Date of Award


Document Type


Degree Name

Doctor of Psychology (PsyD)


Graduate Department of Clinical Psychology

First Advisor

Nancy Thurston, PsyD

Second Advisor

Rodger Bufford, PhD

Third Advisor

Kathleen Gathercoal, PhD


Past research has shown that Adverse Childhood Experiences (ACEs), including neglect and abuse, are correlated with obesity and other adverse outcomes in adulthood. Here it is proposed that childhood adversity follows a path to internalized shame, which then motivates a coping mechanism which can result in extreme obesity. Participants were gathered through a bariatric surgery program through support groups and as part of an amended intake process. They completed the ACEs as well as the Internalized Shame Scale (ISS). Data analysis attempted to find relationships between ACEs, the ISS, and each participant’s highest BMI at any point in the bariatric program. Results confirmed ACEs correlated with high shame, as well as with high BMI. Shame/low self-esteem also correlated with high BMI. Stepwise regression analysis showed that ACEs and low self-esteem were the only significant predictors of BMI in the model which included measures of shame, anxiety, depression, and binge eating as well. The variance in BMI more than doubles when low self-esteem is added to the variance accounted for by participants’ ACEs scores. This study indicates that other factors are at play (namely low self-esteem) other than purely the childhood adversity. The adversity one experiences creates low self-esteem which needs to be coped with. When the coping mechanism is food, this coping behavior results in extreme obesity.