Shame and PTSD Symptoms Heidi La Bash and Anthony Papa University of Nevada, Reno Although current theories emphasize the role of fear in the etiology of posttraumatic stress disorder (PTSD), recent research suggests that shame may also play a role in the development of PTSD symptoms. This study tested if the experience of peritraumatic shame mediates the relationship between 2 concep- tually linked PTSD risk factors (i.e., experiencing an interpersonal vs. impersonal reference trauma and number of previous potentially traumatic events [PTEs]) and current levels of PTSD symptoms. Path analysis was used to test a series of nested models assessing the indirect effects of these risk factors on PTSD via peritraumatic shame, while controlling for the potential indirect effect of these risk factors via peritraumatic fear. The final structural model found that the number of previous PTEs had a direct effect on current levels of PTSD, no association with fear, and a marginally significant indirect effect on PTSD symptoms via shame. The effects of reference trauma type on PTSD symptom levels was mediated by levels of both peritraumatic shame and fear, suggesting that shame, in addition to fear, may contribute to the development of PTSD symptoms in survivors of interpersonal traumas. The results underscore the need for further, more fine-grained research in this area and contribute to the nascent literature suggesting that other emotions, beyond fear, are important to our theoretical understanding of PTSD. Keywords: posttraumatic stress disorder, risk factors, emotions, shame, fear Although the experience of overwhelming fear is linked to the maintenance of posttraumatic stress disorder (PTSD), recent re- search suggests that other emotions, particularly shame, may also play a role in the experience of PTSD symptoms (Hathaway, Boals, & Banks, 2010; Leskela, Dieperink, & Thuras, 2002). The goal of the current study is to explore if the relations of two conceptually linked PTSD risk factors (experiencing an interper- sonal vs. impersonal reference trauma and number of previous potentially traumatic events [PTEs]) to ongoing PTSD symptom levels was mediated by the experience of peritraumatic shame and/or fear. Emotional Responses to Trauma Current theoretical understandings of PTSD, like those found in the emotion processing theory of PTSD, hypothesize that PTSD is a result of dysregulated fear responding in reaction to a PTE. In these theories, the experience of the trauma is hypothesized to cause hypersensitivity to fear cues and hyperactivation of fear- related memories (Foa & Kozak, 1986; Keane, Fairbank, Caddell, Zimering, & Bender, 1985). Over time these responses generalize to other stimuli, leading to hypersensitivity to a broad range of threat cues, physiological hyperarousal, and avoidance of stimuli associated with the trauma, which negates the opportunity for new learning (Foa & Riggs, 1993). Thus, fear responding is hypothe- sized to both cause and maintain PTSD (Foa & Rothbaum, 1998). However, a growing body of research suggests that other emo- tions, such as shame, may also be salient to PTSD symptom development and maintenance (Brewin, Andrews, & Rose, 2000; Leskela et al., 2002). Indeed, shame has been linked to PTSD symptom severity in a range of populations, including college students, battered women, and combat veterans (e.g., Andrews, Brewin, Stewart, Philpott, & Hejdenberg, 2009; Kubany et al., 1996; Pineles, Street, & Koenen, 2006; Wong & Cook, 1992). Shame and PTSD Basic research on the phenomenology of shame suggests that it is a highly aversive negative emotion arising when a part of the self is thought to be corrupted by an irredeemable act or by a contaminating event that evokes the perceived judgment of others (Tangney & Dearing, 2002). A necessary precondition of this attribution-emotion link is that the defect must be attributed to global, stable, and internal causes rather than to specific, situation- ally bound behaviors as in the experience of guilt (Lewis, 1971; Lewis, 1992). The attributional bases of shame versus guilt have distinct functional implications. Guilt entails a differentiation be- tween behavior and the nature of the self and motivates prosocial responses aimed at making amends for specific, time-bound trans- gressions (Tangney & Dearing, 2002). In shame, the attribution is that the commission of a socially unacceptable behavior is repre- sentative of a stable, trait-like morally unacceptable aspect of the self that the individual is powerless to moderate. This leads to internalized attributions regarding the locus of responsibility for the action, self-blame, and a sense that the individual is weak, flawed, and inadequate. As such, behavioral responses to the experience of shame tend to be self-protective in nature and focused on hiding the perceived defect from others (Leith & Baumeister, 1998; Tangney, 1994). Common shame-based re- sponses include withdrawal from others, self-protective anger, and This article was published Online First July 8, 2013. Heidi La Bash and Anthony Papa, Department of Psychology, Univer- sity of Nevada, Reno. Correspondence concerning this article should be addressed to Heidi La Bash, Department of Psychology/298, University of Nevada, Reno, NV 89557. E-mail: hlabash@gmail.com This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. Psychological Trauma: Theory, Research, Practice, and Policy © 2013 American Psychological Association 2014, Vol. 6, No. 2, 159 –166 1942-9681/14/$12.00 http://dx.doi.org/10.1037/a0032637 159