The Grateful Paradox


As some of you who are familiar with my work are aware, I believe eating disorders are caused when the needs of the self are unmet. These unmet needs arise when one’s system of need satisfaction breaks down, becomes imbalanced, or otherwise misoperates. In order to lend support to this theory, I would like to take a look at the role that gratitude plays in eating disorders.
Last year I read an article written by Vartaniant, et al. (2014) entitled “Early Adversity, Personal Resources, Body Dissatisfaction and Disordered Eating”. When participants with eating disorders completed the Gratitude Questionnaire, which measures the degree to which one is grateful for a variety of life’s aspects, there emerged a negative correlation between scores on the gratitude questionnaire and body image–as gratitude increased, body image worsened. This finding was unexpected, as the authors assumed that gratitude would decrease eating disorder severity and negative body image.
Gratitude is an emotion that one has in response to receiving help and nurturing (McCullough, et al., 2001). Therefore, it stands to reason that gratitude would be positively correlated with the amount of help one receives–the more others care for you, the more gratitude you feel (Komter, 2004). The fact that there was an inverse relationship between gratitude and body image might seem to fly in the face of my need-fulfillment theory. However, in psychology, paradoxes abound, and perhaps there is a more complex relationship between gratitude and social nurturing. I believe people with eating disorders may experience gratitude such that the feeling sometimes impairs their ability to receive nurturing from others.  If one believes that “others have already done so much for me, I ask for too much, I should be satisfied with what I have already received, etc.” they might hesitate to express unfulfilled needs or accept additional acts of caring from other people. Over time, gratitude might lead to a restricting of a person’s ability to solicit and receive nurturing from those in the immediate social circle–a habit that will lead to unmet self needs, thereby worsening eating disorder pathology. With regard to body image, I believe there is a mediating variable of guilt. Guilt, in my observation, causes body image issues to worsen. I believe the more grateful one is to others, the more likely he or she is to also experience guilty feelings in that relationship, particularly if there continue to be unmet needs experienced in the dyad.
It is important to understand how variables such as gratitude, guilt, entitlement, obligation, and accountability are unique in the minds and interactions of people with eating disorders. What is a positive, bond-building strength for some individuals could function as an impediment to social intimacy and need fulfillment in a person who is predisposed toward certain brain-based emotional and cognitive traits. We should primarily understand how feelings, beliefs, behavioral patterns and roles all impact the degree to which a person meets his or her psychological needs, because these unmet needs often lead to unmet physical needs, which is the embodiment of an eating disorder. So often in this field, things are not as they seem upon first glance and if we are to meaningfully join with those we serve we must look beyond the obvious and explore the hidden paradoxes.

Komter, A. E. (2004). Gratitude and Gift Exchange. The psychology of gratitude, 195.

McCullough, M. E., Kilpatrick, S. D., Emmons, R. A., & Larson, D. B. (2001). Is gratitude a moral affect?. Psychological bulletin, 127(2), 249.

Vartaniant, L.R., Smuth, J.M., Zawadzki, M.J., Heron, K.E. & Coleman, S.R.M. (2014). Early Adversity, Personal Resources, Body Dissatisfaction and Disordered Eating. International Journal of Eating Disorders, 47 (6), 620-629.




6 thoughts on “The Grateful Paradox”

  1. Brett,
    Do you carry malpractice liability insurance? I ask because your ideas are so clearly inconsistent with the best-available scientific knowledge of how to treat anorexia nervosa that I’m afraid you might run into serious legal trouble if you implement your ideas in your clinical practice.

    1. Yes, all LMHCs in Washington state must carry liability insurance as part of a private practice. My theories are more effective than standard approaches and almost all of my clients (save 3 in the past 5 years) complete treatment and make a full recovery. It is incumbent upon counselors to use the best practices possible as part of our responsibility to care for our clients. My approach is the best that I have found and it is firmly rooted in extant theory, it takes a more full accounting of the various moving parts of eating disorders than existing approaches, it makes more intuitive sense to my clients and it enables them to invest in treatment more fully. I have thoroughly aware of the ethical ramifications of going against evidenced-based practices, but again, almost every ED journal you pick up states clearly that our existing approaches are falling short, we need new theories and treatments and that there is no agree-upon evidenced-based treatments for eating disorders.

      1. Most sufferers and their families, these days, are not willing to accept on face value the success rates claimed by treatment providers. If you want to be believed, therefore, you’ll need to give us better evidence than you have so far. For example, you would need to give us proof that the people you have treated have been evaluated by neutral third parties who have corroborated your claims. Otherwise, your assertions will continue to be viewed as driven by nothing more than marketing and self-interest.

        1. I agree with you completely, third party evaluation is needed with any new treatment and it is my intent and purpose to proliferate this new modality so that it can be tested objectively. I disagree of course about the self-interest part, it is through an interest in the well-being of people with eating disorders that I am creating new systems.

          1. Brett,
            If you are convinced that your treatments are so effective, and that you are not doing this for self-interest, are you willing to give parents a money-back guarantee? In other words, if, at any time, parents are not completely satisfied that your treatment has cured their child or teenager from anorexia nervosa, would you be willing to refund to the parents every dollar they paid you?

          2. No. I invest a huge amount of my time, energy and resources to run very small retreats. I am not in a position to provide a full refund of this service based on parent’s decision that they don’t want to pay for treatment after the fact. However, I am also certain that any other eating disorders treatment facility also does not offer a money back guarantee as that is very much outside of industry standard.

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