Intrusive Thoughts, Self-blame, and Shame in PTSD

Lesson objective:

This lesson outlines some scenarios, questions, and reactions that a person can experience mid trauma and stress. Those reactions can force someone to act in a way that is contrary to their ethics or manners, which causes a great deal of guilt and shame in different ways.

Your brain craves certainty and safety. 

Conflict, displacement, injustice, violence, or any form of trauma dramatically reduce both certainty and safety. 

Traumatic experiences create abundant opportunities for guilt and shame, for the brain to guess “what if…” in response to many imagined scenarios. 

What if I had done something differently? 

Questions like these can become endless as the brain tries to make meaning out of pain. The attributions we make in the wake of a traumatic experience can greatly affect how we then feel and confront our pain. 

Is this pain the result of something I did?

Is this pain the result of who I am?

And so often, the pain felt by those who survive conflict, violence, and trauma is related to the fact that not everyone made it out alive, or safe.

In the context of conflict and violence in particular, if one person escapes a dangerous situation relatively unharmed while another is injured or dies, the person who left unharmed may experience a number of different responses:

 

They may, A, draw no conclusions about themselves or their role. They may think: “It was just luck, it was a coincidence; during the chaos it was just as likely to have been me who got injured.”

 

They might, B, experience guilt, thinking: “What else could I have done to help them? What if I had done this instead of that? What if I had behaved differently?”; or

 

They might, C, experience shame: “I do not deserve to be alive or be healthy. I did not deserve to survive.”

The same is true for situations in which you might have found yourself forced or coerced to behave in ways that are inconsistent with your personal ethics and morals. 

For example, if you were forced to destroy someone’s home, or steal something, despite personal hesitation or moral opposition, this can create tremendous feelings of guilt or shame. 

In these situations, you or anyone could then react by feeling:

 

  • guilt —“I shouldn’t have done it regardless of the circumstances,” 
  • shame – “I am a terrible person.” 
  • or neither —“I had no choice. There was no other way.”

Situations like chronic poverty, injustice, violence, conflict, or displacement create countless stressful and traumatic situations that can lead to feelings of guilt or shame.

The types of stress and trauma we experience can contribute to our feelings of guilt and shame. 

Additionally, repeated trauma exposure can lead to feelings of shame. It might be the case that upon the first experience of a dangerous and violent event, a person does not feel a self-conscious emotion.

For example, after surviving a single bombing a person might feel fear and a sense of relief at having survived.

However, experiencing the same types of situations over and over might lead to a shift– a focus on the self. 

That shift can dramatically alter how we think about ourselves, and how we interact with loved ones. 

Guilt and shame can appear as part of post-traumatic stress disorder, but they are not merely symptoms of PTSD.

 It is possible to experience guilt and shame without other symptoms, and it is possible to experience no guilt or shame at all, despite having lived through horrible and stressful experiences. 

That said, shame in particular may exacerbate other symptoms after trauma or may be a risk factor for developing other negative responses to stress. 

Importantly, the experience of shame correlates with the severity of post-traumatic stress responses. Specifically, shame is related to an increase in negative and self-critical thinking, hyperarousal, and most strongly, avoidance behaviors.

Because shame impacts our core identity and our evaluation of who we are as a person, it can be harder to manage than guilt, which focuses on our actions and possible actions to repair the damage. 

Recent research suggests that shame is a risk factor for the development of immediate symptoms following a traumatic event, and also for delayed onset of stress symptoms years after the trauma. In other words, the degree to which you feel shame after a traumatic event may affect the likelihood of developing PTSD in the immediate aftermath, or even years later.

This means that even after we find ourselves in a relatively safe space after trauma, any internalized feelings of shame further place our mental health and well-being at risk.

In short, the more we blame ourselves, and who we are, the harder it may be to cope with trauma. In this context, addressing and confronting shame is a critical part of coping with PTSD and various symptoms of chronic stress and trauma.