After writing a few posts on the intricacies of complex anorexia care, it seems fitting to talk about a more global concern: the poor body image and low self-esteem that go hand-in-hand with an eating disorder. 

In Unlocking the Mysteries of Eating Disorders: A Life-Saving Guide to Your Child's Treatment and Recoverywritten by David Herzog, MD and Debra Franko, PhD, the authors point to one common finding among their patients: the feeling of “I’m not good enough.” They note that eating-disordered kids come from a wide variety of backgrounds: some report idyllic and happy childhoods, some have a history of trauma or abuse. “The paths that lead to ‘I’m not good enough,’ differ from one person to another,” they write.

In Johanna Marie McShane, PhD and Tony Paulson, PhD's book Why She Feels Fat: Understanding Your Loved One's Eating Disorders and How You Can Help,'the authors take readers inside the mind of an eating-disordered person and attempt to explain the anorexia sufferer's baffling conviction--no matter how skeletal her body may appear--that she is fat. 

Eating disorders, write McShane and Paulson, can be many things: A way to feel secure, a way to make life feel predictable, a means of communicating emotions, a way to simulate the calming sense of "being in control" for the person who feels his life is completely out of control. Eating disorders, in other words, are a solution to that feeling of not being "good enough." Eating disorders become a cherished coping mechanism.

I recently came across another explanation/interpretation of the eating-disordered mindset, in Eckhart Tolle's A New Earth: Awakening to Your Life's Purpose. "In the West, it is the physical appearance of the body that contributes greatly to the sense of who you think you are: its strength or weakness, its perceived beauty or ugliness relative to others...Many feel a diminished sense of self-worth because they perceive their body as ugly or imperfect."

Leaving aside the fact that there are plenty of people in the eastern hemisphere who feel inadquate because of their outward appearance, Tolle captures a common feeling that describes nearly everyone as well as the severly eating disordered. He attributes this faulty perception to being overly "mind-identified," a condition in which one's ego is in the driver's seat and fails to see that the real essense of a person does not lie in a body "destined to grow old, wither and die," but in "the formless dimension, the light of consciousness" that "can shine more easily through the fading form." 

He's not completely fixated on conscious awareness and non-being, though, allowing that "If [one's body] is strong, beautiful, or vigorous, you can enjoy and appreciate those attributes--while they last. You can also improve the body's condition through right nutrition and exercise." Tolle adds, "If you don't equate the body with who you are, when beauty fades, vigor diminishes, or the body becomes incapaciated, this will not affect your sense of worth or identity in any way."

Tolle's remedy for egoistic body-identification is to focus on "the feeling of aliveness inside" the body rather than by obsessing about outward flaws. Instead of getting lost amid incessant negative mind chatter he advises focusing on a calming "inner body awareness." In its attempt to correct basic errors of perception, his approach shares some aspects of cognitive behavioral therapy, in which a therapist helps restructure the patient's erroneous assumptions about herself.

Drs. Herzog and Franko advise counseling a perfectionistic child to strive for "excellence, not perfection." They note, "Excellence is achievable; perfection isn't."

In our book, Marcia and I note that low self-esteem is the most potent risk factor for both disordered eating and a full-blown eating disorder. We advise trying to foster a sense of autonomy in your child, the feeling that she has control over important aspects of her life. Give her opportunities to succeed within in the family, such as playing a role in making important family decisions, or helping with at-home projets. Praise skill, achievement, mastery and personality traits such as kindness, generosity and fairness, not appearance. Teach your child to understand to identify his feelings, and understand that even those that are unpleasant or painful are legitimate. And instead of using food to soothe, calm or reward a child, offer him a hug instead of a cookie.

We'd love to hear your suggestions for teaching better coping mechanisms and raising your child's self esteem.

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