Institute of Psychology, Health and Society, University of Liverpool, UK.
The School of Psychology, University of Central Lancashire, Preston, UK.
Psychol Psychother. 2020 Mar;93(1):134-159. doi: 10.1111/papt.12198. Epub 2018 Sep 4.
Emotional states may play an important role in the development and maintenance of anorexia (AN) and bulimia nervosa (BN). This systematic review aimed to examine the evidence regarding the relationship that shame and guilt have with two eating disorders, AN and BN.
Four major databases (Pubmed, PsychINFO, Web of Science, Medline) were searched (up until April 2018) for studies measuring guilt or shame in clinically diagnosed AN and BN groups. Included papers were evaluated for risk of bias.
Twenty-four papers met the inclusion criteria. Several methodological issues were noted within the reviewed studies, including a lack of longitudinal data and unaccounted confounding variables. Nonetheless, shame was typically more common in those with AN and BN than controls, was positively related to the severity of symptoms, and associated with the onset of eating disorder-related difficulties (e.g., binging or purging). Effect sizes were typically moderate to large. The role of guilt was less clear, with few studies and mixed results.
There is preliminary evidence that shame is implicated in the aetiology of AN and BN presentations, whilst there is currently insufficient evidence of such a role for guilt. It remains unclear whether shame is a risk factor for the development of AN and BN or a consequence of these difficulties.
Elevated shame appears to be a feature of anorexia (AN) and bulimia nervosa (BN). Shame appears to fluctuate with the occurrence of eating disordered behaviours like binging, purging or restricted eating. Guilt is less consistently linked to AN and BN presentations. Interventions directed at shame may be helpful for these populations. A lack of longitudinal data means the temporal features of these relationships are still unclear.
情绪状态可能在厌食症（AN）和贪食症（BN）的发展和维持中起着重要作用。本系统综述旨在检查羞耻感和内疚感与两种进食障碍（AN 和 BN）之间关系的证据。
四个主要数据库（Pubmed、PsychINFO、Web of Science、Medline）被搜索（截至 2018 年 4 月），以查找测量临床诊断为 AN 和 BN 组的内疚或羞耻感的研究。纳入的论文评估了偏倚风险。
有 24 篇论文符合纳入标准。在审查的研究中注意到了几个方法学问题，包括缺乏纵向数据和未考虑混杂变量。尽管如此，羞耻感在 AN 和 BN 患者中比对照组更常见，与症状严重程度呈正相关，与进食障碍相关困难的发病有关（例如，暴食或清肠）。效应大小通常为中等至较大。内疚的作用则不太清楚，研究较少且结果不一致。
有初步证据表明，羞耻感与 AN 和 BN 的发病机制有关，而内疚感目前尚无这种作用的证据。尚不清楚羞耻感是 AN 和 BN 发展的危险因素，还是这些困难的后果。
升高的羞耻感似乎是厌食症（AN）和贪食症（BN）的特征。羞耻感似乎随着暴食、清肠或限制进食等进食障碍行为的发生而波动。内疚感与 AN 和 BN 的表现不太一致。针对羞耻感的干预措施可能对这些人群有帮助。缺乏纵向数据意味着这些关系的时间特征仍然不清楚。
