Social anxiety in anorexia and bulimia nervosa: the mediating role of shame

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Objective: The close relationship between social anxiety and eating disorders has attracted considerable scholarly attention in recent years. Shame has been identified as the key emotional symptom in the link between social anxiety and social phobia. While shame is commonly recognized as a meaningful construct for understanding eating disorders, empirical research into this issue has been lacking. Thus, the objective of this study was to determine the strength of influence shame and social anxiety have in the psychopathology of anorexia nervosa and bulimia nervosa compared with other clinical groups. Furthermore, the issue of whether shame can account for clinical group differences in the experienced levels of social anxiety was examined. Method: The sample consisted of 120 female inpatients, divided into four groups of 30 according to individual diagnoses: anorexia nervosa, bulimia nervosa, anxiety disorders and depression. The Social Interaction Anxiety Scale (SIAS), the Social Phobia Scale (SPS) and the Internalized Shame Scale (ISS) were used to measure the target constructs for this investigation. Results: Patients with anorexia and bulimia nervosa have higher scores in internalized global shame than patients with anxiety disorders and depressions. In contrast to anorectic patients, however, patients with bulimia also have higher scores than the other two groups in the area of social performance anxiety; they also differ significantly from the anxiety disorders in terms of interaction anxiety. Once shame was partialled out, group differences of social anxiety were shown to disappear. Discussion: Both shame and social anxiety have to be regarded as important influencing factors in anorexia and bulimia nervosa, with shame making a significant contribution to the explanation of social anxieties. The interaction between shame and social anxiety as well as its relevance for eating disorders are discussed. With regards to the therapeutic implications, it would seem reasonable not only to focus on treating shame affect but also to specifically adopt a therapeutic strategy targeting social anxiety fears. Copyright © 2006 John Wiley & Sons, Ltd.