Background: Proneness to shame has been shown to be a central element in the development of eating disorders. Clinical challenges arise not only from the painful nature of shame when experienced, but also because shame activates our primordial threat response. Effective and meaningful treatment of eating disorders requires an appreciation of identity, self-worth, and shame as undeniably intertwined. We will provide an overview of current research on shame in eating disorders, examine both direct and indirect interventions for addressing shame, and engage with participants around the question of how to foster hope by creating environments in which shame cannot survive.
Objectives:
- ...the central role and impact of shame on the development and course of eating disorder symptoms
- ...the distinctive expression of shame in people with eating disorders who've also experienced marginalization and other traumas
- ...the importance of developing interventions rooted in acceptance, compassion, and grace as antidotes to shame in eating disorder treatment in service of creating hope and re-establishing meaning.
- Landscape of Shame
- What is it?
- Why is it important?
- Evolutionary Perspective on Shame
- Universal
- Social
- "Master Emotion"
- Neurobiology of Shame and survival function
- Differentiating Shame and Guilt
- Healthy guilt versus unhealthy guilt and unhealthy shame
- The development of shame
- How we shame ourselves
- Potential family system contribution to development of shame or healthy individual identity
- Eating disorder illnesses and trauma as sources of shame
- Marginalization and Shame
- Stigma of Mental Illness
- ED in Marginalized Communities
- Shame Centered Risk factors for ED
- Beyond "Thinness"
- Expression of Shame in Marginalized Communities
- Clinical challenges
- The importance of actively addressing shame – the damage of shame unchecked
- Assessment of shame: Formal measures and informal assessment
- Shame of Existing
- Treating shame prone individuals
- Treating original sources of shame
- Treating current sources of shame: boundary work and creating internal and external support
- Treating loss of identity and the reconstruction of identity
- Treating shame prone systems: couples, families, communities
- Treatment when the source of shame is oneself: self – compassion and grace
- Understanding and healing your own shame as clinical provider
- The role of spirituality in healing shame: spiritual sources of identity, addressing principles of undeserving and grace versus justice and moral reasoning
- Creating an environment in which shame cannot survive:
- Indirect interventions and considerations for healing shame
- acceptance, loving kindness, and compassion as antidotes for shame
- Direct interventions for healing shame: individual, family, and group
- Forgiving our “shamers” as a healing experience
Proneness to shame has been shown to be a central element in the development of eating disorder symptomatology. People suffering from eating disorders have greater levels of self-reported shame than either healthy controls or other psychiatric groups. Shame has also been shown to predict greater eating disorder pathology and poorer outcomes. These data suggest that shame is not only a cardinal feature of eating disorders, but that it is also a significant developmental and maintaining factor. This is particularly salient for women, people from ethnic minority groups, and those in LGBTQ communities, who must often grapple with stigma and discrimination, resulting in a multiple dose of shame and reasons for experiencing self-hatred. Among other factors, a history of chronic microaggressions and discrimination and the well-documented confluence of stressors associated with minority status puts people from marginalized communities at particularly high risk for the development of disordered eating behaviors and their attendant consequences.
Clinical challenges arise not only from the painful nature of shame when experienced, but shame is also particularly challenging because it directly activates our primordial threat response. Whether criticism or judgment is perceived to be coming from others or from one’s self, shame is a powerful threat signal that results in a heightened focus on all aspects of the self as a self-protective response.
Effective and meaningful treatment of eating and body image issues requires an appreciation of identity, self-worth, and shame issues as undeniably intertwined. We will provide an overview of current research and understanding of the role of shame in eating disorders and examine both direct and indirect interventions for addressing shame. We will discuss the particular clinical challenges that arise when the source of shame is oneself, and engage with participants around the question of how to foster hope by creating environments in which shame cannot survive.
Dr. Michael E. Berrett is a Licensed Psychologist and is CEO and Co-founder of Center for Change, a specialty hospital and program for Eating Disorders.He has been treating Eating Disorders and related mental, emotional and addictive illness for more than 30 years. He is the Author of the APA bestseller "Spiritual Approaches in the Treatment of Women with Eating Disorders" and various other books, book chapters, and peer review professional journal articles. He is a nationally known presenter and clinical trainer. His workshops are engaging, active, practical, and from the heart.
Dr. Kim is the National Director of Reasons Eating Disorder Center and Center for Change. He completed his B.A. at Yale and his Ph.D. at UCLA, where he received an NIH National Research Service Award. He has developed an expertise in treating and teaching about psychiatrically complex populations and diagnostic assessment. Norman is a frequent, national speaker and educator, and is a passionate advocate for eating disorder awareness and translating research into clinical practice. He is on the Board of Directors of the Eating Disorders Coalition, the Eating Disorder Advisory Council for the Joint Commission, and the Clinical Advisory Board for Recovery Warriors and Tikvah V’Chizuk.
