Trauma-Related Guilt in People With PTSD

People who develop post-traumatic stress disorder (PTSD) also commonly experience guilt. In particular, individuals who have endured traumatic events may also begin to feel what's known as trauma-related guilt. But what does the term mean exactly?

How Guilt Develops After Trauma

Trauma-related guilt refers to the unpleasant feeling of regret stemming from the belief that you could or should have done something different at the time a traumatic event occurred. For example, a military veteran may regret not going back into a combat zone to save a fallen soldier. A rape survivor may feel guilty about not fighting back at the time of the assault.

Trauma survivors may also experience a particular type of trauma-related guilt, called survivor guilt. Survivor guilt is often experienced when a person has made it through some kind of traumatic event while others have not. A person may question why they survived. They may even blame themselves for surviving a traumatic event as if they did something wrong.

The experience of trauma-related guilt does not seem to depend on the type of traumatic event experienced. Combat exposure, physical abuse, sexual abuse, and the loss of a loved one have all been found to be associated with the experience of trauma-related guilt.

Consequences 

Feeling guilt after the experience of a traumatic event is serious, as it has been linked to a number of negative consequences. For example, trauma-related guilt has been found to be associated with depression, shame, social anxiety, low self-esteem, and thoughts of suicide. In addition, feeling a lot of trauma-related guilt has been connected to the development of PTSD.

Given the potential negative consequences of trauma-related guilt, it is important that any such guilt is addressed in PTSD treatment.

Treatment

Trauma-related guilt can be treated with cognitive behavioral therapy. Trauma-related guilt may originate in how you think or interpret a situation.

For instance, a rape survivor may feel like they should have seen their attack coming, even though it was impossible to predict that the assault would occur. Likewise, a combat veteran may think to themselves that they should have done something different to prevent the death of a fellow soldier, even though the event may have been completely out of their control.

Cognitive behavioral therapy for trauma-related guilt would focus on helping people become more aware of the thoughts or beliefs that underlie feelings of guilt, such as through self-monitoring. The therapist would then help the person come up with more realistic interpretations of the situation. For example, lessen your guilt by realizing that the traumatic event was completely out of your control, and you acted in the best way you could given the situation. By reducing guilt, cognitive behavioral therapy may also help increase self-compassion and acceptance.

In addition to cognitive behavioral therapy, psychodynamic/psychoanalytic approaches can also be helpful in addressing this form of guilt. Psychodynamic and psychoanalytic approaches would aid the person in exploring their early life experiences (for example, relationships with significant others, early childhood traumas or fears) in order to identify experiences and factors that may make someone more likely to feel trauma-related guilt and shame.

Importance of Treatment

It's important to state again that trauma-related guilt is something that desperately needs to be addressed. You may think of trauma-related guilt as a nuisance—something which diminishes your quality of life alone. In contrast, trauma-related guilt is much more serious, and, at least in veterans, is closely linked with suicidal thoughts. Without being alarmist, we encourage anyone coping with this guilt to talk openly with their doctors. Help is available, and studies suggest this help can make a significant difference for those forced to live with PTSD.