Does body shame mediate the relationship between parental bonding, self-esteem, maladaptive perfectionism, body mass index and eating disorders? A structural equation model

  • Stefania CellaEmail author
  • Mara Iannaccone
  • Paolo Cotrufo
Original Article



Body shame has been strongly associated with eating pathology. However, less is known about the predisposing factors linked to these feelings and how they interact with other variables in eating disorder development. Thus, the aim of the present study was to provide a preliminary understanding of the relationship between body shame and some of the major risk factors for eating disorder onset, identifying the possible mechanisms of action. Specifically, we tested a structural equation model in which perceived parental bonding, self-esteem, perfectionism, and body mass index are associated with eating disorder risk via body shame.


1156 high school students aged 13–20 were screened by means of self-report measures of parental behavior, self-esteem, perfectionism, body shame and eating disorder risk. The height and weight of each individual were measured.


In predicting eating disorder risk, parental protectiveness (β = 0.09), body mass index (β = 0.18), self-esteem (β = − 0.14) and body shame (β = 0.58) had a direct effect on this variable and overall our model accounted for 58% of its variance. The experience of shame related to one’s body appeared to have a considerably significant influence on eating disturbances vulnerability and it also serves as a mediator between other risk factors and eating disturbance risk. A series of multi-group analyses indicated no significant difference between males and females.


The emotion of shame may enhance our understanding of eating disorders, as well as being a salient factor for the development of preventive programs and treatment approaches.

Level of evidence

Level V, cross-sectional descriptive study.


Body shame Eating disorder risk Parental bonding Perfectionism Self-esteem Body mass index 


Author contributions

PC designed the study and wrote the protocol. SC and MI conducted literature searches and provided summaries of previous research studies. SC and MI conducted the statistical analysis and wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.


No funding was received.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Andrews B, Qian M, Valentine JD (2002) Predicting depressive symptoms with a new measure of shame: the experience of shame scale. Br J Clin Psychol 41:29–42. CrossRefPubMedGoogle Scholar
  2. 2.
    Goss K, Gilbert P (2002) Eating disorders, shame and pride: a cognitive-behavioural functional analysis. In: Gilbert P, Miles J (eds) Body shame: conceptualisation, research and treatment. Brunner-Routledge, Hove, pp 219–255Google Scholar
  3. 3.
    Troop NA, Redshaw C (2012) General shame and bodily shame in eating disorders: a 2.5-year longitudinal study. Eur Eat Disord 20:373–378. CrossRefGoogle Scholar
  4. 4.
    Doran J, Lewis CA (2012) Components of shame and eating disturbance among clinical and non-clinical populations. Eur Eat Disord 20:265–270. CrossRefGoogle Scholar
  5. 5.
    Duarte C, Pinto-Gouveia J, Ferreira C (2014) Escaping from body image shame and harsh self-criticism: exploration of underlying mechanisms of binge eating. Eat Behav 15:638–643. CrossRefPubMedGoogle Scholar
  6. 6.
    Higgins MK, Lin SL, Alvarez A, Bardone-Cone AM (2015) Examining impulsivity as a moderator of the relationship between body shame and bulimic symptoms in Black and White young women. Body Image 14:39–46. CrossRefPubMedGoogle Scholar
  7. 7.
    Skårderud F (2007) Shame and pride in anorexia nervosa: a qualitative descriptive study. Eur Eat Disord 15:81–97. CrossRefGoogle Scholar
  8. 8.
    Cavalera C, Pagnini F, Zurloni V, Diana B, Realdon O, Castelnuovo G, Todisco P, Molinari E (2016) Shame proneness and eating disorders: a comparison between clinical and non-clinical samples. Eat Weight Disord 21:701–707. CrossRefPubMedGoogle Scholar
  9. 9.
    Rosenberg M (1965) Society and the adolescent self-image. Princeton University Press, PrincetonCrossRefGoogle Scholar
  10. 10.
    Sassaroli S, Gallucci M, Ruggiero GM (2008) Low perception of control as a cognitive factor of eating disorders. Its independent effects on measures of eating disorders and its interactive effects with perfectionism and self-esteem. J Behav Ther Exp Psy 39:467–488. CrossRefGoogle Scholar
  11. 11.
    Shea ME, Pritchard ME (2007) Is self-esteem the primary predictor of disordered eating? Pers Individ Differ 42:1527–1537. CrossRefGoogle Scholar
  12. 12.
    Tylka TL, Subich LM (2004) Examining a multidimensional model of eating disorder symptomatology among college women. J Couns Psychol 51:314–328. CrossRefGoogle Scholar
  13. 13.
    Iannaccone M, D’Olimpio F, Cella S, Cotrufo P (2016) Self-esteem, body shame and eating disorder risk in obese and normal weight adolescents: a mediation model. Eat Behav 2:80–83. CrossRefGoogle Scholar
  14. 14.
    Sim LA, Lebow J, Billings M (2013) Eating disorders in adolescents with a history of obesity. Pediatrics 132:e1026–e1030.
  15. 15.
    Sjöberg RL, Nilsson KW, Leppert J (2005) Obesity, shame, and depression in school-aged children: a population-based study. Pediatrics 116:e389–e392. CrossRefPubMedGoogle Scholar
  16. 16.
    Mensinger JL, Tylka TL, Calamari ME (2018) Mechanisms underlying weight status and healthcare avoidance in women: a study of weight stigma, body-related shame and guilt, and healthcare stress. Body Image 25:139–147. CrossRefPubMedGoogle Scholar
  17. 17.
    Moreira H, Canavarro MC (2017) Is body shame a significant mediator of the relationship between mindfulness skills and the quality of life of treatment-seeking children and adolescents with overweight and obesity? Body Image 20:49–57. CrossRefPubMedGoogle Scholar
  18. 18.
    Lissau I, Sørensen TI (1994) Parental neglect during childhood and increased risk of obesity in young adulthood. Lancet 5:324–327. CrossRefGoogle Scholar
  19. 19.
    Frost RO, Marten P, Lahart CM, Rosenblate R (1990) The Dimensions of perfectionism. Cogn Ther Res 14:449–468. CrossRefGoogle Scholar
  20. 20.
    Holland LA, Bodell LP, Keel PK (2013) Psychological factors predict eating disorder onset and maintenance at 10-year follow-up. Eur Eat Disord 21:405–410. CrossRefGoogle Scholar
  21. 21.
    Egan SJ, Wade TD, Shafran R (2011) Perfectionism as a transdiagnostic process: a clinical review. Clin Psychol Rev 31:203–212. CrossRefPubMedGoogle Scholar
  22. 22.
    Boone L, Soenens B, Vansteenkiste M, Braet C (2012) Is there a perfectionist in each of us? An experimental study on perfectionism and eating disorder symptoms. Appetite 59:531–540. CrossRefPubMedGoogle Scholar
  23. 23.
    Joyce F, Watson HJ, Egan SJ, Kane RT (2012) Mediators between perfectionism and eating disorder psychopathology in a community sample. Eat Behav 13:361–365. CrossRefPubMedGoogle Scholar
  24. 24.
    Ferreira C, Trindade IA, Ornelas L (2015) Exploring drive for thinness as a perfectionistic strategy to escape from shame experiences. Span J Psychol 20:18:E29. CrossRefGoogle Scholar
  25. 25.
    Marta-Simões J, Ferreira C (2016) Seeking a perfect body look: feeding the pathogenic impact of shame? Eat Weight Disord 21:477–485. CrossRefPubMedGoogle Scholar
  26. 26.
    Oliveira S, Trindade IA, Ferreira C (2018) Explaining male body attitudes: the role of early peer emotional experiences and shame. Eat Weight Disord. Google Scholar
  27. 27.
    Duarte C, Pinto-Gouveia J, Stubbs RJ (2017) The prospective associations between bullying experiences, body image shame and disordered eating in a sample of adolescent girls. Pers Individ Differ 116:319–325. CrossRefGoogle Scholar
  28. 28.
    Andrews B (1997) Bodily shame in relation to abuse in childhood and bulimia: a preliminary investigation. Br J Clin Psychol 36:41–49. CrossRefPubMedGoogle Scholar
  29. 29.
    Talmon A, Ginzburg K (2018) “Body self” in the shadow of childhood sexual abuse: the long-term implications of sexual abuse for male and female adult survivors. Child Abuse Negl 76:416–425. CrossRefPubMedGoogle Scholar
  30. 30.
    Jáuregui Lobera I, Bolaños Ríos P, Garrido Casals O (2011) Parenting styles and eating disorders. J Psychiatr Ment Health Nurs 18:728–735. CrossRefPubMedGoogle Scholar
  31. 31.
    Perry JA, Silvera DH, Neilands TB, Rosenvinge JH, Hanssen T (2008) A study of the relationship between parental bonding, self-concept and eating disturbances in Norwegian and American college populations. Eat Behav 9:13–24. CrossRefPubMedGoogle Scholar
  32. 32.
    Cella S, Iannaccone M, Cotrufo P (2014) How perceived parental bonding affects self-concept and drive for thinness: a community-based study. Eat Behav 15:110–115. CrossRefPubMedGoogle Scholar
  33. 33.
    Lutwak N, Ferrari JR (1997) Understanding shame in adults: retrospective perceptions of parental bonding during childhood. J Nerv Ment Dis 185:595–598. CrossRefPubMedGoogle Scholar
  34. 34.
    Leung N, Thomas G, Waller G (2000) The relationship between parental bonding and core beliefs in anorexic and bulimic women. Br J Clin Psychol 39:205–213. CrossRefPubMedGoogle Scholar
  35. 35.
    Murray C, Waller G, Legg C (2000) Family dysfunction and bulimic psychopathology: the mediating role of shame. Int J Eat Disord 28:84–89. CrossRefPubMedGoogle Scholar
  36. 36.
    Turner HM, Rose KS, Cooper MJ (2005) Parental bonding and eating disorder symptoms in adolescents: the meditating role of core beliefs. Eat Behav 6:113–118. CrossRefPubMedGoogle Scholar
  37. 37.
    Markham A, Thompson T, Bowling A (2005) Determinants of body-image shame. Pers Individ Differ 38:1529–1541. CrossRefGoogle Scholar
  38. 38.
    Parker G, Tupling H, Brown LB (1979) A parental bonding instrument. Br J Med Psychol 52:1–10. CrossRefGoogle Scholar
  39. 39.
    Garner DM (2004) Eating Disorder Inventory-third edition (EDI-3). Psychological Assessment Resources, LutzGoogle Scholar
  40. 40.
    Segura-García C, Aloi M, Rania M, Ciambrone P, Palmieri A, Pugliese V, Ruiz Moruno AJ, De Fazio P (2015) Ability of EDI-2 and EDI-3 to correctly identify patients and subjects at risk for eating disorders. Eat Behav 19:20–23. CrossRefPubMedGoogle Scholar
  41. 41.
    Jöreskog KG, Sörbom D (2006) LISREL 8.80 for Windows. Scientific Software International, LincolnwoodGoogle Scholar
  42. 42.
    Anderson JC, Gerbing DW (1988) Structural equation modeling in practice: a review and recommended two-step approach. Psychol Bull 103:411–423. CrossRefGoogle Scholar
  43. 43.
    Hoyle RH, Panter AT (1995) Writing about structural equation models. In: Hoyle RH (ed) Structural equation modeling: concepts, issues, and applications. Sage, Newbury ParkGoogle Scholar
  44. 44.
    Steiger JH (1990) Structural model evaluation and modification: an interval estimation approach. Multivar Behav Res 25:173–180. CrossRefGoogle Scholar
  45. 45.
    Bentler PM (1990) Comparative fit indexes in structural models. Psychol Bull 107:238–246. CrossRefPubMedGoogle Scholar
  46. 46.
    Bentler PM, Bonnet DC (1980) Significance tests and goodness of fit in the analysis of covariance structures. Psychol Bull 88:588–606. CrossRefGoogle Scholar
  47. 47.
    Satorra A, Bentler PM (2001) A scaled difference Chi-square test statistic for moment structure analysis. Psychometrika 66:507–514. CrossRefGoogle Scholar
  48. 48.
    Cheung GW, Rensvold RB (2002) Evaluating goodness-of-fit indexes for testing measurement invariance. Struct Equ Model 9:233–255. CrossRefGoogle Scholar
  49. 49.
    Byrne BM (1998) Structural equation modeling with LISREL, PRELIS and SIMPLIS: basic concepts, applications and programming. Lawrence Erlbaum Associates Publishers, MahwahGoogle Scholar
  50. 50.
    Byrne BM (2006) Structural equation modeling with EQS: basic concepts, applications and programming, 2nd edn. Lawrence Erlbaum Associates Publishers, MahwahGoogle Scholar
  51. 51.
    Horn JL, McArdle JJ (1992) A practical and theoretical guide to measurement invariance in aging research. Exp Aging Res 105:117–144. CrossRefGoogle Scholar
  52. 52.
    Tangney JP (1992) Situational determinants of shame and guilt in young adulthood. Pers Soc Psychol Bull 18:199–206. CrossRefGoogle Scholar
  53. 53.
    Swanson H, Power K, Collin P, Deas S, Paterson G, Grierson D, Yellowlees A, Park K, Taylor L (2010) The relationship between parental bonding, social problem solving and eating pathology in an anorexic inpatient sample. Eur Eat Disord 18:22–32. CrossRefGoogle Scholar
  54. 54.
    Grenon R, Tasca GA, Maxwell H, Balfour L, Proulx G, Bissada H (2016) Parental bonds and body dissatisfaction in a clinical sample: the mediating roles of attachment anxiety and media internalization. Body Image 19:49–56. CrossRefPubMedGoogle Scholar
  55. 55.
    Levinson CA, Rodebaugh TL, White EK, Menatti AR, Weeks JW, Iacovino JM, Warren CS (2013) Social appearance anxiety, perfectionism, and fear of negative evaluation: distinct or shared risk factors for social anxiety and eating disorders? Appetite 67:125–133. CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Fairburn CG (1995) Overcoming binge eating. Guilford Press, New YorkGoogle Scholar
  57. 57.
    Wade TD, Wilksch SM, Paxton SJ, Byrne SM, Austin SB (2015) How perfectionism and ineffectiveness influence growth of eating disorder risk in young adolescent girls. Behav Res Ther 66:56–63. CrossRefPubMedGoogle Scholar
  58. 58.
    Hewitt PL, Flett GL, Ediger E (1995) Perfectionism traits and perfectionistic self-presentation in eating disorder attitudes, characteristics, and symptoms. Int J Eat Disord 18:317–326. CrossRefPubMedGoogle Scholar
  59. 59.
    Button EJ, Loan P, Davies J, Sonuga-Barke EJ (1997) Self-esteem, eating problems, and psychological well-being in a cohort of schoolgirls aged 15–16: a questionnaire and interview study. Int J Eat Disord 21:39–47. CrossRefPubMedGoogle Scholar
  60. 60.
    Oliveira S, Trindade IA, Ferreira C (2018) The buffer effect of body compassion on the association between shame and body and eating difficulties. Appetite 125:118–123. CrossRefPubMedGoogle Scholar
  61. 61.
    Dias BS, Ferreira C, Trindade IA (2018) Influence of fears of compassion on body image shame and disordered eating. Eat Weight Disord. PubMedGoogle Scholar
  62. 62.
    Cella S, Cipriano A, Iannaccone M, Cotrufo P (2017) Identifying predictors associated with the severity of eating concerns in females with eating disorders. RIPPPO 20:91–99. Google Scholar
  63. 63.
    Baker J, White N, Mengersen K (2014) Missing in space: an evaluation of imputation methods for missing data in spatial analysis of risk factors for type II diabetes. Int J Health Geogr 13:47. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Observatory on Eating Disorders, Department of PsychologyUniversity of Campania “Luigi Vanvitelli”CasertaItaly

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