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Social anxiety disorder and shame cognitions in psychosis

Published online by Cambridge University Press:  21 May 2012

M. Michail  and
M. Birchwood
M. Michail*
Affiliation:
Division of Nursing, School of Nursing, Midwifery and Physiotherapy, University of Nottingham, UK
M. Birchwood
Affiliation:
Youth Services Programme, Birmingham and Solihull Mental Health Foundation Trust, Early Intervention Service, Birmingham, UK School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
*
*Address for correspondence: Dr M. Michail, Division of Nursing, School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Nottingham NG7 2HA, UK. (Email: maria.michail@nottingham.ac.uk)
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Abstract

Background

Social anxiety disorder (SAD) is surprisingly prevalent among people with psychosis and exerts significant impact on social disability. The processes that underlie its development remain unclear. The aim of this study was to investigate the relationship between shame cognitions arising from a stigmatizing psychosis illness and perceived loss of social status in co-morbid SAD in psychosis.

Method

This was a cross-sectional study. A sample of individuals with SAD (with or without psychosis) was compared with a sample with psychosis only and healthy controls on shame proneness, shame cognitions linked to psychosis and perceived social status.

Results

Shame proneness (p < 0.01) and loss of social status (p < 0.01) were significantly elevated in those with SAD (with or without psychosis) compared to those with psychosis only and healthy controls. Individuals with psychosis and social anxiety expressed significantly greater levels of shame (p < 0.05), rejection (p < 0.01) and appraisals of entrapment (p < 0.01) linked to their diagnosis and associated stigma, compared to those without social anxiety.

Conclusions

These findings suggest that shame cognitions arising from a stigmatizing illness play a significant role in social anxiety in psychosis. Psychological interventions could be enhanced by taking into consideration these idiosyncratic shame appraisals when addressing symptoms of social anxiety and associated distress in psychosis. Further investigation into the content of shame cognitions and their role in motivating concealment of the stigmatized identity of being ‘ill’ is needed.

Keywords

Entrapmentpsychosisshamesocial anxietysocial statusstigma
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 1 , January 2013 , pp. 133 - 142
Copyright
Copyright © Cambridge University Press 2012

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