Measuring shame and guilt by self-report questionnaires: a validation study

Quantitative assessment of shame and guilt using self-report questionnaires can help to understand the role of these emotions in various mental disorders. However, shame and guilt measures have predominantly been tested among healthy subjects that usually show low levels of guilt and shame. Thus, little is known about the comparative validity of different shame and guilt questionnaires in a population of shame- and guilt-prone persons with mental illness as compared to healthy subjects. This study used the Test of Self-Conscious Affect (TOSCA-3), the Personal Feelings Questionnaire (PFQ-2) and the Experiential Shame Scale (ESS) among 60 women with borderline personality disorder (BPD) and 60 healthy women. Intercorrelations of shame-proneness, guilt-proneness and state shame as well as their correlations with self-efficacy, empowerment, state and trait-anxiety, experiential avoidance, depression, and general psychopathology were assessed. In both groups, shame-proneness was moderately related to guilt-proneness, both as assessed by the TOSCA-3 and the PFQ-2. For the TOSCA-3, among healthy subjects shame-proneness was significantly correlated with other constructs while guilt-proneness was not. This difference turned largely insignificant among women with BPD. For the PFQ-2, shame- and guilt-proneness showed similar correlational patterns with other constructs in both groups. The guilt-proneness scale of the TOSCA-3 showed poor internal consistency. State shame (ESS) was strongly related to state anxiety in both groups, and its correlations with other constructs were similar to state anxiety. The discriminant validity of the TOSCA-3 to distinguish between shame- and guilt-proneness may be diminished in clinical samples. The measure of state shame (ESS) showed a large overlap with state anxiety.     

Early distinction between shame and guilt processing in an interpersonal context

Shame and guilt have been compared in many behavioral and functional magnetic resonance imaging studies. However, the time course of shame and guilt processing remains unknown. We conducted an event-related potential (ERP) study to investigate the temporal dynamics of shame and guilt in an interpersonal context. Behaviorally, participants reported “shame” when their wrong advice was correctly rejected by a confederate, whereas reported “guilt” when their wrong advice resulted in economic loss of a confederate. The ERP results showed significant difference between the shame and guilt conditions in the early P2 component (140–220 ms) over the frontal region and the alpha oscillations (240–1000 ms) over the parietal region. No significant difference was found between the shame and guilt conditions in the N2, P3, and theta oscillations. These results supported previous findings that shame compared to guilt involves more self-referential processing, whereas guilt compared to shame involves more empathetic processing, and provided evidence that the distinction between shame and guilt could occur in an early stage.     

A mental health program for ground zero rescue and recovery workers: cases and observations

Clinical vignettes from the World Trade Center Worker and Volunteer Mental Health Monitoring and Treatment Program at the Mount Sinai Medical Center in New York City are presented. The hospital-based program pairs mental health screenings with federally funded occupational medical screenings to identify persons with mental health problems related to their rescue and recovery roles. The program also provides on-site mental health treatment. The cases illustrate the diverse mental health needs of the rescue and recovery workers, some of whom initially sought treatment years after September 11, 2001. The cases show that in addition to symptoms of posttraumatic stress disorder, workers experienced survivor guilt, distressing memories of childhood trauma, shame associated with intense feelings, substance abuse relapse, psychosis, and problems with family relationships.     

Mental contamination,disgust, and other negative emotions among survivors of sexual trauma: Results from a daily monitoring study

Mental contamination (MC)—feelings of dirtiness triggered by internal sources—is a potentially important yet understudied factor for survivors of sexual trauma. MC has been linked to disgust and other negative emotions (e.g., shame, guilt) cross-sectionally and in lab-based paradigms but not yet examined in ecological contexts. Additionally, links between MC and distinct negative emotions have not been studied systematically. The present study thus modeled relationships between MC and specific emotions both across and within days over a daily monitoring period. Forty-one females with sexual trauma history and associated MC completed twice-daily assessments of MC and seven emotions (disgust, shame, guilt, anger, hopelessness, sadness, anxiety) over 2 weeks via a smartphone app. Baseline MC and average daily MC were largely associated with higher daily averages of negative emotions. Concurrently, within-person changes in MC and negative emotions were also positively linked. Unexpectedly, intraindividual changes in MC were largely not associated with later negative emotions, whereas several emotions were negatively associated with later MC. Notably, MC among screened sexual trauma survivors was much more prevalent compared to prior research. Clinical relevance and future recommendations for ecological research in trauma-related mental contamination are discussed.     

Relationships between self-reflectiveness and clinical symptoms in individuals during pre-morbid and early clinical stages of psychosis

BackgroundSelf-reflectiveness, one dimension of cognitive insight, plays a protective role in an individual’s mental state. Both high and low levels of self-reflectiveness have been reported in patients with schizophrenia and individuals at clinical high risk for the illness.AimsThis study aimed to explore the relationship patterns between self-reflectiveness and clinical symptoms in individuals during the pre-morbid and early clinical stages of psychosis.MethodsA total of 181 subjects, including individuals with attenuated positive symptoms (APS, n=122) and patients with first-episode psychosis (FEP, n=59), completed the Beck Cognitive Insight Scale and were evaluated using the Schedule of Assessment of Insight and Positive and Negative Syndrome Scale. All subjects were classified into three groups according to their level of self-reflectiveness: low level (LSR, n=59), medium level (MSR, n=67) and high level (HSR, n=55). Both linear and non-linear relationships between self-reflectiveness and clinical symptoms were explored.ResultsMore individuals with APS were classified into the MSR group, while more patients with FEP were classified into the LSR group. The LSR group demonstrated less awareness of illness than the MSR and HSR groups, more stereotyped thinking and poorer impulse control but less anxiety than the MSR group, and lower levels of blunted affect and guilt feelings than the HSR group. The MSR group demonstrated lower stereotyped thinking than the HSR group. Compared to the LSR group, the MSR group had increased self-reflectiveness, improved awareness of illness, decreased stereotyped thinking, and better impulse control, but increased feelings of guilt. The HSR group showed increased stereotyped thinking when compared to the MSR group, but the other variables did not change significantly between these two groups. Overall, self-reflectiveness demonstrated an approximately inverse S-shaped relationship with the awareness of illness, a U-shaped relationship with stereotyped thinking and poor impulse control, and an almost linear relationship with anxiety and guilt feelings.ConclusionsSelf-reflectiveness demonstrates complex relationships with clinical symptoms and fails to exert significant positive effects when reaching a certain high level.     

General Self-efficacy and Its Relationship to Self-reported Mental Illness and Barriers to Care: A General Population Study

Given the prevalence of mental illness worldwide, it is important to better understand the dynamics of mental health help-seeking behavior to improve access to care. The aim of this study was to investigate if general self-efficacy (GSE) was associated with self-reported mental illness and help-seeking behavior and barriers to care in a randomized population. This study utilized a mailed questionnaire completed by 3,981 persons aged 19–64 years who resided in Western Sweden. GSE was measured and logistic regression models calculated, controlling for various sociodemographic variables. Results showed that 25 % of men and 43 % of women reported a lifetime prevalence of mental illness that they felt could have benefitted from treatment. Of those, 37 % of the men and 27 % of the women reported barriers to care. Men and women with low GSE were more likely to suffer from mental illness compared with persons high in GSE, but GSE did not enhance help-seeking behavior or perceived barriers to care. The most prevalent barriers to care for both sexes were beliefs that the illness will pass by itself, doubt whether treatment works, lack of knowledge of where to go and feelings of shame. Overall, GSE scores did not differ among those who experienced various barriers to care with the exception of two barriers only among women.     

Adolescent Siblings of Individuals With Intellectual Disabilities With and Without Comorbid Mental Health Problems: A Preliminary Comparison of Sibling Perceptions

Introduction: The presence of comorbid mental illness in individuals with intellectual and developmental disabilities (IDD) has been shown to have additional negative impact on parents and caregivers. However, the impact of such dual diagnoses on typically developing siblings has yet to be examined. Methods: Parents and typically developing adolescent siblings of a child with IDD from 49 families completed online surveys about the presence or absence of comorbid mental illness, target-child behavior problems, impact on the family, and sibling emotions toward the child with IDD. T-tests were used to compare results of families with a child with both IDD and MI and families with a child with IDD only. Results: Parents reported more behavior problems in children with comorbid IDD and MI, and a greater overall impact on the family. Adolescent siblings in the comorbid IDD/MI group reported higher levels of hostility, anxiety, and dysphoria toward their sibling, though there were no group differences in positive affect. Hierarchical linear regression results found that group membership was uniquely related to sibling dysphoria beyond target-child behavior problems. Conclusions: Having a brother or sister with comorbid mental illness and IDD seems to contribute to more negative feelings from adolescent siblings, though the absence of MI does not relate to more positive feelings. Results suggest that families of children with IDD/MI may need to be more proactive in fostering healthy sibling relationships.     

Mental contamination: the perpetrator effect

In order to test the proposition that imagining carrying out an unacceptable non-consensual act can evoke contamination-related feelings in the perpetrator, 4 connected experiments were carried out involving male students. The effects of the experimental procedure were enhanced by the introduction of a theme of betrayal which boosted the feelings of contamination and urges to wash. The non-consensual scenarios were followed by substantial increases in negative emotions, notably shame, disgust and guilt, and these increases were boosted over successive enhancements of the procedure. Overall the results show that perpetrators of (imagined) unacceptable acts report a range of negative emotions and feelings of dirtiness. The main conclusion of this research is that imagining an unacceptable, non-consensual act can produce feelings of contamination. It is an experimental illustration of mental contamination, that is, contamination which is evoked by a mental event without any contact with a tangible contaminant.     

Le sentiment de culpabilité et de honte chez les survivants de l’Holocauste

Participants in the study were Jewish Holocaust survivors (n = 89). A total of 70 respondents constituted the trauma group. The remaining 19 participants were regarded as the controls. The control group consisted of persons of Jewish nationality who had experienced the trauma of anti-Semitic persecution, but their life had not been directly threatened. The aim of the study was to find out whether feelings of guilt and shame are still present in narratives of the Holocaust survivors, years after their traumatic experiences. A quantitative analysis of responses concerning guilt and shame feelings revealed no significant differences between the study group and the controls. The paper presents a historical outline of thought regarding survivors’ guilt and shame. Combining data reported in the literature and contemporary narratives of the survivors, it can be hypothesized that we are confronted with a dynamic process of the survivor's working through grief and bereavement. An open question remains whether the bereavement process can be completed in survivors – it is difficult to complete because of the extent of trauma. Completion of the process is perhaps possible, but requires more time, besides, some conditions must be fulfilled first – particularly, a place for the Jewish Holocaust should be acknowledged and affirmed not only in personal narratives, but also in social discourse.     

No excuses: televised pornography harms children

All youngsters are at some risk from exposure to televised pornography, as described above. At particular risk for harm, however, are the most vulnerable children in our society--children in single-parent homes, children with mental and emotional disturbances, mentally challenged children, children who have been physically and/or sexually abused, and children in dysfunctional families. Youngsters for whom television serves as a babysitter or parental surrogate unfortunately are exposed to few competing influences to television viewing. In addition, parents in such homes are least likely to know what their children are viewing and to be able to pass on their own values about sex and sexual behavior. The main possible effects of televised pornography that must concern us as clinicians, educators, and parents are modeling and imitation of language heard and behaviors observed in televised pornography; negative interference with children's normal sexual development; emotional reactions such as nightmares and feelings of anxiety, guilt, confusion, and/or shame; stimulation of premature sexual activity; development of unrealistic, misleading, and/or harmful attitudes toward sex and adult male-female relationships; and undermining of family values with resultant conflict between parents and children. Much more research is clearly needed on this topic. Because of the ethical and procedural problems surrounding research on children exposed to pornography, ideal research designs may never be possible. Nonetheless, we hope that this article will stimulate further discussion and work. To devise public policy that protects children from potentially harmful material while at the same time respecting the media's First Amendment rights, such public discourse and responsible research are essential.     

Grief experiences of parents whose children suffer from mental illness

OBJECTIVE: To examine the grief experience of parents of adult children with a mental illness and its relationship to parental health and well-being and parent child attachment and affective relationship. METHODS: Participants were recruited from a variety of organizations throughout Australia that provide support services for sufferers of mental illness and/or for their families. Seventy-one participants (62 mothers and nine fathers) all of whom had a child diagnosed with mental illness volunteered to take part in the study. All completed measures of grief, health status and parent-child relationship. RESULTS: Parents reported experiencing grief in relation to their child's illness as evidenced by intrusive thoughts and feelings and avoidance of behaviour as well as difficulties adapting to and distress associated with reminders of the illness. Parental grief appears to reduce over time, but only in some aspects of grief and after an extended period. Increased parental grief was related to lowered psychological well-being and health status and associated with an anxious/ambivalent and a negative affective parent-child relationship. CONCLUSION: The study provides important insights into the grief experiences of parents following their child's diagnosis with mental illness. The significant relationship between parental grief and parental psychological well-being and health status as well as to parent-child relationship has important implications for health professionals. Foremost amongst these are the need to validate the distress and grief of parents and to better understand how to provide interventions that promote grief work and family bonds while reducing emotional distress and life disruption.     

Narratives by Japanese mothers with chronic mental illness in the Tokyo metropolitan area: their feelings toward their children and perceptions of their children's feelings

Women with mental illness generally have normal fertility rates. Mothers with mental illness think that their children are important for their lives but also experience difficulties in relating to their children. Therefore, it is important to understand the mothers' perception of what experiences influence them or their parenting practices in relationships with their children. We conducted narrative interviews with 20 Japanese mothers who were being treated for either schizophrenia or mood disorders. The data were analyzed using the Modified Grounded Theory Approach. For the mothers, their feelings toward their children and their perception of their children's feelings toward them or their illness influenced the mothers and their parenting practices. Implications for support are discussed and directions for future research are presented.     

Ethnic differences in expressions of shame feeling by mothers of severely handicapped children

Shame on the part of parents of mentally handicapped children has pronounced effects on child-rearing practices. The aim of this study was to compare expressions of shame of different ethnic groups in Israel. The attitudes of 23 Western mothers and 26 Eastern mothers towards their moderately and severely retarded children were studied. Significant differences (p less than 0.05-p less than 0.01) were found, suggesting that the Eastern mothers strongly expressed their shame, whereas the Western mothers 'felt ashamed' to express it at all. The Western mothers felt that the social norms that reject feelings of shame and their own personal feelings of embarrassment were in conflict.     

Guilt and subjective feelings of guilt in the context of separation and divorce

In this paper the vicissitudes of guilt and responsibility and development and function of guilt feelings are discussed in the context of the typical family dynamics in cases of divorce (delegation, claiming of loyalty, parentification). The "guilt" of the parents is often transformed to the feeling of guilt of the children in the sense of a traumatic feeling of guilt. This happens especially when sufficient mourning is not possible. Feelings of guilt by reason of the mere existence of the child (basic feelings of guilt) and the oedipal and other feelings of guilt out of rivalry can be reinforced (feelings of guilt out of vitality). Strivings for separation may be connected with guilt by the children (feelings of guilt regarding separation). The recognition of the adults' responsibility (especially choice of partners, functionalization of the child to facilitate the separation from the own parents, to maintain the image of an intact family or the struggle for power at the cost of the children) diminishes the feelings of guilt of the children.     

Patterns of contact of patients' families with mental health professionals and attitudes toward professionals.

Previous studies have shown that many relatives of mentally ill persons are dissatisfied with their relationships with mental health professionals. In this study, 274 relatives or close friends of 168 recently discharged mental patients reported on 1,198 separate contacts with mental health professionals during the course of the patient's illness. Primary kin, such as parents and spouses, were most likely to be in contact with professionals. Different types of professionals were more likely to be in contact with relatives at different points in the patient's illness. Relatives' satisfaction varied significantly for the different types of professionals. Depending on the reason for the contact, 53 to 73 percent of the relatives reported being very satisfied or satisfied with the outcome. Respondents were most satisfied with their contacts with psychologists, followed by nurses, case managers, social workers, and psychiatrists.     

Negative emotions in children with newly diagnosed epilepsy

PURPOSE: To understand the emotional predicament in children with recently diagnosed idiopathic or cryptogenic epilepsy. METHODS: We used the well-tried method of structured projection for the first time in children with epilepsy. Thirty-six children with epilepsy, aged 7-15 years (mean age, 9.5 years) and in 35 control children aged 7-15 years (mean age, 9.4 years), attributed shame and guilt in relation to three types of situation (non-illness related, illness related, and epilepsy related). Children were evaluated twice: shortly after diagnosis, before antiepileptic drug (AED) use and after an interval of 3 months. RESULTS: Children with epilepsy and healthy controls were similar in their way of attributing shame and guilt. However, the type of situation was of influence: Both children with epilepsy and healthy children attributed more shame to incompetence due to epilepsy than to incompetence due to other illnesses. CONCLUSIONS: Increased affective problems in childhood epilepsy cannot be explained by excessive attribution of shame and guilt, affects known to be important precursors of psychopathology, yet both healthy children and children with epilepsy attribute more shame to epilepsy than to other illnesses. Epilepsy is not like any other disease.     

The Influence of Negative Feedback and Social Rank on Feelings of Shame and Guilt: A Vignette Study in 8- to 13-Year-Old Non-Clinical Children

This experimental study examined the role of negative feedback and social rank in the experience of self-conscious emotions, shame and guilt, in typically developing children aged 8 to 13 years. Participants were tested by means of a vignette paradigm in which feedback and social rank were systematically manipulated and levels of shame and guilt were assessed after listening to each of the vignettes. In addition, children completed a set of questionnaires for measuring individual differences in shame and guilt proneness, social comparison, submissive behavior, and external shame. The results showed that children presented with negative feedback reported higher ratings of shame and guilt than when presented with positive feedback, implying that the provision of negative feedback has a significant impact on children’s experience of self-conscious emotions. Social rank had less effect on children’s report of these self-conscious emotions. Furthermore, the individual difference variables of guilt proneness, and to a lesser extent shame proneness and submissive behavior, appeared to be positively related to self-conscious emotions as reported during the vignette task.

     

Shame,guilt, and posttraumatic stress symptoms: A three-level meta-analysis

Existing empirical findings are inconsistent on the correlations of shame and guilt with posttraumatic stress symptoms (PTSS). This study aimed to quantitatively summarize the strength of the associations of shame and guilt with PTSS and explore potential moderators. Based on a three-level meta-analytic method, shame was positively correlated with PTSS, no matter whether the effects of guilt were controlled; guilt also had a positive correlation with PTSS, regardless of whether the effects of shame were partialling out. Moderator analyses showed that type of shame measure (generalized vs. contextual vs. trauma-specific shame) moderated the relation between shame and PTSS, and type of guilt measure (generalized vs. contextual vs. trauma-specific guilt) moderated the relation between guilt and PTSS. In addition, culture had a marginally significant moderating effect on the relation between guilt and PTSS, with a stronger association of guilt with PTSS in Western culture than in Eastern culture. These results supported the links of shame and guilt to PTSS and implied that we should focus on the conceptual underpinnings of the manifest psychometric issue and maintain cultural sensitivity in future research. The implications for posttraumatic stress disorder treatment were also discussed.     

The relation of entrapment, shame and guilt to depression, in carers of people with dementia

There is increasing research exploring depression in carers of people with dementia. This study explored the relation of entrapment, shame and guilt to depression in a group of 70 carers of those with dementia. As in other studies the experience of entrapment in the role was highly related to depression. Moreover, experiences of shame relating to self-criticism, other people's expectations and the fear of their criticism were significantly related to depression, entrapment and guilt. Guilt however, as focused on the fears of harming others, letting others down and sense of responsibility, was not associated with depression or entrapment. Depression in carers may relate in part to feeling trapped in a role but also being vulnerable to criticism and feelings of inadequacy in that role. In this study, degree of behavioural disturbance/dependence was not found to be significantly associated with any of the research variables.