Unmasking the Role of External and Internal Shame in Eating Disorders

Objective: Feelings of shame can play a role in the development and maintenance of mental disorders. However, the role and measurement of shame in relation to eating disorders remain poorly understood. The current work presents the adaptation of a measure of external and internal shame in relation to eating disorders (EISS-ED) based on an integrative perspective that leverages the strengths of the biopsychosocial model and shame-pride cycle framework. Specifically, the EISS-ED accounts for how individuals believe they are perceived by others (external shame) and how they perceive themselves (internal shame), in relation to eating. Method: The study used exploratory and confirmatory factor analyses to examine the factor structure and psychometric properties of the EISS-ED (N = 478). Spearman’s correlations and Receiving Operator Characteristic curves were used for validity testing. Results: The results supported the two-factor structure (including 14 items) of the EISS-ED and its factorial invariance by clinical history and gender. Concurrent validity analyses showed positive correlations between external and internal shame and eating disorder symptoms, negative affect, and detachment. Both external and internal shame measures provided fair classification accuracy of participants based on self-reported history of clinical assessment or treatment for eating disorders. Discussion: These findings improve the understanding of the role of shame in eating disorders and offer evidence on a valid assessment that can aid in identifying, measuring, and addressing this important construct, supporting targeted interventions.