Experiences of shame and guilt in Anorexia and Bulimia Nervosa: A systematic review

Blythin, Suzanne P. M, Nicholson, Hannah L., Macintyre, Vanessa, Dickson, Joanne M., Fox, John R. E. ORCID: https://orcid.org/0000-0003-3039-8024 and Taylor, Peter J. 2020. Experiences of shame and guilt in Anorexia and Bulimia Nervosa: A systematic review. Psychology and Psychotherapy: Theory, Research and Practice 93 (1) , pp. 134-159. 10.1111/papt.12198

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Abstract

Objectives Emotional states may play an important role in the development and maintenance of anorexia (AN) and bulimia nervosa (BN). This systematic review aimed to examine the evidence regarding the relationship that shame and guilt have with two eating disorders, AN and BN. Methods Four major databases (Pubmed, PsychINFO, Web of Science, Medline) were searched (up until April 2018) for studies measuring guilt or shame in clinically diagnosed AN and BN groups. Included papers were evaluated for risk of bias. Results Twenty‐four papers met the inclusion criteria. Several methodological issues were noted within the reviewed studies, including a lack of longitudinal data and unaccounted confounding variables. Nonetheless, shame was typically more common in those with AN and BN than controls, was positively related to the severity of symptoms, and associated with the onset of eating disorder‐related difficulties (e.g., binging or purging). Effect sizes were typically moderate to large. The role of guilt was less clear, with few studies and mixed results. Discussion There is preliminary evidence that shame is implicated in the aetiology of AN and BN presentations, whilst there is currently insufficient evidence of such a role for guilt. It remains unclear whether shame is a risk factor for the development of AN and BN or a consequence of these difficulties.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Psychology
Publisher:	Wiley
ISSN:	2044-8341
Date of First Compliant Deposit:	14 August 2018
Date of Acceptance:	13 August 2018
Last Modified:	03 May 2023 19:23
URI:	https://orca.cardiff.ac.uk/id/eprint/114168

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