Self‐harm in a mixed clinical population: The roles of self‐criticism, shame, and social rank
Abstract
Objectives. This study explored the relationship of forms and functions of self‐criticism, shame, and social rank variables to self‐harm, depression, and anxiety. Design. The study used a questionnaire design. Method. In‐patients and day‐patients ( N = 73) completed a series of questionnaires measuring self‐harm, mood, self‐criticism, shame, and social comparison. Results. Self‐harm was significantly associated with forms and functions of self‐criticism, shame, and feelings of inferiority (low social rank). The self‐persecuting function of self‐criticism was especially linked to self‐harm, depression, and anxiety. Conclusions. This study adds to a growing literature on the importance of recognizing the pathogenic effects of negative self‐critical thoughts and feelings about the self and the value of distinguishing different types of self‐criticism.
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Both low self-esteem and self-criticism have been linked to NSSI; poor self-esteem, along with weak coping strategies, appears to mediate the relationship between personality pathology and self-injury.
“Both low self-esteem [122, 123] and self-criticism [124–127] have been linked to NSSI; poor self-esteem, in particular, appears (along with weak coping strategies) to mediate the relationship between personality pathology and self-injury [128].”
From A 'choice', an 'addiction', a way 'out of the lost': Exploring self-injury in autistic people without intellectual disability (2019) · cites this paper as [125]
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Swerdlow, B. A., Pearlstein, J. G., Sandel, D. B., Mauss, I. B., & Johnson, S. L. (2020) · Emotion · doi:10.1037/emo0000660 · Cited by 38 · see citing works
Ferrari, M., Beath, A., Einstein, D. A., Yap, K., & Hunt, C. J. (2022) · Current Psychology · doi:10.1007/s12144-022-03408-0 · Cited by 38 · see citing works
Shame and the psychosis continuum: A systematic review of the literature
Carden, L. J., Saini, P., Seddon, C., Watkins, M., & Taylor, P. J. (2018) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12204 · Cited by 38 · see citing works
The role of self-compassion and self-criticism in binge eating behaviour
Serpell, L., Amey, R., & Kamboj, S. K. (2019) · Appetite · doi:10.1016/j.appet.2019.104470 · Cited by 38 · see citing works
Góis, A., Ferreira, C., & Mendes, A. L. (2018) · Appetite · doi:10.1016/j.appet.2018.01.025 · Cited by 33 · see citing works
The role of shame and self-criticism in social anxiety: a daily diary study in a nonclinical sample
Lazarus, G., & Shahar, B. (2018) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2018.37.2.107 · Cited by 32 · see citing works
Self-Compassion, Self-Injury, and Pain
Gregory, W. E., Glazer, J. V., & Berenson, K. R. (2017) · Cognitive Therapy and Research · doi:10.1007/s10608-017-9846-9 · Cited by 36 · see citing works
“2010), and vulnerability to intense feelings of shame, disgust, and hatred directed at the self (Gilbert et al. 2010; Nock et al. 2009; Schoenleber et al. 2014; Xavier et al. 2016).”
BackgroundSassover, E., Abrahamovitch, Z., Amsel, Y., Halle, D., Mishan, Y., Efrati, Y., & Weinstein, A. M. (2021) · Current Psychology · doi:10.1007/s12144-021-02188-3 · Cited by 32 · see citing works
“Although feelings of shame and self-criticisms might imply overlapping attitudes toward the self, shame includes another component which is the experience and belief of the individual that others perceive him or her as inferior, inadequate, or flawed (Gilbert et al., 2010).”
BackgroundSelf-Acceptance Group Therapy: A Transdiagnostic, Cognitive-Behavioral Treatment for Shame
Schoenleber, M., & Gratz, K. L. (2018) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2017.05.002 · Cited by 31 · see citing works
Addiction to Self-harm? The Case of Online Postings on Self-harm Message Boards
Davis, S. M., & Lewis, C. A. (2018) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-018-9975-8 · Cited by 31 · see citing works
Comparing shame in clinical and nonclinical populations: Preliminary findings.
Dyer, K. F. W., Dorahy, M. J., Corry, M., Black, R., Matheson, L., Coles, H., Curran, D. B., Seager, L., & Middleton, W. (2016) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000158 · Cited by 30 · see citing works
“Several investigations examining shame, trauma and mental health have found that the more dominant means of managing shame is to turn this self-conscious emotion inwards or try to avoid its activation, rather than discharging the feeling onto others (Dyer et al., 2013; Gilbert et al., 2010).”
BackgroundShame, trauma, temperament and psychopathology: Construct validity of the Experience of Shame Scale.
Vizin, G., Urbán, R., & Unoka, Z. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.09.017 · Cited by 26 · see citing works
Fox, J., Cattani, K., & Burlingame, G. M. (2020) · Psychotherapy Research · doi:10.1080/10503307.2020.1783708 · Cited by 32 · see citing works
“The association between shame, self-criticism, and psychopathology has been well-established (e.g., Allan & Gilbert, 1997; Gilbert et al., 2010; Kelly & Carter, 2013; Lucre & Corten, 2013; PintoGouveia et al., 2014), particularly with depression (e.g., Kelly et al., 2009; Marshall et al., 2008).”
BackgroundExpressive writing, self‐criticism, and self‐reassurance
Troop, N. A., Chilcot, J., Hutchings, L., & Varnaite, G. (2012) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/j.2044-8341.2012.02065.x · Cited by 29 · see citing works
Savari, Y., Mohagheghi, H., & Petrocchi, N. (2021) · Mindfulness · doi:10.1007/s12671-020-01584-3 · Cited by 31 · see citing works
To see in a mirror dimly. The looking glass self is self-shaming in borderline personality disorder
Unoka, Z., & Vizin, G. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.08.055 · Cited by 28 · see citing works
Taylor, P. J., McDonald, J., Smith, M., Nicholson, H., & Forrester, R. L. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.12.033 · Cited by 28 · see citing works
Social stressors, emotional responses, and NSSI urges and behaviors in daily life
Haliczer, L. A., & Dixon–Gordon, K. L. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.06.043 · Cited by 27 · see citing works
“For instance, this model is supported by consistent correlations between both propensities for negative attitudes towards the self, especially self-criticism, and self-conscious negative emotions that are linked to self-criticism, such as shame and guilt (Castilho, Pinto-Gouveia, & Duarte, 2017; Gilbert et al., 2010;…”
BackgroundResultXavier, A., Pinto‐Gouveia, J., Cunha, M. I. V. A., & Carvalho, S. A. (2016) · The Journal of Psychology · doi:10.1080/00223980.2016.1235538 · Cited by 26 · see citing works
“Studies showed that this pervasive form of self-criticism is associated with depressive symptoms (Castilho, Pinto-Gouveia, & Duarte, 2013; Gilbert et al., 2004) and NSSI (Gilbert et al., 2010; Xavier, Pinto-Gouveia, & Cunha, 2016).”
BackgroundCarter, A., Hoang, A., Gilbert, P., & Kirby, J. N. (2021) · Journal of Health Psychology · doi:10.1177/13591053211027641 · Cited by 26 · see citing works
“However, the forms and functions of self-criticism can be either (a) about inadequacies that need improving, or (b) attacking self-hatred in order to remove or expel, with the latter being particularly toxic and linked to depression (Gilbert et al., 2010).”
BackgroundSelf-citationA systematic review of self‐report measures of generalized shame
Lear, M. K., Lee, E. B., Smith, S. M., & Luoma, J. B. (2022) · Journal of Clinical Psychology · doi:10.1002/jclp.23311 · Cited by 26 · see citing works
de Valle, M. K., & Wade, T. D. (2022) · International Journal of Eating Disorders · doi:10.1002/eat.23756 · Cited by 30 · see citing works
The Self-perpetuating Cycle of Shame and Self-injury
Gunnarsson, N. V. (2020) · Humanity & Society · doi:10.1177/0160597620904475 · Cited by 25 · see citing works
“…research, shame is typically studied as one of many other possible variables involved in self-injury, or indirectly, for example, through self-hatred, low self-esteem, self-punishment, and self-dissatisfaction (e.g., Gilbert et al., 2010; Ivanhoff, Linehan, and Brown 2001; Victor and Klonsky 2013).”
BackgroundLin, M., Ni, J., & Lin, M.-Y. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.915190 · Cited by 20 · see citing works
“Even after controlling variables such as self-criticism and self-esteem, selfcompassion is negatively correlated with anxiety and depression, indicating that people with low levels of self-compassion might bemore prone to self-criticism and self-aggression (Gilbert et al., 2010).”
BackgroundDyer, K. F. W., Dorahy, M. J., Shannon, M., & Corry, M. (2012) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2012.710184 · Cited by 23 · see citing works
“In Nathanson's (1992) compass of shame model, self-harm represents an “attack self” coping strategy whereby individuals cope with the aversive feeling of shame by engaging in self-harm to punish themselves as a result of self-loathing or as a means of directly regulating such a diffuse, unsettling emotion ( Gilbert et…”
BackgroundButter, S., Shevlin, M. E., & Murphy, J. (2018) · Psychological Medicine · doi:10.1017/s0033291718003562 · Cited by 22 · see citing works
Lindkvist, R., Westling, S., Liljedahl, S. I., & Landgren, K. (2020) · Issues in Mental Health Nursing · doi:10.1080/01612840.2020.1789787 · Cited by 22 · see citing works
Cognition and Non-Suicidal Self-Injury: Exploring Relationships with Psychological Functions
Sorgi, K. M., Cheung, J. C., Ciesinski, N. K., & McCloskey, M. S. (2022) · Archives of Suicide Research · doi:10.1080/13811118.2022.2106919 · Cited by 22 · see citing works
“Regarding the relationship between self-criticism and psychological functions, NSSI is linked to self-critical thoughts rooted in a desire to hurt or take revenge on oneself (Gilbert et al., 2010).”
Xavier, A., Pinto‐Gouveia, J., Cunha, M. I. V. A., & Dinis, A. (2017) · Child & Youth Care Forum · doi:10.1007/s10566-017-9406-1 · Cited by 22 · see citing works
Shame in Anxiety and Obsessive-Compulsive Disorders
Szentágotai-Tătar, A., Nechita, D., & Miu, A. C. (2020) · Current Psychiatry Reports · doi:10.1007/s11920-020-1142-9 · Cited by 21 · see citing works
Emotional changes following discrimination induction in gender- and sexuality-diverse adolescents.
Smith, D. M. Y., Fox, K. R., Carter, M. L., Thoma, B. C., & Hooley, J. M. (2020) · Emotion · doi:10.1037/emo0000862 · Cited by 21 · see citing works
“We focused on these constructs because there is substantial research linking self-criticism (e.g., Fox, et al., 2018; Gilbert et al., 2010; Glassman, Weierich, Hooley, Deliberto, & Nock, 2007; St Germain & Hooley, 2012) and self-reported emotion reactivity (Franklin et al.”
BackgroundDyslexia: Investigating Self-Harm and Suicidal Thoughts/Attempts as a Coping Strategy
Alexander‐Passe, N. (2015) · Journal of Psychology & Psychotherapy · doi:10.4172/2161-0487.1000224 · Cited by 21 · see citing works
“[43] describes self-harm as being often:”
Self-referential processing in individuals with nonsuicidal self-injury: An fMRI study
Nam, G., Moon, H., Lee, J.-H., & Hur, J. (2022) · NeuroImage Clinical · doi:10.1016/j.nicl.2022.103058 · Cited by 19 · see citing works
“For example, individuals who engage in NSSI exhibit a high level of self-criticism (Gilbert et al., 2010; Zelkowitz and Cole, 2019), negative feelings about the self (Forrester et al.”
BackgroundAssessment of Different Dimensions of Shame Proneness: Validation of the SHAME
Scheel, C. N., Eisenbarth, H., & Rentzsch, K. (2018) · Assessment · doi:10.1177/1073191118820130 · Cited by 19 · see citing works
“Shame is a highly aversive self-conscious emotion that is typically evoked after moral transgressions or the experience of incompetence and is accompanied by intense feelings of worthlessness, inferiority, and a damaged selfimage (de Hooge, 2013; de Hooge, Zeelenberg, & Breugelmans, 2011; Gilbert et al., 2010; M. Lewi…”
BackgroundWhen body dysmorphia symptomatology meets disordered eating: The role of shame and self-criticism
de Matos, M. B. C., Coimbra, M., & Ferreira, C. (2023) · Appetite · doi:10.1016/j.appet.2023.106552 · Cited by 17 · see citing works
Semenchuk, B. N., Boreskie, K. F., Hay, J. L., Miller, C., Duhamel, T. A., & Strachan, S. M. (2020) · Journal of Health Psychology · doi:10.1177/1359105320909860 · Cited by 17 · see citing works
“…(e.g. shame) associated with chronic conditions can lead to depression and stress (e.g. Pinto-Gouveia et al., 2014) and are known to interfere with self-regulation (Gilbert et al., 2010; Gross, 2002) including engagement in health-promoting behaviors (Sirois, 2015b; Sirois and Hirsch, 2019).”
BackgroundGao, Y., Liu, X., Liu, J., & Wang, H. (2023) · Psychology Research and Behavior Management · doi:10.2147/prbm.s417258 · Cited by 16 · see citing works
“Under adverse conditions, self-criticism can stimulate the threat system, eliciting feelings of anger and hatred with the self.(18) Individuals who are fearful of experiencing and expressing these negative self-directed emotions may be more likely to feel depressed and hurt themselves.”
BackgroundWorking With Clients Who Self‐Injure: A Grounded Theory Approach
Whisenhunt, J. L., Chang, C. Y., Flowers, L. R., Brack, G., O’Hara, C. L., & Raines, T. C. (2014) · Journal of Counseling & Development · doi:10.1002/j.1556-6676.2014.00165.x · Cited by 16 · see citing works
Inhibitors and facilitators of compassion‐focused imagery in personality disorder
Naismith, I., Mwale, A. L., & Feigenbaum, J. (2017) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2161 · Cited by 16 · see citing works
Neural and Self-Report Markers of Reassurance: A Generalized Additive Modelling Approach
Kim, J. J., Henderson, T., Best, T., Cunnington, R., & Kirby, J. N. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.566141 · Cited by 16 · see citing works
“What this self-report scale measures is the degree to which an individual feels inadequate and inferior, and therefore their self-criticism is used to correct and improve the self, in order to try harder, to achieve goals and to maintain certain standards (32, 33).”
BackgroundStrachan, S. M., Bean, C. N., & Jung, M. E. (2018) · Health & Social Care in the Community · doi:10.1111/hsc.12628 · Cited by 15 · see citing works
Persönlichkeitsfunktionsniveau, maladaptive Traits und Kindheitstraumata
Back, S. N., Zettl, M., Bertsch, K., & Taubner, S. (2020) · Psychotherapeut · doi:10.1007/s00278-020-00445-7 · Cited by 15 · see citing works
“Traumatische Kindheitserlebnisse stellen einen erheblichen Risikofaktor für psychische Störungen, chronische Erkrankungen, Suizidalität sowie eine insgesamt verkürzte Lebenserwartung dar (Brown et al. 2009; Felitti 1998; Gilbert et al. 2010; Metzler et al. 2017).”
BackgroundKhanipour, H., Shooshtari, M. H., & Bidaki, R. (2016) · international journal high risk behaviors & addiction · doi:10.5812/ijhrba.23675 · Cited by 15 · see citing works
“According to the evolutionary model of self-criticism (18), self-criticism triggers threat and defensive emotions and behaviors, which lead to negative emotions that are difficult to regulate; thus, different kinds of psychopathology, like suicide behaviors, occur.”
BackgroundFarahani, H., Azadfallah, P., Watson, P., Qaderi, K., Pasha, A., Dirmina, F., Esrafilian, F., Koulaie, B., Fayazi, N., Sepehrnia, N., et al. (2022) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-022-00501-1 · Cited by 16 · see citing works
Liu, H., Liu, Q., Li, Z., Deng, C., Zhang, X., & Wan, L. (2024) · Journal of Clinical Nursing · doi:10.1111/jocn.16909 · Cited by 14 · see citing works
Silva, C., Ferreira, C., Mendes, A. L., & Marta-Simões, J. (2019) · Women & Health · doi:10.1080/03630242.2018.1487906 · Cited by 13 · see citing works
“Also, recent studies suggested that the fear of receiving compassion from others is associated to alexithymia, depression, anxiety, self-criticism and low self-reassurance (Gilbert et al. 2011a, 2010).”
BackgroundNavarrete, J., Herrero, R., Soler, J., Domínguez-Clavé, E., Baños, R., & Cebolla, A. (2021) · PLOS ONE · doi:10.1371/journal.pone.0252089 · Cited by 13 · see citing works
“It underlies the development and maintenance of depressive [7–11], anxiety [12,13], and psychotic symptoms [14], eating disorders [15–18], non-suicidal self-injury [19], and suicidality [20,21].”
BackgroundResultRamsey, W. A., Berlin, K. S., Conte, G. S. D., Lightsey, O. R., Schimmel‐Bristow, A., Marks, L. R., & Strohmer, D. C. (2021) · Child and Adolescent Mental Health · doi:10.1111/camh.12452 · Cited by 13 · see citing works
Dizon, J. I. W. T., & Mendoza, N. B. (2022) · Archives of Suicide Research · doi:10.1080/13811118.2021.2022050 · Cited by 13 · see citing works
“…2014) and depression (Appel, Crusius, & Gerlach, 2015; Furnham & Brewin, 1988; Radovic, Gmelin, Stein, & Miller, 2017; see Wetherall et al., 2019, for a review) but also to possible selfharm (Gilbert, Mcewan, Bellew, Mills, & Gale, 2009, Gilbert et al., 2010; Williams, Gilbert, & McEwan, 2009).”
Amoss, S., Lynch, M., & Bratley, M. (2016) · Journal of Family Therapy · doi:10.1111/1467-6427.12101 · Cited by 13 · see citing works
Development and Psychometric Properties of the Test of Passive Aggression
Schanz, C. G., Equit, M., Schäfer, S. K., Käfer, M., Mattheus, H. K., & Michael, T. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.579183 · Cited by 13 · see citing works
Giménez‐Llort, L., Martín-González, J. J., & Maurel, S. (2021) · Brain Sciences · doi:10.3390/brainsci11091233 · Cited by 13 · see citing works
“[57], with reference to self-compassion, he discovered that different subsystems of the nervous system are activated when we are compassionate and when we feel threatened.”
BackgroundSchanche, E., Vøllestad, J., Visted, E., Svendsen, J. L., Binder, P., Osnes, B., Franer, P., & Sørensen, L. (2021) · Counselling and Psychotherapy Research · doi:10.1002/capr.12381 · Cited by 12 · see citing works
The Toxicity of Shame Applications for Acceptance and Commitment Therapy
Gutiérrez, D., & Hagedorn, W. B. (2013) · Journal of Mental Health Counseling · doi:10.17744/mehc.35.1.5n16p4x782601253 · Cited by 12 · see citing works
- Authors
- Gilbert, P., McEwan, K., Irons, C., Bhundia, R., Christie, R., Broomhead, C., & Rockliff, H.
- Corresponding author
- Gilbert, Paul.
- Venue
- British Journal of Clinical Psychology
- Publisher
- Wiley
- Published
- 2010-11
- Volume
- 49
- Issue
- 4
- Pages
- 563-576
- ISSN
- 0144-6657 (ISSN-L)
- 2044-8260
- OpenAlex
- W2030095275
- Cited by
- 214
- References
- 51
- Citations by year
- 2026: 13 · 2025: 14 · 2024: 7 · 2023: 23 · 2022: 15 · 2021: 18 · 2020: 18 · 2019: 15 · 2018: 20 · 2017: 15 · 2016: 17 · 2015: 12 · 2014: 8 · 2013: 8 · 2012: 10
- FWCI
- 7.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- British Journal of Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- University of Derby Online Research Archive. (University of Derby) (submittedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- Funders
- National Institute for Health and Care Research
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Emotions and Moral Behavior
- Keywords
- self-harm, self-criticism, shame, social rank, social comparison, depression, anxiety, inferiority feelings
- MeSH terms
- Adult, Aged, Alcoholism, Anxiety Disorders, Bipolar Disorder, Cross-Sectional Studies, Depressive Disorder, Dominance-Subordination, Female, Humans, Male, Middle Aged, Personality Disorders, Personality Inventory, Phobic Disorders, Psychometrics, Self Concept, Shame, Comorbidity, Self-Injurious Behavior, Substance-Related Disorders, Young Adult
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