Targeting a Destructive Cycle of Inferiority

A sense of shame and self-criticism may help perpetuate ED symptoms.

Reprinted from Eating Disorders Review
May/June Volume 27, Number 3
©2016 IAEDP

Many patients with anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) share a sense of inferiority and severe self-criticism. In addition, several core symptoms “feed” the perpetual cycle of eating psychopathology, according to Dr. Cristiana Duarte and her colleagues at the University of Coimbra, Portugal. The researchers also tested whether self-criticism and social comparisons provided the link between overvaluation and shame as part of a study that traced the similarities and differences among patients with AN, BN, and BED (Comprehensive Psychiatry. 2016. 66:123).

When the researchers attempted to understand how overvaluation of body shape and weight and eating were associated with an increased sense of shame, they found that basing one’s sense of self-worth on eating behavior and physical appearance did not lead to a more valued sense of self, but paradoxically increased self-monitoring and self-correction, and lowered self-esteem. 

Dr. Duarte and colleagues studied 119 adolescent and adult female eating disorders outpatients who were seeking treatment at public hospitals and who had ED diagnoses based on results from the Eating Disorders Examination (EDE). Thirty-four patients were diagnosed with AN, 34 had BN, and 51 had BED. In addition to the EDE, all patients completed a number of questionnaires, including the Other asShamer Scale (Personality and Individual Differences. 1994. 17:719), which asks 18 questions about external shame; the Forms of Self-Criticizing & Self-Reassuring Scale(Clin Psychol Psychother. 2015. 22:153), which measures social comparisons based on physical appearances compared to peers as well as models/actresses/celebrities; and the Depression, Anxiety and Stress Scales (Manual for the depression anxiety stress scales. 2nd ed. Sydney, Australia: Psychology Foundation, 1995).

Dr. Duarte and colleagues reported that the patients’ overvaluation predicted internal shame, but this effect was mediated by unfavorable social comparisons and harsh self-criticism, even after controlling for depressive symptoms. 

The authors’ findings have conceptual and practical implications. High levels of a flawed and diminished sense of self cut across EDs. The authors suggest that the findings highlight the relevance of working with patients to change their self-criticism and sense of inferiority.