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Somatic Complaints and Attachment in Former Prisoners of War: A Longitudinal Study
Abstract
Objective:
War captivity includes a unique constellation of simultaneous somatic and interpersonal assaults. This raises questions about the link between attachment and somatic complaints among ex-prisoners of war (ex-POWs). Although the attachment literature assumes that attachment affects somatic complaints and not vice versa, to date no empirical studies assess the association between the two variables over time. In this article we prospectively examine the association between attachment and somatic complaints over time among ex-POWs and comparable veterans.
Method:
The current study included two groups of male Israeli veterans of the 1973 Yom Kippur War: ex-POWs and comparable veterans who were not taken captive. Both groups were assessed via self-report measures at three times: T1 (1991), T2 (2003), and T3 (2008)-18, 30, and 35 years after the war, respectively.
Results:
Ex-POWs reported higher levels of somatic complaints and attachment insecurities. These levels increased over time compared to combatant veterans. Moreover, while there was a unidirectional influence of somatic complaints on attachment security over time among combatant veterans, this relationship was bidirectional among ex-POWs.
Conclusions:
The present study suggests that the combined physical and interpersonal assaults experienced during captivity have adverse effects on combatants and on attachment security, even three decades later. More important, in ex-POWs the relationship between these domains appears to be interactive and mutual, with one reinforcing the other, and vice versa.
... Initially, these distortions may result from the need to ignore or detach from inner physical experiences, such as severe pain, in order to survive (Herman, 1992). Later, particularly among those who develop posttraumatic stress disorder (PTSD), even normal day-today physical sensations may act as trauma reminders (Lahav et al., 2015), resembling and sometimes reactivating the traumatic experience (Rothschield, 2003). Among ex-POWs who experienced torture, somatic symptoms may be perceived as agonising and torturing (Tsur, Shahar, Defrin, Lahav, & Ginzburg, 2017). ...
... Indeed, findings have demonstrated that ex-POWs experience their body differently than others, to a certain extent. For example ex-POWs have been shown to report more somatic complains (Lahav et al., 2015;Sutker, Winstead, Goist, Malow, & Allain, 1986), alterations in pain perception (Defrin, Ginzburg, Mikulincer, & Solomon, 2014), and espouse a catastrophic orientation towards bodily signals (L opez-Mart ınez, Ram ırez-Maestre, & Esteve, 2014; Viana et al., 2016). Altogether these findings suggest that trauma in general, and in our case, war captivity, is implicated in alterations to subjective as well as objective somatic manifestations. ...
... On the other hand, it is also possible that the unique impact of trauma on the subjective experience of the body rather contributes to the ability to locate bodily signals and processes. More specifically, the heightened experience of somatic symptoms among traumatised individuals (Lahav et al., 2015;Sutker et al., 1986) may reflect a higher preoccupation with the body, which preserves or increases the ability to accurately evaluate health. Findings in support of this explanation demonstrated that anxiety is implicated in a tendency to monitor the body (Ginzburg, Tsur, Barak-Nahum, & Defrin, 2014), increase body vigilance (Schmidt, Lerew, & Trakowski, 1997) and higher interoceptive accuracy (Pollatos, Traut-Mattausch, & Schandry, 2009). ...
Objective:
Ill-health and early mortality are amongst the most significant ramifications of trauma. Furthermore, trauma alters the subjective perception and experience of the body. The aim of this study is to examine the extent to which deteriorations in perceived health among traumatised individuals are associated with cellular health as manifested in telomere length.
Methods:
Specifically, 88 former prisoners of war (ex-POWs) evaluated their health (self-rated health; SRH) at 18 (T1), 35 (T2) and 42 (T3) years after the war, and were assessed for telomere length at T3. Health behaviour, BMI, morbidity and PTSD were also examined at T3.
Results:
The findings demonstrated that SRH was cross-sectionally correlated with telomere length. Furthermore, a significant sequential indirect effect was found, in which worse SRH in T1 was associated with shorter telomere length at T3, through worse SRH at T2 and at T3.
Conclusions:
These findings demonstrate that long-term deteriorations in the subjective evaluations of health are implicated in actual cellular health among individuals exposed to trauma.
... While examinations of the association between exposure to trauma and orientation to bodily signals are scarce, research has shown that emotional and physical abuse during childhood is associated with a more catastrophic orientation to bodily signals (e.g., Pieritz et al., 2015). Furthermore, some studies have pointed to an altered perception of somatic experiences among ex-POWs, such as frequent reports of somatic symptoms (Sutker et al., 1986;Lahav et al., 2015), and poorer self-rated health (Benyamini et al., 2009). Although reports of somatic symptoms (or somatization) may be related to orientation to bodily signals (Vervoort et al., 2005;Tsao et al., 2009), to our knowledge, orientation towards bodily signals among ex-POWs has not been previously examined. ...
... Thus, it is possible that this 'wear and tear,' manifested in hyperarousal symptoms and allostatic load, leads to more frequent experiences of physical symptoms, which, over time, alters the way these symptoms are perceived and experienced by individuals, i.e., orientation to bodily signals. Furthermore, and especially when the traumatic event involves substantial physical suffering, such as in war captivity, somatic signals may act as trauma reminders (Lahav et al., 2015), leading to the sense that the traumatic experience is reoccurring ( Van der Kolk, 1994). This phenomenon can be explained by classical conditioning theory (Pavlov, 2010), according to which, as a result of repeated aversive stimulation, future stimuli that resonate with a past experience may elicit the original reaction. ...
... The current findings also demonstrated that symptoms of intrusion mediated the indirect association between captivity and catastrophizing orientation. As expressed earlier, somatic signals, especially among individuals who were subjected to physical suffering, may act as trauma reminders, triggering a re-experiencing of the past trauma (Van der Kolk, 1994;Lahav et al., 2015). Thus, it is possible that intrusion symptoms may reinforce the activation of trauma related fear, and by this activate hyperarousal symptoms. ...
Orientation to bodily signals is defined as the way somatic sensations are attended, perceived and interpreted. Research suggests that trauma exposure, particularly the pathological reaction to trauma (i.e., PTSD), is associated with catastrophic and frightful orientation to bodily signals. However, little is known regarding the long-term ramifications of trauma exposure and PTSD for orientation to bodily signals. Less is known regarding which PTSD symptom cluster manifests in the 'somatic route' through which orientation to bodily signals is altered. The current study examined the long-term implications of trauma and PTSD trajectories on orientation to bodily signals. Fifty-nine ex-prisoners of war (ex-POWs) and 44 controls were assessed for PTSD along three time-points (18, 30 and 35 years post-war). Orientation to bodily signals (pain catastrophizing and anxiety sensitivity-physical concerns) was assessed at T3. Participants with a chronic PTSD trajectory had higher pain catastrophizing compared to participants with no PTSD. PTSD symptom severity at T2 and T3 mediated the association between captivity and orientation. Among PTSD symptom clusters, hyperarousal at two time-points and intrusion at three time-point mediated the association between captivity and orientation. These findings allude to the cardinal role of long-term PTSD in the subjective experience of the body following trauma.
... War captivity is one of the most traumatic experiences known to man, as it exposes victims to extensive physical and psychological abuse inflicted by their captors (e.g., [2]). Although some former prisoners-of-war (ex-POWs) exhibit positive adjustment [3], they remain at a high-risk for physical (e.g., [4]) and psychological [5,6] impediments decades thereafter. Many ex-POWs exhibit high rates of morbidity and mortality [7][8][9], and report worse perceived health (e.g., [4,10,11]). ...
... Although some former prisoners-of-war (ex-POWs) exhibit positive adjustment [3], they remain at a high-risk for physical (e.g., [4]) and psychological [5,6] impediments decades thereafter. Many ex-POWs exhibit high rates of morbidity and mortality [7][8][9], and report worse perceived health (e.g., [4,10,11]). Psychiatric symptoms are common among ex-POWs, most notably posttraumatic stress symptoms (PTSS), including intrusion (e.g., flashbacks), avoidance (e.g., numbness), hyper-arousal (e.g., alertness) and negative alterations in cognitions and mood (e.g., negative world-views) [12]. ...
... Bootstrapping method analyses yielded several interesting findings (Table 3; Figs. [2][3][4]. Fusion-with-others fully mediated the relations between indirect captivity exposure and the indicators of health problems and self-rated health. Indirect exposure to captivity predicted increased fusion-with-others and PTSS, which in turn were associated with more health problems. ...
... Studies that utilized objective measures indicated that combat exposure and posttraumatic distress are associated with detrimental effects on physical health (e.g., El-Gabalawy, Blaney, Tsai, Sumner, & Pietrzak, 2018;Nichter, Norman, Haller, & Pietrzak, 2019) and premature aging (Bersani et al., 2016). Furthermore, research revealed that aging veterans appraise their age and health in a negative fashion; when compared to similar demographic groups, veterans report relatively older subjective age and poorer perceived health (Ahmadian, Neylan, Metzler, & Cohen, 2019;Avidor, Benyamini, & Solomon, 2014;Lahav, Rodin, & Solomon, 2015). Though subjective age and perceived health rely on individuals' evaluations, and thus might differ from objective indicators of health (Schnurr & Green, 2004), research revealed that these appraisals are predictors of detriments in mental and physical health and wellbeing (Spuling, Miche, Wurm, & Wahl, 2013;Westerhof et al., 2014). ...
... A similar trend has been documented concerning veterans' perceived health, which refers to perceptions regarding one's own physical health (Schnurr & Green, 2004;Schnurr, Green, & Kaltman, 2007). Research indicates that veterans and particularly those with PTSD or depressive symptoms reported more somatic complaints (Bourn, Sexton, Raggio, Porter, & Rauch, 2016;Lahav et al., 2015;Sikharulidze et al., 2017) and negative health-related appraisals (Aversa et al., 2012;Kramarow & Pastor, 2012;Tsur, Stein, Levin, Siegel, & Solomon, 2019) compared to control groups. Although conducted among samples comprised of relatively young participants, a study among veterans who served in Iraq and Afghanistan revealed that PTSD severity was related to an increased likelihood of rating one's health as poor or fair as well as reporting that one's physical health limits participation in various daily activities (Schry et al., 2015). ...
Rationale:
Aging veterans often suffer from increased vulnerability, manifested among other things in old subjective age and poor perceived health. Though research has documented the contribution of trauma related variables to these negative appraisals, their associations with impostorism (i.e., the subjective experience that one is less adequate than others perceive) remain unexamined.
Objective:
Filling this gap, this study explored the relations between impostorism and subjective age and perceived health among aging combat veterans.
Method:
The study was conducted among 146 Israeli veterans of the 1973 Yom Kippur War. Participants were assessed for combat exposure, Posttraumatic Stress Disorder (PTSD) symptoms, and health-related behaviors during middle adulthood (1991; T1), and for subjective age, perceived health, impostorism, PTSD symptoms, and depressive symptoms during old age (2018; T2).
Results:
The veterans' impostorism was associated with relatively old subjective age and poor perceived health, above and beyond the effects of age, health-related behaviors, combat exposure, depressive symptoms, and PTSD symptoms.
Conclusions:
The current results suggest that impostorism may contribute to veterans' stress and negatively affect their evaluations regarding age and health.
... They note numerous medical disorders aid-workers experienced while undertaking their humanitarian work, in addition to complaints of physical pain and general fatigue (Costa et al., 2015). Researchers found associations between survivors' trauma, poor health and somatization, specified in local pain, or unspecified it terms of unexplained medical symptoms (Lahav, Rodin, & Solomon, 2015;Lahav, Stein, & Solomon, 2016). STS symptoms were associated with somatization symptoms among spouses of veterans whom suffered from PTSD in Iran (Kianpoor, Rahmanian, Mojahed, & Amouchie, 2017). ...
Background: Organizations assisting refugees are over burdened with the Syrian humanitarian catastrophe and encounter diverse difficulties facing the consequences of this massive displacement. Aid-workers experience the horrors of war through their efforts to alleviate suffering of Syrian refugees.
Objective: This study of Syrian refugee aid-workers in Jordan examined work-stressors identified as secondary traumatic stress (STS), number of refugees assisted, worker feelings towards the organization, and their associations to PTSD-symptoms, wellbeing and intimacy. It also examined whether self-differentiation, physical health, and physical pain were associated with these variables.
Method: Syrian refugee aid-workers (N = 317) in Jordan’s NGOs were surveyed. Univariate statistics and structural equation modeling (SEM) were utilized to test study hypotheses.
Results: Increased STS was associated with lower self-differentiation, decreased physical health and increased physical pain, as well as elevated PTSD-symptoms and decreased intimacy. Decreased connection to the NGO was associated with lower self-differentiation, decreased physical health, increased physical pain, and with decreased intimacy and wellbeing. Lower self-differentiation was associated with increased PTSD-symptoms, decreased wellbeing and intimacy. Elevated physical pain was associated with increased PTSD-symptoms, and decreased wellbeing. Diverse mediation effects of physical health, physical pain and self-differentiation were found among the study’s variables.
Conclusions: Aid-workers who assist refugees were at risk of physical and mental sequelae as well as suffering from degraded self-differentiation, intimacy and wellbeing. Organizations need to develop prevention policies and tailor interventions to better support their aid-workers while operating in such stressful fieldwork.
... Furthermore, research has indicated that trauma and PTSD may also be implicated in the subjective experience of the body (Rothschild, 2003;Van der Kolk, 2014). Specifically, traumatized individuals have been found to experience and report more somatic complaints (i.e., somatization; Kimerling et al., 2000;Krause et al., 2004;Lahav et al., 2015). Individuals who experienced trauma were also found to perceive and evaluate their health as poorer, reflecting poorer self-rated health (Benyamini et al., 2009;Krause et al., 2004;Zinzow et al., 2011). ...
Rationale:
Poor subjective physical health and loneliness are among the most detrimental ramifications of trauma. Indeed, substantial research has examined the link between subjective physical health and loneliness, mainly focusing on how loneliness leads to poorer physical health. However, the effects of poor subjective physical health on loneliness, as well as the reciprocal effects of these two factors, have scarcely been examined. Even less is known regarding the course of these mutual effects among individuals who have been exposed to trauma.
Objective:
The current investigation examines the reciprocal effects of subjective physical health and loneliness among a group of war veterans over four decades.
Methods:
Two-hundred and seventy-four Israeli veterans from the 1973 Yom- Kippur War reported self-rated health (SRH), somatization and loneliness at 1991 (T1), 2003 (T2), 2008 (T3) and 2015 (T4). An autoregressive cross-lagged (ARCL) modeling strategy was employed to test the bidirectional relationship between subjective health and loneliness.
Results:
The results showed that from T1 to T2, loneliness predicted subjective physical health. However, from T2 to T3, and from T3 to T4, subjective physical health predicted loneliness. PTSD moderated the association between loneliness and subjective physical health.
Conclusion:
The findings show a novel pattern of influences, demonstrating that the reciprocal effects of subjective physical health and loneliness change over time. The findings imply that subjective health and interpersonal experiences are inherently connected.
... Indeed, in its detrimental physical and psychological ramifications (e.g. Lahav, Rodin, & Solomon, 2015), which are known to progress into a deterioration of self and other representations (Mikulincer, Solomon, Shaver, & Ein-Dor, 2014) and interpersonal relationship problems (Levin, Bachem, & Solomon, 2017), captivity may give birth to complex reactions after repatriation. It is therefore surprising to acknowledge the sparse literature regarding CPTSD among ex-POWs. ...
Background: The World Health Organization(WHO) International Classification of Diseases, 11th version (ICD-11), has proposed a new trauma-related diagnosis of complex posttraumatic stress disorder (CPTSD), separate and distinct from posttraumatic stress disorder (PTSD). However, to date, no study has examined CPTSD over time.
Objectives: This prospective study aimed to examine predictors and outcomes of latent classes of PTSD and CPTSD following war captivity.
Method: A sample of 183 Israeli former prisoners of the 1973 Yom Kippur War (ex-POWs) participated in a 24-year longitudinal study with three waves of measurements (T1: 1991, T2: 2008, and T3: 2015). Participants completed validated self-report measures, and their cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA).
Results: Estimated rates of PTSD and CPTSD were high at all waves, with PTSD rates higher than CPTSD. A Latent Class Analysis (LCA) identified three main classes at T2: (1) a small class with low probability to meet PTSD and CPTSD clusters criteria (15.26%); (2) a class high only in PTSD symptoms (42.37%) and (3) a class high only in CPTSD symptoms (42.37%). Importantly, higher levels of psychological suffering in captivity at T1 were associated with higher odds of being in the CPTSD class at T2. In addition, CPTSD at T2 was more strongly associated with low self-rated health, functional impairment, and cognitive performance at T3, compared to the PTSD only class.
Conclusions: Adulthood prolonged trauma of severe interpersonal intensity such as war captivity is related to CPTSD, years after the end of the war. Exposure to psychological suffering in captivity is a risk factor for future endorsement of CPTSD symptoms. CPTSD among ex-POWs is a marker for future dire mental health and functional consequences.
... It has been suggested that PTSD denotes the implicit memory of traumatic experiences (Rothschield, 2003). Somatic manifestation of PTSD, or the "somatic memory" of trauma, may correspond with the traumatic experience, or act as a trauma reminder (Lahav et al., 2015), thus leading to distrust in one's own somatic experience (Van der Kolk, 1994;Van Der Kolk, 2014). Thereby, witnessing a traumatic injury of a close relative may render the fragility of the physical body, thus impeding the sense of confidence and security of somatic integrity and functioning. ...
Severe Traumatic brain injury (sTBI) often instigates widespread long-lasting disability and is accompanied by extensive rehabilitation. Unsurprisingly, sTBI also holds malignant consequences for patients' close relatives. The burden caused by the injury and its severity explains some of the ramifications for the relatives. Additionally, some findings demonstrate that patients with sTBI and their relatives develop posttraumatic stress (PTS) symptoms. However, although the link between PTS symptoms and physical and mental health is well-documented in literature, the effect of PTS symptoms on relatives of patients with sTBI has barely been examined. This study examines the influence of PTS symptoms of patients with sTBI and their relatives on the physical and mental health and functioning of the relatives. Patients who sustained a severe sTBI (Abbreviated Injury Scale of the head region > 3) and close relatives were included in a multi-center, prospective cohort study (TRAST-MI). One-hundred patients and their relatives were assessed at 2, 6, and 12 months post injury. Outcome variables included health-related quality of life (SF-12) as well as emotional, cognitive, interpersonal, and total functioning (PCRS). Relatives' physical health was predicted by relatives' PTS symptoms (Slope=-1.76; p = .043), and mental health was predicted by both patients' (Slope=-2.77; p = .034) and relatives' (Slope=-6.59; p < .001) PTS symptoms. Functioning level was only predicted by patients' PTS symptoms (Slope=-.25; p< .001). The findings emphasize that TBI should be considered a comprehensive traumatic experience reaching further than mere physical damage to the brain and its direct consequences, affecting the injured individual and close relatives.
... Exposure to war captivity entails prolonged and complex stressors, that increase the risk for multiple psychiatric (Rintamaki, Weaver, Elbaum, Klama, & Miskevics, 2009) and physical disturbances (Lahav, Rodin, & Solomon, 2015), even many years after repatriation. Such detriments may be exacerbated as ex-POWs grow older. ...
Objectives:
Exposure to captivity increases the risk for multiple disturbances that may intensify during old age. In later phases of life, former-prisoners-of-war (ex-POWs) may suffer from depression as well as from accelerated aging, manifested in older subjective age and leukocyte telomere shortening. The current study assesses the link between these varied facets of increased vulnerability during old age and explores (a) the associations between subjective age and telomere length; (b) the mediating role of changes in subjective age over time within the associations between depression and telomere length.
Methods:
Eighty eight ex-POWs were assessed prospectively 30 (T1), 35 (T2) and 45 (T3) years after the 1973 Israeli Yom-Kippur War. Depression was assessed at T1; subjective age was assessed at T2 and T3; and telomere length and control variables were assessed at T3.
Results:
Older subjective age at T3 was associated with concurrent shorter telomeres, beyond the effect of chronological age. Change in subjective age between T2 and T3 mediated the relations between depression at T1 and shorter telomeres at T3 beyond the effects of control variables.
Discussion:
Findings suggest that the detrimental ramifications of accelerated subjective age involve premature cellular senesces, and may explain the relation between depression and accelerated aging processes among trauma victims. Hence, clinical interventions may seek to address accelerated subjective age among trauma survivors who suffer from depression.
Child abuse has been shown to increase the risk for chronic pain. The illness personification theory implies that individuals tend to ascribe humanlike characteristics to chronic pain, and that this personification is embedded in the way they cope with their chronic condition. Recent findings demonstrate that individuals who experienced interpersonal violence tend to personify chronic pain in a way that resonates with past abusive experience. Although findings prevail to the link between trauma and the experience of the body, the personification of chronic pain among individuals who experienced child abuse has not been examined before. This article includes two studies that tested whether child abuse is implicated in abusive chronic pain personification in a young adult female sample (Study 1) and among females who experienced child abuse (Study 2). In both studies, self-report measures of child abuse, posttraumatic stress (PTS) symptoms, complex posttraumatic symptoms (disturbances of self-organization [DSO]), and abusive chronic pain personification were administered. Structural equation modeling was utilized to assess the hypotheses. The findings of the two studies showed a significant association between child abuse and pain personification. Whereas PTS symptoms did not mediate this link (Study 1), DSO symptoms mediated this association (Study 2). The findings of these studies support the understanding that the experience of interpersonal violence is engraved in the experience of the body, as reflected in abusive chronic pain personification. Disturbances in self-organization seem to underlie this process, thus pertaining to the link between the experience of the body, self, and interpersonal trauma.
Trauma survivors may suffer from posttraumatic stress disorder (PTSD), elevated posttraumatic guilt (PG), and alterations in the pain system. However, the association between PG and alterations in pain perception and modulation among trauma survivors has not been
established, nor has the possible underlying role of PG. This longitudinal study investigated:
1) the unique contribution of PG in predicting pain perception and modulation, while controlling for PTSD symptoms; and 2) the mediating role of PG in explaining pain perception and modulation among torture survivors, above and beyond PTSD symptoms.
Participants were 59 torture survivors and 44 age-matched controls. PG and PTSD symptoms were assessed in 2003 (T1). Heat-pain threshold, heat-pain tolerance, temporal summation of pain (TSP) and conditioned pain modulation (CPM) were measured five years later (T2).
Torture survivors had elevated PG and PTSD symptoms, enhanced TSP, and reduced CPM, compared to controls. While PTSD predicted reduced pain tolerance and CPM, PG predicted increased pain tolerance. Moreover, PG mediated the associations between torture and (increased) pain threshold, pain tolerance, and TSP. It appears that PTSD and PG induce opposite effects on the pain modulation capacity of torture survivors, a dichotomy that may explain paradoxical pain responses among trauma survivors, as discussed.
Perspective: This longitudinal study sheds light on the possible mechanisms underlying variations in pain perception and modulation among trauma survivors. PTSD and posttraumatic guilt each mediated opposing pain modulation profiles, suggesting that individual responses to trauma, rather than the trauma itself, influence pain responses.
Repercussions of war captivity may transmit to spouses of former prisoners of war (POW) via posttraumatic stress symptoms (PTSS). Overidentification with their partners underlies the PTSS experienced by former wives of POWs, thus implying impaired self-differentiation. Although wives' indirect exposure to their husbands' captivity and subsequent PTSS has been associated with the wives' PTSS and differentiation, the combined effects remain unclear. Furthermore, previous cross-sectional studies could not illuminate directionality. This prospective study investigates (a) the moderating role of indirect exposure to captivity in the association between husbands' PTSS and wives' PTSS and differentiation; and (b) the directionality of the association between wives' differentiation and PTSS over time. The wives of both former POWs (n = 143) and combatants (n = 102) were assessed 30 (T1) and 38 (T2) years after the 1973 Yom Kippur War. The wives of former POWs endorsed higher PTSS and fusion differentiation, η(2)p = .06 to .14. Indirect exposure to captivity moderated the associations between husbands' PTSS and wives' PTSS, Cohen's f(2) = .01 to .03. The association between the wives' differentiation and PTSS over time was bidirectional, β = -0.18 to 0.68; R(2) = .54 to .73. Results suggest a vicious cycle between PTSS and differentiation, and the need for clinical interventions that further differentiation for spouses of prolonged trauma victims.
The present study assesses the possible disruption effect of posttraumatic stress symptoms (PTSS) with regard to the protective role of attachment on pain, among ex-POWs. While secure attachment seems to serve as a buffer, decreasing the perception of pain, this function may be disrupted by PTSS. The study sample included 104 subjects who were combat veterans of the 1973 Yom Kippur War comprising of 60 male ex-prisoners of war (ex-POWs) and 44 comparable male combat veterans. Both attachment and pain were investigated experimentally in the laboratory and via questionnaires. We found that ex-POWs showed higher levels of clinical pain and attachment insecurities compared to controls. Moreover, attachment avoidance and soothing effect of attachment (SEA) were both associated with lower levels of clinical pain. Most importantly, PTSS moderated the associations between attachment and pain, as well as the mediation role of attachment between captivity and pain. The results imply that although attachment can be an important resource for coping with pain, it can be severely disrupted by PTSS among trauma survivors.
The current study aims to (1) assess the long-term impact of war captivity on mortality and various health aspects and (2) evaluate the potential mediating role of posttraumatic stress disorder (PTSD) and depressive symptoms. Israeli ex-prisoners of war (ex-POWs) (N = 154) and a matched control group of combat veterans (N = 161) were assessed on health conditions and self-rated health 18 years post-war (1991: T1). The whole population of ex-POWs, and the T1 sample of controls were then contacted 35 years after the war (2008: T2), and invited to participate in a second wave of measurement (ex-POWs: N = 171; controls: N = 116) Captivity was implicated in premature mortality, more health-related conditions and worse self-rated health. PTSD and depressive symptoms mediated the relationship between war captivity and self-rated health, and partially mediated the relationship between war captivity and health conditions, and these effects were amplified with age. Aging ex-POWs who develop psychiatric symptomatology should be considered a high-risk group entering a high-risk period in the life cycle. It is important to monitor ex-POWs and provide them with appropriate medical and psychological treatment as they age.
The purpose of this study was to determine the psychiatric status and risk profile of repatriated prisoners of war (RPOWs) 25 years after their return. Subjects were 260 of the original 566 Vietnam War RPOWs and 81 of the original 138 Navy Vietnam veteran controls from Operation Homecoming. Methods included a brief questionnaire in 2000 to obtain baseline veteran and family health risk factor and psychological status screening information. Additionally, computer-based telephone interviews in 2001 using the Quick Diagnostic Interview Schedule provided clinically based lifetime and recent diagnoses. Results among 44 matched pairs showed RPOWs significantly more likely than controls to be limited in activities, perceive their health as poorer, experience higher rates of arthritis and back/neck problems, and score more negatively on Duke Health Profile measures of depression and anxiety. Current physical health status appeared to be more related to the psychiatric status of naval aviator Vietnam veterans than the POW experience itself. Strengths of the current study over previous studies are the use of controls, longitudinal analyses, and a longer time frame for follow-up.
In this study, we assessed the 17-year trajectories of attachment insecurities (anxiety and avoidance) and examined their relations to having been a prisoner of war and suffering from Posttraumatic Stress Disorder (PTSD). The sample included two groups of Israeli veterans from the 1973 Yom Kippur war: ex-prisoners of war and comparable control individuals who had not been held captive. They completed self-report measures of anxious and avoidant attachment and PTSD at three time points: 18, 30, and 35 years after the war. Ex-POWs were less secure with respect to attachment than the controls at the initial assessment, and although the controls experienced a decline in attachment insecurity over the 17-year period, the anxiety and avoidance scores of the ex-POWs increased over time. We also found that PTSD was associated with higher attachment insecurity scores at each time point, beyond the effect of war captivity. Implications of the findings for both attachment theory and the psychological effects of trauma are discussed.
The relation between attachment styles and fear of personal death was assessed. We classified a sample of Israeli undergraduate students into secure, ambivalent, and avoidant attachment groups and assessed the extent of, and the meaning attached to, overt fear of personal death as well as the extent of fear at a low level of awareness. Ambivalent subjects exhibited stronger overt fear of death than did secure and avoidant subjects, and both ambivalent and avoidant subjects showed stronger fear of death at a low level of awareness than secure subjects. Ambivalent subjects were also more likely to fear the loss of their social identity in death, and avoidant subjects were more likely to fear the unknown nature of their death. Results are discussed in terms of the effects of attachment styles on affect regulation. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Adult attachment style and post-traumatic stress disorder (PTSD) symptomatology were investigated in 107 former prisoner of war veterans. Those with secure attachment styles scored significantly lower on measures of PTSD than did those with insecure styles, and attachment style was a stronger predictor of PTSD symptom intensity than was trauma severity. The suggested association between attachment style and PTSD's development and persistence are discussed in relation to research and clinical practice.
Although war captivity is a potent pathogen for psychiatric illness, little is known about the long-term trajectories of post-traumatic stress disorder (PTSD) among ex-prisoners of wars (ex-POWs). This study aimed to assess the long-term trajectories of PTSD and their predictors following war captivity. One hundred and sixty four Israeli ex-POWs and 185 comparable combatants from the 1973 Yom Kippur War were followed over 35 years, with three follow-ups (1991, 2003, 2008). Ex-POWs reported higher PTSD rates than controls at all three assessments. Four trajectories of PTSD were identified: chronic PTSD, delayed PTSD, recovery and resilience. The majority of POWs reported delayed PTSD, while the majority of controls were classified as resilient. While PTSD rates remained relatively stable over time among controls, a steep increase in rates was observed among POWs between 1991 and 2003, followed by stabilization in rates between 2003 and 2008. Finally, subjective experience of captivity was the variable that best distinguished between the resilience and PTSD groups of ex-POWs, followed by participation in previous wars and negative life events during childhood. War captivity carries long-lasting psychiatric implications, even decades after release. Aging processes, as well as unique stressors that exist in Israel, may account for the elevated PTSD rates found here.
Attachment insecurity has been hypothesized to be a risk factor for the development of disease and chronic illness. This study was the first to investigate associations between adult attachment ratings and a wide range of health conditions.
Cross-sectional data from the National Comorbidity Survey Replication (N = 5645) were used.
Participants completed Hazan and Shaver's (1987) measure of adult attachment and provided reports regarding 15 health conditions.
Logistic regression analyses that adjusted for demographic variables indicated that avoidant attachment ratings were positively associated with conditions defined primarily by pain (e.g., frequent or severe headaches). Anxious attachment ratings were positively associated with a wider range of health conditions, including several involving the cardiovascular system (i.e., stroke, heart attack, high blood pressure). Secure attachment ratings were unrelated to the health conditions. Additional analyses investigated whether the attachment ratings accounted for unique variance in the health conditions beyond that accounted for by lifetime histories of depressive, anxiety, and alcohol- or substance-related disorders. In these analyses, anxious attachment ratings continued to have significant positive associations with chronic pain, stroke, heart attack, high blood pressure, and ulcers.
The findings were generally supportive of the theory that insecure attachment is a risk factor for the development of disease and chronic illness, particularly conditions involving the cardiovascular system. Further research regarding the role of attachment in the development of specific health conditions is warranted.
Ever since people's responses to overwhelming experiences have been systematically explored, researchers have noted that a trauma is stored in somatic memory and expressed as changes in the biological stress response. Intense emotions at the time of the trauma initiate the long-term conditional responses to reminders of the event, which are associated both with chronic alterations in the physiological stress response and with the amnesias and hypermnesias characteristic of posttraumatic stress disorder (PTSD). Continued physiological hyperarousal and altered stress hormone secretion affect the ongoing evaluation of sensory stimuli as well. Although memory is ordinarily an active and constructive process, in PTSD failure of declarative memory may lead to organization of the trauma on a somatosensory level (as visual images or physical sensations) that is relatively impervious to change. The inability of people with PTSD to integrate traumatic experiences and their tendency, instead, to continuously relieve the past are mirrored physiologically and hormonally in the misinterpretation of innocuous stimuli as potential threats. Animal research suggests that intense emotional memories are processed outside of the hippocampally mediated memory system and are difficult to extinguish. Cortical activity can inhibit the expression of these subcortically based emotional memories. The effectiveness of this inhibition depends, in part, on physiological arousal and neurohormonal activity. These formulations have implications for both the psychotherapy and the pharmacotherapy of PTSD.
The authors examined the longitudinal changes in posttraumatic stress disorder (PTSD) symptom levels and prevalence rates over a 4-year time period among American former prisoners of war (POWs) from World War II and the Korean War. Retrospective symptom reports by World War II POWs dating back to shortly after repatriation were examined for 1) additional evidence of changing PTSD symptom levels and 2) evidence of PTSD cases with a long-delayed onset.
PTSD prevalence rates and symptom levels were measured by the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder. For the longitudinal portion of the study, participants were 177 community-dwelling World War II and Korean POWs. For the retrospective portion, participants were 244 community-dwelling World War II POWs.
PTSD prevalence rates and symptom levels increased significantly over the 4-year measurement interval. Retrospective symptom reports indicated that symptoms were highest shortly after the war, declined for several decades, and increased within the past two decades. Long-delayed onset of PTSD symptoms was rare. Demographic and psychosocial variables were used to characterize participants whose symptoms increased over 4 years and differentiate participants who reported a long-delayed symptom onset.
Both longitudinal and retrospective data support a PTSD symptom pattern of immediate onset and gradual decline, followed by increasing PTSD symptom levels among older survivors of remote trauma.
This study examined the stability of adult attachment representations across the transition to marriage. One hundred fifty-seven couples were assessed using the Adult Attachment Interview (AAI; C. George, N. Kaplan, & M. Main, 1985), the Current Relationship Interview (J. A. Crowell & G. Owens, 1996), and measures describing relationship functioning and life events 3 months prior to their weddings and 18 months into their marriages. The authors tested the hypotheses that attachment classifications are stable and that change is related to experiences in the relationship and/or life events; 78% of the sample received the same primary AAI classification (secure, preoccupied, and dismissing) at both times. Change was toward increased security and was associated with feelings and cognitions about the relationship. Only 46% of participants initially classified as unresolved retained the classification. Stability of the unresolved classification was associated with stressful life events and relationship aggression.
Attachment theory proposes that cognitive schemas based on earlier repeated experiences with caregivers influence how individuals perceive and act within interpersonal relationships. We hypothesized that medical patients with two types of insecure attachment-preoccupied and fearful attachment-would have higher physical symptom reporting compared with those with other attachment styles, but that preoccupied attachment would be associated with higher and fearful attachment with lower primary care utilization and costs.
In a large sample of adult female primary care health maintenance organization patients (N = 701), we used analysis of covariance and Poisson regressions to determine whether attachment style was significantly associated with 1) symptom reporting based on questions from the somatization section of the Diagnostic Interview Schedule and 2) contemporaneous automated utilization and cost data.
Attachment style was significantly associated with symptom reporting (p =.02), with patients with preoccupied (p =.03) and fearful (p =.003) attachment having a significantly greater number of physical symptoms compared with secure patients. There were no significant differences in medical comorbidity between attachment groups. Attachment was also significantly associated with primary care visits and costs. Patients with preoccupied attachment had the highest primary care costs and utilization, whereas patients with fearful attachment had the lowest.
These results suggest that attachment style is an important factor in assessing symptom perception and health care utilization. Despite being on opposite ends of the utilization spectrum, patients with preoccupied and fearful attachment have the highest symptom reporting. These data challenge the observation that increased symptom reporting is uniformly associated with increased utilization in medical patients.
Victims of war captivity sometimes suffer from complex post-traumatic stress disorder (PTSD), a unique form of PTSD that entails various alterations in personality. These alterations may involve changes in attachment orientation.
The sample comprised two groups of veterans from the 1973 Yom Kippur War: 103 ex-prisoners of war (ex-POWs) and 106 comparable control veterans. They were assessed at two points in time, 18 years and 30 years after the war.
Ex-POWs suffered from more post-traumatic symptoms than controls at both measurements points and these symptoms increased only among ex-POWs from Time 1 to Time 2. In addition, both attachment anxiety and attachment avoidance increased with time among ex-POWs, whereas they decreased slightly or remained stable among controls. Finally, the increases in attachment anxiety and avoidance were positively associated with the increase in post-traumatic symptoms among both study groups. Further analyses indicated that early PTSD symptoms predicted later attachment better than early attachment predicted later PTSD symptoms.
The results suggest that: (1) complex traumas are implicated in attachment orientations and PTSD symptoms even many years after captivity; (2) there is an increase in attachment insecurities (anxiety, avoidance) and an increase in PTSD symptoms decades after the captivity; (3) and post-traumatic stress symptoms predict attachment orientations better than attachment orientations predict an increase in PTSD symptoms.
The study tested the key assumption of the individual difference model of adult attachment change: that people who have experienced certain vulnerability factors will be prone to change attachment styles because they have developed unclear models of self and others that render their attachment models unstable. This model was compared to a life stress model, which states that change occurs as an adaptation to new, interpersonally relevant life circumstances. Changes in self-reported and interviewer-assessed attachment were examined among 94 young adults who were followed over 1 year. Analyses yielded support for the individual difference model for change in both self-reported and interviewer-assessed attachment. The life stress model was supported for change in interviewer-assessed attachment only. Implications for differential change processes for self-reported versus interviewer-assessed aspects of adult attachment are discussed.
US Army veterans taken prisoner (POW's) in World War II and in the Korean War are compared with controls as to hospital admissions from 1946 to 1965 (1954–1965 for Korean War POW's), and as to symptoms, disability, and maladjustments in 1966–1967. Sequelae of the POW experience are both somatic and psychiatric, and are of greatest extent and severity among Pacific World War II POW's. Among European World War II POW's only psychiatric sequelae are apparent. Somatic sequelae were most prevalent in the early years after liberation, but for Pacific World War II POW's they persist in the form of higher hospital admission rates for many specific causes in the most recent period. Nevertheless, persistent psychiatric sequelae (especially psychoneurosis but also schizophrenia) are the more notable and pervasive for both Pacific World War II POW's and Korean War POW's as seen not only in elevated hospital admission rates but also in VA disability awards and in symptoms reported on the Cornell Medical Index Health Questionnaire. The excess morbidity appears to correlate well with retrospective accounts of weight-loss and nutritional deficiency diseases and symptoms during the POW period.
Posttraumatic stress disorder (PTSD) is an illness of considerable prevalence, often characterized by high morbidity, treatment resistance, and a chronic course. The core symptoms of PTSD include persistent reexperiencing of the traumatic event, avoidance of stimuli associated with the trauma, and autonomic hyperarousal. We propose several neurobiologic mechanisms that may account for these primary symptoms of PTSD. Preclinical investigations of the effects of stress on learning and memory processes suggest that fear conditioning, behavioral sensitization, and a failure of extinction may be important in the persistence and reexperiencing of traumatic memories and stressor sensitivity. The pathophysiology of PTSD may involve dysfunction of several brain structures, particularly the amygdala, locus coeruleus, and hippocampus, as well as noradrenergic, dopamine, opiate, and corticotropinreleasing factor neurochemical systems. Acutely, severe psychological trauma results in the parallel activation of these systems, producing an array of adaptive behavioral and physiologic responses necessary for survival. In PTSD, however
An effective technique for data analysis in the social sciences The recent explosion in longitudinal data in the social sciences highlights the need for this timely publication. Latent Curve Models: A Structural Equation Perspective provides an effective technique to analyze latent curve models (LCMs). This type of data features random intercepts and slopes that permit each case in a sample to have a different trajectory over time. Furthermore, researchers can include variables to predict the parameters governing these trajectories. The authors synthesize a vast amount of research and findings and, at the same time, provide original results. The book analyzes LCMs from the perspective of structural equation models (SEMs) with latent variables. While the authors discuss simple regression-based procedures that are useful in the early stages of LCMs, most of the presentation uses SEMs as a driving tool. This cutting-edge work includes some of the authors' recent work on the autoregressive latent trajectory model, suggests new models for method factors in multiple indicators, discusses repeated latent variable models, and establishes the identification of a variety of LCMs. This text has been thoroughly class-tested and makes extensive use of pedagogical tools to aid readers in mastering and applying LCMs quickly and easily to their own data sets. Key features include: • Chapter introductions and summaries that provide a quick overview of highlights • Empirical examples provided throughout that allow readers to test their newly found knowledge and discover practical applications • Conclusions at the end of each chapter that stress the essential points that readers need to understand for advancement to more sophisticated topics • Extensive footnoting that points the way to the primary literature for more information on particular topics With its emphasis on modeling and the use of numerous examples, this is an excellent book for graduate courses in latent trajectory models as well as a supplemental text for courses in structural modeling. This book is an excellent aid and reference for researchers in quantitative social and behavioral sciences who need to analyze longitudinal data.
With the growing interest in the role of cognitions in PTSD, this prospective study examined the course and bi-directional relationship between post-trauma cognitions and symptoms of PTSD. A sample of Israeli combat veterans, including former prisoners of war, was assessed in 1991, and later followed up in 2003 and 2008. PTSD symptoms were measured at three time points. Cognitions concerning the self and the world were measured twice. Applying Autoregressive Cross-Lagged (ARCL) modeling strategy, initial PTSD symptoms predicted subsequent negative cognitions but not vice versa. In addition, repeated measures design revealed that individuals with chronic PTSD symptoms had relatively negative cognitions that further amplified with time. More specifically, increasingly negative cognitions were documented among ex-prisoners of war. The main findings suggest that negative cognitions are fueled by PTSD and that in chronic PTSD there is an amplification of pathogenic outcomes over time. Discussion of the findings is in the context of current cognitive models of PTSD.
This is an 18-year follow-up of 164 former prisoners of war (POWs) and 190 controls. The study examined long-term morbidity, psychophysiological complaints, and illness-related behaviors. Psychophysiological complaints were found to be significantly higher among the POWs than among the controls. A significant association was also found between such complaints and symptoms of posttraumatic stress disorder (PTSD). The individual's degree of impairment was associated with both objective and subjective characteristics of captivity. The authors outline differences in types of illness observed in POWs in the current study and in studies conducted in other countries, and consider the implication of characteristics of captivity and culture.
Between 1973 and 1993, over 30 of the 591 American ex-POWs from the Vietnam War (1973) published autobiographies; on the Israeli side, a book was written by only 1 of the 314 ex-POWs from the Yom Kippur War (1973). In the United States, their return transformed the POWs into national heroes. Alternatively, in Israel, the ex-POWs put on a thick cover of silence, to disappear from the public eye and the public discourse for almost twenty-five years. This article attempts to delve into the meaning of the voluntary reticence of Yom Kippur War ex-POWs. An examination of the complex relationship between their personal stories and Israel’s cultural code of captivity helps explain that silence. The article contributes to our understanding of the influence of cultural codes in the construction of military history, military autobiography, and military values and myths.
This paper attempts to understand the interpersonal nature of bodily experience. It explores the way the body symptoms we meet in the consulting room, and in everyday life, express and communicate disturbances in our relationships with others. The article seeks to understand how others that are close to us can really get under our skins. The work of the philosopher of the body, MerleauPonty, findings from contemporary developmental psychology, recent psycho-biological studies and psychoanalytic insights are all drawn upon as a way of offering an introduction to contemporary developments in thinking and research on the body.The article explores the interdependence of body and environment. In particular, the body is always in an interpersonal context with others. Bodies are interdependent; communication is first and foremost bodily. Bodily behaviour and biological functions develop in the context of a relationship. The relationship with the other influences the formation of bodily processes and actions. Clinical examples are drawn upon to illustrate how interpersonal disturbances in development are expressed in bodily symptoms. The difference between a hysterical and psychosomatic body symptom is also briefly addressed.
Positive self- and emotional development is often measured by optimization of happiness, but a second aspect of positive development—the ability to tolerate tension and negativity in the interest of maintaining objective representations—needs to be integrated with this hedonic emphasis. The integration of these two aspects, optimization and differentiation, reflects a dynamic balance. Such integration is possible when emotional activation or arousal is moderate, but is impaired at very high levels of activation. From youth to middle adulthood, the capacity for integration increases, but later in life, limitations or poor regulation strategies foster compensatory processes that compromise integration.
A paperback edition of the translation by Anrep, first published in 1927 by the Oxford University Press, containing a series of 23 lectures on the research of Pavlov's laboratory in the 1st quarter of the 20th century. From Psyc Abstracts 36:05:5CG30P. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Throughout history, soldiers have suffered the psychologic consequences of war. PTSD in the WWII combat veteran presents with physical, psychologic, and social manifestations. Specific physical problems, such as traumatic arthritis and digestive disorders, may be linked to POW experiences. Psychologic symptoms include denial, numbing, intrusive images and thoughts, and nightmares. The older combat veteran may experience long-delayed PTSD symptoms when facing the losses associated with aging, loss of loved ones and declining physical health. Nurses are challenged to discover which elderly patients are combat veterans, what their military experiences were, how the experiences are affecting their mental and physical health, and whether biopsychosocial factors are concurrently affecting the health of the patients known to have PTSD.
US Army veterans taken prisoner (POW's) in World War II and in the Korean War are compared with controls as to hospital admissions from 1946 to 1965 (1954-1965 for Korean War POW's), and as to symptoms, disability, and maladjustments in 1966-1967. Sequelae of the POW experience are both somatic and psychiatric, and are of greatest extent and severity among Pacific World War II POW's. Among European World War II POW's only psychiatric sequelae are apparent. Somatic sequelae were most prevalent in the early years after liberation, but for Pacific World War II POW's they persist in the form of higher hospital admission rates for many specific causes in the most recent period. Nevertheless, persistent psychiatric sequelae (especially psychoneurosis but also schizophrenia) are the more notable and pervasive for both Pacific World War II POW's and Korean War POW's as seen not only in elevated hospital admission rates but also in VA disability awards and in symptoms reported on the cornell Medical Index Health Questionnaire. The excess morbidity appears to correlate well with retrospective accounts of weight-loss and nutritional deficiency diseases and symptoms during the POW period.
This second summary article from an epidemiological review of the health of former prisoners of war (POWs) and other Australian veterans, commissioned by the Sir Edward Dunlop Medical Research Foundation, reports on studies of mortality.
The MEDLARS database, from 1966 to the present, under the terms military personnel, veterans, veterans' disability claims, combat disorders and prisoners (matched against war); databases of the Department of Veterans' Affairs (Victoria) and the Central Library, Commonwealth Department of Defense, under the term "prisoner of war"; and the microfiche listings of the Department of Veterans' Affairs, under "prisoner of war" and "repatriation". Only studies in English or French were reviewed, reaching a total of 172.
Four studies in this paper constitute the main evidence about postwar mortality in Australians who were POWs of World War II or Vietnam veterans. Other mortality studies are cited in the complete literature review published elsewhere.
Only the data with an epidemiological basis are considered here.
All-cause mortality rates were no greater in former POWs or Vietnam veterans than in the general Australian male population. There was, however, evidence of increased mortality among former POWs compared with other non-POW veterans, and among Vietnam veterans in one particular corps compared with veterans of the same era who served in Australia.
Elevated early postwar mortality of young former POWs implicates diseases with short latent periods (including psychiatric disorders). This is consistent with the greater health risks of this group of survivors that were identified in the earlier review of morbidity. Mortality among former POWs and other veterans requires continued surveillance because a "healthy worker effect" (or exclusion of unfit persons from the armed forces) may partly conceal increased morbidity or mortality that should be attributed to war service.
Studies of former prisoners of war (POWs) provide valuable insights into posttraumatic adaptation because they gather information from a large population who survived the traumatic experiences of military captivity. Previous studies of POWs have shown elevated rates of psychiatric symptoms and disorders. This report presents evidence from a longitudinal study of three large, representative, national samples of former POWs. The study finds that depressive symptomatology, as measured by the Center for Epidemiologic Studies Depression Scale, is elevated in World War II POWs from the Pacific and European theaters and in Korean conflict POWs. Decades later, depressive symptomatology is found to be strongly associated with prior treatment in captivity. Differences in depressive symptomatology among the three POW groups can be attributed to captivity-related factors and to buffering factors, such as age at capture and education.
Throughout history, soldiers have suffered the psychologic consequences of war. PTSD in the WWII combat veteran presents with physical, psychologic, and social manifestations. Specific physical problems, such as traumatic arthritis and digestive disorders, may be linked to POW experiences. Psychologic symptoms include denial, numbing, intrusive images and thoughts, and nightmares. The older combat veteran may experience long-delayed PTSD symptoms when facing the losses associated with aging, loss of loved ones and declining physical health. Nurses are challenged to discover which elderly patients are combat veterans, what their military experiences were, how the experiences are affecting their mental and physical health, and whether biopsychosocial factors are concurrently affecting the health of the patients known to have PTSD.
We set out to test the hypothesis that severe malnutrition and stress experienced by prisoners of war (POWs) are associated with cognitive deficits later in life. We assessed 101 former Australian POWs of the Japanese and 108 veteran control subjects using a battery of neuropsychological tests, a depression scale, a clinical examination for dementia, and CT. We divided the POWs into high weight loss (>35%) and low weight loss groups (<35%). We found no significant differences in cognitive performance between the POWs and control subjects or between high and low weight loss groups on any of the tests or in the prevalence of dementia. Scores on the depression scale showed that the former POWs had more depressive symptoms than the control subjects a decade previous, but the difference had diminished over time. This study does not support the hypothesis that malnutrition is a risk factor for accelerated cognitive decline nor the theory that severe stress can lead to hippocampal neuronal loss and cognitive deficits. Cognitive deficits in earlier studies of former POWs may have been associated with concurrent depression.
To determine whether the experience of internment as a Prisoner of War (POW) during World War II was associated with a higher prevalence of chronic disease and diminished functional performance in later life.
A retrospective and prospective cohort design.
Concord Repatriation General Hospital, Sydney, Australia.
A random sample of 101 Australian, male, ex-prisoners of the Japanese and a comparison group of 107 non-POW combatants from the same theatre of war.
Outcome variables were self-perceived health status, hospital admissions and length of stay, number of prescription medications used, number of somatic symptoms reported, number and types of medical diagnoses, a neurology of aging clinical examination, and the Instrumental Activities of Daily Living (IADL) and Physical Self Maintenance Scales (PSMS).
Prisoners of War reported more somatic symptoms (mean 7.2 vs 5.4, P = .002) than non-POWs, had more diagnoses (mean 9.4 vs 7.7 P < .001), and used a greater number of different medications (mean 4.5 vs 3.4, P = .001). There were no differences in hospital admissions or length of stay. Among 15 broad categories of diagnosis, differences were confined to gastrointestinal disorders (POWs 63% vs non-POWs 49%, P = .032), musculoskeletal disorders (POWs 76% vs non-POWs 60%, P = .011), and cognitive disorders (excluding head injury, dementia, and stroke) (POWs 31% vs non-POWs 15%, P = .006). Of the 36 signs in the neurology of aging examination, POWs had a significantly higher proportion of seven extrapyramidal signs and six signs relating to ataxia. POWs were more likely to be impaired on the IADL scale than were non-POWs (33% vs 17%, P = .012) but not significantly more likely to be impaired on the PSMS.
There were few differences between POWs and controls, and those differences were relatively small. Our findings do not support a major role for a catastrophic life stress in the development of chronic illness and disability in later life. However it is possible that the POW experience played a part in premature, abnormal, or unsuccessful aging in some individuals.
The object of this study was to evaluate the evidence linking attachment insecurity to illness. Attachment theory describes lifelong patterns of response to threat that are learned in the interaction between an infant and his or her primary caregiver. Despite its biopsychosocial domain, attachment theory has only recently been applied to psychosomatic medicine.
MEDLINE and PsychInfo databases were searched from 1966 to 2000 for English language papers with key words "attachment" and "object relations." Papers and their cited references were reviewed if they were directly related to physical illness, symptoms, or physiology. A hypothetical causal model was developed.
Direct and indirect evidence from survey studies supports an association between attachment insecurity and disease. Animal studies and human experiments suggest that attachment contributes to individual differences in physiological stress response. There is also less robust support for insecure attachment leading to symptom reporting and to more frequent health risk behaviors, especially substance use and treatment nonadherence. Evidence supports the prediction from attachment theory that the benefits of social support derive more from attachment relationships than nonattachment relationships.
Although the available data are suggestive rather than conclusive, the data can be organized into a model that describe attachment insecurity leading to disease risk through three mechanisms. These are increased susceptibility to stress, increased use of external regulators of affect, and altered help-seeking behavior. This model warrants further prospective investigation.
The objective of this study was to test a hypothesised model of associations between adult attachment style and two health-related outcomes, symptom reporting and coping with health problems. Alexithymia, a construct involving a deficit in the ability to identify and describe emotions, is thought to develop as a result of childhood interactions with caregivers. We wished to determine whether alexithymia acted as a mediating variable between attachment and health outcomes.
Two hundred and one female undergraduates, aged 18-34, completed questionnaire measures of attachment style, alexithymia, positive and negative affectivity, symptom reporting, and coping with health problems.
Insecure attachment (both avoidant and anxious), alexithymia, and negative affectivity were all weakly intercorrelated. However, insecure attachment was associated with alexithymia independent of its association with negative affectivity. Avoidant attachment was weakly predictive of symptom reporting and emotional preoccupation as a way of coping with health problems. Regression analyses showed that the association between avoidant attachment and these health-related outcomes was mediated by alexithymia and negative affectivity, both of which made significant independent contributions to the health outcomes.
Our results are consistent with the proposition that alexithymia develops in response to interactions with primary caregivers that also influence infant and adult attachment. Associations between adult attachment and health outcomes may be due in part to disturbances in affect regulation.
Numerous languages characterize 'social pain', the feelings resulting from social estrangement, with words typically reserved for describing physical pain ('broken heart', 'broken bones') and perhaps for good reason. It has been suggested that, in mammalian species, the social-attachment system borrowed the computations of the pain system to prevent the potentially harmful consequences of social separation. Mounting evidence from the animal lesion and human neuroimaging literatures suggests that physical and social pain overlap in their underlying neural circuitry and computational processes. We review evidence suggesting that the anterior cingulate cortex plays a key role in the physical-social pain overlap. We also suggest that the physical-social pain circuitry might share components of a broader neural alarm system.
Pain self-efficacy and anxiety have each been shown to contribute substantially to pain intensity and pain-related disability. Although adult attachment theory has been related separately to chronic pain, anxiety, and self-efficacy, it has not before been investigated with either pain self-efficacy or anxiety in the context of chronic pain. This study investigated the interrelations between these aspects of the chronic pain experience and their relative contributions towards pain intensity and disability. A clinical sample of 152 chronic pain patients participated in this study, completing self-report measures of attachment, self-efficacy, pain intensity, and disability, prior to attending a multidisciplinary pain clinic. Results revealed that fearful and preoccupied (anxious) attachment categories were associated with low pain self-efficacy, while high scores on the attachment dimension of comfort with closeness were linked with high pain self-efficacy, particularly for males. Insecure attachment (whether defined in terms of categories or dimensions) was related to higher levels of anxiety. Pain self-efficacy proved a stronger predictor of pain intensity than did anxiety and was a stronger predictor of disability than pain intensity or anxiety. In addition, comfort with closeness moderated the associations between pain self-efficacy and disability, pain self-efficacy and pain intensity, and anxiety and disability. Together, these findings support the value of adopting an attachment theoretical approach in the context of chronic pain. Treatment considerations and future research directions are considered.
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