Elsevier

Journal of Affective Disorders

Volume 57, Issues 1–3, January–March 2000, Pages 223-228
Journal of Affective Disorders

Brief report
Is self-criticism unique for depression? A comparison with social phobia

https://doi.org/10.1016/S0165-0327(99)00043-9Get rights and content

Abstract

Background: This study further examined the diagnostic specificity of the self-critical personality dimension, as measured by the Depressive Experiences Questionnaire (DEQ; Blatt et al., 1976. The Depressive Experiences Questionnaire. Yale University Press, New Haven). Methods: Patients with major depression (n=26) were compared to social phobia patients (n=32). Results: Depressed patients scored significantly higher on the DEQ Self-Criticism dimension. However, when current level of depressed mood was controlled for, self-criticism was not a significant predictor of diagnostic status. Further, the level of DEQ self-criticism reported by patients with social phobia was almost three times greater than the level reported in an earlier diagnostic specificity study with panic disorder patients [Bagby et al., 1992. Diagnostic specificity of the dependent and self-critical personality dimensions in major depression. J. Affect. Disord. 26, 59–64]. Limitations: Only one measure of self-criticism was used in this study, and the research design was cross-sectional rather than prospective. Conclusions: Self-criticism is not unique to major depression, and this personality dimension may be implicated in other forms of psychopathology [Blatt, 1991. A cognitive morphology of psychopathology. J. Nerv. Ment. Dis. 179, 449–458]. Some cognitive features believed to play an important role in depression may also be salient in persons with social phobia.

Introduction

Blatt (1974) proposed two personality structures which could strongly influence vulnerability to depression. Anaclitic depression or dependency was characterized by feelings of helplessness and fears of abandonment, and was primarily concerned with interpersonal relationships. Introjective depression or self-criticism was characterized by feelings of worthlessness and guilt, and was related in large part to “the sense that one has failed to live up to expectations and will be disapproved of and criticized” (p. 117). Although on the surface it would appear that dependency would be more linked to interpersonal concerns, a fact that is sometimes overlooked is that self-criticism was also believed to arise from poor interpersonal experiences. Blatt (1991) stated that “an increasingly differentiated, integrated, and mature sense of self is contingent upon establishing satisfying interpersonal experiences, and, conversely, the continued development of increasingly mature and satisfying interpersonal relationships is contingent upon the development of a more mature self-definition and identity” (p. 453). Dependent and self-critical personality dimensions are assessed by the Depressive Experiences Questionnaire (DEQ; Blatt et al., 1976).

Blatt’s theoretical model and the DEQ have generated an impressive amount of research activity over the past several years. Blatt (1991) stressed the importance of not focussing solely on symptom-based, descriptive approaches to psychopathology. However, the dependent, and especially the self-critical personality dimensions, have been strongly linked to depression in his writings. Along with the higher-order personality trait of neuroticism, dependency and self-criticism have received extensive empirical support as specific personality dimensions involved in depression (for a review see Nietzel and Harris, 1990; Enns and Cox, 1997). One line of investigation has involved the diagnostic specificity of the dependent and self-critical personality dimensions with regard to various forms of psychopathology. Bagby et al. (1992) compared a sample of outpatients with unipolar major depression to a sample of outpatients with panic disorder with agoraphobia on the DEQ. As hypothesized, the self-criticism dimension, but not the dependency dimension, significantly differentiated the two diagnostic groups when the effects of depressed mood were statistically controlled. The authors concluded that the results supported the uniqueness of self-criticism in relation to depression. However, because of Blatt’s (1991) emphasis on interpersonal experiences and their interactions with self-definition, there is reason to believe that self-criticism may play a significant role in social phobia as well.

Social phobia is defined in the DSM-IV (APA, 1994) as a fear of social or performance situations in which embarrassment may occur. Common associated features include a hypersensitivity to negative evaluation and “low self-esteem or feelings of inferiority” (APA, 1994, p. 413). Recent theoretical accounts of social phobia are also consistent with the idea that self-criticism may be an important element. For example, the self-presentation model of social anxiety states that some socially anxious individuals “have generally low self-esteem, assuming that others share their less than flattering self-views” (Leary and Kowalski, 1995, p. 107). Similarly, in their cognitive model of social phobia, Clark and Wells (1995) stated that “like depressed patients, many social phobics have negative beliefs about their worth and value” (p. 76). Unlike the belief system in depression, Clark and Wells (1995) hypothesized that the negative self-image in social phobia was not a global one, and it was restricted to social situations. This hypothesis requires empirical study.

In general, there is a paucity of research that has directly compared cognitive traits and processes in depressed versus socially anxious individuals. However, available evidence suggests that some features are shared in both groups, such as a maladaptive attributional style (Heimberg et al., 1989). We sought to extend this research, and to further examine the diagnostic specificity of self-criticism, by comparing patients with major depression to those with social phobia. Blatt (1991) implicated self-criticism in depression and several other conditions such as obsessive–compulsive disorder, but did not identify social phobia. Therefore, the hypothesis most consistent with Blatt’s model is that self-criticism would be significantly higher in depressed patients compared to social phobia patients. It was also hypothesized that individuals with social phobia would have higher levels of self-criticism compared to our previous sample of panic disorder patients (Bagby et al., 1992).

Section snippets

Subjects

The two patient samples were derived from consecutive referrals to either the Mood Disorders Clinic or the Anxiety Disorders Clinic at the Clarke Institute of Psychiatry in Toronto. The depressive disorder patient sample consisted of 26 patients (seven men, 19 women) from the Mood Disorders Clinic diagnosed as suffering from unipolar, non-psychotic major depression according to DSM-III-R (APA, 1987) criteria (and all patients would have satisfied DSM-IV criteria as well). Diagnoses were made on

Sample characteristics

The means and standard deviations for the BDI and DEQ Dependency and Self-Criticism scales for the depressed and social phobic patients are displayed in Table 1.

BDI scores were significantly higher in the depressed patient group than in the social phobic group. While no significant between-group differences were found on the DEQ Dependency scale between these patient groups, the depressed patients had higher scores on the DEQ Self-Criticism scale than did the social phobia patients.

Regression Analyses

A logistic,

Discussion

The results of this study provide only limited support for the diagnostic specificity of the self-criticism personality trait in major depression. Although depressed patients scored significantly higher on this personality dimension compared to social phobia patients, this variable was not a significant predictor of diagnostic status when current level of depressed mood was controlled. Further, social phobia patients obtained scores to the DEQ self-criticism dimension that were almost three

References (21)

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