Shame is thought to be a ubiquitous and destructive psychological process associated with psychiatric and medical conditions. This study examined its nature in two contrasting health problems that influence women's self-evaluations of their bodies and attractiveness, namely an eating disorder (a psychiatric disorder with medical implications) or vulvodynia (i.e., vulvar pain; a newly identified medical condition with psychiatric implications). A community sample of adult women without medical conditions served as an additional comparison group. Participants were 203 adult females: 72 with DSM-IV-defined Binge Eating Disorder (BED), 57 with vulvodynia, and 74 non-patient controls. The three study groups differed significantly: the BED group reported greater shame than the vulvodynia group, and the BED and vulvodynia groups reported greater shame than the control group. Higher levels of shame were associated with higher levels of symptomatic functioning within each group.