Shame, Social Anxiety, and Psychosis


Researchers in England examined shame and social anxiety in a cross-sectional sample of people with and without psychosis. They found that social anxiety disorder (SAD) is “surprisingly prevalent among people with psychosis.” The authors suggest that shame cognitions “arising from a stigmatizing illness play a significant role in social anxiety in psychosis.” The article appeared in the FirstView section of Psychological Medicine on May 21, 2012.

Abstract → 

Note from Kermit Cole, “In the News” editor:
Of course this study can make no inferences about etiology or causation, being a cross-sectional study, and the question of whether the shame and/or social anxiety pre-existed social anxiety and/or psychosis is open for discussion.


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected]


  1. I think they are overlooking the role of shame in causing a, “Breakdown,” in the first place. Yes, there is stigma that makes things worse, and yes, involuntary treatment and patronising staff who don’t want to know how someone really sees the world or how they came to have the breakdown in the first place can make things a whole lot worse, but I read that shame is a prime driver of extreme states and it seems to be true in many cases.

    This kind of breakdown often comes on in early adult hood, when the person is making a transition form teenager to independent adult. they needed more support than they were getting, often due to earlier traumas that have now resulted in them not having the confidence to deal with adult life. The person then feels ashamed for not being able to deal with things, their mental state spirals down and a breakdown results (hearing voices etc). This can all be compounded by the early trauma being perceived as a shameful event.

    So I think the paper is only partly right.

    • Agree 100%, ooo. Society should feel shame for how it treats people who have experienced adverse life conditions and experiences and were not blessed with strong support systems. Its general treatment of such people and situations is inexcusable.