Punishing the Self: Post-Traumatic Guilt Mediates the Link Between Trauma and Deficient Pain Modulation

The relationship between traumatic exposure and pain perception in children: the moderating role of posttraumatic symptoms

ABSTRACT

Adverse childhood experiences (ACEs) affect approximately half of all children worldwide. These experiences have been linked to increased pain sensitivity in adulthood and a higher likelihood of developing severe chronic pain. However, most studies have assessed the effects of ACEs retrospectively, long after they occurred, leaving room for other factors to influence the observed outcomes. We investigated, for the first time, the association between ACEs and concurrent pain perception among young children who live in a conflict zone and are consistently exposed to potentially traumatic experiences. Participants were 60 elementary school children (ages 8-11 years) living in conflict regions (n = 39) or nonconflict regions (n = 21). Posttraumatic stress symptom (PTSS) severity, traumatic exposure, pressure pain threshold (PPT), and mechanical detection threshold (MDT) were measured. Trauma-exposed children had significantly lower PPT than did controls, but MDT was similar across groups. Pressure pain threshold correlated positively with proximity to the conflict zone and inversely with traumatic exposure magnitude and PTSS severity. In addition, PTSSs moderated the relationship between repeated traumatic exposure and PPT. Children with higher PTSS severity displayed pain hypersensitivity regardless of their traumatic exposure level, whereas in children with lower PTSS severity, greater traumatic exposure correlated with pain hypersensitivity. The results suggest that ACEs among children lead to concurrent pain hypersensitivity and distress and may put them at elevated risk of chronic pain early in life. In addition, our findings emphasize the need for identifying children with various PTSS levels to provide tailored interventions and mitigate the long-term negative effects of ACEs.

A Complex Relationship: Intimate Partner Violence, Identification With the Aggressor, and Guilt

This study explored the relation between guilt and identification with the aggressor (IWA) and the moderating role of IWA in the relation between intimate partner violence (IPV) and guilt. An online survey was conducted among a convenience sample of 700 women. IPV survivors demonstrated elevated guilt, and IWA was related to guilt. Furthermore, IWA moderated the relation between IPV and guilt: Among participants with low IWA levels, IPV was unrelated to guilt, but among participants with high IWA levels, IPV was related to guilt. These findings suggest that IWA may be a key element in explaining guilt among IPV survivors.

Traumatic Life Experience and Pain Sensitization: Meta-analysis of Laboratory Findings

OBJECTIVES

Psychological trauma often co-occurs with pain. This relationship has been explored using laboratory pain measures; however, findings have been mixed. Previous studies have limited operationalization of trauma (eg, posttraumatic stress disorder) or pain (eg, pain thresholds), which may contribute to conflicting results. Further, prior reviews likely underrepresent trauma experiences among people who are not receiving clinical care, limiting generalizability.

MATERIALS AND METHODS

We systematically reviewed the existing literature on the relationship between psychological trauma (eg, car accidents, sexual assault, childhood abuse, neglect) and laboratory pain (ie, quantitative sensory testing measures of pain threshold, intensity, summation, modulation), using inclusive criteria. The direction of the relationship between psychological trauma and pain sensitivity was evaluated, and moderation by purported pain mechanism (ie, pain detection, suprathreshold pain, central sensitization, inhibition) was explored.

RESULTS

Analyses were conducted using 48 studies that provided 147 effect sizes. A multivariate random-effects model with robust variance estimation resulted in a small but statistically significant overall effect size of g=0.24 (P=0.0002), reflecting a positive association between psychological trauma and enhanced laboratory pain sensitivity. Upon examination of mechanistic moderators, this relationship appears driven by effects on pain detection (g=0.28, P=0.002) and central sensitization (g=0.22, P=0.04). While effect sizes were similar across all moderators, effects on suprathreshold pain and inhibition were not statistically significant.

DISCUSSION

Findings demonstrate an overall pattern of trauma-related pain enhancement and point to central sensitization as a key underlying mechanism.

Longitudinal relationships between bullying and prosocial behavior: The mediating roles of trauma-related guilt and shame

The present study examined the relationships between bullying, trauma-related guilt, trauma-related shame, and prosocial behaviors. We investigated 1,322 college students using a longitudinal approach to explore the internal mechanism between bullying, prosocial behaviors, and the probable mediating effects of trauma-related guilt and shame. The results suggested that bullying negatively predicted prosocial behaviors and that trauma-related guilt played a positive mediating role. In contrast, trauma-related shame played a negative mediating role in the relationship between bullying and prosocial behaviors. These findings indicated that trauma-related guilt and shame played adaptive and maladaptive roles after bullying victimization, which also provided a theoretical basis for the relevant intervention.

Trauma-related guilt and pain among veterans with PTSD

Despite the well-known co-occurrence of posttraumatic stress disorder (PTSD) and chronic pain, large gaps remain in understanding how these two conditions influence each other. The aim of the present study was to examine the association between trauma-related guilt and pain among veterans with PTSD. Participants were 140 veterans enrolling in treatment for PTSD and alcohol use disorder. Trauma-related guilt was assessed by the trauma-related guilt inventory, including the global guilt, distress, and guilt cognitions scales. Measures of pain included pain severity, pain disability, and fear of pain. Several significant bivariate associations were observed between trauma-related guilt scales and pain outcomes; however, in linear regression models, only the association between thoughts of trauma-related guilt and fear of pain remained statistically significant after controlling for confounding factors. Further, thoughts of trauma-related guilt, specifically thoughts of wrongdoing, partially mediated the association between PTSD severity and fear of pain. Our findings suggest that trauma-related guilt may play a role in the relationship between PTSD and chronic pain. Future research is encouraged to examine thoughts of trauma-related guilt as a potential therapeutic target in the treatment of persons with comorbid PTSD and chronic pain.