Background: Shame is an acknowledged part of several psychopathological conditions, but is underrepresented in clinical research. Cook's Internalized Shame Scale (ISS) is the most promising measure, but has mostly been used for testing small clinical samples biased toward depressive pathology and female participants.
Aims: To contribute to establishing indicators of pathological shame in outpatients with depression and anxiety disorder, and to contribute to establishing norms for the ISS in Scandinavia.
Method: The ISS was administered to n = 200 gender balanced non-patient and outpatient samples. A total of 100 patients each were diagnosed as suffering from a depression or anxiety disorder. The diagnoses were supported by Beck's Depression (BDI) and Anxiety Inventory (BAI). The analyses used were the principal component analysis (PCA) and confirmatory factor analysis (CFA) for item structure and sample equivalence, ANOVAs, t-tests and Mann-Whitney non-parametric statistics for index scores, and the receiver operating curve (ROC) for break-off.
Results: Patients' ISS score were similar to the results from previous research, the effect size of patient-non-patient difference was 0.68, correlations indicated a higher level of shame in depression than in anxiety, and the BDI-BAI correlation was 0.56 for both clinical samples. The PCA showed three factors that were identified as: "Inadequacy", "Emptiness", and "Vulnerability".
Conclusions: The ISS is a viable instrument, which indicates a widespread shame pathology in both depressive and anxious out-patients. The instrument may not be uni-dimensional, but exploration of factor variation may be a promising goal for further research.
Clinical implications: Assessment of shame should be included in diagnosis and treatment of emotional disorder.