Complex PTSD and identification with the aggressor among survivors of childhood abuse

Yael Lahav; Marylene Cloitre; Philip Hyland; Mark Shevlin; Menachem Ben-Ezra; Thanos Karatzias

doi:10.1016/j.chiabu.2024.107196

Complex PTSD and identification with the aggressor among survivors of childhood abuse

Child Abuse Negl. 2024 Dec 18:160:107196. doi: 10.1016/j.chiabu.2024.107196. Online ahead of print.

Authors

Yael Lahav¹, Marylene Cloitre², Philip Hyland³, Mark Shevlin⁴, Menachem Ben-Ezra⁵, Thanos Karatzias⁶

Affiliations

¹ Department of Occupational Therapy, Tel Aviv University, Tel Aviv, Israel. Electronic address: [email protected].
² National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, United States of America; Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, CA, United States of America. Electronic address: [email protected].
³ Department of Psychology, Maynooth University, Kildare, Ireland. Electronic address: [email protected].
⁴ School of Psychology, Ulster University, Coleraine, Northern Ireland, UK. Electronic address: [email protected].
⁵ School of Social Work, Ariel University, Ariel, Israel. Electronic address: [email protected].
⁶ School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK. Electronic address: [email protected].

PMID: 39700595
DOI: 10.1016/j.chiabu.2024.107196

Abstract

Background: Childhood abuse (CA) is a risk factor for trauma-related disorders including posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (CPTSD). This severe form of interpersonal trauma may result in "identification with the aggressor" (IWA), in which the individual may take on the beliefs, perspectives, and behaviors of the perpetrator. Although previous evidence suggests that IWA may be particularly related to CPTSD as compared to PTSD, there has been no study that investigated this hypothesis.

Objective: The current study explored the relations between IWA and PTSD and CPTSD symptoms, and the contribution of IWA to the excess probability of PTSD and CPTSD classifications, as compared to no classification.

Participants and setting: This cross-sectional study was conducted among 320 Israeli adult CA survivors aged 21-63 (M = 42.04, SD = 10.81).

Methods: An online survey was completed by a convenience sample of adult CA survivors.

Results: Replacing one's agency with that of the perpetrator as part of IWA had a significant effect on both PTSD and CPTSD symptoms (ES = 0.36 and 0.24, respectively), and served as a risk factor for both PTSD and CPTSD classifications. Moreover, analysis of the models' predicted values reveals that the predicted probability of CPTSD classification was 3 to 5 times higher than on the probability of PTSD classifications, for low to high values of the replacing one's agency scale, respectively.

Conclusions: The current findings suggest that IWA may describe some of the deep and long-lasting detriments of CA on self, and may contribute to the development of CPTSD symptoms.

Keywords: Childhood abuse; Complex posttraumatic stress disorder (CPTSD); Identification with the aggressor; Posttraumatic stress disorder (PTSD); Trauma.