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Hiramatsuetal. BMC Res Notes (2021) 14:297
https://doi.org/10.1186/s13104-021-05698-2
RESEARCH NOTE
Development oftheexternal andinternal
shame scale: Japanese version
Yoichi Hiramatsu1,2,3* , Kenichi Asano1,2,4,5, Yasuhiro Kotera6, Ayumu Endo7, Eiji Shimizu1,8 and Marcela Matos9
Abstract
Objective: Shame contains external and internal aspects. However, a Japanese language scale for simultaneously
assessing both aspects of shame has not been developed to date. This study aimed to standardize the Japanese ver-
sion of the External and Internal Shame Scale (EISS-J). An online survey was conducted among university students
(N = 203) at six universities in Japan (Study 1). A retest questionnaire was sent to the participants by email three
weeks after the first survey (Study 2). Study 1 examined the internal consistency, factor structure, and criterion-related
validity of the EISS-J, while Study 2 examined its test-retest reliability. Moreover, an additional study was conducted to
examine the criterion-related validity of the scale.
Results: Study 1 demonstrated the high internal consistency of the EISS-J. Moreover, confirmatory factor analysis
indicated a two-factor model: external and internal shame. However, exploratory factor analysis indicated a three-
factor structure. Study 2 confirmed the test-retest reliability of the scale. Furthermore, both studies indicated correla-
tions between the EISS-J and fear of compassion, anger, humiliation, depression, anxiety, and stress. In addition, the
study established the criterion-related validity of the scale. These results confirmed adequate reliability and validity of
the EISS-J.
Keywords: External shame, Internal shame, Depression, Fear of compassion
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Introduction
Shame comprises two dimensions [1]. Internal shame is
related to the internal dynamics of the self and how the
self judges and feels about itself [2], including tenden-
cies to focus on negative aspects of the self and main-
tain global self-judgments of being bad, inferior, and
flawed [3–5]. is type of shame is related to negative
self-evaluations and self-directed affects, such as feelings
of self-disgust [2]. On the other hand, external shame
is associated with the perception that others have bad
impressions of oneself, such as being inferior or worthless
[6]. When experiencing external shame, people engage in
defensive maneuvers, with the behavior oriented toward
trying to positively influence one’s image in the minds of
others inferior and worthless [6].
External and internal shame are regarded as different
dimensions of the identical emotional experience, which
are closely linked and encompass the same core domains
of inferiority/inadequacy, exclusion, emptiness, and criti-
cism [7]. Both aspects of shame are crucial for social
functioning [7].
Until recently, there have been no scales for simultane-
ously assessing these two dimensions of shame. Recently,
the External and Internal Shame Scale (EISS) for assess-
ing external and internal shame was developed [7]. e
present study aimed to develop a Japanese version of the
EISS and verify its validity and reliability.
Open Access
BMC Research Notes
*Correspondence: Hfcjf228@ybb.ne.jp
1 Research Center for Child Mental Development, Chiba University
Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670,
Japan
Full list of author information is available at the end of the article
Page 2 of 5
Hiramatsuetal. BMC Res Notes (2021) 14:297
Main text
Materials andmethods
Participants
A questionnaire was administered to university students
(N = 203) from six universities in the metropolitan area of
Japan, and the responses of participants without missing
data were analyzed (N = 202). Many of them were under-
graduates, but some were graduate students. e partici-
pants included 54 men, 146 women, and two respondents
who did not disclose their gender. eir age ranged from 18
to 28 years, with a mean age of 20.09 years (SD = 1.78).
Measures
Japanese version oftheExternal andInternal Shame Scale
(EISS‑J)
e EISS contains eight items rated on a 5-point Likert scale
ranging from 0 to 4, with four items assessing external shame
and four assessing internal shame. e original EISS con-
tained the following core domains of shame experiences: (1)
inferiority/inadequacy, (2) sense of isolation/exclusion, (3)
uselessness/emptiness, and (4) criticism/judgment, result-
ing in a pool of 16 initial items. Subsequently, researchers
selected one pair of items from the pool that adequately
expressed each domain. Consequently, a scale consisting of
final eight items was developed (example items in the inferi-
ority/inadequacy domain included "I am different and infe-
rior to others" and "People around me see me as not being up
to their standards") [7]. e English version was translated
into Japanese by two experts (YH and YK) after obtaining the
original authors’ approval. Back-translations were conducted
by two native English speakers from a translation company
(Crimson Interactive Japan Co., Ltd.). e two retranslated
English versions were integrated, and the resulting version
was sent to the original author, who confirmed the homoge-
neity of the Japanese version of the scale.
Japanese version oftheOther asShamer Scale (OAS)
e OAS was developed to assess external shame [8]. e
Japanese version is composed of 18 items rated on a 5-point
Likert scale ranging from 0 to 4, which are similar to the orig-
inal version [9]. A strong positive correlation was reported
between the EISS and the OAS [7].
Japanese version oftheState‑Trait Anger Expression Inventory
(STAXI)
e STAXI was developed to measure anger [10]. e Japa-
nese version, which contains ten items of the Trait Anger
scale rated on a 4-point Likert scale ranging from 1 to 3,
was used in the present study [11]. A positive correlation
between anger and external shame was confirmed [12].
A total of 106 participants responded to the STAXI, as the
STAXI was added midway through the study to reinforce the
examination of the validity of external shame.
Japanese version oftheFear ofCompassion Scale (FC)
e FC [13] and its Japanese version [14] are composed of
three subscales that include 38 items: fear of compassion
for others (FCforO, ten items), from others (FCfromO, 13
items), and for self (FCforS, 15 items). is scale is rated on a
5-point Likert scale ranging from 0 to 4. Fear of compassion
is the sense of resistance to expressing compassion for oth-
ers or receiving compassion from others. Previous research
noted shame memories as a background to the fear of com-
passion, suggesting that shame experiences increase depres-
sion and anxiety, mediated by fear of compassion for and
from others [15].
The Japanese version oftheBeck Depression Inventory‑Second
Edition (BDI‑II)
e BDI-II [16] and its Japanese version [17] assess depres-
sion. e high validity and reliability of the scale for assessing
depression have been confirmed [17]. e scale contains 21
items rated on a 4-point Likert scale ranging from 0 to 3.
Japanese version oftheHumiliation Inventory (HI‑J)
Humiliation, like shame, is a form of self-consciousness emo-
tion [18]. It has been shown that during the experience of
shame, there is an aggressive aspect that is focused on others.
[18]. A positive correlation was predicted between the HI-J
and the EISS-J by using the 12 items of cumulative humilia-
tion rated on a 5-point Likert scale ranging from 1 to 5.
Japanese version oftheDepression, Anxiety, Stress Scale‑15
(DASS‑15)
e DASS-15 consists of 15 items rated on a 4-point Likert
scale ranging from 0 to 3 [19] and is used to assess depres-
sion, anxiety, and stress. A positive correlation was demon-
strated between the DASS-21 and the EISS [7]. erefore,
the present study predicted a positive correlation between
the DASS-15 and the EISS-J.
Procedures
An online questionnaire was conducted with university
students enrolled in six Japanese universities that agreed to
participate in the research. Participants were recruited by
providing a link to the survey to students attending online
lectures and one university also on the universities’ subject
recruitment websites. e survey was conducted between
July and November 2020. Responses were anonymous. Par-
ticipants were provided with written explanations regard-
ing the survey’s purpose, personal information protection,
confidentiality, and arbitrariness of responses. Afterwards,
participants were instructed, "If you agree to complete the
survey after reviewing the above instructions, please click the
’Answer’ button below to proceed and answer the questions.
is study was approved by the ethics committee of Chiba
University (No. 3441). e number of accesses to the site
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Hiramatsuetal. BMC Res Notes (2021) 14:297
was 577, and the number of respondents was 203 (35.18%).
However, test accesses and multiple accesses by the same
person are included. Emails were sent to the participants
three weeks after the survey, requesting them to participate
in the online retest study to identify the scale’s test-retest
reliability. e emails contained the URL of the retest ques-
tionnaire. Participants were able to respond on the same day
or later. All respondents completed the survey within five
weeks of the initial survey, except for one who completed it
eight weeks after the initial survey. e method for obtaining
informed consent was the same as that in Study 1. Statistical
analyses were conducted using SPSS and AMOS software.
Results
e factor structure of the eight-item EISS-J was exam-
ined using confirmatory factor analysis (CFA) by assuming
a higher-order factor (global shame) and two lower-order
factors (external shame and internal shame), similar to
the original version. However, a satisfactory level of fit rate
could not be obtained (Additional file2: Figure S1); there-
fore, exploratory factor analysis (EFA) was implemented.
ree factors were identified based on eigenvalue decay
(4.001, 0.941, 0.911, 0.626), unlike the original factor struc-
ture. e first and second factors were extracted as external
and internal shame, respectively; however, out of the four
shame domains, only the sense of isolation/exclusion was
extracted separately, forming the third factor. is factor
was called Isolation (Additional file 1: TableS1). e CFA
with error covariance between Items 2 and 3 relating to the
isolation factor was conducted again using EFA results as a
reference (Additional file2: Figure S1), which improved the
fit rate (Table1). Subsequent analyses were conducted using
a higher-order factor and two lower-order factors, external
shame (EISS-J-ES) and internal shame (EISS-J-IS), based on
the CFA results, which was consistent with the original and
allowed for cross-national comparisons.
e reliability of the EISS-J was examined using internal
consistency and test-retest methods. Cronbach’s alphas for
all scales were shown in Additional file3: TableS2.
A correlation analysis was conducted between the
EISS-J and its subfactors (EISS-J-ES and EISS-J-IS) and
related scales to examine the criterion-related validity of
the EISS-J. e results are presented in Table2. A strong
positive correlation was found between the EISS-J and the
OAS, the FC, and the BDI-II. e two subfactors of the
EISS-J demonstrated a significant positive correlation with
the OAS, which was consistent with the original [7]. As in
previous studies [15], the FC showed a high positive corre-
lation with centrality of shame memory. However, only one
strong correlation was not found between fear of compas-
sion for others and internal shame. In addition, a signifi-
cant positive correlation was observed between the STAXI
and the EISS-J. However, there was no strong correlation
between the STAXI and the EISS-J-ES, as predicted.
Study 2
A retest study was conducted using an online questionnaire
three weeks after Study 1 to examine the scale’s test-retest
reliability and criterion-related validity.
A total of 84 students (20 men, 62 women, and two
respondents who did not disclose their gender) participated
in this study. eir age ranged from 18 to 28 years (mean
age = 20.37, SD = 1.94).
e results indicated a high test-retest correlation (EISS-
J: r = 0.83, EISS-J-ES: r = 0.77, EISS-J-IS: r = 0.82) and test-
retest reliability of the scale. Cronbach’s alphas for all scales
were shown in Additional file4: TableS3. Moreover, cor-
relation analysis conducted on the HI-J and the DASS-15
indicated a high positive correlation between the DASS-15
and the EISS-J, suggesting a correlation between shame and
mental health symptoms, such as depression, anxiety, and
stress. However, there was no significant correlation between
the HI-J and the EISS-J (Table3).
Discussion
e CFA results identified two EISS-J factors. e EISS-J
included both internal and external shame factors, similar
to the original version. However, the EFA extracted isolation
as a separate factor. Shame includes negative self-cognition
[2, 8]; however, the sense of isolation may have encompassed
pure isolation that did not include critical self-recognition.
For instance, meeting other people was restricted at the time
of the study due to the COVID-19 pandemic. erefore,
people may have faced increased loneliness not associated
with criticism or exclusion from others.
Examining correlations between the other EISS-J scales
indicated that the EISS-J, similar to the original scale, was
strongly correlated with various symptoms of mental health,
such as depression, stress, anxiety, and fear of compassion.
Moreover, the results of criterion-validity studies were partly
Table 1 Goodness-of-fit statistics of EISS-J
χ2 df CMIN GFI AGFI CFI TLI RMSEA
Higher-order factor model
Higher-order (with error covariance) 103.398
58.252 19
18 p < 0.001
p < 0.001 0.888
0.935 0.788
0.869 0.864
0.935 0.791
0.899 0.148
0.105
Original model (Ferreira et al. [7]) 126.73 19 p < 0.001 0.96 – 0.96 0.94 0.09
Page 4 of 5
Hiramatsuetal. BMC Res Notes (2021) 14:297
different, although they were generally consistent with the
predictions. No significant correlation was found between
external shame and the STAXI. Similarly, external shame
was not significantly correlated with humiliation, which
was related to aggressive emotions focused on others, such
as resentment and the desire to take revenge. Anger and
humiliation are aggressive feelings toward others. Shame
has a submissive aspect (damage limitation), which is a strat-
egy to reduce attacks and exclusion by others [2]. In con-
trast, anger is an emotion expressed by attacking others or
destroying targets [11]. External shame factors of the EISS-J
may more closely reflect the aspects of submissive strategies.
e relationship between the EISS-J and feelings of aggres-
sion toward others, such as anger and humiliation, requires
further investigation.
e findings confirmed the adequate reliability and validity
of the EISS-J for simultaneously assessing external and inter-
nal shame. is study validated the three-factor model using
the EFA and a higher-order factor model using the CFA. e
higher-order factor model could be used for future interna-
tional studies, while the three-factor model could be used for
studies in Japan.
Limitations
e participants in this survey were healthy university stu-
dents. In addition, as many participants were women, the
gender distribution was disproportionate. erefore, a gen-
der bias may have occurred. Moreover, the retest study con-
tained a relatively small sample size. Future studies should
investigate extensive and diverse participants to confirm the
results of this study. Furthermore, the model should be re-
examined with the CFA based on larger datasets.
Abbreviations
CFA: Confirmation factor analysis; EFA: Exploratory factor analysis; EISS: External
and Internal Shame Scale; EISS-J: External and Internal Shame Scale—Japanese
version; OAS: Other as Shamer Scale—Japanese version; STAXI: State-Trait Anger
Expression Inventory—Japanese version; FC: Fear of Compassion Scale—Japanese
version; BDI-II: Beck Depression Inventory, Second Edition—Japanese version; HI-J:
Humiliation Inventory—Japanese version; DASS-15: Depression, Anxiety, Stress
Scale-15—Japanese version.
Supplementary Information
The online version contains supplementary material available at https:// doi. org/ 10.
1186/ s13104- 021- 05698-2.
Additional le1: TableS1. Factor loading for the EISS-J
Additional le2: Figure S1. Results of confirmatory factor analysis of EISS-J
Additional le3: TableS2. The cronbach’s α for all scale in study 1.
Additional le4: TableS3. The cronbach’s α for all scale in study 2.
Acknowledgements
The back-translation of the Japanese version of the EISS was provided by Crimson
Interactive Japan Co. editorial support by TEXT.
Authors’ contributions
YH designed and managed the study, performed the statistical analyses, translated
the EISS-J, and drafted the manuscript. KA designed the study, drafted the manu-
script, supervised the overall study implementation. ES designed the study, drafted
the manuscript, supervised the ethics approval and consent to participate. YK
supported the translation of EISS-J and confirmed the consistency of the scale. MM
checked the back-translation of the scale and confirmed the consistency of the
Table 2 Correlations between the EISS-J and oher scales
EISS-J, External and Internal Shame Scale Japanese version: ES, external shame: IS, internal shame: Isol, Isolation: OAS, Other As Shamer scale japanese version: FC,
Fear of Compassion scale: FCforO, fear of compassion for other: FCfromO, fear of compassion from other: FCforS, fear of compassion for self: STXI, State-Trait Anger
Expression Inventory (trate anger items)
**p < 0.01. *p < 0.05
EISS-J ES IS OAS FC FCforO FCfromO FCforS STAXI
ES 0.658**
IS 0.625** 0.713**
OAS 0.832** 0.588** 0.482**
FC 0.686** 0.451** 0.412** 0.630**
FCforO 0.243** 0.187** 0.086 0.287** 0.661**
FCfromO 0.691** 0.499** 0.438** 0.637** 0.885** 0.460**
FCforS 0.637** 0.365** 0.417** 0.542** 0.896** 0.378** 0.686**
STAXI 0.287** 0.017 −0.048 0.341** 0.351** 0.369** 0.221* 0.307**
BDI-2 0.651** 0.396** 0.469** 0.608** 0.637** 0.241** 0.583** 0.655** 0.352**
Table 3 Correlations between the EISS-J, DASS and HI-J
EISS-J, External and Internal Shame Scale Japanese version: ES, external shame:
IS, internal shame: DASS, Japanese version of the Depression, Anxiety, Stress
Scale-15: HI-J, Japanese version of the Humiliation Inventory (Cumulative
Humiliation)
**p < 0.01. *p < 0.05
EISS-J ES IS DASS
ES 0.907**
IS 0.929** 0.687**
DASS 0.514** 0.462** 0.474**
HI-J 0.182 0.210 0.129 0.499**
Page 5 of 5
Hiramatsuetal. BMC Res Notes (2021) 14:297
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scale. KA and AE conducted the questionnaire, calculated and interpretation the
data. All authors read and approved the final manuscript.
Funding
This work was supported by JSPS KAKENHI (Grant Number JP19K14412).
Availability of data and materials
The datasets generated and analyzed during the current study are available from
the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
The study was approved by the ethics committee at the Chiba University Graduate
School of Medicine (Reference Number: 3441). Written explanations were provided
to participants in advance outlining the purpose of the survey, personal informa-
tion protection, and voluntary nature of participation. Afterwards, participants were
instructed, "If you agree to complete the survey after reviewing the above instruc-
tions, please click the ’Answer’ button below to proceed and answer the questions.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Author details
1 Research Center for Child Mental Development, Chiba University Graduate School
of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan. 2 The Japanese Centre
for Compassionate Mind Research and Training, Tokyo, Japan. 3 Komachi Clinical
Psychology Office, 2-11-1, Minamisaiwai, Nishi-ku, Yokohama-MS Bldg., Yokohama,
Kanagawa 220-0005, Japan. 4 Department of Psychological Counseling, Faculty
of Psychology, Mejiro University, 4-31-1 Nakaochiai, Shinjuku-ku, Tokyo 161-0032,
Japan. 5 National Center for Cognitive Behavior Therapy and Research, National
Center of Neurology and Psychiatry, Kodaira, Japan. 6 Human Sciences Research
Centre University of Darby, Kedleston Road, Derby DE22 1GB, United Kingdom.
7 Department of Psychology, Faculty of Letters, Komazawa University, 1-23-1, Kom-
azawa, Setagaya-ku, Tokyo 154-8525, Japan. 8 Department of Cognitive Behavioral
Physiology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku,
Chiba 260-8670, Japan. 9 University of Coimbra, Faculty of Psychology and Educa-
tional Sciences, Center for Research in Neuropsychology and Cognitive Behavioral
Intervention (CINEICC), Rua do Colégio Novo 3000-115 Coimbra, Portugal.
Received: 25 February 2021 Accepted: 14 July 2021
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