Shame as a prospective predictor of self-inflicted injury in borderline personality disorder: a multi-modal analysis

Abstract

The primary aim of this study was to examine the prospective association of shame with self-inflicted injury (SII), including suicide attempts and nonsuicidal self-injury, among women with borderline personality disorder (BPD) who were enrolled in a clinical trial (N = 77). A multi-method approach was used to assess self-reported shame, nonverbal shame behaviors, and assessor ratings of shame during an interview regarding antecedents for a recent episode of SII. Higher levels of nonverbal shame behaviors predicted a higher likelihood of subsequent SII, and shorter time to SII, after controlling for past SII as well as other emotions associated with SII. Self-reported state shame and assessor ratings of shame were associated with prospective SII, but not after controlling for other emotions. These findings underscore the important role of shame in SII, particularly shame in the presence of contextual prompts for events that surround episodes of SII.

Figure 1

Kaplan-Meier Survival Plot for High versus Low Self-reported State Shame During Discussion of Recent Self-Inflicted Injury Figure Note: On the X-axis, 0 days indicates the day of the pre-treatment SASII interview. The Y-axis indicates the proportion of the sample with no SII since pre-treatment. High and low shame groups were formed based on a median split of the post-SASII PANAS shame scores.