Specific linguistic modes of shame communication in patients with eating disorders

Introduction. Empirical studies and clinical models agree in seeing shame as one of the central emotional processes of psychopathological functioning. Shame in fact is that process that underlies the dissociation of emotional processes at the interpersonal and intrapsychic levels. If this is true in all severe psychopathologies it takes specific forms in eating disorder patients, where the body is the central medium used for self-definition in competitive confrontation with others. The aim of the study was to investigate specific ways through which shame and dissociation can be captured in the narratives of patients with eating disorders. Methods. Twenty-nine eating disorder patients treated at a public hospital in northern Italy and 29 nonclinical participants matched for gender, age and education were enrolled. Both groups of participants were asked to complete the Thurston Cradock Test of Shame, a projective narrative test that collects narratives stimulated by figures and interpersonal scenes that indirectly elicit shame-related themes. The dictionaries of the Referential Process, a set of computerized analysis tools that analyze and measure linguistic style in terms of emotional expressiveness and reflexivity, were applied to the collected protocol transcripts. Results. The stories told by eating disorder patients compared with those in the non-clinical group were twice as short as those in the clinical group, with more dysfluencies and lower emotional elaboration scores. Unexpectedly, the number of shame themes was lower in the clinical group, as was the number of shame defenses, while story resolution was significantly more dysfunctional. Discussion. Compared with nonclinical people, eating disorder patients express shame without making it explicit; shame emerges from other linguistic (shorter narratives with more disfluencies and less elaboration) and content (more maladaptive story resolutions) cues. Dissociative processes are thus active, but these patients' typical motivation for good performance leads them to produce seemingly shame-free stories. It seems necessary for practitioners to become skilled and sensitive to these modes of manifestation of shame and dissociation to avoid reinforcing them in the treatment of these patients.