title: The role of guilt in the development of post-traumatic stress disorder: A systematic review.
abstract: BACKGROUND
  Post-traumatic stress disorder (PTSD) can be a debilitating condition associated with a myriad of emotions. Guilt is an important associated feature of PTSD that has received far less recognition than other symptoms often associated with fear and intense threat. The nature of the relationship between guilt and PTSD remains elusive and requires further clarification. The aim of the current paper was to review the extant literature regarding the link between guilt and PTSD.
  
  
  METHODS
  A systematic database search of PsycINFO, Medline, Embase and Web of Science identified articles that enabled examination of the guilt-PTSD relationship. A total of 27 articles met inclusion criteria for this review.
  
  
  RESULTS
  There were cross-sectional relationships between guilt and PTSD symptomology with evidence of associations between PTSD symptoms and cognitions related to perceived wrong doing and self-blame. However, the direction of association between guilt and PTSD is unclear and possibly confounded by overlapping constructs such as shame.
  
  
  CONCLUSIONS
  The review is constrained by the absence of longitudinal and experimental research and studies, which control for potential confounding variables. The reliability and validity of measures of guilt and PTSD is also not consistently reported.
  
  
  CONCLUSIONS
  This review outlines four competing models of the guilt-PTSD relationship and examines existing evidence linking the two constructs. The current literature is too preliminary to offer any strong support for one model over the other. However, in critically appraising existing studies, this review helps to inform the design of future studies investigating the association between guilt and PTSD.
authors.affiliation: Salford Primary Care Psychology Service, Gloucester House, Back Duncan Street, Manchester M7 2EY, England. Electronic address: laurenpugh@hotmail.com.
authors.forename: Lauren R
authors.initials: LR
authors.lastname: Pugh
authors.affiliation: Institute of Psychology, Health & Society, The University of Liverpool, Brownlow Hill, Liverpool L69 3GB, England.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Taylor
authors.affiliation: School of Psychological Sciences, The University of Manchester, Oxford Road, Manchester M13 9PL, England.
authors.forename: Katherine
authors.initials: K
authors.lastname: Berry
mesh_terms: D003430:Cross-Sectional Studies; D004644:Emotions; D006167:Guilt; D006801:Humans; D015203:Reproducibility of Results; D012752:Shame; D012919:Social Behavior; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*
keywords: Appraisals; Guilt; PTSD; Responsibility; Self-blame; Trauma