Reducing Shame, Promoting Dignity: A Model for the Primary Prevention of Complex Post-Traumatic Stress Disorder

摘要

Complex post-traumatic stress disorder (CPTSD) refers to the complex psychological and psychosocial sequelae caused by prolonged interpersonal abuse. Contemporary approaches to CPTSD are dominated by individualized psychological interventions that are long term and costly. However, accumulating evidence indicates that CPTSD is a high prevalence mental illness implicated in significant social problems, with a pattern of lateral and intergenerational transmission that impacts on already disadvantaged communities. Consequently, there have been calls for a public health model for the prevention of CPSTD; however, there has been a lack of clarity as to what this should entail. This article argues that empirical and conceptual shifts framing CPTSD as a shame disorder offers new preventative opportunities. The article presents a series of interconnected literature reviews including a review of available prevalence data on CPTSD, the public health implications of CPTSD, the role of shame and humiliation in CPTSD, and current scholarship on dignity in public policy and professional practice. Drawing on these reviews, this article develops a social ecological model of primary prevention to CPTSD with a focus on the reduction of shame and the promotion of dignity at the relational, community, institutional, and macrolevel. A broad overview of this model is provided with examples of preventative programs and interventions. While the epidemiology of CPTSD is still emerging, this article argues that this model provides the conceptual foundations necessary for the coordination of preventative interventions necessary to reduce to the risk and prevalence of CPSTD.