Modern Psychological Studies

Volume 27 Number 1 Article 10

February 2022

The Relationship Between Adverse Childhood Experience, Guilt

Proneness, and Shame-Proneness: An Exploratory Investigation
Martha G. Weaver
Harding University, mpike@harding.edu

Jeremiah Sullins
Harding University, jsullins@harding.edu

Follow this and additional works at: https://scholar.utc.edu/mps

Recommended Citation
Weaver, Martha G. and Sullins, Jeremiah (2022) "The Relationship Between Adverse Childhood
Experience, Guilt Proneness, and Shame-Proneness: An Exploratory Investigation," Modern Psychological
Studies: Vol. 27 : No. 1 , Article 10.
Available at: https://scholar.utc.edu/mps/vol27/iss1/10

This articles is brought to you for free and open access by the Journals, Magazines, and Newsletters at UTC
Scholar. It has been accepted for inclusion in Modern Psychological Studies by an authorized editor of UTC Scholar.
For more information, please contact scholar@utc.edu.
THE RELATIONSHIP BETWEEN ADVERSE CHILDHOOD 1

Author Note

Correspondence concerning this article should be addressed to Jeremiah R. Sullins,

Department of Behavioral Sciences, Harding University, 915 E. Market Ave., Searcy, AR 72149,

United States. Email: jsullins@harding.edu

THE RELATIONSHIP BETWEEN ADVERSE CHILDHOOD 2

Abstract

The research on adverse childhood experiences (ACEs) in relation to shame and guilt proneness

in adults is limited. Studies have shown that children and adults can be affected by ACEs. More

specifically, ACEs are associated with negative health and wellness. This study examines a

unique relationship between ACEs and guilt and shame proneness. Participants in this study were

comprised of a convenience sample of 137 adults. Two primary assessment instruments were

used: Adverse Childhood Experience questionnaire and the Test of Self-Conscious Affect-3

(TOSCA). The surveys were distributed through social media, email, and classrooms. Results

revealed a statistically significant positive relationship between ACE scores and shame

proneness. Furthermore, a statistically significant difference was discovered between participants

with high ACEs versus participants with low ACEs regarding shame proneness.

Keywords: adverse childhood experience, shame, guilt

THE RELATIONSHIP BETWEEN ADVERSE CHILDHOOD 3

The Relationship between Adverse Childhood Experiences,

Guilt Proneness and Shame Proneness: An Exploratory Investigation

According to the CDC (2019), Adverse Childhood Experiences (ACEs) are potentially

traumatic events that occur in childhood. ACEs can include violence, abuse, and growing up in a

family with mental health or substance use problems. The CDC also has reported that: 1) one in

six adults experienced four or more types of ACEs, 2) at least five of the top ten leading causes

of death are associated with ACEs, and 3) preventing ACEs could reduce the number of adults

with depression by as much as 44%. Other research has revealed that children and adults can be

affected by (ACEs). For example, Shonkoff and Garner (2012) found that ACEs are associated

with negative health and wellness.

Shame and guilt are emotions that have garnered the attention of clinical, social, and

developmental psychologists for generations. It is thought that “guilt and especially shame lurk

in corners we never imagined. These are powerful, ubiquitous emotions that come into play

across most important areas of life” (Tangney & Dearing, 2002, p.8). Research has shown that

guilt and shame are distinct affective experiences that result in different behavioral reactions. For

example, it has been shown that shame can interfere with other-oriented empathetic connections,

is generally more painful than guilt, can lead to a feeling of worthlessness, and leads to a desire

to hide, escape, and strike back. However, a gap currently exists in the literature regarding

Adverse Childhood Experiences (ACEs) in relation to shame and guilt-proneness in adults. To

fill this gap, the current study examined the relationship between ACEs and shame and guilt-

proneness with the hope to better understand this complex association.

Defining ACE
THE RELATIONSHIP BETWEEN ADVERSE CHILDHOOD 4

Adverse childhood experiences (ACE) are traumatic events that happen before the age of

18 (Felitti et al., 1998). ACEs include experiencing or witnessing violence, abuse, or neglect.

ACEs also include any part of a child’s environment that could significantly worsen their sense

of safety, stability, and/or ability to bond with an adult in a healthy way. Understanding ACEs

and their effect on how people respond to their environment can help us understand the effect

ACEs have on large demographic groups. People in certain demographic groups, such as

minorities or those in poverty (Hughes & Tucker, 2018), those who did not complete high

school, and those who make less than $15,000 per year have a disproportionately higher chance

of having an ACE (Merrick et al., 2018). An ACE study conducted in 1998 was the first to

examine adverse childhood experiences in relation to health risk behaviors and diseases in adults

(Felitti et al., 1998). A strong association was found between ACEs and chronic health problems,

mental illness, and substance abuse (Kerker et al., 2015; Putnam, 2006; Uddin et al., 2020).

Adverse Childhood Experiences and Their Effects on Children

The brain is more sensitive to influence as a child (“Child Development,” n.d.; Frederiksen,

n.d.; Putnam, 2006; Su et al., 2015). The effects of childhood trauma on mental, physical, and

emotional health can even begin while a child is in the mother’s womb (Shonkoff & Garner,

2012). The majority of a person’s physical and mental development occurs between the ages of

0-18 (“Child Development,” n.d.). Living through any form of ACE can also disrupt children’s

proper neurodevelopment and even lead to premature death. Chronic stress increases the

occurrence of the body’s natural defense mechanisms, such as fight or flight responses. This

alteration to the brain can contribute to biological changes that lead to negative health outcomes

(Kelly-Irving et al., 2013). Repeated trauma, neglect, or abuse is toxic to children and the

potential increased activation of defense mechanisms disrupts normal development (Shonkoff &
THE RELATIONSHIP BETWEEN ADVERSE CHILDHOOD 5

Garner, 2012). Continued trauma not only affects an individual’s experience of childhood but

also adulthood, as they become parents, friends, and members of society (Putnam, 2006).

Children’s healthy emotional and cognitive development depends on the caregiving of adults

(Uddin et al., 2020). Responsive, dependable, and appropriate interactions with adults help

children develop properly. Although ACE can impact people immediately, the lifelong

consequences of ACE often display more readily in adults and are often the ones studied.

Adverse Childhood Experience and Effect on Adults

ACEs have lifelong effects. The more stress someone experiences early in life, the more

likely they are to experience avoidable injuries, mental, physical, and emotional health problems,

and the more likely they are to exhibit risky behavior (Merrick et al., 2018). Those who have

ACE are more likely to respond to stress poorly, because they have not developed healthy coping

strategies (Merrick et al., 2018; Merrick & Guinn, 2018; Felitti, 2002). This response suggests

that ACEs are often generational, because those who have experienced childhood trauma were

never given the tools to handle higher levels of emotional, physical, and mental stress (Kelly-

Irving et al., 2013; Merrick et al., 2018; Murphy et al., 2014; Uddin et al., 2020). When we

consider the generational trend of ACEs, it demonstrates how doctors, healthcare physicians, and

policymakers can look at ACEs as a large contributor to society’s overall experience of physical

health and wellbeing. Recognizing that ACEs have a direct relationship to health and wellbeing

forces physicians and mental health professionals to consider options beyond modern medicine

to treat patients.

Adverse Childhood Experience and Mental Health

Like physical health, mental health alters one’s ability to appropriately, effectively, and

successfully operate in society (Shonkoff & Garner, 2012). ACE prevalence is high among
THE RELATIONSHIP BETWEEN ADVERSE CHILDHOOD 6

vulnerable populations (Felitti et al., 1998), and studies suggest that the effects of trauma are

almost immediate (Merrick & Guinn, 2018; Shonkoff & Garner, 2012). In a child welfare study,

it was found that children in this demographic had a statistically higher chance of having ACE

(Kerker et al., 2015). The likelihood of encountering an ACE before the age of five increases the

likelihood of developing mental health problems. In the U.S. in 2017, mental illness affected

approximately 1 out of 5 people which is 46.6 million individuals (Kerker et al., 2015; NIMH »

Mental Illness, n.d.). The tangible effects of ACEs on adult mental health are as strong as their

effects on our physical health. Because childhood is a critical period of development, and it has

been shown that exposure to ACE increases the likelihood of reported mental health problems by

33% (Uddin et al., 2020), it is important that we understand the multiple aspects of ACEs. How

adults learn to connect experiences, whether positive or negative, internalize how they feel about

them, and process the world around them drastically affect how we interact with themselves, the

world, and the future (Kerker et al., 2015). Understanding how ACEs affect our mental health

can also help us understand how we internalize our emotions and behaviors.

Guilt and Shame

In the same way that ACEs can alter the foundation of how someone views the world

around them, residual shame and guilt can alter the way someone views themselves and their

actions (Miceli & Castelfranchi, 2018; Tangney & Dearing, 2003). Shame and guilt are distinct,

internal, self-conscious emotions (O’Leary et al., 2019). Shame and guilt can both be felt

publicly or privately by the person experiencing them (Miceli & Castelfranchi, 2018; Tangney et

al., 2007; Tangney & Dearing, 2003; Wojcik et al., 2019). In the English language, these

emotions are often used as synonyms; however, recognition of their differences dates back

decades (Tangney & Dearing, 2003). While shame and guilt are similar, but they are not the
THE RELATIONSHIP BETWEEN ADVERSE CHILDHOOD 7

same. Both shame and guilt are self-conscious emotions, which means a reflection on oneself,

and both are negative evaluations based on cultural standards of either self or behavior (Tracy &

Robins, 2004). Shame is usually defined as a maladaptive emotion; and guilt is usually viewed as

an adaptive, prosocial emotion. These behaviors can be either maladaptive or adaptive, and the

result of these emotions are often dependent on the ability to regulate emotions (Robins &

Schriber, n.d.; Tangney & Dearing, 2003).

Guilt

Unlike shame, guilt is a negative emotion related to one’s self behaviors, not one's ideal

self (Miceli & Castelfranchi, 2018; Tangney et al., 2007; Tangney & Dearing, 2003). These

views are connected to one’s moral standards and based on a society’s understanding of right and

wrong, which are based on the goals and beliefs for which the person feels personally

responsible (Tangney et al., 2007). Guilt is usually an adaptive, constructive emotion. It helps

people alter our behavior in a positive way. Shame reduces people’s ability to act appropriately

in constructive ways, because it is often easier to alter one’s behaviors rather than one’s internal

view of oneself (Brown, 2012). Guilt allows us to look at decisions outside of ourselves and see

how we have broken moral or ethical norms; but shame is often internalized and negatively

skews one’s self-concept (Covert et al., 2003).

Shame

When someone experiences shame, that feeling often reflects a negative view of their

internal view of themselves. The effect of that negative internal self-concept is internalized as

oneself being bad, rather than the actions or behavior committed (Miceli & Castelfranchi, 2018;

Tangney et al., 2007; Tangney & Dearing, 2003). In this way, shame is more likely to be a

maladaptive emotion. When we cannot appropriately process our emotions in adaptive ways, we
THE RELATIONSHIP BETWEEN ADVERSE CHILDHOOD 8

are more likely to hurt ourselves and others over time (O’Leary et al., 2019). Shame proneness

(i.e., the likelihood of experiencing shame in any given situation) is associated with higher

anxiety, whereas guilt proneness is not (Cândea & Szentagotai-Tătar, 2018). When people

experience shame, they are more likely to respond to life’s challenges in a debilitating, self-

defeating cycle of negative behavior, whereas those who experience guilt are more inclined to

take positive steps toward changing their behavior itself (Miceli & Castelfranchi, 2018). Shame

is highly correlated with behaviors like addiction, depression, violence, aggression, suicide, and

eating disorders. In contrast, guilt is inversely correlated (Brown, 2012). This supports the theory

that shame is much more destructive and maladaptive than guilt.

Based on previous studies, researchers have begun to better understand ACE in relation to

health and wellbeing (Kelly-Irving et al., 2013; Murphy et al., 2014; Putnam, 2006). However,

there is still an insignificant understanding of the relationship between ACEs and shame and

guilt proneness which is the focus of the current study. To better understand the complex

association among ACEs, guilt-proneness, and shame proneness, the current study sought to

answer the following questions: RQ1) Is there a significant correlation between ACEs and

shame-proneness in adulthood? RQ2) Is there a significant correlation between ACEs and guilt-

proneness in adulthood? RQ3) Is there a significant difference in levels of shame-proneness

between those with high versus low ACEs?

Methods

Sample

Participants were collected through a convenience sampling technique, which included

students from a private, liberal arts university and posting the survey on social media. The survey

included age range, gender, race, and amount of school completed. For this study, of the 137
THE RELATIONSHIP BETWEEN ADVERSE CHILDHOOD 9

sampled, 104 (76%) were female and 33 (24%) were male. Regarding ethnicity, 119 (87%)

identified as Caucasian. Regarding the sample’s education level, 63 (46%) were college

graduates, 66(48%) had completed some college, and 8 (6%) had only completed high school.

The age range included 94 (69%) 18-29 olds, 22 (16%) 30-49 year olds, and 21 (15%) who were

50 and over.

Instruments

For this study, there were two primary instruments. The first was the Adverse Childhood

Experience (ACE) Questionnaire (Felitti et al., 1998), which includes ten self-report items. The

ten questions help identify if a child has experienced or witnessed violence, abuse, or neglect in

the home or community. It also identifies if someone has experienced the death of a relative. All

questions are answered either “yes” or “no.” For each “yes” answer, a person is given one point,

with ten being the highest score possible. The Adverse Childhood Experience test is the largest

one to be used to examine the connection between childhood trauma and well-being later in life,

it has a modest test-retest coefficient, r = .71, p < .001, and a Cronbach’s alpha of .88 (Murphy et

al., 2014). The following is an example question, “Before your 18th birthday, did you often feel

that ...You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or

Your parents were too drunk or high to take care of you or take you to the doctor if you needed

it?”

The second instrument, the Test of Self-Conscious Affect-3 (TOSCA), uses a scenario-

based measurement to assess the guilt and shame proneness of participants (Broerman, 2018;

Covert et al., 2003; Tangney et al., 2007). The TOSCA is also a self-report measure, and it

consists of 16 scenarios. Participants hear a scenario, then imagine how they would respond, then

rate how they would likely respond on a 5-point scale, with 1 being not likely and 5 being very
THE RELATIONSHIP BETWEEN ADVERSE CHILDHOOD 10

likely. There are 11 negative scenarios and five positive scenarios (Broerman, 2018). Shame and

guilt can be measured as an emotional state or a disposition (Tangney, 1996). For this study, the

TOSCA measures it as a disposition. The internal consistency reliability of the TOSCA

Questionnaire has a Cronbach’s alpha for the Shame and Guilt scales of .76 and .66, with face

validity being high as well (Broerman, 2018). An example of a TOSCA question is, “You make

a mistake at work and find out a coworker is blamed for the error. You would think the company

did not like the coworker, You would think Life is not fair, You would keep quiet and avoid the

coworker, and You would feel unhappy and eager to correct the situation.”

Procedure

After IRB approval was obtained, professors at the university where the study was

conducted were contacted to gain permission to use their classes to distribute the surveys. Once

permission was given, the researcher arranged a time to distribute the surveys at the beginning of

a class period. The completion of the study from start to finish took approximately 20 minutes.

Access to participate in the study online was posted on social media during this same time

period. Participants that were recruited through social media were sent a Google Form link that

contained the surveys. They were able to complete the surveys at their convenience from any

location. All participants were free to choose to participate and were not encouraged or coerced

in any way. Participants were also notified that they were under no obligation to complete the

form and could withdraw at any time without penalty. All participants completed the surveys in

the following order: informed consent, the Adverse Childhood Experience (ACE) Questionnaire

(Felitti et al., 1998; Murphy et al., 2014), the Test of Self-Conscious Affect-3 (TOSCA-3)

(Covert et al., 2003), and a debriefing form.

Results
THE RELATIONSHIP BETWEEN ADVERSE CHILDHOOD 11

A Pearson’s correlation coefficient was used to examine any relationships that exist

between ACEs and guilt/shame proneness. The results revealed no statistically significant

relationship between ACE scores and guilt-proneness, r(136) = .164, p > .05. However, there

was a statistically significant positive relationship found between ACE scores and shame

proneness, r(136) = .197, p < .05. Figure 1 displays the scatterplot between ACEs and shame

proneness.

Figure 1

Scatterplot between ACEs and Shame Proneness

Additionally, an independent sample t-test was conducted to determine if a significant

difference existed in shame proneness in those with “high” versus “low” ACEs. In this study, the

mean ACE score was 1.85, thus an ACE score of two or more was considered high. Furthermore,

an ACE score of two or more also allowed equal sample sizes. A statistically significant

difference was discovered between those with high ACE (M = 55.94) versus low ACE (M =
THE RELATIONSHIP BETWEEN ADVERSE CHILDHOOD 12

51.19) scores and shame proneness, t(135) = -2.56, p = .011, d =.44. A bar chart showing mean

differences between participants with high and low ACEs can be seen in Figure 2.

Figure 2

Shame Proneness as a Function of ACEs

Discussion

The answer to RQ1 (Is there a significant correlation between ACEs and shame-proneness

in adulthood?) was answered in the affirmative. More specifically, the results indicated that the

presence of ACEs is related to shame proneness in adulthood. However, similar patterns were

not seen in relation to levels of guilt proneness (RQ2: Is there a significant correlation between

ACEs and guilt-proneness in adulthood?). Lastly, a significant difference was discovered in

levels of shame-proneness (as measured by the TOSCA) as a function of ACEs (RQ3: Is there a

significant difference in levels of shame-proneness between those with high versus low ACEs?).

Participants with high ACEs had significantly higher levels of shame-proneness in adulthood
THE RELATIONSHIP BETWEEN ADVERSE CHILDHOOD 13

compared to participants with low ACEs. These results are consistent with previous findings that

have suggested that guilt and shame “develop from our earliest interpersonal experiences—in the

family and in other key relationships” (Tangney & Dearing, 2002, p. 2). If shame is related with

ACEs, what does this say about someone regarding how they experience the world? According

to Tangney and Dearing (2002), “these experiences of shame or guilt can guide our behavior and

influence who we are in our own eyes.” (p.2).

Because the increase of ACEs appears to be associated with an increase in shame

proneness as adults, it suggests that the two are connected in some way. Adverse childhood

experiences are foundational experiences of someone’s life that are forced. Because shame had a

statistically significant correlation, it leads the authors to believe that shame is at least one of the

lifelong negative psychological effects of ACEs (Putnam, 2006; Shonkoff & Garner, 2012). ACE

involves negative experiences caused by someone else and not the individual who experiences

them. Therefore, ACEs threaten someone’s whole being. Shame is a threat to someone’s ideal

self. The discovered relationship was expected due to shame being correlated to addiction,

depression, violence, aggression, suicide, and eating disorders (Brown, 2012). Because previous

research has found that shame is more harmful than guilt (Covert et al., 2003; Miceli &

Castelfranchi, 2018; Norman et al., 2019; Tangney et al., 2007; Tangney & Dearing, 2003), the

results from the current study warrant further investigation. More specifically, future studies are

needed to pinpoint which specific ACEs are related to the development of shame proneness. In

the current study, a total ACE score was computed without consideration of different categories

of ACEs (e.g., verbal abuse versus physical abuse). It also warrants mentioning that the current

study only examined the association between shame proneness and ACEs and therefore causal

relationships cannot be determined. The results from the current study add to the extant body of
THE RELATIONSHIP BETWEEN ADVERSE CHILDHOOD 14

literature that can assist researchers and clinicians alike in understanding the complex self-

conscious emotion of shame.

THE RELATIONSHIP BETWEEN ADVERSE CHILDHOOD 15

References

Broerman, R. (2018). Test of Self-Conscious Affect (TOSCA). Encyclopedia of personality and

individual differences, 1–3. https://doi.org/10.1007/978-3-319-28099-8_954-1

Brown, B. (2012, March). Listening to shame.

https://www.ted.com/talks/brene_brown_listening_to_shame

Cândea, D.-M., & Szentagotai-Tătar, A. (2018). Shame-proneness, guilt-proneness and anxiety

symptoms: A meta-analysis. Journal of Anxiety Disorders, 58, 78–106.

https://doi.org/10.1016/j.janxdis.2018.07.005

Child Development: Ages and Stages. (n.d.). CHOC Children’s. Retrieved June 18, 2020, from

https://www.choc.org/primary-care/ages-stages/

Covert, M. V., Tangney, J. P., Maddux, J. E., & Heleno, N. M. (2003). Shame-proneness, guilt-

proneness, and interpersonal problem solving: A social cognitive analysis. Journal of

Social & Clinical Psychology, 22(1), 1. https://doi.org/10.1521/jscp.22.1.1.22765

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss,

M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction

to many of the leading causes of death in adults. The Adverse Childhood Experiences

(ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258.

Frederiksen, L. (n.d.). The developing brain & Adverse Childhood Experiences (ACEs).

ACEsConnection. Retrieved June 18, 2020, from

https://www.acesconnection.com/blog/the-developing-brain-and-adverse-childhood-

experiences-aces?reply=476303634588520707.

Hughes, M., & Tucker, W. (2018). Poverty as an Adverse Childhood Experience. North

Carolina Medical Journal, 79(2), 124–126. https://doi.org/10.18043/ncm.79.2.124

THE RELATIONSHIP BETWEEN ADVERSE CHILDHOOD 16

Kelly-Irving, M., Lepage, B., Dedieu, D., Bartley, M., Blane, D., Grosclaude, P., Lang, T., &

Delpierre, C. (2013). Adverse childhood experiences and premature all-cause mortality.

European Journal of Epidemiology, 28(9), 721–734. https://doi.org/10.1007/s10654-013-

9832-9

Kerker, B. D., Jinjin Zhang, Nadeem, E., Stein, R. E. K., Hurlburt, M. S., Heneghan, A.,

Landsverk, J., & Horwitz, S. M. (2015). Adverse Childhood Experiences. Adverse

Childhood Experiences and mental health, chronic medical conditions, and development in

young children. Academic Pediatrics, 15(5), 510–517.

https://doi.org/10.1016/j.acap.2015.05.005

Merrick, M. T., Ford, D. C., Ports, K. A., & Guinn, A. S. (2018). Prevalence of Adverse

Childhood Experiences from the 2011-2014 Behavioral Risk Factor Surveillance System in

23 states. JAMA Pediatrics, 172(11), 1038–1044.

https://doi.org/10.1001/jamapediatrics.2018.2537

Merrick, M. T., & Guinn, A. S. (2018). Child abuse and neglect: Breaking the intergenerational

link. American Journal of Public Health, 108(9), 1117–1118.

https://doi.org/10.2105/AJPH.2018.304636

Miceli, M., & Castelfranchi, C. (2018). Reconsidering the differences between shame and guilt.

Europe’s Journal of Psychology, 14(3), 710–733. https://doi.org/10.5964/ejop.v14i3.1564

Murphy, A., Steele, M., Dube, S. R., Bate, J., Bonuck, K., Meissner, P., Goldman, H., & Steele,

H. (2014). Adverse Childhood Experiences (ACEs) Questionnaire and Adult Attachment

Interview (AAI): Implications for parent child relationships. Child Abuse & Neglect, 38(2),

224–233. https://doi.org/10.1016/j.chiabu.2013.09.004
THE RELATIONSHIP BETWEEN ADVERSE CHILDHOOD 17

NIMH » Mental Illness. (n.d.). Retrieved June 18, 2020, from

https://www.nimh.nih.gov/health/statistics/mental-illness.shtml

Norman, S., Allard, C., Browne, K., Capone, C., Davis, B., & Kubany, E. (2019). Trauma

informed guilt reduction therapy: Treating guilt and shame resulting from trauma and

moral injury. Academic Press.

O’Leary, J. L., McKee, L. G., & Faro, A. L. (2019). Guilt and shame: Explaining associations

between emotion socialization and emerging adult well-being. Family Relations, 68(5),

608. https://doi.org/10.1111/fare.12394

Putnam, F. W. (2006). The impact of trauma on child development. Juvenile and Family Court

Journal, 57(1), 1–11. https://doi.org/10.1111/j.1755-6988.2006.tb00110.x

Robins, R. W., & Schriber, R. A. (n.d.). (PDF) The self-conscious emotions: How are they

experienced, expressed, and assessed? Retrieved July 15, 2020, from

https://www.researchgate.net/publication/247689527_The_Self-

Conscious_Emotions_How_are_they_Experienced_Expressed_and_Assessed

Shonkoff, J. P., & Garner, A. S. (2012). The lifelong effects of early childhood adversity and

toxic stress. Pediatrics, 129(1), e232–e246. https://doi.org/10.1542/peds.2011-2663

Su, S., Jimenez, M. P., Roberts, C. T. F., & Loucks, E. B. (2015). The role of adverse childhood

experiences in cardiovascular disease risk: A review with emphasis on plausible

mechanisms. Current Cardiology Reports, 17(10), 88. https://doi.org/10.1007/s11886-015-

0645-1

Tangney, J. P. (1996). Conceptual and methodological issues in the assessment of shame and

guilt. Behaviour Research and Therapy, 34(9), 741–754. https://doi.org/10.1016/0005-

7967(96)00034-4
THE RELATIONSHIP BETWEEN ADVERSE CHILDHOOD 18

Tangney, J. P., & Dearing, R. L. (2003). Shame and guilt. Guilford Press.

Tangney, J. P., Stuewig, J., & Mashek, D. J. (2007). Moral emotions and moral behavior. Annual

Review of Psychology, 58, 345–372.

https://doi.org/10.1146/annurev.psych.56.091103.070145

Tracy, J., & Robins, R. (2004). Putting the self into self-conscious emotions: A theoretical

model. Psychological Inquiry - PSYCHOL INQ, 15, 103–125.

https://doi.org/10.1207/s15327965pli1502_01

Uddin, J., Alharbi, N., Uddin, H., Hossain, M. B., Hatipoğlu, S. S., Long, D. L., & Carson, A. P.

(2020). Parenting stress and family resilience affect the association of adverse childhood

experiences with children’s mental health and attention-deficit/hyperactivity disorder.

Journal of Affective Disorders, 272, 104–109. https://doi.org/10.1016/j.jad.2020.03.132

Vincent J. Felitti. (2002). The relationship of adverse childhood experiences to adult health:

Turning gold into lead / Belastungen in der Kindheit und Gesundheit im Erwachsenenalter:

die Verwandlung von Gold in Blei. Zeitschrift Für Psychosomatische Medizin Und

Psychotherapie, 48(4), 359.

Wojcik, K. D., Cox, D. W., & Kealy, D. (2019). Adverse childhood experiences and shame- and

guilt-proneness: Examining the mediating roles of interpersonal problems in a community

sample. Child Abuse & Neglect, 98. https://doi.org/10.1016/j.chiabu.2019.104233