- After trauma, survivors can feel disconnected from themselves and others.
- Alienation is linked with psychological distress, such as PTSD, depression, and dissociation symptoms.
- We can each take actions to support connection after trauma.
Even though I had friends, I was still lonely.
My friends didn’t understand my reactions.
There was a huge void inside me.
These are some of the ways that people describe feeling alienated after trauma; that is, disconnected from themselves and others. In fact, these are items from the Trauma Appraisal Questionnaire (TAQ), developed by my research team to measure common post-traumatic thoughts and feelings.
The TAQ measures alienation along with shame, self-blame, fear, anger, and betrayal. Some of these post-traumatic appraisals have received more research and clinical attention than others. For instance, fear has been a focus in models of post-traumatic stress disorder (PTSD) as well as cognitive behavioral treatments.
Beyond fear, though, research points to the importance of recognizing other posttraumatic appraisals, particularly alienation.
Does Alienation Matter?
Alienation is linked with multiple forms of post-traumatic distress. For example, feeling more alienated has been associated with worse PTSD, depression, and dissociation symptom severity. Links between alienation and symptoms have been documented across diverse samples, including adult and adolescent survivors of child abuse as well as adult survivors of intimate partner violence.
Drawing on nine published studies that examined alienation-PTSD links specifically, a recent meta-analysis revealed a large effect size relationship between alienation appraisals and PTSD symptoms. As alienation appraisals increased, so did PTSD symptoms. However, the correlational nature of the studies in the meta-analysis means that we do not know whether alienation caused increases in PTSD or vice versa.
Alienation also distinguished people with trauma histories who met the criteria for either PTSD or Dissociative Identity Disorder (DID). In particular, the group diagnosed with DID reported more severe alienation than people diagnosed with PTSD. This suggests that alienation may play a role in complex responses to trauma.
Is It Alienation or Something Else?
While several studies have found alienation-distress patterns, making sense of these links requires weighing related constructs. For instance, it could be that the alienation captures aspects of social support, loneliness, or a more general difficulty identifying emotions (called alexithymia) – each of which could potentially account for links with posttraumatic distress. Such connections matter for interpreting alienation-distress links. If social support accounted for symptoms better than alienation, for example, then we might draw different implications from this research by focusing on interventions that increase social support.
Fortunately, researchers began to tease out these related constructs in a 2019 study that involved 100 college students as well as 93 adults seeking services in Northern Ireland who had survived trauma. Participants reported their trauma histories, alienation, social support, loneliness, and alexithymia as well as PTSD and depression symptoms. Alienation explained links between trauma histories and post-traumatic stress and depression symptoms, even when taking into account social support, loneliness, and alexithymia. This finding suggests that there is, indeed, something important about alienation for understanding post-traumatic distress.
What Are the Implications of Alienation Research for Our Response to Trauma?
If alienation is part of the harm of trauma, then connection should be part of our response.
That’s the conclusion I’ve come to based on my team's research on community responses to intimate violence. For example, we’ve seen that outreach from victim advocates to survivors in the aftermath of intimate partner abuse predicts less distress a year later, relative to a comparison condition that offered referrals instead of outreach. A phone call may go a long way in communicating that survivors are not alone and that people understand and care about what happened to them.
Of course, we can each take actions to support connection after trauma, even if we aren’t victim advocates. For example, each of us can focus on listening and responding with practical help when people disclose traumas such as sexual assault to us, as I described in this recent post.
We can also change how we talk about and collaborate to address trauma, particularly intimate violence. For instance, my book Every 90 Seconds: Our Common Cause Ending Violence Against Women explores what is possible if we talk about intimate violence in open and solution-focused ways. By doing so, we communicate that survivors are not alone, that we each take the issue seriously, and that change is possible.
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