Making Explicit and Addressing Shame in Eating Disorders

Shame is an emotion that has begun to be recognized for its role on psychopathology and its impact on access to treatment. In patients with eating disorder (ED) pathology, this role and impact are certainly important because of the self and others’ judgment towards the body. In this study we sought to intensively investigate shame through a narrative projecting test to detect the complex and multifaced expression of this feeling in ED patients. We used the Thurston Cradock Test of Shame (TCTS) to compare levels of internalized shame in 40 ED patients with levels of shame in 100 nonclinical individuals. ED patients’ narratives had more shame contents (F = 12.59, p = .004), expressed more directly (F = 8.18, p = .009), with less aggressive defenses (F = 5.54, p = .027) and more maladaptive story resolutions (F = 4.72, p = .046). Results highlight the role played by shame in the maintenance of dysfunctional eating behaviors. Eliciting narratives with shame-related stimuli is one way to develop metacognitive skills about this highly disabling emotion in interpersonal relationships and build an effective working alliance at the beginning of treatment.