Tip # 97 Shame and Guilt

Guilt and shame often arise in nutrition counseling, so it’s useful to understand these feelings.

Humility is wisdom.
Shame is not. 

Thom Rutledge

Positive guilt occurs when we begin to
break rules that need to be broken.

Dede Beasley

Guilt is what a person feels when he believes he has done something wrong (or neglected to do something) and thereby harmed someone or violated a moral code. The focus is on the action. “I did something wrong/immoral/bad.” The person may experience remorse and feel the need to make up for it somehow. At times, guilt is based on an erroneous belief. Examples you may see:

  • A client who experiences guilt at having one bite of a cookie based on the belief that this will cause a blood sugar spike.
  • A client arrives for a session and says, “I was bad. I ate some foods not on your food plan.” The client has internalized a rigid standard around food. Then when she can’t adhere, she feels guilt. This guilt may even cause her to not keep a follow-up appointment.
  • Sometimes guilt over eating “bad” foods or eating too much may lead to a client’s  attempt to “punish” herself with unrealistic restricting or excessive exercising. This strategy for coping with feelings of guilt perpetuates eating problems.

In shame, the focus is on the self. “I am a bad/unworthy person.” Shame feels like intense embarrassment. Those experiencing shame look down, may blush and often have difficulty thinking clearly or speaking. It is experienced as a strong desire to disappear. Shame is a particularly intense emotion. Examples you may see:

  • A client has great difficulty telling you about a particular eating behavior such as purging. It may be hard to distinguish here between guilt and shame. Downcast eyes and focus on her self-worth and what you will think of her are clues it is shame.
  • Shame over excess weight or over a chronic condition such as diabetes may keep a person from engaging in life.
  • Clients who have difficulty eating in public are likely experiencing shame.
  • Many clients avoid weighing themselves because seeing the number causes them to feel shame.

Those who experienced childhood abuse or neglect generally experience more shame, and it is easily triggered.  This “false” or “toxic” shame results from chronic inaccurate and negative mirroring.

Over the centuries, shame campaigns have been used in an effort to control behavior. The “scarlet letter” in puritan times is one example. Today, TV shows, magazines, and comments by medical professionals, family members and even strangers can be shaming. They are often directed at body weight. The intention may be to change behavior. However, shame is not an effective motivator of behavior change. Shame leads to inaction, depression and a repeated drive to feel better, which may include turning to bingeing, restricting or other maladaptive behaviors. For some, guilt experienced over and over also contributes to depression.

What you can do to address guilt and shame:

  • Carefully tease out the beliefs about food and body that underlie the shame and/or guilt. When you encounter erroneous beliefs, provide a different perspective. Sometimes I refer to this part of my job as reality-checking. “Oh, so you assume you did something wrong when you chose to eat the french fries? Would you like my perspective based on research and other clients’ experiences?” (See Tip #59, A Format for Providing Advice.)
  • When you see signs of shame, pause. Then after a moment, gently get the client’s attention. This may be a good time to use the client’s name. When the client appears to have recovered from the shame, you may choose to offer a reframe. (See Tip #10, available in the Practice Workbook, Vol 1)
  • Some clients have difficulty talking about negative behaviors because they believe you will look down on them or find them disgusting. Theantidote to shame is contact. This means being “seen” and accepted as a worthy person in spite of certain behaviors. When a client shares embarrassing behaviors, it’s best to continue to look at the client. If she sees that you can look at her with positive regard, this helps heal the shame.
  • Take care when weighing clients. Carefully notice the response to the number and “reality-check” when necessary. Shifting to blind weighing helps some clients let go of a shame relationship with the scale.
  • Avoid using words that may shame such as “obese.” Many people with chronic conditions find it shaming when professionals refer to them as a “diabetic” rather than a “person with diabetes.” Some “you” statements induce shame or guilt, such as “You shouldn’t drink regular soda,” “You don’t get enough exercise,” or “You just shouldn’t go to buffets.” (Also see Tip #54, Watch Your Language.)
  • Avoid talking about “good” and “bad” foods. This sets up the client for guilt when invariably he does eat some of the “bad” foods. Many clients use this language themselves. You can educate them about the ineffectiveness of this manner of choosing foods.
  • Reframe guilt as regret. Shift from “I am bad because I ate cake” to “I regret having eaten the cake because my blood sugar was high afterwards and I care about my health.” This allows more room for choice next time.
  • Refer for psychotherapy when you see signs of depression (see Tip #41, in Practice Workbook, Vol. 2) or when you offer counter-beliefs to the client’s inaccurate guilt and/or shame-inducing beliefs and the client seems unable to absorb them. Clients who isolate themselves out of shame will likely need therapy to work through it and reenter life.

Shame and guilt are very uncomfortable and powerful feelings. Gain skill at recognizing and responding to them to serve clients well. This has been only a brief overview.  For more in-depth reading, I recommend:

  • Eating Problems, by Carol Bloom et al., 1994, HarperCollins, takes a more complex look at the interplay between shame, guilt and eating.
  • Cognitive Behavior Therapy and Eating Disorders, by Christopher G. Fairburn, 2008, Guilford, has practical approaches to addressing irrational beliefs.

A special thank you to Linda S. Ber, RD, LDN, CDE, who helped me tweak this Tip.

Posted in Tips