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. Author manuscript; available in PMC: 2024 May 1.
Published in final edited form as: Psychol Trauma. 2022 Jun 6;15(4):576–583. doi: 10.1037/tra0001288

The Influence of Trauma-Related Shame on the Associations Between Posttraumatic Symptoms and Impulsivity Facets

Shannon R Forkus 1, Ateka A Contractor 2, Alexa M Raudales 1, Nicole H Weiss 1
PMCID: PMC10392103  NIHMSID: NIHMS1895418  PMID: 35666935

Abstract

Introduction:

The co-occurrence of posttraumatic symptoms (PTS) and impulsivity is associated with higher levels of risky and self-destructive behaviors, and consequent safety and health risks. Trauma-related shame (TRS) may influence the association between PTS and impulsivity, such that engaging in impulsive behaviors may serve to cope with emotional distress. Alternatively, TRS may motivate a deliberate consideration of behaviors (i.e., less impulsivity) to prevent further cognitive and emotional distress.

Objective:

The goal of the current study was to examine the influence of TRS on the associations between PTS and impulsivity facets (lack of premeditation, lack of perseverance, negative urgency, positive urgency, sensation seeking).

Method:

Data were collected from 506 community individuals who endorsed lifetime sexual trauma (Mage = 34.56, 54.3% women, 78.7% white).

Results:

Findings indicated that TRS moderated associations between PTS and impulsivity facets of lack of perseverance, b = −0.001, SE = 0.0003, t = −2.68, p = .008, 95% CI [−0.001, −0.0002], and premeditation, b = −0.001, SE = 0.0003, t = −3.70, p < .001, 95% CI [−0.002, −0.001]; these associations were significant at low, but not high, levels of TRS.

Conclusions:

Findings suggest that in the context of PTS, TRS may reduce certain forms of impulsivity, potentially as a means to self-protect against further cognitive and emotional distress. Findings have important implications for understanding how individuals regulate and respond to shame in the context of PTS.

Keywords: posttraumatic stress disorder, TRS, impulsivity

Introduction

Impulsivity is a transdiagnostic mechanism that has been theoretically and empirically linked to various forms of psychopathology (Berg et al., 2015) including posttraumatic symptoms (PTS; Evren et al., 2018; Contractor et al., 2015; Weiss et al., 2013). Growing recognition that PTS is marked by impairments in impulse control have led to the addition of the “reckless and self-destructive” diagnostic criterion in the DSM-5 for posttraumatic stress disorder (PTSD; American Psychiatric Association [APA], 2013). PTSD is associated with impulsive behaviors (Contractor et al., 2017; Contractor et al., 2020; Sommer et al., 2020), such as substance use, disordered eating, reckless driving, HIV/sexual-risk behaviors, non-suicidal self-injury, suicidal behaviors, and aggressive behaviors (Ardino 2012; Brewerton, 2007; Ford & Gomez, 2015; Jacobsen et al., 2001; Taft et al., 2017; Weiss et al., 2013). The presence of these behaviors is associated with significant personal and public health burden, including poorer mental and physical health, injury and illness, risk for long-term disability, involvement in the criminal justice system, and premature death (Bogg & Roberts, 2004; Moffitt et al., 2011; Sadeh et al., 2014; Sommer et al., 2020). Thus, research examining the association between PTS and impulsivity is of public health relevance.

Several theoretical explanations have been offered to explain the link between PTS and impulsivity. The disinhibition perspective suggests that individuals with PTS may experience more difficulty inhibiting behaviors in response to perceived rewards (Casada & Roache, 2005), such that they may engage in acts that are immediately gratifying with little consideration for long-term consequences. According to the emotion regulation explanation, PTS may motivate impulsive action to modulate trauma-related emotional experiences (Weiss et al., 2015). Specifically, individuals may engage in impulsive behavior to temporarily increase positive emotions or decrease negative emotions (Ben-Zur & Zeidner, 2009). The cognitive explanation suggests that PTS may interfere with cognitive capacities, which can impede rational decision making, increasing impulsive behavior (Ben-Zur & Zeidner, 2009). Notably, these theoretical perspectives align with the five dispositional facets of impulsivity (Contractor et al., 2018): lack of premeditation (i.e., acting without thought and planning), lack of perseverance (i.e., difficulty completing tasks), negative urgency (i.e., acting rashly in response to negative emotions), positive urgency (i.e., acting rashly in response to positive emotions), and sensation seeking (i.e., pursuit of activities that are new and exciting; Cyders et al., 2007; Whiteside & Lynam, 2001). Moreover, the theoretical perspectives are supported by empirical investigations of associations between PTS and impulsivity facets (Contractor et al., 2015; Roley et al., 2017). An important next step is to identify factors that alter the strength and/or direction of the association between PTS and impulsivity; such information can inform treatments that target a reduction in maladaptive impulsive behaviors among trauma-exposed individuals reporting posttrauma distress.

In this regard, we consider TRS as one such factor that may influence associations between PTS and impulsivity. TRS is characterized by painful negative self-evaluations and a tendency to withdraw to conceal perceived deficiencies (Øktedalen et al., 2014). TRS involves internally referenced shame (i.e., negative evaluation of one’s role in trauma and its consequences) and externally referenced trauma (i.e., the perception of how others may negatively evaluate one’s role in the trauma and its consequences). TRS is a central feature of PTSD and is included in PTSD’s diagnostic criterion in the DSM-5 (APA, 2013). TRS is linked with both greater PTS (DeCou et al., 2021; Lopez-Castro et al., 2019) and engagement in several impulsive behaviors (Stuewig & Tangney, 2007), such as substance use (Dearing et al., 2005), non-suicidal self-injury (Sheehy et al., 2019), and disordered eating behaviors (Troop et al., 2008). TRS may exacerbate the influence of PTS on impulsivity by compounding levels of emotional distress. Specifically, heightened levels of distress accompanying shame can contribute to impulsive behaviors by depleting self-regulatory resources (Muraven & Baumeister, 2000) and interfering with rational decision-making (Shiv et al., 2005) such as prioritizing more immediate rewards (e.g., reducing distress) at the expense of long-term consequences. Thus, TRS may amplify emotional distress, thereby strengthening relations between PTS and impulsivity.

Alternatively, TRS may promote the use of more controlled, or carefully planned actions (i.e., less impulsivity) among trauma-exposed individuals. The self-critical and evaluative process associated with TRS (Øktedalen et al., 2014) may function as a type of safety strategy to motivate behaviors that protect against future threats to safety, functioning, and self-image. Specifically, self-critical processes have been proposed to serve self-correcting/punishing functions, such that individuals are more critical to prevent future mistakes (Gilbert et al., 2004) and/or rid themselves of the “bad” (Gilbert & Proctor, 2006). In the context of trauma, TRS may motivate more protective or conscientious behaviors (i.e., less impulsivity) to avoid danger and distress. Thus, TRS may weaken the relation between PTS and impulsivity, as individuals reporting greater PTS and higher levels of shame may engage in more careful or controlled behaviors (i.e., less impulsivity) to prevent future harm.

The goal of the current study is to examine the influence of TRS on the associations between PTS and the impulsivity facets (lack of premeditation, lack of perseverance, negative urgency, positive urgency, sensation seeking). In doing so, we focused on a sample of individuals with a history of sexual trauma. Individuals with a history of sexual trauma report elevated PTS (Jakob et al., 2017; Perrin et al., 2014) and high rates of impulsive behaviors (Forkus et al., 2020; Lang et al., 2003). Moreover, shame has been found to be pronounced and persistent among those with a history of sexual trauma (Aakvaag et al., 2016; Feiring & Taska, 2005). Thus, examination of the relations among PTS, TRS, and impulsivity in a sample of individuals with a history of sexual trauma is of utmost clinical relevance. We propose two opposing hypotheses based on the existing mixed evidence in the literature as detailed above: (1) TRS will strengthen the positive associations between PTS and each facet of impulsivity, consistent with an emotion-regulatory process; or (2) TRS will weaken the positive associations between PTS and each facet of impulsivity, consistent with a more cognitive/self-protective process.

Method

Procedure and Participants

Participants were recruited via Amazon’s Mechanical Turk (MTurk). MTurk is a crowdsourcing platform that has shown to be capable of generating reliable data (Buhrmester et al., 2011; Shapiro et al., 2013) and has been identified as a useful resource for collecting clinical data (Shapiro et al., 2013), including on trauma-exposed samples (van Stolk-Cooke et al., 2018). The study was advertised on the MTurk platform as an investigation to better understand the impact of trauma on community individuals. For the current study, inclusion criteria included: (a) age 18+, (b) had working knowledge of the English language (i.e., indicated ability to fluently read, write, and speak in English), (c) living in North America, and (d) history of lifetime sexual trauma (i.e., sexual assault or other unwanted sexual experience).

Eligible participants provided informed consent and completed the MTurk survey on an external data collection platform (i.e., Qualtrics). To improve data quality, four validity checks were embedded in the MTurk survey and used to assess attentive responding and comprehension (n = 4; e.g., “I have never brushed my teeth”; Aust et al., 2013; Meade & Craig, 2012; Oppenheimer et al., 2009; Thomas & Clifford, 2017). Participants who failed to correctly respond to any of the four validity checks were excluded from the final sample. All procedures were approved by the Institutional Review Board at the University of Rhode Island.

Exclusions

A total of 3,157 individuals attempted the survey. Of those, 2,076 participants were excluded for not meeting one or more of the inclusion criteria (see Participants and Procedure; remaining n = 1,081). We then removed 427 participants who failed to pass any of the four validity questions placed throughout the survey (remaining n = 654), as well as 40 participants who attempted to complete the survey more than once (remaining n = 614). An additional 100 participants (remaining n = 514) were removed due to missing more than 30% of item-level data on measures of interests. Finally, eight participants were excluded for not endorsing a trauma on the Life Events Checklist for DSM-5 (LEC-5; Weathers et al., 2013). Thus, the final sample for the present study included 506 participants. See Table 1 for sample demographic information.

Table 1.

Sample Characteristics

Full Sample (N = 506)
Variables M (SD) n (%)
Age 34.56 (10.48)
Gender
 Men 227 (45.0%)
 Women 276 (54.3%)
 Woman to Man (FTM) Transgender 1 (0.2%)
 Genderqueer/Non-Binary 2 (0.4%)
 Other 1 (0.2%)
Race
 White 398 (78.7%)
 African American/Black 64 (12.6%)
 Hispanic/Latinx 37 (7.3%)
 Asian 33 (6.5%)
 American Indian/Alaskan Native 7 (1.4%)
 Native Hawaiian/Pacific Islander 2 (0.4%)
 Other 2 (0.4%)
Employment Status
 Full-Time 384 (76.3%)
 Part-Time 71 (14.1%)
 Unemployed 29 (5.8%)
 Not in Labor Force (Student, Homemaker) 19 (3.8%)
Highest Level of Education
 No Formal Schooling 2 (0.4%)
 ≤ 12 years 27 (9.3%)
 > 12 years 470 (90.3%)
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Measures

Life Events Checklist for DSM-5 (LEC-5; Weathers et al., 2013).

The LEC-5 is a 17-item self-report measure assessing lifetime experiences of traumatic events and was used to confirm sexual trauma history. Participants indicated their exposure to each event on a 6-point scale: happened to me, witnessed it, learned about it, part of my job, not sure, and does not apply. Endorsement of any of the first four response options was considered a positive endorsement of a traumatic event consistent with the DSM-5 Criterion A (American Psychiatric Association, 2013).

PTSD Checklist for DSM-5 (PCL-5; Weathers et al., 2013).

The PCL-5 is a 20-item self-report measure used to assess PTS according to the DSM-5 criteria. Participants completed the PCL-5 in response to the most distressing traumatic event endorsed on the LEC-5. Participants were asked to indicate how often they have been bothered by each of the symptoms over the past month. Responses are given on a 5-point Likert scale ranging from 0 (not at all) to 4 (extremely). A total score was calculated by summing all the items, with higher scores indicating greater PTS. The PCL-5 has excellent psychometric properties (Bovin et al., 2016). Cronbach’s α was .96 in the current sample.

Trauma Related Shame Inventory (TRSI; Øktedalen, Hagtvet, Hoffart, Langkaas, & Smucker, 2014).

The TRSI is a 24-item self-report scale used to assess experiences of shame across four categories: internal condemnation (e.g., “As a result of my traumatic experience, I have lost respect for myself”), internal affective-behavioral (e.g., “I am ashamed of myself because of what happened to me”), external condemnation (e.g., “If others knew what had happened to me, they would look down on me”), and external affective-behavioral components (“If others knew what happened to me, they would be ashamed of me”). Participants were asked to read statements about different types of shame reactions and indicate how true each statement was for them over the past week. Responses are given on a 4-point Likert-type scale ranging from 0 (not true of me) to 3 (completely true of me). A total score was computed by summing items, with higher scores reflecting greater TRS. The TRSI has previously demonstrated strong psychometric properties (Øktedalen et al., 2014). Cronbach’s α was .98 in the current sample.

Short Form of the UPPS-P Impulsive Behavior Scale (SUPPS-P; Cyders et al., 2014).

The SUPPS-P is a 20-item self-report measure derived from the UPPS-P Impulsive Behavior Scale (Whiteside & Lynam, 2001). Participants are asked to indicate how much they agree or disagree with a list of statements that describe ways in which people act and think. Specific facets of impulsivity include lack of premeditation, lack of perseverance, negative urgency, positive urgency, and sensation seeking. Responses were provided on a 4-point scale ranging from 1 (agree strongly) to 4 (disagree strongly). Select items were reverse coded so higher scores represented greater impulsivity. A total score was computed for each facet of impulsivity by summing the respective items. The SUPPS-P has demonstrated acceptable psychometric properties (Cyders et al., 2014). In the current sample, Cronbach’s α for the scales were acceptable: lack of premeditation α = .81, lack of perseverance α = .72, negative urgency α = .76, positive urgency α = .81, and sensation seeking α = .74.

Data Analytic Plan

Descriptive statistics and Pearson product-moment correlations among primary variables were computed. Next, moderated regression analyses were conducted to assess whether TRS influenced the strength and/or direction of the associations between PTS and the impulsivity facets of lack of premeditation, lack of perseverance, negative urgency, positive urgency, and sensation seeking. To examine moderation, we used the PROCESS SPSS macro (Model 1; Hayes, 2013). The predictor and moderator variables were mean centered for these analyses. When significant interaction effects were obtained, we plotted regression slopes of PTS on impulsivity in participants with low (1 SD below mean) and high (1 SD above mean) trauma-related shame scores to examine whether the slopes differed significantly from zero (Aiken et al., 1991). To account for multiple comparisons and limit Type 1 error, the Benjamini-Hochberg adjustment was used (Benjamini & Hochberg, 1995).

Results

Preliminary Analyses

All variables met acceptable standards for skewness and kurtosis. The means, standard deviations, and correlations among the study variables are reported in Table 2. Significant positive associations were identified between PTS, TRS, and each facet of impulsivity, with the exception of sensation seeking, which was not significantly related to PTS or TRS. All findings were significant after applying the Benjamini-Hochberg adjustment.

Table 2.

Bivariate Correlations among Primary Study Variables

1 2 3 4 5 6 M(SD)
1. PTS -- -- -- -- -- -- 35.10 (19.23)
2. TRS .63** -- -- -- -- -- 25.76 (20.44)
3. Lack of Premeditation .28** .31** -- -- -- -- 7.91 (2.89)
4. Lack of Perseverance .26** .31** .70** -- -- -- 8.13 (2.67)
5. Negative Urgency .37** .27** .08 −.01 -- -- 9.37 (3.08)
6. Positive Urgency .38** .33** .16** .11* .64** -- 8.55 (3.19)
7. Sensation Seeking .07 .02 −.10* −.10* .26** .47** 9.45 (3.18)
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Note. PTS = Posttraumatic Symptoms.

*

p <.05

**

p < .001.

Primary Analyses

Interactive effects of PTS and TRS on the five distinct facets of impulsivity (i.e., lack of premeditation, lack of perseverance, negative urgency, positive urgency, sensation seeking) were examined (see Table 3).1 Analysis of simple slopes indicated that PTS was significantly associated with lack of premeditation when TRS was low, b = 0.04, SE = 0.01, t = 4.29, p < .001, 95% CI [0.02, 0.06], but not when TRS was high, b = −0.006, SE = 0.01, t = −0.55, p =.58, 95% CI [−0.03, 0.02]. Similarly, PTS was significantly associated with lack of perseverance when TRS was low, b = 0.03, SE = 0.01, t = 3.23, p =.001, 95% CI [0.01, 0.05], but not when TRS was high, b = −0.003, SE = 0.01, t = −0.29, p =.77, 95% CI [−0.02, 0.02].2

Table 3.

Main and Interactive Effect of PTS and TRS on Impulsivity Facets

Outcome Predictor b SE t p 95% CI R 2 F
Lack of Premeditation .14 24.68**
PTS 0.02 0.01 2.12 .03 [0.001, 0.04]
TRS 0.003 0.01 4.31 < .001 [0.02, 0.05]
PTS x TRS −0.001 0.0003 −3.70 <.001 [−0.002, −0.001]
Lack of Perseverance .12 20.50**
PTS 0.01 0.01 1.69 .09 [−0.002, 0.03]
TRS 0.03 0.01 4.40 < .001 [0.02, 0.05]
PTS x TRS −0.001 0.0003 −2.68 .008 [−0.001, −0.0002]
Negative Urgency .13 23.81**
PTS 0.05 0.01 5.06 <.001 [0.03, 0.06]
TRS 0.01 0.02 1.54 .12 [−0.004, 0.03]
PTS x TRS −0.001 0.0003 −1.83 .07 [−0.001, 0.000]
Positive Urgency .16 29.36**
PTS 0.04 0.01 4.46 <.001 [0.02, 0.06]
TRS 0.03 0.01 3.24 .001 [0.01, 0.05]
PTS x TRS −0.001 0.0004 −1.51 .13 [−0.001, 0.002]
Sensation Seeking .005 0.85
PTS 0.01 0.01 1.41 .16 [−0.01, 0.03]
TRS −0.004 0.009 −0.45 .65 [−0.02, 0.01]
PTS x TRS 0.0003 0.0004 0.67 .51 [−0.001, 0.001]
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Note. PTS = Posttraumatic symptoms.

**

p < .001.

All findings are significant after applying the Benjamini-Hochberg adjustment.

Discussion

The goal of the current study was to examine the influence of TRS on the associations between PTS and impulsivity facets among individuals with a history of sexual trauma. We found that TRS moderated the associations between PTS and lack of premeditation and lack of perseverance only, such that higher levels of TRS weakened the association between PTS and these impulsivity facets. Specifically, based on simple slope analyses, the positive association between PTS and these forms of impulsivity (i.e., lack of premeditation and perseverance) were only significant at low (vs. high) levels of TRS. These findings have important implications for future research and practice in this area, which we detail below.

The associations between PTS and lack of premeditation and lack of perseverance were significant at low levels of TRS, consistent with the emotion regulatory hypothesis. However, at high levels of TRS, the associations between PTS and these impulsivity facets were no longer significant, suggesting that as TRS increases, the strength of the relation between PTS and impulsivity weakens, highlighting a potential protective function at increasing levels of TRS in this context. Notably, these facets of impulsivity reflect the conscientious personality trait (Miller et al., 2003), which is characterized by more careful, controlled, and goal-directed behavior (Roberts et al., 2014; Whiteside & Lynam, 2001). Reducing these impulsive tendencies may be prioritized as an attempt to self-protect against future experiences that are experienced as unpredictable and undesirable. Findings are consistent with previous work that suggest self-criticism may serve a self-correcting/punishing function, intended to motivate efforts to self-protect (Gilbert et al., 2004). Similarly, shame is theorized to promote behaviors that protect self-image, which can translate as approach behaviors to restore the sense of self; however, in cases where this may be perceived as too risky/impossible (e.g., elevated PTS), shame may motivate behaviors to protect against further damage to self-image (De Hooge et al., 2010). Thus, TRS may motivate behaviors focused on self-protection (i.e., safety and self-image).

The current findings align with the cognitive model of PTSD (Ehlers & Clark, 2000). This model suggests that individuals may process the trauma and its aftermath in a way that maintains an ongoing sense of threat (Ehlers & Clark, 2000), such as buying into negative or distorted thoughts about the causes of the event (e.g., “this happened to me because I was reckless”). Consistent with our findings, these beliefs may motivate more careful consideration of future behaviors (i.e., less impulsivity) to promote a sense of safety. Exploring stuck points related to the traumatic event could provide a better understanding of the role of trauma-related shame in the PTS-impulsivity link. For instance, individuals who view impulsivity/recklessness as the cause of their trauma may be more likely to have high shame and low impulsivity. Whereas individuals who attribute the trauma to another cause (e.g., “this happened to me because I was too nice”) may have high shame, but not necessarily have low levels of impulsivity. Future research is needed in this area to better understand how this relation varies as a function of stuck points related to the perceived causes of the traumatic event.

Notably, while our findings suggest a potential protective function of TRS in this context, we would suggest caution in interpreting this as shame having a beneficial influence on trauma outcomes more broadly. TRS has been consistently linked to negative post-trauma outcomes (Saraiya & Lopez-Castro, 2016), including risky and impulsive behavior (Crocker et al., 2016). Thus, our findings may reflect an increased desire, intention, or effort to reduce impulsive action; however, these attempts may not always be successful. Specifically, individuals may experience difficulty engaging in goal-consistent behaviors in the context of heightened distress, and this may subsequently reinforce feelings of shame and overall distress. Further, in this context, the protective influence of TRS on the link between PTS and impulsivity may reflect a risk-avoidant bias (i.e., safety bias) – a tendency to prioritize safety over any potential risk or harm – which has been implicated in maintaining various forms of anxiety (Lorian & Grisham, 2010). This type of bias may prevent healthy forms of risk, such as those needed to allow for trauma processing (e.g., exposure to corrective information). For instance, individuals who are less impulsive/more conscientious (i.e., scored lower on lack of premeditation and perseverance) may be less willing to approach (i.e., premeditation) or follow through (i.e., perseverance) with behaviors that would be helpful for their recovery due to perceived risk or danger. Moreover, considering that PTS can interfere with discriminating between safety and threat cues (Lanius et al., 2017), individuals may underestimate the risk of certain behaviors (e.g., self-medicating with alcohol/drugs) and overestimate the dangers of other experiences (e.g., trauma-related emotion, thoughts, memories); thus, safety efforts may be misdirected towards harmless experiences, and individuals may intentionally engage in certain risky acts to help facilitate control/avoidance of these internal experiences.

TRS did not moderate the associations between PTS and negative urgency, positive urgency, or sensation seeking. This seems to suggest that, among individuals reporting greater PTS, TRS does not play a role in influencing impulsive tendencies characterized by acting rashly in the context of extreme or distressing emotion (i.e., urgency) or seeking exciting and novel experiences (i.e., sensation seeking). These findings speak to the importance of examining the different facets of impulsivity separately to clarify their role in various forms of psychopathology and to better inform appropriate interventions. Specifically, urgency and sensation seeking may speak more to emotion regulatory processes, as urgency reflects a tendency to act impulsively when in the context of distressing emotions; whereas perseverance and premeditation may speak to more cognitive processes as they reflect tendencies related to planning and effortful attention. Thus, our findings seem to suggest that these cognitive aspects of impulsivity are most relevant to the interaction of PTS and TRS.

These findings have important research and clinical implications. These results underscore important avenues for future research, such as clarifying behavioral responses to TRS. Shame is a central feature of PTSD (Saraiya & Lopez-Castro, 2016), particularly among those with histories of sexual trauma (Weiss, 2010), and thus it is essential to better understand how individuals with trauma regulate shame. Shame has been proposed to serve both risk and protective functions (Luoma et al., 2019), and thus it is important to better understand the role of shame in the context of trauma. Understanding the role of trauma-related shame in the PTS-impulsivity relation is clinically important, as it is essential for clinicians to be able to recognize, understand, and explain these processes to improve case conceptualization and treatment. The goal is not to increase levels of trauma-related shame, but rather to aid clinicians in better understanding and assessing these relations to improve client outcomes.

Findings should be considered within the context of study limitations. First, the cross-sectional and correlational nature of the data prevents causal conclusions. Future work should examine these associations using prospective and longitudinal designs to further clarify the nature of these relations. Second, we exclusively relied on self-report measures, which can be influenced by a willingness/ability to accurately report on experiences. Future research should include behavioral measures (e.g., Go/No-Go Task), impulsivity ratings reported by close family or friends to capture impulsivity more objectively, and diagnostic interviews (e.g., CAPS-5) to capture PTS more accurately. Further, future studies should utilize alternative ways to measure post-trauma impulsivity specifically, versus using global assessments. Third, the majority of the sample is individuals who identified as white and non-Hispanic. Research is needed that replicates these findings across more racially and ethnically diverse samples. Fourth, although MTurk data collection allows access to more diverse and representative samples, online data collection has disadvantages that can limit generalizability (e.g., sample biases, lack of control over research environment; Kraut et al., 2004). Further, the exclusion of those who failed all validity checks may have excluded respondents high in impulsivity, which may have attenuated the magnitude of the current results. Fifth, the use of MTurk data collection required individuals to self-select into the study; thus, there may be systematic differences between those who did (vs. did not) chose to participate. It will be important to replicate and extend findings using other data collection methods, as well among diverse trauma-exposed samples (e.g., military veterans). Sixth, there may be important differences between trait and state experiences of shame. TRS may speak to a more stable or trait-based experience of shame, as the items seem to capture more global and stable self-evaluations. More research is needed to differentiate between trait and state forms of shame in the PTS-impulsivity relation.

Future lines of research should explore the role of trauma-related shame on the associations between impulsivity facets and different forms of impulsive to further explicate the nuanced relationship between these constructs. For instance, there may be important differences based on the type of impulsive behaviors and how it relates to the traumatic experience (e.g., individuals may be more averse to impulsive behaviors that are reminiscent of the traumatic experience). Further, given that there are a wide range of trauma responses and presentations (Galatzer-Levy & Bryant, 2013) and shame and impulsivity reflect common responses to trauma/PTS, additional work is needed that further clarifies and explains this heterogeneity in trauma responses. Future research should also examine the role of negative assumptions and betrayal trauma specifically these relations, as both have been found to be linked to heightened shame (Platt & Freyd, 2012; Platt & Freyd, 2015). Future work should also explore alternative pathways between PTS, trauma-related shame, and impulsivity.

Overall, findings advance our understanding of the associations among PTS, TRS, and impulsivity facets. Specifically, results indicated that high levels of TRS weakened the link between PTS and impulsivity facets of lack of premeditation and lack of perseverance. Findings suggest that TRS may protect against impulsive tendencies, potentially in an effort to self-protect through more careful and disciplined actions. Future research is needed to further clarify how individuals regulate and respond to TRS following trauma.

Figure 1. The Moderating Role of Trauma-Related Shame on the Association between PTS and Lack of Premeditation and Lack of Perseverance.

Figure 1.

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Note. Predictors were mean-centered for analyses. Simple slopes are plotted at the mean of zero and at ±1 standard deviation above and below the mean (±20.44 and ±19.23 for TRS and PTS, respectively). PTS = posttraumatic symptoms.

Clinical Impact Statement.

Posttraumatic symptoms (PTS) and impulsivity facets of lack of premeditation and lack of perseverance were significantly positively related at low (but not high) levels of trauma-related shame (TRS). Findings highlight the need for clinicians to recognize, understand, and explain the nuanced role of TRS on the relation between PTS and impulsivity to improve case conceptualization and treatment. Trauma-related shame may drive distorted thoughts around safety, which, in turn, may reduce impulsivity but also prevent healthy forms of risk, such as those needed to allow for trauma processing (e.g., exposure to corrective information).

Funding:

This work was supported, in part, by grants from the National Institutes of Health awarded to NHW (K23DA039327 and P20GM125507) and to SRF (F31DA051167).

Footnotes

Conflict of Interest: All authors declare that they have no conflict of interest.

1

We considered gender as a potential covariate. In the current sample, there were only statistically significant differences in gender for shame (p =.044), negative urgency (p =.030), and positive urgency (p =.020). Given that gender was only associated with two of the outcomes of interest, we tested these models controlling for gender and the results remained the same. We chose to retain the more parsimonious models.

2

As a test of sensitivity, we reran the analyses after removing PCL-5 items that capture experiences of shame (i.e., “Having strong negative feelings such as fear, horror, anger, guilt, or shame?”) and impulsivity (i.e., “Taking too many risks or doing things that could cause you harm?”). Findings remained the same in strength and direction. As such, we retained the findings that used the full PCL-5 measure.

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