The Development and Exploration of the Experiences of Humiliation Scale (EHS) in an Eating Disordered Population

Previous research has identified a range of factors which contribute to the development and maintenance of eating disorders. While there have been advances in theoretical understanding of eating disorders, they remain complex and difficult to treat. The thesis sought to expand upon the knowledge base in eating disorders by exploring the role of humiliation. The systematic literature review evaluated the evidence for Cognitive Behavioural Therapy (CBT) as an intervention for Anorexia Nervosa (AN). Fourteen quantitative studies were identified and critically appraised. Results suggested that CBT was potentially effective at reducing dropout and improving adherence to treatment in AN. Most studies demonstrated improvements following CBT in terms of weight, eating-disordered symptomatology and broader psychopathology, however when compared with alternative treatment(s) CBT was not found to be superior. Numerous methodological issues were discussed and suggestions for future research considered. For the empirical paper, a questionnaire (the Experiences of Humiliation Scale, EHS) designed to measure the frequency and extent of humiliating experiences was completed by 56 adults with an eating disorder. The scale demonstrated good internal consistency and test-retest reliability. The EHS demonstrated high convergent validity when correlated with an existing humiliation measure, and analysis of divergent validity suggested the EHS was similar to, but separable from measures of the related construct of shame. Preliminary analysis of the scale’s component structure within the current clinical population suggested a similar underlying structure to a larger, non-clinical population. Levels of humiliation reported by the eating-disordered sample were significantly higher than those reported by a non-clinical population. There were no differences in reported levels of humiliation across different eating disorder diagnoses/presentations. Although limited by the small sample size, results suggested that humiliation appears to be important in eating disorders, and the EHS may be a useful tool for its measurement. Implications of the findings were discussed.