Shame-based identity and chronic post-traumatic stress disorder in help -seeking combat veterans
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The long-term effects of post-traumatic stress disorder (PTSD) have been previously investigated. However, developmental and identity issues around trauma and shame have been less extensively examined. For some combat veterans, relief from the primary symptoms of PTSD is a struggle for much of the postwar adjustment period. Moreover, secondary problems associated with living with trauma have substantial impact on veterans' sense of self, capacity for interpersonal relationships, and making meaning of their lives. The current investigation examined relationships between self-reported symptom distress and shame on postwar adjustment of combat veterans. Specifically, the study investigated how shame and sense of self were related to PTSD, depression, trait anxiety, vulnerability, self-handicapping, hope, and overall quality of life. This investigation used archival data that are part of a larger longitudinal study. Correlational, repeated measures, and multivariate analyses examined how symptom distress and resilience measures were related to premilitary, military, and postmilitary factors. Participants completed self-report symptom distress measures and family of origin and demographic questionnaires. Repeated measures on symptom distress were collected at baseline, 2 months, 6 months, and 12 months post-baseline. Twelve hypotheses were postulated regarding how chronic PTSD and shame were related to long term adjustment. Findings contributed substantive new information on relationships among shame, symptom distress, and psychological trauma. Correlational analyses showed significant and positive relationships between shame and symptom distress measures including depression, trait anxiety, vulnerability, PTSD, and self-handicapping. Shame was negatively associated with hope and quality of life. Longitudinal data showed chronic PTSD and shame were amenable to treatment. While treatment data showed initial improvement in all symptom distress measures, maintenance of treatment gains was difficult, with six and twelve month symptom measures returning to near baseline. Multivariate analyses yielded no differences on family factors of chaos, loss, and ethnicity. Socioeconomic status was associated with decreased hope and quality of life. Convergence among the findings indicated a reciprocal relationship between shame and PTSD which warrants continued empirical investigation. Implications for theory, research, and practice are discussed.