People-pleasing tendencies often arise from a complex interplay of childhood experiences, cultural influences, and family dynamics. While being considerate and accommodating is generally seen as positive, chronic people-pleasing—where individuals prioritize others’ needs at the expense of their own—can contribute to significant mental health challenges. Understanding the roots of people-pleasing and the disorders it is commonly associated with can shed light on why these tendencies develop and how they affect mental health. 

Common Mental Health Disorders in People-Pleasers 

Social Phobia and Anxiety

People-pleasers often experience social phobia or generalized anxiety, driven by a fear of rejection or disapproval. The effort to avoid conflict, gain approval, and ensure others’ happiness can create persistent worry about how they are perceived. These individuals may overanalyze interactions, fear making mistakes in social situations, and feel intense pressure to meet expectations, leading to chronic anxiety and avoidance behaviors. 

Low Self-Esteem

Chronic people-pleasing is closely linked to low self-esteem. These individuals may base their self-worth on how well they meet others’ needs or avoid disappointing others. Over time, neglecting their own desires and sacrificing personal boundaries can deepen feelings of inadequacy, unworthiness, or invisibility. 

Depression

Neglecting personal needs in favor of others’ needs can leave people-pleasers feeling unfulfilled and unseen, contributing to depression. Many internalize feelings of guilt or failure when they cannot meet everyone’s expectations, or they may feel trapped in a cycle of giving without receiving the validation or appreciation they long for. This can lead to feelings of emptiness, hopelessness, and disconnection. 

Perfectionism

People-pleasers often struggle with perfectionism, where they set unrealistically high standards for themselves in their efforts to satisfy others or avoid criticism. This constant drive for flawlessness can lead to emotional exhaustion, self-criticism, and difficulty coping with even minor mistakes, which they may perceive as failures. 

Obsessive-Compulsive Personality Disorder (OCPD)

In some cases, people-pleasers may develop traits of obsessive-compulsive personality disorder. This includes an overwhelming need for control, rigid adherence to routines, or perfectionistic tendencies that align with their desire to avoid mistakes and maintain harmony in relationships. This pattern often stems from a deep fear of disappointing others or losing approval. 

Codependency and Relationship Issues

People-pleasers frequently struggle with codependency, where their sense of self becomes intertwined with their ability to care for or please others. This dynamic can lead to unbalanced relationships, difficulty setting boundaries, and a susceptibility to emotional burnout or manipulation. These patterns often leave people feeling depleted and underappreciated. 

Post-Traumatic Stress Disorder (PTSD) or Complex PTSD (C-PTSD)

For some, people-pleasing behaviors are rooted in trauma. Individuals who grew up in environments where their needs were dismissed or punished may develop hyper-vigilance and people-pleasing tendencies as a survival mechanism. These behaviors persist into adulthood as a response to unresolved fear or conflict, creating difficulty with self-advocacy and boundary setting. 

The Origins of People-Pleasing 

Family Dynamics 

Many people-pleasers grow up in family environments where love or approval was conditional. If caregivers only validated them when they were obedient, accommodating, or high-achieving, they may have learned that their worth depends on meeting others’ expectations. Alternatively, children in chaotic or neglectful households may develop people-pleasing behaviors as a way to maintain harmony or avoid conflict, making it a survival strategy that becomes deeply ingrained. 

Cultural Influences 

Cultural expectations often reinforce people-pleasing tendencies, particularly in societies that emphasize collectivism or traditional gender roles. For instance, women may be socialized to prioritize nurturing and self-sacrifice, while certain cultural backgrounds may emphasize family or community needs over individual desires. These influences often create internalized beliefs that prioritizing oneself is selfish or unacceptable. 

Childhood Experiences 

Childhood trauma, including emotional neglect, abuse, or witnessing conflict, is a common precursor to people-pleasing. Children in these environments may internalize the belief that they must earn love or avoid anger to feel safe or valued. Over time, these survival strategies evolve into patterns of behavior that influence how they relate to others well into adulthood. 

Breaking Free from People-Pleasing 

While people-pleasing can lead to a variety of mental health challenges, it is possible to unlearn these patterns and develop healthier relationships with oneself and others. Therapy can help individuals identify the root causes of their tendencies, build assertiveness skills, overcome self-sabotaging techniques, and practice setting boundaries without guilt. Addressing underlying trauma, reshaping beliefs about self-worth, and learning to tolerate discomfort in relationships are key steps in breaking free from these behaviors. 

The journey toward change may not be easy at first, but it is deeply rewarding. People-pleasers can learn to reclaim their voice, prioritize their own needs, and build lives that reflect their true values and desires. With the right support, they can embrace a more balanced and fulfilling way of relating to themselves and others. The point of improvement is not to care more about the self than others, but it is to develop an equal sense of worthiness to the basic components of life and connection. Once someone feels equally worthy of love, respect, validation, support, and success, they will be able to engage with others more authentically and effortlessly which will not only reduce symptoms of anxiety, but it will also result in relationships and opportunities that flourish. 

The appropriate level of eating disorder care depends on a patient’s ability to consume and retain proper nutrition. A qualifying criterion to enter a residential treatment center is that they are unable to maintain the necessary nutrition intake required for their physical and psychological health. A second criterion is that they have difficulty maintaining reasonable nutrition consumption for themselves while living at home, even while receiving care in a partial hospital program or intensive outpatient program.  

Residential treatment provides necessary, 24-hour support for the patient with a multidisciplinary team who will help interrupt the personal battles patients experience to balance their nutrition intake. Over time, the patient can regain personal intake management, develop their independence and confidence in eating, and transition to a lower level of care.  

Nutrition rehabilitation interventions hold a vitally important role in the residential level of care during eating disorder treatment. As each patient works towards recovery, they achieve the best results with hands-on food experiences that engage all their senses, including seeing, smelling, touching, and tasting. Living vibrantly with food encompasses being able to hold conversations about food and cooking as well.  

With these thoughts in mind, Hidden River developed a unique and customizable nutrition and culinary skills training program for their patients.  

Research supports this approach: A narrative review from 2018 found that culinary skills programs ultimately boost young people’s healthy eating behaviors (1). Let’s take a closer look at the main tenets program. 

Nutrition Evaluation  

To start, each patient participates in an in-depth nutrition evaluation by a Registered Dietitian. The assessment reveals the patient’s current and historical relationship with food. The assessment reviews the patients’ beliefs about the various categories of foods, food habits, food-related social activities, and their process of eating in a variety of social settings.  

Many patients have misconceptions about foods and food products that contribute to their disordered eating. When the Registered Dietitian and patient review the assessment results, they identify key issues to address and reasonable goals to achieve over the course of treatment to receive the most benefit. The highest goals may include nutrition education, enhancing their food selection, broadening their palate, and establishing a realistic home-based meal plan menu.   

Culinary Knowledge Evaluation 

At admission, the patient participates in an interview about their culinary knowledge, food preparation experience, and cooking skills. The patient will be given several unique quizzes to obtain their baseline of culinary knowledge. The assessment and interview approach reveals their level of culinary comfort on the Likert Scale. The unique quizzes assess the patient’s current knowledge surrounding grocery shopping, meal planning, food preparation, safe food storage, and the use of basic kitchen appliances and utensils. The food preparation skills assessed include spicing, baking, boiling, basting, frying, roasting, and the use of sharps. Additionally, they consider a patient’s understanding of kitchen safety, techniques, cleaning tips, and more. 

When the RD and patient review the assessment results, they identify where the patient will benefit most from the culinary skills training program. All patients will be guided through the standard features of the program that include establishing a realistic home-based meal plan menu, grocery shopping, developing kitchen safety knowledge and skills, and possibly even preparing a meal or snack on their home-based meal plan. Additional education and skills training will be added to the patient’s treatment experience based upon their unique needs in preparation of establishing their aftercare plan.    

The culinary evaluation also determines the steps needed to accomplish the established goals. Some patients lack adequate culinary skills and benefit from receiving basic education and training. Other patients are well-versed with culinary skills and benefit from taking on the challenges related to fearful foods, uncomfortable textures, tastes, or smells. The Registered Dietitian supports the patient to begin the culinary skills training program from a safe emotional and psychological position.  

Individualized Meal Plans 

Based on the results of the nutrition assessment, the patient and Registered Dietitian collaborate to create a customized daily meal plan that focuses on resolving fear, increasing confidence, and supporting their medical nutrition needs. The daily meals and snacks are prepared by in-house chefs with fresh ingredients. The patient will fill out a weekly menu for each meal that offers a main course and an alternative. The foods consumed are monitored to ensure the patient ingests the adequate energy intake their body requires. 

Nutrition Education 

Each patient participates in daily supported meals and snacks and weekly nutrition education lectures. Throughout the treatment, patients tackle personalized food challenges to resolve distorted thought patterns, irrational fear, and self-destructive behavioral patterns. Nutrition education provides science-based information on nutrition, micro-nutrients, digestive processes, and how the body uses the nutrition it receives. Education is designed to address food and body misconceptions through accurate information of food and body science. 

Nutrition Programming 

Each week the patient’s schedule includes many food exposure episodes as the key feature of the program. In addition, they will participate in one individual nutrition counseling session per week, one nutrition education group, and a culinary skills training event. 

Exposure Response Prevention Therapy 

Exposure Response Prevention (ERP) therapy focuses on helping individuals improve their distress tolerance skills as they face their fears. Eating disorder recovery is particularly challenging because patients are frequently confronted by triggers — in the kitchen, at the dining table, in the grocery store, and so on. During their time in residential treatment, it’s imperative that the patient’s practice skills enable them to handle these diverse events by enhancing their situational awareness, arresting impulsive actions, implementing effective responses, and boosting their confidence.  

The ERP program works by identifying their resilience strengths as well as personal vulnerabilities promoting a range of emotional distress that activates eating disorder behavior. The Registered Dietitian and patient identify the patient’s mild, moderate to severe emotional distress reactions from a multitude of nutrition and culinary experiences reviewed. The ERP program is categorically arranged to strengthen the patient’s ability to successfully manage events that create a moderate distressful emotional response with the goal of reducing the emotional response to the mild range.  

Once this goal is achieved, a subject higher on the moderate to severe scale of distress may become the area of focus. The Registered Dietitian and patient keep in mind that practicing distress tolerance skills during the ERP sessions is the primary skill to realizing a successful outcome. Ultimately, the patient is guided to address forthrightly many distressful facets of their life that hinder their ability to consume their daily nutrition requirements. When the patient returns home to resume an improved quality of living, it is important that they have the knowledge with the forethought of applying effective distress tolerance skills to enact healthy eating behavior. 

Hidden River’s program is in part developed from current research which suggests that culinary skills training programs are especially effective when combined with ERP therapy. Specifically, one study revealed that, based on the shared symptoms of anxiety and anorexia nervosa, ERP is an appropriate treatment approach to avoid relapse of eating disorders (2).  

The most common hope is that the nutrition and culinary skills program assists patients in healing their relationships with food.  

Each individual experiences an emotional connection to food, tying specific memories to the meals. Family relationships and vibrant social events often include meals. In that sense, food is so much more than nutrition. Food is part and partial to the celebration of relationships with family and friends. Cultural traditions as well are ripe with the inclusion of food to highlight one’s heritage, express appreciation, and show love. Ultimately, when a patient begins to rediscover food as part of a joyful life, they can rest assured that the path to healing is possible. 

References 

1. Muzaffar, H., Metcalfe, J.J., Fiese, B. (2018). Narrative Review of Culinary Interventions with Children in Schools to Promote Healthy Eating: Directions for Future Research and Practice. Current Developments in Nutrition, 2(6). 

1. Steinglass, J.E., Sysko, R., Glasofer, D., Albano, A.M., Simpson, B., Walsh, T. (2011). Rationale for the application of exposure and response prevention to the treatment of anorexia nervosa. International Journal of Eating Disorders, 44(2). 

Eating disorders, the most lethal of all the mental health disorders, kill and maim 6 to 13% of their victims, 87% of whom are children under the age of 20. “Best practice” treatment strategies for patients with anorexia nervosa, bulimia nervosa, and binge eating disorder all too frequently fall short of achieving timely and sustainable recovery outcomes. Beyond eating lifestyle dysfunction, eating disorders represent impairment of the patient’s Self, as seen in the loss of self-trust, self-control, self-regulation, self-care, and emotional resiliency, so necessary in coping with adversity and engaging in confidence-building life opportunities.

The development and recovery of the re-integrated Self in eating disorder treatment is best facilitated through the mindful and versatile use of the therapist’s self within a quality therapeutic relationship, the inclusion of parents and families in the treatment process where appropriate, and an appreciation of the fact that within the context of clinical treatment, healing changes in the patient’s behaviors and attitudes represent healing changes in the patient’s brain.

Eating Disorders and the Loss of Self

From infancy to adulthood, self-development occurs primarily within the context of human relationships, be they personal, familial, or professional. The loss of the connection with the eating disordered individual’s authentic Self becomes apparent cognitively, emotionally, physiologically, neurologically, and socially, typically rendering victims resistant to accepting diagnosis and engaging in treatment. Losses of connection can be seen in:

• A lack of neurobiological connectivity within brain domains and within the distributed connections between the cranial-based self and the embodied-self.
• The loss of the patient’s healthy relationship with food.
• The loss of connection to significant others due to social withdrawal.
• Attachment dysfunctions in eating disordered individuals, which often exacerbate challenges in treatment engagement and continuity of care.
• Experiencing disconnection from feelings and sensation; eating disordered individuals may not recognize eating disorder symptoms as signs of dysfunction, denying the existence of a problem.
• Withdrawal from significant others that may result in parents speaking of their eating disordered children as “strangers.” Where weight and behaviors typically reside on the continuum of normal, eating disorders ironically surface all too rarely in physician’s offices during medical examinations and in laboratory tests. Nondisclosure of dysfunctional behaviors is typical in psychotherapy offices as well, in light of the patient’s fear of stigma, rejection, or having to face the reality of the need to recover.

Self re-integration, a pivotal predictor in the achievement of positive mental health (Siegel, 2006) and a benchmark of full eating disorder recovery, becomes enhanced by treatment modalities that facilitate connections between people, mind-brain-and-body systems, and brain domains.

Because eating disorders are principally disorders of connection, the healing energy within the success of any treatment methodology occurs within the context of the therapeutic relationship.

Parents and Families As Recovery Advocates

Eating disorders insinuate themselves into relationships between family members. As family system disorders, eating disorders show up everywhere within the context of daily living, side by side with significant others, at kitchen tables, in restaurants, in family bathrooms, at school, and in places of employment. Though generally not responsible for causing eating disorders, which originate in genetic and temperament susceptibilities, parents who participate in their child’s treatment and engage in psychoeducation enjoy the potential to promote disease prevention and/or recovery. Becoming knowledgeable about eating disorders, the complex nature of their treatment and recovery, and their own role in their child’s recovery (particularly when the child remains in outpatient care while residing at home), parents can become ‘most valuable players’ in their child’s treatment team.

Recovering patients, faced with the demands and challenges of eating healthfully throughout each day, average no more than 50 minutes per week in face-to-face contact with helping professionals. Educated parents can become helpful in filling this void. With the understanding that the nature of parental support offered will need to change to align with their child’s changing needs as they progress, family participation in therapy gives both patient and family a voice, and an ear, in expressing and listening to feelings and in resolving conflicts and problems. By reconnecting with their child and learning how to understand, coach, and support their loved one, parents enhance their child’s emotional development and self-care.

The bonding and trust that develops in family treatment greases the path for the patient’s eventual separation and individuation, increasing the child’s capacity for autonomy and healthy self-regulation. Family sessions also diminish the potential for manipulative “splitting” and/or confidentiality breaches that could otherwise jeopardize a multi-disciplinary team treatment process. If not part of the solution, family members risk becoming part of the problem.

The Patient/Therapist Relationship in Research

Because eating disorders are principally disorders of connection, the healing energy within the success of any treatment methodology occurs within the context of the therapeutic relationship. The trust that develops between therapist and patient within the treatment process ultimately re-ignites the patient’s trusting reconnection within their own exiled Self. The mindful therapeutic relationship ideally becomes the prototype for other healthful, quality relationships elsewhere in the patient’s life outside of the treatment system. Dr. Christopher Germer, in Mindfulness and Psychotherapy (Germer, 2005), considers mindfulness in therapeutic practice to be the pathway to establishing a healthy, healing treatment relationship. He speaks of the therapeutic relationship as “an intervention in itself” with empathy accounting for “as much, and probably more outcome variance than does the specific intervention.” He describes good therapeutic relationships as “the most potent of all the treatment interventions for healing within a mental health venue,” (Germer) providing the pathway out of an eating disorder.

According to Dr. Allan Schore, it is through the quality of the human relationship that “deficits in internal working models of the self and the world are gradually repaired” (Schore, 1996). Schore describes a phenomenon that exists between therapist and patient called “empathic resonance” (Schore & Schore, 2008), “which results in the patient’s right brain hemisphere becoming neurophysiologically altered in form and function in response to a mindful, quality connection to the functioning of the therapist’s right brain hemisphere. Right-brain to right-brain human attachments through mindful psychotherapeutic connectedness often result in the patient feeling ‘felt,’ creating a state of neural activation with coherence in the moment that has been shown to improve the patient’s capacity for self regulation” (Siegel, 2006).

A quality patient-therapist connection lays the foundation for the patient’s development of the Self, in addition to the foundation of a complete and lasting eating disorder recovery.

References:

1. Germer, C. K., Siegel, R .D., & Fulton, P. R. (2005). Mindfulness and psychotherapy. New York, NY: Guilford Press.
2. National Eating Disorder Association. (n.d.). Retrieved from https://www.nationaleatingdisorders.org
3. Schore, J. R. & Schore, A. N. (2008). Modern attachment theory: The central role of affect regulation in development and treatment. Clinical Social Work Journal, 36(1), 9-20. doi: http://dx.doi.org/10.1007/s10615-007-0111-7
4. Siegel, D. J. (2006). An interpersonal neurobiology approach to psychotherapy; Awareness, mirror neurons, and neural plasticity in the development of well-being. Psychiatric Annals, 36(4), 248-256. Retrieved from https://www.researchgate.net/publication/241200655_An_Interpersonal_Neurobiology_Approach_to_Psychotherapy_Awareness_Mirror_Neurons_and_Neural_Plasticity_in_the_Development_of_Well-Being

For many of us, stress is a fundamental part of life. Perhaps we tend to overextend ourselves with work, social commitments, and our personal lives. Or maybe we never turn off our many devices, which can prevent us from being able to simply relax and enjoy each moment. As a result of this overstimulation, we often end up seeking out ways to self-soothe.

Food can be a source of comfort for many people. And while emotional eating can help us feel good in the moment, it can often have negative effects over time.

How can we know if we have an unhealthy relationship with food? Signs that indicate emotional eating may be having a negative impact can include:

• Craving certain kinds of food. When we eat to comfort ourselves, the types of foods we choose are usually those that are the worst for us. People don’t often reach for nutritious foods like broccoli or spinach when trying to feel better. We are instead usually drawn to greasy, fried foods or sweet treats. These foods may make us feel better at first, but they do not provide us with any real nutritional value. What’s more, if we consistently choose them, we will be more likely to crave them when stressed. This can contribute to an unhealthy cycle.
• Eating more than we should. When we eat for emotional reasons rather than to satisfy our hunger, we are more likely to miss the cues the body gives us when we’re full. Many people try to “fill” an inner sense of emptiness or numb out uncomfortable emotions through mindless eating. But this can frequently lead to overindulgence, as the food never truly fulfills the need we’re trying to meet. [fat_widget_right]
• Weight gain and health issues. Frequent overeating and choosing foods that have little nutritional value can lead to weight gain and medical issues, such as diabetes, high cholesterol levels, and heart problems, among others.
• Yo-yo dieting and/or eating disorders. When people gain weight as a result of eating to self-soothe, they may then be more likely to go diet frequently or skip meals in order to lose weight. Others may start an unhealthy cycle of bingeing and purging in an attempt to avoid putting on weight. Both of these patterns can be extremely harmful to the body.
• Low self-esteem. When we feel unable to cope with stress in ways that support physical and emotional well-being, emotional eating can negatively impact the way we view ourselves and our bodies. This added challenge can make the stress we are trying to cope with even more difficult to effectively address.

You don’t have to change all of your eating habits overnight. It’s often easier to begin by making small changes.

If you believe you might have an unhealthy relationship with food, you may find it helpful to try some of the following techniques:

• Practice mindful eating. Being more aware of our eating habits can help us begin to eat healthier. If we eat in front of the computer or while watching TV or texting, we pay less attention to what we are doing and may end up eating more than we intend. By sitting down at a table and removing all distractions, we can begin to eat more mindfully. By truly tuning in to our bodies, we are better able to notice when we start to feel full.
• Find more effective ways to deal with stress. It may be difficult, if not impossible, to remove all of your stress from your life. But you can help reduce its effects by choosing activities that help decrease stress levels. You might find it helpful to go out for a walk, practice yoga, meditate, or garden, for example. Other options include doing hobbies you enjoy, listening to calming music, spending time in nature, and practicing relaxation exercises.
• Take small steps to start to eat healthier. You don’t have to change all of your eating habits overnight. It’s often easier to begin by making small changes. Try bringing more nutritious snacks to work, cutting back on processed and fast foods, eliminating or reducing your soda intake, and including more fruits and vegetables in your diet.
• Seek help from a trained professional. If you feel as though you are struggling to control your eating habits or if you believe you may be struggling with an eating disorder, you may find it helpful to contact a therapist experienced in working with eating and food issues. The support of a compassionate therapist or counselor can help you take steps to get back on track.

If you believe your relationship with food has become unhealthy or you find yourself struggling to manage your eating habits, you may find some of the suggestions above to be helpful. Exploring them on your own, or with the help of a qualified professional, can be beneficial as you work to develop healthier eating habits.

Making one small change at a time can help you deal with stress in more effective and productive ways, and eating to self-soothe may become less of a habit as a result. Being able to eat better is not only likely to help us feel better physically, but can also lead to improvements in how we feel about ourselves!

Reference:
Smith, M., Segal, J., & Segal, R. (2018). Emotional eating: How to recognize and stop emotional and stress eating. Retrieved from https://www.helpguide.org/articles/diets/emotional-eating.htm

Adolescence is well known to be a challenging time. Much has been written about the difficulties of early adolescence, especially as it relates to the development of girls. Dr. Mary Pipher’s 2005 book, Reviving Ophelia: Saving the Selves of Adolescent Girls, written from her years of experience working with young women in therapy, is an exploration of her discovery that the process of developing into women is painful for many girls. Development in young women, she found, often involves the loss of self, which happens as girls internalize the pressure to be in service to others by becoming what other people seem to expect of them. In this way, they are fulfilling the desires of others. These pressures can manifest in many ways. The onset of negative body image or eating disorders are just two examples.

In my practice I have seen this loss of identity myself, in people who have struggled for years with disordered eating and poor body image. Many young women make an effort to control and hide their emotions by over-focusing on the body, hoping to earn back a sense of stability by attaining a certain ideal. But when attempts of trying to cope with difficult feelings and social pressures are externally focused, girls can end up losing who they are in the struggle.

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Rather than determining on their own who they are and how they want to navigate adulthood, many girls don’t know how they feel about anything, independent of the opinions of others. They cannot identify their likes or dislikes, and they no longer know what they stand for anymore. Sometimes they are unable to determine whether they are angry, bored, or hungry. They talk about feeling lost. I have found that the more time girls have spent fixated on the body and the way they look, the more work they often have to do to reclaim their sense of self.

Recently, researchers have been studying how social media affects the development of young women today. Consumption of social media can contribute to poor body image. One study found an overwhelming majority of girls had both home internet access and social media accounts. The time they spent online “significantly related” to unhealthy body monitoring and the internalization of the thin ideal. Further, the girls who used Facebook scored higher on all body image concern measures than those who did not use Facebook (Tiggermann &  Slater, 2013).

In another study, girls who had positive body images tended to be critical of the body ideals presented to them on social media and had a more complex and personal view of beauty. The authors discussed the importance of teaching media literacy and feminist theory to create more resilience in young women faced with societal pressure to achieve and maintain a certain type of body or appearance.

Helping Young Women Develop Strong Selves

We often cannot prevent the young women in our lives from being exposed to pressures such as the thin ideal, but we can protect them. Specifically, we can help girls increase their resilience by encouraging the growth and sustenance of a strong sense of self.

• Open discussion of the ways society pressures girls to please others and conform to certain standards of beauty can help them understand how and why these standards are flawed. Talk openly at home with young teens about their social experiences. Do they feel pressured to fit in by conforming to the expectations of others? Encourage them to question how they can grow their strongest sense of internal self if they focus on external aspects.
• Avoid focusing on body size or shape. Encourage them to give time and attention to interests that are not about the body or appearance. Encourage nutritious food choices and physical activity in addition to other healthy habits, but avoid “diet talk” and discussion of size or weight (your own as well as theirs—if you disparage your own body, your child is likely to absorb this language and behavior). Speak of food in terms of the energy it provides and how it fuels the body, not in terms of how it affects size.
• Encourage them to critically reflect on gender role expectations, especially with regard to their bodies. Is their body for strength, movement, their own enjoyment—or is it there for the pleasure of others? Does it matter to them what others think of their body? If so, why? What do they personally see as an ideal body? Where did they get that idea from?
• Encourage them to think critically about the ideas they encounter. If they show you a photo of a friend on Facebook and comment on the person’s appearance, or compare their own, take the opportunity to discuss their thoughts (without criticizing them). Ask why they feel the way they do. Ask how the images they see online make them feel. You might share how how social comparison in general makes you feel, and ask how it makes them feel.
• Allow for a full range of expressed emotion. We learn about boundaries and self-regulation through expression. Allow your children to (safely) be happy, sad, angry, excited, or anything else. Encourage them to explore healthy coping methods for difficult emotions, and help them learn to practice self-regulation so they do not feel the need to conceal, suppress, or escape their feelings.
• Be a good role model for emotional self-acceptance and self-care. Showing your own acceptance of and love for all aspects of your body is one of the most effective ways to help your children learn to love and accept their own bodies. Devote regular time to self-care, and encourage your child to do the same.

If you are unsure of how to begin exploring any of the above issues with your child, the support of a compassionate, qualified therapist or counselor may be of benefit. You might also consider seeking professional help if you struggle with your own emotions or sense of self or if your daughter is preoccupied with her weight or body and these conversations do not seem to helping.

We recognize the many challenges of adolescence, especially those related to body image and social pressures, are not specific to girls and young women. While this article focuses on the experience of young women, individuals of any gender may experience body image issues and disordered eating. If you (or your child) are struggling, we encourage you to seek support from a counselor. Help is available for all. 

References:

1. Pipher, M. (2005). Reviving Ophelia: Saving the selves of adolescent girls. New York, NY: Riverhead Books.
2. Holmqvist, K., & Frisén, A. (2012). “I bet they aren’t that perfect in reality:” Appearance ideals viewed from the perspective of adolescents with a positive body image. Body Image, 9(3), 388-395. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22542634
3. Santa Cruz, J. (2014, March 10). Body image pressure increasingly affects boys. The Atlantic. Retrieved from https://www.theatlantic.com/health/archive/2014/03/body-image-pressure-increasingly-affects-boys/283897
4. Tiggermann, M., & Slater, A. (2013). NetGirls: The internet, Facebook, and body image concern in adolescent girls. International Journal of Eating Disorders, 46(6). 630-633. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23712456

Food is an important element of every culture; the less of it available, the more important the meaning surrounding it. From holiday and traditional celebrations to the ritual of Sunday dinners, almost everyone has memories—happy, comforting memories—tied to food. So it is no surprise that people who are experiencing difficulties sometimes turn to food to try to evoke pleasant feelings.

Everyone is familiar with the idea of self-soothing through food. Eating a pint (or more!) of ice cream after a romantic breakup is a cliché. A cup of tea and a biscuit is an equally iconic response to an upset in English culture. However, this usually harmless form of self-soothing can become a problem for people with serious and persistent emotional challenges such as those occurring as the result of posttraumatic stress (PTSD). These problematic reactions may include:

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• Binge eating
• Anorexia
• Bulimia

What Is Posttraumatic Stress?

Briefly stated, PTSD is the result of experiencing a “shocking, scary, or dangerous event” (Post-Traumatic Stress Disorder, 2016). While not everyone will develop persistent symptoms as the result of such events, some people will go on to feel afraid or anxious even though they are no longer in danger. Symptoms may include flashbacks (intrusive memories), nightmares, avoiding places or things which trigger bad memories, being easily startled, or having difficulty sleeping. Sometimes symptoms don’t appear until months or even years after the experience.

Binge Eating

According to Dr. Cynthia Bulik, an expert on eating disorders at the University of North Carolina, “Binge eating is not just a lot of overeating … there’s this sense of loss of control. You start eating and you feel like you just can’t stop” (When Food Consumes You, 2017). This is the most common eating disorder in the United States. People with this condition eat past the point where they are full; they often feel compelled to go on eating. This may lead to obesity and the problems that come with it.

What is the link between the two? Most of the time, the trauma comes first and binge eating later (Brody, 2017). Research shows both PTSD and binge eating are related to production of stress hormones and mood-boosting brain chemicals. About one in four people who binge eat is believed to have PTSD; about 35% of women with a binge eating disorder have been sexually assaulted. PTSD and binge eating are linked in the body.

Bulimia

Sometimes, people who have indulged in binge eating will follow with an attempt to rid themselves of the excess calories. This may be done through self-induced vomiting; the use of laxatives to help food pass quickly through the body; prolonged exercise; or, paradoxically, periods of fasting. People with this condition (known medically as bulimia nervosa) may be able to maintain a normal weight because of their efforts to counteract the high caloric intake of an eating event. However, the cycle of overeating and purging may cause other health issues, including problems with the digestive system or heart irregularities, along with problems from a poorly balanced diet.

One study found about 25% of women with this condition have PTSD. (Blinder, et al., 2006), In a study of women in a residential treatment program for eating disorders, almost three-quarters had experienced significant trauma, and more than half reported symptoms typical of PTSD (Brewerton, 2008).

Anorexia

The least common eating disorder, but potentially the most deadly, is known as anorexia nervosa medically. People who have this condition typically think of themselves as overweight, leading to chronic under-nutrition. People literally starve themselves to death, thinking the whole time that they are obese. People with anorexia are six times more likely to die prematurely than members of the general population (DeNoon, 2011). People who are diagnosed with anorexia in their 20s are 18 times more likely to die prematurely.

Exactly what causes eating disorders may well be a mix of several factors: genes and family history are considered possible factors, along with environment and culture.

Causes and Treatment Options

Exactly what causes eating disorders may well be a mix of several factors: genes and family history are considered possible factors, along with environment and culture. Physical and emotional health, particularly PTSD, are additional factors which may offer opportunities to influence the course of this condition (When Food Consumes You, 2017). Early diagnosis and treatment are critical.

The Substance Abuse and Mental Health Services Administration (SAMHSA) recognizes five evidence-based treatments for PTSD: cognitive behavioral therapy (CBT), cognitive processing therapy (CPT), prolonged exposure therapy (PET), eye movement desensitization and reprocessing (EMDR), and accelerated resolution therapy (ART). However, prolonged exposure therapy may increase the risk of binging at least temporarily (Brody, 2015).

Recent research has suggested that accelerated resolution therapy may be most effective. Walden Behavioral Care, which specializes in treating people with eating disorders, psychiatric conditions, and other comorbid issues, conducted an informal study for purposes of self-improvement. The study, which included 28 people, showed a significant reduction in self-reported levels of stress following treatment with ART. Before intervention, participants reported a mean level of distress of 7.62 (out of 10); after treatment, the level had dropped to 3.16, a reduction of more than half.

For help with problematic eating patterns, contact a therapist.

References:

1. Blinder B. J., Cumella E. J., & Sanathara V. A. (2006). Psychiatric comorbidities of female inpatients with eating disorders. Psychosomatic Medicine, 68, 454-462.
2. Brewerton, T. D. (2008, May 8). The Links Between PTSD and eating disorders. Psychiatric Times, 25(6). Retrieved from http://www.psychiatrictimes.com/articles/links-between-ptsd-and-eating-disorders
3. Brody, B. (2015, January 24). The link between trauma and binge eating. Retrieved from https://www.webmd.com/mental-health/eating-disorders/binge-eating-disorder/features/ptsd-binge-eating#1
4. DeNoon, D. J. (2011, July 12). Deadliest psychiatric disorder: Anorexia. Retrieved from https://www.webmd.com/mental-health/eating-disorders/anorexia-nervosa/news/20110711/deadliest-psychiatric-disorder-anorexia
5. Post-traumatic stress disorder. (n.d.). Retrieved from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
6. Walden Behavioral Care reports aggregate quality assessment information on patients treated with ART. (n.d.). Retrieved from http://acceleratedresolutiontherapy.com/walden-behavioral-care-pilot-study-art/
7. When food consumes you. (2017). Retrieved from https://newsinhealth.nih.gov/2017/11/when-food-consumes-you