Unveiling the hidden self: Developmental trauma and pathological shame

Part 1

In this blog we and cite and use excerpts from an excellent paper  we came across recently on ResearchGate

This article (1) focuses on the role played by developmental trauma in generating impairing feelings of shame as observed in several psychological disorders.

The article looked at better understanding the role pathological shame plays the  psychic functioning of patients who have experienced parental neglect or abuse.

It uses a clinical study (vignette) of a patient who suffered emotional neglect as a child to show how developmental trauma can dramatically affect the patient’s personality and behaviour. in this case, it led to negative expectations towards interpersonal relationships, disturbing feelings of shame, and a sense of a defective self.

These shame experiences deriving from the internalisation of bad or unworthy parents are subsequently linked to some psychopathological manifestations, such as withdrawal from social contacts, narcissistic rage, addiction and perversions.

“For a long time shame has been considered the ‘Cinderella of unpleasant emotions’ among psychoanalysts (Rycroft, 1968). The topic of shame is not even indexed in many of the authoritative handbooks of psychoanalytic technique published in the past century…For a long time shame has been considered the ‘Cinderella of unpleasant emotions’ among psychoanalysts (Rycroft, 1968). The topic of shame is not even indexed in many of the authoritative handbooks of psychoanalytic technique published in the past century…

Emotional, physical and sexual abuse during infancy and childhood indeed have disruptive effects on development and personality (Bifulco & Moran, 1998). For example, such experiences can prevent a child’s behavioural states from consolidating and unifying (Putnam, 2001), interfere with the development of coherent mental representations (Main & Morgan, 1996), and cause harm to psychosomatic integration (Scaer, 2007). Such negative experiences can also represent a developmental trauma, a condition of psychological vulnerability resulting from the lack of affection and care during childhood.

This concept of developmental trauma can be very useful in helping us understand psychopathology because it highlights the consequences of child abuse and neglect. In fact, developmental trauma may negatively impact on an individual’s ability to regulate and modulate affects when facing stressful events later in life (Schimmenti & Caretti, 2010): when children are repeatedly exposed to abuse, neglect…it is very unlikely that they will develop a ‘secure base’ (Bowlby, 1988) that permits them to trust the world.

Moreover, these experiences may damage the child’s ability to mentalise (Fonagy & Target, 1997; Fonagy et al., 2002; Jurist, Slade, & Bergner, 2008), i.e. the ability to make sense of one’s own mental state and that of another. It is noteworthy that mentalisation becomes essential for the individual’s metacognitive monitoring of experience, affect and behaviour during adolescence and adulthood. So, when a developmental trauma exists, it is likely that pathogenic forms of parenting have negatively influenced the representational system that guides the individual’s approach to the world and relationships (i.e. the internal working models; Bowlby, 1973), thus leading to a misconception of the self and other, as well as negative expectations towards interpersonal relationships…

A developmental trauma continuously threatens an individual’s sense of agency and self-esteem, thus increasing the risk for psychopathology. Empirical literature has shown that people who grow up in an abusive environment are more likely to have personality disorders, as well as internalising and externalising symptoms…

Concerning this, van der Kolk (2005) has suggested that a chronic exposure to one or more forms of developmentally adverse interpersonal trauma (such as abandonment, betrayal, physical assaults, sexual assaults, threats to bodily integrity, coercive practices, emotional abuse, witnessing violence and death) generates patterns of repeated dysregulation that can be observed at multiple levels (affective, somatic, behavioural, cognitive, relational and representational); at the same time, a developmental trauma leads to persistently altered attributions and expectancies, such as negative self-image, distrust towards protective caretakers, loss of the expectation of being protected by others, and a constant fear of future victimisation.

Cook et al. (2005) further highlighted seven primary domains of impairment observed in children exposed to developmental trauma. These are as follows: attachment, biology, affect regulation, dissociation, behavioural control, cognition and self-concept. Just to summarise: (a) the attachment domain is affected by uncertainties about the reliability and predictability of the world, that generate difficulty attuning to other people’s emotional states, social isolation, and interpersonal difficulties; (b) the biological impairments involve sensorimotor developmental problems, somatisation, increased medical problems across a wide span; (c) affect regulation problems involve difficulty with emotional self-regulation, difficulty knowing and describing internal states, difficulty communicating wishes and desires; (d) the dissociation domain concerns significant alterations in states of consciousness, with amnesia, depersonalisation and derealisation; (e) behavioural control is reduced, with poor modulation of impulses, self-destructive behaviour, aggression against others, pathological self-soothing behaviours (including substance abuse and eating disorders); (f) the cognition domain is affected by difficulties in attention regulation and executive functioning, problems with processing novel information, problems with object constancy, difficulty planning and anticipating, with all their developmental consequencies; (g) self-concept is dramatically damaged, with a poor sense of separateness, disturbances of body image, low self-esteem, shame and guilt, together with a lack of a continuous, predictable sense of self.

Recent neurobiological findings further support the idea that child abuse and neglect have disruptive effects on personality and the self. Such negative experiences produce significant alterations in the developing right brain, the prefrontal cortex, the hippocampus, the hypothalamic-pituitary axis, the concentrations of corticotrophin release hormone, the noradrenergic system and so on (De Bellis, 2005; Ford, 2005; van der Kolk, 2003; Schore, 2003, 2009). Accordingly, the network of cortical and subcortical interactions that produces the emergence of self-awareness and the ability to organise mental states is damaged in children who have been maltreated or have experienced significant failures of care.

From a psychodynamic perspective, the introjection of negative relationships with parents in the form of bad internal objects can represent the core problem…Leonard Shengold argued that ‘our identity depends initially on good parental care and good parental caring – on the transmitted feeling that it is good that we are there’ (Shengold, 1989: 24). Childhood experience of abuse and neglect represent the opposite condition, something like ‘it is no good that you are here; you are only a problem’.

When one views one’s relationships through such a lens, pathological feelings of shame can emerge (Lewis, 1987a), as the following clinical vignette illustrates.

TBC

Reference

1. Schimmenti, A. (2012). Unveiling the hidden self: Developmental trauma and pathological shame. Psychodynamic Practice, 18(2), 195-211.