Many people with borderline personality disorder (BPD) experience intense and chronic shame. Shame, a self-conscious emotion associated with a sense of worthlessness, self-contempt, or self-loathing, may in part explain the high rates of self-harm and suicidal behavior in people with BPD.
What Is Shame?
We use the word all the time, but what exactly is "shame?" Shame is considered one of the self-conscious emotions; it is an emotion that relates to our behavior or self (often in relation to other people). Other self-conscious emotions include embarrassment and guilt.
Although the lines between these emotions have been conceptualized in different ways, one way to think about this is that shame is different than embarrassment or guilt because we experience these two emotions in relation to our behavior, whereas shame is an emotion that relates directly to our sense of self. To understand this distinction, let's use the example of an impulsive act that some people with BPD struggle with: shoplifting.
Imagine that, on impulse, you shoplifted something from a store. Even if no one found out about the shoplifting, you may experience guilt-- a feeling that you have done something that is wrong. If someone did find out about your behavior, you might experience embarrassment-- the feeling you get when other people find out you have done something that violates social norms.
Shame, on the other hand, is a feeling that you are bad or worthy of contempt. It is not necessarily about a specific behavior or event, but is a feeling of being wholly unacceptable as a person. Thus, you may feel shame after shoplifting, but shame carries with it an additional judgment; i.e., "I am a terrible human being."
BPD and Shame - Evidence of Shame-Proneness
Many people with BPD experience pervasive and chronic shame, regardless of their behavior. In fact, research suggests that shame may distinguish BPD from other disorders. For example, Rusch and colleagues demonstrated that women with BPD report more shame-proneness than healthy women or women with social phobia (an anxiety disorder characterized by fear of social situations and being evaluated by others).
Rusch and colleagues have also shown that women with BPD and posttraumatic stress disorder (PTSD) do not have greater shame-proneness than women with BPD alone. Thus, shame-proneness seems to be related to specifically to BPD rather than to co-occurring trauma-related symptoms.
The Relationship Between Shame, Self-Harm, and Suicide
In addition to a growing research literature showing a connection between BPD and shame, a number of experts have suggested a connection between shame and deliberate self-harm and suicide attempts.Self-reported shame has been shown to be associated with past suicide threats, and current and past suicidal thoughts. Shame may also precede episodes of deliberate self-harm. For example, one study by Brown and colleagues demonstrated that women with BPD who expressed more shame when talking about their self-harm behaviors were more likely to self-harm in the future.
Reducing Shame
Despite the intense emotional pain generated by feelings of shame in BPD, very few experts have attempted to develop treatments that directly reduce shameful feelings. However, Dr. Shireen Rizvi, a clinical psychologist and expert in shame and BPD (as well as Dialectical Behavior Therapy, or DBT) has demonstrated preliminary evidence that the DBT skill of "Opposite Action" may help reduce shame about specific events. For more on this technique, see:
Reducing Shame Through Opposite Action
BPD and Shame - Conclusions
Clearly, much more work is needed to understand the causes of shame in BPD, and to address shame in BPD treatment. Shame is an intense, often pervasive emotion that is associated with high-risk behaviors.
Unfortunately, people who feel high levels of shame may also feel motivated to hide their shame for fear that others may judge them to be unacceptable. But, this secrecy may also get in the way of recovery. If your therapist doesn't know that you are experiencing shame, it will be hard for them to intervene. Keep this in mind; if you are in treatment, consider sharing your experience of shame with your therapist. If you are not in treatment, perhaps it is time to find a therapist to help you to address your feelings of shame.
Sources:
Brown MZ, Linehan MM, Comtois KA, Murray A, Chapman AL. "Shame as a Prospective Predictor of Self-Inflicted Injury in Borderline Personality Disorder: A Multi-Modal Analysis." Behaviour Research and Therapy; 47(10):815-822, 2009.
Linehan, MM. "Skills Training Manual for Treating Borderline Personality Disorder." New York: Guilford Press, 1993.
Rizvi SL, Linehan MM. "The Treatment of Maladaptive Shame in Borderline Personality Disorder: A Pilot Study of 'Opposite Action.'" Cognitive and Behavioral Practice; 12(4):437-447, 2005.
Rüsch N, Lieb K, Göttler I, Hermann C, Schramm E, Richter H, Jacob GA, Corrigan PW, Bohus M. "Shame and Implicit Self-Concept in Women with Borderline Personality Disorder." The American Journal of Psychiatry; 164(3):500-508, 2007.
Rüsch N, Corrigan PW, Bohus M, Kühler T, Jacob GA, Lieb K. "The Impact of Posttraumatic Stress Disorder on Dysfunctional Implicit and Explicit Emotions Among Women with Borderline Personality Disorder. Journal of Nervous and Mental Disease; 195(6):537-539, 2007.
