“I am ashamed that I exist. I feel like apologizing for existing”: The phenomenology of shame in patients with borderline personality disorder: A qualitative study.

Abstract

Shame is an essential affect in many patients with borderline personality disorder (BPD) and can be associated with most of the BPD diagnostic criteria. Severe shame is a highly aversive emotion with concomitant beliefs about the self as deeply inferior, insignificant, disgusting, and unloved. Shame and how it is manifested in the subjective experience and behavior in people diagnosed with BPD is remarkably underresearched, and our knowledge of the phenomenology of shame in BPD needs to be improved. Severe shame is often less accessible and available to conscious awareness, making it difficult to access via questionnaires and self-report measures. Therefore, this study is based on semi-structured interviews with 21 women Structural clinical interview for DSM-5 disorders' diagnosed with BPD. All interviews were analyzed using the interpretive phenomenological approach. Based on the analysis, the participants' descriptions of how severe shame manifests itself in their subjective experience and behavior are classified into 10 themes: the self is deeply flawed and unlovable; self-hatred/self-contempt; eye contact is awkward and shameful; shameful over being mentally ill; shameful identity diffusion; hiding behind façade/social roles; pleasing others/performing to avoid shame; self-destructive behavior to mitigate shame; sex associated with shame; and shame during the therapy session.

Investigation of the relationship between borderline personality organization and perceived abuse experiences in romantic relationships: moderating role of rejection sensitivity

“…People with borderline personality organization have fears about being rejected, and they are susceptible to engaging in self-silencing kind of behaviors and attitudes. [7][8][9][10][11] On the other hand, low tolerance to rejection may also lead to IPV victimization. Borderline individualss who encounter stressors exhibit impulsivity in order to get rid of the tension, and impulsivity can lead to possible victimization experiences.…”

“…29 The feeling of worthlessness is one of the central emotions in borderline personality disorder. 7,8,11 Therefore, each encounter with the other triggers the sensitivity of rejection, and, subsequently, the feeling of worthlessness, and the resulting stress leads the individual to impulsivity. 29,30 Individuals diagnosed with borderline personality disorder are more prone to show signs of increased sexual obsession, to participate in sexual activity earlier in life, to be in casual relationships, to be promiscuous, and to have more than one sexual partner, as well as to have homosexual experiences.…”

“…5,6 Since borderline individuals believe that even their existence in the world is disturbing, they turn to more submissive attitudes in order to neutralize this discomfort and prevent rejection. 7,8 They have difficulty turning down the offer of sex. 9 Besides, their intolerance of separation makes individuals with BPO more susceptible to being in abusive relationships.…”

Unified Protocol Versus Self‐Acceptance Group Therapy for Emotional Disorders in People With Severe Shame

“…• Excessive shame can be effectively treated by a transdiagnostic psychotherapy (Unified Protocol) that targets patients' negative emotions Rüsch et al 2007;Théberge and Gamache 2022). Jørgensen and Bøye (2024) examined the phenomenology of shame in 21 women diagnosed with BPD who were asked to describe the ways in which shame manifests in their subjective experience, behaviour and daily life. Their findings supported the notion of severe shame as a highly significant aspect of BPD.…”

“…Although it is not explicitly listed as a criterion for BPD in DSM, shame is arguably associated with most, if not all, the diagnostic criteria for BPD (Jørgensen and Bøye 2024). In patients with BPD, shame is associated with poor self-esteem, poor quality of life and aggression (Buchman-Wildbaum et al 2021;…”