The Relationship Between PTSD and Shame

How Feelings of Shame Can Affect Posttraumatic Stress Disorder

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Following exposure to a traumatic event, people may experience a variety of emotions, such as fear, anxiety, sadness, anger, guilt, or shame. Although all of these emotions may be very distressing, shame can be a particularly difficult emotion to cope with after trauma. So much so that there is increasing evidence that the experience of shame is associated with the severity of post traumatic stress disorder, or PTSD, symptoms following a traumatic event.

Before we discuss the relationship between shame and PTSD, it's first important to understand what shame is and how it differs from other emotions.

The Difference Between Shame and Guilt

Shame is often considered a "self-conscious emotion" and it's generally very closely related to the emotion of guilt. In fact, many people have difficulty distinguishing between shame and guilt. Here's the difference:

Shame is an emotion that occurs when you evaluate or judge yourself in a negative light. For example, you might experience shame if you view themselves as worthless, weak, bad or useless.

Guilt occurs when you evaluate a behavior or an action as negative. For example, if you borrow money from someone and then fail to pay them back, you might experience guilt because you did something that can be perceived as wrong or inconsiderate.

It's important to distinguish between shame and guilt because they influence your behavior in different ways.

Guilt can motivate you to make amends, apologize, or correct a behavior. Doing such things will help alleviate guilt and may increase the extent to which you feel positive about yourself. In this way, guilt can be a helpful emotion.

Shame, on the other hand, is rarely useful. With shame, you may be more likely to engage in self-punishment (such as through deliberate self-harm) or isolate yourself from others.

This is going to do little to alleviate the shame in the long-term and can even intensify your shame.

The Link Between Shame and PTSD

Studies have consistently found a strong association between shame and the experience of PTSD symptoms following a traumatic event.

For example, the experience of shame has been found to be connected to the severity of PTSD among older male veterans who were prisoners of war and women who had been exposed to interpersonal violence. Interestingly, these studies found that shame had a stronger connection with PTSD than guilt.

Researchers have theorized that the experience of shame following a traumatic event may lead you to use unhealthy coping strategies, such as alcohol use, avoidance, or self-destructive behaviors, which can interfere with your ability to process the emotions associated with the traumatic event. This inability to process emotions may then contribute to the development or intensification of PTSD symptoms.

Additionally, since the experience of shame can be related to judgments of weakness or worth, survivors may feel more stigma about having experienced a traumatic event.

This stigma could then prevent you from seeking out the appropriate care.

Reducing the Experience of Shame

Shame can be a very difficult emotion to cope with. However, some coping strategies may be particularly useful for shame after a trauma.

When experiencing shame, it's important to take "opposite action." That is, do something that is counter to the emotion of shame. For example, if shame is causing you to feel as though you need to do something self-destructive, do something that is about caring for yourself instead. Self-soothing and self-compassion coping strategies can be particularly useful in this regard.

These healthy coping strategies are not without their challenges, but the more that you can use them in response to shame, the less likely it becomes that shame will take hold and lead to unhealthy behaviors.

Certain treatments may also be useful in reducing shame. Cognitive Processing Therapy for PTSD has been found to be effective in reducing shame among people with PTSD. Dialectical Behavior Therapy can also be useful in reducing shame.

If you are interested in finding a therapist trained in these treatments, you can search for one in your area through the website of the Association for Behavioral and Cognitive Therapies (ABCT).

Sources:

Beck, J.G., McNiff, J., Clapp, J.D., Olsen, S.A., Avery, M.L., & Hagewood, J.H. (2011). Exploring negative emotion in women experiencing intimate partner violence: Shame, guilt, and PTSD. Behavior Therapy, 42, 740-750.

Leskela, J., Dieperink, M., & Thuras, P. (2002). Shame and posttraumatic stress disorder. Journal of Traumatic Stress, 15,, 223-226.

Lewis, H.B. (1971). Shame and guilt in neurosis. New York, NY: International Universities Press.

Resick, P., & Schnicke, M.K. (1992). Cognitive processing therapy for sexual assault victims. Journal of Consulting and Clinical Psychology, 60, 748-756.

Street, A.E., & Arias, I. (2001). Psychological abuse and posttraumatic stress disroder in battered women: Examining the roles of shame and guilt. Violence and Victims, 16, 748-756.

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