Shame: An Overlooked Factor in Conceptualizing and Treating Borderline Personality Disorder: Its’ Powerful Role in the Lives and Suicides of People with BPD

Abstract

Shame, a central emotion in borderline personality disorder (BPD), has been overlooked despite its’ relationship to self-injurious behaviour, chronic suicidality, self-esteem, quality of life, and angry-hostile feelings. Patients describe shame when explaining acute feelings of emotional pain. There is a paucity of research exploring the impact of shame on the person with BPD's sense of self and behaviors. BPD symptoms may be the expression of and defenses against this painful emotion. Shame-proneness is related to anger arousal and the tendency to externalize attributions for one's own behavior by blaming others or not taking responsibility for one's behavior. The relationship between shame-proneness and BPD has important implications for treatment. TARA for BPD, an educational and advocacy organization, developed a Family Psycho-education program teaching how shame is often the common denominator of BPD responses, triggering escalations, emotional shifts, volatile reactions, anger and misperceptions. Shame is the response to perceived negative evaluations (judgment, criticism, or blame) and general misinterpretation of social situations. Shame is an impediment to thinking clearly, exaggerates ambiguity and overwhelms cognitive ability in the moment. As shame is often confused with guilt, raising awareness of shame responses is essential for improving family relationships. Families can learn to recognize shame responses and implement evidence based techniques from dialectic behavior therapy (DBT) and mentalization based therapy (MBT) to decrease its’ impact on their loved one with BPD. Demonstration of methodology to address shame in family interactions and data from a TARA Internet survey of The Experience of Shame will be presented.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.