Alternative hypotheses

Compare mechanisms

Compare function, sequence, patient language, and treatment leverage. The aim is not to choose a label—it is to identify which hypothesis best explains this person’s pattern.

Ask this

Which pattern better explains the sequence, protective function, and consequences: shame or emotional dysregulation?

Shame

Shame often links trauma, attachment threat, avoidance, concealment, anger, self-criticism, and disengagement from care.

AffectTraumaAttachment+1

Emotional dysregulation

Emotional dysregulation is a transdiagnostic formulation mechanism that can amplify impulsivity, interpersonal rupture, avoidance, and risk.

AffectBehaviourInterpersonal+1

Definition

AA painful self-conscious affect in which the self is experienced as exposed, defective, unacceptable, or at risk of rejection.

BDifficulty modulating the intensity, duration, expression, or behavioural consequences of emotional states.

Core process

AGlobal negative self-evaluation and anticipated social devaluation drive hiding, appeasing, attacking, or withdrawal.

BHigh emotional sensitivity, intense arousal, limited regulation strategies, and rapid action urges interact under stress.

Look for

ADowncast gaze · Concealment

BRapid affect shifts · Impulsive coping

Patient language

A“There is something wrong with me”

B“It goes from zero to one hundred”

Maintaining cycle

AExposure -> shame -> hiding or attack -> isolation or rupture -> shame intensifies

BTrigger -> intense emotion -> urgent behaviour -> consequences -> shame or threat -> further dysregulation

Treatment leverage

AReduce concealment and self-attack while building tolerable interpersonal safety.

BIncrease pause, labelling, and tolerable regulation options before action urges dominate.

Check before using

AThe primary affect is guilt about a specific harm with intact self-worth.

BMood shifts are better explained by episodic mania, delirium, intoxication, or seizure activity.

Formulation language

Shame appears to organise the patient around hiding and self-protection, reducing exposure but maintaining isolation and self-criticism.

Open full guide

Formulation language

Emotional dysregulation appears to intensify threat cues into urgent action, creating consequences that then feed further distress.

Open full guide

Browse the map Use both hypotheses

Alternative hypotheses

Compare mechanisms

Compare function, sequence, patient language, and treatment leverage. The aim is not to choose a label—it is to identify which hypothesis best explains this person’s pattern.

Ask this

Which pattern better explains the sequence, protective function, and consequences: shame or emotional dysregulation?

Shame

Shame often links trauma, attachment threat, avoidance, concealment, anger, self-criticism, and disengagement from care.

AffectTraumaAttachment+1

Emotional dysregulation

Emotional dysregulation is a transdiagnostic formulation mechanism that can amplify impulsivity, interpersonal rupture, avoidance, and risk.

AffectBehaviourInterpersonal+1

Definition

AA painful self-conscious affect in which the self is experienced as exposed, defective, unacceptable, or at risk of rejection.

BDifficulty modulating the intensity, duration, expression, or behavioural consequences of emotional states.

Core process

AGlobal negative self-evaluation and anticipated social devaluation drive hiding, appeasing, attacking, or withdrawal.

BHigh emotional sensitivity, intense arousal, limited regulation strategies, and rapid action urges interact under stress.

Look for

ADowncast gaze · Concealment

BRapid affect shifts · Impulsive coping

Patient language

A“There is something wrong with me”

B“It goes from zero to one hundred”

Maintaining cycle

AExposure -> shame -> hiding or attack -> isolation or rupture -> shame intensifies

BTrigger -> intense emotion -> urgent behaviour -> consequences -> shame or threat -> further dysregulation

Treatment leverage

AReduce concealment and self-attack while building tolerable interpersonal safety.

BIncrease pause, labelling, and tolerable regulation options before action urges dominate.

Check before using

AThe primary affect is guilt about a specific harm with intact self-worth.

BMood shifts are better explained by episodic mania, delirium, intoxication, or seizure activity.

Formulation language

Shame appears to organise the patient around hiding and self-protection, reducing exposure but maintaining isolation and self-criticism.

Open full guide

Formulation language

Emotional dysregulation appears to intensify threat cues into urgent action, creating consequences that then feed further distress.

Open full guide

Browse the map Use both hypotheses