Research article

BMC Psychiatry

, 12:50

Open Access This content is freely available online to anyone, anywhere at any time.

Shame-proneness in attempted suicide patients

  • Maria WiklanderAffiliated withDepartment of Clinical Neuroscience, Karolinska InstitutetDepartment of Clinical Sciences Danderyd Hospital, Karolinska InstitutetDepartment of Neurobiology, Care Sciences and Society, Karolinska Institutet Email author 
  • , Mats SamuelssonAffiliated withDepartment of Neurobiology, Care Sciences and Society, Karolinska Institutet
  • , Jussi JokinenAffiliated withDepartment of Clinical Neuroscience, Karolinska Institutet
  • , Åsa NilsonneAffiliated withDepartment of Clinical Neuroscience, Karolinska Institutet
  • , Alexander WilczekAffiliated withDepartment of Clinical Neuroscience, Karolinska Institutet
  • , Gunnar RylanderAffiliated withDepartment of Clinical Neuroscience, Karolinska Institutet
  • , Marie ÅsbergAffiliated withDepartment of Clinical Sciences Danderyd Hospital, Karolinska Institutet

Abstract

Background

It has been suggested that shame may be an important feature in suicidal behaviors. The disposition to react with shame, “shame-proneness”, has previously not been investigated in groups of attempted suicide patients. We examined shame-proneness in two groups of attempted suicide patients, one group of non-suicidal patients and one group of healthy controls. We hypothesized that the attempted suicide patients would be more shame-prone than non-suicidal patients and healthy controls.

Methods

The Test of Self-Conscious Affect (TOSCA), which is the most used measure of shame-proneness, was completed by attempted suicide patients (n = 175: 105 women and 3 men with borderline personality disorder [BPD], 45 women and 22 men without BPD), non-suicidal psychiatric patients (n = 162), and healthy controls (n = 161). The participants were convenience samples, with patients from three clinical research projects and healthy controls from a fourth research project. The relationship between shame-proneness and attempted suicide was studied with group comparisons and multiple regressions. Men and women were analyzed separately.

Results

Women were generally more shame-prone than men of the same participant group. Female suicide attempters with BPD were significantly more shame-prone than both female suicide attempters without BPD and female non-suicidal patients and controls. Male suicide attempters without BPD were significantly less shame-prone than non-suicidal male patients. In multiple regressions, shame-proneness was predicted by level of depression and BPD (but not by attempted suicide) in female patients, and level of depression and non-suicidality in male patients.

Conclusions

Contrary to our hypothesis and related previous research, there was no general relationship between shame-proneness and attempted suicide. Shame-proneness was differentially related to attempted suicide in different groups of suicide attempters, with significantly high shame-proneness among female suicide attempters with BPD and a negative relationship between shame-proneness and attempted suicide among male patients. More research on state and trait shame in different groups of suicidal individuals seems clinically relevant.

Keywords

Attempted suicide Shame Borderline personality disorder Affective disorders