# Measuring shame in eating disorders: confirmatory factor analyses and psychometric properties of a new internal and external shame scale

## TL;DR

This study introduces a new scale to measure internal and external shame in eating disorders, validating its structure and usefulness for understanding and addressing these conditions.

## Contribution

The paper presents a novel, validated scale (EISS-ED) for measuring both internal and external shame in the context of eating disorders.

## Key findings

- The EISS-ED has a two-factor structure with 12 items and shows factorial invariance by clinical history and gender.
- External and internal shame correlated positively with eating disorder symptoms, negative affect, and detachment.
- The scale provides fair classification accuracy for individuals with a history of eating disorder treatment or clinical assessment.

## Abstract

Feelings of shame can play a role in the development and maintenance of mental disorders. However, the role and measurement of shame in relation to eating disorders remain poorly understood. The current work presents the adaptation of a measure of external and internal shame in relation to eating disorders (EISS-ED) based on an integrative perspective that leverages the strengths of the biopsychosocial model and shame-pride cycle framework. Specifically, the EISS-ED accounts for how individuals believe they are perceived by others (external shame) and how they perceive themselves (internal shame) in relation to eating.

The study used confirmatory factor analyses to examine the factor structure and psychometric properties of the EISS-ED (N = 478), Spearman’s correlations and Receiver Operator Characteristic curves were used for validity testing.

The results supported the two-factor structure (including 12 items) of the EISS-ED and its factorial invariance by clinical history and gender. Concurrent validity analyses showed positive correlations between external and internal shame and eating disorder symptoms, negative affect, and detachment. Both external and internal shame measures provided fair classification accuracy of participants based on self-reported history of clinical assessment or treatment for eating disorders.

These findings improve the understanding of the role of shame in eating disorders and offer evidence on a valid assessment that can aid in identifying, measuring, and addressing this important construct, supporting targeted interventions.

Level of evidence: Level V, descriptive study.