Comorbid eating, depressive, and anxiety psychopathology is associated with elevated shame in women with food insecurity

ObjectiveTo compare participants with current food insecurity and different psychopathology profiles on shame, guilt, anxiety, and depression using a cross-sectional design. MethodWomen with current food insecurity (n = 99; 54% White) were placed into four groups based on their endorsement of symptoms of psychopathology: eating disorder with depression/anxiety comorbidity (ED-C group; n = 17), depression/anxiety only (Depression/anxiety group; n = 34), eating disorder only (ED group; n = 12), and No-diagnosis group (n = 36). Groups were compared on self-report measures of shame, guilt, depression, and anxiety using analysis of covariance. ResultsThe presence of an eating disorder was associated with quadruple the risk of screening positive for comorbid depression and anxiety. The ED-C group reported elevated shame relative to the ED and No-diagnosis groups. The ED-C group reported the highest levels of anxiety, followed by the Depression/anxiety group, and the ED and No-diagnosis groups. DiscussionThe presence of an eating disorder with comorbidity among women with food insecurity is associated with heightened shame. Given shame's status as a transdiagnostic predictor of psychopathology, it may serve as a putative mechanism underlying the relationship between food insecurity and eating disorder comorbidity. Public Significance StatementWomen with food insecurity and an ED were more likely to also screen positive for depression and/or anxiety than women with food insecurity and no ED. Overlap between ED, depression, and anxiety was associated with elevated shame, a harmful, maladaptive emotion with negative psychosocial consequences.