Background: Anger and shame are aspects that are specifically associated with psychopathology and maladaptation after childhood abuse and neglect. They are known to influence symptom maintenance and exacerbation; however, their interaction is not fully understood. Objective: To explore with network analysis the association and interaction of prolonged, complex interpersonal childhood abuse and neglect in institutional foster care settings [institutional abuse (IA)] with anger, shame, and the proposed 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) post-traumatic stress disorder (PTSD) symptoms in adult survivors. Method: Adult survivors of IA (N = 220, mean age = 57.95 years) participated in the study and were interviewed using the Childhood Trauma Questionnaire, the International Trauma Questionnaire, the State-Trait Anger Expression Inventory, the Displaced Aggression Questionnaire, and shame-related items. To identify the most central aspects, we used a staged network analysis and centrality analysis approach: (1) on the scale level; (2) on the item/symptom level; and (3) with modularity analysis to find communities within the item-level network. Results: Trait anger, anger rumination, emotional abuse, and PTSD re-experiencing symptoms played the most important roles on a scale level and were then further analyzed on the item/symptom level. The most central symptom on the item level was anger rumination related to meaningful past events. The modularity analysis supported discriminant validity of the included scales. Conclusions: Anger is an important factor in the psychopathological processes following childhood abuse. Anger rumination is closely related to PTSD symptoms; however, anger is not a part of the proposed ICD-11 PTSD in the present study.
背景：在经受童年虐待和忽视之后，愤怒和羞愧明确地与心理病理和适应不良相关联。它们也被认为可以影响系统的维持和恶化，但其中的相互作用还没有被完全理解。 目标：使用网络分析探索成年幸存者在寄养机构（institutional abuse, IA）长期、复杂的人际间童年虐待和忽视与愤怒、羞愧、ICD-11 PTSD症状之间的关联和相互作用。 方法：IA的成年幸存者（N=220，平均年龄57.95岁）参与了本研究，并使用童年创伤问卷、国际创伤问卷、状态-特质-愤怒-表达清单、转向攻击问卷和羞愧有关题目对其进行访谈。为了识别最核心的方面，我们使用了阶段化的网络分析和中心度分析方法：(1)量表水平，(2)题目/症状水平，(3)使用模块性分析在题目水平的网络中寻找社群。 结果：特质愤怒、愤怒反刍、情感虐待和PTSD再体验症状在量表水平有最重要的作用，并对其进行更进一步的题目/症状水平分析。在题目水平最核心的症状是和有意义的过去事件有关的愤怒反刍。模块性分析支持所包含量表的区分效度。 结论：愤怒是童年虐待之后心理病理过程的一个重要因素。愤怒反刍和PTSD症状紧密关联，但在本研究中愤怒没有成为ICD-11 PTSD的一部分。.
Keywords: Anger; ICD-11; PTSD; childhood trauma; institutional abuse; modularity; network analysis; rumination; shame.