Elsevier

Journal of Affective Disorders

Volume 186, 1 November 2015, Pages 337-341
Journal of Affective Disorders

The role of self-blame and worthlessness in the psychopathology of major depressive disorder

https://doi.org/10.1016/j.jad.2015.08.001Get rights and content
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open access

Highlights

  • Feelings of inadequacy were part of the core major depressive syndrome

  • Self-blaming emotions occurred in most patients

  • Self-disgust/contempt was slightly more frequent than guilt

  • Only a minority of patients was most distressed by negative emotions towards others

  • This demonstrates a central role of self-blaming emotions in major depression

Abstract

Background

Cognitive models predict that vulnerability to major depressive disorder (MDD) is due to a bias to blame oneself for failure in a global way resulting in excessive self-blaming emotions, decreased self-worth, hopelessness and depressed mood. Clinical studies comparing the consistency and coherence of these symptoms in order to probe the predictions of the model are lacking.

Methods

132 patients with remitted MDD and no relevant lifetime co-morbid axis-I disorders were assessed using a phenomenological psychopathology-based interview (AMDP) including novel items to assess moral emotions (n=94 patients) and the structured clinical interview-I for DSM-IV-TR. Cluster analysis was employed to identify symptom coherence for the most severe episode.

Results

Feelings of inadequacy, depressed mood, and hopelessness emerged as the most closely co-occurring and consistent symptoms (≥90% of patients). Self-blaming emotions occurred in most patients (>80%) with self-disgust/contempt being more frequent than guilt, followed by shame. Anger or disgust towards others was experienced by only 26% of patients. 85% of patients reported feelings of inadequacy and self-blaming emotions as the most bothering symptoms compared with 10% being more distressed by negative emotions towards others.

Limitations

Symptom assessment was retrospective, but this is unlikely to have biased patients towards particular emotions relative to others.

Conclusions

As predicted, feelings of inadequacy and hopelessness were part of the core depressive syndrome, closely co-occurring with depressed mood. Self-blaming emotions were highly frequent and bothering but not restricted to guilt. This calls for a refined assessment of self-blaming emotions to improve the diagnosis and stratification of MDD.

Keywords

Moral emotions
Attributional style
Major depression
Self-blame
Symptoms
Nosology

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