Saturday, June 15, 2024

Shame and Psychopathology

 



 
Ruwan M Jayatunge M.D. PhD 

 

Shame is a complex emotion. It is a basic feeling of inferiority, and it is self-judging the self. Shame is generally defined as strong negative emotions characterized by perceptions of the global devaluation of oneself (Budiarto & Helmi, 2021). shame brings a malignant focus on the self (Zaslav,1998).  Brockman, (2017) states that shame is a crisis of homeostasis. Shame arises from self-relevant failures and transgressions (Tangney et al., 2014).

  

The term ‘shame’ should be considered an umbrella term that refers to a whole range of experiences, including cognate emotions such as embarrassment, chagrin, mortification, and humiliation (Dolezal et al., 2022). Lewis (2000) states that shame is incapacitating and a self-conscious emotion. Shame is a multifaceted experience, and it has a social or external cognitive component, an internal self-evaluative component, an emotional component, a behavioral component, and a physiological component (Gilbert, 2002). 

 

According to Budiarto and Helmi (2021), shame is a self-evaluative emotion that involves concern and attention about oneself.  Trumbull (2020) conceptualized shame as an acute stress response to an unacceptable view of oneself mediated through another's perspective. Roberts (2023) points out that humiliation and embarrassment relate to shame. Shame occurs in relation to the perception of an observing other (Bero, 2020). Shame has been identified as a persistent negative emotional state (Taylor, 2015).

 

The experience of shame is not universal. The concept of shame should be discussed with historical and cultural backgrounds.  In an evolutionary context, shame is the affective response to the loss of one's place in the group (Brockman, 2017). Shame is strongly influenced by cultural and social factors (Collardeau et al., 2023). Wallbott and Scherer (1995) state that shame is experienced differently in collectivist cultures. The cultural anthropologist Ruth Benedict (1934) elucidated that shame arises from a violation of cultural or social values.

Shame has been linked to psychopathology. Shame can cause a devaluation of self and lower self-esteem. Franzoni and colleagues (2013) point out that Shame can cause severance of body image, low self-esteem, and feelings of guilt. Shame can disrupt cognition (Roberts,2023). Shame leads to maladaptive self-defensive actions (Liyanage et al., 2023). As described by Bynum and team (2021) shame can be associated with depression. Shame is a key emotional aftereffect of trauma (Dolezal & Gibson, 2022).  Shame can emerge following trauma and play an important role in the development and maintenance of post-traumatic stress disorder (PTSD) (Fine et al.,2023). Saraiya and team (2016) highlight shame’s functional role in the emergence and maintenance of PTSD.

 

Shame predicts depressive and anxious symptoms, as well as substance abuse, non-suicidal self-injury, and aggression (Martin et al., 2021). There is a strong link between addiction disorders and shame (Rahim & Patton, 2015). Research has identified higher levels of shame in problem gamblers (de Ridder & Deighton, 2022).  Kouri and team (2023) found a strong relationship between shame and dissociation. Nechita et al (2021) indicate that shame is a common experience among individuals across the eating disorder spectrum.

 

Shame is a core feature of borderline personality disorder (Buchman-Wildbaum et al., 2021). Wurmser (1987) states that Narcissistic personality disorders are seen to be linked to defenses against shame.  Fjermestad-Noll and colleagues (2020) speculate that shame is a mediating or a moderating factor for aggression in patients with Narcissistic Personality Disorder. Schoenleber and team (2010)) identified shame-pain associations in dependent personality disorder. According to Sanderson (2015), toxic shame destroys social bonds and can lead to antisocial behavior.

 

In schizophrenia, intense feelings of shame are observed during the early period of illness and persist despite remission from symptoms. (Miller & Mason, 2005). Keen and team (2017) analyzed the role of shame in people with a diagnosis of schizophrenia. Severity delusion in schizophrenia depends, at least in part, on a complex interplay between cognitive-perceptual disturbances and experiences of shame (Borrelli et al., 2023).

 

Research indicates that prolonged shame has psychopathological outcomes. Psychotherapeutic interventions are required to treat sequelae of self-conscious emotions such as shame. Psychological therapies should aim for the client to regulate shame. Working with shame in psychotherapy effectively has been found to alleviate symptoms and decrease distress thus creating opportunities for accepting the self as it is (Malik, 2019).

 

Cognitive-behavioral therapy (CBT) can be used to treat pathological shame. Wang and team (2020) denote the successful use of CBT to treat Social Anxiety Disorder. Cognitive behavioral therapy, mindfulness, interpersonal therapy, group therapy, family therapy, expressive arts, and community-level interventions can be effective in reducing shame (Goffnett et al.,2020).  Swales (2009) highlights the importance of using Dialectical behavior therapy (DBT) to treat shame. Balcom and colleagues (2000) indicate using EMDR (Eye Movement Desensitization and Reprocessing) to treat internalized shame. 

 

 

 

 

References

 

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