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 splitting?

Shame

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

AffectTraumaAttachment+1

Splitting

Splitting can simplify unbearable ambivalence but may destabilise relationships, teams, and self-experience.

DefenceInterpersonalAffect+1

Definition

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

BAn all-or-none way of organising self, others, or situations into wholly good or wholly bad categories when mixed representations feel intolerable.

Core process

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

BConflicting positive and negative representations are not integrated, so affective state strongly shapes the current view.

Look for

ADowncast gaze · Concealment

BSudden idealisation or devaluation · Team splitting

Patient language

A“There is something wrong with me”

B“They are the only one who understands me”

Maintaining cycle

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

BAttachment threat -> intense affect -> polarised appraisal -> rupture -> threat increases

Treatment leverage

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

BHelp the patient tolerate mixed representations without escalating shame or abandonment fear.

Check before using

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

BThe person can hold mixed views but is making a stable, evidence-based judgement.

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

Under attachment threat, splitting may make it hard to hold mixed feelings about self and others, intensifying rupture and repair cycles.

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 splitting?

Shame

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

AffectTraumaAttachment+1

Splitting

Splitting can simplify unbearable ambivalence but may destabilise relationships, teams, and self-experience.

DefenceInterpersonalAffect+1

Definition

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

BAn all-or-none way of organising self, others, or situations into wholly good or wholly bad categories when mixed representations feel intolerable.

Core process

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

BConflicting positive and negative representations are not integrated, so affective state strongly shapes the current view.

Look for

ADowncast gaze · Concealment

BSudden idealisation or devaluation · Team splitting

Patient language

A“There is something wrong with me”

B“They are the only one who understands me”

Maintaining cycle

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

BAttachment threat -> intense affect -> polarised appraisal -> rupture -> threat increases

Treatment leverage

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

BHelp the patient tolerate mixed representations without escalating shame or abandonment fear.

Check before using

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

BThe person can hold mixed views but is making a stable, evidence-based judgement.

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

Under attachment threat, splitting may make it hard to hold mixed feelings about self and others, intensifying rupture and repair cycles.

Open full guide

Browse the map Use both hypotheses