During a program with a customer who has long suffered by having an eating disorder I was discussing what it will be like if she could feel positive about herself. I was shocked with the response she gave me. Instead of reporting a want to feel a lot better about herself, this client laughed at me and retorted, "Self-esteem is laughable to me. I really hope to be gone the disturbing behaviors of the eating disorder, but I know it's asking a lot to like myselfnutritionniste." This encounter has been as intriguing since it has been disturbing. In this interaction I think I came to comprehend, in small measure, what many women who have problems with eating disorders must experience themselves. And, I better realize that when therapists, dietitians, and other helpers meet these women, survival is the goal rather than happiness or feelings of self-worth. This interaction has arrive at symbolize for me personally the lie of the eating disorder in so it so efficiently creates such hopelessness, self-hate, and shame in women.

RELATIONSHIP BETWEEN SELF-ESTEEM AND EATING DISORDERS

Anyone dealing with women with disordered eating recognizes that self-esteem is intricately connected, however precisely how the two are related isn't entirely well-defined. Inevitably, any discussion of eating disorders and self-esteem contributes to the question of the chicken and the egg-which came first: poor self-esteem which made someone more prone to disordered eating or an eating disorder which wreaked havoc on an individual's self-esteem? While there's no simple answer to the question, there's substantial research that has investigated the connection between self-esteem and eating disorders, and provides interesting insights.

In overview of the literature, Ghaderi (2001) concluded that low self-esteem, along with other factors, not only puts women at greater risk for the development of disordered eating but also serves to keep an eating disorder. Numerous reports support the contention that low self-esteem is often present ahead of the development of disordered eating, and that low self-esteem is a significant risk factor for both bulimia and anorexia even in young, school-age girls (Ghaderi, 2001).

Based on Robson (1989, as in Ghaderi, 2001), self-esteem is "a sense of contentment and self-acceptance that results from the person's appraisal of their own worth, attractiveness, competence and power to satisfy their aspirations." With all this definition, it is clear to observe that self-esteem is multifaceted. Similarly, the development and maintenance of eating disorders is complex, including such factors as family environment, cultural environment, history of dieting, genetic predisposition, history of abuse, age and developmental concerns, length of time in eating disorder, immediate factors such as support system, emotional factors, and spiritual factors, of which self-esteem is just one factor of many (Berrett, 2002). However, self-esteem appears to be always a primary risk factor that will donate to the development of other risk factors for eating disorders. As an example, three separate research studies unearthed that development of bulimia is predicted by perfectionistic tendencies and body dissatisfaction only among low self-esteem women, whereas women with higher self-esteem didn't have these risk factors and accordingly didn't develop bulimia (Vohs, Voelz, Pettit, Bardone, Katz, Abramson, Heatherton, & Joiner, 2001; Vohs, Bardone, Joiner, Abramson, & Heatherton, 1999; Joiner, Heatherton, Rudd, & Schmidt, 1997).

Identity formation is a location of focus when discussing eating disorders and self-esteem. Attention has been fond of the parent-child relationship and how parents' perfectionistic expectations work to limit the child's development of autonomy, consequently creating an environment where the little one is reliant on parental expectations rather than on individual needs and desires (Stein, 1996). Bruch (1982) posited that as children attempt to generally meet unrealistic parental demands, they often create a sense of being "nothing." As these children grow into adolescence they may turn to an eating disorder as a means of defining self and establishing a sense of self-control (Stein, 1996).

SELF-ESTEEM INTERVENTIONS

While self-esteem is a significant risk factor for eating disorders, one research team found body dissatisfaction to function as single strongest predictor of eating disorder symptoms (Button, Sonug Barke, Davies, & Thompson, 1996). Therefore, in targeting body dissatisfaction, therapists do well to wait to improving self-esteem, an important determinant of one's body image. For instance, one study unearthed that assisting adolescents in recognizing what's positive about their bodies and physical appearances while at the same time increasing their sense of personal competence contributes to less internalization of sociocultural norms idealizing thinness (Phelps, Dempsey, Sapia, & Nelson, 1999). This resulted in significantly less body dissatisfaction, which meant less eating disorder behavior among the adolescents (Phelps et al., 1999). Improving self-esteem is a challenging task for girls with disordered eating. Often, their mental poison and beliefs are deeply entrenched and consequently difficult to provide up. Once mental poison are established they serve to keep low self-esteem and an eating disorder.

A critical intervention for girls with anorexia, bulimia, or compulsive eating is to begin challenging the deeply held negative beliefs. As an example, most women with disordered eating equate their worth making use of their weight, dress size, or shape. The sooner a female can let go of these negative self-evaluations and replace them with more meaningful alternatives, the sooner she can be on the highway to recovery. This could include exploring questions such as, "What are you wanting for your lifetime, your future, your family members?" Answering these questions may be difficult and could result in significant shifts in a individual's vocational roles, leisure activities, and relationships (Ghaderi, 2001). Therapists can assist ladies in identifying and building upon positive resources of self-definition. The eating disorder functions to limit an individual's resources, yet through therapy women can be challenged to test on new roles and pursue activities where they could gain confidence.

Too often, people who have eating disorders make themselves the exception in life. They feel that others deserve happiness, love, and joy, but which they themselves deserve sorrow, disappointment, and punishment. One of the first challenges therapists can give the eating disorder is to begin disputing these false beliefs. Therapists can begin pointing out the way the client has made herself the exception, and will then begin exploring where these false beliefs come from, if they be from past abuse, negative family interactions, childhood teasing, and other difficult experiences. Teaching the client that she's worthy of love and acceptance, and that there are no conditions to her worth can prove essential to improving self-esteem.

It is very important to bear in mind that, at the very least initially, these kinds of interventions, along with the therapist, will probably be rejected by women experiencing anorexia, bulimia, or compulsive eating. Challenges to the negative mind-set do unfit using what several women believe is true of themselves. However, with persistence, patience, and continuing acceptance, therapists will help clients to recognize their value and can help to create hope - one of the very most critical the different parts of overcoming anorexia, bulimia, or compulsive eating.

Addressing perfectionistic tendencies is also essential to addressing self-esteem among women with disordered eating. Typically, these women make their worth conditional upon their accomplishments, if it be through grades, vocational achievements, and other activities. However, inevitably as these women achieve goals their standards be unattainable, creating a pattern by which they could never reach the idea of acceptance or value. One of the tasks of therapy is to separate your lives the individual's worth from perfectionistic strivings.

For most women with anorexia, bulimia, or compulsive eating, the eating disorder becomes their identity. Considering perfectionistic tendencies, these women often want to become perfect - striving to exercise longer, eat less, and do a lot more than is healthy. Many women declare that the eating disorder is what they are "good at" and it becomes all-consuming. A woman's identity based in the disordered eating prevents her from trying new activities, especially since there is the danger that she may not do them "perfectly." From the perspective of the women, it is safer to do the disorder perfectly than to risk failure in other arenas.

Therapists do well to produce this pattern explicit in therapy. By addressing the underlying fear of failure and unmasking the disorder for what it is, these women can begin facing their fears by taking small steps, while receiving support from therapists and other helpers. Such small steps may initially be related to disorder behavior. For instance, these individuals may be challenged to begin replacing disordered eating behaviors with healthier alternatives, such as calling a friend or having a walk when the urge to self-harm surfaces. As these women find success in choosing healthier alternatives to the disorder, their self-esteem is strengthened and they could be challenged to take even bigger risks, such as reaching friends, strengthening relationships, or trying new activities.

Along side perfectionism, most women with disordered eating compare themselves with others, especially other women. When these women compare themselves to others, they never seem to measure up-in their minds someone else is always more capable, thinner, or maybe more attractive. These comparisons serve to further destroy self-esteem, thus perpetuating the deleterious cycle of compensating for negative feelings via a disorder. Along with harming self-esteem, comparisons strain relationships and contribute to further isolation from others. Therefore, therapy must focus, in part, on the comparisons these women make and how these comparisons serve to damage self and relationships. Therapists can encourage women to decide on a brand new way of being with regards to self and others - an easy method that is based on kindness and respect rather than on hurtful comparisonsnutritionniste. As these women recognize that there are no gradations to self-worth, hopefully they could begin letting go of needless comparisons.