title: Shame, Dissociation, and Complex PTSD Symptoms in Traumatized Psychiatric and Control Groups: Direct and Indirect Associations With Relationship Distress.
abstract: OBJECTIVE
  Elevated shame and dissociation are common in dissociative identity disorder (DID) and chronic posttraumatic stress disorder (PTSD) and are part of the constellation of symptoms defined as complex PTSD. Previous work examined the relationship between shame, dissociation, and complex PTSD and whether they are associated with intimate relationship anxiety, relationship depression, and fear of relationships. This study investigated these variables in traumatized clinical samples and a nonclinical community group.
  
  
  METHODS
  Participants were drawn from the DID (n = 20), conflict-related chronic PTSD (n = 65), and nonclinical (n = 125) populations and completed questionnaires assessing the variables of interest. A model examining the direct impact of shame and dissociation on relationship functioning, and their indirect effect via complex PTSD symptoms, was tested through path analysis.
  
  
  RESULTS
  The DID sample reported significantly higher dissociation, shame, complex PTSD symptom severity, relationship anxiety, relationship depression, and fear of relationships than the other two samples. Support was found for the proposed model, with shame directly affecting relationship anxiety and fear of relationships, and pathological dissociation directly affecting relationship anxiety and relationship depression. The indirect effect of shame and dissociation via complex PTSD symptom severity was evident on all relationship variables.
  
  
  CONCLUSIONS
  Shame and pathological dissociation are important for not only the effect they have on the development of other complex PTSD symptoms, but also their direct and indirect effects on distress associated with relationships.
authors.affiliation: University of Canterbury, Christchurch.|The Cannan Institute.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Dorahy
authors.affiliation: Trauma Resource Centre, Everton Complex, Belfast Health and Social Care Trust.
authors.forename: Mary
authors.initials: M
authors.lastname: Corry
authors.affiliation: SET Connects, South Eastern Health and Social Care Trust.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Black
authors.affiliation: Queen's University Belfast.
authors.forename: Laura
authors.initials: L
authors.lastname: Matheson
authors.affiliation: Queen's University Belfast.
authors.forename: Holly
authors.initials: H
authors.lastname: Coles
authors.affiliation: Queen's University Belfast.
authors.forename: David
authors.initials: D
authors.lastname: Curran
authors.affiliation: The Cannan Institute.
authors.forename: Lenaire
authors.initials: L
authors.lastname: Seager
authors.affiliation: The Cannan Institute.
authors.forename: Warwick
authors.initials: W
authors.lastname: Middleton
authors.affiliation: Queen's University Belfast.|Psychological Therapies Service, Northern Health and Social Care Trust.
authors.forename: Kevin F W
authors.initials: KF
authors.lastname: Dyer
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D004213:Dissociative Disorders / Q000523:psychology*; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D012747:Sexual Partners / Q000523:psychology*; D012752:Shame; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D055815:Young Adult
keywords: Shame; complex PTSD; dissociation; relationship distress