A meta‐analysis of the association between shame and dissociation

Abstract

Shame and dissociation have been implicated theoretically and empirically in trauma exposure and its sequelae, with shame understood as an intense negative emotion and dissociation as a reaction to intense negative emotions. Understanding the connection between shame and dissociation is important for theory and practice; however, the strength of this association remains unclear. For example, in therapy, both shame and dissociation serve as a barrier to engaging with emotion. Theoretically, these two states should be distinct, as one (dissociation) confers low affective intensity and the other (shame) high intensity. The present meta-analysis focused on the magnitude of the association between these two phenomena and investigated the extent to which gender, trauma exposure, psychiatric comorbidities, and demographic characteristics influence this association given their independent links to shame and dissociation. An initial search of six databases identified 151,844 articles. Duplicates were removed, and additional articles were excluded based on abstract and title screening. After contacting authors for missing data, a full-text screen yielded 25 articles for the present analysis. The results indicate that shame and dissociation were moderately correlated (k = 33, n = 4,705), r = .42, 95% CI [.35, .48], p < .001, but no clear clinical moderators emerged. Despite this association, very few studies utilized experimental designs to examine the association between these constructs. Future research should focus on experimental study designs to investigate the extent to which shame induces dissociation or vice versa. A meta-analysis of the association between shame and dissociationSymptoms commonly reported by trauma survivors represent a paradox: On one hand, these individuals report intense negative emotion; at the same time-even within the same individual-blunted affect or emotional numbing are also reported. Some work has suggested that high-intensity affect has the potential to evoke numbed or blunted affective states (van der Kolk & Fisler, 1995). Relevant to this discourse are two states particularly com-mon to survivors of childhood trauma: dissociation (Terr, 1991;Vonderlin et al., 2018) and shame (Platt & Freyd, 2015;J. Kim et al., 2009). The goal of this meta-analysis was to examine the overlap between these constructs to further understand the paradox of intense and blunted states within trauma survivors. Affirming the association between shame and dissociation may have implications for future directional research as well as treatment factors (e.g., intervention pacing).Dissociation is a psychological process by which normally integrated functions, including thoughts, emotions, physical sensations, and behaviors, become fragmented 1318

“G-d, in you I trusted, let me never be ashamed”: Shame and sexual abuse among Orthodox Jews.

“…What are the implications of these findings? First, previous research suggests that shame is a mediating factor between sexual abuse and a variety of long-term negative outcomes such as persistent posttraumatic stress disorder (Feiring & Taska, 2005), sexual dysfunction (Pulverman & Meston, 2020), and dissociative symptoms (Kizilhan et al, 2020; Rudy et al, 2022). Given that Orthodox Jewish patients with a history of sexual abuse have highly elevated levels of shame, it is likely that effective treatment requires particular attention to shame.…”

Survival, Attachment, and Healing: An Evolutionary Lens on Interventions for Trauma-Related Dissociation

“…After repeated failed attempts at connection or repeated abuse, an individual may learn to avoid others altogether or incorporate the experiences as evidence of not being worthy of care, creating trauma-related states of shame. 49 Such shame is itself associated with inflammation, helplessness, withdrawal, depressive and dissociative symptoms, and altered information processing. [49][50][51][52][53][54] Thus, dissociation can become the default, or there may be oscillation between states of feeling out of control and states of feeling disconnected, robotic or unalive.…”

“…49 Such shame is itself associated with inflammation, helplessness, withdrawal, depressive and dissociative symptoms, and altered information processing. [49][50][51][52][53][54] Thus, dissociation can become the default, or there may be oscillation between states of feeling out of control and states of feeling disconnected, robotic or unalive.…”

Researching Shame, Dissociation, and Their Relationship Using Latent Change Modeling

“…However, the precise relation between these two symptoms remains unclear. Although a recent meta-analysis found evidence of a correlation between the two constructs, only five studies with an experimental design were included (Rudy et al, 2022).…”

“…Some researchers see dissociations as emotion regulation mechanisms, which would explain their occurrence after or during aversive feelings of shame, hence supporting bypass theory. However, most evidence can only support a correlation between trait shame and trait dissociation (Irwin, 1998; Rudy et al, 2022; Talbot et al, 2004; Thomson & Jaque, 2013).…”