Purpose of Review
Studies on the relations between shame and anxiety and obsessive-compulsive and related disorders (OCRDs) are reviewed, with a focus on recent work.
Medium-sized positive correlations have been consistently found across anxiety disorders and OCRDs, suggesting that this relation is transdiagnostic. Most studies focused on shame-proneness and found similar relations across multiple types (e.g. internal, external) and domains (e.g. bodily, characterological, behavioural) of shame, with little variation between clinical and non-clinical populations and different age categories. However, most studies are cross-sectional and correlational and by separately studying clinical and non-clinical populations, they do not give a unitary dimensional view of the relation between shame and symptoms. Emerging findings suggest that shame may be a marker of the response to treatment in these disorders, and its relation with symptoms may be bidirectional.
The consistent but medium-sized associations between shame and symptoms of anxiety and OCRDs warrant the future search for mediators and moderators.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Tangney JP, Tracy JL. Self-conscious emotion. In: Leary MR, Tangney JP, editors. handbook of self and identity. New York: The Guilford Press; 2012.
Gilbert P. The relationship of shame, social anxiety and depression: the role of the evaluation of social rank. Clin Psychol Psychother. 2000;7:174–89.
de Hooge IE, Breugelmans SM, Zeelenberg M. Not so ugly after all: when shame acts as a commitment device. J Pers Soc Psychol. 2008;95(4):933–43.
•• Cândea D-M, Szentagotai-Tătar A. Shame-proneness, guilt-proneness and anxiety symptoms: a meta-analysis. J Anxiety Disord. 2018;58:78–106. This is the first meta-analysis of the relation between shame, non-specific anxiety symptoms, anxiety disorders, and obsessive-compulsive disorder.
Vikan A, Hassel AM, Rugset A, Johansen HE, Moen T. A test of shame in outpatients with emotional disorder. Nord J Psychiatry. 2010;64:196–202.
Gilbert P, McEwan K, Bellew R, Mills A, Corinne G. The dark side of competition: how competitive behaviour and striving to avoid inferiority are linked to depression, anxiety, stress and self-harm. Psychol Psychother Theory Res Pract. 2009;82:123–36.
Keith L, Gillanders D, Simpson S. An exploration of the main sources of shame in an eating-disordered population. Clin Psychol Psychother. 2009;16:317–27.
Rüsch N, Lieb K, Göttler I, Hermann C, Schramm E, Richter H, et al. Shame and implicit self-concept in women with borderline personality disorder. Am J Psychiatry. 2007;164:500–8.
Gilbert P, McEwan K, Irons C, Bhundia R, Christie R, Broomhead C, et al. Self-harm in a mixed clinical population: the roles of self-criticism, shame, and social rank. Br J Clin Psychol. 2010;49:563–76.
Crossley D, Rockett K. The experience of shame in older psychiatric patients: a preliminary enquiry. Aging Ment Health. 2005;9:368–73.
Paulus DJ, Vanwoerden S, Norton PJ, Sharp C. Emotion dysregulation, psychological inflexibility, and shame as explanatory factors between neuroticism and depression. J Affect Disord. 2016;190:376–85.
Gilbert P. What is shame? Some core issues and controversies. In: Gilbert P, Andrews B, editors. Shame: interpersonal behavior, psychopathology, and culture. New York: Oxford University Press; 1998.
Andrews B, Qian M, Valentine JD. Predicting depressive symptoms with a new measure of shame: the Experience of Shame Scale. Br J Clin Psychol. 2002;41(1):29–42.
Kolves K, Ide N, De Leo D. Marital breakdown, shame, and suicidality in men: a direct link? Suicide Life Threat Behav. 2011;41(2):149–59.
Cunha M, Matos M, Faria D, Zagalo S. Shame memories and psychopathology in adolescence: the mediator effect of shame. Int J Psychol Psychol Ther. 2012;12:203–18.
Matos M, Pinto-Gouveia J. Shame as a traumatic memory. Clin Psychol Psychother. 2010;17:299–312.
Matos M, Pinto-Gouveia J, Gilbert P, Duarte C, Figueiredo C. The Other As Shamer Scale-2: development and validation of a short version of a measure of external shame. Personal Individ Differ. 2015;74:6–11.
Szentágotai-Tătar A, Miu AC. Individual differences in emotion regulation, childhood trauma and proneness to shame and guilt in adolescence. PLoS One. 2016;11(11):e0167299.
Shorey RC, Sherman AE, Kivisto AJ, Elkins SR, Rhatigan DL, Moore TM. Gender differences in depression and anxiety among victims of intimate partner violence: the moderating effect of shame proneness. J Interpers Violence. 2011;26:1834–50.
Thompson T, Altmann R, Davidson J. Shame-proneness and achievement behaviour. Personal Individ Differ. 2004;36:613–27.
Hedman E, Ström P, Stünkel A, Mörtberg E. Shame and guilt in social anxiety disorder: effects of cognitive behavior therapy and association with social anxiety and depressive symptoms. PLoS One. 2013;8(4):e61713. https://doi.org/10.1371/journal.pone.0061713
Beck AT, Emery G, Greenberg, RL. Anxiety disorders and phobias. A cognitive perspective. New York: Basic Books; 2005.
•• Clark DM, Wells A. A cognitive model of social phobia. In: Heimberg R, Liebowitz M, Hope DA, Schneier FR, editors. Social phobia: Diagnosis, assessment and treatment. New York: Guilford Press; 1995. This study shows that shame-proneness decreases following cognitive behavior therapy in patients with social anxiety disorders.
Rapee RM, Heimberg RG. A cognitive-behavioral model of anxiety in social phobia. Behav Res Ther. 1997;35(8):741–56.
Gilbert P. Evolution and social anxiety: the role of attraction, social competition, and social hierarchies. Psychiatr Clin North Am. 2001;24:723–51.
Gilbert P. Evolution, social roles, and the differences in shame and guilt. Soc Res: An Int Q. 2003;70(4):1205–30.
Michail M, Birchwood M. Social anxiety disorder and shame cognitions in psychosis. Psychol Med. 2013;43:133–42.
Kapur V, Rai S. The experience of shame in social phobia. J Psychosoc Res. 2013;8(2):299.
Scheel CN, Bender C, Tuschen-Caffier B, Brodführer A, Matthies S, Hermann C, et al. Do patients with different mental disorders show specific aspects of shame? Psychiatry Res. 2014;220:490–5.
Gilbert P, Pehl J, Allan S. The phenomenology of shame and guilt: an empirical investigation. Br J Med Psychol. 1994;67(1):23–36.
Gilbert P, Miles JNV. Sensitivity to social put-down: It’s relationship to perceptions of social rank, shame, social anxiety, depression, anger and self-other blame. Personal Individ Differ. 2000;29:757–74.
Lutwak N, Ferrari J. Shame-related social anxiety: replicating a link with various social interaction measures. Anxiety Stress Coping Int J. 1997;10:335–40.
Matos M, Pinto-Gouveia J, Gilbert P. The effect of shame and shame memories on paranoid ideation and social anxiety. Clin Psychol Psychother. 2013;20:334–49.
Shahar B, Doron G, Szepsenwol O. Childhood maltreatment, shame-proneness and self-criticism in social anxiety disorder: a sequential mediational model: shame and self-criticism in social anxiety. Clin Psychol Psychother. 2015;22(6):570–9.
Levinson CA, Byrne M, Rodebaugh TL. Shame and guilt as shared vulnerability factors: shame, but not guilt, prospectively predicts both social anxiety and bulimic symptoms. Eat Behav. 2016;22:188–93.
Arditte KA, Morabito DM, Shaw AM, Timpano KR. Interpersonal risk for suicide in social anxiety: the roles of shame and depression. Psychiatry Res. 2016;239:139–44.
Cândea D-M, Szentágotai-Tătar A. Shame as a predictor of post-event rumination in social anxiety. Cognit Emot. 2017;31(8):1684–91.
Lazarus G, Shahar B. The role of shame and self-criticism in social anxiety: a daily-diary study in a nonclinical sample. J Soc Clin Psychol. 2018;37(2):107–27.
• Shahar B, Bar-Kalifa E, Hen-Weissberg A. Shame during social interactions predicts subsequent generalized anxiety symptoms: a daily-diary study. J Soc Clin Psychol. 2015;34:827–37. This daily-diary design study shows that state shame during social interactions predicts subsequent generalized anxiety symptoms.
Fergus TA, Valentiner DP, McGrath PB, Jencius S. Shame- and guilt-proneness: relationships with anxiety disorder symptoms in a clinical sample. J Anxiety Disord. 2010;24:811–5.
Zimmerman J, Morrison AS, Heimberg RG. Social anxiety, submissiveness, and shame in men and women: a moderated mediation analysis. Br J Clin Psychol. 2015;54:1–15.
Muris P, Meesters C, Bouwman L, Notermans S. Relations among behavioral inhibition, shame- and guilt-proneness, and anxiety disorders symptoms in non-clinical children. Child Psychiatry Hum Dev. 2015;46(2):209–16.
Novin S, Rieffe C. Validation of the Brief Shame and Guilt Questionnaire for Children. Personal Individ Differ. 2015;85:56–9.
• Muris P, Meesters C, van Asseldonk M. Shame on me! Self-conscious emotions and big five personality traits and their relations to anxiety disorders symptoms in young, non-clinical adolescents. Child Psychiatry Hum Dev. 2018;49(2):268–78. This recent study shows that shame-proneness is related to a variety of anxiety symptoms in adolescents.
Mills RSL. Taking stock of the developmental literature on shame. Dev Rev. 2005;25:26–63.
•• Mills RS, Hastings PD, Serbin LA, Stack DM, Abela JR, Arbeau KA, et al. Depressogenic thinking and shame proneness in the development of internalizing problems. Child Psychiatry Hum Dev. 2015;46:194–208. This longitudinal study examines the role of shame-proneness in the development of anxiety problems in children.
Field AP, Cartwright-Hatton S. Shared and unique cognitive factors in social anxiety. Int J Cogn Ther. 2008;1:206–22.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Authors; 2013.
Schoenleber M, Chow PI, Berenbaum H. Self-conscious emotions in worry and generalized anxiety disorder. Br J Clin Psychol. 2014;53:299–314.
Hill J, Holcombe C, Clark L, Boothby MRK, Hincks A, Fisher J, et al. Predictors of onset of depression and anxiety in the year after diagnosis of breast cancer. Psychol Med. 2011;41:1429–36.
Borkovec TD, Alcaine O, Behar ES. Avoidance theory of worry and generalized anxiety disorder. In: Heimberg R, Mennin D, Turk C, editors. Generalized anxiety disorder: advances in research and practice. New York: Guilford; 2004.
Mennin DS, Heimberg RG, Turk CL, Fresco DM. Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behav Res Ther. 2005;43(10):1281–310.
Roemer L, Salters K, Raffa SD, Orsillo SM. Fear and avoidance of internal experiences in GAD: preliminary tests of a conceptual model. Cogn Ther Res. 2005 Feb;29(1):71–88.
Tangney JP, Wagner P, Gramzow R. Proneness to shame, proneness to guilt, and psychopathology. J Abnorm Psychol. 1992;101:469–78.
Abramowitz JS, Jacoby RJ. Obsessive-compulsive and related disorders: a critical review of the new diagnostic class. Annu Rev Clin Psychol. 2015;11(1):165–86.
• Weingarden H, Renshaw KD. Shame in the obsessive compulsive related disorders: a conceptual review. J Affect Disord. 2015;171:74–84. This is a systematic review of studies on shame in obsessive-compulsive disorders.
Hezel DM, Riemann BC, McNally RJ. Emotional distress and pain tolerance in obsessive-compulsive disorder. J Behav Ther Exp Psychiatry. 2012;43:981–7.
Hennig-Fast K, Michl P, Müller J, Niedermeier N, Coates U, Müller N, et al. Obsessive-compulsive disorder - a question of conscience? An fMRI study of behavioural and neurofunctional correlates of shame and guilt. J Psychiatr Res. 2015;68:354–62.
Clerkin EM, Teachman BA, Smith AR, Buhlmann U. Specificity of implicit-shame associations: comparison across body dysmorphic, obsessive-compulsive, and social anxiety disorders. Clin Psychol Sci. 2014;2:560–75.
Weingarden H, Renshaw KD, Wilhelm S, Tangney JP, DiMauro J. Anxiety and shame as risk factors for depression, suicidality, and functional impairment in body dysmorphic disorder and obsessive compulsive disorder. J Nerv Ment Dis. 2016;204(11):832–9.
Weingarden H, Renshaw KD. Associations of obsessive compulsive symptoms and beliefs with depression: testing mediation by shame and guilt. Int J Cogn Ther. 2014;7:305–19.
Olatunji BO, Cox R, Kim EH. Self-disgust mediates the associations between shame and symptoms of bulimia and obsessive-compulsive disorder. J Soc Clin Psychol. 2015;34(3):239.
Wetterneck CT, Singh S, Hart J. Shame proneness in symptom dimensions of obsessive-compulsive disorder. Bull Menn Clin. 2014;78:177–90.
•• Singh S, Wetterneck CT, Williams MT, Knott LE. The role of shame and symptom severity on quality of life in obsessive-compulsive and related disorders. J Obsessive-Compuls Relat Disord. 2016;11:49–55. This study found that shame is a stronger predictor of reduced quality of life than symptom severity in individuals with self-reported obsessive-compulsive disorder, trichotillomania and skin picking disorder.
Rachman S. Obsessions, responsibility and guilt. Behav Res Ther. 1993;31:149–54.
Valentiner DP, Smith SA. Believing that intrusive thoughts can be immoral moderates the relationship between obsessions and compulsions for shame-prone individuals. Cogn Ther Res. 2008;32:714–20.
Kollei I, Brunhoeber S, Rauh E, de Zwaan M, Martin A. Body image, emotions and thought control strategies in body dysmorphic disorder compared to eating disorders and healthy controls. J Psychosom Res. 2012;72(4):321–7.
Weingarden H, Renshaw KD, Davidson E, Wilhelm S. Relative relationships of general shame and body shame with body dysmorphic phenomenology and psychosocial outcomes. J Obsessive-Compuls Relat Disord. 2017;14:1–6.
• Weingarden H, Shaw AM, Phillips KA, Wilhelm S. Shame and defectiveness beliefs in treatment seeking patients with body dysmorphic disorder. J Nerv Ment Dis. 2018;206(6):417–22. This is one of the few large-scales studies examining the role of shame in patients diagnosed with BDD. It also shows that shame decreases following treatment.
Lochner C, Seedat S, du Toit PL, Nel DG, Niehaus DJ, Sandler R, et al. Obsessive-compulsive disorder and trichotillomania: a phenomenological comparison. BMC psychiatry. 2005;5(1):2.
Norberg MM, Wetterneck CT, Woods DW, Conelea CA. Experiential avoidance as a mediator of relationships between cognitions and hair-pulling severity. Behav Modif. 2007;31(4):367–81.
Keuthen NJ, Deckersbach T, Wilhelm S, Engelhard I, Forker A, O’Sullivan RL, et al. The Skin Picking Impact Scale (SPIS): scale development and psychometric analyses. Psychosom J Consult Liaison Psychiatry. 2001;42:397–403.
Keuthen NJ, Deckersbach T, Wilhelm S, Hale E, Fraim C, Baer L, et al. Repetitive skin-picking in a student population and comparison with a sample of self-injurious skin-pickers. Psychosomatics. 2000;41(3):210–5.
Muris P, Meesters C. Small or big in the eyes of the other: on the developmental psychopathology of self-conscious emotions as shame, guilt, and pride. Clin Child Fam Psychol Rev. 2014;17:19–40.
This work was supported by a grant from the Romanian National Authority for Scientific Research, CNCS–UEFISCDI, grant number PN-III-P4-ID-PCE-2016-0864.
Conflict of Interest
Aurora Szentágotai-Tătar, Diana-Mirela Nechita and Andrei C. Miu each declare no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Anxiety Disorders
About this article
Cite this article
Szentágotai-Tătar, A., Nechita, DM. & Miu, A.C. Shame in Anxiety and Obsessive-Compulsive Disorders. Curr Psychiatry Rep 22, 16 (2020). https://doi.org/10.1007/s11920-020-1142-9
- Anxiety disorders
- Obsessive-compulsive and related disorders
- Social anxiety
- Generalized anxiety