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Research has demonstrated that individuals experiencing trauma-related shame exhibit greater posttraumatic stress disorder (PTSD) symptoms. However, little research has investigated additional factors relevant to the shame–PTSD relationship. The current study examined the role of avoidance and approach coping in accounting for the trauma-related sh...
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... from the first model predicting interviewer-assessed PTSD symptoms via the CAPS-5 (Weathers et al., 2013a) are displayed in Figure 1. As expected, trauma-related shame was positively related to avoidance coping (Path A 1 ). ...
Citations
... Women experience interpersonal trauma (IPT; physical or sexual abuse and/or assault) at substantially higher rates compared to men and are more than twice as likely to develop posttraumatic stress disorder (PTSD), in part, due to a higher likelihood of experiencing IPT (Kilpatrick et al., 2013). Though theoretical models of PTSD have long focused on fear and anxiety, recent evidence demonstrates that shame is robustly associated with greater PTSD symptoms post-IPT (Badour et al., 2017;Beck et al., 2011;DeCou et al., 2023;Saraiya & Lopez-Castro, 2016;Tipsword et al., 2022). Posttraumatic shame is a distressing moral emotion that results from broad, negative, and painful evaluations of the self after a traumatic event (Øktedalen et al., 2014). ...
... Despite growing recognition of the importance of links between shame and PTSD post-IPT, the frequency (i.e., how often shame occurs), intensity (i.e., how strongly shame is experienced), and stability of shame (i.e., extent to which shame fluctuates in the short term) in the daily lives of women post-IPT remain poorly understood. Previous researchers have used cross-sectional and longitudinal panel designs to characterize overall levels of shame post-IPT (Badour et al., 2017;Saraiya & Lopez-Castro, 2016;Tipsword et al., 2022). However, preliminary examinations of specific features of posttraumatic shame (frequency, intensity, and stability) have yet to be conducted among women post-IPT, and associations between PTSD symptoms and subsequent momentary shame also have yet to be explored. ...
... Though women who tended to experience more intense shame reported using approach-and avoidance-oriented ER strategies more often, these associations were not significant after adjusting for PTSD symptoms, time since the first assessment, time of day, and the number of IPT instances and types experienced. This pattern of findings is in line with work documenting the use of both approach-and avoidance-oriented strategies posttrauma (e.g., Munroe et al., 2022;Tipsword et al., 2022). However, findings regarding the use of approach strategies have been mixed (Boden et al., 2013;Hassija et al., 2012;Littleton et al., 2007), and work has consistently linked shame to lower use of approach strategies posttrauma (Dorahy et al., 2013;Holl et al., 2017;Szentágotai-Tătar & Miu, 2016;Velotti et al., 2017). ...
Objective: Posttraumatic shame—an emotion stemming from harsh attitudes about the self after trauma—is central to posttraumatic stress disorder for many women following physical or sexual assault or abuse (interpersonal trauma [IPT]). However, knowledge of how shame is experienced in daily life post-IPT (e.g., frequency, intensity, and stability) is lacking. Additionally, though some research has explored shame-specific emotion regulation (ER) or processes aimed at changing emotional responses to shame, it remains unclear which ER strategies are effective in reducing shame. Method: We explored momentary experiences and regulation of posttraumatic shame via a secondary analysis of ecological momentary assessment data. Sixty women post-IPT completed assessments of shame and their use of six ER strategies (reflection, rumination, reappraisal, emotion sharing, emotion suppression, and distraction) five times per day for 14 days. Results: Women experiencing more severe baseline posttraumatic stress disorder symptoms reported more intense momentary shame. Experiencing more intense shame than typical was associated with greater next-assessment use of rumination, emotion sharing, and reappraisal. Higher than typical use of rumination, emotion suppression, and distraction was associated with more intense next-assessment shame, and higher than typical use of emotion sharing was associated with more severe next-assessment shame among women with low or moderate posttraumatic stress disorder symptoms. Conclusions: Findings suggest that women may use both avoidance- and approach-oriented ER strategies at times when shame is more intense. Future researchers should consider contextual factors that may shape the daily experience and regulation of posttraumatic shame post-IPT.
... Moreover, shameful feelings (i.e., negative beliefs about the self) after trauma have been recognized as a typical symptom of the PTSD diagnosis in DSM-V (American Psychiatric Association, 2013). Indeed, the relationship between trauma-elicited shame and PTSD symptoms has also been supported by empirical evidence (Tipsword et al., 2022). Accordingly, in this study, a mediating association of shame and PTSD symptoms is expected. ...
... Consistent with previous research (Tipsword et al., 2022), the study also found evidence for internal shame's mediating mechanism, but not external shame, in the relationship between bullying victimization and PTSD symptoms. Internal shame influences self-cognition by internalizing the traumatic event and corresponding negative judgments from others as confirmations of their weak nature. ...
With its susceptibility in victimized populations and the potential for suicidality, non-suicidal self-injury (NSSI) is among the most severe health concerns in college students, indicating an urgency to explore its antecedents and interventions. The present study aims to examine the relationship between bullying victimization and NSSI and the mediating roles of internal shame, external shame, depressive symptoms, and PTSD symptoms based on the general strain theory, the vulnerability-stress theory, and the transactional stress theory. By adopting a three-time-point design with 6-month intervals, hypotheses were tested using data from 634 Chinese college students (374 female; Mage = 18.97). Through a structural equation modeling approach, the study found that bullying victimization was positively correlated with NSSI via internal shame and depressive symptoms. However, this study found no evidence for the mediating association of either external shame or PTSD symptoms in the examined relationship. Through a lens of emotion-driven mechanism, this study contributes to understanding the roles of internal shame and depressive symptoms in NSSI intervention strategies among victims of bullying. The results also illuminate the differentiation of the mechanisms of internal and external shame and the discrepancy between depressive symptoms and PTSD symptoms as two types of post-traumatic symptomatology.
... Full mediation by EA between CHRp and trauma distress was found in our study, being only partial for ES. Previous research has stablished that trauma-related distress may persist over time due to deficits in emotion regulation (Tipsword et al., 2022;Villalta et al., 2018), highlighting the importance of the ER strategy employed; an avoidant coping with the traumatic experience can lead to greater distress in the long term (Marulanda and Addington, 2016). I. Fernández et al. ...
... Shame has been found to mediate the relationship between post-trauma appraisals, such as self-blame (e.g., "It is my fault"), and PTSD symptom severity in studies of child sexual abuse survivors and community samples (Alix et al., 2017;Feiring et al., 2002;Uji et al., 2007), even after controlling for risk factors (e.g., number of traumas, worst trauma, time since trauma, depressive symptoms; Seah & Berle, 2022). Shame may maintain or prolong PTSD symptoms through responses such as hyperarousal and avoidance (Feiring et al., 2002;Feiring & Taska, 2005;Leonard et al., 2020;Tipsword et al., 2022) and maladaptive cognitive and behavioral strategies (Lee et al., 2001;Taylor, 2015). Interpersonal violence survivors typically report more shame than survivors of non-interpersonal trauma (Amstadter & Vernon, 2008;DePrince et al., 2011;La Bash & Papa, 2014;Seah & Berle, 2023). ...
Women who have survived interpersonal trauma are at elevated risk of developing posttraumatic stress disorder (PTSD), and potentially modifiable factors that may be targeted in treatment warrant further investigation. This study examined a pathway from interpersonal trauma to PTSD symptoms via emotion dysregulation and shame in a large non-clinical sample of women. The sample comprised 380 women, aged 18 to 59 years (M = 31.70, standard deviation = 10.06), all of whom had a history of interpersonal trauma. Participants completed the Experience of Shame Scale, the Difficulties in Emotion Regulation Scale-Short Form, and the Life Events Checklist for DSM-5. A serial and parallel process model with interpersonal trauma as a predictor of PTSD symptoms, emotional dysregulation and facets of shame as intermediary variables, was analyzed using Statistical Package for Social Sciences Statistics PROCESS Model 81with bias-corrected bootstrap tests of indirect effects. Non-interpersonal trauma was included as a covariate. Interpersonal trauma, emotion dysregulation, and characterological and bodily shame were significantly and directly associated with PTSD symptoms, together explaining 59% of the variation in PTSD symptoms. While emotion dysregulation was associated with behavioral shame, interpersonal trauma was not associated with behavioral shame, nor was behavioral shame associated with PTSD symptoms. Tests of indirect effects supported a pathway from interpersonal trauma to PTSD symptoms via emotion dysregulation and characterological and bodily shame. These findings suggest interventions that are particularly effective at reducing emotion dysregulation and characterological and bodily shame, such as compassion and acceptance-based approaches, may complement evidence-based PTSD interventions when working with women who have survived interpersonal trauma.
... Results are in line with the growing recognition of the importance of posttrauma shame in the development and maintenance of PTSD (La Bash & Papa, 2014;Saraiya & Lopez-Castro, 2016;Tipsword et al., 2022). Experiences of interpersonal violence in particular are associated with greater feelings of shame (La Bash & Papa, 2014). ...
... One process may be related to the avoidance and withdrawal behaviors elicited by shame, which may prevent individuals from processing the trauma (Saraiya & Lopez-Castro, 2016). Indeed, Tipsword et al. (2022) found that avoidance coping mediated the link between trauma-related shame and PTSD symptoms among women who experienced physical and/or sexual assault. Straub et al.'s (2018) findings with lesbian and bisexual women also indicated that shame proneness-withdrawal tendencies (vs. ...
Bisexual women experience higher rates of rape and post-traumatic stress disorder (PTSD) prevalence compared to heterosexual and lesbian women. In addition, bisexual women experience unique antibisexual stigma and minority stress, which are associated with post-trauma outcomes. The aim of the current study was to test trauma-related shame as a mechanism in the relations of self-blame and bisexual minority stress (i.e., antibisexual stigma and internalized binegativity) with rape-related PTSD symptom. The sample consisted of 192 cisgender bisexual women (ages 18–35 years) who reported an experience of rape since the age of 18. Results from path analysis conducted in Mplus indicated that trauma-related shame mediated the link between self-blame and rape-related PTSD severity, as well as the links from antibisexual stigma and internalized binegativity to rape-related PTSD severity. There was also an indirect serial effect from antibisexual stigma to internalized binegativity to shame to PTSD severity. Thus, findings highlight the mechanistic role of trauma-related shame in rape-related PTSD symptoms. We identified two risk pathways: (a) general/universal risk from self-blame about rape and shame to PTSD severity and (b) group-specific risk from bisexual minority stress and shame to PTSD severity. Results indicate that reducing trauma-related shame may be an important target to improve post-rape outcomes. Finally, stigma associated with rape and sexual violence as well as antibisexual stigma must be eradicated to improve post-trauma outcomes among bisexual survivors.
... Even in the absence of an external threat, the individual may still feel a sense of impending threat due to fear of rejection and stigmatisation but also an internal threat due to ongoing negative self-evaluation. Consequently, the feeling of shame is often painful, and promotes avoidance, which could impede trauma processing and recovery (Leonard et al., 2020;Tipsword et al., 2021). Thus, understanding the factors that may give rise to shame may present a potential target for therapeutic intervention. ...
Shame is a common trauma response that is associated with the development and maintenance of PTSD. Phenomenological descriptions of shame indicate that shame arises from internal, stable and global causal attributions (negative attributions) for the precipitating event. The current study investigated whether negative attributions would be associated with higher levels of shame and PTSD, and whether shame would mediate the relationship between causal attributions and PTSD. As negative attributions may reflect a common transdiagnostic process in both depression and PTSD, it also examined whether depression would moderate this relationship. Eighty-seven participants meeting criteria for a Criterion A stressor were administered a structured PTSD diagnostic interview and a series of self-report measures. Findings indicate that shame mediated the relationship between internal, stable and global trauma-related causal attributions and PTSD symptoms. Further, depression did not moderate this relationship, indicating that negative causal attributions are associated with shame and PTSD independent of depression. Results provide empirical support for the cognitive concomitants of trauma-related shame, which raise the possibility that addressing negative attributions through cognitive therapeutic methods may be pertinent in reducing trauma-related shame. Future prospective data is needed to establish cognitive antecedents to shame.
... A recent ecological momentary assessment study found that greater momentary experiential avoidance predicted worse affect and valued living (Levin et al., 2018). Furthermore, shame has been associated with avoidance behaviors as a way to cope with this emotional distress, such that individuals either avoid stimuli that might trigger reminders of the trauma or withdraw from valued activities and relationships (Saraiya & Lopez-Castro, 2016;Tipsword et al., 2021). While cumulative research supports the associations between trauma-related shame and disruption to valued consistent behavior, to our knowledge, no research has examined this relation. ...
Objectives
Trauma-related shame is predictive of negative health consequences following interpersonal violence victimization, including development and severity of PTSD; however, less is known about its impact on other indicators of psychosocial functioning. Valued living refers to engagement in behaviors based on what brings someone purpose and may be disrupted in the aftermath of interpersonal violence victimization. A lack of a self-compassionate attitude may explain the negative effects of trauma-related shame in obstructing values-consistent behavior.
Methods
A cross-sectional survey design was used. One hundred forty-one survivors of interpersonal violence (age: M = 19.74, SD = 1.64 years; 83.7% female; 69.5% White) completed this anonymous, internet-based study. Participants completed measures assessing trauma history, self-compassion, trauma-related shame, and valued living.
Results
Parallel mediation models were used to examine the mediating effects of two components of self-compassion, compassionate self-responding and uncompassionate self-responding, on the relation between trauma-related shame and values obstruction and values progress, respectively. Results demonstrated significant indirect effects of uncompassionate self-responding on the relation between trauma-related shame and values obstruction (β = .20, p < .001, CI = 0.09, 0.30) and values progress (β = − 0.12, p < .01, CI = − 0.22, − 0.03), while controlling for PTSD symptom severity. Indirect effects through compassionate self-responding were not significant.
Conclusions
An inability to respond in a compassionate way to one’s own distressing internal states, such as trauma-related shame, may disrupt valued living. Future work should continue to highlight valued living as an important consideration in trauma recovery.
Post-traumatic stress disorder (PTSD) and complex PTSD (cPTSD) are debilitating psychiatric conditions associated with disability and morbidity; historically, PTSD has been conceptualized as a fear-based anxiety disorder. More recently, it has been found that other negative emotions are also primary in PTSD/cPTSD. Shame is a diagnostic component of cPTSD and is known to be positively associated with PTSD. Thus, PTSD with shame and cPTSD are reviewed together in this article. Two reviews were conducted an umbrella review of previous reviews, systematic reviews, and meta-analyses of the relationship between PTSD/cPTSD and shame as well as a research update. The umbrella review was comprised four reviews and the research update 10 articles published after the last review, Shi et al . The findings indicate a strong relationship between PTSD/cPTSD and shame. Further trauma-related shame has a role in the development of PTSD/cPTSD and trait-based shame has a role in the maintenance of PTSD/cPTSD. The findings and limitations of this review are discussed.
