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Shame-proneness in attempted suicide patients

Maria Wiklander123*, Mats Samuelsson3, Jussi Jokinen1, Åsa Nilsonne1, Alexander Wilczek1, Gunnar Rylander1 and Marie Åsberg2

Author Affiliations

1 Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

2 Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden

3 Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden

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BMC Psychiatry 2012, 12:50  doi:10.1186/1471-244X-12-50

Published: 25 May 2012



It has been suggested that shame may be an important feature in suicidal behaviors. The disposition to react with shame, “shame-proneness”, has previously not been investigated in groups of attempted suicide patients. We examined shame-proneness in two groups of attempted suicide patients, one group of non-suicidal patients and one group of healthy controls. We hypothesized that the attempted suicide patients would be more shame-prone than non-suicidal patients and healthy controls.


The Test of Self-Conscious Affect (TOSCA), which is the most used measure of shame-proneness, was completed by attempted suicide patients (n = 175: 105 women and 3 men with borderline personality disorder [BPD], 45 women and 22 men without BPD), non-suicidal psychiatric patients (n = 162), and healthy controls (n = 161). The participants were convenience samples, with patients from three clinical research projects and healthy controls from a fourth research project. The relationship between shame-proneness and attempted suicide was studied with group comparisons and multiple regressions. Men and women were analyzed separately.


Women were generally more shame-prone than men of the same participant group. Female suicide attempters with BPD were significantly more shame-prone than both female suicide attempters without BPD and female non-suicidal patients and controls. Male suicide attempters without BPD were significantly less shame-prone than non-suicidal male patients. In multiple regressions, shame-proneness was predicted by level of depression and BPD (but not by attempted suicide) in female patients, and level of depression and non-suicidality in male patients.


Contrary to our hypothesis and related previous research, there was no general relationship between shame-proneness and attempted suicide. Shame-proneness was differentially related to attempted suicide in different groups of suicide attempters, with significantly high shame-proneness among female suicide attempters with BPD and a negative relationship between shame-proneness and attempted suicide among male patients. More research on state and trait shame in different groups of suicidal individuals seems clinically relevant.

Attempted suicide; Shame; Borderline personality disorder; Affective disorders