External Shame as a Mediator between Paranoia and Social Safeness in Psychosis

Abstract

Background: The overactivation of the threat-defence system combined with an underdeveloped affiliative system has been emphasised as important in psychosis, usually leading to negative affect and impaired social functioning. Difficulties in feeling safe and content in relationships with others, common in individuals with psychotic symptoms, have been linked to two specific outputs of the threat-defence system: Paranoid ideation and external shame. This study sought to explore the associations between paranoid ideation, external shame, and social safeness.Methods: Participants diagnosed with psychotic disorders (N = 37) completed a series of self-report questionnaires.Results: Results showed a significant negative association between social safeness and external shame and frequency of paranoid ideation, while external shame was positively associated with both frequency and distress of paranoid ideation. Results revealed that the relationship between frequency of paranoid ideation and social safeness was mediated by external shame.Conclusions: These findings suggest that feelings of being inferior and subordinate in the eyes of others increases vulnerability to difficulties in social connectedness and safeness. Treatment for paranoid ideation could benefit from integrating strategies to help patients deal with shame.

Moral Emotions and Social Economic Games in Paranoia

“…Shameful feelings in response to deliberate harm are more consistent with activation of negative schemas about the self (“Bad Me” paranoia) rather than the protection against distress from others (“Poor Me” paranoia) ( 53 ). Shame is strongly associated with the frequency and distress of paranoid thinking in patients with psychotic disorders ( 54 ), although less is known about its relationship with the content of delusions. As the PDI contains some items of persecution, suspiciousness, and paranoid ideas, it is possible that multidimensional delusional beliefs, including thoughts of persecution, predict shame in response to interpersonal harm.…”

An Experimental Investigation into the Effect of State-Anxiety on State-Paranoia in People Experiencing Psychosis

“…Interestingly, the measure of affect used in this study included shame, which may have contributed to the strong links found between negative affect and paranoia. Indeed, high shame has been found to increase vulnerability to paranoia in the face of stressful situations (Johnson et al, 2014) and decrease sense of social safeness (Castilho et al, 2017) in clinical populations. Clinically paranoid individuals have been found to experience significantly higher levels of negative cognitions about the self, such as low self-esteem and low self-compassion (Collett et al, 2016).…”

Are shame and self‐criticism the path to the pervasive effect of social stress reactivity on social functioning in psychosis?

“…There are two described types of shame: internal (focused on the self) and external (focused on others). External shame has been associated with higher levels of paranoia, negative symptoms and post-psychotic distress (Argel, 2018;Birchwood et al, 2007;Castilho et al, 2017;Turner, Bernard, Birchwood, Jackson, & Jones, 2013), on one hand, and difficulties in personal recovery on the other (Wood & Irons, 2016). People with psychotic symptoms have reported higher levels of external shame when compared with non-clinical controls (Keen, George, Scragg, & Peters, 2017).…”

“…External shame has also been stressed as an important mediator between symptoms and the ability to feel safe and connected in the social world (Argel, 2018;Castilho et al, 2017). Internal shame refers to negative self-evaluations focused on perceived personal mistakes and shortcomings, and thus, a key component of internal shame is self-devaluation and self-criticism (Gilbert & Procter, 2006).…”

“…External shame has also been stressed as an important mediator between symptoms and the ability to feel safe and connected in the social world (Argel, 2018;Castilho et al, 2017).…”