Understanding and Managing PD-Related Shame and Embarrassment

Those of us living with PD often experience distressing shame and embarrassment secondary to some of our PD symptoms. When eating in public, for example, hand tremors can cause us to spill food all over the dining table and ourselves. The same tremors plus slowness of movement, have us struggle getting money or credit cards out of our wallets while the cashier, and customers waiting in line, show clear signs of impatience. Excessive salivation can result in drooling. Poor balance makes us walk unsteadily, as if under the influence of alcohol or drugs. The list is not exhaustive.

A good friend of mine who has struggled with PD for the past three years put it this way:

I am embarrassed by my hand shaking, I don’t like the feeling of having little control over such an expressive part of my body. Unfortunately, trying hard to make it stop only seems to make it worse…

[I feel embarrassment] when gesturing during personal conversations I notice the eyes of my conversational companion move to my tremoring hand…

Embarrassment and shame are powerful emotions that can seriously disrupt our sense of well-being. They heighten our anxiety. They place us at risk for greater distress in the form of social and emotional isolation, and/or psychiatric disorders such as phobias and depression.

We cope with shame and embarrassment in different ways. Typically we keep ourselves in a state of constant alertness wherein we scan the environment for potentially shame-inducing situations and when we spot them we proceed to avoid them. If avoidance is not possible, we anticipate possible obstacles and formulate a solution. We hide symptoms. We dissimulate.

Shame, while frequently encountered by PWP’s, is infrequently discussed. There is irony at play. For many PWPs, it is embarrassing to talk about embarrassments.

The Psychology behind Shame
Viewed from the lens of psychology, cognitively, shame is an emotion that originates from a set of beliefs, namely that one’s body and/or mind are flawed in some significant way; that the presumed defect or stigmata must be kept hidden, secret, away from the scrutiny of others; that to do otherwise exposes the self to public ridicule, scorn or rejection. We fear exposure.

When shame is experienced in public, and it is of mild to moderate intensity, it is known as embarrassment. We feel observed and reproached by others. We blush, we cover our faces, we wish to escape the situation. In its severe form, shame becomes humiliation, and then we wish we had never existed at all.

It appears that the frequency and intensity of felt shame and embarrassment vary; there are individual differences. PWP’s with a premorbid history of self-consciousness, shyness, introversion, interpersonal sensitivity, or socially avoidant behaviors are presumed to be more vulnerable than their extroverted, socially outgoing counterparts.

But living in fear and defending ourselves through avoidances needs not be our fate.

Coping Effectively with Shame & Embarrassment
A more effective way to cope is to confront the fears head on, with assistance from a psychotherapist trained in Cognitive-Behavioral Therapy (CBT). One helpful technique, among many others, is that of behavioral exposure to the paralyzing fear. The idea is that the client engages in an activity that brings on the fear of embarrassment and in doing so, and working through it, learns that the situation is not devastating. When combined with other CBT techniques, such as cognitive restructuring, thought stopping, disputing the inner critic, relaxation techniques, mindfulness training, such forms of behavioral exposure can result in lasting changes. Practical advice: Discuss your fears with your health team and obtain a referral for CBT with a trained therapist.

But psychotherapy is not for everyone.  Some PWP’s might  prefer to enlist the help of a life coach  who will assist the PWP with the formulation and implementation of  behavioral goals and objectives that are antidotes to fear—like courage, for example. Practical advice: Access a reputable website on coaching and positive psychology, such as www.positiveacorn.com

It might also be the case that the PWP prefers self-management or self-help efforts. This can be effective too, provided that the recommended interventions are evidence based.  The work involved, as with coaching, focuses on designing and implementing goals, but the coach is you. Practical advice: Pick up a copy of Norcross, J. C. (2012) Changeology: 5 Steps to Realizing Your Goals and Resolutions.

NWPF-plus-PRO-Logos_292x147This post was originally published by its proprietor, the Northwest Parkinson’s Disease Foundation. It is reproduced here with their permission.

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