How might eating disorders stigmatization worsen eating disorders symptom severity? Evaluation of a stigma internalization model

Objective: Eating disorders stigmatization is common and is associated with greater eating disorders symptom severity. This study sought to elucidate stigma internalization as a potential mechanism underlying this association. Two central aspects of stigma internalization were focused on: alienation and social withdrawal. Method: A cross-national sample of individuals with self-reported eating disorders (N =260) completed measures of eating disorders stigmatization, symptom severity, alienation, and social withdrawal. Results: The model evidenced excellent fit. Eating disorders stigmatization directly predicted both alienation and social withdrawal, which, in turn, directly predicted symptom severity. Indirect effect analyses indicated that greater eating disorders stigmatization ultimately predicted greater symptom severity via alienation and social withdrawal. Moreover, social withdrawal mediated the association of alienation with symptom severity. Fitting a direct pathway from eating disorder stigmatization to symptom severity did not improve model fit. Discussion: Our model provides a potentially useful account of the mechanisms by which eating disorders stigmatization might worsen eating disorder symptom severity. Specifically, the stigma internalization processes of alienation and social withdrawal may be important factors linking stigmatization with symptom severity. The findings have implications for clinicians attempting to help individuals with eating disorders to monitor and modify their responses to eating disorders stigmatization.