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Anxiety and eating disorders are highly comorbid (Hudson et al., 2007). The presence of comorbid anxiety along with eating disorders is likely to increase severity of the disorder, chronicity, and treatment resistance (Blinder et al., 2006). A better understanding of how this comorbidity is maintained will aid with the development of precision interventions and improvements in treatment outcomes. The present study (N= 70 adolescent females; ages 13-15) explores how maintenance factors for eating disorders (concern over mistakes [CM; the excessive worry of making errors], shame, and social appearance anxiety [SAA; the fear of being negatively judged based on one’s appearance]) relate to eating disorder and anxiety symptoms in a comorbidity model

The path model included SAA, CM, and shame around eating in association with anxiety and eating disorder symptoms. The model displayed excellent fit: CFI = 1.00; TLI: 1.00, RMSEA: 0.00. Shame was significantly associated with both anxiety (b*= 0.26; p= .033) and eating disorder symptoms (b*= 0.40; p = 0.012). Interestingly, CM was only significantly associated with anxiety (b*= 0.34; p = 0.008) but not eating disorder (p= 0.135) symptoms. Further, SAA was only significantly associated with eating disorder (b*= 0.55; p< 0.001) but not anxiety (p= 0.135) symptoms.

It was found that only shame served as a shared maintenance factor between eating disorder and anxiety symptoms in adolescent females. Interestingly, concern over mistakes was uniquely associated with anxiety, while social appearance anxiety was uniquely associated with eating disorder symptoms. Current research supports that those with eating disorders exhibit generalized shame, beyond just their eating behavior (Keith, Gillanders & Simpson, 2009). It is thus possible that shame maintains both eating disorder and anxiety symptoms by fueling avoidance behaviors in a variety of situations. Thus, targeting shame can potentially help alleviate this comorbidity and future research should explore how shame is maintained.

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Eating disorders, anxiety, comorbidity


Social and Behavioral Sciences

Shame is the Shared Maintenance Factor in an Eating Diosrder-Anxiety Symptom Comorbidity Model in Female Adolescents