Shame and Defectiveness Beliefs in Treatment Seeking Patients With Body Dysmorphic Disorder

Abstract

Shame is a distressing emotion experienced when individuals judge themselves in a broadly negative and critical manner. Clinical descriptions of body dysmorphic disorder (BDD) emphasize the centrality of shame, yet research on shame in BDD remains scarce. This study is the largest investigation of shame in clinically diagnosed individuals with BDD, and it is the first to examine whether shame changes with treatment. Eighty-three adults with BDD were treated with 14 weeks of open-label escitalopram. Shame was measured using the Young Schema Questionnaire-Short Form. Shame was significantly higher in individuals with BDD than in previously reported healthy control and psychiatric outpatient samples. Shame was significantly, moderately correlated with greater suicidal thoughts and hopelessness and marginally significantly correlated with greater BDD severity. Shame decreased significantly with treatment. Reductions in shame with escitalopram were significantly associated with reductions in suicidal thoughts and hopelessness, even when accounting for reductions in BDD and depression severity.

Trial registration: ClinicalTrials.gov NCT00149799.

Figures

Figure 1

Path diagram with standardized path estimates shown. Note: Structural paths shown with a dotted line indicate non-significant paths. YSQ-DS = Young Schema Questionnaire Defectiveness-Shame Subscale; BDD-YBOCS = Yale-Brown Obsessive Compulsive Scale, Modified for Body Dysmorphic Disorder; HAM-D = Hamilton Depression Rating Scale; BDI-II #9 = Beck Depression Inventory-II Item 9 (suicidality item); BHS = Beck Hopelessness Scale. *p < .01. **p < .001.