Eating Disorder Research by Allison C. Kelly, Ph.D., C.Psych.
My name is Allison Kelly and I’m a psychologist and professor in clinical psychology at the University of Waterloo. My recent research has focused on trying to understand some of the factors that lead to people developing eating disorders and staying ill, as well as the factors that help people get better. Below I summarize what my collaborators and I have found in our research, and what these findings seem to suggest about how people with eating disorders might work to overcome their eating and body image struggles. Please be advised that these findings may not apply to every person with an eating disorder.
1. Shame, more than other negative feelings, seems to keep eating disorders alive. Shame is a painful self-conscious emotion that makes us feel as if there is something wrong with us, something flawed, defective, and repelling. When we feel ashamed, we often put a lot of effort into hiding what we feel ashamed about from others because we are afraid we will be rejected or criticized. We also try to avoid thinking about the sources of our shame because of how painful it can be to acknowledge them. My research suggests that some of the behaviours we see in eating disorders, like trying to restrict eating, exercising excessively, bingeing, and purging, might actually help people escape feelings of shame in the short-term, but ultimately perpetuate feelings of shame long-term. This may be because these behaviours are not typical for most people and because individuals usually perform them in secret, which only intensifies shame and the belief that one is different and abnormal.
2. When people with eating disorders come to feel less ashamed of themselves, their symptoms seem to improve. In my research, we found that among patients who were attending day hospital or inpatient eating disorders treatment, those who had larger improvements in shame in the first few weeks of treatment had greater decreases in eating disorder symptoms over 12 weeks of treatment. That is, those who came to feel less defective and flawed grew to have fewer concerns about their eating, weight, and shape, and came to eat in a more flexible, less rule-driven manner. These findings suggest that the process of overcoming the feeling that there’s something wrong with you, and the tendency to try and hide one’s vulnerabilities from others, makes recovery more possible.
3. Self-compassion helps people with eating disorders feel less ashamed. Self-compassion is a kind, caring attitude we can show ourselves when we feel upset or inadequate in some way. It involves giving ourselves the warmth, non-judgment, and understanding we might show a friend in a distress. So, instead of saying self-critical things to ourselves like “You shouldn’t be feeling this upset,” or “There’s something wrong with you for struggling like this,” a self-compassionate approach might be to say, “It’s understandable that you’re feeling so upset – you’ve been having a tough go of things lately” and “Most people in your shoes would be upset – this is understandable.” It seems from my research that the more people with eating disorders come to respond to their struggles in this self-compassionate way, the more their feelings of shame come to decrease. And, as shame decreases, so too do eating disorder symptoms.
4. Cultivating self-compassion through self-talk, letter-writing, and imagery tasks can help people with eating disorders overcome their symptoms and their eating and weight concerns. We conducted a study of individuals with binge eating problems, and randomly assigned (like flipping a coin) them to cope with urges to binge by distracting themselves with a fun or meaningful activity, by visualizing a compassionate image and encouraging themselves with self-compassion, or by doing nothing. We found that the distraction and self-compassion interventions were equally effective at reducing binge eating, but that only the self-compassion intervention reduced underlying concerns about eating and weight. This finding suggests that although distraction may help to change certain eating disorder behaviours, self-compassion strategies might help people gradually overcome the issues at the root of their eating disorder.
5. People with eating disorders tend to be afraid of self-compassion, and this fear can make it difficult for them to benefit from therapy and treatment. Although self-compassion seems to be helpful, we now know that many people have worries about being kind to themselves: they may feel underserving of it, or they may think that self-compassion will lead to negative outcomes like weakness, laziness, or a lowering of standards. Although it is understandable to be afraid of self-compassion if it is unfamiliar to you, our research shows that people who are highly afraid of self-compassion do not benefit as much from treatment for their eating disorder. Not surprisingly, they also benefit little from self-compassion strategies. These results suggest that it would probably be helpful for people with eating disorders to explore and try to work through the worries they have about being kind to themselves.
I hope you find these research findings useful to you in some way. I welcome any questions or feedback at email@example.com.
For more information about my research, please visit:
Kelly, A.C., Carter, J.C., & Borairi, S. (in press). Are improvements in shame and self-compassion early in eating disorders treatment associated with better patient outcomes? International Journal of Eating Disorders.
Kelly, A.C., Carter, J.C., Zuroff, D.C., & Borairi, S. (2013). Self-compassion and fear of self-compassion interact to predict response to eating disorders treatment: A preliminary investigation. Psychotherapy Research, 23, 252-264. DOI 10.1080/10503307.2012.717310
Kelly, A.C., & Carter, J.C. (2013). Why self-critical patients present with more severe eating disorder pathology: The mediating role of shame. British Journal of Clinical Psychology, 52, 148–161. DOI: 10.1111/bjc.12006