The role of guilt in the development of post-traumatic stress disorder: A systematic review.

BACKGROUND: Post-traumatic stress disorder (PTSD) can be a debilitating condition associated with a myriad of emotions. Guilt is an important associated feature of PTSD that has received far less recognition than other symptoms often associated with fear and intense threat. The nature of the relationship between guilt and PTSD remains elusive and requires further clarification. The aim of the current paper was to review the extant literature regarding the link between guilt and PTSD. METHOD: A systematic database search of PsycINFO, Medline, Embase and Web of Science identified articles that enabled examination of the guilt-PTSD relationship. A total of 27 articles met inclusion criteria for this review. RESULTS: There were cross-sectional relationships between guilt and PTSD symptomology with evidence of associations between PTSD symptoms and cognitions related to perceived wrong doing and self-blame. However, the direction of association between guilt and PTSD is unclear and possibly confounded by overlapping constructs such as shame. LIMITATIONS: The review is constrained by the absence of longitudinal and experimental research and studies, which control for potential confounding variables. The reliability and validity of measures of guilt and PTSD is also not consistently reported. CONCLUSION: This review outlines four competing models of the guilt-PTSD relationship and examines existing evidence linking the two constructs. The current literature is too preliminary to offer any strong support for one model over the other. However, in critically appraising existing studies, this review helps to inform the design of future studies investigating the association between guilt and PTSD.