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Access Type

WSU Access

Date of Award

January 2011

Degree Type


Degree Name




First Advisor

Valerie A. Simon


Nearly one million children experience childhood maltreatment each year (United States Department of Health and Human Services, 2006). Childhood maltreatment is often accompanied by feelings of shame which, for some, may persist long after the maltreatment ends and is linked to a number of important outcomes including Posttraumatic Stress Disorder (Alessandri & Lewis, 1996; Feiring & Taska, 2005; Toth, Cicchetti, Macfie, & Emde, 1997). Longitudinal research by Feiring and colleagues indicates that among those with histories of child sexual abuse (CSA), the persistence of self-reported CSA-specific shame predicts later symptoms of PTSD (Feiring, Taska, & Lewis, 2005; Feiring, Simon, & Cleland, 2009). Informed by previous studies, this study differed in a number of ways. The current study examines whether nonverbal (observer-rated) indicators of shame are associated with concurrent levels of PTSD symptoms among a sample of women with histories of child maltreatment.

Shame may be measured nonverbally or via self-report; however, self-reports of shame may not fully capture shameful emotions (Andrews, 1998a). Therefore, assessments of nonverbal shame may provide a more comprehensive measure. The measure of observed, nonverbal shame created for this study addresses several limitations in the extant literature by integrating multiple indicators used in prior studies into a single comprehensive assessment of the occurrence of maltreatment-specific shame (Bennett, Sullivan, & Lewis, 2005; Bonanno et al., 2002; Lewis, 1992; Lewis & Alessandri, 1996; Negrao, Bonanno, Noll, Putnam, & Tricket, 2005; Stipek, Recchia, McClintic & Lewis, 1992). Observer ratings of nonverbal shame were compared to participants' self-reported ratings of maltreatment-related shame, and with concurrent reports of PTSD symptoms. Moreover, the current study focused on women during the post-pregnancy period, a time when women are re-examining their childhood maltreatment and a time when women are vulnerable for a resurgence of PTSD symptoms (Lev-Wiesel, Daphna-Tekoah, & Hallak, 2009).

Six months after the birth of their child, ninety-four women completed a video-taped Trauma Meaning Making Interview discussing their history of childhood maltreatment. The participants' behavior during the interview was rated on a scale of one to five on three nonverbal shame indicators: head down, avoidant posture, and collapsed posture. Women also answered questionnaires regarding current symptoms of Posttraumatic Stress Disorder.

Results indicated nonverbal shame can be reliably measured using this new system. Moreover, head down occurred significantly more often than postures. Demonstrating convergent validity, nonverbal shame assessed by head down behaviors and an overall composite of nonverbal shame was significantly correlated with self-reported shame. Nonverbal abuse related shame was associated with concurrent PTSD symptoms and diagnosis, with head down behaviors significantly predicting PTSD symptoms and diagnosis. Replication of these findings is needed to clarify the reasons for the discrepancies between head down behaviors and posture behaviors. This difference could be due to inconsistencies in the thresholds between head downs and postures, or the interview being a social interaction that is likely to elicit more head down behavior than postural behaviors. The current findings suggest that nonverbal shame has a unique effect on PTSD symptoms and diagnosis. The clinical implications of this finding point to the importance of observing and recognizing patient shameful behavior during treatment for childhood maltreatment and PTSD.

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