Why self-critical patients present with more severe eating disorder pathology: the mediating role of shame

Allison C Kelly, Jacqueline C Carter
British Journal of Clinical Psychology 2013, 52 (2): 148-61

OBJECTIVES: Gilbert (Compassion: Conceptualisations, Research, and Use in Psychotherapy. London: Routledge, 2005) theorized that self-critical individuals have more severe psychopathology due in part to their elevated feelings of shame. We sought to test this model in a sample of eating disorder sufferers.

METHOD: Seventy-four patients admitted to a specialized day or inpatient eating disorders treatment programme completed the Forms of Self-Criticism and Self-Reassurance Scale, Rosenberg Self-Esteem Inventory, Experience of Shame Scale, Beck Depression Inventory, Positive and Negative Affect Schedule, and Eating Disorder Examination Questionnaire.

RESULTS: We tested our mediational model with Preacher and Hayes' (Behavior Research Methods, 40, 879, 2008) bootstrapping approach entering self-criticism as a predictor, self-esteem as a covariate, and shame, negative affect, positive affect, and depressive symptoms as simultaneous mediators. Applying a 95% confidence interval, the total indirect effect of self-criticism on eating disorder pathology was significantly different from zero suggesting that its influence occurred through the proposed set of mediators. Specific indirect effects revealed that shame was the only mediator to contribute significantly to the model.

CONCLUSIONS: Results support the theory that among eating disorder patients, higher self-criticism is associated with elevated eating disorder pathology through feelings of shame. Interventions that target the shame of self-critical patients might therefore facilitate their recovery.

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