Personality Disorders: Theory, Research, and Treatment Aversion and Proneness to Shame in Self- and Informant-Reported Personality Disorder Symptoms Michelle Schoenleber and Howard Berenbaum Online First Publication, October 10, 2011. doi: 10.1037/a0025654

CITATION Schoenleber, M., & Berenbaum, H. (2011, October 10). Aversion and Proneness to Shame in Self- and Informant-Reported Personality Disorder Symptoms. Personality Disorders: Theory, Research, and Treatment. Advance online publication. doi: 10.1037/a0025654

Personality Disorders: Theory, Research, and Treatment 2011, Vol. ●●, No. ●, 000 – 000

© 2011 American Psychological Association 1949-2715/11/$12.00 DOI: 10.1037/a0025654

Aversion and Proneness to Shame in Self- and Informant-Reported Personality Disorder Symptoms Michelle Schoenleber and Howard Berenbaum University of Illinois at Urbana-Champaign The present study examined the specificity and extent of relationships between shame and symptoms of five personality disorders (PDs), as they are apparent to both the self and others. Borderline, narcissistic, avoidant, dependent, and obsessive-compulsive PD symptoms were assessed in a sample of 367 undergraduates that evidenced a wide range of symptom levels (25.6% endorsed threshold or greater severity of symptoms on the Schedule of Nonadaptive and Adaptive Personality-2). Importantly, for both conceptual and methodological reasons, information about PD symptoms was also obtained from friends/family of 45.2% of the sample. Shame aversion (the tendency to perceive shame as a particularly painful and unwanted emotion) was assessed using the Shame-Aversive Reactions Questionnaire, and shame-proneness (the propensity to experience shame across situations) was assessed using the Test of Self-Conscious Affect-3. Shame aversion displayed the most consistent relationship with PD symptoms, being associated with self-reports of symptoms of all five PDs and informantreports of symptoms of three PDs, over and above experiential avoidance, trait affect, and guilt. A significant Shame Aversion ⫻ Shame-Proneness interaction further revealed that shame-proneness was associated with symptoms of avoidant and dependent PDs among individuals with high but not low levels of shame aversion. Thus, these findings highlight shame aversion’s specific importance in PD symptoms and suggest important future research directions. Keywords: shame aversion, shame-proneness, Cluster C personality disorders, borderline personality disorder, narcissistic personality disorder

Shame is an unpleasant self-conscious emotion that arises when individuals attribute negative outcomes to personal defects, and it leads to avoidance and withdrawal behaviors (Lewis, 1971). Most research focuses on shameproneness, or the tendency to experience shame readily and often (e.g., Lewis, 1971), which is related to a variety of psychological problems (see, e.g., Tangney & Dearing, 2002). Recently, we postulated that shame aversion, or the pro-

pensity to perceive of shame as an especially unpleasant and undesirable emotion, may also be relevant to psychopathology (Schoenleber & Berenbaum, 2010). Based on existing theory and the current Diagnostic and Statisical Manual of Mental Disorders-IV (DSM-IV; APA, 2000) symptoms/features, we previously predicted that shame aversion and shame-proneness would play important roles in Cluster C personality disorders (PDs; Schoenleber & Berenbaum, 2010). We believe shame, specifically, is important in these and other PDs (see Schoenleber & Berenbaum, in press). People essentially carry their shame triggers— perceived personal defects—around wherever they go. Therefore, similar to PD symptoms themselves, shame and/or the potential for shame may be pervasive across situations for some individuals. Consistent with our expectations, we found that both shame aversion and shame-proneness were independently associated with Cluster C PDs, and these associations remained significant even after taking into ac-

Michelle Schoenleber and Howard Berenbaum, Department of Psychology, University of Illinois at UrbanaChampaign. We thank the other members of our research lab for their valuable contributions on a previous draft of this paper. A copy of the GuAvA is available upon request from the first author. Correspondence concerning this article should be addressed to Michelle Schoenleber, Department of Psychology, University of Illinois at Urbana-Champaign, 603 East Daniel Street, Champaign, IL 61820. E-mail: mschoen2@ illinois.edu 1

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count both trait positive affect (PA) and trait negative affect (NA; Schoenleber & Berenbaum, 2010). Moreover, the relationship between shame-proneness and these disorders was only significant when shame aversion was high, indicating that shame aversion may have a particularly important role in Cluster C PDs. A primary goal of this study was to expand our knowledge by examining shame in some other PDs. Therefore, we considered shame aversion and proneness in borderline personality disorder (BPD) and narcissistic personality disorder (NPD). Although we expect these shame constructs may also be relevant to other non-Cluster C PDs, we focused on BPD and NPD because existing theories and research regarding these disorders are especially suggestive of shame. Further, given the high importance of replication, we again examined Cluster C PDs. Most theories regarding BPD stress the role of invalidating environments in its development, proposing that those with BPD learn they are bad individuals during childhood experiences with invalidating caregivers (e.g., Linehan, 1993). Such a learning history could confer a tendency to feel shame frequently. Moreover, state shame is associated with BPD features, such as self-injury (Brown, Linehan, Comtois, Murray, & Chapman, 2009). We thus posited that BPD symptoms would be positively related to shame aversion and shame-proneness. We also predicted that shame aversion and shame-proneness would be important in NPD. Some theories assert that the grandiosity in NPD is a defensive strategy (e.g., Kohut, 1971). Rather than being convinced of their superiority, this perspective suggests that those with NPD have fragile self-esteem. Providing some support for these theories, NPD is related to fears of criticism/rejection (Russ, Shedler, Bradley, & Westen, 2008), and shame is related to trait narcissism (e.g., Cheek & Hendin, 1996). Therefore, we hypothesized that shame aversion and proneness would be positively associated with NPD symptoms. The present investigation also has the potential to extend our knowledge of the specificity and extent of relationships between shame and Cluster B and C PD symptoms. First, we agree with others that self-reports alone may not provide a complete picture of the consequences of pathological personality features (e.g., Olt-

manns & Turkheimer, 2006). Because of the ego-syntonic nature of PDs (Hirschfeld, 1993) and to address possible issues of shared method variance (Campbell & Fiske, 1959), we obtained both self- and informant-reports of PD symptoms. Thus, we were able to consider the influence of shame on features of PDs that are noticeable both to the self and to others. We hypothesized that shame-related constructs would be positively associated with PD symptoms, assessed via both selfand informant-report. Second, we examined whether these shamerelated constructs would remain important over and above experiential avoidance (i.e., an unwillingness to have and desire to avoid subjectively unpleasant internal experiences; Hayes et al., 2004), a construct that is broader than, but conceptually related to, shame aversion. As we believe that shame is particularly important in PDs, we predicted that shame aversion and shame-proneness would be positively associated with PD symptoms over and above experiential avoidance, as well as trait PA and NA. Third, we considered the specific importance of shame by examining the possible role of guilt, another unpleasant self-conscious emotion. Guilt is elicited when negative outcomes are attributed to bad behavior or decisions, and it leads to apologetic or reparative behaviors (Lewis, 1971). Importantly, guilt in the absence of simultaneous shame (i.e., shame-free guilt) is related to positive outcomes (e.g., Tangney, Wagner, Fletcher, & Gramzow, 1992). Although guilt-proneness may be negatively related to some psychological problems, we predicted that shame aversion and proneness would be related to PDs over and above guilt aversion and proneness. In summary, we predicted that elevations in shame aversion and shame-proneness would be related to increases in self-reported symptoms of BPD and NPD from Cluster B, as well as avoidant personality disorder (APD), dependent personality disorder (DPD), and obsessivecompulsive personality disorder (OCPD) from Cluster C. We also expected that shame aversion and shame-proneness would be related to observable features of these PDs, assessed via informant-reports. Moreover, we hypothesized that these relationships would remain even after taking into account experiential avoidance, trait PA and NA, and guilt aversion and guilt-

SHAME IN SELF- AND INFORMANT-REPORTED PDS

proneness. Finally, because experiencing shame readily across situations may only be a problem for those individuals who cannot tolerate that experience, we expected that individuals prone to shame would be particularly likely to display PD symptoms when shame aversion was high. Methods Participants Participants were 367 undergraduates (58.6% female) between the ages of 18 and 24 (M ⫽ 19.3, SD ⫽ 1.2). The majority of participants (63.8%) were Caucasian/Non-Hispanic, followed by 17.4% Asian-American, 4.9% Hispanic/Latino(a), 4.4% Biracial, 3.3% AfricanAmerican, and with 6.2% choosing to describe themselves as “Other.” Measures Self- and informant-reported PD symptoms. PD symptoms were assessed with the diagnostic scales from the Schedule for Nonadaptive and Adaptive Personality-2 (SNAP-2; Clark, Simms, Wu, & Casillas, in press), which uses a true/false format. Specifically, sum scores for BPD symptoms were measured using 33 items (␣ ⫽ .80; e.g., “I have a lot of ‘love-hate’ relationships”), NPD symptoms with 25 items (␣ ⫽ .68; e.g., “I have many qualities others wish they had”), APD symptoms with 19 items (␣ ⫽ .83; e.g., “I often feel I am not as good as other people”), DPD symptoms with 20 items (␣ ⫽ .78; e.g., “I want approval so much that I have trouble even disagreeing with others”), and OCPD symptoms with 25 items (␣ ⫽ .71; e.g., “I don’t consider a task finished until it’s perfect”). These self-report scales are based on the original SNAP scales (Clark, 1993), with relatively minor modifications to make them more consistent with the DSM–IV PD diagnostic criteria. The original SNAP and SNAP-2 diagnostic scales are highly correlated with interview measures of PDs (e.g., Clark, 1993; Clark, et al., in press). Like the original scales, the SNAP-2 scales have good criterion and construct validity in clinical and normative samples, as well as test–retest reliability (Clark, et al., in press). The internal consistencies herein are also compara-

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ble with those found using the SNAP-2 in previous research (e.g., Samuel et al., 2010). We also used the collateral-report version of the SNAP-2 to assess levels of PD symptoms as they are apparent to friends/family. All items in the collateral-report version are written in thirdperson (e.g., “S/he thinks that s/he is usually right,” rather than “I am usually right”), and informants indicate whether each statement is true or false with regard to the participant. All participants sent a brief description of the study and a link to an online survey to four individuals that they have known well for at least 6 months. Two hundred seventy-one informants completed the online survey, providing data for 166 participants (45.2%). For those participants with two or more informants (N ⫽ 74), we calculated mean scores across informants for our analyses. Treating raters as random effects and the mean of the raters as the unit of reliability (Shrout & Fleiss, 1979), intraclass correlations using responses from the first two informants were statistically significant for all but DPD. Relationship-to-participant data was available from 253 informants; the majority of informants were friends (38.3%), followed by mothers (24.5%), fathers (16.6%), siblings (10.7%), romantic partners (4.7%), other relatives (4.3%), and other acquaintances (0.9%). The collateral-reports had good internal consistency (␣s ⫽ .77, .74, .86, .84, and .73 for BPD, NPD, APD, DPD, and OCPD, respectively) and good validity, as four of the informant-report PD scales were most strongly correlated with the matching self-report PD scale (rs ⫽ .17, .25, .24, and .35, for BPD, NPD, APD, and OCPD, respectively); informant-reported DPD was about equally positively correlated with selfreported DPD (r ⫽ .18) and APD (r ⫽ .19). Finally, comparing the portion of the sample for which we had informant-reports with the portion for which we did not, revealed no differences between these subgroups on any of the demographic, emotion, or self-reported PD variables. Positive and negative affect. The Positive Affect Negative Affect Schedule (PANAS; Watson, Clark, Tellegen, 1988) was used to measure trait PA and NA, using 10 positive emotional words (␣ ⫽ .84; e.g., interested) and 10 negative emotional words (␣ ⫽ .83; e.g., distressed) on a 1 to 5 scale. The “ashamed” and “guilty” items were removed when calculating

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the NA score to ensure that this measure was not simultaneously reflecting these selfconscious emotions. Notably, performing all of the analyses using the full 10-item NA scale had essentially no impact on the results presented. The PANAS has good convergent and discriminant validity, as well as good test-retest reliabilities and internal consistencies (Watson et al., 1988). Shame-proneness and guilt-proneness. Shame-proneness was measured using the shame items from the Test of Self-Conscious Affect-3 (TOSCA-3; Tangney, Dearing, Wagner, & Gramzow, 2000), and guilt-proneness was measured using the guilt items. After reading each of 16 brief scenarios, participants indicated on a 1 to 5 scale how much they would experience a shame response and a guilt response. For example, the scenario “while out with a group of friends, you make fun of a friend who’s not there” is followed by a possible shame response (“You would feel small . . . like a rat”) and a possible guilt response (“You would apologize and talk about that person’s good points”). Both TOSCA-3 scales have displayed expected relationships to psychological functioning and good test–retest reliability (e.g., Tangney, Wagner, Fletcher, & Gramzow, 1992). Internal consistencies for the shame(␣ ⫽ .77) and guilt-proneness (␣ ⫽ .70) scales were commensurate with previous research (see Tangney, 1996). Experiential avoidance. The Acceptance and Action Questionnaire (AAQ; Hayes et al., 2004) measures general intolerance of and concern about experiencing subjectively unpleasant internal states using 9 items (␣ ⫽ .69; e.g., “I am not afraid of my feelings”) on a 1 to 7 scale. The AAQ shows good construct validity and test–retest reliability (e.g., Hayes et al., 2004). Shame aversion. To assess the degree to which shame is perceived as an especially painful and undesirable emotion, we used the Shame-Aversive Reactions Questionnaire (ShARQ; Schoenleber & Berenbaum, 2010). Participants indicated how much they agree with each of 14 statements (␣ ⫽ .87; e.g., “I simply cannot stand to be ridiculed by others”) using a scale from 1 to 7. Previous work demonstrates that the ShARQ has good convergent validity (see Schoenleber & Berenbaum, 2010). Guilt aversion. For the present study, we developed the Guilt Aversion Assessment

(GuAvA) to measure individuals’ perceptions of guilt as particularly painful and unwanted. Originally, we created 20 items to reflect guilt aversion (e.g., “I hate feeling accountable after I’ve done something bad”). Four items were removed because they reduced the internal consistency of the measure or were correlated equally strongly with the ShARQ. Thus, the final version of the GuAvA had 16 items (7 reverse-scored) rated on a 7-point scale (␣ ⫽ .86). Indicative of good convergent validity, the GuAvA showed expected positive associations with guilt-proneness (r ⫽ .13, p ⬍ .05), as well as shame-proneness (r ⫽ .41). This stronger association with shame-proneness is consistent with the self-conscious emotion literature, which indicates that guilt is an adaptive emotion associated with positive outcomes (e.g., Tangney et al., 1992). The overall benefits of guilt may make it unlikely that individuals will develop an aversion to it, at least when it is experienced on its own. On the other hand, if guilt generally coincides with shame (i.e., shamefused guilt, which we expect would be more common among those high on both guilt- and shame-proneness), then guilt may become aversive due to its association with shame. The strong GuAvA-ShARQ correlation (r ⫽ .52) we found is consistent with this idea. Further, when entering both proneness constructs simultaneously into the first step of a regression analysis predicting guilt aversion, guilt aversion remained associated with shame-proneness (␤ ⫽ .41) but not guilt-proneness (␤ ⫽ .01). Entering Guilt-Proneness ⫻ Shame-Proneness in a second step, this interaction term was marginally associated with guilt aversion (␤ ⫽ .08, p ⫽ .09). Thus, there is some indication that individuals with elevated guilt-proneness are somewhat more likely to become averse to guilt if they are also shame-prone. Results Presence of PD Symptoms Using the criterion scoring method (see Clark, et al., in press) and considering the guidelines suggested by Widiger et al. for describing the severity of PD symptoms (Widiger, Mangine, Corbitt, Ellis, & Thomas, 1995), two participants endorsed extremely severe levels of

SHAME IN SELF- AND INFORMANT-REPORTED PDS

one PD, which was BPD in both cases. An additional 20 participants (5.4%) endorsed moderate severity levels of at least one PD, and another 72 participants (19.6%) endorsed threshold severity levels of at least one PD. All five PDs were represented in the portions of the sample endorsing both moderate severity levels of at least one PD (Ns from 1 for NPD to 8 for APD) and threshold severity levels of at least one PD (Ns from 3 for DPD to 22 for OCPD). Thus, a total of 94 participants (25.6%) endorsed threshold or higher levels of at least one PD, indicating that the sample included a relatively wide range of PD symptom severity. As Clark et al. (in press) noted that dimensionally scored SNAP-2 scales have better reliability, the data analyses below used dimensional, rather than criterion, PD symptom scores. Emotions and Self-Reported PD Symptoms Shame aversion and shame-proneness both showed expected positive correlations with experiential avoidance, NA, and guilt aversion (rs ⫽ .57, .42, and .52 for shame aversion; rs ⫽ .43, .32, and .41 for shame-proneness), as well as expected negative correlations with PA (rs ⫽ ⫺.27 and ⫺.17 for shame aversion and proneness, respectively). Consistent with previous research (e.g., Tangney, 1990), shame-proneness was positively correlated with guilt-proneness (r ⫽ .46). Guilt-proneness was not associated

5

with the general emotion constructs or shame aversion. As seen on the left side of the boxed portion of Table 1, BPD, APD, and DPD displayed similar associations with general emotion-, guilt-, and shame-related constructs; however, BPD elevations were related to lower guiltproneness, whereas APD and DPD were not associated with guilt-proneness. Unlike these three disorders, NPD and OCPD were not related to experiential avoidance but were positively related to PA. However, NPD and OCPD diverged in that only OCPD was related to NA and shame-proneness. Moreover, whereas OCPD was positively related to guilt-proneness, NPD was negatively related to that construct. Overall, even with many similarities across these PDs—notably that all five were positively associated with shame aversion and four with shame-proneness—there were also potentially nontrivial differences across PDs. Interested in testing whether shame aversion and/or shame-proneness would predict PD symptoms over and above other emotionrelated constructs, we ran a set of hierarchical multiple regression analyses examining whether shame aversion and/or proneness would significantly predict self-reported PD symptoms even after taking into account, in the following order: (a) demographic variables, (b) experiential avoidance, trait PA, and trait NA, and (c) aversion and proneness to guilt. We also considered

Table 1 Descriptive Statistics for and Correlations Between Emotion-Related Constructs and Personality Disorder Symptoms Emotion-Related Constructs M SD Min Max Exp. avoidance PA NA Guilt aversion Guilt-proneness Shame aversion Shame-proneness M SD Min Max

3.7 3.4 2.0 4.2 4.0 3.7 2.9

0.8 0.6 0.6 0.9 0.4 0.9 0.6

1.8 1.5 1.0 1.1 2.6 1.3 1.3

6.7 4.8 4.0 6.8 4.9 6.5 4.7

Self-Report (N ⫽ 367) BPD ⴱⴱ

NPD

APD ⴱⴱ

DPD

Informant-Report (N ⫽ 166) OCPD BPD NPD

APD

DPD OCPD

ⴱⴱ

.06 .56 .51 .10 .01 –.05 .04 .15 –.04 .40 –.13ⴱⴱ .20ⴱⴱ –.36ⴱⴱ –.26ⴱⴱ .11ⴱ –.13 –.08 –.06 –.11 .08 .41ⴱⴱ .10 .36ⴱⴱ .39ⴱⴱ .19ⴱⴱ .00 .00 .07 .00 .04 .07 .27ⴱⴱ .32ⴱⴱ .21ⴱⴱ –.07 .04 .04 .07 .13 .15ⴱⴱ –.17ⴱⴱ –.16ⴱⴱ –.04 .00 .12ⴱ –.13 –.05 .01 .09 .12 .33ⴱⴱ .12ⴱ .59ⴱⴱ .50ⴱⴱ .22ⴱⴱ .04 .06 .16ⴱ .17ⴱ .18ⴱ .14ⴱⴱ –.02 .38ⴱⴱ .34ⴱⴱ .18ⴱⴱ –.14 –.12 .08 .01 .08 8.0 11.0 5.7 4.2 12.5 4.9 8.1 4.3 3.0 11.7 5.0 3.8 4.2 3.4 4.3 3.6 3.6 3.8 3.0 4.5 0.0 2.0 0.0 0.0 2.0 0.0 1.0 0.0 0.0 0.0 28.0 23.0 18.0 17.0 24.0 19.0 17.0 16.0 19.0 23.0

Note. Exp. avoidance ⫽ Experiential avoidance. Note. Descriptive statistics for emotion-related constructs are based on mean scores from the respective measures. ⴱ p ⬍ .05. ⴱⴱ p ⬍ .01.

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whether guilt or shame would contribute to the prediction of PD symptoms via interactions by entering the two-way interactions between the aversion and proneness variables for guilt and shame, respectively, in the final step of the regressions. The results of the regression analyses in Table 2 show that the demographic variables were largely unrelated to PD symptoms. Not surprisingly, we found that running these analyses without entering demographics in the first step led to no substantial changes in the results. As would be expected, the standardized betas for experiential avoidance, trait PA, and trait NA indicated that these constructs have significant associations with PD symptoms. Guilt was less consistently related to self-reported PD symptoms, with guilt-proneness being negatively related to BPD and NPD, whereas guilt aversion was positively related to DPD and OCPD. Importantly, shame-related constructs were associated with self-reported symptoms of all five PDs. Specifically, shame-proneness predicted APD symptoms, and shame aversion predicted symptoms of each of the PDs. These results are particularly notable, given that they indicate these shame-related constructs contrib-

uted to self-reported PD symptoms over and above demographics, general emotion constructs, and guilt-related constructs. In Step 5, the Guilt Aversion ⫻ GuiltProneness interaction was not significantly associated with self-reported PD symptoms. However, the Shame Aversion ⫻ Shame-Proneness interaction was significant for APD and DPD. Following Aiken and West (1991), shameproneness was related to APD and DPD when shame aversion was high (␤s ⫽ .22 and .20, respectively, ps ⬍ .01) but not when low (␤s ⫽ .07 and ⫺.08, respectively, ps ⫽ ns). This interaction was not significant for BPD or NPD; unlike the previous study, this interaction was also not significant for OCPD. We also reran the regression analyses for self-reported PD symptoms using only the portion of the sample for which we had informant data; generally minor magnitude differences between these results and those presented in Table 2 were found. However, because of the substantial difference in sample size (n ⫽ 166 rather than 367), many of the relationships between emotion-related constructs and PD symptoms were nonsignificant.

Table 2 Summary of Hierarchical Multiple Regression Analyses Predicting Self-Reported Personality Disorder Symptoms (N ⫽ 367) BPD Variable Step 1 Age Gender Step 2 Experiential avoidance PA NA Step 3 Guilt aversion (GuAvA) Guilt-proneness (TOSCA-G) Step 4 Shame aversion (ShARQ) Shame-proneness (TOSCA-S) Step 5 GuAvA ⫻ TOSCA-G ShARQ ⫻ TOSCA-S

NPD ⌬R

2

ß

⌬R

ß

.02ⴱ .13 .04 .27ⴱⴱ .02 .29ⴱⴱ

.22ⴱⴱ

.02ⴱ

.00 ⫺.14ⴱ ⴱ

.14ⴱ .28ⴱⴱ .06

ⴱⴱ

.04ⴱⴱ .02ⴱ

.18 ⫺.02

.15 ⫺.02

.01 .01 .08

.07ⴱ

⌬R

ß

.43ⴱⴱ ⫺.18ⴱⴱ .15ⴱⴱ

.37ⴱⴱ

.01 ⫺.08 .03 ⴱⴱ

.11ⴱⴱ

.39 .14ⴱ

⌬R

ß

ß

.02ⴱ ⫺.06 ⫺.11ⴱ .39ⴱⴱ ⫺.07 .19ⴱⴱ .12ⴱ ⫺.02 ⴱⴱ

.25 .05 .01

.01 .08ⴱ

OCPD 2

.00 .04 .05

.00 ⫺.06 ⫺.02

DPD 2

.01 .09 ⫺.02

.05 ⫺.21ⴱⴱ .01

APD 2

⫺.05 .16ⴱⴱ

.29ⴱⴱ

.01 .09 ⫺.07 .08 .17ⴱⴱ .17ⴱⴱ

.01 .04ⴱⴱ .02ⴱ

⌬R2

.17ⴱⴱ .09 .16ⴱ .06

.06ⴱⴱ

.03ⴱ

.01

.00 .06 ⫺.01

Note. BPD ⫽ borderline personality disorder; NPD ⫽ narcissistic personality disorder; APD ⫽ avoidant personality disorder; DPD ⫽ dependent personality disorder; OCPD ⫽ obsessive-compulsive personality disorder. Note. Gender was coded as female ⫽ 0 and male ⫽ 1. ⴱ p ⬍ .05. ⴱⴱ p ⬍ .01.

SHAME IN SELF- AND INFORMANT-REPORTED PDS

Emotions and Informant-Reported PD Symptoms As shown in the right half of the boxed portion of Table 1, informant-reports of PD symptoms displayed far fewer significant correlations with emotion-related variables, suggesting that many of these intrapersonal constructs may not manifest in ways that are both noticeable to others and relevant to these PDs. Notably, only shame aversion was significantly associated with informant-reported PD symptoms, specifically with all three Cluster C PDs. In other words, elevations in shame aversion were associated with Cluster C PD symptoms observable to others. As depicted in Table 3, we ran a second set of hierarchical multiple regression analyses using scores on the SNAP-2 collateral-reports as the outcome variables. Demographics were again largely unrelated to PD symptoms. Unlike the self-report data, informant-reports of PD symptoms were not significantly associated with experiential avoidance, trait PA, or trait NA. Moreover, PD symptom levels were not associated with guilt aversion or proneness. Shame-related variables were significantly associated with symptoms of all PDs, except

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BPD, again consistent with our hypothesis that shame plays a particularly important role in PD symptoms. Specifically, consistent with expectations, shame aversion was positively associated with APD, DPD, and OCPD. Importantly, due to the substantial sample size differences, our power to detect significant relationships was reduced in the informant-report regressions. Thus, it is all the more noteworthy that these relationships between informant-reported PD symptoms and shame aversion were significant even after taking demographic, general emotion, and guilt-related variables into account. Further, relationships between shame aversion and informant-reported symptoms of BPD and NPD may be statistically significant in larger samples. Moreover, to our surprise, shameproneness was negatively related to NPD and APD in the regression analyses; it should be pointed out, however, that we did not obtain significant negative zero-order correlations between shame-proneness and these disorders. Although we explored the possibility of a suppressor effect, shame-proneness remained at least marginally negatively associated with NPD and APD regardless of any changes we made to the regression model.

Table 3 Summary of Hierarchical Multiple Regression Analyses Predicting Informant-Reported Personality Disorder Symptoms (N ⫽ 166) BPD Variable Step 1 Age Gender Step 2 Experiential avoidance PA NA Step 3 Guilt aversion (GuAvA) Guilt-proneness (TOSCA-G) Step 4 Shame aversion (ShARQ) Shame-proneness (TOSCA-S) Step 5 GuAvA ⫻ TOSCA-G ShARQ ⫻ TOSCA-S

ß

NPD

⌬R

2

ß

.03

⌬R

.01 ⫺.04 ⫺.13 .00

.04 .20 ⫺.22ⴱ

.01

ⴱⴱ

.30 ⫺.26ⴱⴱ .00

.01 .05

.07ⴱⴱ

.03

.01 ⫺.08 .05 .07

.01 .00 .09 ⴱ

.04ⴱ

.23 ⫺.20 .01

⫺.08 .04

.05ⴱ .00 ⫺.22ⴱⴱ

.14 ⫺.06 ⫺.09 .00

.03 ⫺.01

⌬R2

ß

.01

.02

.01

.02

⌬R

ß ⫺.05 ⫺.09

.07 .12 .07

.06 ⫺.07

OCPD 2

.01

.02

.01

.15 ⫺.14

⌬R

ß .08 ⫺.07

⫺.16 ⫺.15 .03

⫺.05 ⫺.07

DPD 2

.01 ⫺.02 ⫺.06

.10 .12

.06 .04

APD 2

.02 .13 .02 ⴱⴱ

.29 ⫺.06 .00

⫺.01 ⫺.05

.04ⴱ

.00 .01 .02

Note. BPD ⫽ borderline personality disorder; NPD ⫽ narcissistic personality disorder; APD ⫽ avoidant personality disorder; DPD ⫽ dependent personality disorder; OCPD ⫽ obsessive-compulsive personality disorder. Note. Gender was coded as female ⫽ 0 and male ⫽ 1. ⴱ p ⬍ .05. ⴱⴱ p ⬍ .01.

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Discussion The present study provides further support for the particular relevance of shame in PDs, especially with regard to shame aversion. Shame aversion was related to self-reports of all five PDs, over and above several alternative emotion-related constructs that had the potential to account for the relationships. Moreover, shame aversion was related to informant-reports of symptoms of all three Cluster C PDs, indicating that perceiving shame as especially painful and unwanted is also related to various observable indicators of PDs. Thus, shame aversion’s relevance to PDs is fairly extensive. In terms of PD symptoms noticeable to others, however, shame aversion seems to contribute more to anxious/fearful PDs than to dramatic/ emotional PDs. Our findings suggest a more limited role for shame-proneness than for shame aversion in the PD symptoms examined herein. Shame-proneness displayed significant zero-order correlations with symptoms of four PDs; however, only the relationship of shame-proneness to APD remained when also taking into account demographics and a variety of other emotionrelated constructs. Further, the relationship of shame-proneness to APD and to DPD was further qualified by a Shame Aversion ⫻ ShameProneness interaction; individuals high on shame-proneness were especially likely to display APD and DPD symptoms when shame aversion was high, but not when shame aversion was low. Ultimately, although shame-proneness is certainly an important psychological construct, as evidenced by its relationships to many problems in functioning (e.g., Tangney & Dearing, 2002), its predictive utility with regards to these PD symptoms is diminished after taking other emotion-related constructs into account. Importantly, our findings are also largely consistent with existing theories of BPD and NPD, two disorders to which we extended our original hypotheses. The positive correlation between BPD and shame-proneness, for example, supports extant theories that those with BPD view themselves as bad individuals (Linehan, 1993), as such a view could contribute to frequent shame. Our findings further indicate that a tendency to perceive shame as especially unwanted and distressing is a particularly important contributor to BPD-related thoughts/

behaviors. Therefore, these results potentially increase our understanding of how shame may be important in BPD symptoms. Future research should consider whether an aversion to shame motivates some individuals to engage in behaviors typical of BPD; for example, the intolerability of shame may contribute to tendencies to harm oneself, which may be a maladaptive (and likely ineffective) attempt to reduce feelings of self-hate. Theories asserting that the grandiose selfpresentational style in NPD is a defense against insults to self-esteem and consequent unpleasant emotions (e.g., Kohut, 1971) are also supported by our findings. However, whereas these theories tend to consider grandiosity a defense against depression, our findings suggest that grandiosity may be a defense against shame specifically, given that shame aversion was associated with self-reported NPD symptoms over and above PA and NA. It is further possible, of course, that defending against shame may assist in reducing the likelihood of depression, especially if the defenses are effective. The present results suggest that those with NPD may be somewhat effective at reducing exposure of personal flaws, as NPD was the only disorder with which shame-proneness showed no zero-order correlation and individuals perceived by informants as displaying elevated NPD endorsed lower shame-proneness. Although elevated shame aversion may contribute to NPD symptoms (e.g., arrogance, exploitativeness, grandiose fantasies), these symptoms may somehow protect those with NPD from experiencing shame often. However, there seem to be two narcissism dimensions — grandiose and vulnerable (e.g., Wink, 1991) — that are related to different external correlates (e.g., different facets of psychopathy and forms of aggression; Schoenleber, Sadeh, & Verona, 2011). In fact, some research indicates that shame-proneness is related negatively to grandiose narcissism but positively to constructs that better reflect vulnerable narcissism (e.g., Gramzow & Tangney, 1992). The present null results for NPD and shame-proneness may be due to the fact that NPD includes aspects of each of these different dimensions. Future studies should further examine whether shame aversion and/or proneness are differentially related to narcissism dimensions.

SHAME IN SELF- AND INFORMANT-REPORTED PDS

Although it remains an open question, we anticipate that shame aversion will be associated with symptoms of other PDs as well. For example, the attribution self-representation model (Bentall, Kinderman, & Kaney, 1994) suggests that latent negative views of the self — suggestive of shame — lead to persecutory delusional beliefs, such as those potentially seen in paranoid personality disorder. By contrast, the callousness and unemotionality of individuals high on the interpersonal/affective dimension of psychopathy (i.e., Factor 1; Hare, 1991) may be related to lower shame aversion. Thus, future work on shame aversion and PDs is still necessary to determine the breadth of shame aversion’s association with pathological personality features. Although shame-proneness was generally not associated with the PD symptoms over and above other emotion-related constructs, future research on the relative influences of shameproneness and shame aversion in Axis I disorders may indicate that shame-proneness is especially relevant to other disorders that were not the focus of this study. For instance, shameproneness is likely to be an important contributor to feelings of hopelessness or the onset and/or maintenance of symptoms of major depressive disorder. Shame aversion, too, may be related to Axis I psychopathology such as social phobia or posttraumatic stress disorder, both of which have already been found to be associated with shame-proneness (e.g., Tangney & Dearing, 2002; Fergus, Valentiner, McGrath, & Jenicus, 2010). Overall, it will be important for future work to consider the relative roles of shame-proneness and shame aversion in Axis I disorders. Guilt-related constructs were also significantly associated with some of the PDs we examined. The negative relationships between guilt-proneness and BPD and NPD are broadly consistent with the literature; given that guiltproneness tends to be related to positive outcomes (e.g., Tangney et al., 1992), we would not expect it to be positively associated with these disorders. However, the positive zeroorder correlation between guilt-proneness and OCPD was significant. This is actually consistent with previous conscientiousness research. Conscientiousness is positively related to both OCPD (e.g., Samuel & Widiger, 2008) and guilt-proneness (e.g., Fayard, Roberts, Robins,

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& Watson, in press). It may be that individuals displaying generally adaptive levels of conscientiousness are prone and averse to guilt, whereas those who have higher, maladaptive levels of conscientiousness are also characterized by an aversion to shame. Future research is necessary in order to more fully consider this hypothesis. Of course, we expected that shame would be especially relevant to PD symptoms, not guilt. Inverting the third and fourth steps in our regression analyses indicated that although guiltproneness was still negatively associated with BPD and NPD, guilt aversion was no longer associated with DPD or OCPD. These findings are consistent with our belief that guilt tends to become aversive when it is generally experienced simultaneously with shame. Overall, our findings are consistent with a more prominent role for shame-related constructs than for guiltrelated constructs in symptoms of these five PDs. However, it will also be important for future research to further validate the GuAvA and to better examine the relationship between guilt aversion and shame aversion to improve our confidence in the present and future findings. As with any investigation, this study has limitations. Although large, we used an undergraduate sample, potentially restricting the generalizability of these findings beyond young adults. This may also have excluded individuals with the most extreme levels of PD symptoms. However, as 25.6% of our sample endorsed threshold or greater severity of PD symptoms, we ultimately considered a relatively wide range of symptom severity. Like others (e.g., Widiger & Simonsen, 2005) we believe it is important to study PDs at all possible symptom levels, ranging from those that would not constitute pathology to those that would be considered extreme, especially as there is a dearth of evidence suggesting that PDs are best represented categorically; existing taxometric studies tend to indicate that BPD and Cluster C PDs are nontaxonic, for example (e.g., Arntz et al., 2009; Rothschild, Cleland, Haslam, & Zimmerman, 2003). Another limitation was our relatively narrow focus on five PDs. Unfortunately, it is not always feasible to assess all 10 PDs in a single study, especially when also considering several external correlates. Having developed our hy-

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potheses regarding shame in the context of Cluster C PDs (Schoenleber & Berenbaum, 2010) and given the need for replication, we again assessed Cluster C PDs in this study. Importantly, in extending our research to BPD and NPD, we also found that shame aversion, in particular, is related to more than just Cluster C PDs. However, future research should examine both shame aversion and proneness in the remaining PDs. Despite its limitations, the present study provides useful information about the emotional correlates of a range of personality pathology and suggests some important future directions. Moreover, our findings have potential clinical implications. It will be important for clinicians working with clients who have the PDs examined herein to assess and target shame during treatment, if they are not doing so already. If warranted, efforts could be made to address shame aversion, such as developing more effective strategies for reducing shame. Believing one has a repertoire of effective strategies for avoiding or coping with shame may reduce the extent to which the prospect of shame is distressing. Alternatively, treatment could focus on acceptance of the presence of personal flaws and the possibility of feeling shame, again with the goal of reducing the perception that shame is a particularly painful emotion. References Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing and interpreting interactions. Thousand Oaks, CA: Sage. American Psychiatric Association (APA). (2000). Diagnostic and statistical manual of mental disorders (4th edition, Text Revision). Washington, DC: Author. Arntz, A., Bernstein, D., Gielen, D., van Nieuwenhuyzen, M., Penders, K., Haslam, N., & Ruscio, J. (2009). Taxometric evidence for the dimensional structure of Cluster-C, paranoid, and borderline personality disorders. Journal of Personality Disorders, 23, 606 – 628. doi:10.1521/ pedi.2009.23.6.606 Bentall, R. P., Kinderman, P., & Kaney, S. (1994). The self, attributional processes and abnormal beliefs: Towards a model of persecutory delusions. Behaviour Research and Therapy, 32, 331–341. doi:10.1016/0005-7967(94)90131-7 Brown, M. Z., Linehan, M. M., Comtois, K. A., Murray, A., & Chapman, A. L. (2009). Shame as a

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