Pathological personality traits in negative affectivity – Depressivity: Pervasive shame (DSM5).

Over the years in writing this blog, I keep coming back to the role of shame in borderline personality disorder, and each time I get a deeper understanding of the role shame has played in my life. Even though I have learned to survive and even thrive with BPD, there are still moments when my mind recreates a moment of shame from my past and the full emotional load of that shame expresses itself throughout my body. So let’s take another look at what science is now saying about shame.

First of all, let’s look at the neuropathways involved in shame. Michl and others (1) , employed functional magnetic resonance imaging with 14 healthy subjects while using shame-related and neutral stimuli. They found that shame resulted in activation of the medial and inferior frontal gyrus. During the imagination of shame, frontal and temporal lobes were responsive regardless of gender. They concluded that frontal, temporal, and limbic areas play a prominent role in the generation of moral feelings. So why is this important? My take is that the human brain is designed to help us stay within the protection of our family and in line with our group norms. In other words, shame is part of the normal physical make-up of our human brain.

The question is then – what goes wrong with the normal shame mechanism in those of us with BPD that results in a pathological trait? An overactive shame mechanism can take two paths – self-loathing and/or anger. Brown and others (2) looked at the relationship of shame with self-inflicted injury (SII) among 77 women with borderline personality disorder. They used self-reported shame and nonverbal shame behaviors involving recent episodes of SII. They found that self-reported state shame and assessor ratings of shame were associated with prospective SII, but not after controlling for other emotions. The last part of that is interesting. This suggests that shame by itself is manageable for those of us with BPD as long as we do not allow it to activate the amygdala and other emotional responses. This suggest that shame that involves emotional episodes may be responsible for self-injury and suicidal behavior with those of us with BPD. On the other hand, there is hope if we take steps to deal with the emotional overload.

The other side of the shame-coin is uncontrolled anger where the person with BPD directs the shame outward instead of inward. Scott and others (3) focused on associations between BPD symptoms, shame, and anger-related behaviors (hostile irritability) in adolescent girls using ecological momentary assessment. They discovered that greater BPD symptoms of shame were associated with more hostile irritability but only in the case of girls of average socioeconomic status (not receiving public assistance). Again this suggests an interesting side-bar to this study. We can surmise that adolescents who receive public assistance may be getting support and counselling to helping them deal with the emotional issues surrounding outbursts of anger. They concluded that shame may be a key clinical target in the treatment of anger-related difficulties among adolescent girls with BPD symptoms.

Fortunately, all is not lost. Recent studies have shown it is possible to reduce shame about a specific event over a short period of time. Through constructive psychological practices, we can bring attention to the event causing the shame and learn to dissect and cope with the event before it is emotionally loaded and locked into long term memory.

My five suggestions for borderliners:

1. Embrace the shame. When shame occurs, instead of trying to fight it, let it flow. This will take you out of the sympathetic mode and give you time to process the circumstances involved with the shame.

2. In processing the shame, involve the body as well as the brain. Vocalize it with a mantra. I like to use the words, “There is no blame; there is no shame. There is only love for myself and for….” If you are having difficulty doing that, find a friend, someone you trust who will listen without judgement and who will let you process the situation and the thought patterns without interrupting.

3. In cases of habitual shame, journal it. This adds another constructive body and brain modality. Enter a state of relaxation and let that flow into a state of mindfulness. Record your thoughts on paper as they are formulated in your mind. Be sure to continue the process until you come to the resolution where there is no blame; there is no shame.

4. If your shame leads to outburst of anger, you will have to deal with your anger before you can deal with your shame. Do not dump your feelings on those you love. Excuse yourself and take a walk which will help you get rid of your excess negative energy. As you walk, breathe deeply and repeat the mantra mentioned above. When you feel calm and in control, begin to process the shame that caused your emotional outburst. When you feel in control again come back and resolve the situation.

5. If you find that you cannot control your shame mechanisms and that you are thinking of harming yourself, get professional help. Find a psychologist or psychiatrist that employs constructive psychology practices.

 

[1] Michl, Petra; Meindl, Thomas; Meister, Franziska; Born, Christine; Engel, Rolf R.; Reiser, Maxililian; and Hennif-Fast, Kristina. Neurobiological underpinnings of shame and guilt: a pilot fMRI study. Social Cognitive and Affective Neuroscience; Vol 9. 2014.  https://doi.org/10.1093/scan/nss114

[2] Brown, Milton Z.; Linehan, Marsha M.; Comtois, Kathryn Anne; Murray, Angela; and Chapman, Alexander L.. Shame as a prospective predictor of self-inflicted injury in borderline personality disorder: A multi-modal analysis. Elsevier, Behavior Research and Therapy, Vol 47. 2009.

[3] Scott, L. N., Stepp, S. D.; Hallquist, M. N.; Whalen, H. J.; Wright, A. G. C.; and Pilkonis, P, A. . Daily shame and hostile irritability in adolescent girls with borderline personality disorder symptoms. Personality Disorders: Theory, Research, and Treatment. 2015. https://doi.org/10.1037/per0000107