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


CONCLUSIONS
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.
Institute of Psychiatry, Psychology & Neuroscience, King's College London, Department of Psychological Medicine, Centre for Affective Disorders, London SE5 8AZ, UK. Electronic address: roland.zahn@kcl.ac.uk.
Roland
R
Zahn
The University of Manchester & Manchester Academic Health Sciences Centre, School of Psychological Sciences, Neuroscience and Aphasia Research Unit, Manchester M13 9PL, UK.
Karen E
KE
Lythe
The University of Manchester & Manchester Academic Health Sciences Centre, School of Psychological Sciences, Neuroscience and Aphasia Research Unit, Manchester M13 9PL, UK.
Jennifer A
JA
Gethin
The University of Manchester & Manchester Academic Health Sciences Centre, School of Psychological Sciences, Neuroscience and Aphasia Research Unit, Manchester M13 9PL, UK.
Sophie
S
Green
The University of Manchester & Manchester Academic Health Sciences Centre, Institute of Brain, Behaviour and Mental Health, Neuroscience & Psychiatry Unit, Manchester M13 9PL, UK.
John F William
JF
Deakin
Institute of Psychiatry, Psychology & Neuroscience, King's College London, Department of Psychological Medicine, Centre for Affective Disorders, London SE5 8AZ, UK.
Allan H
AH
Young
Cognitive and Behavioral Neuroscience Unit, D'Or Institute for Research and Education (IDOR), 22280-080 Rio de Janeiro, RJ, Brazil.
Jorge
J
Moll
D000328:Adult; D016000:Cluster Analysis; D003865:Major Depressive Disorder / Q000523:psychology*; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011599:Psychopathology; D012189:Retrospective Studies; D012647:Self-Assessment
Attributional style; Major depression; Moral emotions; Nosology; Self-blame; Symptoms