Shame often links trauma, attachment threat, avoidance, concealment, anger, self-criticism, and disengagement from care.
AffectTraumaAttachment+1
Emotional dysregulation is a transdiagnostic formulation mechanism that can amplify impulsivity, interpersonal rupture, avoidance, and risk.
AffectBehaviourInterpersonal+1
Painful negative evaluation of the self, often involving felt exposure or anticipated devaluation. Distinguish this from guilt about an action, while allowing overlap.
Difficulty understanding, modulating, tolerating or recovering from affect in a particular context, with relevant functional or interpersonal consequences. Specify which part is difficult. “Dysregulation” is not an explanation of its own cause.
Candidate maintaining process, to be tested in the individual case: perceived exposure → shame → concealment, withdrawal or self-attack → reduced access to support or further negative self-evaluation. Do not infer this sequence solely from quietness, substance use or self-harm.
Candidate maintaining process, to be tested in the individual case: trigger → escalating affect → impulsive action or withdrawal → short-term change in distress → conflict, shame or restriction. Strategy–symptom associations vary and do not establish a single aetiology.
Downcast gaze · Concealment
Rapid affect shifts · Impulsive coping
“There is something wrong with me”
“It goes from zero to one hundred”
Exposure -> shame -> hiding or attack -> isolation or rupture -> shame intensifies
Trigger -> intense emotion -> urgent behaviour -> consequences -> shame or threat -> further dysregulation
Reduce concealment and self-attack while building tolerable interpersonal safety.
Increase pause, labelling, and tolerable regulation options before action urges dominate.
The primary affect is guilt about a specific harm with intact self-worth.
Mood shifts are better explained by episodic mania, delirium, intoxication, or seizure activity.