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Posttraumatic Growth and Perceived Health: The Role of Posttraumatic Stress Symptoms

Authors:
Yael Lahav at Tel Aviv University
Yael Lahav
Zahava Solomon at Tel Aviv University
Zahava Solomon
Yafit Levin at Ariel University
Yafit Levin
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Abstract

The contested discourse regarding the nature of posttraumatic growth (PTG) includes 2 main competitive claims. The first argues that PTG reflects authentic positive transformation while the second posits that PTG reflects illusory defenses that could be maladaptive in the long run. The present study assesses these competing claims by investigating secondary PTG in relation to the somatic domain. Specifically, this study investigates: (a) the association between PTG, and perceived health (PH), as measured by 3 indices of somatic complaints, self-rated health (SRH) and a number of health problems; (b) the association between PTG, posttraumatic stress symptoms (PTSS) and PH over time; and (c) the mediating role of PTSS between PTG and PH, among wives of former prisoners of war (ex-POWs) and wives of control veterans. Assessments were conducted 30 (T1) and 38 (T2) years after the Yom Kippur War. Results showed that wives of ex-POWs endorsed higher PTSS, higher PTG and poorer PH, compared to control wives. Higher PTG was associated with higher PTSS and poorer PH. PTG at T1 predicted an increase in PTSS between T1 and T2, which in turn was correlated with poorer PH. PTSS at T2 as well as changes in PTSS from T1 to T2 mediated the association between T1 PTG and T2 PH measures. The present findings imply that PTG might have negative implications on PH through the amplification of PTSS, among secondary trauma victims. It seems that although spouses of trauma victims describe benefits resulting from vicarious trauma exposures, their body indicates differently. (PsycINFO Database Record
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Posttraumatic Growth and Perceived Health: The
Role of Posttraumatic Stress Symptoms
Yael Lahav, Zahava Solomon, and Yafit Levin
Tel-Aviv University and I-CORE Research Center for Mass Trauma, Tel Aviv, Israel
The contested discourse regarding the nature of posttraumatic growth (PTG) includes 2 main
competitive claims. The first argues that PTG reflects authentic positive transformation while the
second posits that PTG reflects illusory defenses that could be maladaptive in the long run.
The present study assesses these competing claims by investigating secondary PTG in relation
to the somatic domain. Specifically, this study investigates: (a) the association between PTG, and
perceived health (PH), as measured by 3 indices of somatic complaints, self-rated health (SRH)
and a number of health problems; (b) the association between PTG, posttraumatic stress
symptoms (PTSS) and PH over time; and (c) the mediating role of PTSS between PTG and PH,
among wives of former prisoners of war (ex-POWs) and wives of control veterans. Assessments
were conducted 30 (T1) and 38 (T2) years after the Yom Kippur War. Results showed that wives
of ex-POWs endorsed higher PTSS, higher PTG and poorer PH, compared to control wives.
Higher PTG was associated with higher PTSS and poorer PH. PTG at T1 predicted an increase
in PTSS between T1 and T2, which in turn was correlated with poorer PH. PTSS at T2 as well
as changes in PTSS from T1 to T2 mediated the association between T1 PTG and T2 PH
measures. The present findings imply that PTG might have negative implications on PH through
the amplification of PTSS, among secondary trauma victims. It seems that although spouses of
trauma victims describe benefits resulting from vicarious trauma exposures, their body indicates
differently.
Although there is an abundance of evidence for the exis-
tence of posttraumatic growth (PTG; Tedeschi & Cal-
houn, 2004), its nature as well as long term implications
remain very partially understood. The present study works within
this dearth to shed light on the nature of PTG and its long-term
associations. To this end the associations between PTG, perceived
health (PH) and posttraumatic stress symptoms (PTSS) are exam-
ined among wives of former prisoners of war (ex-POWs) and
wives of comparable combatants who were not held captive.
Moreover, the mediating role of PTSS within the PTG-PH rela-
tionship was likewise investigated.
Posttraumatic Growth
War captivity is among the most extreme traumatic events in
existence, typically following active combat which may be
devastating and traumatic in its own right. Prisoners of war are
often subjected to harsh physical and psychological abuse,
torture, severe deprivation of basic needs (i.e., food, water,
sleep), as well as repeated humiliation and degradation at the
hands of their captors (e.g., Herman, 1992). As a result, ex-
POWs are at high risk for physical and psychiatric disorders,
most notably posttraumatic stress disorder (PTSD; e.g., Dikel,
Engdahl, & Eberly, 2005).
The implications of war captivity are not limited to primary
trauma survivors (i.e., ex-POWs), and may be transmitted to
significant others, a phenomenon known as secondary traumatiza-
tion (e.g., Figley, 1986). Moreover, it has recently been incorpo-
rated within the Diagnostic and Statistical Manual of Mental
Disorders, fifth edition (DSM-V; American Psychiatric Associa-
tion, 2013) that learning about a close family member’s traumatic
event constitutes a firsthand trauma. Wives of ex-POWs whose
husbands’ lives were at-risk while they were held captive, are
clearly answer to this criterion and are hence at-risk themselves.
Indeed, research has indicated that wives of ex-POWs endorse
more PTSS and more severe psychological distress than wives of
comparable combat veterans (e.g., Greene, Lahav, Bronstein, &
Solomon, 2014).
Having an intimate relationship with an ex-POW, however, may
also lead to positive gains or transformations, characterized as
PTG (e.g., Tedeschi & Calhoun, 1996). According to Tedeschi and
Calhoun (2004) PTG is exhibited in three domains: elevated pos-
itive self-perception, improved interpersonal relationships, and a
more optimistic world view. Research has documented PTG
among survivors of various traumatic events including disasters,
This article was published Online First February 11, 2016.
Yael Lahav, Zahava Solomon, and Yafit Levin, Bob Shapell School of
Social Work, Tel-Aviv University, and I-CORE Research Center for Mass
Trauma, Tel Aviv, Israel.
Correspondence concerning this article should be addressed to Yael
Lahav, I-CORE Research Center for Mass Trauma, P.O.B. 39040, Tel
Aviv, 69978 Israel. E-mail: lahav.yael62@gmail.com
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
American Journal of Orthopsychiatry © 2016 American Orthopsychiatric Association
2016, Vol. 86, No. 6, 693–703 http://dx.doi.org/10.1037/ort0000155
693
... However, others questioned the validity of PTG as a scientific construct, as well as its retrospective assessment methodology and capacity to evaluate real psychological change (Boals & Schuler, 2023). Furthermore, PTG's positive 'illusory' cognitive bias has been criticised to function as an active coping strategy for self-enhancement when responding to the impacts of trauma (e.g., Lahav, Levin, & Solomon, 2016), and even violation of post-event recovery expectations, or expectations and cultural scripts (Jayawickreme & Blackie, 2014). ...
... It is also important to note the controversies surrounding the concept of PTG. Thus, PTG may act as a positive "illusory" cognitive bias in which GSE may facilitate it as an active coping strategy for self-enhancement when responding to the impacts of trauma (e.g., Lahav, Levin, & Solomon, 2016). ...
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... For instance, the disturbing and unwanted memories of the trauma repeatedly intrude the victim's consciousness, which can lead to strong physical reactions such as palpitations and difficulty breathing, as well as negative feelings such as agitation and anxiety. These physical and emotional reactions are stressful to the body and can increase the physiological work of the autonomic nervous system (Lahav et al., 2016), leading to an escalation of somatic problems, making victims feel unwell. ...
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... In this vein, as our study not only included funeral directors but also cemeteries and morgues employees, these results may directly inform practical guidelines in fostering such interventions among the funeral and mortuary professional categories. Moreover, programs based on the awareness on job risks and characteristics are also functional from a positive perspective in order to prevent the depletion of resources with negative consequences on individual balance and health [79]. ...
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Secondary traumatization describes the phenomenon whereby those in proximity to trauma survivors develop psychological symptoms similar to those experienced by the direct survivor. The current study examined secondary trauma (ST) and generalized distress symptoms (general psychiatric symptomatology, functional disability, and self-rated health) in wives of former prisoners of war (ex-POWs). The study compared wives of Israeli ex-POWs from the 1973 Yom Kippur War with wives of a matched control group of non-POW Yom Kippur War combat veterans (CVs). The wives also were divided into groups based on their husbands' current posttraumatic stress disorder (PTSD) status and PTSD trajectory (i.e., chronic, delayed), and their outcomes were compared with resilient CVs. We found that wives of ex-POWs with PTSD reported higher ST and generalized distress than wives of ex-POWs and non-POW CVs without PTSD. Wives of ex-POWs with chronic PTSD reported the highest levels of functional disability. We also found that the relationships between husbands' prior captivity, and wives' ST and general psychiatric symptomatology were fully mediated by the husbands' PTSD symptoms. These findings indicate that it is exposure to a partner with PTSD that leads to overall ST and other distress symptoms, and not simply to a trauma survivor. Furthermore, the more severe their husbands' PTSD, the more wives are at risk for ST and general psychiatric symptomatology. Wives of partners with PTSD should therefore be considered high-risk groups for ST and distress that may require targeted interventions. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
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Objective: The current study aimed to investigate (a) "secondary" posttraumatic growth (PTG) in wives of former prisoners of war (ex-POWs) and its association to husbands' captivity, husbands' posttraumatic stress disorder (PTSD), and husbands' PTSD trajectories; and (b) the bidirectional relationships over time between wives' posttraumatic stress symptoms (PTSS) and PTG. Method: The study compared 116 wives of Israeli ex-POWs from the 1973 Yom Kippur War with 56 wives of a matched control group of non-POW combat veterans. Wives were divided into groups according to husbands' captivity status, husbands' PTSD status, and husbands' PTSD trajectories; and ANOVAs and MANOVAs were conducted to assess group differences in PTSS and PTG, both cross-sectionally and longitudinally. Autoregressive cross-lag modeling was also used to assess bidirectional relationships between wives' PTSS and PTG over time. Results: Wives of ex-POWs with PTSD reported significantly higher PTG compared with wives of ex-POWs without PTSD and wives of controls. While PTG and PTSS remained stable over time, importantly, the Time 1 (T1) level of PTG predicted avoidance symptoms at Time 2 (T2); the higher the wives' PTG at T1, the higher their avoidance symptoms at T2, but not vice versa. Conclusions: These findings support the notion that "secondary PTG" exists. They also strengthen the theory that growth and distress can co-occur. Finally, the finding that PTG predicted subsequent avoidance symptoms suggests that PTG does not prevent the future development of distress.
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Posttraumatic Growth: Conceptual Foundations and Empirical Evidence
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