Shame-Informed Case Formulation

A New Paradigm for Understanding Emotional Health

Why are normal human reactions — such as fear, shame, self-criticism and the need for love and belonging — labeled as “mental disorders”? The time has come to consider a solution to replace the current disease model, which labels and stigmatizes normal emotions and behaviors as “mental disorders.”

An increasing number of mental health professionals and those harmed by the profession are speaking out against the Diagnostic and Statistical Manual (DSM-5) and International Classification of Diseases (ICD), which inaccurately medicalizes emotional and behavioral patterns. Contrary to the direct-to-consumer advertising messages from pharmaceutical companies, research has failed to find any significant functional, genetic, or biochemical cause of conditions such as ADHD, anxiety, bi-polar disorder, personality disorders, or depression. Notably, a meta-analysis of 107,000 studies failed to find a biological marker for any psychological issues.

Reconsidering how “mental disorders” are defined and described would reduce this over-reliance on biologic etiologies and on prescription medications to alleviate supposed “symptoms” of “disease.”

Increasing research indicates that shame is a major factor in the cause of mood disorders, personality disorders, and behavioral problems.
A scientifically based means of case assessment and formulation based on the involvement of shame as a trans-diagnostic cause of emotional distress would de-stigmatize mental health diagnosis for patients and provide a simple, yet powerful, case formulation model. Unlike the DSM, which provides no etiology or interventions for the disorders listed, this new model would inherently provide guidance toward effective therapeutic interventions. Because compassion-focused interventions are an antidote to shame, this trans-diagnostic and trans-theoretical approach would be more effective and beneficial for clients.

Published (March 2024): Chapter on “Clinical Case Formulation and Intervention Using a Shame-Informed Model” in “Practical Alternatives to the Psychiatric Model of Mental Illness: Beyond DSM and ICD Diagnosing”  Purchase here.



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