Shame and the psychosis continuum: A systematic review of the literature.

Objectives: Shame is increasingly implicated in the development and maintenance of several psychological problems including psychosis. The aim of the current paper is to review the research literature concerning the relationship between shame and the psychosis continuum, examining the nature and direction of this relationship.
Method: Systematic searches of databases PsycINFO, Medline, Scopus and Web of Science (from the earliest available database date until November 2016) were undertaken to identify papers that examined the relationship between shame and psychosis or psychotic experiences.
Results: A total of 20 eligible papers were identified. Risk of bias assessment identified methodological shortcomings across the research in relation to small, unrepresentative samples and failure to control for confounding variables. Narrative synthesis suggested positive associations between shame and paranoia (n = 10, r = .29-.62), shame and psychosis (n = 1, r = .40), shame and affiliation with voices (n = 1, β = .26), and suggested that shame was greater in those with psychosis compared to controls (n = 4, d = 0.76-1.16).
Conclusions: Overall several studies provide partial support for the theory that shame is an important factor in relation to psychotic experiences in both clinical and non-clinical populations, particularly paranoia. However, the predominance of cross-sectional designs prevents any conclusions being drawn concerning the temporal nature of associations. Additional research is necessary to further delineate the role of shame in relation to specific psychotic experiences such as voice-hearing. Longitudinal research is particularly needed to help establish the directionality and temporal aspects of effects.