How Shame Shows up Across different Diagnoses and Coping Strategies
Shame shows up everywhere in mental health, not always clearly, and not always by name, but consistently. Shame is not always the cause of these experiences, but it often becomes the emotional environment they develop inside.
Anxiety: When Being Seen Feels Like a Threat
Anxiety often rides on the back of shame.
“What if they notice I’m anxious?”
“What if I say the wrong thing?”
“What if I look incompetent, awkward, or weak?”
The fear isn’t just that something will go wrong.
It’s that you are wrong.
For many people, anxiety isn’t fear of danger — it’s fear of visibility. Being noticed, evaluated, or perceived feels risky, even in ordinary situations.
The nervous system stays in hypervigilance because it has learned that being seen leads to judgment or rejection.
So people rehearse. They over-prepare. They stay quiet. They monitor themselves constantly. They avoid situations where they might be put on the spot.
Paul’s Narrative:
In relationships, needing reassurance feels embarrassing. Wanting comfort feels weak. I’m afraid that if I ask for too much, I’ll confirm what I already suspect, that I’m needy, insecure, and not worth the effort.
Somewhere along the way, being noticed started to feel like being evaluated. And being evaluated started to feel like rejection waiting to happen.
So anxiety tells me to erase myself.
To overthink before I speak. To prepare excessively so I won’t sound stupid. To rehearse, soften, clarify, explain… just in case. It tells me to anticipate other people’s reactions before they ever have them. So I call myself annoying, and tell myself no one cares about what I have to say, before anyone else can say it.
It tells me this is how I protect myself, but living this way doesn’t feel like safety.
It feels like slowly editing myself out of my own life.
2. Depression: Shame as Nervous System Collapse
Depression and shame are deeply intertwined.
Shame fuels hopelessness: “I’ll never get better.”
Shame fuels self-blame: “Everyone else handles life better than I do.”
Shame fuels withdrawal: “I shouldn’t burden people.”
Depression often isn’t about sadness—it’s about feeling unworthy of joy, rest, or connection.
3. ADHD: A Lifetime of Internalized Failure
ADHD does not cause shame. The response to ADHD causes shame.
A lifetime of:
“Why can’t you try harder?”
“You’re so smart, but…”
“You’re irresponsible.”
“You forgot again?”
This creates a deep neural groove of inadequacy. By adulthood, many individuals with ADHD equate executive dysfunction with moral failure. Shame becomes the primary emotional wound, not the symptoms themselves.
Hannah’s Narrative:
I’m not a perfectionist. That word doesn’t fit. My place is messy. I forget things. I miss deadlines. Perfectionists have their lives together.
But every mistake feels unbearable.
When I can’t start something, my brain doesn’t say this is hard. It says, you’re lazy. When I forget something important, I feel exposed. Like I’ve been caught pretending to be competent.
I tell myself I just need to try harder. Be stricter. Stop making excuses. Self-hatred feels like the only thing keeping me functional. If I let up for even a second, I’m convinced everything will fall apart.
I don’t rest because rest feels undeserved. I don’t feel proud because nothing ever feels like enough.
It’s not that I expect perfection.
It’s that anything less feels like proof that I’m failing at being a person.
4. Trauma: Shame as a False Protector
Trauma survivors often feel shame even when they were powerless.
Why? Because the brain would rather blame you than accept “I was helpless.”
Shame creates the illusion of control:
“If it was my fault, at least I can prevent it from happening again.”
It’s not true, but it’s protective. Painful, but protective.
5. OCD: When Thoughts Feel Like Evidence
Shame does not cause OCD — but it shapes its severity and content. People with high shame around certain topics are more likely to develop obsessions in those exact areas.
For example:
Sexual shame → sexual intrusive thoughts
Religious shame → scrupulosity
Moral perfectionism → harm obsessions
Fear of being “bad” → contamination or checking
If someone grew up believing:
“Sex is sinful,”
“Thoughts equal evil,”
“Bad thoughts mean you’re a bad person,”
…their brain fixates on these forbidden, terrifying themes. Shame makes obsessions stick because the thought feels like evidence of moral failure.
Harriet’s Narrative:
I don’t trust my own mind.
Every thought feels like evidence. If something disturbing pops into my head, I don’t think that was random. I think, what does this say about me?
I analyze my intentions constantly. Was I kind enough? Did I mean that? What if my compassion is fake? What if I’m pretending to be good and don’t know it?
People tell me, “You’d never do that.” But they don’t live inside my head. They don’t hear my thoughts.
I’m not scared of the thoughts. I’m scared of what they might mean about who I am.
I feel like if I were truly honest about what goes on in my head, people wouldn’t just leave — they would run.
6. Autism: Shame From Being Told Your Natural Way of Being Is “Wrong”
Autistic people are not inherently shame-prone.
Shame develops in response to how the world reacts to autism.
Autistic brains process sensory, social, and emotional information differently — not incorrectly. But when these differences are repeatedly misunderstood, corrected, or punished, the nervous system learns a painful lesson: my natural responses lead to rejection.
Masking isn’t a preference. It’s a survival strategy.
William’s Narrative:
He forces eye contact even when it feels uncomfortable. Suppresses stims. Rehearses conversations in advance. Replays social interactions afterward, scanning for what he did wrong.
People describe him as quiet or awkward. They don’t see the effort it takes to appear “normal.”
After social events, he feels exhausted and ashamed — convinced he said something wrong, missed something important, or made others uncomfortable.
The belief isn’t “I struggle socially.”
The belief is “who I am causes rejection.”
Perfectionism: “If I Get It Right, I’ll Be Safe”
Perfectionism often develops in environments where mistakes were met with criticism, withdrawal, or shame. You start to rehearse. You overprepare. You avoid starting until you’re sure you can do it “right.” You delay finishing because nothing feels good enough to share. On the surface, perfectionism can look like high standards or ambition. But underneath, it’s fear.
Fear of being seen as incompetent. Fear of being judged. Fear that one misstep will confirm what you already suspect about yourself. Over time, it robs people of joy, creativity, and rest — because rest feels dangerous when worth is on the line.
People-Pleasing: “If You’re Okay, I’ll Be Okay”
People-pleasing often forms when emotional safety depended on managing other people’s reactions. If staying agreeable reduced conflict, preserved closeness, or prevented anger; the nervous system learned that other people’s comfort mattered more than your own. So you scan constantly. You anticipate needs. You soften your opinions. You apologize reflexively. You say yes when you mean no.
People-pleasing isn’t about kindness. It’s about survival. Over time, this strategy creates deep exhaustion and resentment. Relationships begin to feel unbalanced. Authenticity feels risky, and people begin to struggle to know what they actually want.
Avoidance: “If I’m Not Seen, I Can’t Be Rejected”
Avoidance is one of shame’s most effective protectors.
If social situations, conflict, vulnerability, or visibility led to embarrassment or rejection in the past, the nervous system learned to stay away. So people cancel plans. Delay conversations. Stay quiet in meetings. Put off tasks. Ghost relationships. Withdraw emotionally. Avoidance brings short-term relief. The anxiety drops. The threat passes. But, the cost is isolation.
Over time, life gets smaller. Opportunities shrink. And shame grows stronger, reinforced by the belief that you’re incapable of handling what you’re avoiding.
Emotional Shutdown: “If I Don’t Feel, I Can’t Be Hurt”
For some people, the safest response to shame wasn’t pleasing or avoiding — it was numbing.
If expressing emotion led to ridicule, overwhelm, or dismissal, the nervous system learned to go quiet. To stay contained. To disconnect from feeling altogether. Emotional shutdown can look like calmness, logic, or independence. Inside, it often feels like emptiness or distance.
People in shutdown aren’t unfeeling. They’re protecting themselves from the risk of exposure.
But over time, shutdown creates disconnection, from others and from the self. Relationships feel flat. Joy feels muted. Life feels like something happening at a distance.
Overachievement: “If I’m Impressive, I’ll Be Worth Keeping”
Overachievement often develops in environments where praise or connection was conditional. If success brought attention, safety, or approval, the nervous system learned to perform. So you push. You overwork. You say yes to too much. You tie your identity to productivity.
Achievement becomes a substitute for self-worth. But no amount of success ever feels like enough because the fear underneath hasn’t been addressed. Without performance, there’s a sense of emptiness or panic.
Rest feels unsafe. Slowing down feels like losing your place.
Why These Strategies Become the Problem
Each of these coping mechanisms makes sense in the context they formed. They protected you when you needed protection. But over time, they start to cost more than they give. They exhaust the nervous system. They limit connection. They reinforce the belief that the real you is not safe to show.
Please look for the rest of my shame series including an article on how to heal shame. Also note, these names and narratives don’t represent any specific person.