Violence, revictimization and trauma-related shame and guilt. An investigation of event characteristics and mental health correlates among violenceexposed men and women from the general population and among young survivors of a terrorist attack

Background and aim: Violence is not uncommon and may have a range of negative consequences for victims. While mental health has received much research attention, other consequences are increasingly recognized, including victims’ increased risk of subsequent violence exposure and shame and guilt related to their violent experiences. These latter consequences are adverse for the individual, and may relate to long-term health and well-being. Therefore, it is important to be able to identify those victims of violence who are particularly vulnerable for new violent experiences, shame and guilt. Certain characteristics of the event, including a close relationship to the perpetrator and the type of violence, and multivictimization can impact mental health after violence. However, less is known about how these characteristics relate to other negative consequences. This thesis investigates how the characteristics of violence in childhood relate to violence exposure in adulthood. Further, the thesis examines how various violent experiences are related to emotional responses to violence, namely trauma-related shame and guilt, in male and female violence survivors. Mental health correlates of shame and guilt are examined. Methods: Two different study samples were used. First, a comprehensive telephone interview study (the prevalence study) was conducted to map exposure to violence in the Norwegian population (n=4,529). The study measured child sexual abuse (CSA), childhood physical violence from or between parents, psychological violence and childhood neglect, as well as adult physical violence from partners or others and lifetime rape. The employed mental health measures included a short scale that assessed anxiety/depression symptoms (HSCL-10). For this study, a new shame and guilt after trauma scale (SGATS) was developed. The second study was conducted after the terrorist attack in Norway on 22nd of July, 2011. A sample of 325 survivors, who were primarily adolescents and young adults, were interviewed. This study focused on evaluating the survivors’ experiences and reactions to the event, including posttraumatic stress reactions (PTSR; measured using the UCLA PTSD-RI) and trauma-related shame and guilt. The statistical methods applied in this thesis include multiple regression analyses, logistic regression analyses, chi-square statistics, linear hypothesis testing, and confirmatory factor analysis. Results: Violent experiences were highly overlapping for both women and men. Different types of childhood violence overlapped, and childhood experiences of violence were associated with violence in adulthood. Women who experienced CSA often experienced other violence types in childhood. CSA from a parent almost always co-occurred with other types of violence. The total number of childhood violence experiences (multivictimization) was strongly associated with intimate partner violence or rape in adulthood. Women and men who experienced violence reported more anxiety/depression symptoms, and those symptoms increased with the number of violence categories experienced. All types of violence, including the terrorist attack, were associated with trauma-related shame and guilt. Women reported more shame and guilt than men in the prevalence study, but this gender difference was not found after the terrorist attack. Both emotions were independently associated with mental health problems in both samples. In the prevalence study, shame was more important for mental health. The total number of violence types in childhood and adulthood showed a graded relationship with trauma-related shame and guilt. Conclusions: Violence is associated with various negative consequences, regardless of whether the violence happens in a close relationship, whether the violence happens in childhood or adulthood, and whether the violence is of a sexual nature. Childhood victims of violence have an increased likelihood of adult violent exposure that is not restricted to the same violence type. Both trauma-related shame and guilt contribute to mental health problems after violence, although shame may be more clinically relevant than guilt. Shame and guilt were fairly common among young survivors of a terrorist attack. It is not clear if women have more shame and guilt than men, but violence exposure was highly important for shame and guilt, for both men and women. These findings imply that researchers and clinicians could benefit from a broad assessment of violence, in order to uncover the full scope of respondents and patients’ violent experiences. Clinicians may find it helpful to address shame and guilt after a variety of violent experiences, with both men and women. Future research could investigate the hypothesis that shame and guilt might be a mechanism by which revictimization occurs

But were you drunk? Intoxication during sexual assault in Norway

Background: Sexual assault often occurs when victims are intoxicated. Rape myth research indicates that intoxicated assaults are sometimes seen as less severe or not as ‘real’ assaults; however, it is unclear if victims of intoxicated sexual assaults differ from victims of non-intoxicated assaults in terms of health and functioning. Objective: We investigated possible differences in mental health, social support and loneliness between intoxicated and non-intoxicated sexual assault victims. Methods: Participants were 1011 young adults (505 exposed to childhood violence and 506 non-exposed) selected from a community telephone survey (T1), and a follow-up survey 12–18 months later (T2). Analyses include one-way ANOVA with Tamhane post hoc tests. Results: There were no significant differences in mental health, social support and loneliness between victims of intoxicated and non-intoxicated sexual assault, although both groups differed significantly from those who did not report sexual assault. Conclusions: These results indicate that intoxicated sexual assaults are no less clinically important than non-intoxicated assaults

Violence against children, later victimisation, and mental health: a cross-sectional study of the general Norwegian population

Background: Violence in childhood is associated with mental health problems and risk of revictimisation. Less is known about the relative importance of the various types of childhood and adult victimisation for adult mental health. Objective: To estimate the associations between various types of childhood and adult violence exposure, and their combined associations to adult mental health. Method: This study was a cross-sectional telephone survey of the Norwegian adult population; 2,435 women and 2,092 men aged 18–75 participated (19.3% of those we tried to call and 42.9% of those who answered the phone). The interview comprised a broad array of violence exposure in both childhood and adulthood. Anxiety/depression was measured by the Hopkins Symptom Check List (HSCL-10). Results: Victimisation was commonly reported, for example, child sexual abuse (women: 10.2%, men: 3.5%), childhood–parental physical violence (women: 4.9%, men: 5.1%), and lifetime forcible rape (women: 9.4%, men: 1.1%). All categories of childhood violence were significantly associated with adult victimisation, with a 2.2–5.0 times higher occurrence in exposed children (p<0.05 for all associations). Anxiety/depression (HSCL-10) associated with adult abuse increased with the number of childhood violence categories experienced (p<0.001). All combinations of childhood violence were significantly associated with anxiety/depression (p<0.001 for all associations). Individuals reporting psychological violence/neglect had the highest levels of anxiety/depression. Conclusions: Results should be interpreted in light of the low response rate. Childhood violence in all its forms was a risk factor for victimisation in adulthood. Adult anxiety/depression was associated with both the number of violence categories and the type of childhood violence experienced. A broad assessment of childhood and adult violence exposure is necessary both for research and prevention purposes. Psychological violence and neglect should receive more research attention, especially in combination with other types of violence

The day Norway cried: Proximity and distress in Norwegian citizens following the 22nd July 2011 terrorist attacks in Oslo and on Ut&#x00F8;ya Island

Background: Terrorism may create fear and stress reactions not only in the direct victims, but also in the general population. Objective: This study investigated emotional responses in the Norwegian population following the 22nd July 2011 terrorist attacks. We hypothesized that Oslo residents would report a higher level of fear responses compared with people living outside Oslo and that proximity would be associated with early distress and later post-traumatic stress reactions. Method: Representative samples were drawn from the Norwegian Population Registry. Telephone interviews were conducted 4&#x2013;5 months after the attacks. The response rate for the Oslo sample (N=465) was 24% of the total sample, and 43% of those who were actually reached by phone and asked to participate. Corresponding figures for the sample living outside Oslo (N=716) were 19% and 30%. Results: Our results show strong immediate emotional responses, particularly sadness and a feeling of unreality, in both samples. Jumpiness and other fear responses were significantly higher among Oslo residents. Current level of risk perception was low 4&#x2013;5 months after the attacks; however, a significant minority reported to feel less safe than before. Geographical and psychological proximity were associated with early emotional responses. Psychological proximity was significantly associated with post-traumatic stress reactions, while measures of geographical proximity were not. Immediate emotional responses, first-week reactions, and first-week jumpiness were uniquely and significantly associated with post-traumatic stress reactions. Post-traumatic stress reactions were elevated in ethnic minorities. Conclusions: The terrorist attacks seem to have had a significant effect on the Norwegian population, creating sadness and insecurity, at least in the short term. Proximity to the terrorist attacks was strongly associated with distress in the population, and early distress was strongly related to later post-traumatic stress reactions. Our results indicate that psychological proximity is more strongly associated with post-traumatic stress reactions than geographical proximity, and underline the importance of differentiated measurements of various aspects of early distress

The mediating role of shame in the relationship between childhood bullying victimization and adult psychosocial adjustment

Background: Psychological distress following experiencing bullying victimization in childhood has been well documented. Less is known about the impact of bullying victimization on psychosocial adjustment problems in young adulthood and about potential pathways, such as shame. Moreover, bullying victimization is often studied in isolation from other forms of victimization. Objective: This study investigated (1) whether childhood experiences of bullying victimization and violence were associated with psychosocial adjustment (distress, impaired functioning, social support barriers) in young adulthood; (2) the unique effect of bullying victimization on psychosocial adjustment; and (3) whether shame mediated the relationship between bullying victimization and these outcomes in young adulthood. Method: The sample included 681 respondents (aged 19–37 years) from a follow-up study (2017) conducted via phone interviews derived from a community telephone survey collected in 2013. Results: The regression analyses showed that both bullying victimization and severe violence were significantly and independently associated with psychological distress, impaired functioning, and increased barriers to social support in young adulthood. Moreover, causal mediation analyses indicated that when childhood physical violence, sexual abuse, and sociodemographic factors were controlled, shame mediated 70% of the association between bullying victimization and psychological distress, 55% of the association between bullying victimization and impaired functioning, and 40% of the association between bullying victimization and social support barriers. Conclusions: Our findings support the growing literature acknowledging bullying victimization as a trauma with severe and long-lasting consequences and indicate that shame may be an important pathway to continue to explore. The unique effect of bullying victimization, over and above the effect of violence, supports the call to integrate the two research fields

Broken and guilty since it happened: A population study of trauma-related shame and guilt after violence and sexual abuse

There is increasing interest in trauma-related shame and guilt. However, much remains unknown in terms of how these emotions relate to the type of event, gender and mental health. We investigated shame and guilt in men and women following various types of severe violence and their relation to mental health. Telephone interviews were conducted with a Norwegian general population sample (n=4529; age=18-75; response rate=42.9%). Measures included child sexual abuse, child and adult rape, severe physical violence from/between parents, severe violence from a partner and non-partners, less severe violence and non-violent trauma, the new Shame and Guilt After Trauma Scale, and the Hopkins Symptom Checklist. Analyses included t-tests and linear regressions. All types of severe violence were significantly associated with trauma-related shame and guilt (coefficients from 0.11 to 0.38, p-values <0.001). The number of violence types showed a graded relationship with both emotions. Women had significantly more shame and guilt than men did (p-values <0.001 for both emotions), which was partially explained by violence exposure. Both emotions were independently associated with mental health problems (p-values <0.001). The study is cross-sectional. The shame and guilt measure requires further validation. The more types of violence that were reported, the higher levels of shame and guilt were. Clinicians should be aware of shame and guilt after a variety of violent events, including non-sexual violence, in both men and women and should particularly be aware of whether individuals have multiple violent experience

Screening for consequences of trauma – an update on the global collaboration on traumatic stress

This letter provides an update on the activities of “The Global Collaboration on Traumatic Stress” (GC-TS) as first described by Schnyder et al. in 2017. It presents in further detail the projects of the first theme, in particular the development of and initial data on the Global Psychotrauma Screen (GPS), a brief instrument designed to screen for the wide range of potential outcomes of trauma. English language data and ongoing studies in several languages provide a first indication that the GPS is a feasible, reliable and valid tool, a tool that may be very useful in the current pandemic of the coronavirus disease 2019 (COVID-19). Further multi-language and cross-cultural validation is needed. Since the start of the GC-TS, new themes have been introduced to focus on in the coming years: a) Forcibly displaced persons, b) Global prevalence of stress and trauma related disorders, c) Socio-emotional development across cultures, and d) Collaborating to make traumatic stress research data “FAIR”. The most recent theme added is that of Global crises, currently focusing on COVID-19-related projects