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Self-Blame and PTSD Following Sexual Assault: A Longitudinal Analysis

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Journal of Interpersonal Violence
Authors:
Nora K. Kline at Clark University
Nora K. Kline
Danielle S. Berke at Hunter College of the City University of New York
Danielle S. Berke
  • Hunter College of the City University of New York
Charla Aubrey Rhodes at King's College London
Charla Aubrey Rhodes
Maria Steenkamp at NYU Langone Medical Center
Maria Steenkamp
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Abstract and Figures

Sexual assault is a prevalent trauma associated with high rates of posttraumatic stress disorder (PTSD). Social cognitive theories posit that behavioral self-blame (i.e., attributing the cause of the assault to personal peri-event behavior) contributes to the etiology and maintenance of PTSD symptoms. Yet the direction of the association between self-blame and PTSD symptoms in the acute aftermath of sexual assault is unknown. This study evaluated temporal pathways between behavioral self-blame and PTSD symptom severity in an epidemiological sample of sexual assault survivors (n = 126) assessed at four time points in the months immediately following the assault. Results of cross-lagged panel modeling revealed that reports of behavioral self-blame at the first assessment following sexual assault predicted PTSD symptom severity at Time 2. However, there was no association between behavioral self-blame at Time 2 and PTSD symptom severity at Time 3, nor was there an association between behavioral self-blame at Time 3 and PTSD symptom severity at Time 4. Instead, PTSD symptom severity predicted behavioral self-blame at Times 3 and 4. Findings suggest that behavioral self-blame following sexual assault may be particularly relevant to the onset of PTSD symptoms, while PTSD symptoms themselves appear to intensify subsequent perceptions of behavioral self-blame. Clinical implications and limitations are discussed.
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https://doi.org/10.1177/0886260518770652
Journal of Interpersonal Violence
2021, Vol. 36(5-6) NP3153 –NP3168
© The Author(s) 2018
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DOI: 10.1177/0886260518770652
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Original Research
Self-Blame and PTSD
Following Sexual Assault:
A Longitudinal Analysis
Nora K. Kline,1 Danielle S. Berke,1,2
Charla A. Rhodes,1 Maria M. Steenkamp,3
and Brett T. Litz1,2
Abstract
Sexual assault is a prevalent trauma associated with high rates of posttraumatic
stress disorder (PTSD). Social cognitive theories posit that behavioral
self-blame (i.e., attributing the cause of the assault to personal peri-event
behavior) contributes to the etiology and maintenance of PTSD symptoms.
Yet the direction of the association between self-blame and PTSD symptoms
in the acute aftermath of sexual assault is unknown. This study evaluated
temporal pathways between behavioral self-blame and PTSD symptom
severity in an epidemiological sample of sexual assault survivors (n = 126)
assessed at four time points in the months immediately following the assault.
Results of cross-lagged panel modeling revealed that reports of behavioral
self-blame at the first assessment following sexual assault predicted PTSD
symptom severity at Time 2. However, there was no association between
behavioral self-blame at Time 2 and PTSD symptom severity at Time 3, nor
was there an association between behavioral self-blame at Time 3 and PTSD
symptom severity at Time 4. Instead, PTSD symptom severity predicted
behavioral self-blame at Times 3 and 4. Findings suggest that behavioral
self-blame following sexual assault may be particularly relevant to the onset
of PTSD symptoms, while PTSD symptoms themselves appear to intensify
1VA Boston Healthcare System, MA, USA
2Boston University School of Medicine, MA, USA
3NYU Langone Medical Center, NY, USA
Corresponding Author:
Nora K. Kline, VA Boston Healthcare System, 150 South Huntington Ave., Boston, MA 02130,
USA.
Email: Nora.Kline@va.gov
770652JIVXXXXXX10.1177/088626051877065210.1177/0886260518770652Journal of Interpersonal ViolenceKline et al.
research-article20182018
... Examining trauma-specific appraisals, beyond global beliefs that may have existed prior to the trauma, is critical to fully understand the impact of the trauma on mental and physical health sequelae and inform intervention targets. A body of literature has developed on the effects of one situational appraisal, self-blame, on recovery from sexual trauma (e.g., Frazier et al., 2017;Kline et al., 2021). Self-blame appraisals involve the attribution that the trauma or its aftermath is the direct result of one's actions or character (e.g., "I should have been more cautious" ;Frazier, 2003a). ...
... Self-blame was positively associated with subsequent PTSD symptoms, sleep disturbance, and pain interference, but not depression symptoms. The finding that self-blame predicted subsequent PTSD was consistent with another study that showed that self-blame appraisals in the month after sexual assault predicted PTSD symptoms 1 month later (Kline et al., 2021). Our study extends this finding by demonstrating that the effect of self-blame on subsequent PTSD symptoms is robust even after accounting for key confounding variables and other important trauma appraisals. ...
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... Similarly, the association between PTSD and the punitiveness schema highlights the prominent role of self-blame, which is frequently observed in individuals with PTSD [105,[107][108][109]. The association with the subjugation schema indicates that individuals may express feelings of being controlled or oppressed, with the anonymity afforded by these online platforms likely encouraging the disclosure of such sensitive experiences [105,106,110,111]. ...
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... It is likely that interpersonal trauma affects people differently than non-interpersonal trauma, and treatments must reflect this difference. For instance, self-blame (Kline et al., 2021) and trauma associated with a high level of betrayal (Martin et al., 2013) may be important in the etiology and maintenance of interpersonal trauma. ...
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... In addition, the student population is disproportionately affected by sexual assault, and these numbers may be increasing. In fact, a report redacted by the Standing Committee on the Prevention of Sexual Violence and the Human Rights Office at the University of Ottawa (2022), where the current study was likelihood of revictimization (Miller et al., 2007), and psychological consequences, increasing symptoms of posttraumatic stress, depression, and suicidal ideation (Alix et al., 2017(Alix et al., , 2020Kline et al., 2021). In the present study, 70% of the participants believed that the occurrence of sexual arousal would increase feelings of shame in guilt in victims, who may be left in a state of turmoil in the face of betrayal by their own bodies (Shin & Salter, 2022). ...
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