Eating Disorders, Shame and Tools for Recovery

"Shame is at the core of every eating disorder," says therapist Amy Wasserbauer of Arizona State University Counseling Services. She made her remarks during a presentation entitled, "The Impact of a Shame Identity on Eating Disorders" at IAEDP-Tucson's quarterly meeting on June 8, 2016.

Wasserbauer shared the podium with Pam Micca of Healthy Women, Healthy Girls. Wasserbauer says they chose shame as a topic because "understanding the inner life of an individual who develops an eating disorder is vital to an understanding of treatment and recovery."

Shame is part of the definition of all eating disorders, from the anorexic who never feels thin enough to the bulimic who carries shame about out-of-control cycles of binge eating and compensatory behaviors, to the shame experienced by those diagnosed with BED and obesity, which is heightened by social stigma.

Studies have shown that women with eating disorders report more shame and guilt than women with depression, and that a high percentage of those who suffer from eating disorders are "shame-prone" individuals, who are more likely to respond in any given situation with the emotional reaction of shame, regardless of the situational triggers.

The Impact of Shame

Wasserbauer drew on the work of Sandra Wilson, author of "Released from Shame: Moving Beyond the Pain of the Past", for her definition of shame as "the intensely painful feeling or experience of believing we are flawed and therefore unworthy of love and belonging."

Wilson has identified three types of shame:

  • Value-based shame — an appropriate, healthy response when we acknowledge that we are engaging in behaviors that are contrary to our value system.
  • Biological shame — a child's time-limited, natural response to the observable differences between self and others

  • Damaging shame — a response to being exposed to unhealthy, ineffective or destructive methods of caretaking, and a misinterpretation of the meaning attached to these methods.
Amy Wasserbauer, PhD

Value-based shame can be addressed through forgiveness and behavioral change, and most children will eventually grow out of biological shame. For the eating disorder professional, damaging shame is the most problematic, since recovery means tackling the long and difficult process of identifying the irrational and distorted beliefs about the self and others that fuel the shame identity.

The shame reaction can result from being chronically ignored, invalidated or denied. Wasserbauer contends that the healthiest way to overcome shame is by engaging in dialogue that promotes a sense of mutuality and helps the individual feel more connected, and that therapists can better respond to their eating disorder clients' feelings of vulnerability and shame if they are comfortable with their own sources of shame.

Treatment and Tools

Pam Micca summarized the genetic and environmental origins of distorted belief systems in individuals who develop eating disorders, and introduced a set of skills and tools that can help clients move forward in recovery.

Pam Micca, MEd, LPC, ACS

Life Stories and Narratives

Micca and Wasserbauer encourage their clients to write their life stories, not for discovery, or to find someone to blame, but simply to examine where they came from and how it affected them. Clients are then encouraged to talk about their stories, to identify themes, and to explore ways to communicate about their themes in a way that doesn't result in a defensive reaction.

"What an eating disordered individual needs more than anything else is validation," says Micca. "They need to know that they are someone who deserves to be loved and respected. The life story process teaches a client how to speak their shame and learn skills to break the power of shame, and move toward shame resilience."

Some clients, especially adults, may find it difficult to write their life story. In that case Micca suggests they begin with a timeline that lists important events and identifies the difficulties and life struggles associated with those events as well as the important relationships.

Behavior Chain Analysis and Solution Analysis

Behavior Chain Analysis (BCA) was developed by Dr. Marsha Linehan to help cultivate critical thinking.

"Individuals with eating disorders live on automatic pilot," says Wasserbauer. "BCA (Behavior Chain Analysis) is a way to teach them about the things they've done, to figure out where the behavior came from and how to begin the process of breaking the chain."

Amy WasserbauerOne way to approach the process is to begin by write a narrative of everything that happened over a 12- or 24-hour period that included some problem behavior, which may help the client identify what they were thinking and feeling prior to engaging in the problem behaviors.

  1. Describe the specific problem behavior.
  2. Describe the specific precipitating event that started the chain of behavior.
  3. Describe in general vulnerabilities that might have made the person more susceptible.
  4. Describe, in detail, the chain of events that led up to the problem behavior.
  5. List specific consequences of the problem behavior.
  6. Describe in detail different solutions to the problem.

Solution analysis involves taking each one of the links in the chain and asking yourself what you can do to break the link, with the goal of minimizing vulnerability.

Some skills that could be used to break the chain include:

  • Engaging in better self-care
  • Asking for help
  • Radical acceptance
  • Self-soothing

Micca and Wasserbauer also touched briefly on acceptance and commitment therapy, mindfulness and self-worth assessment.

"All of these are ways of moving out of the shame," Micca concluded. "Staying in the moment, getting that brain more focused .... Our goal is to move the person from mindlessness and inattention to critical awareness of the present experience, without judging the experience or the feeling. If you feel shame, you feel shame, but let that be the alarm clock that tells you it was triggered by something that you need to get in touch with."


IAEDP provides financial support to educational, research, and outreach opportunities that raise awareness and prevention of eating disorders. The Tucson chapter's next event will be its Annual Gala from 2:00-4:00 pm on October 25, 2016, at the Plaza Arboleda Conference Center. Enjoy an afternoon of camaraderie and self-care including hand and neck massages, golf tips, fitness advice, nibbles, beverages and more. You can register online for upcoming events at