Body shame: A biopsychosocial conceptualisation and overview with treatment implications
Shame has recently received increasing theory and research attention, as both a personal experience (to feel ashamed: Tangney & Fischer, 1995; Gilbert & Andrews, 1998) and an interpersonal process, via acts of stigmatising and shaming (Crisp, 2001; Jacoby, 1994). The experience of shame can be focused on many characteristics of the self, such as feeling ashamed of emotions (e.g., one’s anxiety, anger or sexual feelings); behaviours (e.g., things one has done in the past); perceived personality traits (e.g., laziness or carelessness) or even states of mind (e.g., mental illness). When people experience their physical bodies as in some way unattractive, undesirable and a source of a ‘shamed self’ they are at risk of psychological distress and disorders (Thompson & Kent, 2001). Such experiences are sometimes referred to as body image disturbances (e.g., Carr, Chapter 4, this volume; Cash & Grant, 1996). However, the concept of ‘body shame’ directs attention to negative experiences of both appearance and functions of the body, which can involve various sensory modalities (e.g., smell, and touch as well as vision or image, Ekströmer, Chapter 9, this volume). Moreover, by focusing on shame we can distinguish stigma, internal and external shame, and humiliation, and consider body shame in the context of developing self-awareness competencies that unfold in social and cultural contexts. Hence, this book brings together authors from diﬀerent backgrounds to address the nature of ‘body shame’, and its relationship to psychopathology and treatment. As ‘body shame’ is a relatively new concept that can link diﬀerent literatures, the opening sections of this chapter oﬀer an overview of current approaches to shame. We note the complexity of our self-conscious emotions and their relationship to primary emotions. An evolutionary and biopsychosocial framework is outlined that oﬀers the possibility of integrating physiological, psychological and socio-cultural processes and interactions. In the latter sections the relationship of shame to psychopathology is explored with a consideration of some key elements in psychological interventions.