Borderline Personality Disorder and Self-Conscious Affect: Too Much Shame But Not Enough Guilt?

Borderline Personality Disorder and Self-Conscious Affect: Too Much Shame But Not Enough Guilt?

. Author manuscript; available in PMC 2017 Jul 1.
Published in final edited form as:
PMCID: PMC4929016
NIHMSID: NIHMS751322
PMID: 26866901

Jessica R. Peters1 and Paul J. Geiger2
Author information Copyright and License information Disclaimer

Abstract

Shame has emerged as a particularly relevant emotion to the maintenance and exacerbation of borderline personality disorder (BPD) features; however, little attention has been paid to the potentially differing effects of other forms of self-conscious affect. While guilt has been demonstrated to have adaptive functions in the social psychology literature, it has not been previously explored whether a lack of socially adaptive guilt might also contribute to BPD-related dysfunction. The present study examined the relationship between BPD features and self-conscious emotions in a sample of undergraduate students (n=839). Increased shame and decreased guilt independently accounted for significant variance in the association between BPD features and anger, hostility, and externalization of blame. Only increased shame significantly mediated the association between BPD features and anger rumination, and only decreased guilt significantly mediated the relationship between BPD features and aggression. These findings suggest BPD and its associated problems with anger and externalizing may be characterized not only by high levels of shame, but also by lower levels of guilt. Clinical implications include the need to differentiate between self-conscious emotions and teach adaptive responses to warranted guilt.

 

Borderline personality disorder (BPD) consists of a range of symptoms including emotion dysregulation, interpersonal difficulties, intense anger, and impulsivity (American Psychiatric Association, 2013). While theoretical models of BPD differ in their explanations of the disorder, there is a general consensus that shame-proneness is a major component. For example, the biosocial model suggests that high levels of emotional vulnerability interact with the effects of an invalidating childhood environment to produce BPD symptoms (Linehan, 1993). In this environment, a child is frequently shamed for experiencing negative affect. Over time the child learns to invalidate her own emotions and experience shame in response to emotionality, leading to high shame-proneness in adulthood. Object relations theory (Kernberg, 1984) describes shame-proneness as characteristic of BPD due to extremely negative, polarized representations of the self that are disconnected from positive self-representations. Individuals with BPD do report significantly higher levels of shame compared to individuals diagnosed with other affective disorders (Rüsch et al., 2007; Scheel et al., 2014) and exhibit more shame in response to negative affect (Jacob et al., 2009). When experimentally induced, effects of shame, but not other forms of negative affect, last longer in individuals with BPD compared to a psychiatric comparison group (Gratz, Rosenthal, Tull, & Lejuez, 2010).

While the relationship between BPD and shame has been the focus of multiple studies, the relationship between BPD and other self-conscious emotions, including guilt, have received less attention. While both shame and guilt are self-directed negative emotions, shame focuses on the global self as wrong or bad, whereas guilt focuses on a specific action or failure to act as problematic. This conceptualization of guilt can be seen as adaptive, involving engagement in perspective-taking, helping to facilitate empathic concern, whereas shame tends to involve focus on one’s own distress (Joireman, 2004; Tangney, Stuewig, & Mashek, 2007; M.-L. Yang, Yang, & Chiou, 2010). Consistent with this, guilt has been associated with reduced direct, indirect, and displaced anger and aggression (Lutwak, Panish, Ferrari, & Razzino, 2001; Tangney, Miller, Flicker, & Barlow, 1996). In contrast, shame has been shown to increase anger, aggression, and the subsequent externalizing of blame on to others (Tangney, Wagner, Fletcher, & Gramzow, 1992) and ruminating about angering experiences (Peters, Geiger, Smart, & Baer, 2014a). This blaming of others and becoming angry may be an efforts to avoid the distress of shame by directing negative affect externally away from the self (Tangey et al, 1992).

While increased shame has been established as a contributing factor in BPD, it has not been well explored whether a lack of socially adaptive guilt might also contribute to BPD-related dysfunction. In an undergraduate sample, BPD symptoms demonstrated a significant positive association with shame and a negative association with guilt (Schoenleber & Berenbaum, 2012). One study found a link between daily shame and hostility in a community sample of adolescents with BPD features, but no association between daily guilt and hostility (Scott et al., 2015). Several studies have demonstrated guilt as protective compared to shame as a risk factor for a number of BPD-related impulsive symptoms, such as deliberate self-harm (VanDerhei, Rojahn, Stuewig, & McKnight, 2013), substance abuse (Dearing, Stuewig, & Tangney, 2005; Jeffrey Stuewig et al., 2015), and risky sexual behavior (Jeffrey Stuewig et al., 2015); however, no study has examined the differential contributions of shame and guilt to how BPD features may relate to the various forms of externalizing blame and anger expression. It seems plausible that while the intense shame characteristic of BPD may contribute to these problems as efforts to avoid the distress of shame (Schoenleber & Berenbaum, 2012), this tendency to focus on the global self as negative may occur in concert with less specific, action-focused thought and thus less adaptive guilt. By primarily feeling shame and less guilt in response to situations provoking self-conscious emotions, individuals high in BPD features may become more defensive, angry, and less likely to engage in problem-solving or prosocial behaviors.

The present study examines the relationships between BPD features and both shame and guilt, as well as how those associations may contribute to externalizing of blame, anger, and aggression. We hypothesized that while individuals high in BPD features would report increased levels of broadly self-focused shame and endorse significantly lower levels of more adaptive, action-focused guilt. Both high levels of shame and lower levels of guilt were expected to independently account for components of the relationship between BPD features and increased externalizing of blame, anger, and aggression.

Methods

Participants

Participants were 916 undergraduate students who completed an online survey of self-report measures, only some of which were relevant to the present study (see Measures). Following data screening procedures (detailed in Results section), a sample of 839 (70.4% female, 85.9% Caucasian) was used for analyses. Participants ranged in age from 18 to 59, with a mean age of 19.25 (SD = 2.51). Participants received course credit for their participation.

Previous research has shown that clinically significant BPD features occur in undergraduate populations (Trull, 1995; Trull, Useda, Conforti, & Doan, 1997). Students with scores over 37 (T>70) on the Personality Assessment Inventory—Borderline Features Scale (PAI-BOR; Morey, 2007) demonstrate maladjustment similar to clinical populations diagnosed with BPD. Using a student sample in the present study allowed us to examine variables of interest across a continuous, wide range of BPD features, as opposed to the extremes found in clinical samples. In the final sample of the present study, 11% of participants scored above 37 (T =70) on the PAI-BOR, indicating clinically significant BPD features.

Measures

Borderline Personality Features

The PAI-BOR consists of 24 items rated on a 4-point scale (1=false; 4=very true) measuring core features of BPD symptomatology. Individuals with BPD demonstrate elevations on the PAI-BOR, and mood, anxiety, psychotic and substance use disorders, and antisocial personality disorder, in the absence of BPD, do not produce elevations (Morey, 1991). Internal consistencies (Crohnbach’s alpha) in the present study for all measures used are presented on the diagonal in Table 1; all ranged from acceptable to excellent.

Table 1

Descriptive statistics for and correlations between all study variables (N = 839).

1 2 3 4 5 6 7 8 9 10 M SD
1. PAI-BOR (.89) 22.90 10.89
2. TOS Shame .33*** (.77) 32.13 7.21
3. TOS Guilt −.12** .32*** (.76) 44.36 6.06
4. TOS External .27*** .26*** −.23*** (.69) 22.83 6.05
5. PAN Anger .63*** .20*** −.28*** .35*** (.82) 10.78 3.74
6. AQ Anger .48*** .12** −.25*** .32*** .48*** (.84) 19.78 6.68
7. AQ Hostility .60*** .28*** −.15*** .33*** .56*** .55*** (.89) 23.73 10.40
8. AQ Verbal .35*** .02 −.17*** .23*** .37*** .60*** .43*** (.85) 16.33 6.53
9. AQ Physical .38*** −.07* −.30*** .34*** .40*** .65*** .43*** .52*** (.88) 23.01 9.52
10. Anger Rum .64*** .30*** −.10** .23*** .58*** .44*** .53*** .34*** .38*** (.92) 32.80 8.68

Note.

*p < .05
**p < .01
***p < .001

internal consistencies for each measure are presented in parentheses on the diagonal.

PAI-BOR = Personality Assessment Inventory—Borderline Personality Disorder subscale; TOS Shame = Test of Self-Conscious Affect (TOSCA-3) Shame subscale; TOS Guilt = TOSCA-3 Guilt subscale; TOS External = TOSCA-3 Externalization subscale; PAN Anger = Positive Affect Negative Affect Scale (PANAS-X)—Anger subscale; AQ = Aggression Questionnaire; Anger Rum = Anger Rumination Questionnaire (ARS).

Self-Conscious Affect

The Test of Self-Conscious Affect (TOSCA-3; Tangney, Dearing, Wagner, & Gramzow, 2000) is a scenario-based self-report measure assessing shame, guilt, detachment, and externalization (blaming others). A validated short-form of the scale using 11 negative scenarios was used for the present study. A sample scenario is as follows: “You attend your coworker’s housewarming party and you spill red wine on a new cream-colored carpet, but you think no one notices.” Four possible reactions are presented: “You would wish you were anywhere but at the party” (shame); “You would stay late to help clean up the stain after the party” (guilt); “You think your coworker should have expected some accidents at such a big party” (detachment); and “You would wonder why your coworker chose to serve red wine with a new light carpet” (externalization). Each reaction is separately rated on a 5-point scale (1=not likely; 5=very likely), and scores for each reaction type are averaged across scenarios.

Anger and Aggression

Trait-level anger and aggression were measured with two scales. The anger subscale of the Positive and Negative Affect Scale—Expanded Version (PANAS-X; Watson & Clark, 1999) contains six items (e.g., “angry,” “irritable,” etc.) rated on a 5-point scale (1=very slightly or not at all; 5=extremely). The Aggression Questionnaire (AQ; Buss & Perry, 1992) consists of 29-items assessing anger (e.g. “I flare up quickly but get over it quickly”), hostility (e.g. “I wonder why sometimes I feel so bitter about things”), verbal aggression (e.g. “I can’t help getting into arguments when people disagree with me”), and physical aggression (e.g. “Once in a while I can’t control the urge to strike another person”), rated on a 5-point scale (1=extremely uncharacteristic of me; 5=extremely characteristic of me).

Anger Rumination

The Anger Rumination Scale (ARS; Sukhodolsky, Golub, & Cromwell, 2001) consists of 19 items rated on a 4-point scale (1=almost never; 4=almost always) measuring the tendency to focus attention on angry moods, recall past anger episodes, and think about the causes and consequences of anger episodes. The ARS has four subscales: Angry Afterthoughts (e.g., “Whenever I experience anger, I keep thinking about it for a while”), Thoughts of Revenge (e.g., “I have long-living fantasies of revenge after the conflict is over”), Angry Memories (e.g., “I keep thinking about events that angered me for a long time”), and Understanding Causes (e.g., “I think about the reasons people treat me badly”). All subscales are highly correlated in the present sample (r = .49 −.69; p < .001) and other samples (Sukhodolsky et al, 2001), so a total score was used.

Data Screening Questions

Two questions were included in the survey to check whether participants were attending to the content of the items. Each question asked the participant to select a specific answer that corresponded to one of the Likert-scale options for the scale it was inserted into (e.g., “choose moderately for this item”). The first question was inserted after the first third of the survey, and the second question was inserted in the last third of the survey.

Procedure

All measures were administered as part of a larger study on BPD and emotional and interpersonal functioning. The Institutional Review Board approved all study procedures, and all participants provided informed consent.

Data Analysis

Data was analyzed using SPSS 22.0. The PROCESS macro (A. F. Hayes, 2013) was used to estimate indirect effects from BPD via shame and guilt (entered as parallel mediators) on externalizing and anger-related variables, generating both 95% and 99% bias-corrected bootstrapped confidence intervals.

Results

Descriptives

Data was screened for non-responding to survey content, with 77 participants removed for failing to correctly answer the data screening questions embedded in the survey. See Table 1 for descriptives for all study variables. Several of the variables (PAI-BOR, ARS, AQ physical aggression, AQ anger, and PANAS anger) were positively skewed (skew/SE of skew > 5; Tabachnick & Fidell, 2000); however, although transforming them (square root or log transformations) effectively reduced the skew, doing so had no impact on associations with other variables (differences in correlation magnitudes ≤ .01). Accordingly, variables were left untransformed to facilitate ease of interpretation.

Correlations

Correlations were computed between all study variables (see Table 1). As expected, BPD features was significantly positively correlated with study variables measuring anger, aggression, hostility, externalizing behavior, and shame. As hypothesized, BPD features, externalizing, anger, and aggression were significantly negatively correlated with guilt.

Indirect Effects

The indirect effects of BPD features via shame and guilt on anger, aggression and externalizing were estimated, with shame and guilt entered into each model simultaneously (see Table 2). Both increased shame and decreased guilt accounted for significant variance in the association between BPD features and Externalizing, PANAS Anger, and AQ Hostility. Only increased shame accounted for significant variance in the relationship between BPD features and Anger Rumination. Decreased guilt, but not increased shame, significantly mediated the effect of BPD features on both AQ Verbal Aggression and AQ Anger. In contrast, contrary to hypotheses, while a significant indirect effect was observed from BPD features via decreased guilt to increased AQ Physical Aggression, a significant indirect effect via increased shame led to decreased AQ Physical Aggression.

Table 2

Summaries of regression tables predicting externalizing, anger, anger rumination, and aggression from BPD features and self-conscious affect, with bias-corrected bootstrapped confidence intervals for the direct effects of BPD and indirect effects of BPD via shame and guilt on the dependent variable (N = 839).

DV Predictors ΔR2 R2 β 95% CI 99% CI
TOS External PAI-BOR .08*** .28***
PAI-BOR .11*** .18*** .15*** .027 – .104 .015 – .117
Shame .30*** .040 – .077 .033 – .084
Guilt −.30*** .007 – .038 .005 – .040
PAN Anger PAI-BOR .40*** .63***
PAI-BOR .05*** .44*** .58*** .176 – .216 .170 – .223
Shame .07* .003 – .017 .000 – .020
Guilt −.23*** .004 – .017 .002 – .020
AQ Anger PAI-BOR .23*** .48***
PAI-BOR .05*** .28*** .44*** .230 – .314 .217 – .327
Shame .06 −.004 – .024 −.009 – .030
Guilt −.24*** .005 – .030 .002 – .035
AQ Hostility PAI-BOR .36*** .60***
PAI-BOR .03*** .39*** .54*** .457 – .577 .438 – .596
Shame .15*** .024 – .073 .016 – .081
Guilt −.14*** .004 – .030 .001 – .033
AQ Verbal PAI-BOR .12*** .34***
PAI-BOR .02*** .14*** .34*** .171 – .260 .157 – .274
Shame −.05 −.031 – .002 −.033 – .008
Guilt −.12** .002 – .019 .000 – .022
AQ Physical PAI-BOR .14*** .37***
PAI-BOR .09*** .22*** .39*** .276 – .399 .257 – .418
Shame −.13** −.062 – −.017 −.067 – −.008
Guilt −.23*** .005 – .039 .003 – .049
Anger Rum PAI-BOR .44*** .66***
PAI-BOR .01*** .45*** .62*** .431 – .526 .416 – .541
Shame .10** .014 – .050 .010 – .052
Guilt −.07* .000 – .013 −.002 – .019

Note.

*p < .05
**p < .01
***p < .001

PAI-BOR = Personality Assessment Inventory—Borderline Personality Disorder subscale; TOS Shame = Test of Self-Conscious Affect (TOSCA-3) Shame subscale; TOS Guilt = TOSCA-3 Guilt subscale; TOS External = TOSCA-3 Externalization subscale; PAN Anger = Positive Affect Negative Affect Scale (PANAS-X)—Anger subscale; AQ = Aggression Questionnaire; Anger Rum = Anger Rumination Questionnaire (ARS) total score.

Discussion

The present study replicated previous findings that BPD features are associated with higher levels of shame but lower levels of guilt and extended them to demonstrate that, largely, both of these tendencies are likely maladaptive. The heightened shame and decreased guilt associated with BPD features both independently accounted for increased externalizing, hostility, and general levels of angry affect. Lessened guilt alone accounted for increased verbal aggression and the tendency to experience difficult to control and unstable anger, while increased shame alone additionally accounted for increased anger rumination. These self-conscious emotions may each play independent roles in the increased externalizing of blame, anger, hostility, and aggression associated with BPD features.

Contrary to hypotheses, a significant indirect path was found via increased shame to less physical aggression. One possibility is that increased shame and self-blame inhibits the social dominance involved in being physically aggressive. This result may also be due in part to the relatively low levels of physical aggression in the present sample; accordingly, these constructs should be examined in samples engaging in more frequent and intense acts of physical aggression. Other limitations of the present study include the use of a student sample, reliance on self-report measures, and the cross-sectional nature of the data. Future studies should examine these constructs in clinical samples and utilize additional means of assessment, as well as utilize inductions of these emotions and study changes over the course of emotion-regulation interventions. Additionally, the TOSCA-3 may inherently capture less severe and problematic aspects of guilt relative to more damaging aspects of shame (Luyten, Fontaine, & Corveleyn, 2002), so these associations should be explored further with additional measures of guilt, shame, and related constructs (e.g., both adaptive and maladaptive forms emotion regulation) before and after in vivo shame or guilt prompting events. For example, high shame forecasting (predicting and preparing for shame before it happens; Schoenleber & Berenbaum, 2012) as demonstrated in the TOSCA-3, may prompt the use of emotion regulation strategies to mitigate shame, thus reduce an individual’s proneness to actually experience the emotion as acutely.

These findings suggest the potential need for a nuanced approach to self-conscious emotions. Working to decrease more global, self-blaming shame, while increasing awareness and tolerance of more specific, action-focused guilt may help reduce BPD-related interpersonal dysfunction and facilitate more pro-social behavior. Shame focuses on the global self, while guilt focuses on a specific behavior (Lewis, 1971). Oftentimes, clients apply judgmental shame statements (e.g., “I’m such a terrible person” after being rude to an office secretary when arriving late to session), that actually warrant guilt. Mindfulness strategies including nonjudgmentally describing the facts (“I was running late. My tone sounded very irritated, because I was worrying about how late I was. I am now worrying about whether that upset the secretary.”) may be useful to show clients that the global self is not the appropriate target and instead put focus on the specific action and potential avenues for repair.

The ability to engage in adaptive guilt may also be important to the development and pursuit of personal values, given that guilt is characterized by feeling bad about specific actions or behaviors that are inconsistent with one’s moral values (Lewis, 2000). The emotion regulation module of Dialectical Behavior Therapy (DBT; Linehan, 2014) also points to the importance of values in its framework for these emotions; experiencing shame is linked to the threat of rejection and being kicked out of the community, while guilt is linked to the threat of violating one’s own values. While heightened rejection sensitivity is characteristic of BPD (e.g. Peters, Smart, & Baer, 2014b; Staebler, Helbing, Rosenbach, & Renneberg, 2010), individuals with personality disorders also have greater difficulty recalling the individual or specific memories necessary for value development (Dimaggio, Salvatore, Popolo, & Lysaker, 2012). This lack of well-established personal values may contribute to the lower levels of adaptive guilt in individuals with BPD, as guilt-proneness is associated with the identification of a range of values, whereas shame-proneness is more weakly related (Silfver, Helkama, Lönnqvist, & Verkasalo, 2008). The importance of personal values has been emphasized in third wave treatments (S. C. Hayes, Strosahl, & Wilson, 2011), including the revised DBT manual (Linehan, 2014). Identifying and focusing on personal values may be one way to facilitate more adaptive, solution-focused affective responses to committing interpersonal transgressions. Further work is needed to examine how best to foster the development of adaptive self-conscious emotions for individuals with BPD, in addition to the reduction of dysfunctional self-conscious reactivity.

Acknowledgements

This work was supported by a grant from the National Institute of Mental Health (T32MH019927) and National Institute on Aging (F31AG048697). The content is solely the responsibility of the authors and does not necessarily reflect the official views of the National Institutes of Health.

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