Naming and shaming as a strategy for enforcing the Paris Agreement: The role of political institutions and public concern.

Enforcement is a challenge for effective international cooperation. In human rights and environmental law, along with many other domains of international cooperation, "naming and shaming" is often used as an enforcement mechanism in the absence of stronger alternatives. Naming and shaming hinges on the ability to identify countries whose efforts are inadequate and effectively shame them toward better behavior. Research on this approach has struggled to identify factors that explain when it influences state behavior in ways that lead to more cooperation. Via survey of a large (N = 910) novel sample of experienced diplomats involved in the design of the Paris Agreement, we find support for the proposition that naming and shaming is most accepted and effective in influencing the behavior of countries that have high-quality political institutions, strong internal concern about climate change, and ambitious and credible international climate commitments. Naming and shaming appears less effective in other countries, so further enforcement mechanisms will be needed for truly global cooperation. We also find that the climate diplomacy experts favor a process of naming and shaming that relies on official intergovernmental actors, in contrast with studies suggesting that NGOs, media, and other private actors are more effective at naming and shaming. We suggest that these tensions-the inability for naming and shaming to work effectively within the countries least motivated for climate action and the preference for namers and shamers that seem least likely to be effective-will become central policy debates around making cooperation on climate change more enforceable.

Micro-sequences of anger and shame and non-suicidal self-injury in youth: an ecological momentary assessment study.

OBJECTIVE: Non-suicidal self-injury (NSSI) is a significant mental health concern with the highest prevalence among adolescents. NSSI has been conceptualized as one of the maladaptive strategies to cope with challenging affect or a form of self-punishment. Although characterizing moment-to-moment associations between shame and NSSI in individuals' real-world environment and partitioning between- and within-person effects is critical for mobile and timely interventions, most studies examined habitual experiences of negative affective states and focused on adults. METHOD: In this study, we focused on in vivo anger at self and others and shame and NSSI among 158 adolescents 3 weeks following their psychiatric hospitalizations using ecological momentary assessment (EMA) technology. RESULTS: We found that greater between-person levels of anger at self and others were linked to a higher number of subsequent NSSI occurrences within a day. These findings remained primarily unchanged when we statistically adjusted for participants' age, sex assigned at birth, the number of current psychiatric diagnoses, EMA response rates, and youth lifetime history of SI. Within-person increases in NSSI were linked to increased anger at self over and beyond between-person average levels of NSSI. CONCLUSIONS: These findings highlight the potential regulatory role of NSSI to decrease negative affective states and point to the clinical utility of assessing and early mobile interventions targeting challenging affect in youth.

HIV-related Shame among Women Giving Birth in Tanzania: A Mixed Methods Study.

Women living with HIV (WLHIV) commonly experience HIV-related shame which can interfere with HIV care-seeking behavior and lead to poor clinical outcomes. HIV-related shame may be particularly heightened during the pregnancy and postpartum periods. This study aimed to describe HIV-related shame among WLHIV giving birth, identify associated factors, and qualitatively examine the impacts of HIV-related shame on the childbirth experience. Postpartum WLHIV (n = 103) were enrolled in the study between March and July 2022 at six clinics in the Kilimanjaro Region, Tanzania. Participants completed a survey within 48 h after birth, prior to being discharged. The survey included a 13-item measure of HIV-related shame, which assessed levels of HIV-related shame (Range: 0-52). Univariable and multivariable regression models examined factors associated with HIV-related shame. Qualitative in-depth interviews were conducted with pregnant WLHIV (n = 12) and postpartum WLHIV (n = 12). Thematic analysis, including memo writing, coding, and synthesis, was employed to analyze the qualitative data. The survey sample had a mean age of 29.1 (SD = 5.7), and 52% were diagnosed with HIV during the current pregnancy. Nearly all participants (98%) endorsed at least one item reflecting HIV-related shame, with an average endorsement of 9 items (IQR = 6). In the final multivariable model, HIV-related shame was significantly associated with being Muslim vs. Christian (ß = 6.80; 95%CI: 1.51, 12.09), attending less than four antenatal care appointments (ß = 5.30; 95%CI: 0.04, 10.55), and reporting experiences of HIV stigma in the health system (ß = 0.69; 95%CI: 0.27, 1.12). Qualitative discussions revealed three key themes regarding the impact of HIV-related shame on the childbirth experience: reluctance to disclose HIV status, suboptimal adherence to care, and the influence on social support networks. WLHIV giving birth experience high rates of HIV-related shame, and social determinants may contribute to feelings of shame. HIV-related shame impacts the childbirth experience for WLHIV, making the labor and delivery setting an important site for intervention and support.The study is funded by the National Institutes of Health (R21 TW012001) and is registered on clinicaltrials.gov (NCT05271903).

Factors associated with shame and stigma among head and neck cancer patients: a cross-sectional study.

PURPOSE: Head and neck cancer (HNC) patients often suffer from shame and stigma due to treatment limitations or due to societal factors. The purpose of this study was to assess perceived body image, depression, physical and psychosocial function, and self-stigma, as well as to identify factors that predicted shame and stigma in patients with HNC. METHODS: This cross-sectional study recruited 178 HNC patients from the outpatient radiation department of a medical center in Northern Taiwan. Patients were assessed for patient reported outcomes using the Body Image Scale (BIS), the Hospital Anxiety and Depression Scale-Depression Subscale (HADS-Depression Subscale), the University of Washington Quality of Life Scale (UW-QOL) version 4.0, and the Shame and Stigma Scale (SSS). Data were analyzed by descriptive analysis, Pearson's product-moment correlation, and multiple regression. RESULTS: The two top-ranked subscales of shame and stigma were: "speech and social concerns" and "regret". Shame and stigma were positively correlated with a longer time since completion of treatment, more body image concerns, and higher levels of depression. They were negatively correlated with being male and having lower physical function. Multiple regression analysis showed that female gender, a longer time since completing treatment, higher levels of body image concern, greater depression, and less physical function predicted greater shame and stigma. These factors explained 74.7% of the variance in shame and stigma. CONCLUSION: Patients' body image concerns, depression, time since completing treatment, and physical function are associated with shame and stigma. Oncology nurses should assess and record psychological status, provide available resources, and refer appropriate HNC patients to counselling.

Patterns of Sexual Risk Behaviors and Sexuality-Related Risk Factors among Young Adults in Germany: Implications for Prevention and Therapy.

Sexual risk behavior (SRB) includes behavioral (sex without contraception, sexualized substance use, sex work, sexual partner violence, other sexual activities that harm oneself or others) and affective subtypes (sexuality-related feelings of shame/guilt, relationship impairments) and leads to psychosocial and health-related consequences. Young adults comprise a vulnerable group regarding the development of SRB. The study aimed to identify SRB patterns among young adults and their relation to sexuality-related risk factors. A cross-sectional online survey measured behavioral and affective aspects of SRB with nine items. Latent class analysis was conducted to identify patterns of SRB. Gender, sexual orientation, age of first intercourse, number of sexual partners, hypersexuality, and sexual dysfunction were captured as risk factors via multinomial logistic regression. Within this convenience sample (n = 609; nfemale = 365; nmale = 245; Mage = 23.1 years), the SRB patterns unremarkable (67%; low values in all SRB subtypes), shame-ridden (17%; high values in sexual feelings of shame/guilt) and risky sexual behavior (16%; high values in all subtypes of SRB, especially sexualized drug use) were identified. The shame-ridden and risky patterns were strongly associated with higher hypersexuality values, the risky pattern moreover with being non-heterosexual, of younger age at first sexual experience, and a higher number of sexual partners. Male and sexual minority participants demonstrated SRB more often than females and heterosexuals. Within prevention and treatment of SRB, it seems beneficial to address sexuality-related feelings of shame/guilt and addictive patterns (concerning sexual behaviors/substances) via gender- and diversity-sensitive measurements.

Person-specific dynamics between negative emotions and suicidal thoughts.

INTRODUCTION: Recent technology has enabled researchers to collect ecological momentary assessments (EMA) to examine within-person correlates of suicidal thoughts. Prior studies examined generalized temporal dynamics of emotions and suicidal thinking over brief periods, but it is not yet known how variable these processes are across people. METHOD: We use data EMA data delivered over two weeks with youth/young adults (N = 60) who reported past year self-injurious thoughts/behaviors. We used group iterative multiple model estimation (GIMME) to model group- and person-specific associations of negative emotions (i.e., fear, sadness, shame, guilt, and anger) and suicidal thoughts. RESULTS: 29 participants (48.33%) reported at least one instance of a suicidal thought and were included in GIMME models. In group level models, we consistently observed autoregressive effects for suicidal thoughts (e.g., earlier thoughts predicting later thoughts), although the magnitude and direction of this link varied from person-to-person. Among emotions, sadness was most frequently associated with contemporaneous suicidal thoughts, but this was evident for less than half of the sample, while other emotional correlates of suicidal thoughts broadly differed across people. No emotion variable was linked to future suicidal thoughts in >14% of the sample, CONCLUSIONS: Emotion-based correlates of suicidal thoughts are heterogeneous across people. Better understanding of the individual-level pathways maintaining suicidal thoughts/behaviors may lead to more effective, personalized interventions.

Analysis of the hikikomori phenomenon - an international infodemiology study of Twitter data in Portuguese.

BACKGROUND: Hikikomori refers to the extreme isolation of individuals in their own homes, lasting at least six months. In recent years social isolation has become an important clinical, social, and public health problem, with increased awareness of hikikomori around the globe. Portuguese is one of the six most spoken languages in the world, but no studies have analysed the content regarding this phenomenon expressed in Portuguese. OBJECTIVE: To explore the hikikomori phenomenon on Twitter in Portuguese, utilising a mixed-methods approach encompassing content analysis, emotional analysis, and correlation analysis. METHODS: A mixed methods analysis of all publicly available tweets in the Portuguese language using a specific keyword (hikikomori) between 1st January 2008 and 19th October 2022. The content analysis involved categorising tweets based on tone, content, and user types, while correlation analysis was used to investigate user engagement and geographical distribution. Statistical analysis and artificial intelligence were employed to classify and interpret the tweet data. RESULTS: Among the total of 13,915 tweets generated, in terms of tone 10,731 were classified as "negative", and 3184 as "positive". Regarding content, "curiosities" was the most posted, as well as the most retweeted and liked topic. Worldwide, most of the hikikomori related tweets in Portuguese were posted in Europe, while "individuals with hikikomori" were the users most active posting. Regarding emotion analysis, the majority of tweets were "neutral". CONCLUSIONS: These findings show the global prevalence of the discourse on hikikomori phenomenon among Portuguese speakers. It also indicates an increase in the number of tweets on this topic in certain continents over the years. These findings can contribute to developing specific interventions, support networks, and awareness-raising campaigns for affected individuals.

The influence of trauma symptoms on interpersonal attributions in daily life.

There is well-documented evidence that trauma exposure can disrupt relationships. However, limited research has examined whether posttraumatic stress symptoms (PTSS) moderate interpersonal processes in daily life. To this end, undergraduates (N = 98) completed a measure of PTSS at baseline. They then completed smartphone-based surveys after every interpersonal interaction that lasted longer than 3 min. for 10 days. These surveys assessed perceptions of self and other agency and communion as well as feelings of rejection, neglect, abandonment, worthlessness, emptiness, guilt, and shame. Results of multilevel modeling suggest that interpersonal perception and PTSS predicted 10%-26% of the variance in outcomes. Regarding agency, more agentic participants reported higher levels of negative attributions, γs = .47-.56. Participants also reported higher rejection and guilt when they experienced their interaction partner as more agentic than usual, γs = .07, and PTSS did not moderate these associations. For communal perceptions, participants who experienced themselves and others as warmer than other participants reported fewer negative outcomes, γs = -.44--.58. Individuals also reported more negative outcomes when they experienced themselves and others as warmer than they usually did, γs = -.10--.28, and PTSS moderated these associations. The negative associations between self- and other communion ratings and feelings of neglect, abandonment, and shame were stronger in individuals with higher PTSS scores. Together, these findings support continued efforts to understand the ways in which trauma exposure and PTSS disrupt interpersonal dynamics in daily life.

"Shame on Me": Exploring the Role of Self-Stigma in Psychological Outcomes Among Type 2 Diabetes Patients in Hong Kong.

BACKGROUND: Studies have suggested that type 2 diabetes mellitus (T2DM) are at risk of self-stigmatization (i.e., internalized sense of shame about having diabetes). Self-stigma has been found to be associated with poorer psychological outcomes among chronic disease patients; relevant studies examining such an association and its psychosocial mechanisms are scarce among Chinese T2DM patients. This study aimed to examine the association between self-stigma and psychological outcomes among T2DM patients in Hong Kong. Self-stigma was hypothesized to be associated with higher psychological distress and lower quality of life (QoL). Such associations were also hypothesized to be mediated by lower perceived social support, lower self-care self-efficacy, plus higher self-perceived burden to significant others. METHODS: T2DM patients (N = 206) recruited from hospitals and clinics in Hong Kong were invited to complete a cross-sectional survey measuring the aforementioned variables. RESULTS: After controlling for covariates, multiple mediation analysis results indicated the indirect effects from self-stigma to psychological distress via increased self-perceived burden (ß = 0.07; 95% CI = 0.02, 0.15) and decreased self-care self-efficacy (ß = 0.05; 95% CI = 0.01, 0.11) were significant. Moreover, the indirect effect from self-stigma to QoL via decreased self-care self-efficacy was also significant (ß = -0.07; 95% CI = -0.14, -0.02). After considering the mediators, the direct effects from self-stigma to higher psychological distress and lower QoL remained significant (ßs = 0.15 and -0.15 respectively, ps < .05). CONCLUSIONS: Self-stigma could be linked to poorer psychological outcomes through increased self-perceived burden and decreased self-care self-efficacy among T2DM patients. Targeting those variables when designing interventions might facilitate those patients' psychological adjustments.

Winning isn't everything: Guilt proneness and competitive vs. non-competitive motivation.

OBJECTIVE: Guilt proneness is associated with both high motivation to succeed and enhanced concern for others. However, in competition, achieving success requires harming others' interests, which demotivates guilt-prone individuals. Given the prevalence of competition in social and professional life, we examine the relation between guilt proneness, general motivation, and competitive motivation. METHOD: Two experiments and two laboratory studies (N = 1735) measured guilt proneness, general motivation, and competitive motivation, and their effects on competitive preferences and choices. Study settings included students' choice of playing a game individually vs. competitively (Study 1), physicians' likelihood to seek residency in medical fields characterized by high competitiveness (Study 2), amateur athletes' preferences between inclusive and win-oriented team strategies (Study 3), and online workers' evaluations of a hypothetical scenario (Study 4). RESULTS: Guilt proneness was related positively to general motivation, but negatively to competitive motivation. Guilt proneness, indirectly through lower competitive motivation, predicted a lower likelihood of pursuing competitive paths and preference for non-competitive strategies. Emphasizing prosocial aspects of competitiveness attenuated these effects. CONCLUSIONS: Guilt proneness is related to high general motivation but to a lower desire to win. Guilt-prone individuals strive for excellence, but through non-competitive paths, whereas people with lower guilt proneness prefer competing.

How do early affiliative memories explain body image shame? A 12-month longitudinal study in adolescent girls.

OBJECTIVE: This study aimed to explain adolescent girls' body image shame across a 12- month longitudinal design, and its relationship with early parental memories of warmth and safeness and fear of receiving compassion from others. DESIGN AND METHODS: Participants included 231 adolescent girls, who completed self-report measures at three different periods: baseline (W1), 6-month follow-up (W2), and 12-month follow-up (W3). Descriptive and correlational analyses were performed, and differences between participants at the different waves were explored through repeated measures ANOVA. A cross-lagged panel model tested the mediational effect of fears of receiving compassion on the association between early affiliative memories (W1) and body image shame (W3). RESULTS: ANOVA results found significant differences throughout time in memories of warmth and safeness (tending to diminish) and in body image shame (tending to rise). Correlation analysis revealed that all variables were significantly associated in the expected directions, across the three waves. Finally, path analysis revealed that early affiliative parental memories (in W1) had a direct effect on body image shame (in W3), through the fear of receiving compassion from others (in W2), accounting for 85% of body image shame's variance (W3). CONCLUSIONS: These findings indicate that the lack of early affiliative memories often leads to the development of defensive mechanisms such as fears of receiving compassion from others which in turn can foster isolation and distant relationships, enhancing feelings of inferiority and inadequacy, which in female adolescents can emerge centered on body image - body image shame. This study further highlights the importance of prevention and intervention strategies based on compassion to specifically target fears of receiving compassion from others, in adolescent girls dealing with feelings of inferiority and shame regarding their body.

Toward a memory perspective on eating psychopathology: An investigation of the types of childhood and adolescence memories that are associated with eating disorder symptoms.

The cognitive mechanisms through which specific life events affect the development and maintenance of eating disorders (ED) have received limited attention in the scientific literature. The present research aims to address this gap by adopting a memory perspective to explore the type of life events associated with eating psychopathology and how these events are encoded and reconstructed as memories. Two studies (n = 208 and n = 193) were conducted to investigate the relationship between specific memories and eating disorder psychopathology. Study 1 focused on parent-related memories, while Study 2 examined childhood/adolescence memories. Results from both studies revealed that need thwarting and shame in memories were associated with eating disorder symptoms, but only when individuals drew symbolic connections between these memories and food or eating behavior. Moreover, need thwarting and shame in such memories were associated with other eating and body image outcomes, including uncontrolled eating and body esteem. These results also held after controlling for a host of known predictors of eating disorder psychopathology, such as BMI, perfectionism, or thin ideal internalization. Overall, the present findings suggest that the reprocessing of memories symbolically and idiosyncratically linked to food and eating behavior might be a fruitful clinical intervention.

The shame-blame complex of parents with cognitively disabled children in Italy.

This article aims to advance knowledge related to the concept of the 'shame-blame complex' by analysing the accounts and experiences of parents with cognitively disabled children. It draws on 29 interviews with parents of children with Down syndrome and shadowing sessions with one family, carried out in Italy. Results show how the feeling of shame as a consequence of being associated with a disabled child is turned into blame for bad parenting. The sources of this blaming process are twofold: firstly, neoliberalism has disseminated an intensive parenting model based on the imperative of individual responsibility and risk avoidance. Secondly, ableism acts as a network of processes and beliefs that produce a particular kind of self and body as the perfect and complete human being. Participants have been held responsible for their children's condition because they avoided prenatal screening or continued a pregnancy after receiving a positive result. Consequently, parents' moral culpability for their children's diversity and their social marginalisation were enhanced. Although the interviewees resist the shame of being associated with a cognitively disabled child and the blame for bad parenting, they seem unable to escape from the grips of the shame-blame complex. The latter has structural and cultural underpinnings. In an age of 'neoliberal-ableism', this complex is indeed a powerful weapon to erode the rights of families with cognitively disabled members.

Longitudinal association of mindfulness with aggression and non-suicidal self-injury in adolescence: The mediating role of shame-proneness.

The aim of the current study was to investigate the longitudinal association of facets of mindfulness with aggression and non-suicidal self-injury (NSSI) among adolescents and to explore whether shame-proneness can mediate the longitudinal association. The present longitudinal study investigated the associations between mindfulness, aggression, and NSSI in a sample of 706 Chinese adolescents (M = 15.33; SD = 1.34; 50.20% girls). Five facet mindfulness questionnaire was completed at baseline and middle school students' shame scale was completed at 6-month follow-up. The Chinese version of Buss-Perry aggression questionnaire and adolescents' self-harm scale were completed at both baseline and 6-month follow-up. Shame-proneness significantly mediated the longitudinal association between (a) describing and aggression (-0.107, 95% CI: [-0.151 to -0.067]), and NSSI (-0.041, 95% CI: [-0.069 to -0.019]). (b) Acting with awareness and aggression (-0.094, 95% CI: [-0.139 to -0.061]), and NSSI (-0.036, 95% CI: [-0.062 to -0.016]). (c) Nonjudging and aggression (-0.062, 95% CI: [-0.107 to -0.024]) and NSSI (-0.024, 95% CI: [-0.047 to -0.008]). Describing, acting with awareness, and nonjudging were predictive factors of aggression and self-injury in adolescents, and shame-proneness played a crucial role in the negative longitudinal association between them. Findings from the current study may offer some implications in the domains of clinical practice and education to improve mental health and further ameliorate the misbehavior among adolescents.

The Role of Shame in the Relationship between Alcohol Use Severity and Relational Intimacy among Sexual Minority Women.

Background: Sexual Minority Women (SMW) are disproportionately likely to struggle with substance use and shame, two factors that are associated with poorer relationship quality and decreased relational intimacy (Doyle & Molix, 2015). However, there is a dearth of research examining shame and substance use concurrently among SMW. Objectives: The current study elucidated the role of shame-based cognitions (SBCs) and shame-based behaviors (SBBs) in explaining the relationship between alcohol use severity and relational intimacy. We recruited adult cisgender women (N = 105) in a romantic relationship who self-identified as a sexual minority and reported alcohol use during the past three months through Amazon Mechanical Turk. Participants completed an online survey assessing alcohol use, SBCs, SBBs, and relational intimacy. Results: There was a significant positive relationship between alcohol use severity with SBCs (r = .29, p = .003) and with SBBs (r = .62, p <.001). SBBs were shown to be negatively correlated with relational intimacy (r = -.48, p < .001). Parallel mediation analysis demonstrated that SBCs and SBBs accounted for approximately 34.4% of the variance in intimacy. The indirect effects of SBCs were significant (ß = .10, 95% CI [.02, .18] while SBBs (ß = -.14, 95% CI [-.29, .01]) did not show effects. Discussions: Given the disproportionate rates of alcohol use among SMW, this study offers a nuanced picture of the relationships between constructs known to impact alcohol use. The findings underscore the importance of SBCs and point to a potential treatment target among SMW presenting with alcohol use and diminished relational intimacy.

Perceptions and barriers about mental health services among Pacific Islanders: An interpretative phenomenological analysis.

Every year, millions of Americans do not receive needed mental health (MH) services. Although Pacific Islanders (PI) have a high need for MH services, this group has the lowest rate of MH care help seeking. This is especially concerning as the rate of suicide has been increasing within the PI community. This study explored how Pacific Islanders think about MH supports, including their attitudes toward and perceptions of barriers to receiving MH services. An interpretative phenomenological analysis focus group study was conducted with cross-generational Pacific Islanders residing in one western state. The findings include (a) PI perceptions that MH help seeking results in family burdensomeness, stigma, and shame; (b) negotiating PI social customs and beliefs related to MH help seeking, care, and support; and (c) PI mistrust of institutional resources. These themes seemed to interact with each other and create perpetuate barriers which prevent help-seeking behaviors. Clinical and research implications will be provided. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The homeless period: a qualitative evidence synthesis.

Women experiencing homelessness are marginalized not only through their housing status but also through their access and ability to manage their menstrual health. Currently, there are no existing published reviews exploring this topic. This study aimed to begin closing that gap, by systematically reviewing the literature examining women's experiences of menstruation whilst being homeless. In June 2020 (and updated in December 2022), we conducted comprehensive and systematic searches of four electronic databases: Medline, Web of Science, CINAHL, and PsychINFO, from which nine studies were found. The findings were thematically analyzed, using the enhancing transparency in reporting the synthesis of qualitative research tools (ENTREQ) guidelines. Three themes related to menstrual experiences were found: (1) challenges in the logistics of managing menstruation while homeless, (2) feelings of embarrassment, shame, and dignity linked to maintaining menstrual health, and (3) making do: how people experiencing homelessness manage challenges related to menstruation. We discuss barriers women face in getting necessary products and in accessing private, safe, and clean facilities to manage menstrual health. The study found that women living with homelessness often abandon other basic needs in favor of managing menstruation (i.e. using unsuitable materials, stealing, etc.), which furthers their risk. The findings highlight the need for future research to investigate the experiences of women who are menstruating while being homeless and what support they would find helpful. Results show that it is high time for commissioners and policy-makers to address the provision of menstrual resources as a basic human right.

A Discourse of Deviance: Blame, Shame, Stigma and the Social Construction of Head and Neck Cancer.

Cancer of the head and neck is a confronting condition, as the disease and its treatments alter the appearance and function of body organs associated with physical appearance and identity. Many of the risk factors for head and neck cancers, including tobacco, alcohol, and human papilloma virus, can also have significant negative social and moral permutations. Language and action (discourse) plays an important role in constructing disease and illness and shape the way it is managed, both institutionally and socially. This research used a critical constructionist lens to investigate how the common discourses surrounding head and neck cancer are constructed within the healthcare context and how this influences patients and healthcare professionals' responses to the illness. Data were collected through semi-structured interviews, field noting, journaling and literature reviews. Analysis was guided by a three-dimensional approach to critical discourse analysis that investigated text, discursive practices, and social context. The overarching finding was that deviance dominates the common discourse and shapes head and neck cancer and responses to it. Deviance is channelled through metaphors, adjectives, descriptors, and collective nouns and is made overt through labelling, avoidance, blaming, shame, and categorization. Discourse is contextualized by a sociocultural understanding that when someone deviates from what is perceived as normal, they are devalued. Open dialogue and reflection on head and neck cancer discourse could enable better understanding of how people experience their condition and inform more supportive responses.

"I Haven't Told Anyone but You": Experiences and Biopsychosocial Support Needs of People With Type 2 Diabetes and Binge Eating.

Up to 25% of people with type 2 diabetes (T2D) may binge eat which is almost 10 times as many as in the general population. Binge eating is associated with depression, anxiety, and social isolation. Moreover, binge eating may increase the risk of obesity and high blood glucose levels, both of which can accelerate the onset of complications to diabetes and death in people with T2D. Still, little is known about the experiences, needs, and preferences of people with T2D and binge eating that can inform and develop current and future treatment efforts. The aim of the study was therefore to gain in-depth insights into the experiences and biopsychosocial support needs of women and men with T2D and binge eating. Twenty semi-structured individual interviews (65% with females) were conducted and analyzed according to the methodology of Interpretive Description. Four themes were identified: (a) T2D and binge eating: Feeling trapped in a vicious circle; (b) Unwanted outcasts: Responding to continuous criticism; (c) Biomedical relief: Blaming and adjusting the body; and, (d) Silent struggles: Wanting to cease the secrecy. Pertinent to all themes were the guilt, shame, and worries about developing complications that the participants experienced when binge eating despite having T2D. Although binge eating triggered emotional distress, binge eating was at the same time a way of coping with such distress. Implications for treatment and future research are discussed, including the need to systematically assess and address binge eating in routine T2D care.