Childhood Maltreatment, Shame-Proneness and Self-Criticism in Social Anxiety Disorder: A Sequential Mediational Model

Previous research has shown a robust link between emotional abuse and neglect with social anxiety symptoms. However, the mechanisms through which these links operate are less clear. We hypothesized a model in which early experiences of abuse and neglect create aversive shame states, internalized into a stable shame-based cognitive-affective schema. Self-criticism is conceptualized as a safety strategy designed to conceal flaws and prevent further experiences of shame. However, self-criticism maintains negative self-perceptions and insecurity in social situations. To provide preliminary, cross-sectional support for this model, a nonclinical community sample of 219 adults from Israel (110 females, mean age = 38.7) completed measures of childhood trauma, shame-proneness, self-criticism and social anxiety symptoms. A sequential mediational model showed that emotional abuse, but not emotional neglect, predicted shame-proneness, which in turn predicted self-criticism, which in turn predicted social anxiety symptoms. These results provide initial evidence supporting the role of shame and self-criticism in the development and maintenance of social anxiety disorder. The clinical implications of these findings are discussed.

Key practitioner message: Previous research has shown that histories of emotional abuse and emotional neglect predict social anxiety symptoms, but the mechanisms that underlie these associations are not clear. Using psycho-evolutionary and emotion-focused perspectives, the findings of the current study suggest that shame and self-criticism play an important role in social anxiety and may mediate the link between emotional abuse and symptoms. These findings also suggest that therapeutic interventions specifically targeting shame and self-criticism should be incorporated into treatments for social anxiety, especially with socially anxious patients with abuse histories.