Association Between Shame and Posttraumatic Stress Disorder: A Meta‐Analysis

Abstract

Posttraumatic stress disorder (PTSD) is a complex condition with affective components that extend beyond fear and anxiety. The emotion of shame has long been considered critical in the relation between trauma exposure and PTSD symptoms. Yet, to date, no meta‐analytic synthesis of the empirical association between shame and PTSD has been conducted. To address this gap, the current study summarized the magnitude of the association between shame and PTSD symptoms after trauma exposure. A systematic literature search yielded 624 publications, which were screened for inclusion criteria (individuals exposed to a Criterion A trauma, and PTSD and shame assessed using validated measures of each construct). In total, 25 studies employing 3,663 participants met full eligibility criteria. A random‐effects meta‐analysis revealed a significant moderate association between shame and posttraumatic stress symptoms, r = .49, 95% CI [0.43, 0.55], p < .001. Moderator analyses were not completed due to the absence of between‐study heterogeneity. Publication bias analyses revealed minimal bias, determined by small attenuation after the superimposition of weight functions. The results underscore that across a diverse set of populations, shame is characteristic for many individuals with PTSD and that it warrants a central role in understanding the affective structure of PTSD. Highlighting shame as an important clinical target may help improve the efficacy of established treatments. Future research examining shame's interaction with other negative emotions and PTSD symptomology is recommended.

Critical issues in cognitive behavioural therapy (CBT) with gender and sexual minorities (GSMs)

“…unattractive, worthless, unlovable), is significantly predictive of psychopathological symptoms (e.g. López-Castro et al, 2019), and shame experiences can become a central part of autobiographical memory (e.g. Pinto-Gouveia and Matos, 2011).…”

Social–Emotional Profiles of PTSD, Complex PTSD, and Borderline Personality Disorder Among Racially and Ethnically Diverse Young Adults: A Latent Class Analysis

“…Deficits in interpersonal functioning (i.e., difficulties in relationships and relating to others) and social emotions (i.e., feelings of shame, guilt, and self‐blame) are components of these three disorders in the theoretical and empirical literature. A surge of evidence has increasingly documented the prevalence of shame, guilt, and self‐blame across PTSD populations (López‐Castro et al., 2019; Pugh et al., 2015) as well as the ways interpersonal dysfunction exacerbates PTSD by increasing social isolation (Monson et al., 2010). The recognition of these qualities in the PTSD literature led to the expansion of the DSM‐5 diagnosis to include symptoms related to social emotions and interpersonal relationships.…”

Commentary on the Special Section on Complex PTSD: Still Going Strong After All These Years

“…Posttraumatic stress disorder uniquely captures trauma survivors’ defensive preoccupation (Pine et al., ) with threat (i.e., intrusive memories, hypervigilance) and attempts at harm avoidance (Colic et al., ), which would be most likely to be employed as an adaptation when traumatic experiences are recent and clearly recalled. By contrast, CPTSD, and DSO specifically, can be understood as a posttraumatic betrayal disorder (Freyd, ), with affect dysregulation primarily due to attempts to avoid the vulnerability involved in close relationships (Van Dijke, Hopman, & Ford, ) and attempts to cope with profound shame (Lopez‐Castro, Saraiya, Zumberg‐Smith, & Dambreville, ) as a result of having sustained fundamental damage to one's sense of self. Correspondingly, BPD can be understood as a distinct posttraumatic rejection disorder in which cumulative adversity and invalidation in formative and sustaining relationships (Shearin & Linehan, ), first in childhood and then on into adulthood, leads to disinhibited anger, alternating enmeshment with others and impulsive or reactive aggression toward self and others, and an unstable and dissociated sense of self (Ford & Courtois, ).…”