The prevalence of eating disorders in the U.S. has increased over the past several decades. Only 30-50% of those who receive treatment recover and 1/3 of them will relapse. Although there are many treatment foci, boosting self-esteem is often a key component to treatment. However, evidence suggests that there are negative effects of pursuing self-esteem and increased self-focus, particularly for individuals with eating disorders. We propose that in contrast to increasing self-focus, having individuals with eating disorder symptoms focus on others and aspects outside the self may actually be more beneficial. In two studies we examined the effects of having self-image goals, goals that are focused on protecting and inflating desired self-images, and having compassionate goals, goals that are focused on supporting others and contributing to something outside the self, on eating disorder symptoms. We hypothesized that self-image goals would be associated with increased and compassionate goals associated with decreased eating disorder symptoms.
Study one was a 12-week study with 122 females in their first semester of college. We measured goals and eating disorder symptoms at pretest, posttest, and weekly over the semester. Study two was a 6-week clinical study with 53 adults seeking treatment from a local mental health clinic. We measured goals and eating disorder symptoms at pretest (before entering treatment), posttest and for 10 consecutive days 3 weeks into the study.
In study one we found that self-image goals were positively associated with eating disorder symptoms at pretest and posttest (e.g., bulimia β=.26, p<.05, β=.22, p<.05, respectively). However, self-image goals did not predict increases in eating disorder symptoms from pretest to posttest. Compassionate goals were negatively associated with eating disorder symptoms at pretest and posttest and predicted decreases in eating disorder symptoms from pretest to posttest (e.g., body dissatisfaction β=-.16, p<.05). Furthermore, weekly fluctuations in self-image goals were related to weekly fluctuations in disordered eating behaviors. On weeks females were higher in self-image goals they were more likely to participate in disordered eating behaviors.
In study two we partially replicated findings from study one. Self-image goals were positively associated with eating disorder symptoms at pretest and posttest (e.g., bulimia β=.26, p=.05, β=.32, p<.05) and compassionate goals were negatively associated with eating disorder symptoms at pretest (e.g., drive for thinness β=-.29, p<.05). Although goals did not predict changes in symptoms from pretest to posttest, daily fluctuations in self-image goals were related to daily fluctuations in eating disorder symptoms. On days when participants were higher in self-image goals they were higher in eating disorder symptoms.
Conclusions and Implications
Overall, these results support that self-focused attention may be a risk factor for eating disorders. Our findings suggest that being more focused on things outside the self (i.e., having compassionate goals) may serve as a protective factor and this may have implications for the treatment of eating disorders. Goals are often more malleable than behaviors and helping clients shift from self-image to compassionate goals may prove to be a useful intervention for eating disorders.