Match!

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

Published on Aug 1, 2019in The Journal of Pain5.424
路 DOI :10.1016/j.jpain.2019.07.004
Yael Lahav6
Estimated H-index: 6
(TAU: Tel Aviv University),
Zahava Solomon59
Estimated H-index: 59
(TAU: Tel Aviv University)
+ 2 AuthorsRuth Defrin28
Estimated H-index: 28
(TAU: Tel Aviv University)
Abstract
Abstract Trauma survivors may suffer from posttraumatic stress disorder (PTSD), elevated posttraumatic guilt (PG), and alterations in the pain system. However, the association between PG and alterations in pain perception and modulation among trauma survivors has not been established, nor has the possible underlying role of PG. This longitudinal study investigated: 1) the unique contribution of PG in predicting pain perception and modulation, while controlling for PTSD symptoms; and 2) the mediating role of PG in explaining pain perception and modulation among torture survivors, above and beyond PTSD symptoms. Participants were 59 torture survivors and 44 age-matched controls. PG and PTSD symptoms were assessed in 2003 (T1). Heat-pain threshold, heat-pain tolerance, temporal summation of pain (TSP) and conditioned pain modulation (CPM) were measured five years later (T2). Torture survivors had elevated PG and PTSD symptoms, enhanced TSP, and reduced CPM, compared to controls. While PTSD predicted reduced pain tolerance and CPM, PG predicted increased pain tolerance. Moreover, PG mediated the associations between torture and (increased) pain threshold, pain tolerance, and TSP. It appears that PTSD and PG induce opposite effects on the pain modulation capacity of torture survivors, a dichotomy that may explain paradoxical pain responses among trauma survivors, as discussed. Perspective: This longitudinal study sheds light on the possible mechanisms underlying variations in pain perception and modulation among trauma survivors. PTSD and posttraumatic guilt each mediated opposing pain modulation profiles, suggesting that individual responses to trauma, rather than the trauma itself, influence pain responses.
  • References (61)
  • Citations (0)
馃摉 Papers frequently viewed together
11 Citations
7 Citations
78% of Scinapse members use related papers. After signing in, all features are FREE.
References61
Newest
#1Chloe A. Hamza (OISE/UT: Ontario Institute for Studies in Education)H-Index: 2
#2Teena Willoughby (Brock University)H-Index: 39
Abstract Nonsuicidal self-injury (NSSI; e.g., self-cutting without lethal intent) is a widespread mental health concern among emerging adults in university. Although accumulating evidence suggests that NSSI is primarily an emotion coping behaviour, little is known about variability in emotional response to pain among individuals who self-injure. Recent theory on NSSI suggests that individuals who engage in NSSI to self-punish may experience additional affective gains in response to pain compared...
1 CitationsSource
1 CitationsSource
#1Nirit Geva (TAU: Tel Aviv University)H-Index: 4
#2Ruth Defrin (TAU: Tel Aviv University)H-Index: 28
Abstract The effect of acute stress on pain threshold and intolerance threshold are reported as producing either hypoalgesia or hyperalgesia. Yet, the contribution of individual stress reactivity in this respect has not been established. The aim was to test 2 pain modulation paradigms under acute stress manipulation, to our knowledge, for the first time, to study whether stress differentially affects pain modulation, and whether the effect is related to individual stress response. Participants w...
6 CitationsSource
#1A StrigoIrinaH-Index: 1
#2D SpadoniAndreaH-Index: 1
Last. N SimmonsAlanH-Index: 1
view all 4 authors...
Abstract Mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD) are highly comorbid conditions that often co-occur with chronic pain. We have shown that women with PTSD subsequent to intimate partner violence show attenuated brain response to repeated experimental pain that was related to symptoms of avoidance. The aim of this study was to extend our past findings to males with combat trauma and to examine brain response to experimental pain in men with and without PTSD who...
1 CitationsSource
#1Anthony J. Gifuni (McGill University)H-Index: 4
#2Adam Kendal (McGill University)H-Index: 1
Last. Fabrice Jollant (McGill University)H-Index: 32
view all 3 authors...
Guilt is a self-conscious emotion associated with the negative appraisal of one鈥檚 behavior. In recent years, several neuroimaging studies have investigated the neural correlates of guilt, but no meta-analyses have yet identified the most robust activation patterns. A systematic review of literature found 16 functional magnetic resonance imaging studies with whole-brain analyses meeting the inclusion criteria, for a total of 325 participants and 135 foci of activation. A meta-analysis was then co...
10 CitationsSource
4 CitationsSource
#1Ruth Defrin (TAU: Tel Aviv University)H-Index: 28
#2Yael Lahav (TAU: Tel Aviv University)H-Index: 6
Last. Zahava Solomon (TAU: Tel Aviv University)H-Index: 59
view all 3 authors...
11 CitationsSource
#1Coralie Bastin (University of Melbourne)H-Index: 2
#2Ben J. Harrison (University of Melbourne)H-Index: 45
Last. Sarah Whittle (University of Melbourne)H-Index: 33
view all 5 authors...
Abstract This systematic review aimed to provide a comprehensive summary of the current literature on the neurobiological underpinnings of the experience of the negative moral emotions: shame, embarrassment and guilt. PsycINFO, PubMed and MEDLINE were used to identify existing studies. Twenty-one functional and structural magnetic resonance imaging and positron emission tomography studies were reviewed. Although studies differed considerably in methodology, their findings highlight both shared a...
27 CitationsSource
#2Siri ThoresenH-Index: 17
Last. Miranda Olff (UvA: University of Amsterdam)H-Index: 49
view all 6 authors...
Abstract Background 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. Methods Telephone interviews were conducted with a Norwegian general population sample (n=4529; age=18鈥75; response rate=42.9%). Measures included child sexual abuse, chil...
21 CitationsSource
#1Tonny Elmose Andersen (AU: Aarhus University)H-Index: 8
#2Karen-Inge Karstoft (AU: Aarhus University)H-Index: 15
Last. Ask Elklit (AU: Aarhus University)H-Index: 33
view all 4 authors...
Background Knowledge about the course of recovery after whiplash injury is important. Most valuable is identification of prognostic factors that may be reversed by intervention. The mutual maintenance model outlines how post-traumatic stress symptoms (PTSS) and pain may be mutually maintained by attention bias, fear, negative affect and avoidance behaviours. In a similar vein, the fear-avoidance model describes how pain-catastrophizing (PCS), fear-avoidance beliefs (FA) and depression may result...
24 CitationsSource
Cited By0
Newest
#1Matthew S. Herbert (UCSD: University of California, San Diego)H-Index: 15
#2Anne L. Malaktaris (UCSD: University of California, San Diego)H-Index: 1
Last. Sonya B. NormanH-Index: 23
view all 4 authors...
Abstract 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, ...
Source