Exploring the relationship between alienation appraisals, trauma, posttraumatic stress, and depression.

OBJECTIVE: Cognitive models posit negative trauma appraisals as maintaining symptoms of posttraumatic stress disorder. Recent research has demonstrated that alienation appraisals (feeling disconnected from the self and others) are salient in trauma-related distress. Studies show that alienation appraisals fully mediated the relationship between trauma exposure and symptoms of posttraumatic stress disorder (PTSD) in trauma-exposed adults. This study explored alienation appraisals in student and clinical samples, assessing whether alienation significantly mediated the relationship between cumulative trauma and trauma-related distress. It also explored whether alexithymia, social support, and loneliness also mediated the relationship between cumulative trauma and markers of trauma-related distress, clarifying the role of alienation. METHOD: Mediation and hierarchical regression models were tested with questionnaire data from a student sample (N = 100) and clinical sample of trauma-exposed treatment-seeking adults (N = 93). RESULTS: In the student sample, alienation (B = 1.27) fully mediated the relationship between cumulative trauma and posttraumatic stress, but not depression. When alexithymia, social support, and loneliness were entered as parallel mediators, only alienation appraisals (B = 1.03) significantly mediated the relationship between cumulative trauma and posttraumatic stress. For the clinical sample, alienation appraisals (ß = .53) were the only significant predictor of posttraumatic stress, while alienation appraisals (ß = .75) and, to a lesser extent, social support (ß = .19) and loneliness (ß = .30) significantly predicted depression. CONCLUSIONS: Alienation was a salient predictor of posttraumatic distress. Clinical assessment of alienation appraisals is recommended to inform psychological interventions for trauma survivors. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Shame, Dissociation, and Complex PTSD Symptoms in Traumatized Psychiatric and Control Groups: Direct and Indirect Associations With Relationship Distress.

OBJECTIVES: Elevated shame and dissociation are common in dissociative identity disorder (DID) and chronic posttraumatic stress disorder (PTSD) and are part of the constellation of symptoms defined as complex PTSD. Previous work examined the relationship between shame, dissociation, and complex PTSD and whether they are associated with intimate relationship anxiety, relationship depression, and fear of relationships. This study investigated these variables in traumatized clinical samples and a nonclinical community group. METHOD: Participants were drawn from the DID (n = 20), conflict-related chronic PTSD (n = 65), and nonclinical (n = 125) populations and completed questionnaires assessing the variables of interest. A model examining the direct impact of shame and dissociation on relationship functioning, and their indirect effect via complex PTSD symptoms, was tested through path analysis. RESULTS: The DID sample reported significantly higher dissociation, shame, complex PTSD symptom severity, relationship anxiety, relationship depression, and fear of relationships than the other two samples. Support was found for the proposed model, with shame directly affecting relationship anxiety and fear of relationships, and pathological dissociation directly affecting relationship anxiety and relationship depression. The indirect effect of shame and dissociation via complex PTSD symptom severity was evident on all relationship variables. CONCLUSION: Shame and pathological dissociation are important for not only the effect they have on the development of other complex PTSD symptoms, but also their direct and indirect effects on distress associated with relationships.

Comparing shame in clinical and nonclinical populations: Preliminary findings.

OBJECTIVES: To conduct a preliminary study comparing different trauma and clinical populations on types of shame coping style and levels of state shame and guilt. METHODS: A mixed independent groups/correlational design was employed. Participants were recruited by convenience sampling of 3 clinical populations-complex trauma (n = 65), dissociative identity disorder (DID; n = 20), and general mental health (n = 41)-and a control group of healthy volunteers (n = 125). All participants were given (a) the Compass of Shame Scale, which measures the four common shame coping behaviors/styles of "withdrawal," "attack self," "attack other," and "avoidance," and (b) the State Shame and Guilt Scale, which assesses state shame, guilt, and pride. RESULTS: The DID group exhibited significantly higher levels of "attack self," "withdrawal," and "avoidance" relative to the other groups. The complex trauma and general mental health groups did not differ on any shame variable. All three clinical groups had significantly greater levels of the "withdrawal" coping style and significantly impaired shame/guilt/pride relative to the healthy volunteers. "Attack self" emerged as a significant predictor of increased state shame in the complex trauma, general mental health, and healthy volunteer groups, whereas "withdrawal" was the sole predictor of state shame in the DID group. CONCLUSIONS: DID emerged as having a different profile of shame processes compared to the other clinical groups, whereas the complex trauma and general mental health groups had comparable shame levels and variable relationships. These differential profiles of shame coping and state shame are discussed with reference to assessment and treatment. (PsycINFO Database Record

Trauma typology as a risk factor for aggression and self-harm in a complex PTSD population: the mediating role of alterations in self-perception.

This study examined the role of prolonged, repeated traumatic experiences such as childhood and sectarian trauma in the development of posttraumatic aggression and self-harm. Forty-four adult participants attending therapy for complex trauma in Northern Ireland were obtained via convenience sampling. When social desirability was controlled, childhood emotional and physical neglect were significant correlates of posttraumatic hostility and history of self-harm. These relationships were mediated by alterations in self-perception (e.g., shame, guilt). Severity of sectarian-related experiences was not related to self-destructive behaviors. Moreover, none of the trauma factors were related to overt aggressive behavior. The findings have implications for understanding risk factors for posttraumatic aggression and self-harm, as well as their treatment.

Complex trauma and intimate relationships: the impact of shame, guilt and dissociation.

BACKGROUND: This study examined dissociation, shame, guilt and intimate relationship difficulties in those with chronic and complex PTSD. Little is known about how these symptom clusters interplay within the complex PTSD constellation. Dissociation was examined as a principle organizing construct within complex PTSD. In addition, the impact of shame, guilt and dissociation on relationship difficulties was explored. METHODS: Sixty five treatment-receiving adults attending a Northern Irish service for conflict-related trauma were assessed on measures of dissociation, state and trait shame, behavioral responses to shame, state and trait guilt, complex PTSD symptom severity and relationship difficulties. RESULTS: Ninety five percent (n=62) of participants scored above cut-off for complex PTSD. Those with clinical levels of dissociation (n=27) were significantly higher on complex PTSD symptom severity, state and trait shame, state guilt, withdrawal in response to shame and relationship preoccupation than subclinical dissociators (n=38). Dissociation and state and trait shame predicted complex PTSD. Fear of relationships was predicted by dissociation, complex PTSD and avoidance in response to shame, while complex PTSD predicted relationship anxiety and relationship depression. LIMITATIONS: The study was limited to a relatively homogeneous sample of individuals with chronic and complex PTSD drawn from a single service. CONCLUSIONS: Complex PTSD has significant consequences for intimate relationships, and dissociation makes an independent contribution to these difficulties. Dissociation also has an organizing effect on complex PTSD symptoms.

An exploratory analysis of voice hearing in chronic PTSD: potential associated mechanisms.

This research investigated auditory hallucinations (AH) in a sample with chronic posttraumatic stress disorder (PTSD) and examined dissociation and thought suppression as potential associated mechanisms. In all, 40 individuals with PTSD were assessed on the hallucinations subscale of the Positive and Negative Syndrome Scale and on measures of dissociation and thought suppression. Half of the sample reported AH (n = 20, 50%). Those reporting AH had higher general and pathological dissociation scores but did not differ on thought suppression or PTSD symptom severity. Results suggest that (a) AH in chronic PTSD is not a rare phenomenon, (b) dissociation is significantly related to AH, and (c) dissociation may be a potential mediating mechanism for AH in PTSD.

Anger, aggression, and self-harm in PTSD and complex PTSD.

This study examined the contribution of complex posttraumatic stress disorder (PTSD) diagnosis and symptomatology to the difficulties of anger, aggression, and self-harm in a Northern Ireland clinical community sample. A "current complex PTSD" (CCPTSD) group (n=11) was compared with a "current PTSD" group (n=31) on self-report measures of these variables. The CCPTSD group demonstrated significantly higher levels of physical aggression and self-harm than the PTSD group. The complex PTSD symptom of 'alterations in self-perception' was a significant predictor of aggression and history of self-harm, suggesting the potential role of posttraumatic shame and self-loathing in PTSD theoretical models of these destructive behaviors. Social desirability was a notable confounding influence in the assessment of anger, aggression, and self-harm in traumatised individuals.

Complex PTSD, interpersonal trauma and relational consequences: findings from a treatment-receiving Northern Irish sample.

BACKGROUND: The relationship between PTSD and complex PTSD remains unclear. As well as further addressing this issue, the current study aimed to assess the degree to which DESNOS (complex PTSD) was related to interpersonal trauma and had relational consequences. METHODS: Eighty one treatment-receiving participants with a history of exposure to the 'Troubles' in Northern Ireland, were assessed on various forms of interpersonal trauma, including exposure to the Troubles, and measures of interpersonal and community connectedness. RESULTS: DESNOS symptom severity was related to childhood sexual abuse and perceived psychological impact of Troubles-related exposure. A lifetime diagnosis of DESNOS was related to childhood Troubles-related experiences, while a current diagnosis of DESNOS was associated with childhood emotional neglect. PTSD avoidance predicted current DESNOS diagnosis and severity. Feeling emotionally disconnected from family and friends (i.e., interpersonal disconnectedness) was related to all three indices of DESNOS (i.e., lifetime diagnosis, current diagnosis and current symptom severity). LIMITATIONS: Sample characteristics (i.e., treatment-receiving) and size may limit the generalizability of findings. CONCLUSIONS: Complex PTSD is associated with PTSD but when present should be considered a superordinate diagnosis.