Why People With PTSD Experience Trauma-Related Guilt

If You Feel Guilty for Surviving or Not Preventing Trauma

Woman biting lip feeling guilty
Addressing trauma-related guilt for people with PTSD. Image Source/Getty Images

People who develop post-traumatic stress disorder (PTSD) also commonly experience guilt. In particular, individuals who have endured traumatic events may also begin to feel what's known as trauma-related guilt. But what does the term mean exactly?

What is Trauma-Related Guilt?

Trauma-related guilt refers to the unpleasant feeling of regret stemming from the belief that you could or should have done something different at the time a traumatic event occurred.

For example, a military veteran may regret not going back into a combat zone to save a fallen soldier. A rape survivor may feel guilty about not fighting back at the time of the assault.

Trauma survivors may also experience a particular type of trauma-related guilt, called survivor guilt. Survivor guilt is often experienced when a person has made it through some kind of traumatic event while others have not. A person may question why he survived. He may even blame himself for surviving a traumatic event as if he did something wrong.

Traumatic Events and Guilt

The experience of trauma-related guilt does not seem to depend on the type of traumatic event experienced. Combat exposure, physical abuse, sexual abuse, and the loss of a loved one have all been found to be associated with the experience of trauma-related guilt.

For example, in one study of 168 battered women, only six reported experiencing no guilt related to their abuse.

In another study of rape and incest survivors, it was found that well over half reported experiencing moderate to high levels of guilt.

Consequences of Trauma-Related Guilt

Feeling guilt after the experience of a traumatic event is serious, as it has been linked to a number of negative consequences. For example, trauma-related guilt has been found to be associated with depression, shame, social anxiety, low self-esteem and thoughts of suicide.

In addition, feeling a lot of trauma-related guilt has been connected to the development of PTSD.

Given the potential negative consequences of trauma-related guilt, it is important that any such guilt be addressed in PTSD treatment.

Addressing Trauma-Related Guilt

Trauma-related guilt can be treated through cognitive-behavioral therapy. Trauma-related guilt may originate in how you think or interpret a situation.

For instance, a rape survivor may feel like she should have seen her attack coming, even though it was impossible for her to predict that the assault would occur. Likewise, a combat veteran may think to himself that he should have done something different to prevent the death of a fellow soldier, even though the event may have been completely out of his control.

Cognitive-behavioral therapy for trauma-related guilt would focus on helping people become more aware of the thoughts or beliefs that underlie feelings of guilt, such as through self-monitoring. The therapist would then help the person come up with more realistic interpretations of the situation.

For example, lessen your guilt by realizing that the traumatic event was completely out of your control, and you acted in the best way you could given the situation. By reducing guilt, cognitive-behavioral therapy may also help increase self-compassion and acceptance.

In addition to cognitive-behavioral therapy, psychodynamic/psychoanalytic approaches can also be helpful in addressing this form of guilt. Psychodynamic and psychoanalytic approaches would aid the patient in exploring his early life experiences (for example, relationships with significant others, early childhood traumas or fears) in order to identify experiences and factors that may make someone more likely to feel trauma-related guilt and shame.

Importance of Addressing Trauma Related Guilt

It's important to state again that trauma-related guilt is something that desperately needs to be addressed. You may think of trauma related guilt as a nuisance—something which diminishes your quality of life alone. In contrast, trauma-related guilt is much more serious, and, at least in veterans, is closely linked with suicidal thoughts. Without being alarmist, we encourage anyone coping with this guilt to talk openly with their doctors and mental health providers. Help is available, and studies suggest this help can make a significant difference for those forced to live with PTSD.

Sources:

Aakvaag, J., Thoresen, S., Wentzel-Larsen, T., Dyb, G., Roysamb, E., and M. Olff. Broken and Guilty Since it Happened: A Population Study of Trauma-Related Shame and Guilt After Violence and Sexual Abuse. Journal of Affective Disorders. 2016. 204:16-23.

Macdonald, A., Pukay-Martin, N., Wagner, A., Fredman, S., and C. Monson. Cognitive-Behavioral Conjoint Therapy for PTSD Improves Various PTSD Symptoms and Trauma-Related Cognitions: Results from a Randomized Controlled Trial. Journal of Family Psychology. 2016. 30(1):157-62.

Tripp, J., and M. McDevitt-Murphy. Trauma-Related Guilt Mediates the Relationship Between Posttraumatic Stress Disorder and Suicidal Ideation in OEF/OIF/OND Veterans. Suicide and Life-Threatening Behaviors. 2016 Jun 7. (Epub ahead of print).

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