Shame, trauma and addiction are closely associated with chronic vulnerability and this chapter explores the nature of these conditions and the factors that are known to precipitate them. The chapter starts by showing how the origins of shame often lie in childhood abuse and parenting that is harsh and critical, and then describes how children with a low tolerance for stress are dispositionally vulnerable to the effect of shaming and maltreatment.

Attention is then drawn to the insidious effects of shame and the text explains why shame, unlike guilt, does not have a reparative function. Taking this further, it argues that the use of shaming to change behaviour is counterproductive and it describes how shame can variously lead to emotional paralysis or risky behaviours that are driven by unresolved humiliation and rage or coping mechanisms, such as social masking that can drive unhealthy perfectionism.

The content then moves to define and explain trauma and looks at how post-traumatic stress disorder is classified in diagnostic systems. The central ways in which trauma is manifest are detailed and the text explains how the primary trauma event has been shown to differentially affect neural activity in the left and right brain hemispheres. Following this, it describes how vicarious trauma staff can develop in staff, who are continually exposed to others’ trauma and distress. The chapter concludes by examining addiction. It details the shared biological processes that underpin chemical and behavioural addiction, and looks at the key psychological features of addiction. The text then highlights the influence of hereditary factors in addiction, but also the important influence of stress and trauma with particular regard to the higher-than-average rates of addiction that are found in people who have been bereaved and the higher rates in that are found in adults exposed to child trauma and young people diagnosed with autistic spectrum disorder and attention deficit hyperactivity disorder (ADHD).