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As discussed in Chapter 8 (“The Severe Superego and Guilt”), depressed patients can have scrupulously held moral standards. Additionally, their personal expectations of themselves in other realms of endeavor can be unrealistic. These attitudes are rooted in an excessively perfectionistic ego ideal. The ego ideal, considered to be another dimension of the superego, establishes goals to be met and attributes to be held for the person to consider the self praiseworthy or deserving of respect. Failures to meet excessive expectations give rise to depressive affects of shame, humiliation, or unworthiness, as distinct from the guilt stimulated by a failure to meet moral standards.
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