|EATING DISORDERS, DISTORTED THINKING, & SELF-TALK
William C. Shearer, Ph.D., M.P.H., M.B.A.
Robin L. Shearer M.A., M.P.H., M.F.T., R.N.
Developing an eating disorder requires distorted thinking and negative self talk, something that is not unique to those with food and weight issues. All of us deny, falsify, and distort reality. That’s because we’re all human. None of us is a purely rational Mr. Spock (from Star Trek fame).
Because we are human, we tend to put our own particular slant on things we perceive. We process information in accordance with our own set of beliefs. Many of these beliefs are “taught” beliefs, learned in our childhood from those who were closest to us and most significant in helping us meet our needs. Sometimes these beliefs are destructive to our self-esteem and our relationships. We are often unaware of these beliefs at all, yet, all too frequently, we feel overwhelmed by the unpleasant emotions that stem from them. We choose to think that it is the event that we are reacting to without realizing that our feelings stem more from what we tell ourselves about the event than from what is actually happening. In the words of the first century philosopher Epictitus, “People are disturbed not be things, but by the views which they take of them.”
As mentioned above, we all distort reality. We all have long-established beliefs about ourselves, the world, and our relationships. We all disturb ourselves with negative self-talk learned early in life.
By way of an example, consider a situation that demonstrates that only one of these beliefs might be necessary to generate extreme disturbance. Suppose you were one of those people who told yourself, and absolutely believed it to be true, “I must please everyone in everything I do, all of the time.” For one thing, it is an impossible belief; no one can please everyone. There is bound to be someone that you disappoint in some way. In fact, there are many situations where a healthy person is bound to disappoint those around them if only necessary to assert their boundaries and rights in a mentally healthy way. You simply cannot be a person of good self-esteem, with a clear sense of your own identity and boundaries, and be a people pleaser who feels she “must” please those around her.
If you have such a belief -- that you must please everyone -- and you are having a week in which everyone seems to be pleased, you are not off the hook. You are going to be preoccupied with the concern that someone might be displeased, that you might have failed to meet the needs of a family member, friend, or co-worker.
If you do find yourself displeasing someone, it will be grounds for depression and a sense of failure. Either way, you cannot win. By virtue of this one belief, you are destined to be either anxious or depressed all the time.
It gets worse. Others are quick to pick up on the fact that you are prone to guilt and therefore, quite vulnerable to their manipulations. Because the corollary of this belief is that you cannot express anger (that would displease others for sure), you are going to be someone who stuffs her anger and hides behind a smile on the outside. You will find yourself saying “yes” when you mean “no,” and others will take advantage. You will find yourself resenting other people and seeing others as problematic and a source of anxiety. On the extreme, others will be perceived as so threatening that the only solution is to avoid them, leaving you with a sense of loneliness and isolation. Having this one belief leaves you feeling powerless and with lowered self-esteem.
That was an example of having only one irrational belief. We all have many, and they occur in teams. People with eating disorders tend to have a particular set of beliefs which serve to keep them stuck in their disorder. An awareness in the ways in which all of us tend to distort reality can be quite helpful as these thoughts are automatic and like a high speed computer connection. We are scarcely aware of the existence of these beliefs, if we have any awareness at all.
Much of therapy is aimed at helping our clients slow down their thinking and become more aware of their own distortions. Once this is done, they can begin to challenge those beliefs, plugging in more realistic and effective ways of viewing themselves and the world around them. This is vital to eating disorders recovery.
It would be impossible to have an eating disorder without negative and irrational self-talk. An eating disorder is by definition, a set of obsessional thoughts and compulsive behaviors centered around food and weight issues. Distorted thinking is the basis of those obsessions and compulsions.
The following are specific styles of distorted thinking that apply to those with an eating disorder. Each description is followed by examples to illustrate how eating disordered people might unconsciously utilize that style as a way of maintaining their disorder.
When you personalize, you tend to relate everyone and every occurrence around you to yourself in a most negative way. The central aspect of personalization is the habit of continuously comparing yourself to other people, always seeing yourself as not quite measuring up. Opportunities for comparison with others never cease. A basic assumption for personalization is that you have worth only if you compare well with others, and your worth is therefore tentative, temporary, and questionable. Personalization means that you are continuously testing your worth as a person by measuring yourself against others. If you meet someone with major flaws, you may experience brief relief; however, this is not usually the case. Personalization usually means that you find ample evidence to feel diminished, inadequate, and not quite good enough.
Personalization also means that you interpret each experience, each conversation, each glance from another as hard evidence of your inherent unworthiness.
Sally felt extremely uncomfortable in her first anorexic/bulimic group meeting. She was quite sure even before she arrived that each of the other women would be thinner. Additionally, she was expecting they would be more intelligent and successful. It never crossed her mind that because it was an eating disorders group that the others had similar problems. Upon sitting down in group, she was filled with anxiety. In her mind, she excelled in being fat, ugly, and stupid. Her perception was that each of the other women was talented, more successful at meeting their needs, and certainly thinner. Their normal curiosity about a new group member was perceived by Sally to be a clear indication that they were thinking critical thoughts about her. When several group members talked among themselves prior to the start of group, Sally was convinced they had to be talking about her. Only with additional group time, the sharing of other group members, and obvious friendliness toward her, did Sally begin to relax. When the group expressed insecurities similar to her own, Sally was shocked. “Could if be possible that others felt the same way?” It would take many more group sessions before Sally realized fully how her perceptions were distorted. In reality, she was attractive and somewhat underweight. Her intelligence was above average. Personalization, however, virtually always leaves an individual feeling inadequate and depressed.
This is a distortion that leads you to take a small piece of evidence or a single event and make a sweeping generalization that colors your entire life. Overgeneralizations are usually thoughts in the form of absolute statements, such as “always” or “never.” These are distortions that almost always lead to an increasingly restricted life and a gloomier view of self.
Whenever you conclude that “Nobody loves me” or “ I’m never going to recover,” you are over generalizing. Usually your conclusion is based upon some small piece of evidence and involves turning your back on everything you might have ever heard to the contrary.
Jane has very little satisfaction in life. Her life style has been increasingly isolated as she more and more withdraws fearing failure. To Jane, one rejection means nobody will ever want to be with her. If she experiences failure in regard to her food, weight, or fitness goals, it means she should never try again. The extreme anxiety she has experienced with social situations means that she will surely be a wreck every time she attempts to spend time with others. For Jane, every bad experience she has ever had means that whenever she is in a similar situation, she is going to repeat the bad experience. The result is a more and more restricted life, as Jane clings to the familiar and avoids taking risks. Of course, this avoidance inevitably leads to boredom, loneliness, and the extreme stress of un met needs. Food has become her consolation and compensation, a way of coping and an additional reason for Jane to be down on herself. The familiarity and comfort of food, however, far outweighs the anxieties and insecurities of taking risks. All Jane can think of are past failures and her conviction that the future only holds more of the same.
Generalization means that you carefully ignore everything you know about yourself that is contrary to the sweeping conclusion you have drawn from one or two pieces of evidence. Key words that go along with overgeneralization are all, every, no one, never, always, everybody, and nobody.
I am reminded of a Woody Allen movie in which his headache was certain evidence he had brain cancer. Catastrophizing means that whenever bad things can happen, surely they will occur. For eating disordered people, it means that if it is possible to gain four hundred pounds, then surely you will gain four hundred pounds. If it is possible to be rejected on the bases of your weight, then of course that rejection is a certainty.
Catastrophizing self-talk often starts with the words “what if.” What if this happened or that happened? If it can, then it will. The list of possible calamities is endless. Many eating disordered individuals tend to be worriers. In particular, they worry about being out of control with food and about gaining weight. Since these things are possible, they are already guaranteed to happen.
George has struggled with his weight for years. He has tried every diet know to man--and woman. He has never really understood the relationship of dieting to obesity, and so he continues to search for a new diet, the one that will end his food and weight problems forever. All of this restriction, however, leaves him obsessed with food, feeling more out of shape, and extremely depressed over future possibilities. He weighs himself constantly. Each small deviation, each pound gained is certain proof to George that his weight will never be under control, and that he is destined to get larger and larger. Any departure from his food plan means a scale-busting weight gain. The anxiety and depression of it all leads him to vacillate between renewed efforts at dieting and abandonment to binge eating, all the while feeling quite hopeless.
4. Polarized Thinking
The central theme of this distortion is the belief that he world consists of black or white choices. Things have to be either one way or the other. There is very little room for middle ground. People and things are good or bad, wonderful or horrible, successful or miserable failures. Polarized thinking leads to an either/or world where reactions to events swing from one emotional extreme to its opposite. Perhaps the worst problem with polarized thinking is the effect upon self-image and self-esteem. If you are not perfect or wonderful in every respect, then you are surely the worst kind of reject, a “worm” of a person beneath contempt. There is no room for mistakes. Each new day brings with it a thousand more tests, and anything other than a perfect score is ultimate failure.
Louise, like George, weighs herself incessantly. Like many people with food and weight problems, Louise thinks if she is not perfectly thin, she must be terribly fat. If she is not totally in control of her food, then she is absolutely out of control. Food is either good or it is bad. The bad food is to be avoided at all costs, for one small slip, one small bite of the bad food, means that you the dieter has gone from being a good in control dieter to a horrible out of control foodaholic. Of course, Louise does not see the connection between over control and being out of control. She does not realize that this extreme restraint and the polarized thinking leads her to abandon all control once she perceives perfect control is no longer hers. This means any attempt to modify her food and weight behaviors ends with the first deviation, the first small slip. To Louise, any change from the plan is total failure. Either the plan runs perfectly smooth or it is a disaster and readily abandoned, and Louise has once again proven herself unworthy. Each Monday Louise begins a new diet. By midweek, she has abandoned the diet and the incredible self-restraint that goes with it. She once again promises herself, “Monday I will begin again.” Meanwhile, Louise perceives herself as week and ineffectual, someone who has no will power. After all, you either have it or you don’t.
The distortion of filtering means that you have tunnel vision. It means you perceive only an element of a situation and ignore everything else. A single detail or perceived flaw is focused on with extreme intensity. A real or imagined physical blemish or imperfection is obsessed over, worried over for hours or days. Everyone has his or her own particular brand of tunnel vision. Eating disordered people are hypersensitive to anything suggesting a personal defect and blind to any indication of good qualities. They tend to have heightened awareness of elements fro their environment that suggest personal inadequacies, particularly in regard to food and weight. Of course if human beings are intent in finding imperfections in themselves, they certainly will find them. Even the process of remembering can be selective. From an entire personal history and warehouse of experience, people who filter will remember certain kinds of events. Those with an eating disorder tend to review their past and experience memories that leave them feeling inadequate, anxious, or depressed.
Filtering means magnifying and distorting thoughts and memories in isolation from all other perceptions. If negative qualities and events are taken out of context, they are at the same time isolated from all the good experiences that may have surrounded them. In the filtering process, they become larger than life and much more punishing than they would be if viewed accurately. The end result is that your conscious becomes filled with all of your fears, all of your losses, and all of your irritations. These things have become exaggerated to the point where your total awareness consists only of negative perceptions and damning evidence of your lack of worth.
John was a chubby kid. In the process of growing up, he had to endure many insults. Classmates teased him and sometimes bullied him. Gym teachers scolded him and made him run extra laps. Even his parents constantly belittled him about his weight and put him on diets. As an adult, John would be described as successful by virtually anyone’s standards. His income puts him in the top two percent. He is extremely well educated and widely respected for his knowledge and judgment. John has a loving family and an extremely bright professional future. It would seem that everything in John’s life is wonderful. John, however, has a deep sense of self-hatred. No matter what good things befall him, John cannot forget that he was the chubby kid who was the butt of so much ridicule. There is an abundance of good in John’s life, but it seems to do him no good, for it cannot pass through his negative filter. Nothing penetrates his awareness of self unless it reinforces his basic dislike of his physical self. This self- image colors every aspect of John’s life.
6. Mind Reading
This distortion involves making instant judgments about others. In mind reading, it seems you know exactly what other people are thinking, what motivates them, and what they intend to do next. There may be little evidence for these beliefs, but they feel right. This distortion occurs most commonly in conjunction with personalization, as it involves making assumptions about how people are reacting to you. You may believe people are thinking critical thoughts about your qualities or about your appearance.
Mind reading is also found in conjunction with another process called projection. In projection, you believe people are thinking the same thoughts about you that you are thinking about them. Eating disordered people tend to be extremely aware about bodies. They tend to notice particularly whether others are in or out of shape, under or overweight. Because they spend so much time focusing on other people’s appearances, they are absolutely sure others are focusing in them and thinking unkind thoughts.
Sara, a twenty-four year old college student and summer lifeguard, finds herself being extremely self-conscious in her bathing suit at pool side. She is absolutely certain others are examining her, scrutinizing every detail, committing every flaw to memory. She also imagines they cannot wait to tell their family and friends about the
“fat lifeguard.” She feels like quitting her job. The pressure is unbearable. The anxiety builds as she feels all the eyes upon her, knowing the rejection and criticism behind those eyes. She cannot imagine they might be thinking of other things or have their own worries and insecurities to keep them occupied. She is certain their primary focus is upon her.
Blaming means that when things go wrong, someone must be at fault. Those with an eating disorder tend to be into self-blaming. They tend to beat themselves up on an ongoing basis for being worthless, inadequate, out of control with food, or fat.
Marilyn is a diet junky. She begins each new diet with high spirits and excitement that she is at last “on the right track.” Unfortunately for Marilyn, the results are always the same. After an initial weight loss, Marilyn levels off and begins the all too familiar path to regaining her weight and then some. An interesting thing happens to Marilyn as she is losing weight. She cannot wait to tell all of her friends about the wonderful diet she has discovered and how well it is working for her. Often her friends, except those who have been through this with her before, race to sign up for the diet Marilyn has praised so lavishly. As Marilyn regains her weight, which is inevitable on virtually all diet plans, she falls silent. No longer does she mention the plan, and she hopes no one else will mention it. Inwardly, however, Marilyn is all to ready to blame herself. She does not hesitate to condemn herself and herself names for her “failure” in not perfectly sticking to the diet and succeeding at her weight loss goals. The diet gets the credit for any success; Marilyn gets the blame for predictable setbacks.
8. Control Fallacies
There are two possible ways people distort there sense of power and control. Those with eating disorders seem to employ both distortions. On the one hand, you can see yourself as powerless and controlled by everyone around you. On the other hand, you can see yourself as omnipotent and responsible for the well-being of all the important people in your life. Many eating disordered people perceive themselves as trapped and powerless and unable to make important life changes in their lives. At the same time, they tend to be rather codependent, feeling responsible to find solutions to the problems friends and family members experience.
One of our students defined codependence as figuring out how you feel by taking someone else’s temperature. For many of our clients, there is such an extreme focus on other people, their concerns and expectation, that there is little time and energy to figure out who you are, what you feel, or what you want. It is quite possible to feel ineffectual in your own life, yet believe you must instantly fix anything that is wrong for others. It means always being on duty, always being vigilant, always striving to do a better job at taking care of others. You do not believe you can do anything that really changes the shape of your life, yet you carry the world on your shoulders and believe you are responsible for other people’s happiness. Powerlessness and omnipotence simultaneously.
James believes that everyone at work and at home is depending on him. His friends are also depending upon him. He worries he might neglect his responsibilities to others and that he might leave them in pain and angry. He thinks he has to right all wrongs, fill every need, soothe every hurt. Failing to do this, he feels extremely guilty. With the guilt comes resentment. He is angry that he must always be there for others; He wonders when it will be his turn. His turn never comes. It seems he can never deal with his own needs without feeling selfish and unentitled. He is tired of the caretaker role and believes his own needs have long been neglected, but he does not know how to break out of the pattern. Experiencing extreme stress from unmet needs and repressed anger, James turns increasingly to food as a way of nurturing himself and distancing himself from his emotions.
9. Fallacy of Fairness
Children are often observed bickering over what is fair. Pieces of cake have to be the same size. Certainly it is not fair if one child gets more slices than the other. Usually, Mom intervenes with the pronouncement, “Life is not fair. You need to get used to it now.” Often, those with an eating disorder are observed saying, “It’s just not fair!” It isn’t! It is not fair that overweight people receive discrimination at every turn. It is not fair they are the last to be hired and the first to be let go. It is not fair that they often fail to get deserved promotions. It is not fair that hey are perceived as less attractive. Many of our bulimic clients believe it is not fair that there are others who are perceived to be more beautiful or have bodies that appear to come from Vogue magazine. It does not seem fair that some people can eat whatever they please and not gain weight while others gain weight easily. It certainly does not seem fair that some are afflicted with anorexia and bulimia while other others seemingly have no problem controlling their food and their weight. It especially seems unfair that control over food and weight seems so remote, particularly after such monumental efforts to eat right, exercise, and be a slave to have the “perfect body.”
Sue felt overwhelmed by resentment. She worked so hard to be in shape, yet others at the gym seemed to have time to socialize. They seemed carefree, relaxed in their workout, and yet they appeared to Sue to have perfect bodies. It just was not fair. Time and time again, Sue had doubled and redoubled her efforts only to be disappointed. In fact, it often seemed that the harder she worked, the more disappointment awaited her. Others seemed to easily attain what she found so illusive. It just was not fair. She seemed unaware that much of her behavior was self-defeating and in fact contributed to her lack of results. She also was quite unaware that we are not all meant to have ideals bodies, or that her distorted perception slimmed others while adding many pounds to her own mirror-image. In her mind, an ideal body should be attainable if you work hard enough. It just was not fair.
10. “Heaven’s Reward” Fallacy
This is a plan for living your life that involves always doing the right and proper things, always meeting or exceeding others expectations, all in the hope of ultimately being rewarded. There are those who never fail to sacrifice or work exceedingly hard in the belief that they are collecting points to be cashed in some day when it is there turn. Both men and women share this belief, but women especially in pour society have been raised to be there for others and to be perfect in every respect. Many wives and mothers believe they must be perfect in their career and then perfect in their homemaking. They believe that after a day of pleasing the boss and anticipating his every need, they should also be able to cook elaborate meals for the family and make sure that their house is in perfect order. She might carry on this way for years, expecting that there will ultimately be appreciation or special reward. Such rewards may never come and many become increasingly angry and frustrated. The essential problem here is that if you are living your life trying to touch all the bases, please everyone around you, always do the right thing to the exclusion of your own needs and feelings, you are physically and emotionally disintegrating.
Lisa works very hard at her job. For several years she has been earning regular promotions. She prides herself on never missing any details. She regularly brings work home and often goes in on weekends to work additional hours. She is extremely involved in her children’s activities and in supporting her husband in his career. She is often tired, but there seems to be so much to do. She rarely takes time of and cannot seem to relax without feeling terribly guilty. It always seems that she should be working harder. Additionally, it seems that the harder she works, the more others expect of her, her family included. She believes all of this will pay of someday, but someday seems so long off. She seems barely aware of her own needs, and certainly there are so many other things that take priority. She is vaguely aware of a lot of unpleasant emotions and substantial stress. She is becoming increasingly distressed over her weight and binge eating episodes, but believes she should just try harder to control her food intake. She is quite unaware of the connection between food and weight issues and the stress of unmet needs.
11. Emotional Reasoning
This distortion is centered around the belief that whatever you feel must be true. If you feel like a failure, then surely you are a failure. If you feel guilty, for sure you have done something terribly wrong. If you feel fat, then of course you are fat and ugly. In other words, if you feel anything negatively about yourself, than it must be true because it feels true.
One thing often misunderstood is that feelings in and of themselves have little validity. Our feelings stem from our thoughts and beliefs. If our thoughts and beliefs are distorted, then our feelings will be quite out of proportion to the real events. Previously, an example was given of how the belief that you must please everyone all the time in everything you do will lead to constant feelings of anxiety and depression. Similarly, many of our clients feel fat, ugly, and stupid, and take this as absolute reality, unaware that many distorted and perfectionist beliefs are at the root of these erroneous surface perceptions. In short, distorted thoughts and beliefs lead to emotions that reflect these distortions. Feeling fat, ugly, and stupid is really another way of saying you believe you are worthless and hopeless. The reality is that your thinking made it so. All the distortions in this issue seem to combine to produce a sense of being worthless and hopeless with the surface perceptions of being fat, ugly ,and stupid.
Elaine cannot remember when she was not depressed. She was always pessimistic about the future and about her own abilities. Whenever good things happen, she seems unable to enjoy them. Instead, she dwells on her own negative perceptions of self. Elaine can think of nothing positive to say about herself. Instead, she readily calls herself names, puts herself down, and predicts failure in anything she undertakes. Elaine is most self-conscious about her appearance and her intelligence. She is totally convinced she is fat, ugly, and stupid, and that those qualities are readily apparent to everyone she encounters. She feels these things so strongly, they have to be true. It has never occurred to her that the beliefs underlying these self-perceptions are without evidence and are in fact gross distortions of reality. All she knows is that the feelings are ever-present and color everything.
12. Global Labeling
It is hard to think of something more complex than a human being. Any one of us could be described in terms of thousands of qualities and traits. Some of these traits are praise worthy, others are things that could and should be improved upon. The overall picture of any person is quite complex and defies any attempt to quickly and simply summarize the whole person. In fact, it is really quite irrational to slap a label on the total person and believe that label is the person. How can you possibly explain a complex human being with one global label? For example, labeling someone a “loser” or “stupid” is quite absurd. All of us are capable of making mistakes. None of us seems to win all the time. It would be far more accurate to talk about specific instances of poor judgment or mistakes that have proven to be a learning experience. Above all, it is important to see beyond mistakes to the total person.
Jeff sat in my office complaining of his constant lack of success in controlling his food and weight. For him, his difficulties simply represented more proof that he was a “born loser.” Like virtually everything else in Jeff’s life, his attempt at managing his weight was one he entered in already expecting a lack of success. After all, if you are a born loser, what else can happen except failure? Talking to Jeff, it soon became apparent that here was a man incessantly calling himself names like loser, jerk, and stupid. Jeff actually believed that you had to talk to yourself this way if you are ever going to get anything done. You had to whip yourself into shape and keep yourself in line or else you will really mess up. When told that lots of people are quite successful and never call themselves names or label themselves in any negative fashion, Jeff was incredulous. How could anyone succeed at anything if they were not tough on self? “I do not believe there is anyone that does not talk this way to himself or herself.” Over time, Jeff would learn that global labeling had everything to do with not only his lack of success, but also his on going depression, anxiety, and compulsive eating.
13. Shoulds and Musts
This distortion involves using a list of inflexible rules about how you and other people should act as sacred commandments guiding every aspect of your behavior. These rules are seen as right and indisputable with no deviation allowed. Any departure from strict adherence of these rules is accompanied with extreme guilt and anxiety. Key words that signal the presence of this distortion are “should,” “ought,” or “must.”
One of our anorexic/bulimic groups got to brainstorming a list of musts and shoulds they believed applied to them. It is fascinating that people with anorexia and bulimia can relate so well to the same set of rules. The list put together by the group follows.
1. I should not put myself first.
2. I should not have or express anger.
3. I should not have conspicuous needs or wants.
4. I should not make waves.
5. I should not make time for myself.
6. I should not waste time relaxing.
7. I should not have fun.
8. I should not have expectations for others.
9. I should not get too close to others or they will discover my flaws.
10. I should not be a burden to others.
11. I should not trust.
12. I should not ask for help.
13. I should not make mistakes or fail in any way.
14. I should not be imperfect.
15. I should not lose control; I must be in control at all times.
16. I should not say no.
17. I should not disappoint others or fail to be nice.
18. I should not be my own person.
19. I should not be too visible.
20. I should not be comfortable with compliments.
21. I should not be comfortable with criticism.
22. I should not be overly optimistic or helpful.
23. I should not be assertive.
24. I should not have strong opinions.
25. I should not love myself or even like myself.
26. I should act as though I have rights.
27. I should not be fat.
Years ago the famous psychiatrist Karen Horney called this kind of thinking the “tyranny of the shoulds.” Eating disordered people tend to have extremely high stress levels. For the most part, the anxiety and stress is generated by self talk or at least amplified by you own messages to self. Compulsive eating or food and weight obsessions are ways people deal with anxiety and stress that threatens to overwhelm them.
Some of these “shoulds” have very destructive and far reaching effects. For example, if you believe you should not express anger, the result will be much free floating anxiety, lowered self-esteem, and relationship problems. Other shoulds have similar negative consequences.
As you look over this list of distortions, you will no doubt spot some that are quite familiar and others that you may not utilize to any great extent. Probably you have favorite distortions. Those are the ones one need to become more aware of so that you may begin to dispute them and change them. Specific techniques for doing this are the subject of the next newsletter.
© 2005 William Carey Shearer Ph.D., M.B.A., M.P.H
Robin L. Shearer M.F.T., R.N., M.A., M.P.H.