Shame

Shame is an important aspect of trauma and traumatic stress that hasn’t received great attention in conventional psychology or psychotherapy, despite growing research pointing to its significance, both developmentally and across the lifespan.

What is Shame?

Shame is an emotion and physiological state related to social threat, inferior social standing, or lack of belonging. Shame can be the result of traumatic incidents, more prolonged exposures, or more subtle emotional abuse or neglect such as lack of relational attunement in childhood.

Shame has a pro-social function if shame is momentary or temporary and leads to repair and reconnection with the group; for example, it can promote social order, stimulate learning and repentance, and teach empathy.

However, when shame is chronic (“toxic shame”), it loses its function as a social emotion and instead leads to distortions in one’s core identity. A person who has experienced chronic shame may experience themselves as worthless or bad and believe there is something inherently wrong with them at the core.

Question

What is the difference between shame and guilt?

Shame is different from guilt. Guilt comprises negative judgments related to one’s behaviours or actions, whereas shame comprises negative judgments about one’s core identity or self.

Shame and the Nervous System

Shame and associated shame-based self-appraisals are linked with states of autonomic nervous system states of hypo- and hyper- arousal, as shame activates the fear/threat detection areas of the brain. UCLA Neuropsychologist Dr. Allan Schore describes shame as an “inhibitory state of energy conservation withdrawal.” Subjectively, shame creates a felt sense of shrinking back, smallness, gaze aversion, slouched posture, and often a frozen and foggy feeling characteristic of parasympathetic hypo-arousal (Schore, 2003)

Shame and PTSD

A body of clinical and behavioural research points to shame as central to the development and course of PTSD. Evidence suggests shame may predispose to developing PTSD, that those who experience more shame have more persistent PTSD symptoms, and that shame may increase stigma related to PTSD and decrease care-seeking (Budden, 2009). The DSM-5 revision included shame under the criterion “negative trauma-related emotions”.

Shame and Physical Illness

There is some evidence suggesting that acute and chronic shame can lead to pro-inflammatory states and other disease-relevant immunological health outcomes (Dickerson et al., 2004).

Video: A Simple Strategy to Alleviate Shame After Trauma

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It is important for health professionals who work with traumatized clients to develop an awareness of shame, how it presents, and how to work with shame. Giving lots of space and patience when shame is in the room, naming and providing psychoeducation about shame, and refraining from being overly interrogative, can all help with the gradual unwinding and healing of shame states and shame-based beliefs or identifications. In this video, Dr. Siegel provides a physiological perspective on shame which may be helpful when working with traumatized clients and providing them psychoeducation about shame.

References

Budden, A. (2009). The role of shame in posttraumatic stress disorder: A proposal for a socio-emotional model for DSM-V. Social Science and Medicine, 69(7). 1032-1039.

Dickerson, S. S., Gruenewald, T. L., & Kemeny, M. E. (2004). When the social self is threatened: shame, physiology, and health. Journal of personality, 72(6), 1191–1216.

Schore, Allan. (2003). Affect Regulation and the Repair of the Self. W.W. Norton & Company, Inc.