The Relationship Between Childhood Maltreatment and Shame and Guilt in Individuals with Major Depressive Disorder and Borderline Personality Disorder

Document Type : Original Article

Authors

1 M. A. in Psychology, Department of Psychology and Counseling, Faculty of Psychology and Educational Sciences, University of Yazd, Yazd, Iran.

2 Associate Professor of Department of Psychology and Counseling, Faculty of Psychology and Educational Sciences,Yazd University, Yazd, Iran.

3 Assistant professor of Department of Psychology and Counseling, Faculty of Psychology and Educational Sciences, Yazd University, Yazd, Iran.

4 Assistant Professor of Psychiatry, Department of Psychiatry, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

10.48308/apsy.2025.241152.1887

Abstract

Aim: This study aimed to examine the relationship between childhood maltreatment and feelings of shame and guilt, as well as to determine the differences in childhood maltreatment among individuals with Major Depressive Disorder (MDD) and Borderline Personality Disorder (BPD).
Method: The research employed a descriptive-correlational and causal-comparative design. The population included patients with MDD and BPD who visited psychiatrists in Yazd in 2021, as well as healthy individuals. The sample consisted of 51 patients with MDD, 49 patients with BPD, and 50 healthy controls, selected via convenience sampling. The instruments used were the Childhood Abuse Questionnaire (Mohammadi, 2003), Beck Depression Inventory (Beck, 1996), Leichsenring Borderline Personality Inventory (1999), and the Shame and Guilt Questionnaire (Cohen et al., 2011). Data were analyzed using Pearson correlation, regression analysis, and analysis of variance (ANOVA).
Results: Findings indicated that among individuals with MDD, emotional neglect predicted shame (β = 0.52), while emotional neglect (β = 0.55) and emotional abuse (β = 0.40) predicted guilt. Among individuals with BPD, sexual abuse (β = 0.37) and emotional abuse (β = 0.35) predicted shame, whereas physical abuse (β = 0.55) and neglect (β = 0.26) predicted guilt.
Conclusion: The results highlight the significant role of childhood maltreatment in the development of negative and harmful feelings of shame and guilt in psychological disorders, which may be useful for clinicians and theorists alike.

Keywords

Main Subjects

References

American Psychiatric Association, D. S., & American Psychiatric Association. (2014). Diagnostic and statistical manual of mental disorders: DSM-5. [Link]
Antonijevic, I. A. (2006). Depressive disorders—is it time to endorse different pathophysiology's? Psych neuroendocrinology, 31(1), 1-15. [Link]
Afifi, T. O., Mather, A., Boman, J., Fleisher, W., Enns, M. W., MacMillan, H., & Sareen, J. (2011). Childhood adversity and personality disorders: results from a nationally representative population-based study. Journal of psychiatric research, 45(6), 814-822. [Link]
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Arlington, VA: American Psychiatric Association; 2013. Text Revision, DSM-IV-TR. [Link]
Anderson, P. L., Tiro, J. A., Price, A. W., Bender, M. A., & Kaslow, N. J. (2002). Additive impact of childhood emotional, physical, and sexual abuse on suicide attempts among low-income African American women. Suicide and Life-Threatening Behavior, 32(2), 131-138. [Link]
Asgarizadeh, A., Sharp, C. & Ghanbari, S. (2023). Shame-coping clusters: comparisons regarding attachment insecurities, mentalizing deficits, and personality pathology, controlling for general emotion dysregulation. bord personal disord emot dysregul 10, 25. [Link]
Beck AT, & Freeman A. (1990). Cognitive therapy of personality disorders. New York: The Guilford Press. [Link]
Békés, V., Szabó, D., Lévay, E. E., Salgó, E., & Unoka, Z. (2023). Moral injury and shame mediate the relationship between childhood trauma and borderline personality disorder, PTSD, and complex PTSD symptoms in psychiatric inpatients. Personality Disorders: Theory, Research, and Treatment, 37(4), 406–420. [Link]
Biermann, M. (2023). Shame, self-criticism and fears of compassion in borderline personality disorder (Inaugural dissertation, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg). Heidelberg. [Link]  
Chen, L. P., Murad, M. H., Paras, M. L., Colbenson, K. M., Sattler, A. L., Goranson, E. N., ... & Zirakzadeh, A. (2010, July). Sexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis. In Mayo clinic proceedings (Vol. 85, No. 7, pp. 618-629). Elsevier. [Link]
Christ, C., De Waal, M. M., Dekker, J. J., van Kuijk, I., Van Schaik, D. J., Kikkert, M. J., ... & Messman-Moore, T. L. (2019). Linking childhood emotional abuse and depressive symptoms: The role of emotion dysregulation and interpersonal problems. PLoS One, 14(2), e0211882. [Link]  
Cohen, T. R., Wolf, S. T., Panter, A. T., & Insko, C. A. (2011). Introducing the GASP scale: A new measure of guilt and shame proneness. Journal of Personality and Social Psychology, 100, 947-966. [Link]
De Aquino Ferreira, L. F., Pereira, F. H. Q., Benevides, A. M. L. N., & Melo, M. C. A. (2018). Borderline personality disorder and sexual abuse: a systematic review. Psychiatry research, 262, 70-77. [Link]
Fairbairn, W.R. (1954). Psychological Studies of the Personality. Routledge and Kegan Paul, London. [Link]
Feiring, C., & Taska, L. S. (2005). The persistence of shame following sexual abuse: A longitudinal look at risk and recovery. Child maltreatment, 10(4), 337-349. [Link]
Fairbrother, N., & Moretti, M. (1998). Sociotropy, autonomy, and self-discrepancy: Status in depressed, remitted depressed, and control participants. Cognitive Therapy and Research, 22(3), 279-297. [Link]
Gunderson, J. G. (2011). Borderline personality disorder. New England Journal of Medicine, 364(21), 2037-2042. [Link]
Gilbert, R., Widom, C. S., Browne, K., Fergusson, D., Webb, E., & Janson, S. (2009). Burden and consequences of child maltreatment in high-income countries. The lancet, 373(9657), 68-81. [Link]
Gardner, M. J., Thomas, H. J., & Erskine, H. E. (2019). The association between five forms of child maltreatment and depressive and anxiety disorders: A systematic review and meta-analysis. Child abuse & neglect, 96, 104082. [Link]  
Ghassemzadeh, H., Mojtabai, R., Karamghadiri, N., & Ebrahimkhani, N. (2025). Psychometric properties of a Persian-language version of the Beck Depression Inventory-Second Edition (BDI-II-Persian). Depression and Anxiety, 21(4), 185–192. [Link]
Guler, D. (2022). Childhood psychological maltreatment and depressive symptoms: parallel-serial mediating effects of certain psychological factors. Current psychology, 41 (2), 1-11. [Link]
Göttlich, M., Westermair, A. L., Beyer, F., Bußmann, M. L., Schweiger, U., & Krämer, U. M. (2020). Neural basis of shame and guilt experience in women with borderline personality disorder. European archives of psychiatry and clinical neuroscience, 270(8), 979-992. [Link]
Harper, J. M. (2011). Regulating and coping with shame. Re-constructing emotional spaces: From experience to regulation, 189-206. [Link]
Harder, D. W., Lewis, S. J., Butcher, J. N., & Spielberger, C. D. (1987). The assessment of shame and guilt. Advances in personality assessment, 6, 89-114. [Link]
Hillis, S., Mercy, J., Amobi, A., & Kress, H. (2016). Global prevalence of past-year violence against children: a systematic review and minimum estimates. Pediatrics, 137(3). [Link]  
Humphreys, K. L., LeMoult, J., Wear, J. G., Piersiak, H. A., Lee, A., & Gotlib, I. H. (2020). Child maltreatment and depression: A meta-analysis of studies using the Childhood Trauma Questionnaire. Child abuse & neglect, 102, 104361. [Link]
Jafari R. Child abuse reports [Internet]. Tehran: Fars News; 2017 [cited 2018 Oct 8]. Available from: https://www.farsnews.com/news [Persian]. [Link]
Kahya, Y., Munguldar, K., & Gun, M. (2022). Examination of the psychometric properties of the Borderline Personality Inventory in an adolescent sample. Studies in Psychology-Psikoloji Calismalari Dergisi, 42(2). [Link]
Kugler, K., & Jones, W. H. (1992). On conceptualizing and assessing guilt. Journal of personality and Social Psychology, 62(2), 318. [Link]
Kernberg, O. (1968). The treatment of patients with borderline personality organization. International Journal of Psycho-Analysis, 49, 600-619. [Link]
Hofstede, G. (2001). Culture’s consequences: Comparing values, behaviors, institutions, and organizations across nations (2nd ed.). Thousand Oaks, CA: Sage Publications. [Link]
Kilborne, B. (1999). When trauma strikes the soul: Shame, splitting, and psychic pain. American Journal of Psychoanalysis, 59(4), 385-402. [Link]
Labonté, L.E., Kealy, D. Linking childhood maltreatment and depressive symptoms: identity, shame, and age effects. Curr Psychol 43, 11904–11913 (2024).  [Link]
Liu, R. T. (2017). Childhood adversities and depression in adulthood: current findings and future directions. Clinical psychology: science and practice, 24(2), 140-153. [Link]
Li, D., Chu, C. M., & Lai, V. (2020). A developmental perspective on the relationship between child sexual abuse and depression: A systematic and meta‐analytic review. Child abuse review, 29(1), 27-47. [Link]
Linehan, M. (1993). Skills training manual for treating borderline personality disorder (Vol. 29). New York: Guilford press. [Link]
Leichsenring, F. (1999). Development and first results of the Borderline Personality Inventory: A self-report instrument for assessing borderline personality organization. Journal of Personality Assessment, 73(1), 45-63. [Link]
Martins, C. M. S., Baes, C. V. W., de Carvalho Tofoli, S. M., & Juruena, M. F. (2014). Emotional abuse in childhood is a differential factor for the development of depression in adults. The Journal of nervous and mental disease, 202(11), 774-782. [Link]
Mathews, B., Pacella, R., Dunne, M. P., Simunovic, M., & Marston, C. (2020). Improving measurement of child abuse and neglect: A systematic review and analysis of national prevalence studies. PloS one, 15(1), e0227884. [Link]
Maguire-Jack, K., & Font, S. A. (2017). Community and individual risk factors for physical child abuse and child neglect: Variations by poverty status. Child maltreatment, 22(3), 215-226. [Link]
Mohammadzadeh, A., & Rezaei, A. (2011). Validation of the Borderline Personality Inventory in the Iranian population. Journal of Behavioral Sciences, 5(3), 269–277. (Persian). [Link]
Morris, M. C., Kouros, C. D., Fox, K. R., Rao, U., & Garber, J. (2014). Interactive models of depression vulnerability: The role of childhood trauma, dysfunctional attitudes, and coping. British Journal of Clinical Psychology, 53(2), 245-263. [Link]  
McFetridge, M. A., Milner, R., Gavin, V., & Levita, L. (2015). Borderline personality disorder: patterns of self-harm, reported childhood trauma and clinical outcome. BJPsych open, 1(1), 18-20. [Link]
Mandelli, L., Petrelli, C., & Serretti, A. (2015). The role of specific early trauma in adult depression: a meta-analysis of published literature. Childhood trauma and adult depression. European psychiatry, 30(6), 665-680.  [Link]
Mohammadpour, F., Mohajerin, B., Sam Kianimoghadam, A., & Sarani Yaztappeh, J. (2025). The relation between adverse childhood events and self-harm with the mediating roles of shame and self-disgust. International Journal of High Risk Behaviors and Addiction, 14(1), e154506. [Link]  
Nelson, J., Klumparendt, A., Doebler, P., & Ehring, T. (2017). Childhood maltreatment and characteristics of adult depression: meta-analysis. The British Journal of Psychiatry, 210(2), 96-104. [Link]
Osei Sarpong, P. (2025). Exploring the lived experiences of adults with personality disorders arising from childhood trauma: Understanding the connection between childhood trauma and the development of personality disorders in adulthood (Doctoral dissertation, Liberty University). Liberty University. [Link]
Porter, C., Palmier‐Claus, J., Branitsky, A., Mansell, W., Warwick, H., & Varese, F. (2020). Childhood adversity and borderline personality disorder: a meta‐analysis. Acta Psychiatrica Scandinavica, 141(1), 6-20. [Link]  
Rostami, M., Sa'adati, N., & Qazal-Saflou, M. (2015). The relationship between childhood abuse experiences, coping strategies, and early maladaptive schemas. Journal of Mental Health Principles, 17(6), 269–277. (Persian).  [Link]
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2009). Textbook of psychiatry.
Saeedi, Z., Ghorbani, N., Sarafraz, M. R., & Sharifian, M. H. (2013). The effect of self-compassion and self-esteem induction on the experience of shame and guilt. Contemporary Psychology Journal, 8(1), 91–102. (Persian). [Link]
Sekowski, M., Gambin, M., Cudo, A., Wozniak-Prus, M., Penner, F., Fonagy, P., & Sharp, C. (2020). The relations between childhood maltreatment, shame, guilt, depression and suicidal ideation in inpatient adolescents. Journal of Affective Disorders, 276, 667-677. [Link]
Santoro G, Sideli L, Musetti A, Schimmenti A. (2025). The Relationship Between Childhood Trauma and Shame: The Mediating Role of Dissociation. Eur J Investig Health Psychol Educ, 7;15(8):151. [Link]
Slavich GM, Giletta M, Helms SW, Hastings PD, Rudolph KD, Nock MK, Prinstein MJ. (2020). Interpersonal life stress, inflammation, and depression in adolescence: Testing Social Signal Transduction Theory of Depression. Depress Anxiety, 37(2):179-193. [Link]
Sultana Eliav, A., & Lahav, Y. (2023). Posttraumatic Growth, Dissociation and Identification with The Aggressor Among Childhood Abuse Survivors. Journal of Trauma & Dissociation, 24(3), 410–425. [Link]
Scheel, C. N., Bender, C., Tuschen-Caffier, B., Brodführer, A., Matthies, S., Hermann, C., & Jacob, G. A. (2014). Do patients with different mental disorders show specific aspects of shame? Psychiatry research, 220(1-2), 490-495. [Link]
Salavati, M., Selby, E.A. (2024). Childhood Maltreatment and Borderline Personality Disorder. In: Theories of Borderline Personality Disorder. Springer, Cham. [Link]
Schwarzer, N.-H., Nolte, T., Fonagy, P., Feigenbaum, J., King-Casas, B., Rüfenacht, E., Gingelmaier, S., Leibowitz, J., Pilling, S., & Montague, P. R.; London Personality and Mood Disorder Research Network. (2024). Linking mentalizing capacity, shame, and depressive symptoms in the context of childhood maltreatment. Children and Youth Services Review, 163, 107787.  [Link]
Stolper, E., Verdenius, J. P., Dinant, G. J., & van de Wiel, M. (2020). GPs’ suspicion of child abuse: how does it arise and what is the follow-up? Scandinavian journal of primary health care, 38(2), 117-123. [link]
Taillieu, T. L., Brownridge, D. A., Sareen, J., & Afifi, T. O. (2016). Childhood emotional maltreatment and mental disorders: Results from a nationally representative adult sample from the United States. Child abuse & neglect, 59, 1-12.  [Link]
Vilhena-Churchill, N., & Goldstein, A. L. (2014). Child maltreatment and marijuana problems in young adults: Examining the role of motives and emotion dysregulation. Child abuse & neglect, 38(5), 962-972. [Link]
World Health Organization. (2016). World health statistics 2016: monitoring health for the SDGs sustainable development goals. World Health Organization. [Link]
Wilson, H. W., & Widom, C. S. (2010). The role of youth problem behaviors in the path from child abuse and neglect to prostitution: A prospective examination. Journal of research on adolescence, 20(1), 210-236. [Link]
World Health Organization. (2017). Together on the road to universal health coverage: A call to action (17.1). World Health Organization. [Link]
Yuan, Y., Lee, H., Newhill, C.E. et al. Differential associations between childhood maltreatment types and borderline personality disorder from the perspective of emotion dysregulation. bord personal disord emot dysregul 10, 4 (2023).  [Link]
Zhang H, Wang X, Zhang Q, Zhao M, Wang Y. (2025). The association between child maltreatment and shame: A meta-analysis. Child Abuse Negl. 167:107557. [Link]

Files

Share

How to cite

Statistics