Complex trauma and intimate relationships: The impact of shame, guilt and dissociation

Dorahy, Martin J.; Corry, Mary; Shannon, Maria; Webb, Kevin; McDermott, Brian; Ryan, Margaret; F.W. Dyer, Kevin

doi:10.1016/j.jad.2012.10.010

Cited by 145Posttraumatic Stress Disorder ResearchPsychosomatic Disorders and Their TreatmentsPsychoanalysis and Psychopathology Research

Complex trauma and intimate relationships: The impact of shame, guilt and dissociation

Dorahy, Martin J., Corry, Mary, Shannon, Maria, Webb, Kevin, McDermott, Brian, Ryan, Margaret, F.W. Dyer, Kevin·2013·Journal of Affective Disorders

DOI 10.1016/j.jad.2012.10.010

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Abstract

Background This study examined dissociation, shame, guilt and intimate relationship difficulties in those with chronic and complex PTSD. Little is known about how these symptom clusters interplay within the complex PTSD constellation. Dissociation was examined as a principle organizing construct within complex PTSD. In addition, the impact of shame, guilt and dissociation on relationship difficulties was explored.Methods Sixty five treatment-receiving adults attending a Northern Irish service for conflict-related trauma were assessed on measures of dissociation, state and trait shame, behavioral responses to shame, state and trait guilt, complex PTSD symptom severity and relationship difficulties.Results Ninety five percent (n=62) of participants scored above cut-off for complex PTSD. Those with clinical levels of dissociation (n=27) were significantly higher on complex PTSD symptom severity, state and trait shame, state guilt, withdrawal in response to shame and relationship preoccupation than subclinical dissociators (n=38). Dissociation and state and trait shame predicted complex PTSD. Fear of relationships was predicted by dissociation, complex PTSD and avoidance in response to shame, while complex PTSD predicted relationship anxiety and relationship depression.Limitations The study was limited to a relatively homogeneous sample of individuals with chronic and complex PTSD drawn from a single service.Conclusions Complex PTSD has significant consequences for intimate relationships, and dissociation makes an independent contribution to these difficulties. Dissociation also has an organizing effect on complex PTSD symptoms.

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cPTSD is associated with heightened levels of dissociative symptoms among adults in mental health treatment.
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From Is Shame Hallucinogenic? (2017) · cites this paper as Dorahy et al., 2013

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Bannister, J. A., Colvonen, P. J., Angkaw, A. C., & Norman, S. B. (2018) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000392 · Cited by 40 · see citing works
Psychiatric Impact of Organized and Ritual Child Sexual Abuse: Cross-Sectional Findings from Individuals Who Report Being Victimized
Schröder, J., Nick, S., Richter‐Appelt, H., & Briken, P. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15112417 · Cited by 46 · see citing works
“This is in line with [22], who revealed empirical evidence suggesting that a clinical level of dissociation correlates with higher CPTSD symptoms.”
BackgroundResult
Using Psychedelics With Therapeutic Intent Is Associated With Lower Shame and Complex Trauma Symptoms in Adults With Histories of Child Maltreatment
Healy, C. J., Lee, K. A., & D'Andrea, W. M. (2021) · Chronic Stress · doi:10.1177/24705470211029881 · Cited by 38 · see citing works
Neurobiological mechanisms of state-dependent learning
Radulović, J., Jovasevic, V., & Meyer, M. A. A. (2017) · Current Opinion in Neurobiology · doi:10.1016/j.conb.2017.05.013 · Cited by 39 · see citing works
“This could place individuals at risk for a wide variety of psychiatric disorders, especially dissociative disorders and post-traumatic stress-disorder [74], because despite the fact that state-dependent (often traumatic) memories cannot be fully retrieved, they nevertheless strongly influence social and affective beha…”
Background
PTSD and dissociation symptoms as mediators of the relationship between polyvictimization and psychosocial and behavioral problems among justice-involved adolescents
Ford, J. D., Charak, R., Modrowski, C. A., & Kerig, P. K. (2018) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2018.1441354 · Cited by 37 · see citing works
“This is consistent with research that has identified a sub-group of individuals with histories of childhood sexual abuse and other interpersonal traumas who are characterized by comorbid depression and dissociative symptoms (Bohn, Bernardy, Wolfe, & Hauser, 2013; Dorahy et al., 2013; Sar, Akyuz, Ozturk, & Alioglu, 201…”
BackgroundResult
Global Posttrauma Symptoms: A Systematic Review of Qualitative Literature
Michalopoulos, L., Meinhart, M., Yung, J., Barton, S. M., Wang, X., Chakrabarti, U., Ritchey, M., Haroz, E. E., Joseph, N., Bass, J., et al. (2018) · Trauma Violence & Abuse · doi:10.1177/1524838018772293 · Cited by 36 · see citing works
“For example, shame, as a potential symptom currently classified under persistent negative emotional state, has been associated with higher levels of dissociation (Talbot, Talbot, & Tu, 2004) and avoidant behavior with intimate relationships (Dorahy et al., 2013).”
Background
Error in Intensive Care
Laurent, A., Aubert, L., Chahraoui, K., Bioy, A., Mariage, A., Quenot, J., & Capellier, G. (2014) · Critical Care Medicine · doi:10.1097/ccm.0000000000000508 · Cited by 36 · see citing works
“Considered in this way, guilt is defined (28, 29) as an effect which restores the subject to the place of actor “I felt guilty, because I did the procedure which led to the error”: to be an actor in the event is to make the event controllable and thus assure oneself that it cannot be reproduced.”
Background
Adverse childhood experiences and shame- and guilt-proneness: Examining the mediating roles of interpersonal problems in a community sample
Wojcik, K. D., Cox, D. W., & Kealy, D. (2019) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2019.104233 · Cited by 36 · see citing works
Dissociative Depression Among Women with Fibromyalgia or Rheumatoid Arthritis
Kılıç, Ö., Şar, V., Taycan, O., Poyraz, C. A., Turgut Can, E. R. O. L., Tecer, Ö., Emül, M., & Özmen, M. (2013) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2013.844218 · Cited by 36 · see citing works
Traumas and Their Consequences According to Control-Mastery Theory
Fimiani, R., Gazzillo, F., Fiorenza, E., Rodomonti, M., & Silberschatz, G. (2020) · Psychodynamic Psychiatry · doi:10.1521/pdps.2020.48.2.113 · Cited by 33 · see citing works
Shame, Dissociation, and Complex PTSD Symptoms in Traumatized Psychiatric and Control Groups: Direct and Indirect Associations With Relationship Distress
Dorahy, M. J., Corry, M., Black, R., Matheson, L., Coles, H., Curran, D., Seager, L., Middleton, W., & Dyer, K. F. W. (2017) · Journal of Clinical Psychology · doi:10.1002/jclp.22339 · Cited by 34 · see citing works
“This sample has been described in detail elsewhere (Dorahy et al., 2013).”
ResultSelf-citation
Reconceptualizing complex posttraumatic stress disorder: A predictive processing framework for mechanisms and intervention
Putica, A., & Agathos, J. A. (2024) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2024.105836 · Cited by 32 · see citing works
“These challenges are rooted in the individual ’ s traumatic experiences, frequently characterized by their interpersonal nature (Dorahy et al., 2013; Giourou et al., 2018; Palic et al., 2016), leading to a predisposition towards interpreting ambiguous social cues as indications of potential deceit…”
Background
Comparing shame in clinical and nonclinical populations: Preliminary findings.
Dyer, K. F. W., Dorahy, M. J., Corry, M., Black, R., Matheson, L., Coles, H., Curran, D. B., Seager, L., & Middleton, W. (2016) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000158 · Cited by 30 · see citing works
“Further details on sample characteristics can be found in Dorahy et al. (2013).”
BackgroundSelf-citation
Predictors of complex PTSD: the role of trauma characteristics, dissociation, and comorbid psychopathology
Torres, E. G., Krause-Utz, A., & Sack, M. (2023) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-022-00208-7 · Cited by 28 · see citing works
“Furthermore, PTSD symptom severity was related to more comorbidities, such as depression and substance abuse [10, 15], and more physiological impairment.”
Background
Altered connectivity within the salience network during direct eye gaze in PTSD
Thome, J., Frewen, P., Daniels, J. K., Densmore, M., & Lanius, R. A. (2014) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/2051-6673-1-17 · Cited by 26 · see citing works
“The investigation of social cognition is particularly pertinent because PTSD is often associated with significant interpersonal problems, including interpersonal violence and difficulties forming and maintaining intimate and non-intimate relationship [1-6].”
Background
Critical thinking as cooperation and its relation to mental health and social welfare
Ollinheimo, A., & Hakkarainen, K. (2022) · New Ideas in Psychology · doi:10.1016/j.newideapsych.2022.100988 · Cited by 26 · see citing works
Measuring shame regulation: Validation of the Compass of Shame Scale
Schalkwijk, F. W., Stams, G. J. J. M., Dekker, J., Peen, J., & Elison, J. (2016) · Social Behavior and Personality An International Journal · doi:10.2224/sbp.2016.44.11.1775 · Cited by 26 · see citing works
The interpersonal implications of PTSD and complex PTSD: The role of disturbances in self-organization
Bachem, R., Levin, Y., Zerach, G., Cloître, M., & Solomon, Z. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.04.075 · Cited by 25 · see citing works
A meta-analysis of the association between shame and dissociation.
Rudy, J. A., McKernan, S., Kouri, N. A., & D'Andrea, W. (2022) · Journal of Traumatic Stress · doi:10.1002/jts.22854 · Cited by 23 · see citing works
Complex Trauma: Missed and Misdiagnosis in Forensic Evaluations
Bailey, T. D., & Brown, L. S. (2020) · Psychological Injury and Law · doi:10.1007/s12207-020-09383-w · Cited by 23 · see citing works
“…to form a coherent self-narrative frequently lead to disorganized attachment presentations, which have been associated with dissociative disorders and other complex posttraumatic outcomes (Dalenberg et al. 2014; Dorahy et al. 2013; LyonsRuth and Dozier 2016; Lyons-Ruth et al. 2006; Schore 2009).”
Background
Developmental Pathways from Childhood Maltreatment to Young Adult Romantic Relationship Functioning
Fitzgerald, M. (2021) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2020.1869653 · Cited by 24 · see citing works
“Consequently, it may be difficult to develop emotional and physical intimacy (DiLillo et al., 2007; Dorahy et al., 2013; Hansen et al., 2012; Miller et al., 2013).”
Background
Contributing factors predicting nightmares in children: Trauma, anxiety, dissociation, and emotion regulation.
Secrist, M. E., Dalenberg, C. J., & Gevirtz, R. (2018) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000387 · Cited by 23 · see citing works
Depression, anxiety and suicidality among Chinese mental health professionals immediately after China's dynamic zero-COVID policy: A network perspective
Chen, M.-Y., Chen, P., An, F., Sha, S., Feng, Y., Su, Z., Cheung, T. C. C., Ungvari, G. S., Ng, C. H., Zhang, L., et al. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.01.270 · Cited by 22 · see citing works
Predicting fears of intimacy among individuals with post-traumatic stress symptoms by their sensory profile
Engel‐Yeger, B., Palgy-Levin, D., & Lev‐Wiesel, R. (2015) · British Journal of Occupational Therapy · doi:10.1177/0308022614557628 · Cited by 21 · see citing works
“, 1999), and anxiety-related social phobia, all of which may exacerbate feelings of shame, despair, and hopelessness and lead to fears of intimacy (Dorahy et al., 2013; Javidi and Yadollahie, 2012).”
Background
Discussion autour du traumatisme complexe : émergence du concept, étiologie et critères diagnostiques
Tarquinio, C., Houllé, W. A., & Tarquinio, P. (2016) · Sexologies · doi:10.1016/j.sexol.2016.03.007 · Cited by 18 · see citing works
Tracing the paths: a systematic review of mediators of complex trauma and complex post-traumatic stress disorder
Harris, J., Loth, E., & Sethna, V. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1331256 · Cited by 18 · see citing works
The relationship between experiential avoidance and posttraumatic stress symptoms: a moderated mediation model involving dissociation, guilt, and gender
Serrano-Ibáñez, E. R., Ruiz-Párraga, G. T., Gómez-Pérez, L., Ramírez-Maestre, C., Esteve, R., & López-Martínez, A. E. (2021) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2020.1869647 · Cited by 17 · see citing works
“These findings are in line with those reported in the empirical literature regarding the relationships found between PTSD and both dissociation (e.g., see Briere et al., 2005; Dorahy et al., 2013) and guilt (e.g., see Beck et al., 2011; Stotz et al., 2015).”
Result
Longitudinal Relationships between Perceived Social Support and Symptom Outcomes: Findings from a sample of Adult Survivors of Childhood Sexual Abuse
Steine, I. M., Winje, D., Krystal, J. H., Milde, A. M., Bjorvatn, B., Nordhus, I. H., Grønli, J., & Pallesen, S. (2020) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2020.104566 · Cited by 19 · see citing works
“Similarly, trauma-related symptoms such as dissociation, feelings of detachment and emotional numbing may affect the trauma survivors’ ability to engage in close relationships or seek support (Dorahy et al., 2013; Evans et al., 2013), underlining the importance of treating such symptoms as important foundational work…”
BackgroundInfluential
Does affect mediate the relationship between interpersonal trauma and psychosis? A systematic review and meta-analysis
Grady, S., Twomey, C. D., Cullen, C. M., & Gaynor, K. (2024) · Schizophrenia Research · doi:10.1016/j.schres.2024.01.008 · Cited by 16 · see citing works
“…to this wider range of affective processes is supported by research that links affective dysregulation, loneliness and shame to both interpersonal trauma (Dorahy et al., 2013; Merz and Jak, 2013; Villalta et al., 2018) and psychosis (Carden et al., 2020; Lawlor et al., 2020; Lim et al., 2018).”
Psychopathy subfactors distinctively predispose to dispositional and state-level of sadistic pleasure
Lobbestael, J., van Teffelen, M. W., & Baumeister, R. F. (2019) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2019.02.003 · Cited by 16 · see citing works
Perfectionism and Perceived Control in Posttraumatic Stress Disorder Symptoms
Molnar, D. S., Flett, G. L., & Hewitt, P. L. (2020) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-020-00315-y · Cited by 15 · see citing works
“…of people with PTSD who experience profound shame and social anxiety due to a sense of not living up to social expectations and tendencies to anticipate negative social experiences and negative social evaluation (e.g., Budden 2009; Collimore et al. 2010; Dorahy et al. 2013; Zayfert et al. 2005).”
Background
Neuroscientific account of Guilt- and Shame-Driven PTSD phenotypes
Fine, N. B., Ben‐Zion, Z., Biran, I., & Hendler, T. (2023) · European Journal of Psychotraumatology · doi:10.1080/20008066.2023.2202060 · Cited by 17 · see citing works
“This process emerges in post-traumatic stress symptoms of avoidance, withdrawal, isolation, derealization, and depersonalization (Dorahy et al., 2013; Kouri et al., 2023; Platt & Freyd, 2015; Talbot et al., 2004), thus enabling the individual to secure shelter from the exposed and injured self.”
Background
The activation of shame following dissociation in the context of relationships: A vignette study.
Mckeogh, K., Dorahy, M., & Yogeeswaran, K. (2018) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2017.11.001 · Cited by 18 · see citing works
Self-citation
Stress-related memories disrupt sociability and associated patterning of hippocampal activity: a role of hilar oxytocin receptor-positive interneurons
Meyer, M. A. A., Anstötz, M., Ren, L. Y., Fiske, M. P., Guedea, A. L., Grayson, V. S., Schroth, S. L., Cicvaric, A., Nishimori, K., Maccaferri, G., et al. (2020) · Translational Psychiatry · doi:10.1038/s41398-020-01091-y · Cited by 15 · see citing works
A Serial Mediation Model of Insecure Attachment and Psychological Distress: The Role of Dispositional Shame and Shame-Coping Styles
Remondi, C., Casu, G., Pozzi, C., Greco, F., Gremigni, P., & Brugnera, A. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20043193 · Cited by 14 · see citing works
“Consistent with previous research on the role of the shame-coping styles in predicting mental health difficulties, we found that attack self was associated with higher psychological distress [15,16,24,67,68].”
Result
Testing the Validity and Reliability of the Shame Questionnaire among Sexually Abused Girls in Zambia
Michalopoulos, L., Murray, L. K., Kane, J. C., Skavenski, S. V. W., Chomba, E., Cohen, J. A., Imasiku, M. L., Semrau, K. E. A., Unick, J., & Bolton, P. A. (2015) · PLoS ONE · doi:10.1371/journal.pone.0123820 · Cited by 14 · see citing works
“Shame has been noted as an important outcome to include in the development of treatments for mental health problems in Western settings [13,14] as it predicts higher levels of dissociation [7], the development and maintenance of PTSD [8,15,16], fear or avoidant behavior with intimate relationships [17,18] and may help…”
Background
An Ecological Approach to Understanding Pervasive and Hidden Shame in Complex Trauma
Zhu, P., Lau, J. M., & Navalta, C. P. (2020) · Journal of Mental Health Counseling · doi:10.17744/mehc.42.2.05 · Cited by 14 · see citing works
Problem gambling during Covid-19
Frisone, F., Alibrandi, A., & Settineri, S. (2020) · Mediterranean Journal of Clinical Psychology · doi:10.6092/2282-1619/mjcp-2457 · Cited by 15 · see citing works
Childhood Maltreatment Is Associated with Adult Psychopathology through Decreased Dispositional Mindfulness
Fitzgerald, M. (2022) · Journal of Aggression Maltreatment & Trauma · doi:10.1080/10926771.2022.2043971 · Cited by 14 · see citing works
“Numerous studies have reported subclinical symptoms of depression, anxiety, dissociation, and post-traumatic stress (Bolduc et al., 2018; Dorahy et al., 2013; Fitzgerald & Kawar, 2021; Kong et al., 2019; Kratzer et al., 2018; Lang et al., 2008; Sandberg et al., 2010; Widom et al., 2018; Zollman et…”
Background
Integrating Emotionally Focused Therapy, Self-Compassion, and Compassion-Focused Therapy to Assist Shame-Prone Couples Who Have Experienced Trauma
Karris, M., & Caldwell, B. E. (2015) · The Family Journal · doi:10.1177/1066480715601676 · Cited by 12 · see citing works
“Shame and the aforementioned intrapersonal consequences of trauma can wreak havoc on relationships (Dorahy et al., 2012; S. M. Johnson, 2002; Lee, 2008).”
Background
Relationship Variables in Group Psychotherapy for Women Sexual Trauma Survivors
Rosa, S. D. L., & Riva, M. T. (2020) · International Journal of Group Psychotherapy · doi:10.1080/00207284.2020.1772072 · Cited by 11 · see citing works
Relating from the past or the Present: Relationship Mindfulness as a Mediator Linking Childhood Maltreatment to Adult Relationship Quality
Fitzgerald, M. (2021) · Journal of Couple & Relationship Therapy · doi:10.1080/15332691.2021.1926387 · Cited by 11 · see citing works
“For example, adults who were maltreated in childhood reported greater fear, anxiety, and negative sentiments toward romantic relationships (Dorahy et al., 2013).”
Background
Engendered Responses to, and Interventions for, Shame in Dissociative Disorders
Dorahy, M. J., Gorgas, J., Seager, L., & Middleton, W. (2017) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000000740 · Cited by 10 · see citing works
Self-citation
Exploring the relationships between complex post-traumatic stress disorder and depression symptoms in the context of childhood maltreatment through network analysis
Lin, W., Liu, A., Wu, X., & Liu, M. (2024) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2024.107215 · Cited by 9 · see citing works
Moving Forward from Moral Injury: A Mixed Methods Study Investigating the Use of 3MDR for Treatment-Resistant PTSD
Smith‐MacDonald, L., Jones, C., Brown, M. R. G., Dunleavy, R. S., VanderLaan, A., Kaneva, Z., Hamilton, T., Burback, L., Vermetten, E. H. G. J. M., & Brémault‐Phillips, S. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20075415 · Cited by 9 · see citing works
“This may particularly be the case when shame is associated with the pMIE or MI [53].”
Background
‘I am afraid you will see the stain on my soul’: Direct gaze neural processing in individuals with PTSD after moral injury recall
Andrews, K., Lloyd, C., Densmore, M., Kearney, B. E., Harricharan, S., McKinnon, M. C., Théberge, J., Jetly, R., & Lanius, R. A. (2023) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsad053 · Cited by 9 · see citing works
Psychedelic-augmented psychotherapy for overcoming traumatic dissociation: A review of neuroscientific and phenomenological evidence
Rougemont-Bücking, A., Guenot, F., Salamin, V., Gothuey, I., Duffour, C., King-Olivier, J., Girard, V., & Naudin, J. (2024) · European Journal of Trauma & Dissociation · doi:10.1016/j.ejtd.2024.100431 · Cited by 8 · see citing works
Is there positive in the negative? Understanding the role of guilt and shame in physical activity self-regulation
Meade, L. B., Semenchuk, B. N., & Strachan, S. M. (2019) · International Journal of Sport and Exercise Psychology · doi:10.1080/1612197x.2019.1581826 · Cited by 7 · see citing works
Childhood maltreatment and provision of support and strain to family relationships in adulthood: The role of social anxious and depressive symptoms
Fitzgerald, M., & Morgan, A. A. (2022) · Journal of Social and Personal Relationships · doi:10.1177/02654075221137320 · Cited by 8 · see citing works
“Adults maltreated in childhood (AMIC) may struggle with interpersonal relationships due to diminished social interaction skills, difficulty managing emotions, fear of relationships, and making more negative attributions about others’ behavior (Author Citation; Dorahy et al., 2013; Paradis & Boucher, 2010).”
Background
A thematic analysis of practitioners' understanding of domestic abuse in terms of post‐traumatic stress disorder (PTSD) and complex‐PTSD (C‐PTSD)
Kozłowska, W. (2019) · Counselling and Psychotherapy Research · doi:10.1002/capr.12272 · Cited by 7 · see citing works
The shame of implicit racial bias
Stevens, F., & Shriver, E. R. (2022) · The Journal of Social Psychology · doi:10.1080/00224545.2022.2046538 · Cited by 8 · see citing works
“There is already a large literature based on White guilt, and, like guilt in general, it involves a desire to compensate for past transgressions (Baumeister et al., 1994; Iyer et al., 2003), whereas shame appears to cause individuals to move away from themselves (Dorahy et al., 2013).”
Background
Cumulative trauma, adversity, and loss among juvenile justice–involved girls: Implications for health disparities
Lansing, A. E., Park, J., & Beck, A. N. (2023) · Journal of Traumatic Stress · doi:10.1002/jts.22981 · Cited by 7 · see citing works
Shame as Affect Regulation in Dissociative Identity Disorder
Hohfeler, R. A. (2025) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2024.2448419 · Cited by 7 · see citing works
“…increasingly discussed in the literature relevant to trauma and dissociation (Babcock Fenerci & DePrince, 2018; Dorahy, 2010; Dorahy & Clearwater, 2012; Dorahy et al., 2013, 2015, 2017a, 2017b, 2021; Dorahy, Gorgas, et al., 2017; Kluft, 2007; McKeogh et al., 2018; Platt, 2014; Schimmenti, 2021).”
Psychometric Properties of Turkish Compass of Shame Scale
Akıncı, İ., & Atintaş, M. C. (2020) · Psikoloji Çalışmaları / Studies in Psychology · doi:10.26650/sp2019-0053 · Cited by 8 · see citing works
“In fact, a recent study indicated that the avoidance pole of shame coping was associated with fear of intimate relationships (Dorahy et al., 2013).”
Was it me? The Role of Attributions and Shame in Posttraumatic Stress Disorder (PTSD): A Systematic Review
Seah, R., Dwyer, K., & Berle, D. (2023) · Trends in Psychology · doi:10.1007/s43076-023-00315-6 · Cited by 7 · see citing works
“Trauma related shame has been associated with intrusive recollections, hypera-rousal, and avoidance (Dewey et al., 2014; Dorahy et al., 2013; Sippel & Marshall, 2011).”
Using New Approaches in Neurobiology to Rethink Stress-Induced Amnesia
Radulović, J. (2017) · Current Behavioral Neuroscience Reports · doi:10.1007/s40473-017-0109-6 · Cited by 6 · see citing works
Far away, so close: The role of self‐differentiation in psychopathology among spouses of ex‐POWs and comparable combatants
Lev‐Ari, R. K., Solomon, Z., & Horesh, D. (2020) · Journal of Clinical Psychology · doi:10.1002/jclp.22965 · Cited by 6 · see citing works
Dissociation, perceptual processing, and conceptual processing in survivors of the 2011 Christchurch earthquake.
Hooper, A. L., Dorahy, M. J., Blampied, N. M., & Jordan, J. (2014) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/a0037303 · Cited by 6 · see citing works
“Such a finding is consistent with previous work showing a relationship between trait dissociation and PTSD (Dorahy et al., 2012; Kulkarni, Porter, Rauch 2011; Galatzer-Levy et al., 2011).”
ResultSelf-citation
Capacity to love and problematic sexuality: the role of defense mechanisms and psychopathological suffering
Ciocca, G., Origlia, G., Limoncin, E., Mollaioli, D., Tanzilli, A., Lingiardi, V., & Jannini, E. A. (2023) · The Journal of Sexual Medicine · doi:10.1093/jsxmed/qdad066 · Cited by 5 · see citing works
The Price of Needing to Belong: Neurobiology of Working Through Attachment Trauma
Kinley, J. L., & Reyno, S. M. (2019) · Psychodynamic Psychiatry · doi:10.1521/pdps.2019.47.1.39 · Cited by 5 · see citing works
Psychotherapy for complex post-traumatic stress disorder: efficacy and therapeutic factors
Katalan, C., Unterrainer, ., & Gelo, O. C. G. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1684921 · Cited by 5 · see citing works
“Dissociative symptoms are more prevalent in CPTSD patients than in patients with PTSD or other single traumas and are associated with CPTSD symptom severity (Dorahy et al., 2013).”
Pain and tactile dissociation, derealization and depersonalization symptoms in women and recalled traumatic events in childhood, adolescence and early adulthood
Smiatek-Mazgaj, B., Sobański, J. A., Rutkowski, K., Klasa, K., Dembińska, E., Müldner-Nieckowski, Ł., CYRANKA, K. M., & Mielimąka, M. (2015) · Psychiatria Polska · doi:10.12740/pp/onlinefirst/36296 · Cited by 4 · see citing works
“According to many researchers and clinicians trauma and dissociation are interrelated, because the first of these phenomenon is connected with the lack of consistency between the inner world and outer reality, which causes loss of mental balance in the form of dissociation [20, 21].”
Background
The Impact of Relationship Context on Dissociation-Induced Shame Using Vignette Scenarios
Dorahy, M. J., McKeogh, K., & Yogeeswaran, K. (2023) · Psychological Reports · doi:10.1177/00332941231166606 · Cited by 4 · see citing works
“Given shame is in essence a relational affect (Benau, 2020; Benau, 2022; DeYoung, 2015; Dorahy et al., 2013), it is perhaps not surprising that regardless of whether experiencing sadness or dissociation, people felt more ashamed when in the presence of another as opposed to when alone.”
Self-citation
Evidence for the Impact of Stress and Trauma on Sexual Function in Women
Lapping-Carr, L. R., & Pappa, M. L. (2024) · Obstetrics and Gynecology Clinics of North America · doi:10.1016/j.ogc.2024.02.003 · Cited by 4 · see citing works
Incarcerated as a child, reentering as an adult: The unique reentry experiences and needs of juvenile lifers
Huppert, T. K., Covan-Rodriguez, N., Faust, T., & Daftary‐Kapur, T. (2025) · Journal of Criminal Justice · doi:10.1016/j.jcrimjus.2025.102494 · Cited by 3 · see citing works
Early Childhood Teachers’ Relationships with Families When Children Experience Adversity
Lewis, H. R., Lipscomb, S. T., Hatfield, B. E., Jäderholm, C., & Tominey, S. L. (2024) · Journal of Research in Childhood Education · doi:10.1080/02568543.2024.2314611 · Cited by 3 · see citing works
“Adversity experienced by teachers or family members could influence their engagement in relationships with one another, due to feelings of shame (MacGinley et al., 2019) or difficulty trusting others (Dorahy et al., 2013).”
The Resilience Factor: Examining its Potential to Alleviate Shame and Guilt in School Bullying
Quiroga-Garza, A., & Cavalera, C. (2024) · Journal of Interpersonal Violence · doi:10.1177/08862605241270075 · Cited by 7 · see citing works
“Despite this distinction both emotions are strongly correlated, frequently coexisting, overlapping each other as in people with a trauma history (Dorahy et al., 2013; Stotz et al., 2015; Tangney et al., 2007).”
Emotion in cognitive processing therapy for PTSD
Martin, C. E., Stayton, L. E., & Chard, K. M. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-816022-0.00017-x · Cited by 3 · see citing works
Psychometric Evaluation of the Personal Feelings Questionnaire–2 (PFQ-2) Shame Subscale Among Spanish-Speaking Female Sex Workers in Mexico
da Silva, C. E., Pines, H. A., Patterson, T. L., Semple, S. J., Vera, A., Strathdee, S. A., Martı́nez, G., Pitpitan, E. V., & Smith, L. R. (2020) · Assessment · doi:10.1177/1073191120981768 · Cited by 3 · see citing works
“Similar to other studies (Barr & Cacciatore, 2007; Di Sarno et al., 2019; Dorahy et al., 2013; Gambin & Sharp, 2018; D. H. Harder & Zalma, 1990; Rüsch et al., 2007; Tignor & Colvin, 2019), we also observed that the revised shame subscale had good internal consistency and could therefore be…”
Result
Dissociation-Induced Shame in Those with a Dissociative Disorder: Assessing the Impact of Relationship context using Vignettes
Dorahy, M. J., Yogeeswaran, K., & Middleton, W. (2023) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2023.2195402 · Cited by 3 · see citing works
“Studies in traumatized samples have consistently found a correlation between shame and dissociation (e.g., Dorahy et al., 2013; Dorahy, 2010; Oh et al., 2016; Rudy et al., 2022; Talbot et al., 2004).”
BackgroundSelf-citation
Trauma Isn’t One Size Fits All: How Online Support Communities Point to Different Diagnostic Criteria for C-PTSD and PTSD
Wang, W., Blackburn, K. G., Thompson, R. M., Bajaj, K., Pedler, R., & Fucci, K. (2024) · Health Communication · doi:10.1080/10410236.2024.2314343 · Cited by 3 · see citing works
“While C-PTSD can lead to social withdrawal and issues in relationships (Dorahy et al., 2013), research has found an association between social support and decreased trauma symptomatology (Robinaugh et al., 2011).”
The effect of intimate partner violence on treatment response in an intensive outpatient program for suicide-bereaved military widows
Blackburn, A. M., Xu, B., Gibson, L. E., Wright, E. C., & Ohye, B. Y. (2022) · Military Psychology · doi:10.1080/08995605.2022.2040918 · Cited by 3 · see citing works
“, 2007), such as shame or guilt associated with stigma, which can contribute to psychopathology – particularly PTSD (Beck et al., 2011; Dorahy et al., 2013; Robinaugh & McNally, 2010).”
Background
Dissociation, Dissociative Disorders, and PTSD
Myrick, A. C., & Brand, B. L. (2015) · Springer eBooks · doi:10.1007/978-3-319-08613-2_39-1 · Cited by 3 · see citing works
Factors influencing recovery in opioid substitution treatment: a systematic review and thematic synthesisPreprint
Carlisle, V. R., Maynard, O., Padmanathan, P., Hickman, M., Thomas, K. H., & Kesten, J. M. (2020) · doi:10.31234/osf.io/f6c3p · Cited by 3 · see citing works
The impact of childhood trauma on the emergence and development of dissociative disorders
ČR, P. Ú. A., Schmidtová, J., Štěpánek, P., & Čermák, I. (2021) · Ceskoslovenska psychologie · doi:10.51561/cspsych.65.2.178 · Cited by 2 · see citing works
The unexpected power of negative awards
Celse, J., Frey, B. S., Grolleau, G., & Mzoughi, N. (2022) · Kyklos · doi:10.1111/kykl.12296 · Cited by 2 · see citing works
This Smokey Thing Called Healing: A Grounded Theory Analysis of Recovery from Self-Identified C-PTSD
Allen, E., Barrow, B. H., Witting, A. B., & Whiting, J. B. (2024) · Contemporary family therapy · doi:10.1007/s10591-024-09722-y · Cited by 2 · see citing works
“Furthermore, Dorahy et al. (2013) conducted a study in which three symptoms –C-PTSD severity, an avoidance-of-shame coping style, and dissociation severity were found to predict fear of engagement in secure intimate relationships.”
Posttraumatic Stress and Couples
Blow, A. J., Goff, B. S. N., Farero, A. M., & Ruhlmann, L. M. (2020) · Wiley eBooks · doi:10.1002/9781119438519.ch69 · Cited by 2 · see citing works

Shame, Dissociation, and Complex PTSD Symptoms in Traumatized Psychiatric and Control Groups: Direct and Indirect Associations With Relationship Distress
Dorahy, M. J., Corry, M., Black, R., Matheson, L., Coles, H., Curran, D., Seager, L., Middleton, W., & Dyer, K. F. W. (2017) · Journal of Clinical Psychology · doi:10.1002/jclp.22339 · Cited by 34 · see citing works
Self-citation
Dissociation, shame, complex PTSD, child maltreatment and intimate relationship self-concept in dissociative disorder, chronic PTSD and mixed psychiatric groups
Dorahy, M. J., Middleton, W., Seager, L., McGurrin, P., Williams, M., & Chambers, R. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.10.008 · Cited by 59 · see citing works
Self-citation
The impact of dissociation, shame, and guilt on interpersonal relationships in chronically traumatized individuals: A pilot study*
Dorahy, M. J. (2010) · Journal of Traumatic Stress · doi:10.1002/jts.20564 · Cited by 75 · see citing works
Self-citation
Complex PTSD, interpersonal trauma and relational consequences: Findings from a treatment-receiving Northern Irish sample
Dorahy, M. J., Corry, M., Shannon, M., MacSherry, A., Hamilton, G., McRobert, G., Elder, R., & Hanna, D. (2008) · Journal of Affective Disorders · doi:10.1016/j.jad.2008.04.003 · Cited by 90 · see citing works
Self-citation
Researching Shame, Dissociation, and Their Relationship Using Latent Change Modeling
Kulla, P., Braun, T., Reichenberger, T., & Kruse, J. (2023) · Journal of Experimental Psychopathology · doi:10.1177/20438087231162756 · Cited by 5 · see citing works

Authors: Dorahy, M. J., Corry, M., Shannon, M., Webb, K., McDermott, B., Ryan, M., & F.W. Dyer, K.
Affiliations: University of Canterbury (NZ)
Corresponding author: Dorahy, Martin J.
ORCID: Dorahy, Martin J.
Corry, Mary
Ryan, Margaret
Venue: Journal of Affective Disorders
Publisher: Elsevier BV
Published: 2013-05
Volume: 147
Issue: 1-3
Pages: 72-79
ISSN: 0165-0327 (ISSN-L)
DOI: 10.1016/j.jad.2012.10.010
OpenAlex: W1970062920
Cited by: 145
References: 64
Citations by year: 2026: 10 · 2025: 9 · 2024: 13 · 2023: 12 · 2022: 12 · 2021: 9 · 2020: 19 · 2019: 9 · 2018: 10 · 2017: 9 · 2016: 13 · 2015: 8 · 2014: 11 · 2013: 1
FWCI: 7.27
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Affective Disorders (publishedVersion)
PubMed (publishedVersion)
Research Portal (Queen's University Belfast) (submittedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords: complex PTSD, dissociation, shame, guilt, conflict-related trauma, relationship anxiety
MeSH terms: Adult, Dissociative Disorders, Female, Guilt, Humans, Interpersonal Relations, Male, Middle Aged, Shame, Stress Disorders, Post-Traumatic

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Complex trauma and intimate relationships: The impact of shame, guilt and dissociation

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