The relationship between shame, social rank, self-directed hostility, self-esteem, eating disorders beliefs, behaviours and diagnosis

This study investigates: The relationship between shame, social rank, self-directed hostility, and self-esteem in a female eating disordered population; The relationship between anorexic and bulimic beliefs and behaviours and eating disordered diagnosis; The relationship between shame, social rank, self-directed hostility, self-esteem, and eating disordered diagnosis; and The relationship between shame, social rank, self-directed hostility, self-esteem and anorexic and bulimic beliefs and behaviours. Data was collected from 187 eating disordered females. They completed the Stirling Eating Disorders Scale (measuring anorexic and bulimic dietary cognitions and behaviour, low assertiveness, perceived external control, low-self esteem and self-directed hostility), the Internalised Shame Scale, and the Other As Shamer Scale. All met diagnostic criteria for Anorexia Nervosa, Bulimia Nervosa, Eating Disorder Not Otherwise Specified, Or Multi-Impulsive Bulimia Nervosa. The mean scores for all diagnostic groups on internal shame, low assertiveness, perceived external control, and low self-esteem were clinically significant. All diagnostic groups reported means for external shame higher than those found in previous studies with non-clinical samples. Internal and external shame was strongly related to aspects of social rank (low assertiveness and perceived external control), low self-esteem, and self-directed hostility. Anorexic and bulimic cognitions and behaviours were common across eating disordered diagnoses. Results support a 'transdiagnostic' approach to eating disorder assessment and treatment. A large minority of eating disordered patients experience clinically significant restricting and bulimic behaviours. Clinically significant differences were found between participants with differing patterns of anorexic and bulimic beliefs and behaviours in levels of internal and external shame, low-assertiveness, perceived external control, low self-esteem and self-directed hostility.