How might eating disorders stigmatization worsen eating disorders symptom severity? Evaluation of a stigma internalization model

Objective: Eating disorders stigmatization is common and is associated with greater eating disorders symptom severity. This study sought to elucidate stigma internalization as a potentialmechanism underlying this association. Two central aspects of stigma internalization werefocused on: alienation and social withdrawal.Method: A cross-national sample of individuals with self-reported eating disorders (N = 260)completed measures of eating disorders stigmatization, symptom severity, alienation, and socialwithdrawal.Results: The model evidenced excellent fit. Eating disorders stigmatization directly predictedboth alienation and social withdrawal, which, in turn, directly predicted symptom severity. Indirect effect analyses indicated that greater eating disorders stigmatization ultimately predictedgreater symptom severity via alienation and social withdrawal. Moreover, social withdrawalmediated the association of alienation with symptom severity. Fitting a direct pathway from eating disorder stigmatization to symptom severity did not improve model fit.Discussion: Our model provides a potentially useful account of the mechanisms by which eatingdisorders stigmatization might worsen eating disorder symptom severity. Specifically, the stigmainternalization processes of alienation and social withdrawal may be important factors linkingstigmatization with symptom severity. The findings have implications for clinicians attemptingto help individuals with eating disorders to monitor and modify their responses to eating disorders stigmatization