[Epistemic status: I am not nearly smart and well-informed enough to propose the existence of new medical conditions.]
[Content warning: vivid explanation of distorted thought processes, including suicidality, self-harm and eating disorders.]
A lot of my friends seem to have something along the lines of generalized anxiety disorder, but for shame. Generalized anxiety disorder is a condition in which people worry about everything, all the time, without any good reason, even when there is no good reason to worry about anything; people with generalized anxiety disorder can’t get rid of their anxiety, even when they recognize that it is excessive. Similarly, what I’m proposing is a condition in which people feel shame about everything, all the time, without any good reason, even when there is no good reason to feel shame about it.
Let’s be clear about how I’m using the word “shame” here. Shame is not the same thing as guilt, although many people with generalized shame disorder self-identify as having guilt issues. Guilt is a response to doing something wrong; while sometimes people feel guilty too much or guilty about the wrong things, in general, guilt is useful and healthy. Shame, however, is about fundamentally being a bad person. Guilt is “I made a mistake”; shame is “I am a mistake”. Guilt often motivates people to make amends and change their behavior; shame often doesn’t, because fixing a specific defect is much less daunting than fixing an entire defective self. Guilt concerns itself only tangentially with other people; shame, at its core, is often about how other people would respond, the idea that your actions make you unworthy of love or belonging, the idea that everyone is going to hate you and you deserve it for being so bad.
As far as I’m aware, this does not match up with any condition currently in the DSM. The people I know who have generalized shame disorder seem to be diagnosed with a wide variety of things, including depression, generalized anxiety disorder, OCD, and borderline personality disorder. However, I don’t think any of those explains the condition perfectly, although in individual cases they may be correct. Many people I know with generalized shame disorder do not experience the mood swings and relationship instability of BPD, the compulsions or intrusive thoughts of OCD, or the sadness and lack of energy of depression.
Commonly, generalized shame disorder seems to be associated with literal self-destructive impulses. Conventionally, the term “self-destructive” means doing things that have far more negative consequences than positive consequences, such as substance abuse; however, people with generalized shame disorder seem to literally want to destroy themselves. This manifests in a lot of different ways. Suicidal ideation is obvious. Some might have an eating disorder in the hopes that they can waste away until they stop existing. Some people may go to a psychiatrist in the hopes of getting medication that will cause them to be a completely different person. Some people make life choices that make them miserable because the complete opposite of themselves is the only good kind of person to be. I am sure there are others; we are nothing if not inventive.
Regardless of the preferred form of self-destruction (and most people with generalized shame disorder have more than one), the root thought is the same. In fact, if there’s anything besides “lots of shame” that defines this condition for me, it’s that: the urge, in some literal or metaphorical sense, to stop being you. It is very common for people to feel guilt about the fact that they can’t force themselves to be someone else or that they don’t want to.
People with generalized shame disorder often want to punish themselves. This self-punishment is not usually motivated by the idea that it will cause them to stop doing bad things; instead, it satisfies some obscure sense of justice that anyone as bad as they are deserves to be punished. Common forms of self-punishment include self-harm, eating disorders again, and deliberate self-sabotage such as breaking up with a beloved partner, not showing up to class for two weeks, or refusing to complete a major assignment at work.
Many people with generalized shame disorder seem to pedestalize certain people, who are perceived as not being defective. They might try to adopt tangential personality traits of the pedestalized person, such as their political views or taste in furniture, and believe that their inability to adopt those traits means that they’re defective. Conversely, they might wind up getting viciously angry at the pedestalized person for implying that they’re defective, even when the pedestalized person has done no such thing and is just, say, expressing a preference.
Many times, people with generalized shame disorder seem to have thoughts themed around purity: they are bad, dirty, tarnished, gross, disgusting, contaminated; the impulse to get rid of themselves may be perceived as becoming clean or pure. I suspect the purity moral foundation may be involved.
People with generalized shame disorder apologize constantly. They may apologize for things they had nothing to do with (for instance, someone else five feet away dropping something), for existing, for having opinions, for liking somebody, for wanting something.
People with generalized shame disorder often have elaborate systems of rules for what makes them a good person; these rules are usually extreme, self-contradictory, and completely unrelated to actually being a good person. More self-aware people with generalized shame disorder may try to create achievable rules so that they can stop feeling shame; however, this doesn’t usually work, because they become obsessed with the idea that they might have the wrong rules, or might have broken the rules by mistake.
In many cases, people with generalized shame disorder may have thoughts that are distorted to the point of being delusional. Examples from my own life include deciding that I don’t need to eat and the only reason I consume food is because I am bad, declaring that it is a fundamental law of metaphysics that I am a terrible person, and concluding that because I have read a Tumblr post criticizing Klan members I must be a Klan member and I have just forgotten. In most cases, these thoughts seem to be relatively brief in duration (a few hours to a day), although they often recur.
Needless to say, there is a great overlap between generalized shame disorder and scrupulosity.
I would like to conclude this post with some kind of useful advice about what to do, but frankly I don’t have any. So I’m going to stop describing this and instead toss it out there: does this match your experiences? Am I missing any common features? Are some of the features I’ve outlined just weird things that the people I know do? Do you think it is silly of me to attempt to invent mental conditions in the first place?