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Body Image Issues 2/5: Shame

When a feeling of being ‘bad at one’s core’ gets projected onto our physical appearance, no amount of weight loss or cosmetic surgery will ‘fix’ us. Dr Nicole Schnackenberg, psychologist, psychotherapist, specialist in body dysmorphic disorder (BDD) and author of False Bodies, True Selves, continues her blog series with a consideration of the role of shame in eating disorders and BDD.


An important aspect of our work with clients who are experiencing body image struggles is to understand and explore their felt sense of shame, or inner badness. I have had many clients tell me they feel like a monster, a parasite, an alien – their shame is so encompassing that they feel separate from, and painfully different to, the rest of the human race. 

Before we begin our exploration of how shame can, and in my experience typically does, link with body image struggles, let us take a moment to consider what shame is.

While guilt is the sense of ‘I have done something bad’, shame is the experience of ‘I am bad’. In short, shame is a felt sense of badness of the self. In small and attuned doses, early experiences of shame are an important developmental stage through which the infant learns, perhaps more so than through any other emotion, that they are separate to their caregiver. Thus, shame supports the developmental process of individuation. 

Shame – the neurobiological basics

Neurobiologically, shame is a decrescendo, first emerging around the time the infant begins to mobilise away from the caregiver. To use a simple example, imagine a toddler moving away from the caregiver, perhaps towards some mud. In enjoyment, they smear mud on their face and return to the caregiver thrilled and jubilant: ‘Look at what I have done!’ The infant is in an energy-mobilised, sympathetically dominated state of excitement. 

Now imagine that, instead of this nervous system and emotional state being reflected back to them by the caregiver, there is a mis-attunement. Perhaps the caregiver reacts with shock, disbelief, disgust or even a blank face. The infant is left abandoned with their feelings while their nervous system decrescendos into a parasympathetically driven, energy-conserving state. In good-enough caregiving, the caregiver notices the infant’s withdrawal and moves forward at some point to soothe them. The rupture has been repaired. However, in repeated and pervasive experiences of shame, within which no repair takes place, the infant may internalise and assimilate the shame and come to have a sense that they are shameful and bad at their core.

The link between shame and body image struggles

Within body image struggles, this felt sense of shame is projected or pinned onto the physical appearance. The body part, or parts, onto which the person projects their shame and distress then become/s a transitional object of sorts. The person holds onto the hope that, once their perceived body defect is fixed – when their skin clears up, their weight reduces, they have the cosmetic surgery etc. – the sense of shame they feel will disappear and they will feel lovable, safe and whole. 

Naturally, given that an experience which is emotional in nature cannot be ‘fixed’ through weight loss/surgery etc., the master plan fails to deliver. The person perhaps loses the weight yet still feels shameful inside; still feels as though they are bad in some way. So, they move their attention, and pin their hope, onto losing more weight or fixing another body part, entering into what one client described to me as a conveyor belt of appearance-focused projects.

How can we work with this in therapy?

In therapy, this felt sense of shame aches to be understood, witnessed, heard and comforted. As we support our clients to feel lovable, safe and whole, behaviours like trying to lose weight organically drop away. The client no longer needs to engage in their various appearance projects in an attempt to remove the shame. 

In my experience, approaches like Internal Family Systems Therapy (IFS) and Voice Dialogue can be incredibly beneficial when working with shame. Ultimately, the client is supported to view the shameful part of the self as an intensely vulnerable part, which is seeking safety and understanding. Once approached with curiosity and non-judgement and given the airtime it yearns for, this shameful part can return to its naturally valuable state, wherein it is replete with self-esteem, optimism and hope – and any associated projections onto the physical body can depart. 

In my next blog we will take a look at how shame, alongside other emotions and experiences, can inform the felt sense of self in people who project their distress onto their physical appearance. We will also consider how the self-narrative can be supported to ‘thicken’ in the therapeutic space. 



Nicole Schnackenberg

Dr Nicole Schnackenberg is a child, community and educational psychologist: psychotherapist; yoga teacher and yoga therapist. Nicole divides her time between working as an educational  psychologist in Southend, Essex and her position as a trustee of the Body Dysmorphic Disorder Foundation. She is also a director of the Yoga in Healthcare Alliance and a trustee of the Give Back Yoga Foundation UK.

Nicole has authored books on food and body image struggles: False Bodies, True Selves: Moving Beyond Appearance-Focused Identity Struggles and Returning to the True Self  and Bodies Arising: Fall in Love with your Body and Remember your Divine Essence. She co-authored  The Parents Guide to Body Dysmorphic Disorder and co-edited Reflections on Body Dysmorphic Disorder: Stories of Courage, Determination and Hope.

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