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Background Shame is a powerful emotion involved in a wide variety of phenomena including psychopathology. The propensity to react with shame to situations of transgression is formed early in life, but the processes by which elevated shame-proneness causes higher levels of psychological distress and functional impairment in some people rather than in others is as yet poorly understood. Objectives The main objective of this thesis was to further elucidate these processes by investigating the implications for shame states, guilt, general coping strategies, attachment styles, and shame-related coping in this context, as well as to evaluate an assessment method for shame-proneness. Methods The self-report questionnaires Test of Self-Conscious Affect (TOSCA), Compass of Shame Scale (CoSS-5), Harvard Trauma Questionnaire (HTQ), Ways of Coping Questionnaire (WCQ), Attachment Style Questionnaire (ASQ), Symptom Checklist 90 (SCL-90), and an interview measure for event-related shame and guilt were used for assessment in adult normative, healthy-only, crime victim, and patient samples (n=25-361). A combination of uni- and bivariate approaches and multivariate soft and hard modeling approaches were used for statistical analysis. Results Paper I showed that the TOSCA could be used as a reliable measure for shame-proneness. Paper II showed that guilt was unrelated to post-victimization distress. Elevated shame-proneness was related to higher levels of post-victimization distress. This effect was partially mediated by event-related shame. Paper III showed that in CFS patients, higher levels of shame-proneness, escape-avoidance, and accepting responsibility coping contributed to elevated levels of psychological distress. Seeking support, positive reappraisal coping, and proneness to detachment contributed in the opposite direction. These relationships were weaker in the comparison groups. Paper IV showed that shame-proneness was associated with secure attachment style in a negative direction. Higher levels of secure attachment style contributed to lower levels of psychological distress, whereas shame-proneness, insecure attachment styles and withdrawal, attack self, and attack other shame coping strategies contributed in the opposite direction. There were mean differences between women and men regarding most of the variables, butiithe relationships between variables did not differ between men and women. Conclusions The association between shame-proneness and psycho-logical distress seem to involve a complex balancing act between motives toward preserving close relationships and protecting a relatively positive sense of self. If others are perceived as trustworthy and compassionate and are utilized for support in times of need, the effects of shame-proneness may be less debilitating, whereas if others are perceived as distancing or disapproving, and life stress and social transgressions are managed by escape strategies, social withdrawal, self-blame or by transferring blame onto others, the distress effects become more severe. The inner psychodynamics of these functional patterns seem to be rather similar in women and men.