Moving beyond self-esteem and towards self-compassion in eating disorder recovery treatment and recovery

Self-esteem, which is “our sense of self-worth, perceived value, or how much we like ourselves” (K. Neff), is a pretty common topic in eating disorder treatment and recovery because of its link to better psychological well-being. And while having high self-esteem is certainly not a “bad” thing, research has shown that the process of achieving high self-esteem can be problematic and can have some not-so-great side effects for folks. The one thing that really caught my attention when I was learning about self-esteem is that it often involves putting someone else down in order to build ourselves up. And that to me was enough to begin to look beyond self-esteem. Ultimately, having to put others down to build up oneself doesn’t feel helpful to me or helpful to humankind.

Some other side effects of [the pursuit of] self-esteem include:

  • Comparing ourselves to others (which can negatively impact our connection with others and feeling connected to others has been link to a lot of positive things including better health)

  • Bullying and prejudice (including weight and body-based bullying and discrimination, which is a risk factor for eating disorder development among other things)

  • It promotes perfectionism and when self-esteem is tied to being perfect there is not where else to go but down.

  • Self-esteem can be contingent on self-worth (ie. self-esteem can change if levels of self-worth change). And this highlights the fact that self-esteem is unstable. When we need it most, like when we are embarrassed, humiliated or struggling, self-esteem isn’t there to help us out (unlike self-compassion, which I’ll talk more about in a second).

  • And finally, achieving high self-esteem has also been linked to narcissism (eek! No thank you!). In fact, research has shown a relationship between narcissism and the self-esteem movement in schools.

So again, while having high self-esteem can be helpful to us, the process of obtaining self-esteem often has negative effects.

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Let’s talk now about self-compassion…..self-compassion involves “treating yourself like you’d treat a close friend who was struggling” (K. Neff), and interestingly, self-compassion has been shown to have the same benefits as self-esteem but without the negative side effects. For this very reason, many providers (including myself) have begun to move beyond self-esteem in eating disorder treatment and integrating self-compassion into care.

Self-compassion involves three core elements that I think are worth talking about a little more. Dr. Neff states that in order for self-compassion to be in its most healthiest form all three of these elements need to be present. These three elements are: self-kindness, common humanity and mindfulness.

  • Common humanity involves us recognizing and acknowledging that being imperfect and experiencing pain is part of being human and that we aren’t the only ones experiencing it. This is not a way of invalidating our experiences, but rather, revealing that we are not abnormal. This aspect of self-compassion can help us to feel more connected and less isolated.  

  • Mindfulness is awareness and being with things/ourselves just as things are even when they are unpleasant. It is being aware (non-judgmentally) of what is going on and not trying to force anything to happen or push things away but simply just allowing them to be. Additionally, it’s not suppressing what is going on and also not getting lost in our struggle. Once we are aware of what is going on, mindfulness can involve us asking ourselves what we need in those moments.

  • Self-kindness is being gentle and warm with ourselves rather than judgmental and critical, particularly when we mess up or feel like we aren’t good enough. And we are allowed to be kind to ourselves just like we are with others. Self-kindness adds warmth to the mindfulness.

With knowing all of this, how might self-compassion be incorporated specifically into eating disorder recovery and treatment? It certainly can show up in many different ways, but here is one way self-compassion can be involved:

Has there ever been a time when you felt like you’ve done something “wrong” in your recovery? Maybe you weren’t honest with a provider, maybe you engaged in an eating disorder behavior after a long period of being “behavior free”, maybe you relapsed, etc. Instead of being critical, judgmental or shaming yourself for what you’ve done, what if you gently reframed the experience to understand why you acted, reacted or responded in the way you did. As Andrea Papin (who is an amazing therapist in Vancouver and founder of Trauma Aware Care) states, “everything that people say and do makes sense in the context of their lived experience,” and this absolutely applies to eating disorder behaviors. Instead of thinking of a behavior as something you’ve done wrong, could you look at it as information that something is going on in your life that you may be having a hard time coping with? This can be part of pausing and stepping back to examine the bigger picture about what is going on (mindfulness) and extending kindness towards yourself. If it is helpful, think about being your own friend in that situation. You can even visualize yourself comforting yourself (maybe how a friend has sat by you when you were upset) or visualize yourself extending your hand to yourself.

Furthermore, if change is something that a person has a desire for in their life, this non-judgmental (compassionate) reframing allows a better opportunity for change to take place...especially when compared to shaming and guilting oneself into changing. Shame and guilt sometimes seem like they work, but it is usually short-term and also comes with a lot of side effects, like heightened anxiety, depression, internalization of shame and guilt, and decreased self-worth.

Where to start? A helpful place to start in practicing self-compassion can be making ourselves aware about our current self-compassion practices. If you aren’t sure how compassionate you are towards yourself, Kristen Neff has developed a helpful self-assessment tool: Self-Compassion Quiz. Upon taking the quiz and seeing the results it can be very easy to judge yourself, but I invite you to use this opportunity to start practicing a little self-compassion by extending some gentleness, warmth and kindness towards yourself.

A couple of things to be aware of as you begin or re-incorporate self-compassion into your life…

“Backdraft”, or the arising of uncomfortable feelings and painful memories, can occur when you begin practicing self-compassion. When we open the doors to our heart (and allow some warmth to come in), it can also bring up pain and uncomfortable feelings. As uncomfortable and scary as this “backdraft” can be, it is actually a sign that healing has begun (pain has to come out in order for healing to take place) and it doesn’t mean you’re doing self-compassion wrong. Further, that discomfort is not necessarily something you have to stop or prevent, and may just provide some information that you need to slow down the process of practicing self-compassion (yes..you can go slow in this process…it’s not a race, though I understand the desire to get to the benefits as soon as possible). Sometimes even just naming the backdraft (literally saying to ourselves, “there’s the backdraft”) can be helpful. And it is also ok to stop practicing self-compassion at times, especially if it is still very new, and take care of yourself in other ways (doing so can actually strengthen neural pathways of self-care).

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I am very grateful for Dr. Kristen Neff and the work (including research) she has been doing for many years around self-compassion and highly recommend checking out her site for more information: www.self-compassion.org. She is my go-to source for self-compassion resources, research and information!


Sources: Dr. Kristen Neff at www.self-compassion.org; EDRDpro Symposium 2019