Treating PTSD as a Shame Disorder, and the Role of Compassion

Trauma can create deep-rooted feelings of shame that are extraordinarily detrimental to emotional well-being and act as a risk factor for PTSD. This complex relationship between shame and PTSD can create a cycle of shame and distress that disrupts your ability to live a full, stable, and healthy life. By working with experienced mental health professionals to develop self-compassion within a safe, supportive environment, you can heal from shame and unlock your true potential.

Experiences of trauma can elicit a broad range of negative emotions that encompass everything from fear to sadness, anger to anxiety. Many of these emotions—while distressing—are healthy, normal, and even justified.

They are also overwhelmingly temporary, decreasing in intensity as the trauma fades and healing begins. There is one emotion, however, that has been shown to hinder healing and contribute to the development of Post-Traumatic Stress Disorder: shame.



Understanding Shame

Shame is a uniquely destructive emotion because it exists overwhelmingly without purpose, and it is distinct from guilt. Judging your own actions as negative can result in guilt, which can “motivate you to make amends, apologize, or correct a behavior,” allowing you to alleviate those feelings of guilt to restore a positive self-image. But shame isn’t about judging an action and correcting it; shame is about judging yourself negatively, questioning your own worth, and blaming yourself for transgressions committed against you. As Beverly Engel writes, “[Shame] can damage a person’s image of themselves in ways that no other emotion can, causing a person to feel deeply flawed, inferior, worthless and unlovable.” These feelings color not only your private thoughts, but the role you play in interpersonal relationships, the way you orient yourself in the world, and your ability to connect with both internal and external emotional resources.

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The Complex Relationship Between Shame and PTSD

Certain types of trauma are notorious for producing feelings of shame in their victims, particularly sexual violence, childhood abuse, and intimate partner violence, all of which are strongly associated with the development of PTSD due to their extremely dehumanizing and humiliating nature. While PTSD is officially classified as an anxiety disorder that manifests primarily in pathological fear, the International Society for Stress Studies (ISTSS) notes:

[T]his fails to capture an essential characteristic of those traumas that are of human design, especially those that are repeated over an extended period of time. In these cases, where a relationship of dominance and subordination is established, feelings of humiliation, degradation, and shame are central to the victim’s experience. The result can be viewed as both as an anxiety disorder and a shame disorder.

And there is plenty of empirical evidence to bear this out. Dr. Matthew Tull points out that, “Studies have consistently found a strong association between shame and the experience of PTSD symptoms following a traumatic event.”

Engels herself provides a strong case for conceptualizing PTSD as a shame disorder when she describes the effects of intense shame, which strongly overlap with the experiences of many who suffer from PTSD:

If someone experiences enough shame he or she can become self-loathing to the point that he or she becomes self-destructive or even suicidal. Shame is responsible for a myriad of problems, including but not limited to: Self-criticism; self-blame; self-neglect; the belief that one does not deserve good things; self-destructive behaviors (cutting, alcohol and drug abuse); self-sabotaging behavior (starting fights with loved one, sabotaging jobs); perfectionism; and most important, continuing to repeat the cycle of abuse through either victim behavior or abusive behavior.

Indeed, shame-driven unhealthy coping mechanisms can act as significant barriers to being able to process your traumatic experiences in healthy ways, triggering or aggravating PTSD symptoms, or preventing you from seeking help.

Unfortunately, you might take the dysfunction of PTSD as confirmation of your inferiority, and that might intensify feelings of shame, creating a self-perpetuating cycle from which it can be difficult to escape. As a result, you are not only unable to move forward toward healthy coping mechanisms, but you may recoil from even the most basic expressions of love and affection from others, as you do not feel you deserve them. In fact, you may actively revolt against positive interactions with others as you become shame-bound, afraid that they will see the ‘real’ you, and leading you to retreat from the world around you. The result is both deeply painful and profoundly lonely, often leaving you without the social networks that are vital to the human spirit.

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Healing From Shame

It can be relieving to imagine PTSD as a fear-based disorder. Fear, while painful and limiting, is also generally understood to be manageable through pharmacological therapies and specialized interventions such as exposure therapy. Shame, however, is more complicated. There is no anti-shame pill. There is no way to gradually acclimate yourself to your self-loathing. But despite its more complex nature, there is an antidote to shame: compassion.

Self-compassion has become a lively area of research as the effects of shame have come to be more fully understood within the mental health field. Of particular importance is the work of social psychologist Kristin Neff of the University of Texas at Austin:

Neff discovered that self-compassion can act as an antidote to self-criticism—a major characteristic of those who experience intense shame. It was found that self-compassion is a powerful trigger for the release of oxytocin, the hormone that increases feelings of trust, calm, safety, generosity, and connectedness. Self-criticism, on the other hand, has a very different effect on our body. When we experience a threatening situation, the fight-or-flight response is triggered and the amygdala sends signals that increase blood pressure, adrenaline, and the hormone cortisol, mobilizing the strength and energy needed to confront or avoid the threat. Although this system was designed by evolution to deal with physical attacks, it is activated just as readily by emotional attacks—from ourselves and others. Over time increased cortisol levels lead to depression by depleting the various neurotransmitters involved in the ability to experience pleasure.

By developing strategies for self-compassion, you can counteract the effects of shame to create a new, more positive understanding of yourself and diminish the intensity of PTSD symptoms. On a neurobiological level, you can begin to repair the damage caused by trauma and forge new neural networks driven by empathy, kindness, and love.

Self-compassion, however, must begin with an exploration of the trauma that has guided you to the place of shame. For people with PTSD, the best place to do this is often within the context of a residential mental health treatment program with the resources to create safe, positive therapeutic experiences that address both the fear and shame elements of your disorder. At Bridges to Recovery, we offer comprehensive, personalized care for people living with PTSD designed around your unique needs and challenges. By drawing on an array of evidence-based therapies, including specialized trauma therapies, our experienced clinicians can guide you on the path to self-discovery and healing as you gain a deeper understanding of your trauma and develop concrete skills to practice self-compassion. Within an atmosphere of warmth, respect, and support, you can unlock your potential for positive change and move beyond shame to live a richer, fuller, and more joyful life.

Bridges to Recovery offers comprehensive residential treatment for people struggling with PTSD as well as other mental health disorders, substance use disorders, and eating disorders. Contact us to learn more about our innovative program and how we can help you or your loved one start the journey toward lasting wellness.

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