{"id":38999,"date":"2018-07-16T06:00:41","date_gmt":"2018-07-16T13:00:41","guid":{"rendered":"https:\/\/www.goodtherapy.org\/blog\/?p=38999"},"modified":"2018-07-11T16:25:13","modified_gmt":"2018-07-11T23:25:13","slug":"understanding-the-role-of-shame-in-complex-posttraumatic-stress","status":"publish","type":"post","link":"https:\/\/www.goodtherapy.org\/blog\/understanding-role-of-shame-in-complex-posttraumatic-stress-0716184","title":{"rendered":"Understanding the Role of Shame in Complex Posttraumatic Stress"},"content":{"rendered":"

\"ChildThe two most common and well-known mental health issues are depression<\/a> and anxiety<\/a>. About 19% of Americans experience depression at least once in their lives. The figure for anxiety is as high as 30%, though that\u2019s not quite as bad as it sounds because there is significant overlap. For most psychologists, treating depression and anxiety is their bread and butter. These are also the diagnoses for which medication<\/a> is most often prescribed.<\/p>\n

But\u00a0saying anxiety and depression are the most common mental health diagnoses is a bit like saying pain is the most common bodily health diagnosis. If a doctor diagnosed you with chronic back pain or pain disorder unspecified, you wouldn\u2019t be very impressed. Your back doesn\u2019t hurt because\u00a0<\/i>you have back pain, since back pain is just another way of saying your back hurts. A symptom is not a diagnosis. What is true for the body is also true for the mind.<\/p>\n

Symptom, Disorder, or Emotions?<\/h2>\n

Terms like major depression or separation anxiety are descriptions of a pattern of symptoms, not of an underlying disorder. This can be easily seen in the way the definitions change from time. For example, in the transition from the fourth edition of the Diagnostic and Statistical Manual to the fifth edition, the bereavement<\/a> exclusion for depression was removed. This means you can now be diagnosed with depression without a waiting period after the death of a loved one.

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I believe we can, and should, go one step further. It is more accurate to see depression and anxiety as symptoms than disorders. But it is more accurate still to think of them as what they truly are: emotions<\/a> or feelings. It has become something of a cliche in the mental health profession to say this, but it remains just as true: feeling depressed or anxious is not in itself a problem. It is only when these feelings become excessively strong and persistent that they should be considered a problem. Disordered emotional patterns are a manifestation of underlying concerns. Often\u2014many would argue extremely often\u2014they are manifestations of complex trauma<\/a> or C-PTSD.<\/p>\n

Thinking about mental health in this way reminds us of the need to think about all negative emotions and feelings, not just about anxiety and depression.<\/p>\n

One of the most important of these emotions is shame<\/a>. There is no such thing as “generalized shame disorder.” People seeking therapy are rarely given a psychological assessment for their levels of shame, though these assessments do exist. But shame often plays a central role in many mental health concerns, both in terms of the subjective experience of the person experiencing them and the mechanism that causes distress and prevents recovery. Complex posttraumatic stress (C-PTSD) in particular is characterized by the central role shame plays in its function and expression.<\/p>\n

C-PTSD happens when a person experiences repeated suffering or prolonged abuse<\/a> at the hands of someone they have a personal relationship with. Most often this person is a parent or caregiver, and the abuse often occurs during childhood.<\/p>\n

Symptoms of C-PTSD are diverse. They can include:<\/p>\n

Shame often plays a central role in many mental health concerns, both in terms of the subjective experience of the person experiencing them and the mechanism that causes distress and prevents recovery. Complex posttraumatic stress (C-PTSD) in particular is characterized by the central role shame plays in its function and expression.<\/span><\/p>\n