Feelings about the self and body in eating disturbances: the role of internalized shame, self-esteem, externalized self-perceptions, and body shame

Objective: To investigate the roles of feelings of low self-worth (internalized shame and low self-esteem), externalized self-perceptions (self-objectification and body surveillance), body shame, and depressive symptoms in directly and indirectly explaining variance in eating disorder (ED) pathology across two studies. Study 1: In 403 women, internalized shame and self-esteem were found to each be independently associated with ED pathology, over and above one another, depressive symptoms, age and BMI. Further, body shame fully mediated the relationships between ED pathology and internalized shame and self-esteem, controlling for one another, depressive symptoms, age and BMI. Study 2: In a different sample of 548 women, Structural Equation Modeling (SEM) revealed that a path model in which internalized shame predicts ED pathology both directly and indirectly via self-objectification, body surveillance, body shame, and depressive symptoms demonstrated very good fit for the data and explained 68% of the variance in ED pathology. General conclusions: Results support an understanding of EDs as disorders of self, in which negative feelings about the self (internalized shame and low self-esteem) are displaced onto the body (in the form of externalized self-perceptions and body shame) and are associated with increases in depressive symptoms and ED pathology, both directly and indirectly.