Addressing Low Self-Esteem in Adolescents with Eating Disorders

This article aims to provide background and theory supporting the use of a problem-solving, emotion regulation, and self-esteem module for children and adolescents with eating disorders. Eating disorders typically present in adolescence, and low self-esteem and perfectionism are hallmark features of eating disorder pathology. We will examine how low self-esteem and perfectionism interact and serve as risk factors as well as maintaining factors in eating disorders. Both features have distinctly been show to predict poor treatment response in eating disorders, as well as in depression and in certain anxiety disorders. We will review the limited existing models for treating low self-esteem and perfectionism in adults with eating disorders and potential problems of using these models with younger patients. Finally, we present a pilot intervention designed to be integrated into primary eating disorder treatments for patients where low self-esteem, mood intolerance, and problem-solving deficits may present difficulties with eating disorder treatment implementation or risk for relapse. This intervention is based on principles from established treatments, including Christopher Fairburn's cognitive behavioral therapy enhanced for eating disorders, Marsha Linehan's dialectic behavior therapy, Melanie Fennell's and Leslie Sokol's guides to overcoming low self-esteem, Aaron and Judith Beck's cognitive behavioral therapy, and anxiety and phobia treatments for children. We have used this 4 to 6 session interactive module in multi-family groups, family and individual sessions. We believe this will be an important intervention in the treatment of adolescents with eating disorders, and that it merits further study