External Shame Research Articles

The External and Internal Shame Scale (EISS): Turkish Adaptation Study

The aim of this research is to carry out the Turkish adaptation, validity and reliability studies of the "External and Internal Shame Scale”, which was developed to measure the two sub-dimensions of shame, internal and external shame, at once. The sample of the research consists of 434 university students studying at Mersin University and other state universities. In order to provide evidence for the construct validity of the scale, confirmatory factor analysis (CFA) and criterion-related validity studies were conducted and the correlation values between the sub-factors were examined. When the correlation values between CFA and sub-factors and the results of the criterion-related validity study were examined, it was seen that the scale had sufficient construct validity. In order to determine the reliability of the scale, Cronbach's alpha internal consistency reliability coefficient, item-total test correlation (ITTC) coefficient and test-retest correlation coefficient were calculated. Cronbach's alpha internal consistency coefficients were calculated as .77 for internal shame sub-factor, .76 for external shame sub-factor and .87 for total shame. Similarly, ITTC coefficients were found to be between .49 and .64 for the internal shame sub-factor, between .49 and .62 for the external shame sub-factor, and between .56 and .71 for the total shame. In addition, the test-retest reliability coefficients were calculated as .79 for the internal shame subscale and .78 for the external shame subscale. The data obtained showed that the adapted External and Internal Shame Scale (EISS) is a valid and reliable measurement tool for measuring the internal, external and total shame of university students.

From shame to dysmorphic concern and anxiety: the role of body image-related psychological flexibility

ABSTRACT Objective Body image-related psychological flexibility is considered an important positive process in the field of body image, associated with lower levels of psychological distress. The present study hypothesised body image flexibility as a relevant construct in the study of body dysmorphic disorder (BDD). A mediation model was proposed, exploring if body image flexibility mediated the relationship between shame – a core construct of BDD symptomatology – and dysmorphic concern and anxiety while controlling for age and BMI. Methods The sample comprised 477 Portuguese-speaking participants from the general population – male and female, who completed a set of self-report measures. Results Females presented significantly higher levels of dysmorphic concern (d = .42). All main variables under study were significantly correlated, with dysmorphic concern presenting positive correlations with internal shame, external shame, and anxiety, and a negative and weak correlation with body image flexibility. Path analysis results indicated that body image flexibility mediated the relationship between shame, in its internal dimension, and dysmorphic concern and anxiety, explaining 34% of the variance of dysmorphic concern and 24% of anxiety. The model was invariant across biological sex. Conclusions Our results support the pervasive association between internal shame and dysmorphic concern, and indicate body image flexibility as a relevant emotional process in this relationship.

Experiencing Psychosis and Shame: A Systematic Review and Meta-analysis of the Strength and Patterns of Association.

Shame has been linked to the experience of psychosis, with implications for clinical outcomes, however, a meta-analysis of the relationship has not yet been conducted. This systematic review and meta-analysis aimed to examine the strength of the association between shame and psychosis, and any variations between clinical and non-clinical populations and shame type (internal vs external shame). Searches were conducted in CINAHL, EMBASE, PsycInfo, PubMed, Scopus, and Web of Science from the inception of the e-databases until July 2023. For inclusion, studies reported a quantitative association between psychosis and shame, or data that could be used to identify a relationship. From 11372 unique retrieved records, 40 articles met the inclusion criteria and 38 were included in the meta-analyses. A significant large pooled estimate of the psychosis-shame association was identified (Zr = 0.36, [95% CI: 0.28, 0.44], P < .001), indicating that higher levels of shame were associated with greater severity of psychotic symptoms. The strength of the association was similar across clinical and non-clinical populations, however, differed by type of shame and psychosis symptom measured. External shame was strongly associated with paranoia suggesting possible confounding. Only a minority of studies met the highest quality criteria. Shame is strongly associated with the severity of psychotic symptoms in clinical and non-clinical populations. Given the overlap with paranoia, measurement of external shame alone is not advised. Larger studies in clinical populations, with measures of a range of psychosis symptoms, are needed to better understand the relationship between shame and specific symptoms.

Resilience and Self-Compassion: Shields Against Age-Related Declines in Oral Health and Shame.

Objective This study aimed to investigate the complex relationships between demographic factors, oral health indicators, self-compassion, and psychological well-being among elderly individuals by using a path model analysis. Methods The findings of this cross-sectional study are derived from data collected from a sample of 204 patients, including 120 females and 84 males, aged between 60 and 92 years, with an average age of 74.2 years (SD = 7.1). Participants took part in assessments including the Geriatric Oral Health Assessment Index (GOHAI) to measure oral health (physical function, psychosocial function, pain/discomfort), self-compassion scale, and measures of shame and "other as shamer" experiences. Demographic information including age and gender was also collected. Path analysis was employed to examine the direct and indirect effects of demographic variables, oral health indicators, and self-compassion on psychological well-being. Results Older age was consistently associated with poorer oral health outcomes across all GOHAI oral health subscales. However, resilience and self-compassion appear to exert a correspondingly large positive influence, neutralizing the negative effects of increasing age on physical and psychosocial aspects of oral health-related quality of life. Additionally, resilience was positively associated with better physical and psychosocial function related to oral health while oral health was confirmed to be related to internal and external (social) shame. However, resilience and self-compassion outperformed oral health as far as their effect on internal and external (social) shame is concerned. Gender had minimal effects on most outcome variables. Conclusions The findings underscore the importance of addressing both physical and psychological aspects of health in elderly care and oral health interventions. By promoting psychological resilience and self-compassion, healthcare providers can potentially enhance oral health-related quality of life and overall well-being among elderly populations. Our results also highlight that promoting social and leisure activities may be a means of improving mental well-being, enhancing oral health outcomes, and reducing shame-related distress among elderly individuals.

Social influences on the relationship between dissociation and psychotic-like experiences.

Shame is experienced as a threat to social self, and so activates threat-protective responses. There is evidence that shame has trauma-like characteristics, suggesting it can be understood within the same conceptual framework as trauma and dissociation. Evidence for causal links among trauma, dissociation, and psychosis thus warrant the investigation of how shame may influence causal mechanisms for psychosis symptoms. This study tested the interaction between dissociation and shame, specifically external shame (feeling shamed by others), in predicting psychotic-like experiences (PLEs) six months later in a general population sample (N = 314). It also tested if social safeness moderates these effects. A longitudinal, online questionnaire design tested a moderation model (dissociation-shame) and a moderated moderation model (adding social safeness), using multiple regressions with bootstrap procedures. Although there was no direct effect of dissociation on PLEs six months later, there was a significant interaction effect with shame, controlling for PLEs at baseline. There were complex patterns in the directions of effects: For high-shame-scorers, higher dissociation predicted higher PLE scores, but for low-shame-scorers, higher dissociation predicted lower PLE scores. Social safeness was found to significantly moderate these interaction effects, which were unexpectedly more pronounced in the context of higher social safeness. The results demonstrate evidence for an interaction between dissociation and shame on its impact on PLEs, which manifests particularly for those experiencing higher social safeness. This suggests a potential role of social mechanisms in both the etiology and treatment of psychosis, which warrants further testing in clinical populations.

From childhood psychological maltreatment to fear of happiness: Exploring the serial mediation of external shame and family communication

BackgroundIt is known that childhood psychological maltreatment has an adverse influence on the present and future lives of individuals as well as on their past lives. Individuals exposed to psychological maltreatment avoid positive emotions throughout their lives, and their fear of happiness is triggered. ObjectiveConsidering that other factors may have an effect on this link, this study aims to examine the mediating role of external shame and family communication in the relationship between childhood psychological maltreatment and fear of happiness. MethodIn total 390 Turkish individuals participated from 51 different cities in Türkiye. Research data were analyzed by structural equation modeling. ResultsThe findings of the study indicated that external shame and family communication played a full mediating role in the relationship between childhood psychological maltreatment and fear of happiness. ConclusionsThe results revealed that external shame and family communication are important variables to change the beliefs about the happiness of individuals who are exposed to psychological maltreatment. All findings were discussed and interpreted in detail in light of the literature.

The Role of Shame and Traumatic Stress in Paranoia

Paranoia and persecutory delusions comprise the symptoms of established disorders such as schizophrenia in clinical populations. Paranoia is believed to exist on a continuum within the general population as well. There is limited research on the possible underpinnings of paranoia, but theoretical models of paranoia suggest that negative life events, trauma, negative views of the self and others, and emotional distress are important factors. Specifically, shame and traumatic life events/stress has been extensively entwined with the development of paranoid ideations among individuals. In this study, we explored the role of internal and external shame along with traumatic stress as it related to paranoia and emotional distress in a sample of ninety college students. Results showed that all variables were modestly correlated but further analysis showed that only external shame was related to the presence of paranoid ideation; internal shame was linked to anxiety and depression. Implications for the role of shame in paranoia are discussed.

'Food can help numb the pain': A mixed methods exploration of disordered eating, shame and self-compassion in an international community sample of men and women.

Background: Research into disordered eating (DE), shame and self-compassion (SC) has poorly represented men, general populations and non-Western communities. Aim: To explore associations between these variables in an international community sample of men and women. Methods: An online exploratory sequential mixed methods cross-sectional survey assessed levels of (quantitative Phase 1) and perceptions of (qualitative Phase 2) eating behaviours, external shame and body image shame (BIS) and SC. Results: Phase 1: Nearly 60% of our 142 survey participants were male (82/142) and about one-third were from India (43/142). About one-third of people (41/142) had a high-level concern regarding dieting, body weight, or eating (based on Eating Attitudes Test scores), and they had significantly higher levels of external shame, BIS and (SC-related) self-judgement and overidentification - compared to the 101/142 participants with low concern. Men had healthier levels of study outcomes than women. Phase 2: Four key themes were identified using inductive thematic analysis of the responses of 55 survey participants: (T1) DE as a Psychological Issue, (T2) DE as a Social Issue, (T3) The Vicious Cycle of Shame and (T4) Seeking Help. Conclusion: In participants in Phase 1 of our study - who were mostly male - DE behaviours were related to more external shame and body image-specific shame, and to less SC. Men had healthier levels of study variables than women. In Phase 2, participants talked about a vicious cycle of pathological eating and shame.

Psychometric properties of an Arabic translation of the external and internal shame scale (EISS)

BackgroundThe concept of shame in Arab societies displays multiple differences when compared to Western societies in terms of nature, sources, types, and correlates. Surprisingly, we could not find any study investigating this increasingly important construct in Arab countries or the broad Arabic-speaking communities. This may likely be due to the lack of valid instruments assessing shame in the Arabic language. To address this major gap and contribute to the international literature, we sought to examine the psychometric properties of an Arabic translation of the External and Internal Shame Scale (EISS) among a community sample of Arabic-speaking adults from Lebanon.MethodsAn online survey was conducted among Lebanese adults between July and August 2022. A total of 570 Lebanese adults completed the EISS, as well as Depression Anxiety Stress Scales, Other as shamer scale, and the Standardized Stigmatization Questionnaire. Exploratory-to-confirmatory (EFA-CFA) factor analyses were conducted.ResultsExploratory and confirmatory factor analyses supported a unidimensional model of EISS scores, with all eight items retained. Scores achieved scalar invariance across gender, with no significant difference reported between females and males. EISS scores were found to have adequate composite reliability (McDonald’s ω = 0.88 for the total score); as well as adequate patterns of correlations with depression, anxiety and stress symptoms, as well as stigmatization scores. Finally, our analyses provide support to the concurrent validity of the Arabic version of the scale, by showing that the EISS total scores strongly correlated with the external shame measure “other as shamer”.ConclusionAlthough further validations are necessary before our findings could be generalized, we preliminarily suggest that this is a short, easy-to-use, self-report scale that enables a reliable and valid measure of the shame construct among Arabic-speaking people.

Gendered racism, family and external shame, depressive symptoms, and alcohol use severity among Asian American men.

We investigated whether gendered racism predicts depressive symptoms and alcohol use severity among Asian American men (AAM) through indirect relations via culture-specific family and external shame. We analyzed convenience data from 409 AAM. Sample age (M = 21.24), nativity, ethnicity, education, income, and self-reported social class were diverse and controlled for. We path modeled direct associations among gendered racism and depressive symptoms and alcohol use severity, and their indirect (mediated) associations through family and external shame. About 21% and 25% of the sample met the clinical cutoffs for depressive symptoms and risky alcohol use, respectively. Gendered racism predicted depressive symptoms indirectly via external shame, and predicted alcohol use severity directly and indirectly via family shame. The hypothesized model fits the data better than an alternative model with shame factors as predictors. Gendered racism is an insidious psychiatric risk factor for AAM and appears to exacerbate family and external shame, which may subsequently and divergently increase depressive symptoms and alcohol use severity. Findings highlight the role of cultural factors within gendered racism-related stress processes among AAM. Future research should consider longitudinal designs and additional mediating and outcome variables to examine the behavioral health sequelae of gendered racism among AAM. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Construction and Statistical Validation of a Path Model of the Factors Influencing Non-suicidal Self Injury (NSSI) among Female Adolescents

Introduction: Despite having innumerable literatures, there has been dearth of comprehensive model of the manifestation of non-suicidal self-injury (NSSI). Aim and Objectives: The current study aims to construct a statistically validated model to explore the theoretical connections and the pathway to NSSI among female adolescents. Material and Method: A model was proposed based on the constructs empirically associated with NSSI. The research aims to explore the direct effects of external shame, hated self, and self-compassion on NSSI, and whether this relationship is mediated by borderline personality traits and menstrual phase. A total of 168 female adolescents completed the survey, including informed assent from the adolescents. The Other as Shamer Scale-2, the Forms of Self-Criticism/Self-Reassuring Scale, Self-Compassion Scale, the Risk-Taking and Self-Harm Inventory for Adolescents, and Borderline Personality Features Scale for Children were administered to the participants. Analysis of data involved descriptive statistics and path analysis. Result: The pathway shows hated self, disturbed intrapersonal relationship, and the inability to direct compassion for self may increase NSSI. Borderline personality traits and premenstrual dysphoria form indirect but contributory factors to strengthen the association between internal traits and NSSI. Conclusion: Thus it may be concluded from the present finding that external shame has significant negative effect on self-compassion and external shame has a significant positive effect on hated self. Also, self-compassion has a significant negative effect, and hated self as well external shame have significant positive effects on borderline traits. Thus, exploring this path would help to plan a suitable preventive action.

A Brief Self-Compassionate Letter-Writing Intervention for Individuals with High Shame.

Over the last decade, the mental health of undergraduate students has been of increasing concern and the prevalence of psychological disorders among this population has reached an unprecedented high. Compassion-based interventions have been used to treat shame and self-criticism, both of which are common experiences among undergraduate students and transdiagnostic vulnerability factors for an array of psychological disorders. This randomized controlled study examined the utility of a brief online self-compassionate letter-writing intervention for undergraduate students with high shame. Participants were 68 undergraduates who scored in the upper quartile on shame. Individuals were randomly assigned to a 16-day self-compassionate letter-writing intervention (n = 29) or a waitlist control group (n = 39). Participants completed baseline, post-assessment, and one-month follow-up measures. Participants who practiced self-compassionate letter writing evidenced medium-to-large reductions in global shame, external shame, self-criticism, and general anxiety at post-assessment, and gains were sustained at follow-up. Additionally, there were trend-level effects for increases in self-compassion and decreases in depression for those who participated in the intervention. This study examined the efficacy of self-compassionate letter-writing as a stand-alone intervention for undergraduate students with high shame. This brief, easily accessible, and self-administered practice may be beneficial for a host of internalizing symptoms in this population and may support university counseling centers as they navigate high demand for mental health services.

External and Internal Shame in people with migraines

IntroductionMigraine often leads to reduction of social power and prestige of the patients, hence leading further emotions of shame.ObjectivesExploring the role of external and internal shame in people with migraines.MethodsThe sample consisted of 180 people, more specifically 140 people from the general population and 40 people who have been diagnosed with migraine and receiving treatment for migraine, who completed the following questionnaires voluntarily and anonymously: a) Migraine Experience Questionnaire and Headache Impact Test-6 (HIT-6), b) the Other As Shamer scale (OAS) c) the Experience of Shame Scale (ESS), and socio-demographic and self-reported questionnaire.ResultsPatients scored higher level external Shame (OAS) rates (31.28 ± 6.98) than people from the general population who scored lower external Shame (OAS) rates (16.89 ± 10.00) with a statistically significant difference between them (p = 0.000). Also, patients scored lower-level internal shame (ESS) rates (45.58 ± 6.91) than people from the general population who scored higher internal shame (ESS) rates (53.36 ± 15.62) with a statistically significant difference between them (p = 0.003).ConclusionsPatients with symptoms of migraine show statistically higher level of external shame and lower level of internal shame and further study is considered necessary.Disclosure of InterestNone Declared

The psychodynamic role of the displacement defense mechanism in people with obesity and anorexia nervosa

IntroductionFeeding plays a very important role in our lives. First of all survival, but in general it has a much wider and important social role. Through feeding, in addition to satisfying life’s needs and basic instincts, we experience a sense of satisfaction through the investment of libido. Anorexia nervosa and obesity as the two extremes of eating disorders can be considered as a disturbed experience of the satisfaction of eating, and in the background there is usually a very weak, fragile personality structure. A fragile personality structure tends to use primitive defense mechanisms, but the use of healthier, neurotic defense mechanisms in people with eating disorders should not be neglected.Objectives To investigate the role of the psychological defense mechanism of displacement in people with obesity and anorexia nervosa.MethodsSearch of contemporary professional and scientific literature in the field of psychodynamics of eating disorders.ResultsDisplacement is a defense mechanism in which, when faced with a problem, the problem is not solved with the initial object of aggression, but the problem is moved to another object or situation that the individual perceives as less dangerous. Thus, when faced with a stressful situation or sadness, obese people may have a need for emotional eating, which can be interpreted as displacement of the problem, which is temporarily “solved” by satisfying the basic instinct, but later the person becomes overwhelmed by internal and external shame. Equally so, a traumatic upbringing and disturbed interpersonal family dynamics, which are often present in people with anorexia nervosa, can cause anxiety drives that are displaced in the form of the need for a strong restriction of food intake.ConclusionsIn people with obesity and anorexia nervosa, the use of the defense mechanism of displacement is pointed out. Through psychodynamic psychotherapy it can be very useful to recognize and interpert the use of displacement and, thus to enable reaching a neurotic and healthier level of functioning in people with the aforementioned eating disorders.Disclosure of InterestNone Declared

Compassion-Focused Therapy to Reduce Body Weight Shame for Individuals With Obesity: A Randomized Controlled Trial

Adults living in larger bodies (Body Mass Index > 30) often experience body weight shame, are highly self-critical, and are at increased risk for anxiety and depression. To date, there have been no RCTs examining the efficacy of Compassion-Focused Therapy (CFT) to help those experiencing body weight shame. The aim of the current study was to investigate the efficacy of CFT as a 12-session group intervention to reduce body weight shame for individuals living in larger bodies. The study used an RCT design with participants randomized to the CFT (n = 28) or waitlist control (n = 27) condition. Participants in both groups were assessed at pre- and postintervention, with the CFT group alone assessed at 3- and 6-month follow-up intervention. Both self-report and a physiological measure of parasympathetic nervous system activity were used (i.e., heart rate variability). Results indicated that CFT had a significant positive impact at postintervention compared to the control group for body weight shame (internal and external), increasing self-compassion, reducing fears of compassion (self, other, and receiving), reducing self-criticism, and reducing external shame. Although there were no significant group effects at postintervention on depression and anxiety, 66% of participants had clinical improvement on depression in the CFT group compared to 8% in the control group at postintervention. CFT did not shift baseline heart rate variability at postintervention. The evidence from this RCT supports CFT as an efficacious intervention to reduce body weight shame for individuals with obesity.

Quality of Life in Bipolar Disorder: Portuguese validation of the Brief QoL.BD questionnaire

The Brief Quality of Life in Bipolar Disorder (Brief QoL.BD) questionnaire is a short version of the first disorder-specific scale developed for Bipolar Disorder (BD), the QoL.BD, designed for use in research settings. This questionnaire has been considered a useful measure to assess psychological interventions’ improvements. This study aimed to validate and assess the psychometric properties of the Brief QoL.BD. Method: The Brief QoL.BD questionnaire was translated to Portuguese according to international guidelines, and participants with BD, psychiatrists and psychologists were consulted regarding its intelligibility. It was then administered to 110 people with BD (M = 43.81 ± 11.72, 66.4% ♀; 33.6% ♂), in addition to other self-report questionnaires, to assess satisfaction with life, anxiety, depression, external shame and positive and negative affect. Results: The Brief QoL.BD revealed good internal consistency (a = .84). Positive correlations with satisfaction with life and positive affect supported the scale’s convergent validity. Significant negative correlations supported the divergent validity with negative affect, depression, anxiety and external shame. Confirmatory factor analysis validated the original one-factor structure showing a good fit. Conclusion: The Portuguese translation of Brief QoL.BD questionnaire (European) proved to be a valid, and reliable quality of life measure to be used with people with bipolar disorder. BD type II displayed significantly lower levels of QoL than type I. Brief QoL.BD is short and easy to apply, being recommended for research purposes, specifically tracking psychological intervention’s impact.

The Role of Negative Emotions in Binge Eating Disorder

Binge Eating Disorder (BED) refers to the abnormal condition in which patients uncontrollably consume a large quantity of food for a persisting period. There are severe physical and mental health problems brought about by binging. This review is written with the purpose of analyzing the effects and mechanisms of negative emotions on BED. In addition, intervention approaches for BED are discussed. Negative moods are found to precede often binging behavior, and almost all non-purging patients of BED display feelings of guilt after binge eating episodes. From a biological point of view, cortisol and the HPA-Axis are suspected to be closely related to binge eating in response to stress. In addition, shame specifically is found to be positively correlated with binge eating, and binge-induced shame could trigger even more external shame, which forms the vicious cycle of BED. Several existing treatments for BED are reported to be effective to different extents, including either therapist-led or self-guided cognitive Behavior Treatment, Interpersonal Therapy, and Dialectical Behavior Therapy.

Compassionate mind training for ex-service personnel with PTSD and their partners.

Posttraumatic stress disorder (PTSD) is a significant issue for a substantial proportion of Australian ex-service personnel. In addition to the functional impact on individuals, PTSD can have a significant impact on intimate partner relationships. Research has demonstrated that practicing compassion and self-compassion may be an important component of psychological therapy for survivors of trauma, while also demonstrating benefits to intimate relationships. This pilot study aimed to investigate the utility of a Compassionate Mind Training intervention for ex-service personnel with PTSD and their partners. An uncontrolled, within-subjects, longitudinal design was utilized with assessment at pre-intervention, post-intervention and 3-month follow-up. Twenty-four participants attended 12 biweekly group sessions. Self-report measures of compassion, quality of life and psychological symptoms were administered at each time point. Findings demonstrated a significant reduction in fears of compassion and PTSD symptoms for ex-service personnel at 3-month follow-up and a reduction in depressive symptoms and increase in quality-of-life and social safeness at post-intervention. Additionally, significant reductions in anxiety, stress, external shame and self-criticism at 3-month follow-up were found, and couples reported significant increases in relationship satisfaction. Findings from this pilot study demonstrate promising outcomes, warranting further investigation in a larger randomized controlled trial of Compassionate Mind Training for ex-service personnel and their partners.

Construction and factorial validation of a short version of the Attitudes Towards Mental Health Problems Scale (SATMHPS)

ABSTRACT Negative attitudes and shame towards mental health problems are detrimental to mental health. An established measure for mental health attitudes and shame is the Attitudes Towards Mental Health Problems Scale (ATMHPS), comprising 35 items. This comprehensive instrument evaluates Community/Family Attitudes, Community/Family External Shame, Internal Shame, and Family/Self Reflected Shame. One weakness of the ATMHPS is its length. The present study constructed and validated a shorter version of the ATMHPS (SATMHPS), comprising 14 items. Samples of UK university students (274 business and 301 healthcare students) were recruited, and analyses were performed to construct and validate the factorial structure. The SATMHPS demonstrated good to excellent internal consistency, and very strong correlations with the original ATMHPS in both samples. Confirmatory factor analyses on the SATMHPS replicated the seven-factor model identified in the original ATMHPS. The SATMHPS can be a reliable, valid and user-friendly instrument to measure attitudes and shame towards mental health problems.

Understanding psychological mechanisms linking social anxiety and paranoia: A cross-cultural general population survey in Thailand and the United Kingdom

Effective interventions for treating social anxiety in psychosis, and understanding mechanisms between social anxiety to paranoia are limited. This study investigated stigma, internal and external shame, social rank appraisals, self-esteem and safety behaviours as mediators between social anxiety and paranoia in cross-cultural Thai and UK samples. Participants aged ≥18-year-old completed a cross-sectional internet-delivered survey. Social anxiety, paranoia, depression, and hypothesised mediating variables were measured. Both of the Thailand and UK samples were analysed separately to explore cultural differences. Associations between social anxiety and paranoia were calculated by linear regression. Mediation analysis was used to test the indirect effects of mediators. Eight-hundred and forty-two people completed the survey (427 from Thailand: 415 from the UK). Linear relationships between social anxiety and paranoia were found across both countries. In multiple mediation analyses, the social anxiety-paranoia relationship controlling for depression was significantly mediated by external shame and safety behaviours in both countries. Self-esteem was also significant, but only in the UK. External shame and safety behaviours were significant mediators, cross-culturally, explaining the indirect pathway of the social anxiety-paranoia relationship. Interventions targeting external shame and safety behaviours should be tested in clinical population to guide intervention for psychosis. Hypothesised potential factors were discussed. • A relationship between social anxiety and paranoia was found across Thailand and the UK. • Higher social anxiety is associated with higher paranoia through shame appraisals. • External shame was a key mediator in the social anxiety and paranoia process. • Future studies should test shame appraisals to confirm findings in clinical populations.