Shame and guilt in preschool depression: evidence for elevations in self-conscious emotions in depression as early as age 3

Background: Empirical findings from two divergent bodies of literature illustrate that depression can arise in the preschool period and that the complex self-conscious emotions of guilt and shame may develop normatively as early as age 3. Despite these related findings, few studies have examined whether the emotions of shame and guilt are salient in early childhood depression. This is important to further understand the emotional characteristics of preschool depression. Based on the hypothesis that preschool depression would be uniquely associated with higher levels of shame and maladaptive guilt, these emotions were investigated in a sample that included depressed, anxious, and disruptive disordered preschoolers as well as healthy peers using multiple methods. Method: Structured psychiatric diagnoses were derived in a sample of N = 305 preschoolers ascertained from community sites. Preschoolers’ tendency to experience shame and guilt were explored using a story stem completion task coded by raters blind to symptoms and diagnosis of the subjects. Guilt experience and reparation behaviors were also measured using parent report. Results: Based on preschooler’s emotion themes during the narrative tasks, gender, age, and depression severity predicted unique and significant portions of the variance in preschoolers’ expressions of shame. Parent report measures revealed that increasing depression severity was associated with children’s more frequent experiences of guilt feelings and less frequent attempts at guilt reparation (maladaptive guilt). Conclusions: Findings demonstrated that high levels of shame and maladaptive guilt were related to preschool onset depression when using observational measures of children’s internal representations of their self-conscious emotions as well as parent report. These findings demonstrate continuity of these core emotions of depression as early as age 3. These findings suggest that guilt and shame should be explored in clinical assessments of young children and may be an important focus for future studies of the developmental psychopathology of depression. Keywords: Guilt, shame, depression, young children, preschoolers. Increasing empirical evidence now suggests that major depressive disorder (MDD) may arise as early as age 3. The validity of preschool depression is evidenced by a specific and stable symptom constellation, discriminant validity from other early onset psychiatric disorders, and familial aggregation of affective disorders (for review see Stalets & Luby, 2006). Consistent with findings on the early emergence of clinically pertinent emotions, studies have shown that preschool children are also far more emotionally competent normatively than previously recognized (see Denham, 1998). Specifically, empirical data have indicated that the complex selfconscious emotions, such as guilt, embarrassment, and shame, may be experienced as early as 2 or 3 years of age (Barrett, Cole, & Zahn-Waxler, 1993). Despite these conceptually related but independent findings, few studies have investigated manifestations of guilt and shame in early childhood mood disorders. Investigations of self-conscious emotions in preschool mood disorders are of interest to further elucidate the clinical characteristics of these disorders in early childhood. Conversely, the relationship between alterations in emotion development and vulnerability to psychopathology is an area of increasing interest in developmental psychopathology research as better characterizations of this association may aid in the identification of risk factors and precursors of mood disorders (Cole, Luby, & Sullivan, 2008; Luby & Belden, 2006; Cole & Hall,