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Under the Hurt Umbrella: Shame and Body-Focused Repetitive Disorders

In my work with clients who deal with Body-Focused Repetitive Disorders (BFRDs) I have become convinced that in many individuals shame drives the behavior. BFRDs manifest in compulsive pulling of one’s hair (Trichotillomania), picking at skin and
scabs (Excoriation), cutting, carving, biting, and starving (Non-Suicidal Self-Injury NSSI). This shame results from an individual’s unrealistic(even grandiose) expectations of oneself. When expectations are not met perfectly and an individual cannot accept that the expectations were unrealistic in the first place, the system is overwhelmed with fear and anxiety that result in shame.

•Shame is different from guilt.
• Guilt can be explained – you did something wrong. You can confess and be forgiven.
• Shame – you are wrong. You hide and conceal your weakness. The result? A combination of blurred boundaries, depression, and defensive rage It is a vicious cycle. Unrealistic expectations set up anxiety and fear of failure. The anxiety and fear become overwhelming. Self-harm temporarily offers escape from the intolerable state. Engaging in the behavior results in shame and negative selftalk. When efforts to conceal are discovered, and individual defends the secret behaviorwith narcissistic rage. Once the cycle is complete, the individual resolves to “do better,” “to quit,” and to be the perfect self that set them up for failure in the beginning. Eventually Depression inevitably set in.

Shame is a challenge for therapists because it causes clients to hide and conceal. Clients will often admit to feelings of aggression-feelings that have power. When you first suggest shameful feelings – clients will deny them and try to escape the discussion.

What can be done to uncover shame and self-blame? It’s not a “Name it and Claim it”moment. Recognizing is important, but perfectionism and shame both must be approached subtly and with systematic compassion. The ways to accomplish this are simple but not easy. First, we understand how shame and perfectionism flourish.

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