Why self‐critical patients present with more severe eating disorder pathology: The mediating role of shame
Bibliographic record
Abstract
Objectives Gilbert ( Compassion: Conceptualisations, Research, and Use in Psychotherapy . London: Routledge, 2005) theorized that self‐critical individuals have more severe psychopathology due in part to their elevated feelings of shame. We sought to test this model in a sample of eating disorder sufferers. Method Seventy‐four patients admitted to a specialized day or inpatient eating disorders treatment programme completed the Forms of Self‐Criticism and Self‐Reassurance Scale, Rosenberg Self‐Esteem Inventory, Experience of Shame Scale, Beck Depression Inventory, Positive and Negative Affect Schedule, and Eating Disorder Examination Questionnaire. Results We tested our mediational model with Preacher and Hayes' ( Behavior Research Methods , 40 , 879, 2008) bootstrapping approach entering self‐criticism as a predictor, self‐esteem as a covariate, and shame, negative affect, positive affect, and depressive symptoms as simultaneous mediators. Applying a 95% confidence interval, the total indirect effect of self‐criticism on eating disorder pathology was significantly different from zero suggesting that its influence occurred through the proposed set of mediators. Specific indirect effects revealed that shame was the only mediator to contribute significantly to the model. Conclusions Results support the theory that among eating disorder patients, higher self‐criticism is associated with elevated eating disorder pathology through feelings of shame. Interventions that target the shame of self‐critical patients might therefore facilitate their recovery. Practitioner Points Assessing and intervening with the feelings of shame experienced by high self‐critical patients might be particularly important in helping them overcome their eating disorder. Working with patients to understand and alter the links between their self‐criticism, shame, and eating disorder behaviours might be a fruitful therapeutic avenue. Case conceptualizations in the eating disorders and perhaps other forms of psychopathology might benefit from integrating theoretical models that integrate a focus on self‐criticism and shame. Limitations This is a cross‐sectional study, meaning that we cannot make conclusions about the directionality of the relationships observed. It will be important to examine the temporal relationships between self‐criticism, shame, and eating disorder symptoms in future research. We rely on correlational data and so can only make predictive inferences based on our results. An experimental study in which self‐criticism and/or shame are manipulated will be an important next step to allow for causal inferences.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".