Martin J Dorahy
Department of Psychology
University of Canterbury
Lenaire Seager
Warwick Middleton
The Cannan Institute
Belmont Private Hospital
Brisbane, Australia
 Shame discussed increasingly in complex trauma and
dissociation literatures (e.g., Chu, 2011; Dorahy, 2010;
Dyer et al., 2009; Kluft, 2007
 Yet, very little work has empirically examined shame in
dissociative disorders.
 Is shame elevated in DID compared to psychiatric
comparison groups?
 Is there an association between shame and
dissociation (e.g., Talbot et al., 2004)
 Are difficulties with intimacy more evident in DID
compared to psychiatric comparisons?
 Are difficulties with intimacy related to dissociation
and/or shame in traumatized groups?
 Previous work has suggested that dissociation is a
stronger predictor of relational/intimacy difficulties
than shame in complex trauma groups (e.g., Dorahy,
2010; Dorahy et al., 2013)
 Complex PTSD
 N = 73 psychiatric patients
Age (sd)
Gender F/M
DD (DID=36; C-PTSD,
OSDD=3),
n=13
n=39
MP
(nonPTSD
anx; dep),
n=21
44.67 (10.65)
36/3
41.62
15/6
38.08
11/2
 No sig for age [F(2,70) = 2.06, p = .14]
 No sig gender [(2) = 4.65, p = .10]
 All had child abuse and/or neglect
 Completed:
 Multidimensional Relationship Questionnaire (MRQ;
Snell et al., 1996): Rel preoccupation, Rel. anxiety, Rel. Dep. Fear of rels.;
Rel. esteem, motivation, satisfaction.
 Personal Feelings Questionnaire-2 (PFQ-2; Harder & Lewis,
1987)
 The Compass of Shame Scale (CoSS; Elison et al., 2006)
 Avoidance, withdrawal, attack self, attack other
 The State Shame and Guilt Scale (SSGS; Marschall et al., 1994)
 Stress Reactions Checklist for Disorders of Extreme
Stress (SRC; Ford et al., 2007)
 The Childhood Trauma Questionnaire (CTQ; Bernstein &
Fink, 1998)
 Dissociative Disorders Interview Schedule: BPD, DID
(DDIS; Ross et al., 1989).
 Dissociative Experiences Scale (Carlson & Putnam, 1993
Schneiderian. Sx.
BPD Sx
DES Total
DD
C-PTSD
MP
Mean (SD)
Mean (SD)
Mean (SD)
7.58 (3.07)
4.00 (3.27)
2.33 (2.65)
t(69) = -3.72, p < .001
t(69) = -6.45, p < .001
5.54 (2.37)
4.19 (2.75)
t(69) = -2.02, p = .047
t(69) = -4.68, p < .001
6.95 (1.69)
53.25 (22.17) 32.97 (13.31)
t(69) = -3.82, p < .001
DES-Taxon
Complex PTSD
50.90 (11.17) 26.82 (19.66)
32.84 (9.06)
15.71 (10.95)
t(69) = -8.68, p < .001
7.68 (7.36)
t(69) = -3.91, p < .001
t(69) = -8.56, p < .001
29.46 (9.76)
18.05 (7.30)
t(69) = -1.21, p = .23
t(69) = -6.24, p < .001
Trait shame
Trait guilt
State shame
State guilt
State pride
DID
C-PTSD
MP
25.28 (6.46)
22.38 (5.36)
18.90 (7.94)
t(70) = -1.34, p = .19
t(70) = -3.49, p = .001
15.38 (3.59)
12.71 (3.36)
t(70) = -.93, p = .92
t(70) = -2.40, p = 02
14.15 (3.99)
9.69 (4.72)
t(70) = -1.00, p = .32
t(70) = -4.44, p < .001
15.85 (3.60)
11.44 (4.23)
t(70) = .28, p = .78
t(70) = -2.86, p = .006
9.62 (4.46)
13.29 (4.90)
t(70) = -.78, p = .44
t(70) = 2.05, p = .04
15.51 (4.93)
15.77 (5.51)
15.36 (6.38)
10.76 (4.39)
CoSS-Withdrawal
CoSS-Avoidance
CoSS-Attack self
CoSS-Attack other
DID
C-PTSD
MP
49.62
49.85
43.57*
(6.26)
(6.04) [13]
(8.95) [21]
[39]
t(70) = .10, p = .92
t(70) = -3.15, p = .002
32.46
31.92
33.29
(6.74)
(9.70) [13]
(4.93) [21]
[39]
t(70) = -.24, p = .81
t(70) = .44, p = .66
48.79
50.31
43.81
(9.34)
(8.51) [13]
(10.49) [21]
[39]
t(70) = .50, p = .62
t(70) = -1.93, p = .06
22.92
24.85
29.43*
(8.44)
(8.32) [13]
(8.81) [21]
[39]
t(70) = .70, p = .48
t(70) = 2.82, p = .006
DD
C-PTSD
MP
Mean (SD)
Mean (SD)
Mean (SD)
12.62 (6.24)
8.76 (7.03)
t(70) = -1.34, p = .19
t(70) = -3.82, p < .001
12.07 (7.55)
7.62 (5.72)
t(70) = -.57, p = .57
t(70) = -3.34, p = .001
15.08 (5.09)
11.43 (6.39)
t(70) = -.66, p = .51
t(70) = -3.16, p = .002
Relationship anxiety 15.36 (6.05)
Relationship
13.20 (5.93)
depression
Fear of
Relationships
16.28 (5.45)
Emotional abuse
Physical abuse
Sexual abuse
Emotional neglect
Physical neglect
DD
C-PTSD
MP
Mean (SD)
Mean (SD)
Mean (SD)
19.67 (5.79)
17.23 (5.96)
13.76 (5.53)
t(69) = -1.21, p = .23
t(69) = -3.62, p = .001
13.54 (5.49)
10.19 (5.19)
t(69) = -.65, p = .52
t(69) = -2.88, p = .005
14.85 (7.91)
8.10 (6.08)
t(68) = -2.74, p = .008
t(68) = -6.93, p < .001
16.92 (5.35)
13.48 (5.45)
t(69) = -.86, p = .39
t(69) = -3.25, p = .002
13.31 (5.47)
8.71 (4.16)
t(69) = -.41, p = .67
t(69) = -3.78, p < .001
15.00 (6.22)
20.75 (6.66)
18.69 (5.63)
14.14 (5.51)
 hierarchical regression on relationship anxiety, rel.
depression and fear of relationships
 Predictors:
 Complex PTSD (without dissociation sx), Child abuse, guilt (step 1)
 Controlled for impact of these variables
 Shame (step 2);
 DES-T (step 3);
 Shame × DES-T (Step 4): To test whether dissociation has a
moderating effect on relationship between shame and rel.
difficulties
Shame
UniqR2=3%, p =. 08
Rel. Anxiety
DES-T
Shame by
DES-T
UniqR2=7%, p <.05
Rel. Depression
Fear of Rels.
 Relationship Anxiety: Rsq = 36.3%, F(6,63)=5.98, p<.001
 Relationship Depression: Rsq=23.4%, F(6,63)=3.31,
p=.008
 Fear of Relationships: Rsq=31.2%, F(6,63)=4.75, p<.05.
 DID in comparison to C-PTSD, had increased:
 Schneiderian first symptoms
 BPD Sx
 Dissociation (trait & pathological)
 Sexual abuse
 DID in comparison to Mixed Psych, had increased:
 All variables
 Thus DID ‘looked’ quite different from C-PTSD and very
different from MP
 More severe symptom profile, more sexual abuse
 When controlling for complex PTSD, CA&N, guilt, &
dissociation, shame showed trend to relationship anxiety.
 Consequently the sense of shame, at least in psychiatric
patients with a history of CA&N, increases anxiety in
relationship (?incl. therapeutic rel), thus best examined early
and gently.
 When controlling for complex PTSD, CA&N, guilt, &
shame, dissociation related to relationship depression
 More dissociation, more negative evaluation of relationships
 Thus dissociation an interpersonal variable
 Warwick Middleton
 Lenaire Seager
 Ron Chambers
 Patrick McGurrin
 Mary Williams