The psychological toll of shame in military personnel

Feelings of shame may make the symptoms of post-traumatic stress disorder (PTSD) more severe in current and former members of the Armed Services.

That is the conclusion of research published in the British Journal of Clinical Psychology today by a team led by Dr Katherine C. Cunningham from the Department of Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina.

In the forthcoming article, Dr Cunningham and colleagues say:

"The military conflicts in Iraq and Afghanistan have resulted in increased awareness of the impact of war on military service members. Many returning service members and veterans have been diagnosed with PTSD, which is associated with poorer physical health, unemployment, legal problems, relationship conflict and reduced quality of life."

The research study, conducted at The University of Tulsa in Oklahoma, surveyed 61 American service personnel and veterans who completed an online psychological survey covering PTSD symptom severity as well as trauma-related guilt and trauma-related shame.

When the results were analysed, the researchers found that both shame and guilt predicted the presence of PTSD, jointly accounting for 46 per cent of the variance in its severity. However, they also found that trauma-related shame accounted for significantly more of that variance than trauma-related guilt.

In this study, the feeling of guilt was defined as being associated with having done something wrong, for instance "I didn't keep my friend safe in combat" or "I killed civilians during the war". Shame was defined as a belief that one is intrinsically and irrevocably flawed, for example "I'm a failure" or "I'm a monster."

In other words, guilt arises from the belief that you have done a bad thing and shame from the belief that you are a bad person.

Dr Cunningham said:

"Guilt may result in more prosocial behaviour, because the underlying attributions are tied to a specific harmful action and not to one's identity. Feeling guilty can motivate an attempt to repair and strengthen social relationships by making amends, while feeling shame can lead people to withdraw from society.

"The findings of our study provide additional evidence that we should see shame and guilt as distinct emotions with unique roles in PTSD. Given shame's greater importance in explaining