PTSD Related Conditions Trauma-Related Guilt in People With PTSD By Matthew Tull, PhD Matthew Tull, PhD Twitter Matthew Tull, PhD is a professor of psychology at the University of Toledo, specializing in post-traumatic stress disorder. Learn about our editorial process Updated on March 22, 2020 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD LinkedIn Twitter Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print asiseeit / Getty Images People who develop post-traumatic stress disorder (PTSD) also commonly experience guilt. In particular, individuals who have endured traumatic events may also begin to feel what's known as trauma-related guilt. But what does the term mean exactly? How Guilt Develops After Trauma Trauma-related guilt refers to the unpleasant feeling of regret stemming from the belief that you could or should have done something different at the time a traumatic event occurred. For example, a military veteran may regret not going back into a combat zone to save a fallen soldier. A rape survivor may feel guilty about not fighting back at the time of the assault. Trauma survivors may also experience a particular type of trauma-related guilt, called survivor guilt. Survivor guilt is often experienced when a person has made it through some kind of traumatic event while others have not. A person may question why they survived. They may even blame themselves for surviving a traumatic event as if they did something wrong. The experience of trauma-related guilt does not seem to depend on the type of traumatic event experienced. Combat exposure, physical abuse, sexual abuse, and the loss of a loved one have all been found to be associated with the experience of trauma-related guilt. In one study of 168 battered women, only six reported experiencing no guilt related to their abuse. In another study of rape and incest survivors, it was found that well over half reported experiencing moderate to high levels of guilt. Consequences Feeling guilt after the experience of a traumatic event is serious, as it has been linked to a number of negative consequences. For example, trauma-related guilt has been found to be associated with depression, shame, social anxiety, low self-esteem, and thoughts of suicide. In addition, feeling a lot of trauma-related guilt has been connected to the development of PTSD. Given the potential negative consequences of trauma-related guilt, it is important that any such guilt is addressed in PTSD treatment. Treatment Trauma-related guilt can be treated with cognitive behavioral therapy. Trauma-related guilt may originate in how you think or interpret a situation. The Best Online Therapy Programs We've tried, tested and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain. For instance, a rape survivor may feel like they should have seen their attack coming, even though it was impossible to predict that the assault would occur. Likewise, a combat veteran may think to themselves that they should have done something different to prevent the death of a fellow soldier, even though the event may have been completely out of their control. Cognitive behavioral therapy for trauma-related guilt would focus on helping people become more aware of the thoughts or beliefs that underlie feelings of guilt, such as through self-monitoring. The therapist would then help the person come up with more realistic interpretations of the situation. For example, lessen your guilt by realizing that the traumatic event was completely out of your control, and you acted in the best way you could given the situation. By reducing guilt, cognitive behavioral therapy may also help increase self-compassion and acceptance. In addition to cognitive behavioral therapy, psychodynamic/psychoanalytic approaches can also be helpful in addressing this form of guilt. Psychodynamic and psychoanalytic approaches would aid the person in exploring their early life experiences (for example, relationships with significant others, early childhood traumas or fears) in order to identify experiences and factors that may make someone more likely to feel trauma-related guilt and shame. Importance of Treatment It's important to state again that trauma-related guilt is something that desperately needs to be addressed. You may think of trauma-related guilt as a nuisance—something which diminishes your quality of life alone. In contrast, trauma-related guilt is much more serious, and, at least in veterans, is closely linked with suicidal thoughts. Without being alarmist, we encourage anyone coping with this guilt to talk openly with their doctors. Help is available, and studies suggest this help can make a significant difference for those forced to live with PTSD. If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. For more mental health resources, see our National Helpline Database. 5 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Bub K, Lommen MJJ. The role of guilt in posttraumatic stress disorder. Eur J Psychotraumatol. 2017;8(1):1407202. doi:10.1080/20008198.2017.1407202 Street AE, Gibson LE, Holohan DR. Impact of childhood traumatic events, trauma-related guilt, and avoidant coping strategies on PTSD symptoms in female survivors of domestic violence. J Trauma Stress. 2005;18(3):245-52. doi:10.1002/jts.20026 Stotz SJ, Elbert T, Müller V, Schauer M. The relationship between trauma, shame, and guilt: findings from a community-based study of refugee minors in Germany. Eur J Psychotraumatol. 2015;6:25863. doi:10.3402/ejpt.v6.25863 Norman SB, Wilkins KC, Myers US, Allard CB. Trauma informed guilt reduction therapy with combat veterans. Cogn Behav Pract. 2014;21(1):78-88. doi:10.1016/j.cbpra.2013.08.001 Reisman M. PTSD Treatment for Veterans: What's Working, What's New, and What's Next. P T. 2016;41(10):623-634. Additional Reading Aakvaag HF, Thoresen S, Wentzel-Larsen T, Dyb G, Røysamb E, Olff M. Broken and guilty since it happened: A population study of trauma-related shame and guilt after violence and sexual abuse. J Affect Disord. 2016;204:16-23. doi:10.1016/j.jad.2016.06.004 Macdonald A, Pukay-martin ND, Wagner AC, Fredman SJ, Monson CM. Cognitive-behavioral conjoint therapy for PTSD improves various PTSD symptoms and trauma-related cognitions: Results from a randomized controlled trial. J Fam Psychol. 2016;30(1):157-62. doi:10.1037/fam0000177 Tripp JC, Mcdevitt-Murphy ME. Trauma-related guilt mediates the relationship between posttraumatic stress disorder and suicidal ideation in OEF/OIF/OND veterans. Suicide Life Threat Behav. 2017;47(1):78-85. doi:10.1111/sltb.12266 By Matthew Tull, PhD Matthew Tull, PhD is a professor of psychology at the University of Toledo, specializing in post-traumatic stress disorder. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for PTSD Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.