Shame and family relations in bulimia

Empirical studies show a relationship between family factors and disturbed eating behavior. Feelings of shame are associated with a higher level of eating disorder symptoms and with family relations perceived as being dysfunctional. Thus shame can be understood as a mediator of the relationship between dysfunctional family relations and eating disorder symptoms. For 69 female patients, including 55 with bulimia nervosa and 14 with eating disorder not otherwise specified (EDNOS) between 14 and 22 years of age, who participated in a comparative study of psychotherapy outcome, eating disorder symptoms (EDI, EDE-Q), general psychiatric symptoms severity (SCL-90R), level of shame (TESE-KJ) and perceived family relations (FB-A) were measured at the beginning of psychotherapy. The higher the feeling of shame the more dysfunctional the perceived family relationships were and the more the eating disorders and general symptoms severity were reported. Shame was a partial mediator of the relationship between family functionality and symptoms. Feelings of shame could originate in dysfunctional family relationships but could also evoke more negative perceptions of interpersonal relationships. The direction of causality could not be proven in the correlative design; nevertheless, shame contributes to an understanding of the mechanisms between dysfunctional family relationships and eating disorder symptoms.