Despair, Posttraumatic

Cognitive Factors

Traumatization can have a shattering impact on the survivor's view of himself or herself and the surrounding world. Ronnie Janoff-Bulman identified three fundamental assumptions typically disrupted by trauma: (1) that the world is benevolent, (2) that life is meaningful, and (3) that the self is worthy. In addition to these changes to fundamental assumptions, the trauma survivor's ongoing symptomatic experience disrupts cognitive functioning. When the survivor has a reexperiencing symptom and enters a state of heightened arousal or a state of dissociation, cognitive functioning is disrupted, leading to problems in a variety of cognitive processes, including perception, attention, memory, and planning. The survivor's inability to control these symptoms contributes to feelings of helplessness and powerlessness.

Relational Factors

Trauma survivors typically feel estranged. Their avoidance of former activities and inability to enjoy them increases their physical isolation. Cognitive symptoms can undermine their confidence in their own perceptions, judgment, and capacity to manage the demands of living. As a result, they often need greater amounts of validation from others, but they are also sensitive to being different. A nonvalidating response from a significant other can have a devastating impact. A relational trauma occurs when a survivor comes to believe that there is something fundamentally wrong with himself or herself—some defect that precedes the trauma—and he or she despairs of ever being like other people.

Emotional Factors

The central emotion of PTSD is the conditioned fear associated with the trauma, and many survivors live with anxiety about something happening that will trigger the fear response. Their heightened state of arousal makes them irritable and prone to anger. Their emotional numbing and inability to experience positive emotions further skew their experience toward negative emotions. Being a person prone to negative emotions provokes shame in some survivors, but that is only one of many reasons survivors tend to feel shame. The primary source of shame in most survivors is the individual's view of himself or herself as defective, inadequate, or incompetent because of his or her inability to manage the traumatic stress. Feelings of shame are most easily triggered in social interactions, and many survivors, sensing the fragility of their self-esteem and the despair that ensues when it is punctured, avoid social situations just as they avoid situations that are likely to trigger trauma memories.

[Page 201]The Central Source of Despair: Deterioration of the Self

Trauma survivors experience despair about overcoming their symptoms, just as people do with other medical and psychological disorders, but their deepest despair is about the self. If survivors stop believing in themselves, they will give in to despair—hence their need for greater validation from others. They also need to pay attention to life stressors, both current and past (their trauma memories), because the overall load of stressors determines whether trauma survivors are functioning well or feeling overwhelmed. When people with chronic posttraumatic disorders can achieve a balance in their current life—a combination of challenging themselves and still keeping limits on stressors—they increase their feelings of self-efficacy and are less prone to despair.

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