Laurie Jean Baptiste

Concept Analysis: Shame amongst individuals with eating disorders

NUR 654

Discuss the importance of the concept you selected in practice

The concept selected is “shame” amongst individuals diagnosed with eating disorders

(ED). It is important to explore the relationship shame has within the presentation of eating

disorders to improve patient outcomes and clinical practice guidelines. For this concept analysis,

the ED disorders considered will be Anorexia, Bulimia, and BED. Merriam-Webster collegiate

dictionary (2011) defines shame as a painful emotion caused by consciousness of guilt,

shortcomings, or impropriety and the susceptibility to such emotion. Studies have shown a

significant correlation between shame and severity of ED symptomatology (Kelly & Carter,

2013). Likewise, early changes in shame appears to produce quicker reductions in ED symptoms

during treatment (Kelly & Carter, 2014).

Determine the aims of the analysis

The aim of this partial concept analysis is to examine shame and its implications with individuals

diagnosed with eating disorders. Shame is a complex concept and understanding the role it plays

in Anorexia, Bulimia, and BED may improve current prevention and intervention programs. For

instance, studies have predicted the onset and severity of restrictive, purging, and binge eating

behaviors are interconnected to internalized feelings of shame and guilt or external shame

perceived as insubordination (Troop et al, 2008). Even after treatment, shame may continue to

linger, thus increases the chance of relapsing behaviors in patients. I believe more efforts in

clinical practice should be made to educate effective shame regulation strategies in therapy and

treatment programs.
Laurie Jean Baptiste
Concept Analysis: Shame amongst individuals with eating disorders
NUR 654
Defining attributes, Antecedents, and Consequences

Early identification of antecedents and attributes of shame in ED individuals can improve the

therapeutic relationship between provider and client therefore reducing the risk of negative

consequences occurring.

 Shame: a negative emotion associated with low self-esteem: Low self-esteem is

interrelated to ED symptoms such as restrictive and binge eating behaviors, food

aversions, purging, and negative thoughts concerning body image (Colmsee et al, 2021).

 Shame: a negative emotion concurrent to mood and anxiety: Eating disorders are highly

comorbid with mood and anxiety disorders and consequently can increase the severity of

the disorders (Hazzard, 2022).

 Physical expressions of shame in ED: Behaviors occurring when a person experiences

shame including increase risk in ED behaviors or secretive patterns and use of

maladaptive behaviors and negative coping mechanism (Wright, 2000).

 Worthlessness: feelings of inadequacy/worthlessness often leaves a person powerless to

desire change or recognized need for change. (Kelly & Tasca, 2016).

 PTSD: Evidence show there seems to be a relationship between ED causing PTSD like

symptoms related to negative alterations in cognitions and mood thus increasing

relapsing behaviors (Nelson, 2022). Some studies reveal in addition to anxiety and

depression, trauma can be perceived as a comorbidity precursor to ED (Tagay, 2014).

Laurie Jean Baptiste
Concept Analysis: Shame amongst individuals with eating disorders
NUR 654

Defining Attributes Antecedents Concesequences Concept

Shame: a negative Distorted views of Negative coping Shame

emotion associated Self (Colmsee et al, mechanism, risk of
with low self-esteem 2021) maladaptive amongst
(Colmsee et al, Trauma (Tagay, behaviors and self- individuals
2021). 2014) harm (Wright, 2000) with Eating
Shame: a negative Anxiety (Tagay, Increase in mood
emotion associated 2014) dysregulation and disorders
to mood and anxiety: Depression anxiety (Hazzard,
(Hazzard, 2022). (Tagay, 2014) 2022)
Physical expressions PTSD (Nelson,
of shame in ED 2022)
(Wright, 2000). Relapsing behavior
Worthlessness (Kelly (Nelson, 2022)
& Tasca, 2016).
Laurie Jean Baptiste
Concept Analysis: Shame amongst individuals with eating disorders
NUR 654
References

Colmsee, I.-S. O., Hank, P., & Bošnjak, M. (2021). Low Self-Esteem as a Risk Factor for Eating

Disorders: A Meta-Analysis. Zeitschrift Für Psychologie, 229(1), 48–69. https://doi-

org.access.library.miami.edu/10.1027/2151-2604/a000433

Hazzard, V. M., Barry, M. R., Leung, C. W., Sonneville, K. R., Wonderlich, S. A., & Crosby, R.

D. (2022). Food insecurity and its associations with bulimic-spectrum eating disorders,

mood disorders, and anxiety disorders in a nationally representative sample of U.S. adults.

Social Psychiatry & Psychiatric Epidemiology, 57(7), 1483–1490. https://doi-

org.access.library.miami.edu/10.1007/s00127-021-02126-5

Kelly, A. C., & Carter, J. C. (2013). Why self‐critical patients present with more severe eating

disorder pathology: The mediating role of shame. British Journal of Clinical Psychology,

52 (2), 148 – 161. https://doi-org.access.library.miami.edu/10.1111/bjc.12006

Kelly, A. C., & Carter, J. C. (2014). Eating disorder subtypes differ in their rates of psychosocial

improvement over treatment. Journal of Eating Disorders, 2 (1). https://doi-

org.access.library.miami.edu/10.1186/2050-2974-2-2

Kelly, A. C., & Tasca, G. A. (2016). Within-persons predictors of change during eating disorders

treatment: An examination of self-compassion, self-criticism, shame, and eating disorder

symptoms. International Journal of Eating Disorders, 49(7), 716–722. https://doi-

org.access.library.miami.edu/10.1002/eat.22527

Nechita, D., Bud, S., & David, D. (2021). Shame and eating disorders symptoms: A meta‐

analysis. International Journal of Eating Disorders, 54(11), 1899–1945. https://doi-

org.access.library.miami.edu/10.1002/eat.23583
Laurie Jean Baptiste
Concept Analysis: Shame amongst individuals with eating disorders
NUR 654
Nelson, J. D., Cuellar, A. E., Cheskin, L. J., & Fischer, S. (2022). Eating disorders and

posttraumatic stress disorder: A network analysis of the comorbidity. Behavior Therapy,

53(2), 310–322. https://doi-org.access.library.miami.edu/10.1016/j.beth.2021.09.006

Merriam-Webster. (2011). Shame. In Merriam-Webster collegiate dictionary. (2011). Retrieved

March 9, 2023, from https://www.merriam-webster.com/dictionary/shame 

Tagay, S., Schlottbohm, E., Reyes-Rodriguez, M. L., Repic, N., & Senf, W. (2014). Eating

disorders, trauma, PTSD, and psychosocial resources. Eating disorders, 22(1), 33–49.

https://doi.org/10.1080/10640266.2014.857517

Troop, N, Allan, S., Serpell, L., & Treasure, J. L. (2008). Shame in women with a history of

eating disorders. European eating disorders review : the journal of the Eating Disorders

Association, 16(6), 480–488. https://doi.org/10.1002/erv.858

Wright, K. (2000). The secret and all-consuming obsessions: eating disorders. In In Youth risk: a

prevention resource for counselors, teachers, and parents (3rd ed.), Alexandria, Va.,

American Counseling Association, 2000, p.197-242.