Brief reportIs self-criticism unique for depression? A comparison 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)
Social anxiety, hypomania and the bipolar spectrum: data, theory and clinical issues
J. Affect. Disord.
(1998)- et al.
Relationship of dependency and achievement/autonomy to depression
Clin. Psychol. Rev.
(1990) The bipolar spectrum: New concepts in classification and diagnosis
- et al.
Diagnostic specificity of the dependent and self-critical personality dimensions in major depression
J. Affect. Disord.
(1992) - et al.
An inventory for measuring depression
Arch. Gen. Psychiatry
(1961) Levels of object representation in anaclitic and introjective depression
Psychoanal. Study Child
(1974)A cognitive morphology of psychopathology
J. Nerv. Ment. Dis.
(1991)- et al.
Cited by (78)
Breaking the anxious cycle of self-criticism: Action orientation buffers the detrimental effects of a self-critical personality style
2022, Journal of Affective DisordersRole of self-criticism in reward and punishment probabilistic learning
2018, Personality and Individual DifferencesThe role of self-criticism in common mental health difficulties in students: A systematic review of prospective studies
2018, Mental Health and PreventionThe metacognitions about self-critical rumination questionnaire
2017, Journal of Affective DisordersCitation Excerpt :The results of this study provide further evidence that self-critical rumination accounts for the relationship between self-criticism and distress and also adds that metacognitions measured by the MSCRQ and MCQ-30 may further account for the relationship between self-critical rumination and distress (James et al., 2015; Smart et al., 2015; Spada et al., 2008; Spasojević and Alloy, 2001). Self-criticism as a construct is transdiagnostic and not solely linked to mood disorders (Blatt, 1995; Cox et al., 2000, 2004a, 2004b; Littleton and Henderson, 2009; Rudich et al., 2008) and the associated ruminative process should reflect that. Research into self-critical rumination is still in its infancy, though, and further research will be required to distinguish it from other styles of rumination.
Changes in the self during cognitive behavioural therapy for social anxiety disorder: A systematic review
2017, Clinical Psychology ReviewCitation Excerpt :It is therefore likely that individuals with these disorders share common cognitive features. Consistent with this proposition, several studies have now documented that individuals with social anxiety and depression share similar negative self-schematic structures for interpersonal context (Dozois & Frewen, 2006) and corresponding levels of self-criticism and attributional styles (Cox et al., 2000). Like those with social anxiety, individuals with depression are also often characterised as having low self-esteem, low self-confidence (APA, 2013), and cognitive biases like self-focused attention (Aldao, Nolen-Hoeksema, & Schweizer, 2010).
Development and validation of the Core Beliefs Questionnaire in a sample of individuals with social anxiety disorder
2017, Journal of Affective DisordersCitation Excerpt :Interestingly, these results in relation to the three versions of the CBQ have implications at the disorder level. SAD and depression commonly co-occur (e.g., Ohayon and Schatzberg, 2010) and studies have shown that individuals with SAD and individuals with depression display similar cognitive features (e.g., corresponding levels of self-criticism and attributional styles, similar negative self-schematic structures for interpersonal content; Cox et al., 2000; Dozois and Frewen, 2006). Extending this research, our finding that each version of the CBQ was associated with both social anxiety levels and depression levels raises the possibility that enduring maladaptive beliefs about the self may be a transdiagnostic vulnerability factor linking SAD and depression.