The Effects of PTSD on Emotion Regulation
PTSD (or post-traumatic stress disorder) affects a person's reactions to the world, both physically and emotionally. PTSD is a disorder that presents in some people after experiencing a traumatic event with symptoms such as hypervigilance, heightened startle response, and emotional flashbacks. In this paper, the effects of PTSD on emotion regulation are examined. It has been found that fear is an emotion that people with this disorder have difficulty controlling through emotion regulation and it is hypothesized that other negative emotions may also be difficult to control. The following literature will attempt to support that hypothesis.
Literature review
A study by Tull et al. (2007) found that the severity of PTSD symptoms is positively associated with severity of lack of emotion regulation. A group of undergraduates from university were given questionnaires to screen for traumatic events. Out of that group, 73 women and 43 men reported a traumatic event and were selected for the study. Those participants were given a battery of questionnaires, including the Traumatic Events Questionnaire (TEQ), the PTSD Checklist (PCL), the Difficulties in Emotion Regulation Scale (DERS), and the Positive and Negative Affect Schedule (PANAS). It was also discovered that severity in PTSD symptoms were related to self-reported negative affect, level of income, and deficits in impulse control and recognition of emotional situations.
The results of Weiss et al. (2012) indicate that there is a relationship between the impulsive behaviors of PTSD and emotion regulation. Patients with both PTSD and substance abuse disorder (SUD) reported deficits in emotion regulation and increases in impulsive behaviors that patients without PTSD did not experience. A sample of SUD patients from a SUD treatment facility was used for the study and were mostly male. Over the course of two days, patients were asked to complete a battery of tests, including the Clinician-Administered PTSD Scale (CAPS), the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV), the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I/P), and the DERS. It was also found that patients with both PTSD and SUD and low emotion regulation, in order to avoid negative emotional states, were more likely to participate in impulsive behaviors.
Shepard and Wild (2014) investigated the correlation between PTSD symptoms and emotion regulation and found that disagreeable images initiated more of a response than neutral images. When asked to self-report on their negative feelings, however, the participants did not attribute those feelings to PTSD. After taking into account the skin conductance responses and self-reports, there was no correlation found between the severity of PTSD symptoms and emotion regulation. A sample of 45 EMTs was used, of which 31 participants were male. The participants were tested using a battery of self-report questionnaires, such as the CAPS, the Post-Traumatic Stress Diagnostic Scale (PDS), and the Self-Reported Emotion Regulation Strategies Questionnaire. Disagreeable and neutral photographs from the International Affective Picture Set (IAPS) were shown to the participants. Skin conductance responses were measured during the experiment and Likert scales were used throughout to measure emotion intensity. It is suggested that physiological means of measuring emotion may be more effective than other means.
A study by Boden et al. (2013) examined the correlation between emotion regulation and severity of PTSD symptoms, using a sample of 93 male military veterans. These veterans had been admitted to the VA Hospital for a more intensive PTSD treatment, which involved unlearning poor emotion regulation practices and learning better practices. By studying the patients' PTSD symptom severity and emotion regulation during this treatment, it was discovered that restricting emotions through strict regulation was related to more severe PTSD symptoms.
Cloitre et al. (2005) examined the relationship between the severity of PTSD symptoms and emotion regulation and found that emotion regulation and social issues were associated with impairments other than PTSD. A sample of women (164) with a history of childhood abuse (both physical and sexual) were given a battery of questionnaires that involved self-report, the Childhood Maltreatment Interview Schedule, the Sexual Assault and Additional Interpersonal Violence Schedule, the Social Adjustment Scale – Self-Report (SAS-SR), the Modified PTSD Symptoms Scale (MPSS), the General Expectancy for Negative Mood Regulation scale (NMR), and the Inventory of Interpersonal Problems (IIP). It was also found that childhood trauma that results in PTSD has a lifelong negative effect on a person's life.
The results of Ehring and Quack (2010) suggest that not only does PTSD correlate with emotion regulation, it can correlate more strongly if the trauma is early in life or chronic. The sample of 616 participants (of which most were women) was given an online questionnaire that included the Trauma History Questionnaire, the Impact of Event Scale – Revised (IES-R), the DERS, the Emotion Regulation Questionnaire (ERQ), and the Acceptance and Action Questionnaire (AAQ). The participants who had experienced more traumas or traumas that occurred early in life reported more lack of emotion regulation and more difficulties than people who had experienced a single trauma or traumas that occurred later in life. Differences between the groups were only significant in the categories Lack of Emotional Clarity and Difficulties Engaging in Goal-Directed Behavior but when the sexes' data were analyzed apart, the difference no longer remained for women.
Discussion
From the analysis of these studies, PTSD and emotion regulation are closely related. The severity of PTSD symptoms was found to be related to deficits in emotion regulation in all of the studies reviewed in this paper. Tull et al. (2007) suggest that severity of PTSD symptoms can also be linked to negative affect, level of income, and acceptance of emotional situations. Impulsive behaviors and PTSD symptoms are positively correlated, leading to poor emotion regulation (Weiss et al., 2012). Skin conductance responses were examined and thought to be a potentially better means of analyzing emotion regulation (Shepard & Wild, 2014). Boden et al. (2013) suggest that restricting emotion through emotion regulation can cause PTSD symptoms to worsen. Cloitre et al. (2005) considered the relationship between the severity of PTSD symptoms and emotion regulation and noted that emotion regulation issues could possibly be the result of some other issue. The study conducted by Ehring and Quack (2010) advises that childhood trauma can increase difficulties with handling PTSD symptoms and poor emotion regulation.