PTSD Guilt

PTSD and guilt commonly co-occur. People who have experienced traumatic events may experience something called trauma-related guilt. What is trauma-related guilt?

It refers to the unpleasant feeling of regret stemming from the belief that you could or should have done something different at the time a traumatic event occurred.

Trauma survivors may also experience a particular type of trauma-related guilt, called survivor guilt. Survivor guilt is often experienced when a person has made it through some kind of traumatic event while others have not. A person may question why he survived. He may even blame himself for surviving a traumatic event as if he did something wrong.

Traumatic Events and Guilt

The experience of trauma-related guilt does not seem to depend on the type of traumatic event experienced. Combat exposure, physical abuse, sexual abuse, and the loss of a loved one have all been found to be associated with the experience of trauma-related guilt.

Consequences of Trauma-Related Guilt

Feeling guilt after the experience of a traumatic event is serious, as it has been linked to a number of negative consequences. For example, trauma-related guilt has been found to be associated with depression, shame, social anxiety, low self-esteem, and thoughts of suicide. In addition, feeling a lot of trauma-related guilt has been connected to the development of PTSD.

Given the potential negative consequences of trauma-related guilt, it is important that any trauma-related guilt be addressed in PTSD treatment.

Addressing Trauma-Related Guilt

Trauma-related guilt can be treated through cognitive-behavioral therapy. Trauma-related guilt may originate in how you think or interpret a situation.

Cognitive-behavioral therapy for trauma-related guilt would focus on helping people become more aware of the thoughts or beliefs that underlie feelings of guilt, such as through self-monitoring. The therapist would then help the person come up with more realistic interpretations of the situation.

For example, lessen your guilt by realizing that the traumatic event was completely out of your control, and you acted in the best way you could given the situation. By reducing guilt, cognitive-behavioral therapy may also help increase self-compassion and acceptance.

In addition to cognitive-behavioral therapy, psychodynamic/psychoanalytic approaches can also be helpful in addressing trauma-related guilt. Psychodynamic and psychoanalytic approaches would aid the patient in exploring his early life experiences (for example, relationships with significant others, early childhood traumas or fears) in order to identify experiences and factors that may make someone more likely to feel trauma-related guilt and shame.

If you start feeling like you can’t cope, life is becoming very difficult or your life isn’t worth living, get help. These are signs that you need to talk to someone.
Either contact your GP or call NHS Direct (0845 4647). You can also contact helplines such as PTSD Resolution (0845 021 7873) for confidential, non-judgemental emotional support.
If you’ve had depression and/or anxiety in the past, even if they weren’t formally diagnosed, seek help immediately. You’re more likely to have an episode of depression if you’ve had one before.