Between shame, control, and survival: a grounded theory study of eating disorders among young Chinese women

BACKGROUND: Eating disorders (EDs) among young Chinese women are shaped by sociocultural norms and moralized expectations around thinness and emotional restraint, yet theory grounded in local experiences remains limited. METHOD: Using constructivist grounded theory, we conducted semi-structured interviews with 19 women with current or past ED experiences. Data were analyzed iteratively (open-focused-theoretical coding) with constant comparison, sending analytic memos, and team debriefing to build an explanatory model. RESULTS: Four interrelated themes were identified: (1) risk background, including personality traits, adverse developmental experiences, and sociocultural pressures; (2) onset pathways-appearance-driven and emotion-driven routes; (3) maintenance and change processes, shaped by shame, functional reinforcements, and social feedback; and (4) coping strategies, including professional help, social support, and self-directed adjustment. Thinness was moralized as a symbol of discipline and social worth, while shame reinforced secrecy and chronicity. Turning points often arose through autonomy-supportive relationships and growing awareness of harm. DISCUSSION: This study expands existing models by theorizing how EDs are embedded in the Chinese sociocultural context. It highlights the moralized nature of body control and emotional suppression in shaping illness experiences. Clinical implications include the need for shame-sensitive, culturally attuned interventions.