Pride Before a Fall: Shame, Diagnostic Crossover, and Eating Disorders
Open accessAbstract
This paper discusses the findings of qualitative research that examined the accounts of five "mostly recovered" ex-patients who had experienced transition between two or more eating disorder diagnoses. This study found that, in the minds of participants, the different diagnostic labels were associated with various good or bad character traits. This contributed to the belief in a diagnostic hierarchy, whereby individuals diagnosed with anorexia nervosa were viewed as morally better than those diagnosed with bulimia nervosa or binge eating disorder. Consequently, diagnostic crossover from a "better" to a "worse" eating disorder was often experienced as shameful moral failing, and a new diagnosis impacted the individual's sense of self-identity. These findings are of significance for both ethicists and clinicians; the paper concludes by outlining the relevance and possible clinical implications of shame in diagnostic crossover and suggesting avenues for future research.
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Hierarchies and stigma exist among ED diagnoses and diagnostic subtypes, which may lead to shame, distress, and treatment avoidance.
“Hierarchies and stigma are known to exist among ED diagnoses and diagnostic subtypes, which may lead to shame, distress, and treatment avoidance [8–11]”
From A lived experience response to the proposed diagnosis of terminal anorexia nervosa: learning from iatrogenic harm, ambivalence and enduring hope (2023) · cites this paper as [8]
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Cites
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (2013) · doi:10.1176/appi.books.9780890425596 · Cited by 116,369 · see citing works
The Presentation of Self in Everyday Life.
Naegele, K. D., & Goffman, E. (1956) · American Sociological Review · doi:10.2307/2089106 · Cited by 26,021 · see citing works
The Presentation of Self in Everyday Life
Goffman, E. (2023) · Routledge eBooks · doi:10.4324/9781003320609-59 · Cited by 17,564 · see citing works
Diagnostic and Statistical Manual of Mental Disorders, 5th ed.
Carter, M. J. (2014) · Therapeutic Recreation Journal · Cited by 15,154 · see citing works
Hepburn, R. W., Heidegger, M., Macquarrie, J., & Robinson, E. (1927) · Medical Entomology and Zoology · Cited by 12,201 · see citing works
Merleau-Ponty, M. (1982) · Routledge eBooks · doi:10.4324/9780203981139 · Cited by 11,931 · see citing works
The Constant Comparative Method of Qualitative Analysis
Glaser, B. G. (1965) · Social Problems · doi:10.2307/798843 · Cited by 4,937 · see citing works
Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(02)00088-8 · Cited by 3,374 · see citing works
Williams, B. (1993) · University of California Press eBooks · doi:10.1525/9780520915282 · Cited by 2,074 · see citing works
Giving voice and making sense in interpretative phenomenological analysis
Larkin, M., Watts, S., & Clifton, E. (2006) · Qualitative Research in Psychology · doi:10.1191/1478088706qp062oa · Cited by 1,947 · see citing works
Gurwitsch, A., Merleau-Ponty, M., & Smith, C. I. (1964) · The Philosophical Review · doi:10.2307/2183671 · Cited by 1,828 · see citing works
Hiding from humanity: disgust, shame, and the law
(2004) · Choice Reviews Online · doi:10.5860/choice.42-1849 · Cited by 1,518 · see citing works
Strober, M. A., Freeman, R., Lampert, C., Diamond, J., & Kaye, W. H. (2000) · American Journal of Psychiatry · doi:10.1176/appi.ajp.157.3.393 · Cited by 557 · see citing works
Diagnostic Crossover in Anorexia Nervosa and Bulimia Nervosa: Implications for DSM-V
Eddy, K. T., Dorer, D. J., Franko, D. L., Tahilani, K., Thompson-Brenner, H., & Herzog, D. B. (2008) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2007.07060951 · Cited by 535 · see citing works
What is Shame? Some Core Issues and Controversies
Gilbert, P. (1998) · doi:10.1093/oso/9780195114799.003.0001 · Cited by 503 · see citing works
Interpretative phenomenological analysis and embodied, active, situated cognition
Larkin, M., Eatough, V., & Osborn, M. (2011) · Theory & Psychology · doi:10.1177/0959354310377544 · Cited by 324 · see citing works
Instability of eating disorder diagnoses: prospective study
Milos, G. F., Spindler, A. M., Schnyder, U., & Fairburn, C. G. (2005) · The British Journal of Psychiatry · doi:10.1192/bjp.187.6.573 · Cited by 317 · see citing works
Longitudinal comparison of anorexia nervosa subtypes
Eddy, K. T., Keel, P. K., Dorer, D. J., Delinsky, S. S., Franko, D. L., & Herzog, D. B. (2002) · International Journal of Eating Disorders · doi:10.1002/eat.10016 · Cited by 256 · see citing works
The Oxford Handbook of Contemporary Phenomenology
(2012) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780199594900.001.0001 · Cited by 219 · see citing works
Morality and Health: News Media Constructions of Overweight and Eating Disorders
Saguy, A. C., & Gruys, K. (2010) · Social Problems · doi:10.1525/sp.2010.57.2.231 · Cited by 197 · see citing works
The relationship between shame, eating disorders and disclosure in treatment
Swan, S., & Andrews, B. (2003) · British Journal of Clinical Psychology · doi:10.1348/014466503322528919 · Cited by 189 · see citing works
The Phenomenology of Shame, Guilt and the Body in Body Dysmorphic Disorder and Depression
Fuchs, T. (2002) · Journal of Phenomenological Psychology · doi:10.1163/15691620260622903 · Cited by 172 · cited 2× · see citing works
“In this sense, the lived-body becomes corporeal as the shamed person imagines herself as an object in the eyes of the other (Fuchs 2002), envisioning the conclusions that will be drawn from this evaluation of her body.”
BackgroundKeizer, A., Smeets, M. A. M., Dijkerman, H. C., Uzunbajakau, S., Elburg, A. A. V., & Postma, A. (2013) · PLoS ONE · doi:10.1371/journal.pone.0064602 · Cited by 170 · see citing works
Philosophy, Psychiatry, and Psychology
Deakin, N. A. (2015) · Elsevier eBooks · doi:10.1016/b978-0-08-097086-8.27049-9 · Cited by 148 · see citing works
Shame and pride in anorexia nervosa: a qualitative descriptive study
Skårderud, F. (2007) · European Eating Disorders Review · doi:10.1002/erv.774 · Cited by 137 · see citing works
Generating a model of epileptic stigma: The role of qualitative analysis
Scambler, G., & Hopkins, A. P. (1990) · Social Science & Medicine · doi:10.1016/0277-9536(90)90258-t · Cited by 136 · see citing works
Anorexia Nervosa and the Language of Authenticity
Hope, T., Tan, J. O. A., Stewart, A., & Fitzpatrick, R. M. (2011) · The Hastings Center Report · doi:10.1002/j.1552-146x.2011.tb00153.x · Cited by 93 · see citing works
Looking with both eyes open: fact and value in psychiatric diagnosis?
Fulford, K. W. M., Broome, M. R., Stanghellini, G., & Thornton, T. (2005) · PubMed Central · Cited by 83 · see citing works
Eating Like an Ox: Femininity and Dualistic Constructions of Bulimia and Anorexia
Burns, M. (2004) · Feminism & Psychology · doi:10.1177/0959353504042182 · Cited by 80 · see citing works
Shame as a social phenomenon: A critical analysis of the concept of dispositional shame
Leeming, D., & Boyle, M. (2004) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1348/1476083041839312 · Cited by 73 · see citing works
Saguy, A. C., Gruys, K., & Gong, S. (2010) · Social Problems · doi:10.1525/sp.2010.57.4.586 · Cited by 73 · see citing works
Descriptions and prescriptions : values, mental disorders, and the DSMs
Sadler, J. Z. (2002) · Cited by 54 · see citing works
Teroni, F., & Bruun, O. (2011) · Journal of Moral Philosophy · doi:10.1163/174552411x563574 · Cited by 42 · see citing works
A qualitative investigation into anorexia nervosa: The inner perspective
Marzola, E., Daga, G. A., Gramaglia, C. M., Amianto, F., & Fassino, S. (2015) · Cogent Psychology · doi:10.1080/23311908.2015.1032493 · Cited by 34 · see citing works
Anorexia Nervosa and the Body Uncanny : A Phenomenological Approach
Svenaeus, F. (2013) · Project Muse (Johns Hopkins University) · Cited by 29 · see citing works
Anorexia and Bulimia: Purity and Danger
Squire, S. (2003) · Australian Feminist Studies · doi:10.1080/0816464022000056349 · Cited by 28 · see citing works
Anorexia Nervosa and Bulimia: How to Help
Duker, M., & Slade, R. (2002) · Medical Entomology and Zoology · Cited by 24 · see citing works
How well does Anorexia Nervosa fit with personal values? An exploratory study
Mulkerrin, U., Bamford, B. H., & Serpell, L. (2016) · Journal of Eating Disorders · doi:10.1186/s40337-016-0109-z · Cited by 22 · see citing works
Self, consciousness, and shame
Zahavi, D. (2012) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780199594900.013.0016 · Cited by 18 · see citing works
Distinct and Untamed: Articulating Bulimic Identities
Eli, K. (2018) · Culture, Medicine, and Psychiatry · doi:10.1007/s11013-017-9545-8 · Cited by 17 · see citing works
Descriptions and prescriptions: values, mental disorders, and the DSMs
Drennan, G. (2003) · Social Science & Medicine · doi:10.1016/s0277-9536(03)00326-5 · Cited by 14 · see citing works
Anorexia Nervosa and its Moral Foundations
Giordano, S. (2005) · The International Journal of Children s Rights · doi:10.1163/1571818054545187 · Cited by 10 · see citing works
Flagged first, then by citations
3 of the 45 references couldn’t be matched to a known paper.
Research works printed but not linked: 2
- Mortimer, R. 2015. More than just a label: Identity, diagnosis and recovery from eating disorders. MA dissertation, King’s College London. https://www.academia.edu/37632772/More_than_just_a_label_identity_diagnosis_and_recovery_from_eating_disorders. Accessed June 20 2019.
- Prinz J Goldie P The moral emotions. In The Oxford handbook of philosophy of emotion 2009 Oxford Oxford University Press
Cited by
Sorted by citations
Cheshire, A., Berry, M., & Fixsen, A. M. (2020) · Appetite · doi:10.1016/j.appet.2020.104798 · Cited by 73 · see citing works
Elwyn, R. (2023) · Journal of Eating Disorders · doi:10.1186/s40337-022-00729-0 · Cited by 61 · see citing works
Shame and binge eating pathology: A systematic review
O’Loghlen, E., Grant, S., & Galligan, R. F. (2021) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2615 · Cited by 60 · see citing works
Elwyn, R., Adams, M., Sharpe, S. L., Silverstein, S., LaMarre, A., Downs, J. L., & Burnette, C. B. (2024) · Journal of Eating Disorders · doi:10.1186/s40337-024-01016-w · Cited by 37 · see citing works
Prevalence of diagnosed eating disorders in US transgender adults and youth in insurance claims
Ferrucci, K. A., Lapane, K. L., & Jesdale, B. M. (2022) · International Journal of Eating Disorders · doi:10.1002/eat.23729 · Cited by 34 · see citing works
Sharpe, S. L., Adams, M., Smith, E. K., Urban, B., & Silverstein, S. (2023) · Journal of Eating Disorders · doi:10.1186/s40337-023-00791-2 · Cited by 29 · see citing works
Greene, A. K., Norling, H. N., Brownstone, L. M., Maloul, E. K., Roe, C., & Moody, S. (2023) · Journal of Eating Disorders · doi:10.1186/s40337-023-00827-7 · Cited by 26 · see citing works
Feng, O., & Duncan, L. R. (2023) · Qualitative Research in Sport Exercise and Health · doi:10.1080/2159676x.2023.2296475 · Cited by 9 · see citing works
Fixsen, A. M., Ridge, D., Ponsford, O., Holder, M., & Saran, G. (2022) · Sociology of Health & Illness · doi:10.1111/1467-9566.13601 · Cited by 9 · see citing works
Paradoxical bio-citizenship: Examining healthy eating from lay and professional perspectives
Fixsen, A. M., Ridge, D., Cheshire, A., & Tragantzopoulou, P. (2025) · Social Science & Medicine · doi:10.1016/j.socscimed.2025.118187 · Cited by 7 · see citing works
Orthorexia Nervosa: The Medicalization of Extreme Healthy Eating Practices
Fixsen, A. M., & Cheshire, A. (2022) · Springer eBooks · doi:10.1007/978-3-030-83745-7_7 · Cited by 7 · see citing works
Cobbaert, L., Schweizer, K. W., Thomas, K. S., Elwyn, R., Bier, C., Sharpe, S. L., Hay, P., Mitchell, P. B., & Miskovic‐Wheatley, J. (2026) · Journal of Eating Disorders · doi:10.1186/s40337-026-01551-8 · Cited by 6 · see citing works
Networks of guilt, shame, pride, and disordered eating in youths show stability over time
Uddenberg, C., Everaert, J., Joormann, J., Hedy Kober, A., & Gadassi‐Polack, R. (2025) · Journal of Research on Adolescence · doi:10.1111/jora.70019 · Cited by 5 · see citing works
Brinchmann, B. S., Lyngmo, S., Herholdt‐Lomholdt, S. M., & Blix, B. H. (2022) · Journal of Eating Disorders · doi:10.1186/s40337-022-00554-5 · Cited by 3 · see citing works
Christian, H. P. (2024) · American Journal of Qualitative Research · doi:10.29333/ajqr/14084 · Cited by 2 · see citing works
Serpico, D., Petrolini, V., & Camporesi, S. (2026) · Medicine Health Care and Philosophy · doi:10.1007/s11019-026-10328-4 · Cited by 2 · see citing works
Psychometric properties of the Pride in Eating Pathology Scale in a Spanish population
Testal, J. F. R., Trinidad-Montero, J. M., Becerra, Á. R., Faija, C., & Senín‐Calderón, C. (2023) · Journal of Eating Disorders · doi:10.1186/s40337-023-00847-3 · Cited by 2 · see citing works
Outcomes and moderators of shame in residential treatment for eating disorders in females
Bowers, E. M., Petersen, J. M., Lensegrav-Benson, T., Quakenbush, B., & Twohig, M. P. (2025) · Eating Disorders · doi:10.1080/10640266.2025.2498249 · Cited by 1 · see citing works
Sutphin, T. M. S., Hicks, A. D., Marek, R. J., Gorman, K. S., & McCord, D. (2023) · Assessment · doi:10.1177/10731911231207111 · Cited by 1 · see citing works
What's in a Name? The Social Meanings of Eating Disorder Diagnoses: An Autoethnography
Whiskin, E. (2023) · doi:10.26686/wgtn.23937390 · Cited by 1 · see citing works
(2023) · Emerald Group Publishing Limited eBooks · doi:10.1108/978-1-80455-786-020231019
Greene, A. K., Norling, H. N., Brownstone, L. M., Maloul, E. K., Roe, C., & Moody, S. (2024) · Figshare · doi:10.6084/m9.figshare.26601706
Testal, J. F. R., Trinidad-Montero, J. M., Becerra, Á. R., Faija, C., & Senín‐Calderón, C. (2023) · Figshare · doi:10.6084/m9.figshare.23803115
O’Connell, L. (2026) · Qualitative Health Research · doi:10.1177/10497323261462412
- Authors
- Mortimer, R.
- Affiliations
- Warneford Hospital (GB)
- Corresponding author
- Mortimer, Rose
- ORCID
- Mortimer, Rose
- Venue
- Journal of Bioethical Inquiry
- Published
- 2019-07-01
- Volume
- 16
- Issue
- 3
- Pages
- 365-374
- ISSN
- 1176-7529 (ISSN-L)
- 1872-4353
- PMC
- PMC6831528
- OpenAlex
- W2956132224
- Cited by
- 24
- References
- 45
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 3 · 2023: 9 · 2022: 4 · 2021: 1 · 2020: 1
- FWCI
- 1.75
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Bioethical Inquiry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Wellcome Trust ([104825/Z/14/Z])
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Social Sciences › Psychology › Clinical Psychology › Psychology and Mental Health
- Keywords
- eating disorders, shame, moral failing, anorexia nervosa, bulimia nervosa, binge eating disorder, diagnostic hierarchy, self-identity, recovery, character traits
- MeSH terms
- Weight Prejudice, Adult, Anorexia Nervosa, Attitude, Ethics, Medical, Female, Humans, Interviews as Topic, Morals, Self Concept, Shame, Qualitative Research, Bulimia Nervosa, Young Adult, Binge-Eating Disorder
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