The Relationship Between Shame and PTSD


Shame is a commonly shared emotion in trauma sufferers who often blame themselves for the trauma they have experienced, which is both unhelpful and almost certainly, unwarranted. In the case of Post-traumatic Stress Disorder (PTSD), the relationship becomes even more complex and arguably more relentless in nature, building over time and preventing sufferers from moving forward to live a happy and rewarding life.

Experiencing acute or sustained trauma can give rise to many emotions such as fear, rage, denial, sorrow, regret, and mental health challenges like anxiety and depression. Some of these will resolve more quickly than others, and some will need to be remediated, perhaps with the help of a professional and the adoption of appropriate coping strategies.

People often link PTSD to war veterans (though in this case, although shame is relevant, guilt and fear is more likely to be experienced), and while the numbers for this demographic are high (between 13.5 – 34% dependent on the parameters of the study[1]), anyone can suffer the effects of PTSD, including children. It is especially prevalent in those who experience (especially) sexual and other forms of physical abuse, either in childhood or during their adult life.[2] The degrading and crushing nature of these types of relational abuse and the resultant powerlessness and lack of control makes them excellent breeding grounds for relational trauma-based shame. This feeling of subordination foments equally unhelpful thoughts and behaviours that ensue as a result of the shame, which include:

  • Perfectionism (if I’m perfect, it will never happen to me again)
  • Culpability (it’s my fault, if I didn’t do XYZ, it would not have happened)
  • Low self-worth (I’m no good and don’t deserve anything good or to look or feel good – which can lead to victim behaviour, perpetuating the cycle)
  • Becoming an abuser

Shame is a form of self-judgment which emanates from what is believed to be a deviation away from accepted cultural or societal norms. One of the worst aspects of shame is that people often get locked into it, eschewing the people and activities that could help them break out of this gloomy cycle, devoid of hope or positivity and often, human contact, making the sufferer more vulnerable and treatment more problematic.[3]

When removed from the world, it is easy to believe the negative self-talk that occupies the sufferer’s mind because there is nothing and no one to counter it, which can exacerbate the problem and make recovery seem impossible. Most people have some form of insecurity, but for people who have PTSD, these insecurities can be triggers for reliving painful memories and shame – ushering in intense self-criticism, a major component where shame is concerned. Where most people might feel bad about a particular incident where they think they could have done better, someone suffering the effects of shame judges themselves as a lost cause, completely worthless and, sadly, unlovable.

Guilt and shame hold a strong link, but whereas guilt is often connected to an isolated incident that a person will often seek redemption or make recompense for, shame is more deeply held and relates to the person’s sense of belonging, of self, and of self-worth. In short, it could be described as I’ve done vs I am.[4] The person views themselves as an abject failure and blames themselves for their continuing trauma.

PTSD is, at its root, an anxiety disorder where the subject experiences strong negative emotions such as fear and threat, which are two of the primary emotions and early symptoms or experiences of the condition. The risk of developing more ubiquitous and insidious emotions becomes high, with a large percentage of people living with PTSD experiencing shame despite receiving high-quality treatment for the condition. Studies have shown that treating shame is a key aspect of treating PTSD as a whole, lest it stifle therapeutic gains and that when trauma-related shame increases, PTSD symptoms increase accordingly, along with suicidal ideation.[5] [6] This is perhaps attributable to shame being such a strong response that it is marked by increasing sympathetic nervous system activity, meaning there is evidence that it is associated with visceral, biological stress.[7]

This kind of autonomic arousal is common in trauma survivors and is what often forms a physiological feedback loop that keeps people trapped in a state of trauma, as noted by trauma authorities such as Professor Stephen Porges and Bessel van der Kolk.

Self-Compassion and Other Routes Out of the Shame and Blame Game

Although this is a challenging situation to address, there are routes out of shame. One of these is self-compassion which can help restore a sense of calm, increase trust, and help with forming new connections. Showing compassion for oneself along with kindness and understanding helps to release the love hormone, oxytocin, which is responsible for things like empathy, trust and relationship building which are all necessary to combat (the usually self-imposed) isolation that stems from shame.

Positive and intentional distractions can also help quash negative thoughts and influences and replace them with healthier, more positive ones. Positive distractions include:

  • Popping on some uplifting music when you feel shame bubbling up
  • Physical activity such as walking, cycling, or swimming
  • Having a bath with some uplifting, relaxing aromatherapy oils such as bergamot, lavender, grapefruit, orange, lemon, lime, or white fir
  • A guided meditation to try and clear the mind of unhelpful, unwanted thoughts
  • Reaching out to a friend or attending a support group with like-minded souls

Learning to repeat these feel-good strategies to combat what was most probably the repeated nature of the abuse which led to the trauma in the first instance, makes for a much more positive spin on unhelpful rumination and self-sabotage. It also helps to quell reptilian fight or flight responses which pump excessive amounts of cortisol around the body. When these responses are inappropriately employed on a continual basis, it causes equally inappropriate physiological responses (including hypertension), saps strength, and depletes the feel-good hormones that help us experience pleasure.

Showing love for the self helps bring about behaviours that can align or connect sufferers to outside resources or forms of support, namely fellow humans. In doing so, one of the things which will become apparent is that everyone has flaws and insecurities and makes mistakes but that this does not render them unlovable – what it makes them is human.

These strategies should be undertaken in tandem with specialised care, which can help unpick the damage done by the trauma that led to the shame in the first place. This can include individual or group-based therapy, but it must be tailored to and mindful of the subject and their story on a personal level. With a caring and understanding approach in an environment of respect, empathy, and kindness, people can be shown the path to self-forgiveness (even if there was nothing to forgive themselves for) and a happier and fulfilling life.


If you have a client or know of someone struggling to heal from psychological trauma, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and outpatient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For more information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).



[1] Kimbrel, Nathan A. et al. “An Examination Of The Broader Effects Of Warzone Experiences On Returning Iraq/Afghanistan Veterans׳ Psychiatric Health”. Psychiatry Research, vol 226, no. 1, 2015, pp. 78-83. Elsevier BV, doi:10.1016/j.psychres.2014.12.007. Accessed 27 July 2021.

[2] Lee, Deborah A. et al. “The Role Of Shame And Guilt In Traumatic Events: A Clinical Model Of Shame-Based And Guilt-Based PTSD”. British Journal Of Medical Psychology, vol 74, no. 4, 2001, pp. 451-466. Wiley, doi:10.1348/000711201161109. Accessed 27 July 2021.

[3] Øktedalen, Tuva et al. “Trauma-Related Shame And Guilt As Time-Varying Predictors Of Posttraumatic Stress Disorder Symptoms During Imagery Exposure And Imagery Rescripting—A Randomized Controlled Trial”. Psychotherapy Research, vol 25, no. 5, 2014, pp. 518-532. Informa UK Limited, doi:10.1080/10503307.2014.917217. Accessed 27 July 2021.

[4] Lee, Deborah A. et al. “The Role Of Shame And Guilt In Traumatic Events: A Clinical Model Of Shame-Based And Guilt-Based PTSD”. British Journal Of Medical Psychology, vol 74, no. 4, 2001, pp. 451-466. Wiley, doi:10.1348/000711201161109. Accessed 27 July 2021.

[5] Saraiya, Tanya, and Teresa Lopez-Castro. “Ashamed And Afraid: A Scoping Review Of The Role Of Shame In Post-Traumatic Stress Disorder (PTSD)”. Journal Of Clinical Medicine, vol 5, no. 11, 2016, p. 94. MDPI AG, doi:10.3390/jcm5110094. Accessed 27 July 2021.

[6] Bryan, Craig J. et al. “GUILT, SHAME, AND SUICIDAL IDEATION IN A MILITARY OUTPATIENT CLINICAL SAMPLE”. Depression And Anxiety, vol 30, no. 1, 2012, pp. 55-60. Wiley, doi:10.1002/da.22002. Accessed 27 July 2021.

[7] Freed, Steven, and Wendy D’Andrea. “Autonomic Arousal And Emotion In Victims Of Interpersonal Violence: Shame Proneness But Not Anxiety Predicts Vagal Tone”. Journal Of Trauma & Dissociation, vol 16, no. 4, 2015, pp. 367-383. Informa UK Limited, doi:10.1080/15299732.2015.1004771. Accessed 27 July 2021.