Relationships between self-consistency, trauma-centred identity, and post-traumatic adjustment

Relationships between self-consistency, trauma-centred identity,and post-traumatic adjustmentcp_28 103..111

Heather WEBB and Laura JOBSON

School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, England

Key wordsidentity, post-traumatic stress disorder, self.

CorrespondenceAuthor: Laura Jobson, School of Medicine,

Health Policy and Practice, University of East

Anglia, Norwich, NR4 7TJ, England.

Email: [email protected]

Received 4 February 2011; accepted 16 May

2011.

doi:10.1111/j.1742-9552.2011.00028.x

Abstract

Background: Post-traumatic stress disorder (PTSD) models suggest thattrauma-centred self-change is motivated by self-consistency.Aim: The objective of this study was to investigate the relationships betweenself-consistency, trauma-centred identity, and PTSD symptoms.Method: University students (n = 134) completed measures of trauma-centredidentity (Centrality of Events Scale), self-consistency, and post-traumaticstress symptoms (Impact of Events Scale—Revised, Centre for EpidemiologicalStudies—Depression Scale).Results: A significant positive correlation was found between trauma-centredidentity and post-traumatic symptoms. However, self-consistency was notrelated to post-traumatic symptoms or trauma-centred identity. Given therelationship between depressive symptoms and self-consistency, the correla-tions were also conducted controlling for depression. When the effects ofdepressive symptoms were partialled out, both self-consistency and trauma-centred identity were positively correlated with intrusion symptoms.Discussion and Conclusion: The implications for PTSD models, which suggestself-change is motivated by self-consistency, are discussed and implications forclinical treatments are considered.

An increasing number of recent observations havesuggested a significant connection between alterationin self-concept following trauma and post-traumatic

psychological adjustment. McNally, Lasko, Macklin, andPitman (1995) noted that the self-presentations of someveterans with post-traumatic stress disorder (PTSD) wereintimately connected with memories of themselves asservicemen. Importantly, these veterans had difficulties inretrieving specific autobiographical memories of positiveevents and were more likely to recall personal memoriesof their service experience. Their identity and personalmemories had become trauma-centred. Sutherland andBryant (2006), using a self-defining memory task, foundthat PTSD participants reported themselves as beingmore strongly defined or identified by their trauma thanthose who did not develop PTSD. Further, they found thatretrieval of trauma-related self-defining memories wasstrongly related to reporting trauma-related personalgoals. Byrne, Hyman, and Scott (2001) found, using asample of female undergraduate students who reportedhaving had a traumatic event, that the degree to whichthe trauma memory was rated as important for self-understanding was positively related to the severity ofsymptoms on a PTSD checklist.

Key Points

1. While post-traumatic stress disorder (PTSD) modelssuggest that trauma-centred self-change is moti-vated by self-consistency, the relationships betweenself-consistency, trauma-centred identity and PTSDsymptoms have not been investigated.

2. The study found that when the effects of depres-sive symptoms were partialled out, both self-consistency and trauma-centred identity werepositively correlated with intrusion symptoms.

Funding: Laura Jobson is funded by a Post-Doctoral ResearchFellowship award from the National Institute for HealthResearch.Conflict of interest: None.

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© 2011 The Australian Psychological Society 103

More recently, several studies have examined the rela-tionship between trauma centrality and post-traumaticsymptoms using the Centrality of Events Scale (CES;Berntsen & Rubin, 2006a). The CES measures how centralan identified trauma is to a person’s identity and life story.A series of studies (Berntsen, Willert, & Rubin, 2003;Berntsen & Rubin, 2004, 2006a; Bernstsen & Thomsen,2005; Rubin, Berntsen, & Bohni, 2008; Boelen, 2009;Robinaugh & McNally, 2010) have found that scores onthe CES were significantly positively correlated with PTSDsymptoms, and in particular, intrusive memories. Studiesusing the CES (Berntsen & Rubin, 2006b, 2007) have alsofound that trauma-centred identity significantly predi-cts post-traumatic stress levels. Given the relationshipbetween depression and PTSD, these studies have alsotended to include a measure of depression and havecontrolled for depression in their analyses. They havefound that the CES is independently related to PTSDsymptoms when controlling for depression (e.g., Berntsen& Rubin, 2007; Brown, Antonius, Kramer, Root, & Hirst,2010).

Berntsen and Rubin (2006a, 2007) suggest that self-change occurs because memories of the trauma are highlyaccessible and easily evoked, and hence, the trauma eventbecomes perceived over time as “a major causal agent”(in the life story) and “thus a highly salient turning pointin the person’s life” (2006a, p. 221). Characteristically,turning points are culturally expected transitional eventsthat provide self-definition or change in self-definitionthrough role change (e.g., choice of career, birth of firstchild). The perception of the trauma event as a turningpoint together with the requirement for an “internalconsistency of the life story” (2006a, p. 221) results inthe role of trauma victim or survivor becoming a salientand important component of identity. In a similar way,Conway’s self-system model (Conway & Pleydell-Pearce,2000; Conway, 2005) suggests that incongruence betweenthe trauma event and the existing self-definition or iden-tity motivates change. Conway describes examples wherethe self-system’s response to trauma is to “lower theaccessibility of memories of the events” or “even distort(the) memories” (Conway, 2005, p. 599). Coherence andconsistency are essential to the stability of self and abilityto act effectively in the world by making memory consis-tent with an individual’s current goals, self-images, andself-beliefs, and is related to longer term goals. This modelsuggests that over time self-consistency may need to bemaintained by alteration in the person’s self-construct,leading to the development of a self-identity centred onbeing a victim of trauma or emphasising self-change sincethe event.

In both of these accounts, self-change is motivated byself-consistency (i.e., the degree to which the individual

requires elements within their self-concept to be congru-ent). Some support for the requirement of self-consistencycomes from two studies conducted by Jobson andO’Kearney (2006, 2008). The first study replicated earlierresearch and found that stronger self-definition centredon trauma was positively related to severity of post-traumatic symptoms in an Australian individualistic cul-tural sample. However, this relationship was not evidentin the Asian collectivistic sample. The second study exam-ined the relationship between trauma self-definition andpost-traumatic symptoms in a larger sample of the generalcommunity with and without PTSD. It was found thattrauma survivors with PTSD from Western, individualisticcultures reported more goals, self-defining memories, andself-cognitions that were trauma-related than non-PTSDtrauma survivors from individualistic cultures. In contrast,for those from non-Western, collectivistic cultures, therewas no difference between trauma survivors with andwithout PTSD in terms of trauma-centred goals, self-defining memories, and self-cognitions. These findingswere accounted for by cross-cultural theory (Suh, 2000,2002), and empirical work (Kanagawa, Cross, & Markus,2001) that suggests self-consistency is culturally variable.Suh claims that a coherent self-identity is essential inWestern, individualistic cultures because it creates anefficiency that supports the culturally based focus ofachieving personal goals. Hence, a person needs to inte-grate various components of the self and be consistentacross situations. Information inconsistent with this con-gruent self must go through repair work to align suchinformation with the self. Suh suggests that this is lessrelevant in non-Western, collectivistic cultures wherethere is greater focus on the social context relative topersonal goals. Suh (2002) has also demonstratedvariation in self-consistency within cultures. Therefore,Jobson and O’Kearney (2008) claim that their findingssupport theoretical accounts that self-consistency andself-coherence are instrumental in the move towardstrauma-centred self-definition, which varies across indi-viduals and cultures. Consequently, Jobson’s (2009)threat to conceptual self (TCS) model explicitly statesthat the change of identity following trauma depends onindividual needs for self-consistency.

Although it is suggested that trauma-centred self-change is motivated by self-consistency, this suggestionhas not been explicitly investigated. While the relation-ship between higher self-consistency and trauma-relatedpsychological adjustment has not been examined, socialand personality research have examined the relationshipbetween general psychological adjustment/well-beingand self-consistency. These studies have shown that lowself-consistency is positively related to negative affectand negatively related to positive affect (e.g., Block, 1961;

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Donahue, Robins, Roberts, & John, 1993; Sheldon, Ryan,Rawsthorne, & Ilardi, 1997; Suh, 2000; Cross, Gore, &Morris, 2003). Low levels of self-consistency are associ-ated with depression, anxiety, physical symptoms, stress,and low self-esteem. Cross et al. (2003) state that socialand personality psychologists have long viewed self-consistency as essential for mental health. A relationshipbetween high self-consistency and poor psychologicaladjustment has not been found. Whether or not higherlevels of self-consistency are related to higher levels ofPTSD symptoms, as theoretically predicted by PTSDmodels (e.g., TCS), remains unknown.

This study therefore aims to further previousresearch findings of a positive relationship between thetrauma-centred identity and post-traumatic symptomsby investigating empirically the relationships betweenself-consistency, post-traumatic adjustment, and trauma-centred identity using a sample of British students. It ishypothesised that (1) higher trauma-centred identity willbe associated with poor post-traumatic adjustment; (2)higher self-consistency will be associated with poor post-traumatic adjustment; and (3) higher self-consistencywill be associated with higher trauma-centred identity.If significant relationships are found, the study will alsotest whether self-consistency mediates the relation-ship between trauma-centred identity and post-traumaticadjustment. Additionally, we will follow the methodol-ogy and analyses used in previous research using the CES(e.g., Berntsen & Rubin, 2006a, 2007; Brown et al.,2010), include a measure of depression, and re-run theabove correlations partialling out depression. Thus, thehypotheses will also be tested when controlling fordepression.

Method

Design

This study used a single group cross-sectional correla-tional design.

Participants

All undergraduate and postgraduate students who had agood command of the English language were eligible toparticipate in the study. A student population was chosenbecause significant relationships between trauma-centredidentity and PTSD (e.g., Berntsen & Rubin, 2007), and arange of self-consistency (e.g., Suh, 2000), have previ-ously been found in this population. Furthermore, thisis the first study investigating the relationship betweenthese constructs and thus, a student population is anappropriate population to commence research in this

area. Additionally, a substantial proportion of studentshave experienced trauma (62%) and PTSD symptoms(Twamley, Hami, & Stein, 2004), and previous studiesusing the CES with student samples have generated sig-nificant clinical implications and have been replicated insubsequent clinical samples (e.g., Brown et al., 2010). Onehundred and thirty-four people participated in the study(23.9% male, 74.6% female, and 1.5% did not reportgender). Participants’ ages ranged from 18 to 66 years(M = 30.00 years, standard deviation (SD) = 9.60). Cul-ture was not examined in this study; rather, the aim was torecruit a general British student sample. Within thisBritish sample, 114 participants identified themselvesas white (85.0%), nine as mixed race (7.0%), and nineas Asian/Asian British (7.0%). Participants were notexcluded based on ethnicity because: (1) cultural identitywas not explicitly examined, rather, a general Britishuniversity sample was recruited; and (2) analyses revealedthat those who identified themselves as mixed race orAsian/Asian British did not differ significantly from thosethat identified themselves as white. Forty-four partici-pants were postgraduate students (32.8%), and 88 wereundergraduate students (65.7%) (missing n = 2). Partici-pants were studying within the Faculties of Health(n = 30), Arts and Humanities (n = 42), Social Sciences(n = 29), and Science (n = 23).

Measures

Trauma-centred identity

The CES (Berntsen & Rubin, 2006a) is a self-reportmeasure of how central a distressing event is to a per-son’s identity and life story. Participants are asked tothink back upon the most stressful and traumatic eventin their lives and answer the questions in an honestand sincere way. The CES has 20 items, and each itemis measured on a 5-point Likert scale from 1 (totallydisagree) to 5 (totally agree). The CES has been found tohave high internal consistency (alpha coefficient of .94),and the results of factor analysis have suggested that asingle construct underlies the CES (Berntsen & Rubin,2006a).

Self-consistency

Self-consistency refers to the extent to which personssee themselves consistently across all social contexts/interpersonal relationships. This was measured as in pre-vious research (e.g., Donahue et al., 1993; Suh, 2002;Cross et al., 2003) and has been shown to generate a rangeof scores in a Western student population (Suh, 2002). Toobtain a self-consistency index for each participant, each

Self-consistency, trauma identity, and post-traumatic adjustment


person was asked to rate how accurately 20 personalityattributes (such as tolerant, competitive, formal, i.e., non-trauma-related traits) described his or her “general self”on a scale ranging from 1 (not at all like myself) to 7 (verymuch like myself). Following the procedure outlined by Suh(2002), participants were then asked to complete theother study questionnaires. Then, participants completedthe remaining sections of the self-consistency indexquestionnaire by rating themselves again on these same20 personality traits but in four different interpersonalrelationships (self with partner, self with parent, selfwith friend, and self with stranger). The order in whicheach attribute ¥ interpersonal relationship was presen-ted was randomised. Specifically, a set of random num-bers was created and assigned to the20 attributes ineach interpersonal relationship. By then placing theassigned random numbers in number order, theattribute ¥ situation items became randomly ordered.The resulting order of items was the same for each partici-pant. For each participant, the self-consistency index wasobtained by calculating the overall consistency of the fiveself-views. This was calculated by adopting a methodoriginally developed by Block (1961) but also used byDonahue, Robins, Roberts, and John (1993) and Suh(2002). Each person’s 100 ratings were convertedinto a 20 ¥ 5 matrix (20 traits in five interpersonalcontexts—parent, partner, stranger, friend, and thegeneral self). Each personal matrix was then factoranalysed, i.e., principle components factors were obtainedusing a within-subjects factor analysis. The percentagevariance accounted for by the first factor constituted theSelf-Consistency Index, with higher values indicatinghigher consistency of self-view. Those with higher self-consistency index scores viewed themselves more consis-tently across contexts than those with lower scores whoviewed themselves less consistently across interpersonalcontexts. The self-consistency index has been shownto correlate with theoretically and logically expectedvariables (Suh, 2002).

PTSD symptoms

The Impact of Events Scale—Revised (IES-R; Weiss &Marmar, 1997) was used to measure PTSD sympt-oms because of its reliability and validity in student/community populations. The IES-R is a self-report ques-tionnaire that assesses levels of trauma symptomatologyon three scales—avoidance, intrusions, and hyperarousalon Likert ratings of 0 to 4. Total recorded score rangesfrom 0 to 88. Participants were asked to consider thesesymptoms in relation to the stressful and traumatic eventthey had been thinking about when responding to itemson the CES. The IES-R has been found to be a reliable

screen for PTSD symptoms (Sundin & Mardi, 2002) andto have high internal consistency (Creamer, Bell, & Failla,2003).

Depressive symptoms

The Centre for Epidemiological Studies—DepressionScale (CES-D; Radloff, 1977) was included. Based onevidence to suggest that depression might be a confound-ing factor in the relationship between self-consistencyand PTSD symptoms (e.g., Suh, 2000), depression wasmeasured and controlled for in the analysis. The CES-Dhas been found to be reliable and valid in community andstudent samples, and is used routinely in research. TheCES-D consists of 20 items on a 4-point scale (0 to 3)based on the amount of time in the previous week inwhich symptoms have been experienced (<1 day to 5–7days). Scores range from 0 to 60. CES-D has been foundto have excellent concurrent validity. The sensitivity andspecificity of the CES-D compare favourably with theBeck Depression Inventory (Beck, Ward, Mendelson,Mock & Erbaugh, 1961). Radloff (1991) found that inter-nal consistency was high (a = 0.87) in college students.

Demographics

Participants were asked to disclose their age, gender,ethnicity, and educational details.

Procedure

Recruitment methods used included advertisements inthe university student newspaper, advertisements onlibrary computers, emails to schools, and leaflets acrossdepartments and outlets in the university campus. Therewere three main ways of participating in the study. Thosecontacting the researcher were given the choice of eithercompleting the study with the researcher at a designatedplace on the university campus, by post, or online. Allparticipants were provided with an information sheet(either on paper or online) and were asked to readthis information before providing consent. Participantscompleted the measures in the following order—self-consistency index part one, CES, IES-R, CES-D, self-consistency index part two, and the demographic sheet.All participants were asked to complete the questionnairein one sitting and in the order presented. The study tookapproximately 30 min to complete. Participants wereentered into a prize draw for an iPod. Of the 72 peoplewho contacted the researcher, 30 completed the study(41.70%). Of the 164 people who started the internetversion of the study, 104 people finished the study(63.00%).

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Results

Preliminary Analysis

First, analyses found no significant differences betweenthose who completed the study online (n = 104), bypost (n = 15), or with the researcher (n = 15) in relationto levels of self-consistency, F (2,131) = .99, p = .37, post-traumatic symptoms, F (2,131) = 2.76, p = .07, or levelsof trauma-centred identity, F (2,131) = .50, p = .61.Therefore, the group was analysed as a whole. Second,descriptive statistics showed that the CES was signifi-cantly negatively skewed, and CES-Depression wassignificantly positively skewed. However, both achieveda normal distribution following transformation; CESsquare root transformation achieved a normally skeweddistribution, skew = .08, SE = .21, n.s., while CES-Dsquare root transformation of scores achieved a normallyskewed distribution, skew = .18, SE = .21, ns. The IES-Rand its subscales were also significantly positivelyskewed; however, a normal distribution was not achievedeven after transformation. Therefore, non-parametricSpearman’s rho correlation coefficients will be used whenincluding the IES-R. Table 1 shows the means andstandard deviations for each measure.

Correlations

Table 2 shows the findings from the correlation analyses.Given the hypotheses, one-tailed tests were used. First,as hypothesised, a significant positive correlation wasfound between trauma-centred identity and total post-traumatic symptoms. Positive correlations were alsofound between trauma-centred identity and intrusion,avoidance, and hyperarousal symptoms. Second, unex-pectedly no significant positive relationships were found

between self-consistency and post-traumatic symptoms.Third, contrary to the hypothesis, no significant positivecorrelation was found between self-consistency andtrauma-centred identity. Given that no correlation wasfound between self-consistency and trauma-identity orPTSD symptoms, following Baron and Kenny’s (1986)reasoning, a mediation analysis could not be conducted.When both self-consistency and CES were entered into aregression, only CES predicted PTSD symptoms (b = .32,SE = 1.48, t (133) = 3.93, p < .001). Self-consistencydid not predict PTSD symptoms (b = -0.12, SE = .14,t (133) = 1.46, p = .15).

Partialling the Effects of Depressive Symptoms

It was found that depressive symptoms were negativelycorrelated with self-consistency, r = -0.35, p < .001, two-tailed, and positively correlated with CES, r = .32,p < .001, two-tailed. Depression was also found to corre-late with PTSD symptoms, rho = .67, p < .001, two-tailed.While depressive symptoms form part of the post-traumatic response (e.g., Miller & Chapman, 2001), low

Table 1 Mean, standard deviations, and range for the Impact of Events

Scale—Revised (IES-R), Centrality of Events Scale (CES), self-consistency

index, and Centre for Epidemiological Studies (CES)—Depression

Measure Mean Standard deviation Range

IES-R 27.69 19.27 0–78

Hyperarousal 5.43 5.80 0–23

Avoidance 11.66 7.93 0–32

Intrusion 10.60 7.69 0–30

CES 69.67 16.89 32–98

Self-consistency index 57.13% 11.22 30.10–86.70%

CES-Depression 19.96 12.96 0–57

Table 2 Bivariate and partial correlations (one-tailed) between trauma-centred identity scores, self-consistency scores, and post-traumatic symptom

scores (n = 134)

Trauma-centred identity Self-consistency index

Bivariate correlations

Self-consistency index r = -.03, p = .36 —

Total IES-R rho = .32, p < .01 rho = -.13, p = .94

Avoidance rho = .19, p = .02 rho = -.07, p = .78

Intrusion rho = .40, p < .001 rho = -.10, p = .88

Hyperarousal rho = .32, p < .001 rho = -.23, p >.99

Partial correlations when controlling for depression

Self-consistency index r = .09, p = .16 —

Total PTSD symptoms rho = .22, p = .01 rho = .14, p = .08

Avoidance rho = .06, p = .26 rho = .13, p = .10

Intrusion rho = .28, p < .01 rho = .17, p = .04

Hyperarousal rho = .10, p = .17 rho = .04, p = .37

IES-R, Impact of Events Scale—Revised; PTSD, post-traumatic stress disorder.



levels of self-consistency have been found to be associ-ated with depression. Furthermore, previous researchusing the CES has controlled for depression (e.g., Bernt-sen & Rubin, 2007; Brown et al., 2010). Therefore,partial correlations were used to control for the con-founding effects of depressive symptoms. When depres-sion was controlled for, self-consistency and trauma-centred identity were still not correlated. The correlationbetween total PTSD symptoms and self-consistency wasapproaching significance, and the total PTSD symptomswere positively correlated with trauma identity. It wasalso found that when depression was controlled for,intrusion symptoms were positively correlated withtrauma identity and self-consistency.

To examine the unique contribution of self-consistencyand trauma-centred identity in the explanation of totalPTSD symptoms and intrusion symptoms, two hierarchi-cal multiple regression analyses were performed. In step 1,depression was entered. In step 2, self-consistency andtrauma-centred identity were entered into the step 1equation. When examining total PTSD symptoms, theresults of step 1 indicated that the variance accounted for(R

2) equalled .46 (adjusted R2 = .46), which was signifi-

cant, F (1, 132) = 113.49, p < .001. Depression was obvi-ously a significant predictor, b = .68, SE = .81, p < .001. Instep 2, the change in variance accounted for (DR2) wasequal to .02, which was not significant, F (2, 130) = 2.36,p = .10. The overall model was significant, R2 = .47,F (3, 130) = 38.29, p < .001. However, only depressioncontributed significantly to the explanation of PTSDsymptoms, b = .68, SE = .90, t = 9.23, p < .001 (CES, b =.10, SE = 1.22, t (133) = 1.45, p = .15; self-consistency,b = .10, SE = .12, t (133) = 1.48, p = .14). In the secondregression, when examining intrusion symptoms, theresults of step 1 indicated that the variance accountedfor (R2) equalled .44 (adjusted R2 = .43), which was sig-nificant, F (1, 132) = 102.39, p < .001. Depression was asignificant predictor, b = .66, SE = .04, p < .001. In step 2,the change in variance accounted for (DR2) was equal to.04, which was significant, F (2, 130) = 5.14, p < .01. Themodel was significant, R2 = .48, F (3, 130) = 39.69,p < .001. Both depression (b = .64, SE = .04, t = 8.84,p < .001) and trauma identity (CES, b = .18, SE = .49,t (133) = 2.67, p < .01) contributed significantly to theexplanation of intrusion symptoms (self-consistency,b = .10, SE = .05, t (133) = 1.52, p = .13).

Discussion

Previous research has identified that trauma-centredidentity is related to poor post-traumatic psychologicaladjustment. Models of PTSD suggest that self-change(where identity and the life story become centred on

trauma) is motivated by self-consistency and is associatedwith PTSD symptoms. In the current study, therefore,it was hypothesised that (1) trauma-centred identitywould be associated with poor post-traumatic adjust-ment; (2) self-consistency and poor post-traumaticadjustment would be associated; and (3) self-consistencyand trauma-centred identity would be associated. Sup-porting previous studies it was found that those withhigher scores on trauma-centred identity had higherscores on post-traumatic symptomatology. Second, unex-pectedly no significant positive relationships were foundbetween self-consistency and post-traumatic symptoms.Third, while theories and models of PTSD suggest thatself-consistency and trauma-centred identity may berelated, no significant positive correlation was foundbetween self-consistency and trauma-centred identity.Finally, only trauma-centred identity was found topredict PTSD symptoms.

Given that low scores on self-consistency were relatedto high scores on depressive symptoms, and research hasfound low levels of self-consistency to be related tohigh levels of depressive symptoms, the above findingsmay have been confounded by the effects of depressivesymptoms. Therefore, it was decided to control fordepressive symptoms as in previous studies using theCES (e.g., Brown et al., 2010). It was found that whendepression was controlled for, self-consistency andtrauma-centred identity were still not correlated. Therelationship between total PTSD symptoms and self-consistency was approaching significance, and total PTSDsymptoms and trauma-centred identity were positivelycorrelated. When the effects of depressive symptomswere partialled out, intrusion symptoms were signifi-cantly positively correlated with both trauma-centredidentity and self-consistency.

PTSD models suggest that self-consistency and coher-ence are instrumental in the move towards trauma-themed self-definition (e.g., Conway, 2005; Berntsen &Rubin, 2006a, 2007; Jobson, 2009). The findings of thecurrent study support the theory that where trauma ismore central to the person’s identity, the person is alsomore likely to suffer from higher levels of PTSD symp-toms, and in particular intrusive memories. Contrary tothe suggestion that self-consistency motivates self-change, the relationship between self-consistency andpost-traumatic symptoms was non-significant. However,when depression was controlled for, support for thishypothesis was found. The relationship between totalPTSD symptoms and self-consistency was approachingsignificance, and high levels of self-consistency werepositively related to intrusion symptoms. It is importantto note that the correlation effect size was small. Never-theless, it provides some preliminary support for this

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relationship, contrary to research suggesting that lowlevels of self-consistency are associated with poor psycho-logical adjustment. Therefore, PTSD may have a uniquerelationship with self-consistency compared with otherdisorders, such as anxiety and depression. It is possiblethat the more consistent the self, the more likely traumais to destabilise and de-anchor the self and have an influ-ence across most social interactions, resulting in threatto the self and PTSD symptoms (Ehlers & Clark, 2000;Jobson, 2009). Third, while theories and models ofPTSD suggest that self-consistency and trauma-centredidentity may be related, the study did not find supportfor this theoretical suggestion. This may suggestthat self-consistency and trauma-related identity bothindependently influence PTSD symptoms. It also may bethe result of the non-clinical sample that precludeddetecting this finding.

Results indicate that stronger trauma-centred identityis associated with higher levels of PTSD suggesting thatelaboration of the trauma memory may run the risk ofover-accommodating self-schema to the traumatic event.In turn, accessibility of the trauma memory is increased,resulting in PTSD symptoms (Rubin et al., 2008). Over-accommodation of self-schema to the trauma memorymay lead to concerns about safety or harsh self-judgments, which make the world seem overly threaten-ing and thus, result in poor psychological adjustment(Ehlers & Clark, 2000; Resick, 2001; Rubin et al., 2008).Findings therefore support the need to avert/convertover-accommodation of existing schema to the traumamemory and thus, the treatment of PTSD needs to focuson accommodation of the traumatic event with moregeneral self-schemas without over-accommodation(Resick & Schnicke, 1992, 1993). It supports cognitivetherapies that aim to identify whether the trauma con-firmed maladaptive beliefs about the self held prior to thetrauma and to what extent these beliefs over-generalisedin a way that maintains post-traumatic symptoms. Thestudy also found preliminary support for self-consistencybeing related to PTSD symptoms, and in particular, intru-sion symptoms. Therefore, in those for whom self-consistency is important, the traumatic event mightconfirm beliefs in one’s inconsistency or shatter previ-ously held beliefs about high self-consistency. Eitheroutcome may lead to intrusions due to the relevance ofself-consistency to identity. Therefore, in treatment, itmay be appropriate to modify extreme beliefs in theneed for self-consistency through, for example, challeng-ing self-statements, and/or by emphasising the waysand levels at which a person is still self-consistent.However, it is important to note that there was alsostrong evidence suggesting that low self-consistency isassociated with higher levels of depression, which is

commonly co-morbid with PTSD. Therefore, it is as yetunknown whether different forms of self-consistencymay represent risk or resilience factors in the develop-ment of PTSD. Thus, further research in this area isrequired to inform assessment and intervention.

It is acknowledged that there are several limitations tothe current study. First, the correlational design meansthat causality cannot be inferred. Second, the universitysample may limit generalisability of findings. However,trauma-centred identity has been found to be related toPTSD symptoms regardless of the type of event or par-ticular emotions related to the event, and in university,non-clinical samples (e.g., Berntsen & Rubin, 2007).Additionally, the sample was largely self-selected, so it ispossible that those with higher levels of post-traumaticsymptoms did not volunteer to participate in the study.The non-clinical sample is also likely to have diminishedthe number of participants with higher levels of post-traumatic symptoms, and thus, possibly the study’sability to detect a relationship with self-consistency. Thestudent sample may also mean that the number of pre-vious traumas, the type of previous traumas, and moredifficult life experiences were less represented than acommunity or clinical sample. The study would havebenefited from including a measure of trauma history.The student sample may have limited those with thehighest levels of self-consistency as resourcefulness andflexibility are required for student life. Third, while thetrauma identity construct has been related to explicitmemory (e.g., Rubin et al., 2008), it is possible that self-consistency also operates at the implicit level of memory.Fourth, there were a number of identified biases withinthe sample that might have influenced the level ofself-consistency. For example, there were higher levelsof depressive symptoms in this sample than previousstudent samples using the CES-D. Post-traumatic symp-toms using IES-R were substantially lower in this samplethan a previous community sample. Finally, in relation tothe measures, although the self-consistency index hasbeen used in previous research, the validity of themeasure may have been limited in terms of the relativerelevance of traits to describe each particular person.Furthermore, self-consistency has been found to berelated to personality factors (Suh, 2002), and personalityfactors have been found to be related to trauma adjust-ment (e.g., Chung, Berger, & Rudd, 2007). Futureresearch should also consider including traits specificallyrelated to trauma.

Despite these limitations, in line with previousresearch, a relationship between trauma-centred identityand PTSD symptoms was found, providing support formodels of PTSD which suggest that trauma memory canbecome central to identity. The proposed relationship



between high self-consistency and high PTSD symptomswas only suggested in relation to intrusion symptomswhen depressive symptoms were controlled. This findingdiffers from previous research that has indicated low self-consistency is related to poor psychological adjustment,such as anxiety and depression, and suggests self-consistency may have a unique relationship with PTSD;trauma may influence the stable, consistent self, whichresults in threat to self and thus, PTSD symptoms (Ehlers& Clark, 2000; Jobson, 2009). This study aimed toexamine the role of self-consistency in the relationshipbetween trauma-centred identity and PTSD symptoms.Based on theories of PTSD and theories of self, it wassuggested that self-consistency may be associated withtrauma-centred identity. This was not found. Based onthe theoretical and clinical implications discussed above,it is clear that future studies are required to examinethese links further.

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Relationships between self-consistency, trauma-centred identity, and post-traumatic adjustment

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