The mediation role of shame proneness in the association between perceived parenting and the severity of addictive behaviors: risk or protective factor?

Adverse early interactions with parents deeply affect the socio-emotional development of an individual, leading to feelings of inferiority and negatively influencing the development of self-conscious emotions, such as shame. Moreover, dysfunctional parenting was found in the histories of people suffering from substance and behavioral addictions. In this context, there is currently no agreement in the literature regarding the role of shame proneness on the severity of the addiction. The present study aimed to evaluate the mediating (risk or protective) role of the two shame dimensions (withdrawal action tendencies and negative self-evaluation) in the association between dysfunctional parenting and the severity of addiction, testing two structural equation models (SEMs; for substance and behavioral addiction respectively). An online survey recruiting 710 Italian young adults was administered using the Measure of Parental Styles, the Guilt and Shame Proneness Scale, and the brief Screener for Substance and Behavioral Addiction. The SEMs confirmed the predictive role of dysfunctional parenting on the severity of the addiction. Moreover, two dimensions of shame mediated the association in opposite ways. The withdrawal action tendencies positively mediated the association between dysfunctional parenting and the severity of substance and behavioral addiction, potentially acting as a risk factor. Negative self-evaluation negatively mediated the association between dysfunctional parenting and the severity of substance addiction, playing a potential protective role. In a therapeutic context, the findings emphasized the importance of evaluating the different dimensions of shame experiences among addicted individuals and assessing the strategies used to withdraw from these experiences.


Introduction
Addiction is a complex phenomenon characterized by the loss of control, compulsive seeking, and the repeated adoption of an addictive behavior despite its adverse consequences (Zou et al., 2017). Studies demonstrated that not only substances, but everything capable of stimulating a person can be addictive (Moghaddam et al., 2019;Zou et al., 2017). The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric to occur (Lewis, 1971;Tangney & Dearing, 2002). In this regard, shame is considered a self-conscious emotion that is related to global and negative feelings about the self and requires high cognitive complexity gradually evolving over the course of development (Lewis, 1971;Mills et al., 2010;Muris & Meesters, 2014). This emotion tends to occur in response to failures or transgressions and leads individuals to negatively evaluate the self, considering their failures as evidence that the self is defective (Lewis, 1971). States of shame are painful and involve a sense of helplessness, eliciting withdrawal behaviors to protect the damaged self (Lewis, 1971). Although the experience of shame is fundamental for development, if it becomes dominant it can be maladaptive (Mills et al., 2010). From a theoretical point of view, dysfunctional parental styles provide low amounts of interaction and positivity and severely undermine the basic need for social acceptance (Bennett et al., 2010;Feiring, 2005;Muris & Meesters, 2014). As a result, the child could form the belief that she or he will not reach the expectations of others, leading to feelings of inferiority and insignificance, and contributing to the development of higher shame proneness (Feiring, 2005;Muris & Meesters, 2014). More specifically, neglectful parenting characterized by low attention and warmth contributed to the development of negative global beliefs about the self (Bennett et al., 2010). Furthermore, it seems that abusive parenting could elicit helplessness which triggers globalized feelings of shame (Mintz et al., 2017). Lastly, feelings of shame could be engendered by parents who exhibit excessive control, treating them as weak and incapable (Mills, 2005).
Several forms of dysfunctional parenting characterized by parental neglect, emotional abuse, and over-protection, were found as important risk factors for psychopathology in adulthood (Farina et al., 2021;Lippard & Nemeroff, 2020). Previous studies proposed that dysfunctional parenting could determine relevant issues in emotional regulation and recognition, negatively influencing social-emotional development, leading to distress, and deficits in coping strategies, which could potentially result in increased vulnerability to developing addiction in adulthood (Durjava, 2018;Jaffee, 2017). An interesting perspective explained addiction in adulthood as an attempt to self-medicate the consequences of dysfunctional parenting lived during childhood and adolescence (Cancrini et al., 1988;Segura-Garcia et al., 2016). Coherently, experiences of emotional and physical abuse and neglect during childhood have been found in the history of individuals suffering from substance and behavioral addictions (Bussone et al., 2020;Capusan et al., 2021;Monteleone et al., 2022;Strathearn et al., 2020). Noteworthy, emotional abuse and neglect were found to be more strongly associated with more intense substance use, and an earlier onset of addiction, when compared with other types of traumatic events, such as sexual abuse (Strathearn et al., 2020).
Thus far, there is currently no agreement in the literature regarding the relationship between shame proneness and risky behaviors. A recent systematic and meta-analytic review showed that shame seems to have both maladaptive and adaptive aspects (Luoma et al., 2019). Positive associations between shame proneness and addiction, both substance (Stuewig et al., 2015) and behavioral related (Bottera et al., 2020;Yi, 2012;Gilliland et al., 2011), were previously found, highlighting its dysfunctional nature (Yi, 2012;Luoma et al., 2018;Merrick et al., 2019;O'Loghlen et al., 2021;Wiechelt, 2007). Moreover, it has been reported that shame seemed to have been involved in behaviors, such as substance use and sexual risk conducts, that allow individuals to evade a sense of worthlessness and failure (Rahim & Patton, 2015). According to these explanations, the use of a substance could be an attempt to cope with this emotion (Treeby & Bruno, 2012). In this regard, some authors have recently hypothesized that shame could mediate the relationship between childhood adverse experiences and negative health outcomes (Rollins & Crandall, 2021). On the contrary, regarding the adaptive functions of shame, some studies reported that shame might protect from substance use and dangerous sexual conduct, through a stigmatization process that led some people to avoid enacting risky behaviors (Satel, 2007). Moreover, it has been found that individuals who were more shame prone were more likely to seek treatment, identifying their substance use as problematic (Rahim & Patton, 2015;Rosenkranz et al., 2012).
To date, the divergence between findings that highlighted the role of shame as a risk factor and those who support its functional aspects must be cleared. This divergence could be due to the different dimensions of shame proneness. In particular, the action tendencies of hiding or withdrawing from a situation that elicits shame could be considered maladaptive internalizing coping scripts associated with psychopathology and addiction in adulthood (Brem et al., 2018;Cohen et al., 2011;Rubin et al., 2009;Teymouri Farkush et al., 2022). Differently, the dimension of the negative evaluations of the self could promote functional strategies, contributing to acting in a socially acceptable way and motivating the improvement of the self (Flanagan, 2013;Mills et al., 2010;Modranský et al., 2020;Sawer et al., 2020;Snoek et al., 2021). Therefore, to clarify the divergence of results on the role of shame in addiction severity, the complexity of the shame construct should be considered by measuring withdrawal action tendencies and negative self-evaluation as two distinct dimensions. Thus far, there are no studies that investigated the role of the two dimensions of shame proneness (shame withdrawal action tendencies and negative self-evaluation) on the severity of the addictions.
The present study aimed to evaluate the mediating (risk or protective) role of the two different dimensions of shame proneness in the association between dysfunctional parenting and the severity of substance and behavioral addictions in young adulthood. Specifically, the hypotheses were that shame withdrawal action tendencies -as a risk factor -will positively mediate the association between dysfunctional parenting styles and the severity of addiction, while negative self-evaluation -as a protective factor -will negatively mediate this association.

Participants
The study was approved by the local Ethics Committee of the Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome. Initially, 733 participants signed the informed consent and took part in the study. The inclusion criteria were 18 years of age or older and being Italian. Data of 23 participants were excluded since their nationality was not Italian. The final sample was composed of the remaining 710 participants.

Measures
Information about gender, age, marital status, level of income, employment status, education level, city and country of residence, and mother tongue were collected. Moreover, perceived dysfunctional parenting, shame proneness, and the severity of addiction were assessed through the following questionnaires.
The GASP (Cohen et al., 2011) is a 16-item scale, which measures one's proneness to experience shame and guilt.
The instrument is a scenario-based scale, and each item contains a transgression with a possible reaction that could be common in that situation. Respondents rate, on a 7-point likert, the probability in which they would react in the way reported, for each scenario. The scale consists of four subscales with 4 items each. The two guilt related subscales are Guilt Negative Behavior Evaluations (NBE) and Guilt Repair (GR) which assess the responses to private transgressions or failures. In particular, NBE describes feeling bad about how an individual act (e.g., "After realizing you have received too much change at a store, you decide to keep it because the salesclerk doesn't notice. What is the likelihood that you would feel uncomfortable about keeping the money?"), GR measures the action tendencies to correct or compensate for the transgression ("You are privately informed that you are the only one in your group that did not make the honor society because you skipped too many days of school. What is the likelihood that this would lead you to become more responsible about attending school?"). The two shame related subscales are Shame Negative Self Evaluations (NSE) and Shame Withdraw (SW) which assess the response to publicly exposed transgressions or failures. Specifically, NSE assesses the tendency to negatively evaluate the self (e.g. "You rip an article out of a journal in the library and take it with you. Your teacher discovers what you did and tells the librarian and your entire class. What is the likelihood that this would make you would feel like a bad person?"). Lastly, SW assesses action tendencies of hiding or withdrawing after a public exposed transgression ("After making a big mistake on an important project at work in which people were depending on you, your boss criticizes you in front of your coworkers. What is the likelihood that you would feign sickness and leave work?"). Higher scores on each subscale indicated higher guilt and/ or shame proneness.
To test the hypotheses, only the shame subscales (NSE and SW) were considered in the analyses. In the present study, the reliability coefficients of the subscales were: NBE: α = 0.710; GR: α = 0.566; NSE: α = 0.681; SW: α = 0.521. The SW subscale showed a low α score as the benchmark of the original version of GASP being set to 0.60 (Cohen et al., 2011). A possible explanation of this poor reliability could be that, as previously reported, in scenario-based measures alpha coefficients tend to show lower reliability because each item has a unique variance for the scenario as well as a common variance for the construct underlying the response (Cohen et al., 2011;Tangney & Dearing, 2002).
The SSBA (Schluter et al., 2020), a 40-item populationlevel screening measure, was used to assess self-reported problems related to four substances (Alcohol, Tobacco, Cannabis, and Cocaine) and six behaviors (Gambling, Videogaming, Shopping, Overeating, Sexual Activity and for an acceptable models' fit (Browne & Cudeck, 1992;Hu & Bentler, 1999;Kline, 2010). Lastly, the coefficient of determination (R 2 values) and standardized path coefficients (beta values) were the parameters used to determine how well the data supported hypothesized relationships. JASP software was used for these statistical analyses (JASP Team (2021). JASP (Version 0.15) [Computer software]).

Procedure
An online survey was composed of a questionnaire that collected demographic data, the MOPS, GASP, and SSBA, using the Google Forms platform. The participants were recruited from the general population, through social networks. All data were collected between March and May 2021.

Correlations between the dysfunctional parenting, shame proneness, and the severity of addiction
Pearson's correlations between all the subscales of the MOPS, the shame subscales scores of the GASP, and the SSBA were presented in Table 1. Mother's Indifference was positively correlated to the Negative Self Evaluation Overworking). For each addictive behavior, the participant rated on a 5-step Likert scale how well the following four items fit his or her pattern of engaging in the behaviors in the previous 12 months: "I did it too much", "Once I started, I can't stop", "I feel I have to do it to function well", and "I kept doing it even though it caused problems". Two additional response options were available: "I didn't do it at all" and "I don't know/prefer not to say". Higher scores indicated more severity of the addiction. In the present study, the reliability coefficients of the SSBA subscales were: Alcohol: α = 0.80; Tobacco: α = 0.91; Cannabis: α = 0.87; Cocaine: α = 0.87; Gambling: α = 0.79; Shopping: α = 0.76; Videogaming: α = 0.83; Overeating: α = 0.85; Compulsive Sex: α = 0.77; Overworking: α = 0.85.

Statistical analyses
Initially, descriptive analyses were performed, calculating frequencies, means, and standard deviations of the main variables of the study. Then, correlations (Pearson's r) between dysfunctional parental styles (MOPS), shame proneness (GASP shame subscales), and the severity of behavioral and substance addiction (SSBA) were performed. Then, correlations (Pearson's r) between shame proneness (GASP shame subscales) and the severity of behavioral and substance addiction (SSBA) were performed.
To evaluate the role of shame proneness in the association between dysfunctional parenting and the severity of addictions, two Structural Equation Models (SEM), the first with substance addiction and the second one with behavioral addiction, were built. Considering that the use of substances is generally more associated with a social stigmatization process than some behavioral addictions, such as work, shopping, and videogaming, two models were planned to highlight the effects that shame proneness could have respectively on substance and behavioral addictions (Thege et al., 2015).
To test the hypotheses of the study, two structural equation models were designed and tested using the maximum likelihood method (ML). In the two models, the factor loading of one manifest variable was fixed to one to set the metric for the latent variable. The remaining factor loadings, the variance of the latent variables, and residual errors were freely estimated. The chi-square/degree of freedom (χ 2 /df), the Goodness of Fit Index (GFI), Comparative Fit Index (CFI), Tucker Lewis coefficient (TLI), the Root Mean Square Error of Approximation (RMSEA) with its interval of confidence, and the Standardized Root Mean Square Residual (SRMR) were calculated to evaluate the fit of the models. A χ 2 /df below 5; GFI, CFI, and TLI > 0.90 (Kline, 2010); a RMSEA with an upper boundary < 0.10; and a SRMR greater than 0 and lower than 0.08 were considered

Correlations between shame proneness and the severity of addiction
Pearson's correlations between all the shame subscales scores of the GASP and the SSBA were presented in Table 2. Negative Self Evaluation was negatively correlated to Tobacco, Cannabis, Cocaine, Gambling, Videogaming, and Compulsive Sexual Activity. Shame Withdraw was positively correlated to Tobacco, Compulsive Shopping, Overeating, and Compulsive Sexual Activity subscales.

Shame proneness as a mediator between dysfunctional parenting and the severity of substance and behavioral addiction
The goodness of fit of two Structural Equation Models was tested on the whole sample (Fig. 1). Specifically, the prediction of MOPS scores on the severity of substance and behavioral addiction, both directly and indirectly, was tested through the proneness to negatively evaluate oneself and through the proneness to withdraw. To create the Substance Addiction latent variable, the scores obtained on the subscales of the problem severity in substance addiction of the SSBA were used. To create the Behavioral Addiction latent variable, the scores obtained on the subscales of the problem severity in behavioral addiction of the SSBA were used. The dysfunctional Parenting latent variable was created using the scores obtained on the six subscales of MOPS. Finally, Negative Self Evaluation and Shame Withdraw were created using the scores obtained on the items converging on the shame subscales of the GASP.
Concerning the tendency to withdraw, negative parental care may lead to difficulties in dealing with negative emotions and to unhealthy coping mechanisms (Mintz et al., 2017;Sedighimornani et al., 2021). Coherently, it has been formulated that childhood abuse, neglectful, and shameful experiences could overstimulate the threat system, promoting fear-based responses, such as flight (Bahtiyar & Gençöz, 2021;Gilbert, 2005). After a shame-eliciting situation, the desire to avoid and withdraw associated with shame could hesitate in the use of a substance or behavior to regulate the negative experience (Luoma et al., 2018;Wiechelt, 2007).
The result concerning the tendency to evaluate the self negatively suggested that shame proneness should not be considered intrinsically dysfunctional, indeed, probably through a greater reflective ability on the self-identity and on own values, it could potentially protect the person from carrying out actions morally judged like the use of a substance (Declerck et al., 2014;Lickel et al., 2014). This explanation seemed coherent with a functional evolutionary view according to which shame evolved to alert individuals towards threats to social belonging, promoting conformism to moral values and social norms (Leach & Cidam, 2015). Surprisingly, evaluating the self negatively seemed to act as a protective factor on the severity of substance addiction, although this shame-related dimension was positively predicted by dysfunctional parenting. This counterintuitive result suggests that dysfunctional parenting could hesitate in two different shame-related tendencies, the first associated with a lower introspective ability (withdrawal) and the second characterized by a higher ability to interpret the shame feelings as related to own self-identity. This second shame-related tendency could protect from adopting the use of substances, however, it could potentially play a relevant role as a risk factor for more internalized symptoms such as depression or anxiety (Bahtiyar & Gençöz, 2021;Ceclan & Nechita, 2021). In this regard, previous research found these tendencies associated with low self-esteem and depressive symptoms (Butter et al., 2019).
The results of the present study highlighted the importance of assessing the presence of different shame-related experiences among addicted young adults. Clinicians should assess the ability to approach aversive emotional experiences and evaluate if people use a specific behavior or a substance to avoid these experiences. In a therapeutic context, the results emphasized the importance of reducing positively the severity of Substance Addiction (R 2 = 0.17) positively and indirectly through Shame Withdraw. Furthermore, Shame Withdraw was found to predict the severity of Substance Addiction directly and positively. Negative Self Evaluation was found to predict the severity of Substance Addiction negatively. An indirect effect was found between Dysfunctional Parenting, through Negative Self Evaluation, on the severity of Substance Addiction. Lastly, Dysfunctional Parenting was found positively predictive of Negative Self Evaluation (R 2 = 0.01) and of Shame Withdraw (R 2 = 0.10).
The same model was tested using the latent variable of Behavioral Addiction (model "b" in Fig. 1).

Discussion
The main findings of the present study were that the two dimensions of shame differently mediated the association between dysfunctional parenting and the severity of the addiction: the shame-related tendency to withdraw was found to positively mediate the association, playing a role as a risk factor for substance and behavioral addiction, whereas the tendency to negatively evaluate the self negatively mediated the association with substance addiction, playing a potential protective role. Moreover, in the present study, dysfunctional parenting positively predicted the severity of both substance and behavioral addiction.
The results concerning the mediating role of shamerelated tendency to withdraw seemed to confirm previous findings that reported the potential role of shame proneness as a risk factor for substance and behavioral addiction (Gilliland et al., 2011;O'Loghlen et al., 2021). At the same time, the result concerning the tendency to evaluate the self negatively seemed coherent with the literature that highlighted that shame could act as a potential protective factor Data availability The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Declarations
Competing interests The authors declare that they have no conflicts of interest.
Human and animal rights All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Ethical approval The present study was approved by the Ethics Committee of Department of Dynamic and Clinical Psychology, and Health Studies of "Sapienza" University of Rome.
Consent to participate Informed consent was obtained from all individual patients included in the study.

Consent to publish
Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons. org/licenses/by/4.0/. the tendency to avoid after an occurrence of a shameful experience, promoting its elaboration into the self-identity.
Despite the interesting nature of these findings, some study limitations need to be considered. The first limitation was the low number of male participants. A sample that provides equal distribution would render the possibility of generalizing the present study's findings. A further limitation concerns the cross-sectional nature of the study which does not allow to draw conclusions about causation. In addition, due to the nature of the variables investigated, a social desirability response bias could have led participants to under-report the degree of dysfunctional parenting and the addiction severity. Therefore, this bias could have affected the magnitude of the results of the present study. Lastly, retrospective self-reports investigating parental styles could be subjected to recall bias.
In conclusion, the findings of the present study contributed to growing empirical research for understanding the specific roles of shame proneness in the association between dysfunctional parenting and the severity of the addiction. The results suggested that shame proneness, associated with a negative developmental environment, should be considered a complex phenomenon with different consequences for the severity of the addiction. The withdrawal responses seem to be associated with higher severity of addiction, differently, a response with a more reflective negative selfevaluation could protect people from addictive behaviors and potentially from other externalizing symptoms.
Further studies should include more objective methods such as clinical interviews to assess dysfunctional parenting and the severity of the addiction. Future prospective research that uses longitudinal design is needed to address how different parenting styles can influence the development of shame proneness and addiction. Lastly, future studies should consider how relationships with peers or siblings could affect the development of shame proneness and how this is associated with different psychopathological symptoms (Irwin et al., 2019;Kolak & Volling, 2022).