A social rank approach to disordered eating: Exploring relationships between shame, fears of compassion, striving, and body shame

Psychol Psychother. 2020 Sep;93(3):490-502. doi: 10.1111/papt.12241. Epub 2019 Jul 16.

Abstract

Objectives: The impact of a social rank mentality on eating-related difficulties has been previously recognized, although mediating processes involved remain to be clarified. The current study aimed to explore the roles of insecure striving and body image shame on the relationships between external shame and fears of receiving compassion from others with eating difficulties, while controlling for BMI effects.

Methods: A total of 335 women from the general population participated in this study, aged between 18 and 62 years, who completed an investigation protocol, with self-report measures.

Results: Path analysis results showed that, when controlling for BMI, external shame and fears of compassion from others presented an indirect effect on eating difficulties, mediated by insecure striving and body image shame. The model explained 63% of the variance of eating-related difficulties.

Conclusions: Findings suggest that, in Western societies, women who highly feel that others negatively evaluate the self and present higher levels of fears of receiving compassion from others may endorse maladaptive strategies (as insecure striving) which in turn may lead to experiencing greater levels of body image shame and eating-related difficulties.

Practitioner points: This study suggests that therapists may observe that individuals who are vulnerable to developing body image and eating-related difficulties present high levels of shame and fears of compassion from others, as well as a need to compete to avoid inferiority. Therapeutic targets for people with eating-related difficulties may focus on shame, insecure striving, and fears of receiving compassionate and affiliative emotions. Addressing fears of receiving compassion and reducing shame may decrease the need to compete to avoid undesired inferiority and facilitate adaptive eating attitudes and behaviours.

Keywords: body shame; eating psychopathology; fears of compassion; shame; striving.