring out what went wrong, what led to this way of functioning, and what can be changed so that we evaluate ourselves more wholesomely. But how do we do this? How do we find a way to have more self-esteem?

One way is by finding the cracks in our story and filling them, specifically filling them with newfound clarity and forgiveness. Then, looking back at our narrative, we can see the why, and this insight can help us look elsewhere for empowerment, positive emotions, and self-worth. That's not to say that "eating" is not part of the treatment. It definitely is. But eating, in and of itself, does not change how we feel about ourselves. We must do that work. We must find joy from other sources, like friendships, achievement, family, music, nature, and activities we enjoy.

An exercise I ask my patients struggling with eating disorders to complete is to create a pie chart. Then, I ask them to cut the pie into different size slices and write an attribute or source they use to increase their self-esteem in each piece. For example, one client may write 50 percent friends, 25 percent being fit and healthy, and 25 percent achievement. In so doing, my clients often realize that they are unhappy with their current process for self-evaluation.

Try this for yourself, dig dip, find the source, and then, as I do with clients, fill the cracks in the pavement with joy.

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