Shame Increases Psychosis and Paranoia Severity

Increased levels of shame are associated with greater severity of psychotic symptoms, according to study findings published in Schizophrenia Bulletin.

Although previous research findings suggest a link between shame and psychosis, these results have been conflicting. To elucidate the association between shame and psychosis and to examine potential variations on the basis of shame types and a psychosis diagnosis, researchers conducted a systematic review and meta-analysis.

The primary outcome of interest was the association between psychotic symptoms and shame, categorized by type of psychotic symptom, type of shame, and participant characteristics.

The meta-analysis included 38 studies, for a pooled sample size of 8167 individuals. The most common psychosis symptom was paranoia, whereas internal and external shame were measured with similar frequencies in the included studies.

Using all effect sizes, the researchers identified a pooled correlation esti­mate of the association between psychosis and shame (Z =0.36; 95% CI, 0.28-0.44; P <.001), indicating that increased shame was associated with increased severity of psychosis.

The researchers observed a significant positive association between shame and psychosis among both clinical and non-clinical patient populations. However, the external shame had a stronger association with psychosis severity among the non-clinical group (Z =0.591; 95% CI, 0.491-0.690) than the clinical group (Z =0.374; 95% CI, 0.238-0.510).

A particularly strong relationship was also observed between shame and the specific psychotic symptom of paranoia (B =0.19; 95% CI, 0.02-0.36) relative to meeting diagnostic criteria.

“External measures of shame may be significantly influenced by the presence of paranoia, therefore clinicians and researchers examining shame in people experiencing psychosis should utilize measures of shame that also assess internal, or underlying shame for a more reliable assessment,” the researchers concluded.

Study limitations include the lack of longitudinal data, absence of data on co-occurring depression and trauma, and a lack of generalizability to low- and middle-income countries.  

This article originally appeared on Psychiatry Advisor