Doubt regarding abuse-related appraisals and identification with the aggressor as predictors of complex PTSD in female child abuse survivors

Background: Child abuse (CA) is a significant risk factor for trauma-related psychopathology, with potential outcomes that extend beyond posttraumatic stress disorder (PTSD) to include complex PTSD (CPTSD)–a condition characterized by disturbances in self-organization (DSO). This trauma can also lead to identification with the aggressor (IWA), where survivors internalize the perpetrator’s beliefs, perspectives, and behaviors, as well as doubt regarding abuse-related appraisals (DARA), which reflects uncertainty in interpreting aspects of the abuse. Although IWA and DARA have been proposed as potential contributors to trauma-related symptomatology, their predictive roles have not been empirically examined. Objective: This two-wave study explored the implications of IWA and DARA for subsequent PTSD and DSO symptoms. Method: The current study was conducted among 273 adult female CA survivors, aged 18–53 (M = 33.01, SD = 9.78). Participants completed online self-report measures assessing IWA and DARA at the first measurement (T1) and PTSD and DSO symptoms at two time points (T1 and T2). Results: The results revealed positive associations between IWA and DARA at T1 and PTSD and DSO symptoms at T2. Analyses further indicated that the IWA component, which involves the replacement of one’s agency with that of the perpetrator at T1, predicted variance in PTSD and DSO at T2 (ES = 0.15 and 0.15, respectively). Additionally, the DARA component, which reflects doubt regarding the abuse at T1, predicted variance in DSO symptoms at T2 (ES = 0.17). These effects remained significant even after accounting for polyvictimization, PTSD, and DSO at T1. Conclusions: IWA and DARA may be important psychological factors contributing to survivors’ vulnerability to trauma-related psychopathology.