066: Navigating The Shame Response Living With Skin Rashes w/ Ali Shapiro

Skin rashes can lead to self-destructive patterns of behavior. We might isolate ourselves more and more to avoid judgment from others, leading us to give up healthy social relationships and activities. My guest today shares how to overcome these negative patterns.

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My guest today is Ali Shapiro, MSOD. Ali is the creator of Truce with Food®, host of the top-ranked podcast Insatiable, a holistic nutritionist, integrated health coach and rebel with a serious cause.

She’s academically, practically, and empathetically aware of how the medical system, diet culture and body positivity movements all have their own flavor of crazy.

Ali created her Truce with Food method while in graduate school at the University of Pennsylvania, where she earned her Masters in Organizational Dynamics, which is like getting an MBA in the change process, where she drew from her decade plus of working with real life clients and her own personal healing journey from having cancer as a teenager.

Join us as we talk about the three patterns of behavior human beings usually follow in situations of trauma (such as that caused by a chronic skin condition).

Have you managed to overcome isolating behavior patterns? Tell me about it in the comments!

In this episode:

  • Ali's story with skin issues
  • Feeling misunderstood and isolated
  • The three patterns we follow when we're in psychological conflict
  • How to get out of those patterns


“I know what it's like to have that visible feeling of I'm wrong or I'm not enough.” [3:17]

“You not only have the visible issues, but then when you go to try to fix it and you can't figure out what's going on or you go to the dermatologist and they try to tell you something that doesn't work, it starts to erode this sense of self-trust and the sense of enoughness.” [4:38]

“We often block ourselves from the very thing that we need. And it creates a self-fulfilling prophecy where we are isolated, we are misunderstood, and we feel rejected.” [8:58]


Find Ali online

Take the Comfort Eating Quiz

My appearance on Ali's podcast, Insatiable: Pros and Cons of the Elimination Diet

Healthy Skin Show episode 31: How to Thrive Emotionally Living with Chronic Skin Rashes w/ Nitika Chopra

Follow Ali on Facebook | Instagram

066: Navigating The Shame Response Living With Skin Rashes w/ Ali Shapiro FULL TRANSCRIPT

Jennifer: Hi everyone and welcome back. Today you are going to meet one of my friends. I've known her for a really long time. She used to live in Philly but it's recently moved and that's okay. We've stayed in touch and we always have lots of laughs. Many of you have heard me on her podcast and I'm excited to have her here with you today. Her name is Ali Shapiro and she is, I don't know, she's been like my guru to go to when you have relationships with food that are not exactly healthy and you don't know how to deal with it. She created this amazing program called Truce with Food. Isn't that interesting to develop a truce with food. She's also the host of the top-ranked podcast called Insatiable, which I was on and you guys probably listened to that episode. She's a holistic nutritionist, integrative health coach and rebel with a serious cause. Now here's the thing about Ali. She is academically, practically, and empathetically aware of how the medical system, diet, culture and body positivity movements all have their own flavor of crazy. I love that you say that Ali by the way. And as I said, guys, she created this program Truce with Food after going through graduate school at the University of Pennsylvania where she earned her Masters in organizational dynamics. She also draws from her decade-plus of working with real-life clients and her own personal healing journey from having cancer as a teenager. And Ali also shared with me that in former years she also struggled with skin rashes so she can relate to what many of you are going through. And today our focus, this is why she's here, is about the trauma and the pain and the shame that we oftentimes feel when you have this, these markings, you don't look normal. You don't feel healthy, your skin hurts. Every experience is painful in some way, shape or form. And how that can translate in other areas of your life, especially what you end up eating.Let's start Ali. So you said you had rashes when you were younger.

Ali: Well, I had a horrible skin rash actually after being exposed to pesticides when I was a little kid doing cartwheels. After our neighbor got their lawn sprayed with chemicals and I woke up the next day with a full body rash and whenever I went out into the sun, it started itching more. And so my parents took me to the doctor and no one knew what it was. And I basically lived in an Aveeno oatmeal bath for two weeks until it went away. I don't even know if they still make those. This was in the eighties. And then my skin problems became my acne. Oh my God, you remember in the eighties and nineties foundation, I would cake it all over my face, which oddly made it more noticeable. And I tried antibiotics. I tried Cetaphil. In college I tried accutane. The antibiotics never worked. The accutane worked for a while and then my skin problems came back in my early twenties, so I know what it's like to have that visible feeling of I'm wrong or I'm not enough. Right. Or what it really does to us is it makes us feel less than, in a way, or that we have to overcompensate because we don't feel attractive or cause we're in pain and things like that. So I know how that feels.

Jennifer: And I had shared a few times that I even got to the point because I had the Eczema on my hands. And there were moments where, you know, when you go to reach out to shake someone's hand, you know, your gaze sometimes does go in the direction of your hand. That's a natural thing. And they would see this hand that was red and just like really rashed and painful and there's that. You kind of can hear someone's gears turning and they're calculating, How can I get out of this? In that split second. They're like, how can I not shake her hand? Is she infected with something as she dirty? And it really makes you feel awful because people don't want to touch you.

Ali: Yeah. Yeah. And so that sets up this psychological place where we enter of, we're wrong. And there's a conflict there, right? And whenever we feel shame or that we're wrong in a way, right? That there's, there's some defect with our body. Cause that's what it also starts to feel like, right? You not only have the visible issues, but then when you go to try to fix it and you can't figure out what's going on or you go to the dermatologist and they try to tell you something that doesn't work, it starts to erode this sense of self trust and the sense of enoughness is often how my clients describe it around their weight and their body. Right? Because that's something that is visible as well. And so what happens is when we go into this place of feeling misunderstood or feeling wrong or not enough clients use various phases, but we feel defensive in a way, right? Like I have to explain myself or whatnot. There's three patterns that we go into. And I've adapted this based on the Thomas Kilmann Conflict Model because we feel like we're in psychological conflict. And so one of the responses that people choose is what's called the competitor response. What we do there is we're saying, am I ahead or behind with based on my skin in this case, right? Like we compare ourselves maybe to other people who have skin issues, we compare ourselves and we might think like, I'm not progressing as fast enough. Why am I falling behind? Or we compare ourselves to people who don't have skin issues and we're like, what's wrong with me? Like how is this setting me back in my career? Or you know, just in from a pain perspective.

Jennifer: Like if you're in that phase where you're dating, you want to get married, you want to have children and yet you feel like, how do I even, like how do I even tell a prospective person? How do I, you know, I've seen online with women saying like, what do I do when I take the makeup off or my clothes come off? Like how do I explain this?

Ali: Yeah. And if you're comparing yourself to the other pool of mates out there, right. It's like, and what happens then is we slowly isolate ourselves. The behavior becomes, we feel more and more different. We start to think we're more and more broken or there's more and more reasons that we're never going to figure this out or that someone won't want to date us. And that sends us in a very dark spiral that often is then we're like, well, if I can't win, you know, I'm going to just eat that or I'm just going to give up on searching or whatnot. The second pattern is avoid, which is kind of the chuck it, eff it mode that we call it with my clients, where it's like the kind of mindset is why even try, I don't even want to try to, you know, explain this to someone. I think with skin stuff, this is when you stop going out, right? This is when you're like, I don't want to be seen. Or when you're in pain, it's, I don't want to tell anyone it, no one will understand it. So we just avoid engaging with the outer world at all. And the tone kind of in our head is very condescending, self doubt. And so it's really lack of behavior that we then don't get the information we need to get better. We don't have the conversations we need to have with people so they can understand how to support us. And that leads us again, feeling very alone, but isolated in a different way when we're competing in that mindset, we feel isolated in a very bad way versus avoiding is just kind of avoiding. And then the last stress response is accommodating. And that's where often when it comes with skin issues or pain, we feel like we have to make up for, we have to accommodate our skin with other people. Maybe we have to over people please because of that or if you go to the dermatologist. One way that I really struggled was the western medicine saved my life in some ways, but then I'd go to the dermatologist and accommodate whatever they told me to do, when it was actually making things worse. Like antibiotics kills the gut biome, right? But I was trying to be good. And so we accommodate what maybe mainstream medicine tells us or we don't get to the root symptoms. Sometimes mainstream medicine will do that, but not often. When we're out with people, we feel like, oh, I feel like I'm compensating for this skin stuff, so I'm going to eat whatever they give me. Right? I'll feel guilty if I turn it away. And so we get into this pattern of having to people please, which then never gives us really the connection or the safety that we're looking for. Because to use your, your hand example, when you shook the person's hand when you had Eczema, what you wanted was connection, and for them to understand you. Right?And so we often block ourselves from the very thing that we need. And it creates a self-fulfilling prophecy where we are isolated, we are misunderstood, , and we feel rejected. But it's because of these three responses that then create certain behaviors that that lead to the isolation and rejection.

Jennifer: And what's also interesting and I think worth mentioning is, I didn't experience this myself, so I'm not speaking from personal experience, but more seeing this happen through watching what others go through clients as well as just folks online in a lot of these online message boards and groups that I'm in who struggle with these skin issues is that they get, they may get better, but the mindset and the self judgment and the shame, they thought it would go away when they had spent 10, 15, 20 years dealing with this and all of a sudden they wake up, the skin's better, but they're still stuck with this same, this sort of isolating pattern and they don't how to break out of that.

Ali: I love that you bring that up because what happens is the skin at first is kind of why we compete, avoid or accommodate, right? But then it, but that's not the real reason, right? Why we don't feel good about ourselves, it can be a component of it, but that starts to become this stand-in for then why we don't take chances or why we aren't kind of tuned into our own needs and wants because we're so focused on not being rejected or not being in pain, that we don't know, what do I really want? And that's where self esteem and these things come, feeling better about ourselves comes from, Is first tapping into what we want and then going out and making that happen. And so then to your point, sometimes that happens with my clients. They lose weight and they're like, oh, I still feel a mess inside. You know? And it's like, yeah. So part of getting out of these patterns is, if you find yourself in that competition pattern is really focusing on connection and how you have things in common with people or the experiences that you're going to, rather than trying to find all the clues for why you don't belong. Starting to connect on the commonality of what you do have in common with people because that connection starts to make us feel less isolated. When we're avoiding, we tend to be in this all or nothing pattern. We think there's going to be this perfect time when we feel amazing or whatnot. And it's part of that is connecting with others and their humanity and realizing that we all go through these experiences and have kind of this post traumatic, like I was in pain for 15 years or like I didn't like the way I looked and what do I do with all that? Cause I haven't been pursuing certain things and so I need to start pursuing those things and understand that there's no perfect thing to pursue. I have to just start experimenting and finding what I love and what makes me feel engaged and what makes me feel like I belong and build my self esteem. And then with the accommodator pattern is starting to feel out like what feels really meaningful to you. Often the accomodators want to people please or they want to help. They get valued by fixing other people or trying to fix other people cause we can't really fix other people, but starting to think of, Hey, what do I really want to get out of this experience? Like I used to go and hope no one would notice my skin rashes under my shirt, right? Or I was so worried about my skin. Now that I'm going to a concert or to, you know, a dinner party, what do I actually want to get out of that? I know I used to not want to be singled out or you know, be judged. But what do I want to do now when I'm there? What do I want to enjoy and experience? And for most of my clients, I mean most of it comes down to connection, like, like intimate connection in the sense of like connecting with people on things you value or like talking about the hard stuff, right? With people that we feel like we can trust. So that's how we can start to get out of those patterns, based on if we're competing, avoiding or accommodating cause there's this sweet spot of collaboration and co-creation and it's really about being in the moment and like bringing your authentic self. And I know authentic self gets thrown out around a lot, but when we're in these stress responses we hold back so much. So it's practicing with that

Jennifer: You can't be yourself. I didn't feel that way. I stopped teaching cooking classes, I stopped scheduling public events. I just couldn't. Like what am I going to do with the blue gloves on my hand? I mean people are going to be like, why are you wearing blue gloves to this like dinner party? You know, why are you on stage with blue gloves? Like wait, so your hands look like that…but did you cut this food up? I mean like a million things that I started to peel away from my life and realize that it was getting smaller and smaller and smaller. The more I felt the worse I felt basically. And the longer this went on. And so what I'm taking from this conversation, and I hope that you guys listening can really appreciate this because while the research is important, while the, you know, this supplement or this food or this dietary tweak or this question ask your doctor, those things are important. The internal emotional side, the turmoil that happens as a result of this, nobody talks about. And we have these conversations online because for many of us, we don't necessarily know somebody in our direct community or in our neighborhood or at our job or wherever that we can really, you know, somebody really gets you because they have a condition like that. But this, my hope is that by Ali sharing some of this too, you're going to begin to see what you're doing and then say, okay, how do maybe I shift my mindset, how do I shift my focus so that I don't get lost down this rabbit hole. You get to a point that's really dark and the reason this is such a big concern for me and it breaks my heart and Ali, I don't know if you know the stats on this, but with Eczema there was a lot of studies that came out that were published earlier this year as you were doing this, this is 2019, about the rate of suicide and suicidal thoughts in people who have eczema and it's like close to like 36 or 40%. You know, just off the top of my head. Whereas other studies that have looked at people with psoriasis, you're looking at a rate of like a 20% increased risk of suicide. And the younger you are with psoriasis, the higher that rate is. And so there is a lot of emotional baggage and trauma that goes along with this and we really want to help you not only support your skin but support the emotional health that I think is directly. Do you agree with that, that is directly connected?

Ali: Yeah, I mean, on a physiological level, right? If you're in a low grade fight or flight response all the time, right? Which is what happens when you have unresolved trauma. Your nervous system is always on edge. I mean, everything you're doing to heal it doesn't work as well, right? If you're not in a rest and repair type of situation. Right. So like to your point, like if you're withdrawing from the things that you enjoy, it's not that you're just withdrawing and you're missing out and you're missing that replenishment and excitement and meaning in life. And then also for sure, I mean, I've seen with my clients, like the, the emotional piece is 90% once we work through this kind of stuff, the food is like 10% of it. But of course the food matters. And I also find that with these patterns, people then go off of the healing protocols that would help them feel better. Because if they're evaluating, again based on what other people are doing and they're not progressing fast enough or they're avoiding and you're just not even getting the support or the help that they need. I think that speaks to your statistics of like how isolating all these patterns make us. And I would say for people who are in the thick of it and not through it yet, really sharing with people why you're wearing the blue gloves or when people close to you that where it feels safe, that's gonna help you start to bring you out of that emotional space and say, wait a second, I can be me where I am right now. And then that gives you the information and the connection to then like people call it motivation, but it's the safety to pursue the treatments that you need and to work on that stuff.

Jennifer: And I'll also add to this too, I think, you know, I have heard stories where sometimes like a parent is very unsupportive and they'll make really bad comments and unkind comments about like, oh, you have this rash because you did something earlier in your life and your God is punishing you and you know, really unsupportive, not helpful. I didn't even think, to be entirely honest, I thought that I was being punished for something. I kid you not like, this is the dark hole that I had gone into. And I think what's, what is so critical here is that you identify as well who you can and can't open up to in your life because not everybody is the right support for these type of thing. Not everybody has those tools and those skills.

Ali: That's a good point. In Truce with Food, we say experiment, but we're challenging these patterns, but we're finding where it's safe to go further because the world isn't Koombaya. I wish it was. Yeah. As someone who's had a lot of health problems, we can take responsibility, but there are so many environmental things. There's so much that we don't know. And I know in America we kind of view things through this meritocracy lens that we can control everything. And it's all based on how hard we try. Through my own experience with clients and stuff, it's just not, it's not gonna shift anyone's feelings, but just telling you it's not only what you have done. I love that you use that example because that's how we then imprint that we're wrong. Right? And then we're coming at everything from this conflict perspective rather than what if this as a symptom? Or what if this is a growth opportunity? What if this is something that can make me better, not from an aesthetic standpoint, but there's emotional growth opportunity there. And so, I know I didn't feel like that at the time that my skin was, but I, once I started to realize that my skin issues were such a result of my gut issues from the chemo and steroids, it sent me on a really wonderful healing journey. I mean, I can say that now, 12 years out. I know it's challenging and time, but I'm glad you brought up. Yeah. It's so important to find the resources and spaces that can support you in this exploration and really feeling how you really feel and people who aren't going to try to fix it, but we'll just help you help yourself hold space.

Jennifer: You just want to complain. You just want to vent. You just need to let it out because you're holding it in. And it's okay. And if it, if, if you really feel that alone where you can't talk to your parents, you don't have friends that understand, talk to a therapist, talk to a counselor, like reach out for help so that you can process what's happening. Because I will second what Ali has shared. There was a moment where I was ready to just be like, my life's over. Like I guess I can't do this. I guess I'm not going to be a nutritionist. Like, I have failed, you know, three years. Like what the heck? And my husband said to me like, have you really looked under all the stones? Have you turned them all over? And I was like, well, I don't know. And he's like, well, I want you to think about this from a different perspective.He actually helped inspire me to say, maybe this is an opportunity for me to change some things about what I'm doing. Like you said, it's an opportunity to go on a different type of journey where I look at my life, my diet, my environment, everything differently. And that helped me tremendously.

Ali: I think it's a great example of you did the work but you just needed someone to ask you the right question and encourage you.

Jennifer: Exactly. So Ali, I know that you deal mostly with food and patterns of behavior and things like that and you've got a really cool resource that I would love to share with everybody listening called the Comfort Eating Quiz. Can you just share a little bit about what that is and how that might be of benefit to anybody listening?

Ali: Yeah. So we just went over these three patterns. And these are the patterns that also when we live this way causes us stress, right? But stress is this ambiguous term. And so if you take the quiz, you can see what type you're dominant in, whether competitor, avoider or accommodator. And then there's even more resources to have once you figure out what you are, how to get even more out of this pattern, these patterns and questions you can ask yourself. I'm really big on self trust, right. Part of coming out of this emotional place is me not giving you the answers. However, I can give you really good questions so that when you are in that competitor mode or you feel like avoiding, how to get out of that pattern? And so if you take the quiz, you then get the results and some more resources and tools to take it out of them.

Jennifer: That is awesome. I love it. I'm going to have to take that.

Ali: I have a feeling you're competitor.

Jennifer: I might be, but I've done all of them at different phases in my life. So you know, everybody, I hope that you found this conversation very insightful. Again, I think this is just as valuable. This is a different side of the coin or another side of the dice, so to speak that we should look at. We should consider ourselves this multifaceted being. We are multifaceted and this is a very important point. You can't just talk about steroid creams. You can't just talk about your diet. Think about how you feel when you try all these things and they don't work and that dark place that you go. That's why I'm like, we need to have this conversation if we're going to be a community that really cares about us. Yeah, healthy skin is great, that's our goal. But at the end of the day, you can have really healthy skin and be a complete mass of a person and not feel enough. And I, it's my hope that if we can have conversations like this as you begin the process of creating healthier skin, you can then also rebuild that process like Ali shared, about trusting yourself and flourishing in life when you get there. So Ali, thank you so much for joining us.

Ali: Thank you for having me, Jen. It's been great.

I know what it's like to have that visible feeling of I'm wrong or I'm not enough.

Jennifer Fugo, MS, CNS

Jennifer Fugo, MS, CNS is an integrative Clinical Nutritionist and the founder of Skinterrupt. She works with women who are fed up with chronic gut and skin rash issues discover the root causes and create a plan to get them back to a fuller, richer life.

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