Posttraumatic shame and guilt are fraternal concepts with unique characteristics whose origins are rooted in the nature of personal trauma. Posttraumatic shame and guilt can be meaningfully compared across eight psychological dimensions: (1) self-attribution processes; (2) emotional states and capacity for affect regulation; (3) appraisal and interpretation of actions; (4) the impact of states of shame and guilt on personal identity; (5) proneness to posttraumatic stress disorder (PTSD); and (6) dimensions of self structure adversely affected by states of shame and guilt. Posttraumatic shame and guilt have 15 dimensions which are discussed that dynamically interact with each other and deregulate affective states that include anger, fear, sadness, terror, loss, bereavement, and humiliation. Shame is defined as a feeling of humiliation or distress caused by the consciousness of wrong or foolish behavior. In contrast, guilt defined is the fact of having committed an offense or crime, a feeling of having done wrong or failed in an obligation. However, in the human psyche, shame and guilt are Janus-faced partners. Posttraumatic shame and guilt have consequences for proneness to PTSD. Posttraumatic shame and guilt can be coupled with a broad range of affects to form complex states of intrapsychic tension as part of PTSD, depression, anxiety disorder, psychosis, and substance use disorders. Working with the complexities of shame and guilt in the posttraumatic self, both patient and therapist share a common ground of human vulnerability whose management likely determines the quality of outcome. Tables, figure, and references