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

Roland Zahn, Karen E Lythe, Jennifer A Gethin, Sophie Green, John F William Deakin, Allan H Young, Jorge Moll

Research output: Contribution to journalArticlepeer-review

107 Citations (Scopus)


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.

LIMITATIONS: 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.

Original languageEnglish
Number of pages13
JournalJournal of Affective Disorders
Publication statusAccepted/In press - 5 Aug 2015


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