Stopping the Shame Spiral: Addressing the narrative of eating disorders as ‘first-world problems’

“Why can’t you just eat?” 

“Stop being wasteful!” 

“Do you know how many starving people there are in the world??” 

Recently, I’ve been reflecting a lot on the ways in which spirals of shame kept me stuck in my struggle with an eating disorder.

Undoubtedly, many emotional nuances contributed to the “stickiness” or persistence of the eating disorder - anger, frustration, and confusion, just to name a few. But there was a particularly unrelenting quality of shame that I’ve only been able to really process and heal from in recent years. 

A narrative that is often used to characterize eating disorders is describing it as a “first-world problem”.

A few assumptions underlie this narrative.

First, it assumes that eating disorders only affect a privileged subgroup of individuals, who engage in patterns of behavior that are purely motivated by vanity and selfishness. Following from this assumption - that individuals with eating disorders are not self-aware enough to recognize their vain and selfish ways - a second assumption is made: that inducing feelings of shame in the person who is struggling and making them aware of all the pain that they are causing to the people around them will motivate them to change their ways. 

In today’s post, I want to address and challenge this narrative - to change the ways that we characterize individuals struggling with eating disorders, but also to question the ways we have come to use shaming (of the self and others) as a way to address pain. 

So here goes - my list of why we need to stop calling eating disorders “first-world problems”:

First and foremost, a robust (and growing) body of research evidences that eating disorders do not discriminate.

• Eating disorders have been shown to affect individuals from all demographic groups, regardless of race, gender, or socioeconomic status (1). 

Second, calling EDs a first-world problem assumes that individuals with EDs are vain and wasteful, which fails to acknowledge the true underlying reasons for the development of these diseases. 

• Eating disorders manifest fundamentally as a vehicle for expressing deep pain, distress, and confusion (2). Contrary to the common assumption that individuals with eating disorders lack self-awareness, many individuals actually develop these illnesses in response to a hypersensitivity to internal sensations (both physical and emotional), leading to the use of disordered behaviors as a way to self-soothe and numb out unpleasantly amplified experiences (3). 

• The manipulation of food and body are merely culturally-legitimated metaphors - meaning that they point to what attracts positive attention (e.g., praise from peers following weight loss) or negative attention in a given cultural context (e.g., expressions of concern from family members following drastic weight change, especially in contexts where family members do not typically legitimate expressions of emotional distress). 

Third, even if it were to be the case that EDs were more prevalent in developed countries, shame never did anything to reduce pain. 

• Another faulty assumption that people make is that eliciting feelings of shame and guilt in someone who is struggling with an eating disorder can somehow reduce or eliminate the ED behaviors. 

• Why this approach doesn’t ‘work’ is clear when we revisit the point mentioned above - eating disorders are an expression of pain. When we understand this, we can understand how further contribution to this pool of pain through eliciting emotions of shame and guilt is entirely unhelpful and in fact, incredibly counterproductive to recovery. 

• What a person who is struggling - with an eating disorder or another mental illness - is more compassion, not more criticism. Someone who is struggling with mental or emotional distress needs to know that their distress is valid - that they deserve to address this pain, because they are fundamentally worthy of finding joy in life. This is a perspective on life that can only be nurtured through consistent compassion from loved ones, not continuous criticism. 

Finally, we need to remember that we don’t have to minimize one kind of pain in order to legitimize another. 

• The assumption underlying the labelling of EDs and other forms of mental illness as “first world problems” is that they don’t, or shouldn’t matter as much as “bigger” problems. 

• I believe that we must first work to heal our own wounds before we can build the capacity to advocate for what we believe in. In my personal experience, I have seen that investing fully in my recovery - validating the pain of experiencing an eating disorder and tackling it head on instead of diminishing its importance and impact on my life - has helped me slowly move away from allowing the ED to define me. I can focus on advocating for causes that I care about today, precisely because I invested time and energy in healing myself first. 

Cues for Conscious Change:

What role has shame played in your experience of pain, and how might it have kept you stuck? 

What would it mean for you to let go of the narrative that shame is somehow “necessary” for speeding up the process of eliminating thought/behavior patterns that do not serve you? 

In your relationship with yourself and with others, how can you learn to replace shame with compassion instead?