[Shame and social anxiety in anorexia and bulimia nervosa]

Ralph Grabhorn, Hanna Stenner, Johannes Kaufbold, Gerd Overbeck, Ullrich Stangier
Zeitschrift Für Psychosomatische Medizin und Psychotherapie 2005, 51 (2): 179-93

OBJECTIVES: The importance of shame for the understanding of eating disorders has been well-known for a long time, but only few empirical studies exist to date on this aspect. Particularly the sense of self-esteem and external appearance have been attributed a major influence in the emergence of shame. Since social anxiety has increasingly been considered to be a factor in recent discussions related to eating disorders, and shame is a primary symptom of social phobia and of social anxiety in general, the present study focuses on shame and social anxiety in anorexia and bulimia, as compared to other clinical disorders. Another research question is the extent to which the prevalence of shame in eating disorders is influenced by self-esteem, attitudes about appearance and social anxiety.

METHODS: The sample consists of 104 (female) patients, comprising 26 patients, respectively, with anorexia nervosa, bulimia nervosa, anxiety disorders and depression. The various variables were recorded with the Internalized Shame Scale (ISS), the Social Interaction Anxiety Scale (SIAS), the Social Phobia Scale (SPS), the Appearance Attitude Scale (AAS) and the Social Autonomous Self-Esteem Scale (SAS).

RESULTS: Patients with anorexia and bulimia nervosa have higher scores in internalized global shame than patients with anxiety disorders and depressions. In contrast to anorectic patients, however, patients with bulimia also have higher scores than the other two groups in the area of social performance anxiety; they also differ significantly from the anxiety disorders in terms of interaction anxiety. In the multiple regression analysis of the patients with eating disorders, self-esteem, performance anxiety and perfectionism with regard to appearance prove to be predictors of the affect of shame.

DISCUSSION: The findings indicate that not just shame, but also social anxiety, should be regarded as important influencing factors, especially in the case of bulimia nervosa. The question remains as to what extent social anxiety is a result of shame being projected onto the body. For therapeutic considerations, it seems advisable to work on the affect of shame and also include the aspect of social anxiety in focused therapy strategies.

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