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The Role of Self-Criticism and Shame in Body-Focused Repetitive Behaviour Symptoms

Published online by Cambridge University Press:  24 November 2020

S. Houazene ,
F. Aardema ,
J. B. Leclerc  and
K. O'Connor
S. Houazene*
Affiliation:
Research Center, University Institute of Mental Health at Montreal, Montreal, Quebec, Canada Department of Psychology, University of Montreal, Montreal, Quebec, Canada
F. Aardema
Affiliation:
Research Center, University Institute of Mental Health at Montreal, Montreal, Quebec, Canada Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada
J. B. Leclerc
Affiliation:
Research Center, University Institute of Mental Health at Montreal, Montreal, Quebec, Canada Department of Psychology, University of Quebec at Montreal (UQAM), Montreal, Quebec, Canada
K. O'Connor
Affiliation:
Research Center, University Institute of Mental Health at Montreal, Montreal, Quebec, Canada Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada Department of Psychology, University of Quebec at Montreal (UQAM), Montreal, Quebec, Canada
*
*Corresponding author: Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montreal, QC, Canada, H1N 3V2. Email: [email protected].
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Abstract

Body-focused repetitive behaviours (BFRBs), such as hair-pulling, skin-picking, and nail-biting, are non-functional habits associated with difficulties in emotion regulation. Although several models have been developed to explain the difficulties experienced by people suffering from BFRBs, a number of cognitive and emotional processes have yet to be explored. This study sought to investigate the psychological characteristics involved in the development and maintenance of BFRB symptoms. In particular, we aimed to evaluate the relationship of self-criticism, shame, and maladaptive cognitive emotion strategies with symptoms and examine if the relationship between perfectionism and symptoms was mediated by self-criticism and shame. Seventy-six participants from a community sample completed a number of self-report measures. Findings from our multivariate linear regression model supported that shame and maladaptive cognitive emotion regulation strategies significantly predicted BFRB symptoms. Results of our mediational analyses revealed that shame significantly mediated the relationship between perfectionism and BFRB symptoms. Interventions that target shame may be beneficial for treating these conditions. Future studies should replicate these findings with clinical populations and other BFRB subtypes.

Keywords

body-focused repetitive behaviourseating disordersshameself-criticismcognitive emotion regulationperfectionism
Type
Standard Paper
Information
Behaviour Change , Volume 38 , Issue 1 , April 2021 , pp. 10 - 24
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

Abramowitz, JS, Fabricant, LE, Taylor, S, Deacon, BJ, McKay, D and Storch, EA (2014). The relevance of analogue studies for understanding obsessions and compulsions. Clinical Psychology Review, 34, 206–217. doi:10.1016/j.cpr.2014.01.004.CrossRefGoogle ScholarPubMed
Aldao, A, Nolen-Hoeksema, S and Schweizer, S (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30, 217–237. doi:10.1016/j.cpr.2009.11.004.CrossRefGoogle ScholarPubMed
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.Google Scholar
Andrews, B and Hunter, E (1997). Shame, early abuse and course of depression in a clinical sample: A preliminary study. Cognition and Emotion, 11, 373–381. doi:10.1080/026999397379845.CrossRefGoogle Scholar
Bienvenu, OJ, Wang, Y, Shugart, YY, Welch, JM, Grados, MA, Fyer, AJ, … Nestadt, G (2009). Sapap3 and pathological grooming in humans: Results from the OCD collaborative genetics study. American Journal of Medical Genetics Part B, 150B, 710–720. doi:10.1002/ajmg.b.30897.CrossRefGoogle ScholarPubMed
Blatt, SJ (1974). Levels of object representation in anaclitic and introjective depression. The Psychoanalytic Study of the Child, 29, 7–157.10.1080/00797308.1974.11822616CrossRefGoogle ScholarPubMed
Blatt, SJ (1995). The destructiveness of perfectionism: Implications for the treatment of depression. American Psychologist, 50, 1003–1020. doi:10.1037/0003-066X.50.12.1003.CrossRefGoogle ScholarPubMed
Blatt, SJ, D'Afflitti, JP and Quinlan, DM (1976). Experiences of depression in normal young adults. Journal of Abnormal Psychology, 85, 383–389. doi:10.1037/0021-843X.85.4.383.CrossRefGoogle ScholarPubMed
Blatt, SJ, Quinlan, DM, Chevron, ES, McDonald, C and Zuroff, D (1982). Dependency and self-criticism: Psychological dimensions of depression. Journal of Consulting and Clinical Psychology, 50, 113–124. doi:10.1037/0022-006X.50.1.113.CrossRefGoogle ScholarPubMed
Bohne, A, Keuthen, N and Wilhelm, S (2005). Pathologic hairpulling, skin picking, and nail biting. Annals of Clinical Psychiatry, 17, 227–232. doi:10.1080/10401230500295354.CrossRefGoogle ScholarPubMed
Boucher, S, Fortin, A and Cyr, M (2006). Vulnérabilité à la dépression chez les femmes victimes de violence conjugale: Contribution de la dépendance et l'autocritique [Vulnerability to depression among female victims of domestic violence: Contribution of dependency and self-criticism]. Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement, 38, 337–347. doi:10.1037/cjbs2006019.CrossRefGoogle Scholar
Bouvard, M, Robbe Grillet, P, Pham, S, Milliery, M, Amireche, S, Fanget, F, … Cottraux, J (2000). Étude de validation d'une échelle multidimensionnelle de perfectionnisme. Revue Francophone de Clinique Comportementale et Cognitive, 2, 12–22.Google Scholar
Chang, EC (2008). Self-criticism and self-enhancement: Theory, research and clinical implications. Washington, DC: American Psychological Association. doi:10.1037/11624–000.CrossRefGoogle Scholar
Christenson, GA, Pyle, RL and Mitchell, JE (1991). Estimated lifetime prevalence of trichotillomania in college students. Journal of Clinical Psychiatry, 52, 415–417.Google ScholarPubMed
Curtin, R, Presser, S and Singer, E (2000). The effects of response rate changes on the index of consumer sentiment. Public Opinion Quarterly, 64, 413–428. doi:10.1086/318638.CrossRefGoogle ScholarPubMed
Dan-Glauser, ES and Scherer, KR (2013). The Difficulties in Emotion Regulation Scale (DERS): Factor structure and consistency of a French translation. Swiss Journal of Psychology, 72, 5–11. doi:10.1024/1421-0185/a000093.CrossRefGoogle Scholar
Diefenbach, GJ, Tolin, DF, Meunier, S and Worhunsky, P (2008). Emotion regulation and trichotillomania: A comparison of clinical and nonclinical hair pulling. Journal of Behavior Therapy and Experimental Psychiatry, 39, 32–41. doi:10.1016/j.jbtep.2006.09.002.CrossRefGoogle ScholarPubMed
Duke, DC, Bodzin, DK, Tavares, P, Geffken, GR and Storch, EA (2009). The phenomenology of hairpulling in a community sample. Journal of Anxiety Disorders, 23, 118–25. doi:10.1016/j.janxdis.2009.07.015.CrossRefGoogle Scholar
Duke, DC, Keeley, ML, Ricketts, EJ, Geffken, GR and Storch, EA (2010). The phenomenology of hairpulling in college students. Journal of Psychopathology and Behavioral Assessment, 32, 281–292.10.1007/s10862-009-9150-4CrossRefGoogle Scholar
Dunkley, DM, Blankstein, KR, Halsall, J, Williams, M and Winkworth, G (2000). The relation between perfectionism and distress: Hassles, coping, and perceived social support as mediators and moderators. Journal of Counseling Psychology, 47, 437–453. doi:10.1037/0022-0167.47.4.437.CrossRefGoogle Scholar
Dunkley, DM, Blankstein, KR, Masheb, RM and Grilo, CM (2006). Personal standards and evaluative concerns dimensions of “clinical” perfectionism: A reply to Shafran et al. (2002, 2003) and Hewitt et al. (2003). Behaviour Research and Therapy, 44, 63–84. doi:10.1016/j.brat.2004.12.004.CrossRefGoogle Scholar
Dunkley, DM, Zuroff, DC and Blankstein, KR (2006). Specific perfectionism components versus self-criticism in predicting maladjustment. Personality and Individual Differences, 40, 665–676. doi:10.1016/j.paid.2005.08.008.CrossRefGoogle Scholar
Elison, J, Garofalo, C and Velotti, P (2014). Shame and aggression: Theoretical considerations. Aggression and Violent Behavior, 19, 447–453. doi:10.1016/j.avb.2014.05.002.CrossRefGoogle Scholar
Frost, RO, Marten, P, Lahart, C and Rosenblate, R (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14, 449–468. doi:10.1007/BF01172967.CrossRefGoogle Scholar
Garnefski, N, Kraaij, V and Spinhoven, P (2001). Negative life events, cognitive emotion regulation and emotional problems. Personality and Individual Differences, 30, 1311–1327. doi:10.1016/S0191-8869(00)00113-6.CrossRefGoogle Scholar
Gilbert, P (2005). Compassion: Conceptualisations, research and use in psychotherapy. New York: Routledge.10.4324/9780203003459CrossRefGoogle Scholar
Gilbert, P. (2007). The evaluation of shame as a marker for relationship security: A biopsychosocial approach. In J. Tracy, R. W. Robins, and J. P. Tangney (dir.), The self-conscious emotions: Theory and research (pp. 283–309). New York, NY: Guilford Press.Google Scholar
Gilbert, P and Irons, C. (2005). Focused therapies and compassionate mind training for shame and self-attacking. In P. Gilbert (dir.), Compassion: Conceptualisations, research and use in psychotherapy (pp. 263–325). New York, NY: Routledge.Google Scholar
Gosling, SD, Vazire, S, Srivastava, S and John, OP (2004). Should we trust web-based studies? A comparative analysis of six preconceptions about internet questionnaires. American Psychologist, 59, 93–104. doi:10.1037/0003-066X.59.2.93.CrossRefGoogle ScholarPubMed
Grant, JE, Odlaug, BL, Hampshire, A, Schreiber, LR and Chamberlain, SR (2013). White matter abnormalities in skin picking disorder: A diffusion tensor imaging study. Neuropsychopharmacology, 38, 763–769. doi:10.1038/npp.2012.241.CrossRefGoogle ScholarPubMed
Gratz, KL and Roemer, L (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26, 41–54. doi:10.1023/B:JOBA.0000007455.08539.94.CrossRefGoogle Scholar
Hayes, AF (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: Guilford Press.Google Scholar
Hayes, SL, Storch, EA and Berlanga, L (2009). Skin picking behaviors: An examination of the prevalence and severity in a community sample. Journal of Anxiety Disorders, 23, 314–319. doi:10.1016/j.janxdis.2009.01.008.CrossRefGoogle Scholar
Hewitt, PL and Flett, GL (1993). Dimensions of perfectionism, daily stress, and depression: A test of the specific vulnerability hypothesis. Journal of Abnormal Psychology, 102, 58–65. doi:10.1037/0021-843X.102.1.58.CrossRefGoogle ScholarPubMed
Hooley, JM and St. Germain, SA (2013). Nonsuicidal self-injury, pain, and self-criticism: Does changing self-worth change pain endurance in people who engage in self-injury? Clinical Psychological Science, 2, 297–305. doi:10.1177/2167702613509372.CrossRefGoogle Scholar
Jermann, F, Van der Linden, M, d'Acremont, M and Zermatten, A (2006). Cognitive emotion regulation questionnaire (CERQ): Confirmatory factor analysis and psychometric properties of the French translation. European Journal of Psychological Assessment, 22, 126–131. doi:10.1027/1015-5759.22.2.126.CrossRefGoogle Scholar
Keuthen, NJ, O'Sullivan, RL, Ricciardi, JN, Shera, D, Savage, CR, Borgmann, AS, … Baer, L (1995). The Massachusetts General Hospital (MGH) Hairpulling Scale, 1: Development and factor analyses. Psychotherapy and Psychosomatics, 64, 141–145. doi:10.1159/000289003.CrossRefGoogle ScholarPubMed
Keuthen, NJ, Rothbaum, BO, Welch, SS, Taylor, C, Falkenstein, M, Heekin, M, … Jenike, MA (2010). Pilot trial of dialectical behaviour therapy-enhanced habit reversal for trichotillomania. Depression and Anxiety, 1–7. doi:10.1002/da.20732.Google ScholarPubMed
Keuthen, N J, Rothbaum, B O, Welch, S S, Taylor, C, Falkenstein, M, Heekin, M, Jordan, C A, Timpano, K, Meunier, S and Fama, J (2010) Pilot Trial of Dialectical Behaviour Therapy-Enhanced Habit Reversal for Trichotillomania. Depression and Anxiety, 1–7. doi: https://doi.org/10.1002/da.20732.Google ScholarPubMed
Keuthen, NJ, Koran, LM, Aboujaoude, E, Large, MD and Serpe, RT (2010). The prevalence of pathologic skin picking in US adults. Comprehensive Psychiatry, 51, 183–186. doi:10.1016/j.comppsych.2009.04.003.CrossRefGoogle ScholarPubMed
Keuthen, NJ, Rothbaum, BO, Falkenstein, BA, Meunier, S, Timpano, KR, Jenike, MA and Welch, SS (2011). DBT-enhanced habit reversal treatment for trichotillomania: 3- and 6-month follow-up results. Depression and Anxiety, 28, 310–313. doi:10.1002/da.20778.CrossRefGoogle ScholarPubMed
Keuthen, NJ, Rothbaum, BO, Fama, J, Altenburger, E, Falkenstein, MJ, Sprich, SE, … Welch, SS (2012). DBT-enhanced cognitive-behavioural treatment for trichotillomania: A randomized controlled trial. Journal of Behavioural Addictions, 1, 1–9. doi:10.1556/JBA.1.2012.003.CrossRefGoogle Scholar
Labrecque, J, Stephenson, R, Boivin, I and Marchand, A (1998). Validation de l'Échelle multidimensionnelle du perfectionnisme auprès de la population francophone du Québec. Revue Francophone de Clinique Comportementale et Cognitive, 3, 1–14.Google Scholar
Linehan, M M (1993) Diagnosis and treatment of mental disorders. Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.Google Scholar
Lochner, C, Simeon, D, Niehaus, DJH and Stein, DJ (2002). Trichotillomania and skin picking: A phenomenological comparison. Depression and Anxiety, 15, 83–86. doi:10.1002/da.10034.CrossRefGoogle ScholarPubMed
Mansueto, CS, Stemberger, RMT, Thomas, AM and Golomb, RG (1997). Trichotillomania: A comprehensive behavioral model. Clinical Psychology Review, 17, 567–577. doi:10.1016/S0272-7358(97)00028-7.CrossRefGoogle ScholarPubMed
Maraz, A, Hende, B, Urbán, R and Demetrovics, Z (2017). Pathological grooming: Evidence for a single factor behind trichotillomania, skin picking and nail biting. PLoS ONE, 12, e0183806. doi:10.1371/journal.pone.0183806.CrossRefGoogle ScholarPubMed
O'Connor, KP, Gareau, D and Blowers, GH (1994). Personal constructs associated with tics. British Journal of Clinical Psychology, 33, 151–158. doi:10.1111/j.2044-8260.1994.tb01106.x.CrossRefGoogle ScholarPubMed
O'Connor, K, Gareau, D and Borgeat, F (1997). A comparison of a behavioural and a cognitive-behavioural approach to the management of chronic tic disorders. Clinical Psychology and Psychotherapy, 4, 105–117. doi:10.1002/(SICI)1099-0879(199706)4:2<105::AID-CPP126>3.0.CO;2-Y.3.0.CO;2-Y>CrossRefGoogle Scholar
O'Connor, KP, Brault, M, Robillard, S, Loiselle, J, Borgeat, F and Stip, E (2001). Evaluation of a cognitive-behavioral program for the management of chronic tic and habit disorder. Behavior Research and Therapy, 39, 667–681. doi:10.1016/S0005-7967(00)00048-6.CrossRefGoogle Scholar
O'Connor, K, Aardema, F and Pélissier, M-C (2005). Beyond reasonable doubt: Reasoning processes in obsessive-compulsive disorder and related disorders. Chichester, UK: John Wiley & Sons Ltd.Google Scholar
O'Connor, KP, Lavoie, ME, Robert, M, Stip, E and Borgeat, F (2005). Brain-behavior relations during motor processing in chronic tic and habit disorder. Cognitive and Behavioral Neurology, 18, 79–88. doi:10.1097/01.wnq.0000151131.06699.af.CrossRefGoogle ScholarPubMed
O'Connor, K, St-Pierre-Delorme, M-È, Leclerc, J, Lavoie, M and Blais, MT (2014). Meta-cognitions in Tourette syndrome, tic disorders, and body-focused repetitive disorders. The Canadian Journal of Psychiatry, 59, 417–425. doi:10.1177/070674371405900804.CrossRefGoogle Scholar
Patton, MQ (2002). Qualitative research and evaluation methods (3rd ed.). Thousand Oaks, CA: Sage Publications.Google Scholar
Pélissier, MC and O'Connor, K (2004). Cognitive-behavioral treatment of trichotillomania, targeting perfectionism. Clinical Case Studies, 3, 57–69. doi:10.1177/1534650103258973.CrossRefGoogle Scholar
Penzel, F (1995). Skin picking and nail biting: Related habits. In Touch, 2, 10–11.Google Scholar
Penzel, F (2002). A stimulus regulation model of trichotillomania. In Touch, 3, 12–14.Google Scholar
Penzel, F (2003). The Hair-Pulling Problem. Oxford: University Press.Google Scholar
Preacher, JP and Hayes, AF (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, & Computers, 36, 717–731. doi:10.3758/BF03206553.CrossRefGoogle ScholarPubMed
Roberts, S, O'Connor, K and Bélanger, C (2013). Emotion regulation and other psychological models for body-focused repetitive behaviors. Clinical Psychology Review, 33, 745–762. doi:10.1016/j.cpr.2013.05.004.CrossRefGoogle ScholarPubMed
Roberts, S, O'Connor, K, Aaderma, F and Bélanger, C (2015). The impact of emotions on body-focused repetitive behaviors: Evidence from a non-treatment-seeking sample. Journal of Behavior Therapy and Experimental Psychiatry, 46, 189–197. doi:10.1016/j.jbtep.2014.10.007.CrossRefGoogle ScholarPubMed
Roberts, S, O'Connor, K, Aardema, F, Courchesne, C and Bélanger, C (2016). The role of emotion regulation in body-focused repetitive behaviours. Cognitive Behaviour Therapist, 9, 1–17.10.1017/S1754470X16000039CrossRefGoogle Scholar
Shahar, G (2001) Personality, shame, and the breakdown of social ties: The voice of quantitative depression research. Psychiatry: Interpersonal and Biological Processes 64, 229–238.10.1521/psyc.64.3.228.18463CrossRefGoogle ScholarPubMed
Shusterman, A, Feld, L, Baer, L and Keuthen, N (2009). Affective regulation in trichotillomania: Evidence from a large-scale internet Survey. Behaviour Research and Therapy, 47, 637–644. doi:10.1016/j.brat.2009.04.004.CrossRefGoogle ScholarPubMed
Snorrason, I, Smari, J and Olafsson, RP (2010). Emotion regulation in pathological skin picking: findings from a non-treatment seeking sample. Journal of Behavior Therapy and Experimental Psychiatry, 41, 238–245. doi:10.1016/j.jbtep.2010.01.009.CrossRefGoogle ScholarPubMed
Snorrason, I., Ricketts, E. J., Flessner, C. A., Franklin, M. E., Stein, D. J., & Woods, D. W. (2012). Skin picking disorder is associated with other body-focused repetitive behaviors: Findings from an internet study. Annals of Clinical Psychiatry 24, 292-299.Google ScholarPubMed
Snyder, G and Friman, PC (2012). Habitual stereotypic movements: A descriptive analysis of four common types. In Grant, JE, Stein, DJ, Woods, DW and Keuthen, NJ (Eds.), Trichotillomania, skin picking, and other body-focused repetitive behaviors (pp. 43–64). Arlington, VA: American Psychiatric Publishing, Inc.Google Scholar
Stein, DJ, Flessner, CA, Franklin, M, Keuthen, NJ, Lochner, C and Woods, DW (2008). Is trichotillomania a stereotypic movement disorder? An analysis of body focused repetitive behaviors in people with hair pulling. Annals of Clinical Psychiatry, 20, 194–198. doi:10.1080/10401230802435625.CrossRefGoogle ScholarPubMed
Théberge, D, Gamache, D, and Savard, C (2019). Données préliminaires sur la validation de la version francophone de l'Experiences of Shame Scale [Preliminary data on the validation of the French version of the Experiences of Shame Scale]. Poster session presented at the annual meeting of the Société Québécoise pour la Recherche en Psychologie, Mont-Tremblant, Qc, Canada.Google Scholar
Tangney, JP and Dearing, RL (2002). Shame and guilt. Emotions and social behavior. New York, NY: Guilford Press.Google Scholar
Teng, EJ, Woods, DW, Twohig, MP and Marcks, BA (2002). Body-focused repetitive behavior problems: Prevalence in a nonreferred population and differences in perceived somatic activity. Behavior Modification, 26, 340–360. doi:10.1177/0145445502026003003.CrossRefGoogle Scholar
Thompson, RA (1994). Emotion regulation: A theme in search of definition. Monographs of the Society for Research in Child Development, 59, 250–283. doi:10.2307/1166137.CrossRefGoogle ScholarPubMed
Weingarden, H and Renshaw, KD (2015). Shame in the obsessive compulsive-related disorders: A conceptual review. Journal of Affective Disorders, 171, 74–84. doi:10.1016/j.jad.2014.09.010.CrossRefGoogle ScholarPubMed
Wetterneck, C T, Woods, D W and Norberg, M M (2006) The social and economic impact of trichotillomania: Results from two non referred samples. Behavioral Interventions 21, 97–109.10.1002/bin.211CrossRefGoogle Scholar
Whelton, WJ and Greenberg, LS (2005). Emotion in self-criticism. Personality and Individual Differences, 38, 1583–1595. doi:10.1016/j.paid.2004.09.024.CrossRefGoogle Scholar
Williams, TI, Rose, R and Chisholm, S (2007). What is the function of nail biting: An analog assessment study. Behaviour Research and Therapy, 45, 989–995. doi:10.1016/j.brat.2006.07.013.CrossRefGoogle ScholarPubMed
Zuroff, DC, Moskowitz, DS, Wielgus, MS, Powers, TA and Franko, DL (1983). Construct validation of the dependency and self-criticism scales of the depressive experiences questionnaire. Journal of Research in Personality, 17, 226–241. doi:10.1016/0092-6566(83)90033-8.CrossRefGoogle Scholar