Metaphorical language and psychopathological symptoms : a case study of trauma victims’ metaphor use

Background
While clinical diagnosis of mental health issues focuses on factual details represented by literal language (e.g., the onset and process of the triggering event and duration of symptom), the relationship between metaphorical language and psychopathological experiences remains an intriguing question. Focusing on psychological trauma triggered by the 2019–2020 Hong Kong social unrest, this study explored the correlations between trauma victims’ quantitative metaphor usage patterns and their experience of specific Acute Stress Disorder (ASD) symptoms.

Methods
Forty-six individuals with trauma exposure within 28 days were recruited through convenience sampling. Each completed a 20– to 30-minute semi-structured interview and filled out the Chinese version of the Stanford Acute Stress Reaction Questionnaire (SASRQ; 1). Metaphors in the interviews were identified using the discourse dynamic approach (2), and clinically interesting categories related to trauma and emotion expression, as revealed by previous literature, were sorted out. Standardized frequencies of the categories were correlated with participants’ SASRQ scores of five major ASD symptoms, and the correlational patterns were interpreted from a discourse analytic perspective.

Results
The study reveals how metaphor usage patterns can reflect the speakers’ differentiated experiences of psychopathological symptoms. Compared with individuals who experienced less trauma, those more disturbed by the re-experiencing symptom were more inclined to use emotion-related metaphors and to metaphorize about the self and the self-society relationship. Individuals who experienced more severe anxiety and hyperarousal showed a heightened awareness of self-related issues and diminished attention to others. Those who suffered from more severe impairment in functioning produced more metaphors in the negative valence. Dissociation and avoidance, which were less experientially salient and intense than the others, were not significantly correlated with metaphor usage patterns.

Conclusion
This study establishes symptom-level metaphor usage patterns as a previously overlooked but interesting avenue in trauma evaluation, treatment, and research. While the study is confined to a single context, it nevertheless reveals the potential for metaphor research findings to be incorporated as useful materials in psychology education and therapist training.