Shame and Eating Disorders
Shame is defined as the feeling of being wrong associated with very low self-esteem and worthlessness and is very often felt by individuals experiencing eating disorders (EDs) and disordered eating.
Individuals may experience feelings of shame in multiple contexts:
The feeling of one’s body being wrong
Shame in sense of identity or sense of feeling different
Shame associated a mental or physical illness
Shame surrounding adverse life experiences including trauma.
Shame and Eating Disorders
This sense of shame or being wrong can lead someone to ED behaviours as a means to appear more acceptable or “less wrong” e.g. through thinness or exercise deemed as admirable.
ED behaviours can also be a means of managing shame and the big emotions that can accompany this. Subsequently, the ED itself may result in feelings of shame, due to the associations with experiencing a mental health condition. There is absolutely nothing shameful about experiencing mental health difficulties and we invite you to hold compassion for yourself if you are currently feeling this way.
Previous research has found that those who were receiving treatment for an ED and struggling with feelings of shame, but saw changes in this feeling early into their treatment, saw a faster decrease in ED symptoms.
Shame has also been shown to be a significant barrier when it comes to seeking support for an ED, as well as playing a role in the maintenance of disordered eating and ED behaviours. As we know that early intervention predicts better prognosis, this is important to address.
Study
A study published in 2021 aimed to investigate the association between the feeling of shame and eating disorder symptoms. The researchers conducted this using a meta-analytical approach, whereby the findings from 195 studies with 64,267 participants were combined and compared.
Researchers looked at the impact of different types of shame and both specific ED symptoms (e.g. severely limiting calorie intake in anorexia, self-induced vomiting in bulimia) and more general ED symptoms (e.g. desire to change one's body shape).
The types of shame being investigated were:
Characterological shame: evaluation of habits and personal abilities.
Behavioural shame: evaluation of problematic behaviours.
Body shame: negative evaluation the body.
Shame around eating: negative evaluation of food consumption.
Internal shame: self-generated criticism and negative evaluation of self.
External shame: fear of others viewing oneself in a negative light.
Results
All types of shame were significantly associated with ED symptoms.
Body shame and shame around eating were most strongly associated with having an ED.
As age increased, the association between shame and ED symptoms decreased, perhaps indicative of a greater ability to regulate shameful feelings as one gets older.
Limitations
Only 4 of the 195 studies were considered to have “good” methodological quality, with the rest scoring below this. Therefore conclusions from this meta analysis may be tentative.
More than 95% of studies were cross-sectional and therefore correlation. As we know well, correlation does not equal causation and it’s important to consider the other variables at play such as depression, levels of anxiety and socioeconomic status which few studies accounted for.
Although 6 studies used semi-structured interviews, the remaining 189 relied on self-reported measures which are subject to multiple forms of bias, such as recall and desirability bias.
Conclusions
Shame is an important target for eating disorder treatment, especially as it has been found to be a barrier to an individual reaching out for support as well as a facilitator for maintaining eating disorder symptoms. Body shame in particular may be an important target to eating disorder prevention and treatment.
A better understanding of the emotion of shame would allow for the development of evidence-based treatments to support those struggling with the impacts of shame on their relationship to self.
Continuing to dismantle systems of oppression such as racism, homophobia, transphobia, ableism, ageism, healthism, classism patriarchy etc that create the conditions for shame are an important part of this work.
Gentle Reminder
We are holding so much compassion for individuals living with the feelings of shame. A gentle reminder that no matter the sense of shame of your experience, you are worthy and enough.
We see you.