An investigation into the experience of self-conscious emotions in individuals with bipolar disorder, unipolar depression and non-psychiatric controls

There has been little research into the association of shame and other self-conscious emotions in bipolar disorder, although there is evidence linking shame to various psychopathologies. Objectives: This research investigates the levels of shame in individuals with bipolar disorder. Design and Methods: A cross-sectional design was used to compare 24 individuals with a diagnosis of bipolar disorder to a clinical control group of 18 individuals with unipolar depression, and 23 age-matched non-psychiatric controls on measures of mood (Beck Depression Inventory [BDI] and Self Report Manic Inventory [SRMI]) and of self-conscious emotions (Internalized Shame Scale and Test of Self-Conscious Affect). Results: Higher levels of trait shame and lower guilt-proneness were found in the bipolar group. Higher levels of shame-proneness were found in the unipolar group in comparison to the bipolar and control groups. BDI scores positively correlated with trait shame and shame-proneness, and accounted for a large proportion of the variance in these scores. SRMI scores positively correlated with trait (internalized) shame and negatively correlated with guilt-proneness. Conclusions: There was evidence for the presence of shame within bipolar disorder, but this differed to the evidence for shame in individuals with unipolar depression. Clinical implications are discussed. Copyright (C) 2009 John Wiley & Sons, Ltd. Key Practitioner Message: Evidence suggests that cognitive-behavioural therapy is not effective in individuals with bipolar disorder with more than 12 illness episodes. Shame has been elucidated as a factor is some chronic mental health problems, including depression. Compassionate mind training has recently been developed to address experience of shame and is designed as an adjunct to cognitive-behavioural approaches. This paper finds evidence for the presence of shame within bipolar disorder, but with a different manifestation than that found in individuals with depression. This suggests that clinicians should consider shame as a factor for exploration within therapy, possibly using compassionate mind therapy, and its inclusion may improve on therapeutic outcome