Was it me? The Role of Attributions and Shame in Posttraumatic Stress Disorder (PTSD): A Systematic Review

Abstract

AbstractShame has been identified as a key emotional response to trauma exposure and is implicated in the development and maintenance of PTSD. Despite this, there is a lack of empirical research explaining how and why shame emerges following trauma exposure. Current theoretical models of shame converge on the idea that shame is elicited through internal, stable, and global attributions about the precipitating event. A systematic review was conducted to assess the relationship between causal attributions, shame, and PTSD symptomology. A database search of PsycINFO, PubMED, Medline, EMBASE and PTSDPubs identified articles published between 1980 to 2022 that enabled examination of the relationship between attributions, shame, and PTSD. A total of eight articles met inclusion criteria for this review. There were cross-sectional relationships between internal attributions, shame, and PTSD symptoms, with shame demonstrating the strongest relationship with PTSD symptoms. Significant indirect effects were found between internal attributions, shame, and PTSD. Concerns surrounding reliability of measurements and sampling bias made it difficult to draw definitive conclusions. The current evidence is too preliminary to offer strong support for the mediation hypothesis. However, it does offer important avenues for future research that will have important clinical applications.