Violence, revictimization and trauma-related shame and guilt. An investigation of event characteristics and mental health correlates among violence-exposed men and women from the general population and among Young Survivors of a terrorist attack

Aakvaag, H. F. (2016). Violence, revictimization and trauma-related shame and guilt. An investigation of event characteristics and mental health correlates among violence-exposed men and women from the general population and among Young Survivors of a terrorist attack. Oslo: Univeristetet i Oslo. (Doktorgradsavhandling).

This thesis investigates how the characteristics of violence in childhood relate to violence exposure in adulthood. Further, the thesis examines how various violent experiences are related to emotional responses to violence, namely trauma-related shame and guilt, in male and female violence survivors. Mental health correlates of shame and guilt are examined.

Background and aim: Violence is not uncommon and may have a range of negative consequences for victims. While mental health has received much research attention, other consequences are increasingly recognized, including victims’ increased risk of subsequent violence exposure and shame and guilt related to their violent experiences. These latter consequences are adverse for the individual, and may relate to long-term health and well-being. Therefore, it is important to be able to identify those victims of violence who are particularly vulnerable for new violent experiences, shame and guilt. Certain characteristics of the event, including a close relationship to the perpetrator and the type of violence, and multivictimization can impact mental health after violence. However, less is known about how these characteristics relate to other negative consequences. This thesis investigates how the characteristics of violence in childhood relate to violence exposure in adulthood. Further, the thesis examines how various violent experiences are related to emotional responses to violence, namely trauma-related shame and guilt, in male and female violence survivors. Mental health correlates of shame and guilt are examined.

Methods: Two different study samples were used. First, a comprehensive telephone interview study (the prevalence study) was conducted to map exposure to violence in the Norwegian population (n=4,529). The study measured child sexual abuse (CSA), childhood physical violence from or between parents, psychological violence and childhood neglect, as well as adult physical violence from partners or others and lifetime rape. The employed mental health measures included a short scale that assessed anxiety/depression symptoms (HSCL-10). For this study, a new shame and guilt after trauma scale (SGATS) was developed.

The second study was conducted after the terrorist attack in Norway on 22ndof July, 2011.

A sample of 325 survivors, who were primarily adolescents and young adults, were interviewed. This study focused on evaluating the survivors’ experiences and reactions to the event, including posttraumatic stress reactions (PTSR; measured using the UCLA PTSD-RI) and trauma-related shame and guilt.

The statistical methods applied in this thesis include multiple regression analyses, logistic regression analyses, chi-square statistics, linear hypothesis testing, and confirmatory factor analysis.

Results: Violent experiences were highly overlapping for both women and men. Different types of childhood violence overlapped, and childhood experiences of violence were associated with violence in adulthood. Women who experienced CSA often experienced other violence types in childhood. CSA from a parent almost always co-occurred with other types of violence. The total number of childhood violence experiences (multivictimization) was strongly associated with intimate partner violence or rape in adulthood.

Women and men who experienced violence reported more anxiety/depression symptoms, and those symptoms increased with the number of violence categories experienced. All types of violence, including the terrorist attack, were associated with trauma-related shame and guilt.

Women reported more shame and guilt than men in the prevalence study, but this gender difference was not found after the terrorist attack. Both emotions were independently associated with mental health problems in both samples. In the prevalence study, shame was more important for mental health. The total number of violence types in childhood and adulthood showed a graded relationship with trauma-related shame and guilt.

Conclusions: Violence is associated with various negative consequences, regardless of whether the violence happens in a close relationship, whether the violence happens in childhood or adulthood, and whether the violence is of a sexual nature. Childhood victims of violence have an increased likelihood of adult violent exposure that is not restricted to the same violence type. Both trauma-related shame and guilt contribute to mental health problems after violence, although shame may be more clinically relevant than guilt. Shame and guilt were fairly common among young survivors of a terrorist attack. It is not clear if women have more shame and guilt than men, but violence exposure was highly important for shame and guilt, for both men and women.

These findings imply that researchers and clinicians could benefit from a broad assessment of violence, in order to uncover the full scope of respondents and patients’ violent experiences. Clinicians may find it helpful to address shame and guilt after a variety of violent experiences, with both men and women. Future research could investigate the hypothesis that shame and guilt might be a mechanism by which revictimization occurs.