Shame plays a central role in psychosocial functioning, being a transdiagnostic emotion associated with several mental health conditions. According to the evolutionary biopsychosocial model, shame is ...a painful and difficult emotion that may be categorized into two distinct focal components: external and internal shame. External shame is focused on the experience of the self as seen in a judgemental way by others, whereas internal shame is conceptualized as self-focused negative evaluations and feelings about the self. The current study aimed to develop the External and Internal Shame Scale (EISS) to assess in a single measure these two dimensions. The study was conducted in a community sample comprising 665 participants (18 to 61 years old). Three models were tested through confirmatory factor analysis. One higher order factor (global shame) with two lower order factors (external and internal shame) revealed a good fit to the data. The scale reliability and its association with other related constructs measures were also addressed. Additionally, gender differences on shame were explored. Results showed that EISS subscales and global score presented good internal consistency, concurrent validity and were associated with depressive symptoms. Regarding gender differences, results revealed that women presented significantly higher scores both in external and internal shame. The EISS showed to be a short, robust and reliable measure. The EISS allows the assessment of the specific dimensions of external and internal shame as well as a global sense of shame experience and may therefore be an important contribution for clinical work and research in human psychological functioning.
Purpose
Orthorexia nervosa (ON) is considered a pathological fixation with healthy eating. Despite recent research focus, there is still a lot of inconsistent information concerning ON, including its ...definition and validity of its measuring tools. This study aimed to extend the current knowledge on ON, by developing and validating the Portuguese adaptation of the Dusseldorf Orthorexie Scale (DOS) and studying its prevalence and relationship with different psychological indicators, sex, BMI and dietary pattern.
Methods
Data were collected online, through self-report questionnaires, and two different samples were collected, with 513 (Sample 1) and 541 participants (Sample 2) from the general population.
Results
DOS’ one-dimensional factorial structure and reliability was confirmed. ON’s prevalence was 10.52%. Results revealed that women present higher scores on DOS than men, but no differences were found regarding the BMI groups. DOS was positively related to all psychological indicators, with moderate and strong relationships with disordered eating and inflexible eating. Sample 2 was used to explore ON’s differences between dietary patterns, with results demonstrating that omnivores present significantly lower levels of orthorexic tendencies, when compared with the vegetarian, vegan, and paleo groups.
Conclusions
The present study is the first to successfully validate a measure that assesses ON for the Portuguese population and adds to the existing literature in several other important ON aspects.
Level of evidence
Level V—validation study.
Purpose
Orthorexia Nervosa (ON) has been a research focus in recent years. Despite the lack of consensus on its definition and classification as a psychiatric disorder, research has shown that ON is ...linked to certain behaviours (orthorexic behaviours, e.g.: obsessive thinking and compulsive behavior, guilt and self-punishment, restriction), associated with disordered eating. However, very little is known about this relationship. The aim of this study was to explore the eating-related processes inherent to the relationship between orthorexic behaviours and disordered eating, and understand if it is through the adoption of a more inflexible and less intuitive eating approach, that an interest in healthy eating develops into a pathological one, while controlling the effect of age and BMI. Additionally, this relationship was explored for two different groups: Omnivores and Non-omnivores.
Methods
Four hundred fifty-one women (281 Omnivores and 170 Non-omnivores) from the Portuguese population participated in this study, by answering a set of self-report measures.
Results
Non-omnivores presented significant higher levels of orthorexic behaviours and inflexible eating. In both groups, orthorexic behaviours and disordered eating were linked positively to inflexible eating and negatively to intuitive eating. A path model analyses showed that the preferred eating approach mediated the relationship between orthorexic behaviours and disordered eating, explaining 51% of the variance of disordered eating. A multigroup analysis confirmed the model invariance between Omnivores and Non-omnivores.
Conclusions
Our findings contribute to the better understanding of the relationship between orthorexic behaviours and disordered eating and its eating-related processes. Future research regarding the clinical intervention and prevention of ON in women should focus on encouraging a more intuitive eating approach.
Level of evidence
IV, cross-sectional study
This study examined whether compassionate skills (the ability to be self-compassionate and to receive compassion from others) operate as mediator processes in the relationship between negative major ...life events and psychological quality of life (QoL), in 467 adults. The path model accounted for 48% of psychological QoL’ variance and indicated that negative appraisal of major life events was associated with decreased psychological QoL, through increased levels of shame and less compassionate abilities. Findings support the importance of community programmes to enhance psychological QoL, that help individuals cultivate self-compassion and the ability to receive compassion from others, especially in face of adverse events.
Purpose
Despite the growing interest in binge eating, research on this public health problem in male samples is limited. Indeed, the examination of underlying emotional mechanisms and potential ...gender differences in binge eating are still needed. This study explored differences between men and women in binge eating severity and related emotional mechanisms. Also, this study explored the impact of external and internal shame on binge eating severity, when mediated by body image-related shame and cognitive fusion, in men and women.
Methods
The sample consists of 787 participants from the general population (144 men and 643 women), aged from 18 to 40 years.
Results
Women presented higher levels of binge eating symptomatology and also of body image-related difficulties, than men. Path analysis results showed that external and internal shame had a significant impact on binge eating severity, and that these relationships were mediated by body image-related shame and cognitive fusion. Multi-group analysis revealed the invariance of this model in both sexes.
Conclusion
Although men and women revealed significant differences in the severity of binge eating and related emotional mechanisms, underlying mechanisms in binge eating seem to be invariant for gender. Indeed, this study suggested that both external and internal shame experiences play an important role in binge eating symptomatology, when associated with body image-related shame and cognitive fusion, both in men and women. These findings seem to support that binge eating may emerge as a maladaptive attempt to cope with shame experiences in both sexes.
Level of evidence
Level III: case control analytic study.
Purpose
The central role of caregiver eating messages has been recognized on later individual’s eating behaviour, body image and weight status. Additionally, shame is a painful emotion also ...associated with the development and maintenance of body image and eating-related difficulties. The main aim of the present study was to explore the moderator effect of the recall of caregiver eating messages on the associations between external shame, body weight and shape-related concerns, and the adoption of inflexible eating rules.
Methods
The sample comprised 479 women from the general population, aged from 18 to 60 years, who completed self-report measures.
Results
Results of the correlation analyses showed that early caregiver restrictive/critical eating messages were positively associated with external shame, inflexible eating and overvaluation of body weight and shape. Path analysis results demonstrated a moderator effect of early caregiver critical eating messages on the relationship between external shame and both weight and shape-related concerns and inflexible eating. These results revealed that caregiver restrictive/critical eating messages exacerbated the impact of shame on these psychopathological indices, with the tested model accounting for 19% and 38% of the variance of inflexible eating rules and body weight and shape concerns, respectively.
Conclusions
These findings seem to suggest important research and clinical implications, contributing to the understanding of disordered eating patterns, and appear to represent a new avenue for the development of prevention and intervention programs. Particularly, these findings support the relevance of targeting caregiver eating-related attitudes and messages in prevention interventions for eating psychopathology.
Level of evidence
Level V, cross-sectional descriptive study.
Body Dysmorphic Disorder (BDD) is a serious psychiatric condition that has long been identified as an important risk factor for the development of eating-related difficulties. However, little is ...known about the mechanisms that might explain this association. Therefore, the current study aimed to explore the link between body dysmorphic symptomatology and disordered eating, and test whether this relationship is mediated by higher levels of shame and self-criticism. This cross-sectional study included 291 women from the community, aged between 18 and 62 years old, who completed self-report measures. Path analysis revealed that BDD symptomatology has not only a direct effect on disordered eating, but also an indirect effect, mediated by shame and self-criticism. The path model revealed a very good fit, accounting for 38% and 31% of internal and external shames’ variances, respectively, for 69% of self-criticism variance, and 58% of the variance of disordered eating. These findings seem to suggest that in women with BDD symptomatology, disordered eating may emerge as a compensatory strategy to cope with general feelings of inferiority/defectiveness, particularly in the presence of shame experiences and self-critical attitudes/behaviours. Moreover, this study emphasizes the importance to invest in innovative treatment and prevention approaches for BDD that specifically target shame and self-criticism, such as compassion-based therapies.
IV, cross-sectional study.
ObjectivesThe interaction between the immune system and tumor cells is an important feature for the prognosis and treatment of cancer. Multiplex immunohistochemistry (mIHC) and multiplex ...immunofluorescence (mIF) analyses are emerging technologies that can be used to help quantify immune cell subsets, their functional state, and their spatial arrangement within the tumor microenvironment.MethodsThe Society for Immunotherapy of Cancer (SITC) convened a task force of pathologists and laboratory leaders from academic centers as well as experts from pharmaceutical and diagnostic companies to develop best practice guidelines for the optimization and validation of mIHC/mIF assays across platforms.ResultsRepresentative outputs and the advantages and disadvantages of mIHC/mIF approaches, such as multiplexed chromogenic IHC, multiplexed immunohistochemical consecutive staining on single slide, mIF (including multispectral approaches), tissue-based mass spectrometry, and digital spatial profiling are discussed.ConclusionsmIHC/mIF technologies are becoming standard tools for biomarker studies and are likely to enter routine clinical practice in the near future. Careful assay optimization and validation will help ensure outputs are robust and comparable across laboratories as well as potentially across mIHC/mIF platforms. Quantitative image analysis of mIHC/mIF output and data management considerations will be addressed in a complementary manuscript from this task force.
This study aimed to explore, through structural equation modelling, experiential avoidance and committed action’s effects on the association between anxiety and psychological quality of life and ...whether this relationship presents significant differences across a sample of 115 college students with chronic illness and a sample of 232 students without illness. Students with chronic illness presented higher levels of anxiety and experiential avoidance and lower levels of quality of life. The association between anxiety and psychological quality of life was partially explained by experiential avoidance and committed action. This path model was shown to be invariant between the two groups of students.
Adolescence is considered a transitional stage characterized by several physical, psychological and social changes. During this period, there is an increased propensity for the emergence of emotional ...difficulties, especially those related to body image and eating attitudes and behaviours. In particular, shame has been pointed out as a key risk factor for body image and eating-related difficulties. However, research seems to be scarce regarding this association in adolescent samples. Therefore, the current study aimed to explore whether psychological inflexibility impacts the association between general feelings of shame with body image-related shame and eating psychopathology severity. The study was conducted with 226 adolescent girls from the community, aged between 12 and 18, who completed self-report measures. Path analysis indicated that higher levels of external shame were associated with more externalized and internalized body image shame and also with greater engagement in disordered eating behaviours. Furthermore, the model demonstrated that these relationships were mediated by increased levels of psychological inflexibility. The tested model accounted for a total of 30% and 22% of externalized and internalized body image variances, respectively, and 51% of the variance of disordered eating behaviours. These findings appear to suggest that in adolescent girls, body shame and disordered eating may emerge as defensive and maladaptive strategies to cope with general feelings of inferiority, particularly in the presence of psychological inflexibility. Also, this study highlights the importance of assessing and working underlying maladaptive processes in this association, mainly in adolescents with high levels of shame.
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