A Pilot Prospective Study of the Relationship among Cognitive Factors, Shame, and Guilt Proneness on Posttraumatic Stress Disorder Symptoms in Female Victims of Sexual Violence

Abstract

This study prospectively examined the relationships among cognitive factors and severity of Posttraumatic stress disorder (PTSD) symptoms in female victims of sexual violence. Thirty-eight victims of sexual violence recruited from Center for Women Victims of Sexual and Domestic Violence at Ajou University Hospital. Cognitive factors and PTSD symptom were assessed within 4 months of sexual violence and 25 victims were followed-up 1 month after initial assessment. Repeated-measured ANOVA revealed that PTSD incidence and severity decreased over the month (F [1, 21]=6.61). Particularly, avoidant symptoms might decrease earlier than other PTSD symptoms (F [1, 21]=5.92). This study also showed the significant relationship between early negative trauma-related thoughts and subsequent PTSD severity. Shame and guilt proneness had significant cross-sectional correlations with PTSD severity, but did not show associations when depression severity is controlled. Our results suggest that avoidant symptoms might decrease earlier than other PTSD symptoms during the acute phase and that cognitive appraisals concerning the dangerousness of the world seem to play an important role in the maintenance of PTSD (r=0.499, P<0.05).Graphical Abstract

Ashamed and Afraid: A Scoping Review of the Role of Shame in Post-Traumatic Stress Disorder (PTSD)

“…Both women and men were well represented. Representation of racial and ethnic minorities, however, was sparse and relegated to cross-cultural validation studies [29,30] or refugees [31]. Most employed a retrospective, cross-sectional design with thirteen studies reporting on longitudinal data [30,32,33,34,35,36,37,38,39,40,41,42,43].…”

“…In measurements of week-to-week levels during treatment, increases in trauma-related shame were associated with subsequent increases in PTSD symptoms [42]. In contrast to this finding, a longitudinal study of Korean sexual assault survivors found that shame-proneness (one to four months post-trauma) did not predict PTSD levels at a second assessment one month after the first [30]. Research design variations such as the type of shame studied (general versus trauma-specific), proximity of the time points assessed (days, weeks or months), and sample characteristics may all directly impact how shame is understood to maintain PTSD.…”

“…Two of these studies found shame to be related to depression rather than PTSD [30,69] where one of these studies found guilt to be associated with PTSS instead of shame [69]. These two studies may lack significant associations between shame and PTSS/PTSD because of the traumatic exposures in the respective samples.…”

Avoidance symptoms and delayed verbal memory are associated with post-traumatic stress symptoms in female victims of sexual violence

“…Some reported worse performance of measures of sustained and divided attention in rape survivors with PTSD (Jenkins et al, 2000), while others have found few or no impairments in neurocognitive functioning (Crowell et al, 2002;Stein et al, 1999). Similarly, a few longitudinal studies have shown that a victim's maladaptive thoughts and beliefs play an important role in the persistence of PTSD (Ehlers and Clark, 2000;Foa and Rothbaum, 2001;Shin et al, 2014).…”

The Role of Generalized Explicit and Implicit Guilt and Shame in Interpersonal Traumatization and Posttraumatic Stress Disorder

“…Although shameproneness and guilt-proneness are related to general psychological maladjustment (Tangney et al, 1992), the concepts of generalized guilt-and shame-proneness have received little empirical investigation in the field of traumatology and PTSD. However, some studies specifically suggest a link between generalized self-reported guilt, shame, and PTSD (Dorahy et al, 2013;Rüsch et al, 2007) as well as between generalized self-reported guilt, shame, and posttraumatic symptom severity (Leskela et al, 2002;Semb et al, 2011;Shin et al, 2014). Rüsch et al (2007), for example, found significantly higher generalized guilt-proneness in women with PTSD and borderline personality disorder (BPD) than in women with BPD alone.…”