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CMAJ : Canadian Medical Association... Apr 2014
Topics: Humans; New York City; Practice Patterns, Physicians'; Primary Health Care; Private Practice; Shame
PubMed: 24638022
DOI: 10.1503/cmaj.131838 -
Turk Psikiyatri Dergisi = Turkish... 2021Dear Editor, The chapter on mental, behavioural and neurodevelopmental disorders of the 11th revision of the International Classification of Diseases and Related Health...
Dear Editor, The chapter on mental, behavioural and neurodevelopmental disorders of the 11th revision of the International Classification of Diseases and Related Health Problems (ICD-11) has been now finalized. Reporting of health statistics by Member States to the World Health Organization (WHO) using the new diagnostic system will begin in 2022. The section on mood disorders of the ICD-11 is overall consistent with the corresponding section of the ICD-10. However, the definitions of a depressive and a manic episode have been slightly changed, making them consistent with the DSM-5 (see below), and an independent category of bipolar II disorder has been introduced. A significant effort has been made by the WHO and the American Psychiatric Association to harmonize the diagnostic systems they produce (the ICD-11 and the DSM-5). Indeed, the organizational framework ("metastructure") is now the same in the two systems. Nonetheless, several intentional differences between the two classifications remain, or have emerged as a consequence of changes made in the DSM- 5. Here we briefly summarize the convergences and the divergences between the ICD-11 and the DSM-5 regarding the section on mood disorders (see Table 1). A major convergence between the two diagnostic systems regards the minimum number of symptoms required for the diagnosis of major depression ("depressive episode" in the ICD-11). In the ICD-11, contrary to the ICD-10, the threshold for the diagnosis of depression is the same as in the DSM: at least five depressive symptoms. However, the ICD-11 requires at least five symptoms out of a list of ten (instead of nine as in the DSM-5). The additional symptom is "hopelessness", which has been found to outperform more than half of DSM symptoms in differentiating depressed from non-depressed people (McGlinchey et al. 2006). Table 1. Some Main Differences Between ICD-10, ICD-11 and DSM-5 Concerning the Diagnosis Of Mood Disorders ICD-10 ICD-11 DSM-5 Threshold for diagnosis of depressive episode At least four out of ten symptoms, two of which must be depressed mood, loss of interest and enjoyment, or increased fatigability At least five out of ten symptoms, one of which must be depressed mood or diminished interest or pleasure At least five out of nine symptoms, one of which must be depressed mood or diminished interest or pleasure The threshold for the diagnosis of depression is higher if the person is bereaved Not made explicit Yes No Antidepressant-related mania qualifies as a manic episode No Yes Yes Mixed episode is a separate diagnostic entity Yes Yes No Dysthymia is a separate diagnostic entity Yes Yes No Bipolar II disorder is a separate diagnostic entity No Yes Yes "Qualifiers" ("specifiers") for the diagnoses of mood disorders are provided No Yes Yes CONVERGENCES AND DIVERGENCES IN THE ICD-11 VS. DSM-5 CLASSIFICATION OF MOOD DISORDERS 294 The ICD-11 is also following the DSM-5 in requiring the presence of increased activity or a subjective experience of increased energy, in addition to euphoria (or irritability or expansiveness), for the diagnosis of a manic episode, in order to reduce the chance of false positive cases. The two diagnostic systems also converge in considering that a manic or hypomanic syndrome arising during antidepressant treatment, and enduring beyond the known physiological effects of that treatment, qualifies as a manic or hypomanic episode. Bipolar II disorder has become an independent category in the ICD-11 (it was just mentioned as an example of "other bipolar affective disorders" in the ICD-10). Furthermore, for the first time, the ICD follows the DSM in introducing "qualifiers" (corresponding to DSM-5 "specifiers") to the diagnoses of mood disorders, based on specific aspects of symptomatology or course. There are, however, three important aspects in which the two diagnostic systems diverge. All of them are a consequence of changes made in the DSM-5 that the relevant ICD-11 Committee has regarded as not sufficiently supported by the available research evidence. The first of these divergences concerns the issue of bereavement. In the ICD-11, in line with the DSM-IV and ICD-10 approach, it is stated that "a depressive episode should not be considered if the depressive symptoms are consistent with the normative response for grieving within the individual's religious and cultural context". However, the diagnosis of depression is not excluded if the person is bereaved; the diagnostic threshold is just raised, exactly as it happens in ordinary clinical practice. A depressive episode during bereavement is suggested by the persistence of symptoms for at least one month, and the presence of at least one symptom which is unlikely to occur in normal grief (such as extreme beliefs of low self-worth or guilt not related to the lost loved one, presence of psychotic symptoms, suicidal ideation, or psychomotor retardation). In contrast, the special status conferred by the DSM-IV to bereavement among life stressors has been eliminated in the DSM-5. However, two independent follow-up studies (Mojtabai 2011, Wakefield and Schmitz 2012) have reported that, in people with baseline bereavement-related depression, the risk for the occurrence of a further depressive episode during follow-up is significantly lower than in individuals with baseline non-bereavement-related depression, and not significantly different from the risk of people without a baseline history of depression to develop a first depressive episode during follow-up. This research evidence strongly supports the ICD-11 (and DSM-IV) approach. Furthermore, an intensive public debate has highlighted the consequences that the DSM-5 approach to the bereavement issue could have in several cultures, including a high rate of false positives and a trivialization of the concept of depression and consequently of mental disorder (Kleinman 2012). A second divergence between the ICD-11 and DSM-5 sections on mood disorders concerns mixed states. The category of mixed episode is kept in the ICD-11, defined by several prominent manic and depressive symptoms which either occur simultaneously or alternate very rapidly (from day to day or within the same day) during a period of at least two weeks. The mood state is altered throughout the episode (i.e., the mood should be depressed, dysphoric, euphoric or expansive for at least two weeks). When depressive symptoms predominate, common contrapolar symptoms are irritability, racing or crowded thoughts, increased talkativeness, and increased activity. When manic symptoms predominate, common contrapolar symptoms are dysphoric mood, expressed beliefs of worthlessness, hopelessness, and suicidal ideation. This definition is in line with the ICD-10 and completely consistent with both classic and recent research evidence, as well as with clinical experience. In contrast, the DSM-5 solution to eliminate the category of mixed episode and to introduce a specifier "with mixed features", applicable to manic, hypomanic and depressive episodes, has had the consequence to reduce the visibility of "mixity" in ordinary clinical practice (especially since the specifier is not codable, and is therefore at risk of not being recorded in clinical settings). Moreover, the DSM-5 definition of major depression with mixed features, requiring the presence of at least three "classic" manic symptoms (such as elevated mood, grandiosity, and increased involvement in risky activities) has been criticized for being inconsistent with the concept of mixed depression as delineated in both the classic and recent literature (e.g., Koukopoulos and Sani 2014). A third divergence between the two diagnostic systems consists in the fact that the ICD-11 has not followed the DSM-5 in combining dysthymic disorder and chronic major depressive disorder into a single category ("persistent depressive disorder"). In fact, the relevant ICD-11 Committee expert considered that the evidence that the two disorders represent the same condition, to be addressed therapeutically in the same way, is insufficient. The category of dysthymic disorder is kept in the ICD-11, while a qualifier "current episode persistent" is to be used when the diagnostic requirements for depressive episode have been met continuously for at least the past two years. For a discussion of other aspects of the classification of mood disorders, with the relevant therapeutic implications, as well as for information about the differences between the ICD-11 and the DSM-5 concerning other sections of the classification of mental disorders, we refer the reader to previous contributions (Demyttenaere et al. 2015, Fried et al. 2016, Haroz et al. 2017, Boschloo et al. 2019, Bryant 2019, Forbes et al. 2019, Fusar-Poli et al. 2019, Gureje et al. 2019, 295 Received: 13.09.2021, Accepted: 19.09.2021, Available Online Date: 30.11.2021 MD., University of Campania L. Vanvitelli, WHO Collaborating Centre for Research and Training in Mental Health, Naples, Italy. Dr. Arcangelo Di Cerbo, e-mail: [email protected] https://doi.org/10.5080/u26899 Reed et al. 2019, Kendall 2019, van Os et al. 2019, Cuijpers et al. 2020, Fava and Guidi 2020, Gaebel et al. 2019, 2020, Hasler 2020, Jarrett 2020, Kato et al. 2020, Maj et al. 2020, Reynolds 2020, Sanislow 2020, Stein et al. 2020). An International Advisory Group has been established to supervise the activities of translation, training of professionals and implementation of the ICD-11 chapter on mental disorders (see Giallonardo 2019, Pocai 2019, Perris 2020). The experience in the field will tell whether the above divergences from the DSM-5 in the ICD-11 classification of mood disorders are justified. Indeed, divergences in the description of the same mental health condition may sometimes be useful in order to allow the empirical comparison of different approaches to issues that are controversial. Arcangelo DI CERBO REFERENCES Boschloo L, Bekhuis E, Weitz ES et al (2019) The symptom-specific efficacy of antidepressant medication vs. cognitive behavioral therapy in the treatment of depression: results from an individual patient data meta-analysis. World Psychiatry 18:183-91. Bryant RA (2019) Post-traumatic stress disorder: a state-of-the-art review of evidence and challenges. World Psychiatry 18:259-69. Cuijpers P, Noma H, Karyotaki E et al (2020) A network meta-analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression. World Psychiatry 19:92-107. Demyttenaere K, Donneau AF, Albert A et al (2015) What is important in being cured from depression? Discordance between physicians and patients (1). J Affect Disord 174:390-6. Fava GA, Guidi J (2020) The pursuit of euthymia. World Psychiatry 19:40-50. Fried EI, Epskamp S, Nesse RM et al (2016) What are "good" depression symptoms? Comparing the centrality of DSM and non-DSM symptoms of depression in a network analysis. J Affect Disord 189:314-20. Forbes MK, Wright AGC, Markon KE et al (2019) The network approach to psychopathology: promise versus reality. World Psychiatry 18:272-3. Fusar-Poli P, Solmi M, Brondino N et al (2019) Transdiagnostic psychiatry: a systematic review. World Psychiatry 8:192-207. Gaebel W, Reed GM, Jakob R (2019) Neurocognitive disorders in ICD-11: a new proposal and its outcome. World Psychiatry 18:232-3. Gaebel W, Stricker J, Riesbeck M et al (2020) Accuracy of diagnostic classification and clinical utility assessment of ICD-11 compared to ICD-10 in 10 mental disorders: findings from a web-based field study. Eur Arch Psychiatry Clin Neurosci 270:281-9. Giallonardo V (2019) ICD-11 sessions within the 18th World Congress of Psychiatry. World Psychiatry 18:115-6. Gureje O, Lewis-Fernandez R, Hall BJ et al (2019) Systematic inclusion of culture-related information in ICD-11. World Psychiatry 18:357-8. Haroz EE, Ritchey M, Bass JK et al (2017) How is depression experienced around the world? A systematic review of qualitative literature. Soc Sci Med 183:151-62. Hasler G (2020) Understanding mood in mental disorders. World Psychiatry 19:56-7. Jarrett RB (2020) Can we help more? World Psychiatry 19:246-7. Kato TA, Kanba S, Teo AR (2020) Defining pathological social withdrawal: proposed diagnostic criteria for hikikomori. World Psychiatry 19:116-7. Kendall T (2019) Outcomes help map out evidence in an uncertain terrain, but they are relative. World Psychiatry 18:293-5. Kleinman A (2012) Culture, bereavement, and psychiatry. Lancet 379:608-9. Koukopoulos A, Sani G (2014) DSM-5 criteria for depression with mixed features: a farewell to mixed depression. Acta Psychiatr Scand 129:4-16. Kotov R, Jonas KG, Carpenter WT et al (2020) Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): I. Psychosis superspectrum. World Psychiatry 19:151-72. Maj M, Stein DJ, Parker G et al (2020) The clinical characterization of the adult patient with depression aimed at personalization of management. World Psychiatry 19:269-93. McGlinchey JB, Zimmerman M, Young D et al (2006) Diagnosing major depressive disorder VIII. Are some symptoms better than others? J Nerv Ment Dis 194:785-90. Mojtabai R (2011) Bereavement-related depressive episodes: characteristics, 3-year course, and implications for the DSM-5. Arch Gen Psychiatry 68:920-8. Perris F (2020) ICD-11 sessions at the 19th World Congress of Psychiatry. World Psychiatry 19:263-4. Pocai B (2019) The ICD-11 has been adopted by the World Health Assembly. World Psychiatry 18:371-2. Reed GM, First MB, Kogan CS et al (2019) Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry 18:3-19. Reynolds CF 3rd (2020) Optimizing personalized management of depression: the importance of real-world contexts and the need for a new convergence paradigm in mental health. World Psychiatry 19:266-8. Sanislow CA (2020) RDoC at 10: changing the discourse for psychopathology. World Psychiatry 19:311-2. Stein DJ, Szatmari P, Gaebel W et al (2020) Mental, behavioural and neurodevelopmental disorders in the OCD-11: an international perspective on key changes and controversies. BMC Med 18:21. van Os J, Guloksuz S, Vijn TW et al (2019) The evidence-based group-level symptom-reduction model as the organizing principle for mental health care: time for change? World Psychiatry 18:88-96. Wakefield JC, Schmitz MF (2012) Recurrence of bereavement-related depression: evidence for the validity of the DSM-IV bereavement exclusion from the Epidemiologic Catchment Area Study. J Ment Dis 200:480-5.
Topics: Adult; Depressive Disorder, Major; Diagnostic and Statistical Manual of Mental Disorders; Humans; International Classification of Diseases; Mood Disorders; Phobia, Social; Shame
PubMed: 34964106
DOI: 10.5080/u26899 -
Journal of Parkinson's Disease 2019Shame is a self-conscious emotion marked by an intensely negative self-evaluation. It is exhibited by an individual upon realizing that she/he has violated an important... (Review)
Review
Shame is a self-conscious emotion marked by an intensely negative self-evaluation. It is exhibited by an individual upon realizing that she/he has violated an important (usually social) norm. Shame can be a source of emotional distress leading to social withdrawal and depression, with a significant negative impact on quality of life. In Parkinson's disease (PD), shame is rarely addressed. Based on reports of persons affected with Parkinson's disease (PwP) as well as a literature review, this article describes PD-related shame. PD-related shame may emerge from motor and non-motor symptoms, from self-perception of inadequacy due to loss of autonomy and need for help, or from perceived deterioration of body image. The neurobiology of shame delineates neuronal networks involved in cognitive and emotions regulation, self-representation and representation of the others mental states. Although this hypothesis remains to be demonstrated, these substrates could be modulated, at least partially, by dopaminergic depletion related to PD, which may open a window for pharmacotherapy. Owing to the negative impact that shame can produce, shame should be actively explored and addressed in the individual PwP. Teaching PwP how to develop resilience to shame may be a useful strategy in preventing the vicious circle of shame. The paucity of existing data on prevalence and management of PD-specific shame contrasts with the manifold reported situations inducing suffering from shame. There is a crucial need for further investigations of shame in PD and the development of interventions to reduce its impact on PwP's quality of life.
Topics: Humans; Parkinson Disease; Quality of Life; Shame
PubMed: 31081792
DOI: 10.3233/JPD-181462 -
Maternal & Child Nutrition Jul 2021Negative maternal affect (e.g., depression and anxiety) has been associated with shorter breastfeeding duration and poorer breastfeeding intention, initiation, and... (Review)
Review
Negative maternal affect (e.g., depression and anxiety) has been associated with shorter breastfeeding duration and poorer breastfeeding intention, initiation, and exclusivity. Other affective states, including guilt and shame, have been linked with formula feeding practice, though existing literature has yet to be synthesised. A narrative synthesis of quantitative data and a framework synthesis of qualitative and quantitative data were conducted to explore guilt and/or shame in relation to infant feeding outcomes. Searches were conducted on the DISCOVER database between December 2017 and March 2018. The search strategy was rerun in February 2020, together yielding 467 studies. The study selection process identified 20 articles, published between 1997 and 2017. Quantitative results demonstrated formula feeders experienced guilt more commonly than breastfeeding mothers. Formula feeders experienced external guilt most commonly associated with healthcare professionals, whereas breastfeeding mothers experienced guilt most commonly associated with peers and family. No quantitative literature examined shame in relation to infant feeding outcomes, warranting future research. The framework synthesis generated four distinct themes which explored guilt and/or shame in relation to infant feeding outcomes: 'underprepared and ineffectively supported', 'morality and perceived judgement' (breastfeeding), 'frustration with infant feeding care' and 'failures, fears and forbidden practice' (formula feeding). Both guilt and shame were associated with self-perception as a bad mother and poorer maternal mental health. Guilt and shame experiences were qualitatively different in terms of sources and outcomes, dependent on infant feeding method. Suggestions for tailored care to minimise guilt and shame, while supporting breastfeeding, are provided.
Topics: Breast Feeding; Female; Guilt; Humans; Infant; Mothers; Postpartum Period; Shame
PubMed: 33491303
DOI: 10.1111/mcn.13141 -
PloS One 2018Shame and guilt seem to be two synonymous moral emotions but actually lead to contrasting human behaviors or behavioral tendencies. Shame drives people to hide or deny...
Shame and guilt seem to be two synonymous moral emotions but actually lead to contrasting human behaviors or behavioral tendencies. Shame drives people to hide or deny their wrongdoings while guilt drives people to amend their mistakes. How shame and guilt evolved in humans is still obscure. Here we present a computer model featured with reciprocal altruism and gregarious lifestyle for studying this question. We tested ten different strategies in our model and the pairwise contests show that shame-driven-hiding strategy can dominate the other strategies such as tit-for-tat and Pavlov in more than half of parameter combinations. The mathematical analysis of our model demonstrates that shame-driven-hiding strategy is an evolutionary stable strategy within a group as long as hiding can let an individual evade the retaliations to his wrongdoings. However, the problem of hiding is that it reduces an individual's social circle, i.e. living in a smaller group. Our analysis also shows that guilt-driven-amending strategy can outperform shame-driven-denying strategy at both individual and group levels if the cooperative behavior is sustainable within a group (b/(b-c) < T/n). Thus, we propose that shame is more adaptive at the individual level while guilt is more advantageous in the context of intergroup competition.
Topics: Emotions; Female; Game Theory; Guilt; Humans; Male; Models, Psychological; Morals; Shame; Social Behavior
PubMed: 29995883
DOI: 10.1371/journal.pone.0199448 -
Journal of Evaluation in Clinical... Oct 2022The emotional underpinnings that facilitate and complicate the practice of ethical principles like respect warrant sustained interdisciplinary attention. In this...
BACKGROUND & AIMS
The emotional underpinnings that facilitate and complicate the practice of ethical principles like respect warrant sustained interdisciplinary attention. In this article, I suggest that shame is a requisite component of the emotional repertoire than makes respect for persons possible.
MATERIALS & METHODS
I use person-centered interview data from a sample of 54 physicians (including 35 surgeons), 60% of whom are women, to examine the emergence and endurance of shame as a mood with moral significance. Drawing on anthropologist Throop's concept of a moral mood, I explore physicians' first-person narratives of the endurance of shame experiences.
RESULTS
Narratives demonstrate that shame inheres in biomedical contexts that reinforce the physician's responsibilization and culpability for events beyond their control. As a persistent cognitive and affective state, mooded shame is a recursive and compulsory motive force for a physician's dynamic evolution as a moral actor.
DISCUSSION
Variably distressing, looming and commonplace, mooded shame becomes an atmospheric and imaginative mode through which physicians contemplate their responsibilities and connections to patients. Sometimes in a hypercognized manner that conceals its emotional roots, physicians link the mood of shame to their incessant efforts to fulfill responsibilities to each unique patient.
CONCLUSION
I suggest that through reflection made possible within mooded shame, physicians develop a sense of being both accountable to and alongside patients, and I explore the ties between this position and philosophical concepts of respect.
Topics: Affect; Emotions; Female; Humans; Male; Morals; Physicians; Shame
PubMed: 35655432
DOI: 10.1111/jep.13708 -
BMC Psychology Oct 2021There is a knowledge gap in whether psychopathology aspects can shape and mark the social representations about health and lifestyle. In this work, we investigated the...
BACKGROUND
There is a knowledge gap in whether psychopathology aspects can shape and mark the social representations about health and lifestyle. In this work, we investigated the association of psychopathology and shame with the centrality of the words describing eight common social representations of health and lifestyle.
METHODS
A convenience sample of 288 adults participated with an average age of 44.7, and 62.6% were women. The participants were asked to express three consecutive words associated with eight different health and lifestyle experiences by utilizing the free association method. The participants also were completed the Symptom Checklist-90-Revised (SCL-90-R), the Experiences of Shame Scale (ESS), and the Other as Shamer Scale (OAS). Canonical correlation analysis was applied to investigate the relationship between the set of the eight-word centralities and the psycho-demographic variables consisting of the subject's age and gender, the SCL 90 subscales, the OAS, and the ESS. Based on these findings, a structural equation explorative model was formed to test the unidimensionality of the five centralities construct.
RESULTS
Τhe psychological characteristics of interpersonal sensitivity, depression, external shame, and hostility were found to affect the word selection process on the social representations concerning nightlife, health, diet, lifestyle, and alcohol consumption. Participants with increased levels of depression tend to choose more centrally positioned words when the stimulus word was diet and more decentralized responses when the stimulus word was health. At the same time, higher external shame corresponded to more decentralized words for the categories of health and lifestyle.
CONCLUSIONS
Our results indicate that there is a potential interaction between the psychological state and how a social representation of health and lifestyle is constructed through selected words. Graph theory emerged as an additional tool to use to study these relations.
Topics: Adult; Depression; Female; Free Association; Humans; Life Style; Mental Disorders; Middle Aged; Shame
PubMed: 34715929
DOI: 10.1186/s40359-021-00671-x -
Comprehensive Psychiatry Jul 2021Feelings of shame and guilt have rarely been investigated in people at ultra-high risk (UHR) for psychosis. We aimed to outline differences in shame and guilt in...
OBJECTIVE
Feelings of shame and guilt have rarely been investigated in people at ultra-high risk (UHR) for psychosis. We aimed to outline differences in shame and guilt in relation to empathy and theory of mind (ToM) in young people, particularly those at UHR for psychosis.
METHODS
First, 166 young healthy controls were assessed for their proneness to shame and guilt using the Test of Self-Conscious Affect, empathy and its four subdomains (perspective taking, fantasy, empathic concern, and personal distress) using the Interpersonal Reactivity Index (IRI), ToM using the ToM picture stories task, and neurocognitive performance using the Raven's Standard Progressive Matrices (SPM). Next, we evaluated shame and guilt in 24 UHR individuals comparing them to 24 age- and sex-matched healthy controls. Finally, we explored relationships for shame and guilt in relation to empathy and ToM in the UHR individuals.
RESULTS
In the healthy youth, a regression analysis showed fantasy and personal distress in IRI to be significant determinants of shame, while perspective taking and empathic concern in IRI, ToM, and SPM were independent predictors of guilt. Meanwhile, compared to the healthy controls, individuals with UHR exhibited higher levels of shame, which was associated with increased personal distress.
DISCUSSION
Our findings showed that four subdomains of empathy, ToM, and neurocognition were differentially associated with shame and guilt in healthy young people. Given the correlation between excessive feelings of shame and high levels of the personal distress dimension of empathy in UHR for psychosis, redressing the tendency to focus on self-oriented negative emotions upon witnessing distress of others could possibly reduce self-blame or self-stigma of help-seeking individuals.
Topics: Adolescent; Emotions; Empathy; Guilt; Humans; Psychotic Disorders; Shame
PubMed: 33957480
DOI: 10.1016/j.comppsych.2021.152241 -
Tidsskrift For Den Norske Laegeforening... Mar 2019
Topics: Female; Global Health; Humans; Menstruation; Shame; Women's Health
PubMed: 30872823
DOI: 10.4045/tidsskr.19.0158 -
Addictive Behaviors Sep 2021A dominant view of guilt and shame is that they have opposing action tendencies: guilt- prone people are more likely to avoid or overcome dysfunctional patterns of...
A dominant view of guilt and shame is that they have opposing action tendencies: guilt- prone people are more likely to avoid or overcome dysfunctional patterns of behaviour, making amends for past misdoings, whereas shame-prone people are more likely to persist in dysfunctional patterns of behaviour, avoiding responsibility for past misdoings and/or lashing out in defensive aggression. Some have suggested that addiction treatment should make use of these insights, tailoring therapy according to people's degree of guilt-proneness versus shame-proneness. In this paper, we challenge this dominant view, reviewing empirical findings from others as well as our own to question (1) whether shame and guilt can be so easily disentangled in the experience of people with addiction, and (2) whether shame and guilt have the opposing action tendencies standardly attributed to them. We recommend a shift in theoretical perspective that explains our main finding that both emotions can be either destructive or constructive for recovery, depending on how these emotions are managed. We argue such management depends in turn on a person's quality of self-blame (retributive or 'scaffolding'), impacting upon their attitude towards their own agency as someone with fixed and unchanging dispositions (shame and guilt destructive for recovery) or as someone capable of changing themselves (shame and guilt productive for recovery). With an eye to therapeutic intervention, we then explore how this shift in attitude towards the self can be accomplished. Specifically, we discuss empathy-driven affective and narratively-driven cognitive components of a process that allow individuals to move away from the register of retributive self-blame into a register of scaffolding 'reproach', thereby enabling them to manage their experiences of both shame and guilt in a more generative way.
Topics: Emotions; Empathy; Guilt; Humans; Self Concept; Shame
PubMed: 33957551
DOI: 10.1016/j.addbeh.2021.106954