The longitudinal links between shame, eating disorders and social anxiety symptoms: a cross-lagged panel analysis

Eating disorders (ED) symptoms and social anxiety disorder (SAD) symptoms have been found to be highly comorbid, with the presence of social anxiety negatively affecting the course of ED. One explanation advanced for the high co-occurrence is the presence of shared vulnerability factors. One such factor is the experience of shame. In this study we aimed to investigate the longitudinal association between shame and both ED and SAD symptoms. Self-reported measure of different shame facets, ED and SAD symptoms were administered at four time points: baseline, 3 months, 6 months and 1 year to a diverse sample (N = 203 at T1). Both “classical” cross-lagged panels models (CPLM) and random intercept cross-lagged panels models (RI-CPLM) were used to analyze the data. At the between-person level, all types of shame were associated with ED symptoms. At the within-person level, the autoregressive paths indicate that ED and SAD symptoms are relatively stable in time, while the results for shame were mixed. Cross-lagged paths indicated that of the different shame facets only body shame and internal shame predicted ED symptoms and not vice-versa. Shame was not a significant predictor of SAD symptoms. The findings suggest that body shame acts as risk factor for ED symptoms. As existing prevention programs are not particularly efficient, focusing on risk factors such as body shame might be beneficial.