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Guilt and Shame Proneness and

Grief of Perinatal Bereavement
Article in Psychology and Psychotherapy Theory Research and Practice
January 2005
DOI: 10.1348/1476083042555442 Source: PubMed

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493

Psychology and Psychotherapy: Theory, Research and Practice (2004), 77, 493510
q 2004 The British Psychological Society
www.bps.org.uk

Guilt- and shame-proneness and the grief of

perinatal bereavement
Peter Barr *
Royal Alexandra Hospital for Children, Sydney, NSW, Australia
This longitudinal cohort study explored the relationship of guilt- and shame-proneness
to grief in women N 86 and men N 72 1 month (early) and 13 months (late)
after a stillbirth or neonatal death. Hierarchical regression showed that shameproneness explained a small but statistically significant proportion of the variance in
early grief in women (9%) and men (19%), whereas guilt-proneness did not contribute
further to the variance in early grief. Conversely, shame-proneness explained a
statistically significant and substantial proportion of the variance in late grief in women
(27%) and men (56%), and guilt-proneness made a significant further contribution to the
variance in women (21%) and men (11%). Overall, shame- and guilt-proneness
explained 45% of the variance in late grief in women and 63% of the variance in men.
Moreover, early shame-proneness predicted late grief in men. Personality guilt- and
shame-proneness showed important relationships with late grief in both women and
men, but there were notable sex differences.

The overly dependent clinging grief-prone personality has long been recognized as
problematic in clinical descriptions of bereavement (Parkes & Weiss, 1983), but few
empirical studies have considered personality characteristics as predictors of
bereavement outcome (Stroebe & Schut, 2001). Studies that have considered individual
differences in relation to the particular grief of reproductive loss have shown that
(a) neuroticism, (b) lack of ego strength, (c) defensiveness, (d) personal inadequacy, and
(e) selfcriticism not only predict grief but usually do so more strongly than demographic,
social, pregnancy and infant contextual variables (Franche, 2001; Hunfeld,
Wladimiroff, & Passchier, 1997; Hunfeld, Wladimiroff, Verhage, & Passchier, 1995;

* Correspondence to Dr Peter Barr, The Childrens Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145,
Australia (e-mail: peter@chw.edu.au).

494

Peter Barr

Janssen, Cuisinier, de Graauw, & Hoogduin, 1997; Lasker & Toedter, 2000;
Zeanah, Danis, Hirshberg, & Dietz, 1995).
The experience and expression of a myriad of emotions is integral to grief. In the
midst of their lamentation, bereaved parents, particularly mothers, are wont to express
feelings of anxiety, fear, guilt, regret, remorse, anger, resentment, jealousy, envy, rage,
loneliness, sorrow and depression (Simonds & Rothman, 1992). If the aforementioned
personality characteristics predict grief, and emotion states or moods are keenly felt in
grief, then emotion-based personality traits may have important relationships with grief,
since individuals normally manifest emotions along a continuum from acute states
through chronic moods to emotion traits (Ekman & Davidson, 1994).
Guilt and shame are generally considered to be related but separate emotion states
that can be organized into emotion-based personality traits (Malatesta & Wilson, 1988;
Tangney & Fischer, 1995). Guilt and shame are similar in that they are negative, selfconscious, moral emotions occasioned by similar transgressions or failures, and
therefore they commonly co-exist (Tangney & Fischer, 1995). According to Tangney
(1995) and Lewis (1995), the quintessential difference between guilt and shame is the
focus on the self. In guilt, the individual finds fault with his or her behaviour without
denigrating the self, whereas in shame the individuals global self is considered faulty.
There are other important differences between guilt and shame, particularly concerning
the phenomenological experience and the associated action tendencies (Tangney &
Fischer, 1995). The individual who feels guilt feels agitated, regretful and remorseful,
and seeks to apologize, confess or take other reparative action. On the other hand, the
individual who feels shame feels dejected, small, exposed, helpless and powerless, and
seeks to hide or escape or, sometimes, angrily retaliate. Guilt-proneness is also
associated with empathy, perspective taking and the constructive use of anger, whereas
shame-proneness is not related to these prosocial tendencies (Gilbert, 2003; Leith &
Baumeister, 1998; Tangney & Dearing, 2002).
Although once referred to as the sleeper in psychopathology (Lewis, 1987a), shame
is now considered to be central to diverse forms of mental illness (Gilbert & Andrews,
1998; Kaufman, 1989; Lansky & Morrison, 1997). Opinions differ concerning guilts role
in the development of psychological symptoms, particularly whether guilt per se or guilt
fused with shame is responsible for psychopathology (Lewis, 1971; Tangney, Burggraf,
& Wagner, 1995). Nevertheless, guilt has a long-standing association with mental illness
(Bybee & Quiles, 1998; Harder, 1995), particularly depression and obsessionality
(American Psychiatric Association, 2000; Lewis, 1979).
The relationship of guilt- and shame-proneness to grief following bereavement in the
perinatal period has not been studied empirically, though an important relation seems
likely for several reasons. First, bereaved parents, particularly mothers, commonly blame
themselves or feel responsible for their babys death (Benfield, Leib, & Vollman, 1978;
Dunn, Goldbach, Lasker, & Toedter, 1991; Wilson, Witzke, Fenton, & Soule, 1985).
Second, survivor guilt has a long association with bereavement (Niederland, 1981),
including the death of a child (Miles & Demi, 1986). Third, pregnancy failure has been

Guilt, shame and grief

495

couched in terms of narcissistic injury (Furman, 1978; Leon, 1990) and shame is the
veiled companion of narcissism (Wurmser, 1987, p. 64). Fourth, bereaved parents may
feel the shame associated with an unwanted identity (Ferguson, Eyre, & Ashbaker,
2000), because they unwittingly violate social norms concerning matters of fecundity,
nurturance, sexual adequacy and the expression of emotions (Brody, 1999; Fischer,
2000). Finally, grief is widely understood in terms of attachment theory (Shaver &
Tancredy, 2001), and shame- and guilt-proneness have been related to perturbations in
attachment style (Harder & Greenwald, 1999).
The common occurrence of guilt and/or shame states or moods in bereaved parents,
the relation between negative self-conscious emotion traits and psychological
symptoms, and the importance of personality characteristics as predictors of grief
prompted the present research, which was designed to explore the supposition that
personality guilt- and shame-proneness are likely to predict grief in parents who have
suffered a stillbirth or neonatal death.

Methods
Participants
Four of the six hospitals in Sydney, Australia that provide both high-risk obstetric and
neonatal intensive care services participated in the study. Eligibility for the study
required that parents were literate in English and lived in metropolitan Sydney. A letter
explaining the nature of the study was posted to eligible parents 2 3 weeks after they
had experienced either a stillbirth ($ 20 weeks gestation) or neonatal death (# 28 days
from birth), and 1 week later they were contacted to ascertain their willingness to
participate in the study.
The author visited the participating parents at home 1 month and 13 months after
the death. The study questionnaires were usually answered in the authors presence
immediately after a semi-structured interview, which at 1 month included a narrative of
the loss. The small number of parents who lived outside metropolitan Sydney when the
second study period fell due received a follow-up interview by telephone and the
questionnaires were posted to them for completion.
Self-report study questionnaires
The Perinatal Grief Scale-33 (PGS-33; Potvin, Lasker, & Toedter, 1989) has been
widely used to quantify grief intensity after pregnancy loss (Toedter, Lasker, & Janssen,
2001). The scale items are derived from the Expanded Texas Grief Inventory (Zisook,
Devaul, & Click, 1982), the neonatal grief scale of Kennell, Slyter, and Klaus (1970), and
facets of grief thought to be unique to pregnancy loss (Toedter, Lasker, & Alhadeff,
1988). The questionnaire items are presented as statements to which participants
respond on a 5-point scale that ranges from 1 Strongly agree to 5 Strongly disagree.
Negatively valenced items are reverse-scored so that higher total scores indicate
more intense grief. The internal reliability coefficient (Cronbachs a) for the PGS-33

496

Peter Barr

was .94, which was within the range reported by Toedter et al. (2001). Only two of the
PGS-33 items have guilt and/or shame emotion face validity: I feel guilty when I think
about the baby, and I blame myself for the babys death. In addition, the correlations of
shame with grief reported below were not strong enough to suppose that they may be
solely a consequence of a diffuse negative affectivity reflected in both measures
(Andrews, 1998, p. 50).
The Test of Self-Conscious Affect-2 (TOSCA-2; Tangney, Ferguson, Wagner,
Crowley, & Gramzow, 1996) is a measure of scenario-based and, therefore,
situational guilt- and shame-proneness, as well as proneness to ruminative guilt,
pride, externalization and detachment. Only the 16-item TOSCA-2 Guilt and Shame
scores were used in the present study, because doubt has been cast on the
discriminant validity of the Ruminative Guilt scale (Tangney & Dearing, 2002).
Participants are presented with hypothetical everyday life situations and asked their
likelihood of responding in ways that reflect the cognitive, behavioural and affective
aspects of guilt and shame using a 5-point scale that ranges from 1 Not likely to
5 Very likely. TOSCA-2 Guilt is operationalized to measure functional proneness to
remorseful acceptance of responsibility for here-and-now transgression or failure,
accompanied by the desire to seek redress through apology or other reparative
prosocial behaviour (Lewis, 1971; Tangney, 1995). TOSCA-2 Shame is operationalized to measure dysfunctional proneness to notions of inferiority, inadequacy or
incompetence (negative self-evaluation) in relation to transgression or failure,
accompanied by the desire to hide or disappear (Lewis, 1971; Tangney, 1995). For
example, the guilt-relevant response to the scenario, You make a mistake at work
and find out that a co-worker is blamed for the error is You would feel unhappy
and eager to correct the situation, whereas the shame-relevant response is
You would keep quiet and avoid the co-worker. Similarly, the guilt-relevant response
to the scenario, While playing around, you throw a ball and it hits your friend in the
face is You would apologize and make sure your friend feels better, whereas the
shame-relevant response is You would feel inadequate that you cant even throw a
ball. The respective Cronbachs a values for TOSCA-2 Guilt and Shame were
.73 and .74, whereas their respective 12-month test retest reliability coefficients
were .58 and .67 (Tangney & Dearing, 2002). The internal consistency and test retest
reliabilities were similar to those reported by Tangney and Dearing (2002).
The Personal Feelings Questionnaire-2 (PFQ-2; Harder & Zalma, 1990) is an
adjective-based checklist that is operationalized to measure chronic guilt- and shameproneness; that is guilt and shame not integrally linked to a present moment
precipitating event, but perhaps seeded from the preconscious (Bybee & Quiles, 1998;
Harder, 1995). There are six guilt items that include mild guilt, remorse and regret, and
10 shame items that include embarrassment, feeling ridiculous and feeling
humiliated. Participants are presented with an emotion word or phrase and asked
how frequently they experience the designated feeling on a 5-point scale that ranges
from 0 Never experience to 4 Continuously or almost continuously experience.

Guilt, shame and grief

497

The respective Cronbachs a values for PFQ-2 Guilt and Shame were .76 and .76, which
correspond to the values reported by Harder and Zalma (1990). Harder and Zalma
(1990) reported 2-week test retest reliability coefficients for PFQ-2 Guilt and Shame of
.85 and .91, respectively, whereas the respective 12-month test retest reliability
coefficients for PFQ-2 Guilt and Shame in the present study were .63 and .56.
The Interpersonal Guilt Questionnaire-67 (IGQ-67; OConnor, Berry, Weiss, Bush,
& Sampson, 1998) is operationalized to measure guilt based on pathogenic or irrational
belief schemas (OConnor, Berry, Weiss, Bush, & Sampson, 1997). The IGQ-67 has
separate scales for Survivor Guilt, Separation Guilt, Omnipotence Guilt and SelfHate
Guilt, but only the Survivor Guilt and Omnipotence Guilt scores were used in the
present report. Survivor Guilt (22 items) is operationalized to measure guilt derived
from the belief that one is harming others by surpassing them, being better off, being
successful or happy (OConnor, Berry, & Weiss, 1999, p. 190). Survivor Guilt is
captured by items such as, It makes me very uncomfortable if I am more successful at
something than are my friends or family members, and I cant be happy when a friend
or relative is suffering a disappointment. Omnipotence Guilt (14 items) is
operationalized to measure guilt derived from the belief that one [is] responsible for
the well-being of others, and that one has the power to make others successful and
happy (OConnor et al., 1999, p. 190). Omnipotence Guilt is captured by items such as,
I worry a lot about the people I love even when they seem to be fine, and If something
goes wrong in the family I tend to ask myself how could I have prevented it. Participants
are asked to respond to item statements using a 5-point scale that ranges from 1 Very
untrue of me or strongly disagree to 5 Very true of me or strongly agree. The
respective Cronbachs a for Survivor Guilt and Omnipotence Guilt were .74 and .79, and
these values were comparable with those reported by OConnor et al. (1999).
The 12-month test retest reliability coefficients for IGQ-67 Survivor Guilt and
Omnipotence Guilt were .71 and .56, respectively.
The author first became aware of the IGQ-67 when the first data collection period
was underway and consequently only 115 of the 158 parents completed the IGQ-67 at
1 month.
Incorporating different measures of guilt- and shame-proneness into the study
protocol enabled a more comprehensive and discerning evaluation of domains of guilt
possibly germane to parental grief (Miles & Demi, 1986), specifically (a) functional
situational guilt (TOSCA-2), (b) dysfunctional chronic guilt (PFQ-2), (c) pathogenic
survivor guilt (IGQ-67), and (d) pathogenic omnipotence guilt (IGQ-67). In addition, the
different measures of shame-proneness were used to partly compensate for their
individual conceptual and methodological differences and possible deficiencies
(Andrews, 1998; Ferguson & Crowley, 1997; Harder, 1995; OConnor et al., 1999;
Tangney & Dearing, 2002; and see below). Even so, the shame measures used did not
specifically code for certain domains of shame (Greenwald & Harder, 1998), such as
stigma (Lewis, 1998), unwanted identity (Ferguson et al., 2000), and gender role stress
(Efthim, Kenny, & Mahalik, 2001).

498

Peter Barr

Results
Participants
In the period from February 1999 to July 2000, 359 parents became eligible for the study
and 158 (44%) agreed to participate, including 86 of 185 women and 72 of 174 men
x2 1; 359 0:95; p ns: There were 68 couples and 22 individuals. Eighty-two
parents had experienced a stillbirth, which included six terminations for a fetal anomaly,
and 76 had experienced a neonatal death. There were too few terminations to justify
their separate analysis, but they were included because women who have a late
termination for fetal anomaly do not experience more grief or more guilt than woman
who suffer a spontaneous perinatal loss (Zeanah, Dailey, Rosenblatt, & Saller, 1993). The
type of loss had a negligible correlation with early and late grief in both sexes and
therefore stillbirth and neonatal death were considered under the rubric perinatal
death.
The women were younger than the men (M 32:0; SD 6:00 versus M 34:4;
SD 7:09; t156 2:30; p :02). The 201 eligible parents (56%) who did not
participate in the study either declined N 190 or could not be located N 11 and
no data were available for this group. The 158 parents who enrolled at 1 month were
contacted 12 months later and 149 (94%) agreed to continue their participation,
including 80 of 86 women and 69 of 72 men x2 1; 158 0:57; p ns:
The parents ethnicity was English-Australian (75%; born in Australia, New Zealand,
UK, Ireland, or North America), Asian-Australian (11%), European-Australian (8%) and
Other-Australian (6%). The parents highest level of education was high school
attendance (4%), Year 10 (19%), Year 12 or Technical and Further Education diploma
(40%), and university degree (37%). The parents ethnicity and educational level were
not different from their reported proportions in the general population (Australian
Bureau of Statistics, 2003a, 2003b). The parents were married (70%), cohabiting (23%),
single (5%) or separated (2%).

Descriptive statistics for grief, shame and guilt

The descriptive statistics for grief, guilt and shame are shown in Table 1. Women
compared with men self-reported significantly more intense early grief 1 month after
the loss, but there was no significant sex difference in late grief at 13 months. Women,
compared with men, self-reported significantly more TOSCA-2 Shame and Guilt, and
IGQ-67 Survivor Guilt, but there were no significant sex differences in PFQ-2 Shame and
Guilt, and IGQ-67 Omnipotence Guilt.

Shame and guilt partial correlations with grief

A correlation coefficient was coded as small, moderate or large when the Pearson r value
was ^ .10 .29, .30 .49 or .50 1.0, respectively (Cohen, 1988). A matrix of the guilt and
shame correlations is shown in Table 2. There were large within-method correlations

Guilt, shame and grief

499

Table 1. Descriptive statistics for grief, guilt and shame

Women
Variable

PGS-33 Grief
TOSCA-2 Shame
TOSCA-2 Guilt
PFQ-2 Shame
PFQ-2 Guilt
IGQ-67 Survivor Guilt
IGQ-67 Omnipotence Guilt
PGS-33 Grief
TOSCA-2 Shame
TOSCA-2 Guilt
PFQ-2 Shame
PFQ-2 Guilt
IGQ-67 Survivor Guilt
IGQ-67 Omnipotence Guilt

Men

SD

95.4
47.9
66.3
14.7
10.1
67.9
48.9

21.00
8.51
6.33
4.56
3.59
8.48
7.35

76.7
47.3
66.1
13.7
9.7
67.8
48.3

24.02
9.95
6.96
5.28
3.30
9.11
8.20

SD

h2

82.7
41.8
61.3
14.1
9.8
64.0
46.9

One month
20.73
8.78
7.46
5.29
3.96
7.96
5.74

3.81
4.42
4.60
0.70
0.45
2.55
1.58

,.001
,.001
,.001
ns
ns
.01
ns

.08
.11
.12

.05

71.9
40.5
61.6
13.8
9.4
63.6
47.1

13 months
24.57
1.19
9.36
4.28
6.76
3.96
5.71
2 0.09
3.99
0.50
9.99
2.65
6.51
0.96

ns
,.001
,.001
ns
ns
.009
ns

.11
.10

.05

Note. The means for women and men were compared using independent-sample t-tests. IGQ67 Interpersonal Guilt Questionnaire-67, PFQ-2 Personal Feelings Questionnaire-2, PGS33 Perinatal Grief Scale-33, and TOSCA-2 Test of Self-Conscious Affect-2.
Table 2. Correlation matrix of guilt and shame

1.
2.
3.
4.
5.
6.

TOSCA-2 Shame
TOSCA-2 Guilt
PFQ-2 Shame
PFQ-2 Guilt
IGQ-67 Survivor Guilt
IGQ-67 Omnipotence Guilt

.50***
.45***
.36***
.54***
.42***

.13
.12
.36***
.37***

.60***
.31**
.35**

.37***
.31**

.52***

Note. IGQ-67 Interpersonal Guilt Questionnaire-67. PFQ-2 Personal Feelings Questionnaire-2.

TOSCA-2 Test of Self-Conscious Affect-2.
**p , .01, ***p , .001.

between TOSCA-2 Guilt and Shame r :50 and PFQ-2 Guilt and Shame r :60:
In addition, IGQ-67 Survivor Guilt had a stronger correlation with TOSCA-2 Shame
r :54 than with the other extant measures of guilt r :36 :52: In order to explore
the correlations of pure guilt and shame with grief (Harder, 1995; OConnor et al.,
1999; Tangney, 1996), TOSCA-2 Guilt and Shame were partialled or controlled for each

500

Peter Barr

other, as were PFQ-2 Guilt and Shame, and IGQ-67 Survivor Guilt and Omnipotence
Guilt were partialled for TOSCA-2 Shame.
The shame and guilt partial correlations with early grief are shown in Table 3.
TOSCA-2 Shame had a small correlation with early grief in women and a moderate
correlation in men, whereas PFQ-2 Shame had a small correlation with early grief in both
sexes. TOSCA-2 Guilt had a small negative correlation with early grief in women and a
negligible correlation in men. PFQ-2 Guilt had a small correlation with early grief in both
sexes. IGQ-67 Survivor Guilt had a small correlation with early grief in women and a
moderate correlation in men, whereas IGQ-67 Omnipotence Guilt had a small
correlation with early grief in both sexes.
Table 3. Partial correlations of shame and guilt with grief
PGS-33 Grief
One month
Variable
TOSCA-2 Shame
PFQ-2 Shame
TOSCA-2 Guilt
PFQ-2 Guilt
IGQ-67 Survivor Guilt
IGQ-67 Omnipotence Guilt

13 months

Women

Men

Women

Men

.24*
.18
2 .10
.20
.28*
.16

.44***
.15
2 .06
.28*
.39**
.16

.39***
.26*
2.24*
.32**
.30**
.09

.61***
.41**
2 .02
.30*
.38**
.34**

Note. TOSCA-2 Shame and Guilt were partialled for each other. PFQ-2 Shame and Guilt were partialled
for each other. IGQ-67 Survivor Guilt and Omnipotence Guilt were partialled for TOSCA-2 Shame.
IGQ-67 Interpersonal Guilt Questionnaire-67, PFQ-2 Personal Feelings Questionnaire-2, and
TOSCA-2 Test of Self-Conscious Affect-2.
*p , .05, **p , .01, ***p , .001.

The shame and guilt partial correlations with late grief are also shown in Table 3.
TOSCA-2 Shame had a moderate correlation with late grief in women and a large
correlation in men. PFQ-2 Shame had a small correlation with late grief in women and a
moderate correlation in men. TOSCA-2 Guilt had a small but statistically significant
negative correlation with late grief in women, but a negligible correlation in men. PFQ-2
Guilt and IGQ-67 Survivor Guilt had moderate correlations with late grief in both sexes.
IGQ-67 Omnipotence Guilt had a moderate correlation with late grief in men, but a
negligible correlation in women.

Hierarchical regression of grief on shame and guilt

TOSCA-2 Shame and PFQ-2 Shame were entered at Step 1 in a series of hierarchical
multiple regressions, and TOSCA-2 Guilt, PFQ-2 Guilt, and IGQ-67 Survivor Guilt and

Guilt, shame and grief

501

Omnipotence Guilt were entered at Step 2. In this way, guilt was statistically controlled
for shame, thereby enabling a measure of pure guilt, but conceding shame any of the
shared variance with grief (Ferguson & Crowley, 1997; Tabachnick & Fidell, 2001).
The results for the regression of early grief on shame and guilt at 1 month are shown
in Table 4. Shame explained a small but significant proportion of the variance in early
grief in women (9%) and men (19%). PFQ-2 Shame in women and TOSCA-2 Shame in
men made significant unique contributions to the variance in early grief. Guilt
controlled for shame did not make a significant further contribution to the variance in
early grief in either sex. Shame and guilt together explained 13% of the variance in early
grief in women and 27% of the variance in men.
Table 4. Hierarchical regression of early grief on shame and guilt
Women
Variable

Step 1
TOSCA-2 Shame
PFQ-2 Shame

.11
.29

Step 2
TOSCA-2 Shame
PFQ-2 Shame
TOSCA-2 Guilt
PFQ-2 Guilt
IGQ-67 Survivor Guilt
IGQ-67 Omnipotence Guilt

.06
.18
2.17
.19
.27
2.02

0.87
2.24*

0.36
1.17
2 1.16
1.26
1.73
2 0.12

Men
sr 2

.01
.07

.34
.19

2.27*
1.23

.08
.02

.00
.02
.02
.02
.04
.00

.19
.04
2 .08
.17
.35
.05

1.13
0.22
20.59
1.07
2.32*
0.41

.02
.00
.01
.02
.08
.00

sr 2

Note. Women. Step 1: R :35; F2; 61 4:18; p , :05; R 2 :12; R 2 adjusted :09: Step 2:
R :46; F6; 57 2:62; p , :05; R 2 :22; R 2 adjusted :13: DR 2 :10; F change 1:74;
p ns: Men. Step 1: R :47; F2; 48 6:85; p , :01; R 2 :22; R 2 adjusted :19: Step 2: R :60;
F6; 44 4:12; p , :01; R 2 :36; R 2 adjusted :27: DR 2 :14; F change 2:36; p ns:
IGQ-67 Interpersonal Guilt Questionnaire-67, PFQ-2 Personal Feelings Questionnaire-2, and
TOSCA-2 Test of Self-Conscious Affect-2.
*p , .05.

The results for the regression of late grief on shame and guilt at 13 months are shown
in Table 5. Shame explained a substantial proportion of the variance in late grief in
women (27%) and, especially, in men (56%). PFQ-2 Shame in both sexes and TOSCA-2
Shame in men made a significant unique contribution to the variance in late grief. In
addition, guilt controlled for shame made a significant further contribution to the
variance in late grief in women (21%) and men (11%). Shame and guilt together
accounted for 45% of the variance in late grief in women and 63% of the variance in men.
TOSCA-2 Shame, TOSCA-2 Guilt, PFQ-2 Guilt and IGQ-67 Survivor Guilt made significant

502

Peter Barr

Table 5. Hierarchical regression of late grief on shame and guilt

Women
Variable

Step 1
TOSCA-2 Shame
PFQ-2 Shame

.17
.46

.23
.20
2.38
.41
.27
2.19

Step 2
TOSCA-2 Shame
PFQ-2 Shame
TOSCA-2 Guilt
PFQ-2 Guilt
IGQ-67 Survivor Guilt
IGQ-67 Omnipotence Guilt

Men
sr 2

1.62
4.48***

.02
.19

.36
.47

2.20*
1.78
23.96***
3.67***
2.44*
21.78

.03
.02
.11
.09
.04
.02

.21
.29
2 .18
.21
.34
.05

3.30**
4.35***

1.79
2.25*
2 1.88
1.82
2.83**
0.50

sr 2

.07
.12

.02
.03
.02
.02
.04
.00

Note. Women. Step 1: R :54; F2; 77 15:58; p , :001; R 2 :29; R 2 adjusted :27: Step 2:
R :70; F6; 73 11:88; p , :001; R 2 :49; R 2 adjusted :45: DR 2 :21; F change 7:43;
p , :001: Men. Step 1: R :75; F2; 66 43:63; p , :001; R 2 :57; R 2 adjusted :56: Step 2:
R :81; F6; 62 20:31; p , :001; R 2 :66; R 2 adjusted :63: DR 2 :11; F change 4:29;
p , :01: IGQ-67 Interpersonal Guilt Questionnaire-67, PFQ-2 Personal Feelings Questionnaire-2, and TOSCA-2 Test of Self-Conscious Affect-2.
*p , .05, **p , .01, ***p , .001.

unique contributions to the variance in late grief in women, whereas PFQ-2 Shame and
IGQ-67 Survivor Guilt made significant contributions in men.
The results for the regression of late grief on early shame and guilt are shown in
Table 6. Early shame predicted a significant proportion of the variance in late grief in
men (26%). Early guilt controlled for shame made a significant further contribution to
the variance in late grief in men (20%). PFQ-2 Shame and IGQ-67 Survivor Guilt made
significant unique contributions to the variance in late grief in men. Finally, early shame
controlled for early grief continued to contribute significantly to the variance in late grief
in men DR 2 0:9; p :006; but early guilt controlled for early grief and shame no
longer predicted late grief. Early shame and guilt did not predict late grief in women.

Discussion
The observation that personality proneness to shame predicted only a relatively small
proportion of the variance in early grief in women and men, and guilt-proneness did not
make a further contribution to the variance was in accord with Weisss (1993) notion
that a person may organize his affects, impulses, behaviors, and goals in accordance
with his immediate reality : : : [and] override the reality that his conscious and
unconscious beliefs [personality] portray for him (Weiss, 1993, p. 34). The parents

Guilt, shame and grief

503

Table 6. Hierarchical regression of late grief on early shame and guilt

Women

Men

Variable

sr 2

Step 1
TOSCA-2 Shame
PFQ-2 Shame

.10
.11

0.70
0.78

.01
.01

.10
.48

.13
.01
2.20
.20
.14
2.05

0.76
0.06
21.27
1.20
0.79
20.25

.01
.00
.03
.02
.01
.00

2 .11
.37
2 .06
.14
.50
2 .09

Step 2
TOSCA-2 Shame
PFQ-2 Shame
TOSCA-2 Guilt
PFQ-2 Guilt
IGQ-67 Survivor Guilt
IGQ-67 Omnipotence Guilt

sr 2

0.71
3.30**

.01
.16

2 0.74
2.41*
2 0.47
0.98
3.69***
2 0.78

.01
.07
.00
.01
.16
.01

Note. Women. Step 1: R :17; F2; 57 0:87; p ns; R 2 :03; R 2 adjusted 2:005: Step 2:
R :31; F6; 53 0:91; p ns; R 2 :09; R 2 adjusted 2:009: DR 2 :06; F change 0:94; p
ns: Men. Step 1: R :54; F2; 47 9:83; p , :001; R 2 :29; R 2 adjusted :26: Step 2: R :71;
F6; 43 7:13; p , :001; R 2 :50; R 2 adjusted :43: DR 2 :20; F change 4:37; p , :01:
IGQ-67 Interpersonal Guilt Questionnaire-67, PFQ-2 Personal Feelings Questionnaire-2, and
TOSCA-2 Test of Self-Conscious Affect-2.
*p , .05, **p , .01, ***p , .001.

immediate reality of a stillbirth or neonatal death may be expected to evoke shame and
guilt emotion states or moods, since these self-conscious emotions, like the yearning,
pining and searching of acute grief (Bowlby, 1981), serve to signal the loss of an
important attachment relationship or social bond (Baumeister, Stillwell, & Heatherton,
1994; Gilbert, 2003; Harder & Greenwald, 2000; Lewis, 1987b; OConnor, 2000). Once
the loss is acknowledged to be permanent, guilt and shame should abate, unless they
function as enduring, idiosyncratic, cross-situational, emotion-based personality traits
(Ekman & Davidson, 1994; Malatesta & Wilson, 1988; Weiss, 1993). In support of this
notion, the present study showed that shame- and guilt-proneness were important
predictors of late grief in women and men.

Shame and late grief

Chronic (PFQ-2) shame-proneness contributed more than situational (TOSCA-2) shameproneness to the variance in late grief in both sexes. This finding suggests that chronic
shame-proneness cast as the frequency with which individuals report shame in their
everyday lives may be more relevant to late grief than situational shame-proneness
portrayed as the likelihood with which shame is experienced in response to here-andnow, albeit hypothetical, transgressions or failures (Diener, Larsen, Levine, & Emmons,
1985). Alternatively, the PFQ-2 may have been more representative of shame than the

504

Peter Barr

TOSCA-2, since the former does not (a) confound shame with low self-esteem,
(b) constrain shame to negative self-evaluation, and (c) confine shame attribution to
behavioural transgression or failure (Andrews, 1998).
There are a number of speculative explanations for why men made stronger shamerelevant attributions than women for perceived failure or transgression in relation to a
perinatal death. First, the circumstances surrounding the death and the subsequent grief
may have evoked an unwanted identity in men rather than women (Ferguson et al.,
2000); namely the emotionally vulnerable grief-stricken man counterstereotype (Lund,
2001). Second, men may have been less able than women to mollify their shame
experience by evoking a defensive functional situational guilt response (Lewis, 1995,
and see below). Third, men, compared with women, may have felt shame for their
partner (or deceased infant), since the import of shame for others may reach even
deeper than shame for ourselves (Lynd, 1958, p. 56). Finally, the shame measures used
may have failed to capture the full extent of womens shame, since they did not measure
bodily shame (Andrews, 1998), which may be a specific vulnerability of the
narcissistically injured women since both parents include the child in their own
mental self, but only the mother invests him also as a part of her bodily self (Furman,
1996, p. 431).
The correlational nature of the present study does not allow any conclusion
regarding direction of causality (Andrews, 1998). Indeed, the correlation between
shame and grief may have been fortuitous by virtue of a correlation in common with an
unmeasured variable such as depression. However, the most reasonable conclusion is
that shame-proneness is an important concomitant of late grief in both sexes, and a
consequential antecedent to late grief in men.

Guilt and late grief

The significant negative correlation of functional (TOSCA-2) guilt-proneness with late
grief in women was consistent with the prosocial nature of the emotion and its general
lack of positive correlation with psychopathology (Tangney et al., 1995). Thus,
functional guilt, which has a behavioural rather than global attributional focus relative to
the self (Weiner, 1986), may be a useful personality trait in women bereaved by stillbirth
or neonatal death. First, the guilt-based belief that the tragedy may have been averted
had they done something different may offset womens more disconcerting notions that
the death was uncontrollable, inexplicable, starkly random, and, therefore, possibly
shameful (Dunn et al., 1991; Gardner, 1969; Weiner, 1986; Yalom, 1980). Second,
empathic concern for others, which is related to functional guilt (Baumeister et al.,
1994; Gilbert, 2003; Tangney & Dearing, 2002), may help mitigate womens morbid
tendency to ruminate about their loss and become depressed (Nolen-Hoeksema, 2001).
Third, the prosocial communal nature of functional guilt may help women garner
and benefit from post-bereavement psychosocial support (Lasker & Toedter, 2000). The
aforementioned potential benefits of functional guilt-proneness should be tempered

Guilt, shame and grief

505

with the caveat that TOSCA-2 Guilt may be more representative of moral values or
empathy than guilt affect (Ferguson & Stegge, 1998; Kugler & Jones, 1992; Tangney &
Dearing, 2002). Finally, it should be noted that the lack of correlation between
functional guilt-proneness and grief in men may have been because the TOSCA-2 lacked
sensitivity and/or ecological validity in bereaved men (Tangney & Dearing, 2002).
The significant correlation of dysfunctional chronic (PFQ-2) guilt with late grief in
both women and men was consistent with chronic guilts previously reported positive
correlation with psychopathology (Bybee & Quiles, 1998; Harder, 1995; Lewis, 1979).
Chronic guilt may be fused with shame (Lewis, 1971; Tangney et al., 1995) and
therefore it was important to control chronic guilt for shame in the statistical analyses
(Ferguson & Stegge, 1998; Harder, 1995; Tangney et al., 1995). Unfortunately, there was
a downside to the use of partial correlations, which was the probable removal of valid
variance due to guilt and a substantial watering-down of the true strength of association
between chronic guilt and late grief. Nevertheless, chronic guilt was a significant
independent contributor to late grief in women.
Thus, guilt-proneness had both functional and dysfunctional relationships with grief
in women, whereas the relationship was one-sidedly dysfunctional in men (Bybee &
Quiles, 1998). Although, once again, the correlational nature of the study precludes any
definite conclusion regarding direction of causality, it may be argued that situational
guilt-proneness ameliorates late grief in women, whereas chronic guilt-proneness tends
to aggravate it in both sexes. Although men have been reported to be less likely than
women to feel guilt over the death of a baby (Benfield et al., 1978; Wilson et al., 1985),
the dysfunctional nature of their guilt-proneness may make guilt-related grief more
problematic for men than for women. The degree to which personality, prevailing mood
and the immutability of the death were responsible for the relationship between chronic
guilt-proneness and grief is speculative (Bybee & Quiles, 1998), but the apparent
difference between women and men suggests that personality was perhaps more
important than the immutability of the death or thwarted attempts at reparation.
Miles and Demi (1986) included survivor guilt in their typology of guilt states
experienced by bereaved parents, but, otherwise, there are few unambiguous
references to survivor guilt in the empirical perinatal bereavement literature. In recent
years, the term survivor guilt has been extended beyond the original association with
bereavement to include personal inequities of a more general nature (OConnor, 2000).
In this context, the present research showed that proneness to survivor guilt construed
to accord with the irrational belief that one is harming others by surpassing them, being
better off, being successful or happy (OConnor et al., 1999, p. 190) had a significant
correlation with late grief in women and men. In addition, early survivor guilt was a
predictor of late grief in men. Thus, survivor guilt-proneness, like chronic shameproneness, was an important concomitant or consequence of late grief in women and
men, and a notable antecedent of late grief in the latter. The important association of
survivor guilt with late grief echoes the results of previous research that has shown

506

Peter Barr

significant correlations between survivor guilt and psychological symptoms, including

depression (OConnor et al., 1999; OConnor, Berry, Weiss, & Gilbert, 2002).
Although men were not generally more prone to omnipotence guilt-proneness than
women, guilt cast as the pathogenic belief that one [is] responsible for the well-being of
others, and that one has the power to make others successful and happy (OConnor
et al., 1999, p. 190), was germane to late grief in men, but not women. There are several
possible explanations for this sex difference in the relation of omnipotence guiltproneness to late grief. First, men may have anguished more than women over their
apparent inability to alleviate their partners distress and this anguish, aided and abetted
by their proneness to omnipotence guilt, may have been a substantial contributor to
their own grief. Second, men compared with women may have been more instrumental
in their grief and, therefore, more attuned to controlling events and initiating problemsolving behaviours, thereby rendering them more susceptible to the negative
consequences of omnipotence guilt, including vulnerability to feelings of
helplessness and powerlessness in the face of an immutable loss (Brody, Muderrisoglu,
& Nakash-Eisikovits, 2002; Lund, 2001).
Although the present study was at pains to distinguish between guilt- and shameproneness and evaluate their separate within- and between-sex relationships with
perinatal grief, the emotions are by no means dichotomous (Lynd, 1958). In deference to
the complex interweaving of guilt and shame in individual experience, including their
possible fusion (Lewis, 1971; Tangney et al., 1995), the present study also showed that
guilt and shame together explain a considerable proportion of the variance in late grief
in women and men.
In concluding, it should be noted that the participants in the present study were
predominantly well-educated, perinatally bereaved Anglo-Australians in their 30 s, and,
therefore, caution should be exercised in extrapolating the findings to individuals with
different sociocultural profiles or experiencing other kinds of bereavement.

Acknowledgement
The author is grateful to Dr Douglas Farnill for his comments on an earlier draft of this article.

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Received 22 October 2003; revised version received 22 April 2004

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