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Keeping a healthy distance: Self-differentiation and perceived health among ex-prisoners-of-war's wives

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... 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). ...
... STS symptoms were associated with somatization symptoms among spouses of veterans whom suffered from PTSD in Iran (Kianpoor, Rahmanian, Mojahed, & Amouchie, 2017). Wives of veterans with combat stress reaction suffered from psychiatric and somatic symptoms, six years after their husbands returned from the war (Mikulincer et al., 1995), while wives of former war prisoners reported higher PTSD-symptoms and negative perceived health (Lahav et al., 2016). These studies provide some justification for examining physical health and pain as potential mediating variables in this study analyses. ...
... Additionally, wives who were indirectly exposed to their husbands' war captivity reported low selfdifferentiation and elevated PTSD-symptoms. Selfdifferentiation mediated the relationship between these variables (Lahav et al., 2016). Adult children of former war-prisoners reported low self-differentiation to mediate the association between exposure to stress and STSsymptoms, forty years after their fathers returned from the war (Zerach, 2015). ...
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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.
... This construct refers to an individual approach to the relationship and an individual sense of ideal self-differentiation including the individual's capacity to maintain the relationship while respecting individuality (Peleg, Deutch & Dan, 2016). Self-differentiation has two parts, intrapersonal (a person's ability to distinguish between emotional feelings and rational thoughts) and interpersonal (a person's ability to balance independence and close relationships with others) (Lahav, Stein & Solomon, 2016). Differentiation allows people to maintain their independence and individuality without fear of becoming one while experiencing intimacy in close relationships and maintain or even improve their peace when their partner is anxious (Monaghan Simon, DiPlacido & Conway, 2019). ...
... Since self-differentiation has both cognitive and motivational dimensions, it can be expected to be a suitable mediating variable between family functioning and social interest. Another important point is that the effect of family functioning on social interest can be realized through the mediation of intra-individual and inter-individual variables, and since based on the research of Lahav, et al (2016), self-differentiation has two intra-individual parts (a person's ability to distinguish between emotional feelings and logical thoughts) and Interpersonality (a person's ability to balance independence and close relationships with others), therefore, can act as a suitable mediating variable between them. As a result, the family functioning variable had an indirect and significant effect on social interest through the mediation of self-differentiation. ...
... Malestar psicológico en esposas de exprisioneros de guerra y mujeres veteranas que regresan a la guerra Los autores Lahav et al. (2016) encontraron como resultado del estudio que las esposas de exprisioneros de guerra respaldaron un PTSS más alto, una autodiferenciación más baja y una salud percibida negativa, en comparación con las esposas de control. La exposición indirecta al cautiverio de guerra se relacionó con baja autodiferenciación y PTSS elevado, que predijo la salud percibida negativa. ...
... La teoría sugiere que el desarrollo de esta se produce a través de la relación con el sobreviviente del trauma primario Figley (1986), lo que implica que la capacidad de mantener una distancia emocional equilibrada en la relación puede desempeñar un papel fundamental. No obstante, la contribución de la autodiferenciación a las perturbaciones somáticas secundarias sigue estando, en gran medida, sin investigar.En el estudio realizado porLahav et al. (2016), fueron evaluadas, prospectivamente, 30 (T1) y 38 (T2) años después de la Guerra del Yom Kippur de 1973, las esposas de exprisioneros de guerra (n=143) y las esposas de excombatientes de control (n=102). La autodiferenciación y PTSS se evaluaron en ambos puntos de tiempo, mientras que las medidas de salud percibidas fueron evaluadas en T2. ...
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La violencia, además de considerarse como una condición inherente a las relaciones humanas, también se concibe como un problema de salud pública que afecta significativamente la salud mental de las personas implicadas. De hecho, son varios los estudios que reportan las implicaciones o secuelas psicológicas en combatientes y población civil expuesta a conflictos bélicos o similares que impliquen violencia. Algunas de las cifras exponen que hasta un 30% de las personas expuestas a violencia padecen síndrome de estrés postraumático y depresión, incluso se ha reportado un 100% en poblaciones con una afectación muy significativa (Larizgoitia et al., 2011). Por tanto, el abordaje psicológico, requiere competencias amplias que inscriban un campo de conocimiento inter o transdisciplinar que vincule las cualidades y procesos humanos, sus circunstancias vitales y contextuales en el tiempo y, particularmente, los recursos personales, familiares y comunitarios.
... Malestar psicológico en esposas de exprisioneros de guerra y mujeres veteranas que regresan a la guerra Los autores Lahav et al. (2016) encontraron como resultado del estudio que las esposas de exprisioneros de guerra respaldaron un PTSS más alto, una autodiferenciación más baja y una salud percibida negativa, en comparación con las esposas de control. La exposición indirecta al cautiverio de guerra se relacionó con baja autodiferenciación y PTSS elevado, que predijo la salud percibida negativa. ...
... La teoría sugiere que el desarrollo de esta se produce a través de la relación con el sobreviviente del trauma primario Figley (1986), lo que implica que la capacidad de mantener una distancia emocional equilibrada en la relación puede desempeñar un papel fundamental. No obstante, la contribución de la autodiferenciación a las perturbaciones somáticas secundarias sigue estando, en gran medida, sin investigar.En el estudio realizado porLahav et al. (2016), fueron evaluadas, prospectivamente, 30 (T1) y 38 (T2) años después de la Guerra del Yom Kippur de 1973, las esposas de exprisioneros de guerra (n=143) y las esposas de excombatientes de control (n=102). La autodiferenciación y PTSS se evaluaron en ambos puntos de tiempo, mientras que las medidas de salud percibidas fueron evaluadas en T2. ...
Article
Full-text available
La violencia, además de considerarse como una condición inherente a las relaciones humanas, también se concibe como un problema de salud pública que afecta significativamente la salud mental de las personas implicadas. De hecho, son varios los estudios que reportan las implicaciones o secuelas psicológicas en combatientes y población civil expuesta a conflictos bélicos o similares que impliquen violencia. Algunas de las cifras exponen que hasta un 30% de las personas expuestas a violencia padecen síndrome de estrés postraumático y depresión, incluso se ha reportado un 100% en poblaciones con una afectación muy significativa (Larizgoitia et al., 2011). Por tanto, el abordaje psicológico, requiere competencias amplias que inscriban un campo de conocimiento inter o transdisciplinar que vincule las cualidades y procesos humanos, sus circunstancias vitales y contextuales en el tiempo y, particularmente, los recursos personales, familiares y comunitarios.
... These mental health sequelae may contribute to interpersonal challenges, and survivors are at risk of impaired marital relations, sexual dysfunction, emotional dysregulation, anxious and avoidant attachments, and intimate partner violence (Abu Suhaiban et al., 2019;Kira, 2017;Lahav et al., 2015;Rees et al., 2018;Zerach, 2015). Furthermore, spouses of survivors may experience similar somatic and psychological symptoms, including decreased marital and sexual satisfaction, guilt, and low self-esteem, in addition to secondary trauma symptoms (Lahav et al., 2016(Lahav et al., , 2019. Children of torture survivors may be directly exposed to their parents' psychiatric morbidity and impacted by stressful interactions with them (including negative parental style, or lack of involvement). ...
... For example, it has been tested in Iranian couples (Ghanbarian et al., 2020), Spanish adults (Rodríguez-González et al., 2016, Chinese college students (Lu, 2019;Zhu, 2019), middle-eastern population (Sadeghi et al., 2020), Israeli population (Nicolai et al., 2016) and Chinese adults (Du, 2015). In addition, there were also many cross-disciplinary studies had been done on self-differentiation, such as organizational commitment (Sloan et al., 2017), religion (Frederick et al., 2016), marital conflicts counselling (Karkhaneh et al., 2016), psychological wellness (Lahav et al., 2016;Teixeira & Pereira, 2015), academic commitment (Human-Vogel & Rabe, 2015), social adaptation (Hao, 2020), psychological adjustment (Moral et al., 2021), mental health (Priest, 2017) and parenting (Ragelienė & Justickis, 2016). ...
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Murray Bowen (1978) claimed that the self-differentiation framework is universally applicable even it was developed in the Western culture. This study explores the exceptional cases of two self-differentiation constructs (a) I-position and (b) fusion with others among the Malaysian Chinese Muslim converts from the collectivistic and religious conversion perspective. It is a qualitative phenomenology study that involves five participants. The data collection method is one-to-one in-depth interviews. The interview protocol is a series of semi-structured open-ended questionnaires modified from Lam's study (2005) to explore participants' religious conversion experience and Gomori's Guide Manual (1998) to explore participants' self-differentiation experience. The data analysis method is thematic analysis. This study has shown that the Malaysian Chinese might need pseudo-I-position because of their low self-differentiation, they need another interpretation of the I-position aligned with their cultural context, and in the Islamic perspective, Muslims would regain their functionalities after fusion with God.
... Em relação as implicações negativas nos relacionamentos, níveis mais altos de ETS foram associados significativamente com: menor satisfação no relacionamento conjugal, redução da habilidade de comunicação social, aumento da evitação de pessoas e rupturas nos relacionamentos interpessoais (Bride, 2007;Dekel, Levinstein, Siegel, Fridkin, & Svetlitzky, 2016;Lahav, Stein, & Solomon, 2016;Robinson-Kilig, 2014). Essas alterações também podem estar associadas ao fato de que os parceiros conjugais de pessoas acometidas pelo ETS tendem a apresentar maior nível de sofrimento psíquico, caracterizado por sintomas de estresse pós--traumático ansiedade e depressão (Dekel et al., 2016). ...
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Resumo O Estresse Traumático Secundário caracteriza-se por um conjunto de sintomas e condutas que se manifestam após a exposição indireta ao trauma. Profissionais que cuidam de pessoas traumatizadas estão susceptíveis ao transtorno. Este estudo examinou a estrutura interna da versão brasileira do Cuestionario de Estrés Traumático Secundario. Participaram 624 profissionais da saúde, acessados on-line. Para realização das análises fatoriais, a amostra foi dividida em dois grupos. Na análise exploratória, foram retidos 12 componentes, com cargas fatoriais entre 0,312 e 0,999. Os resultados da análise confirmatória revelaram que o modelo de doze fatores para 50 itens forneceu o melhor ajuste possível para os dados (RMSEA = 0,044; IC = 10%-90%; CFI = 0,949; TLI = 0,904) e índice de consistência interna geral do modelo foi de 0,91. Esses doze fatores foram distribuídos em quatro escalas (Antecedentes, Síndrome de Trauma Secundário, Personalidade e Consequências), com índices psicométricos relativamente baixos e uma nova organização dos itens das escalas do QETS, em contraste com a versão teórica original do instrumento. Sugere-se que novos estudos psicométricos analisem as escalas do questionário, separadamente, e investiguem outras categorias profissionais, especialmente na área dos serviços de emergências, além de estudos comparativos com amostras clínicas.
... For example, in a recent study, the second and third generations of Holocaust survivors reported significantly lower levels of differentiation of self, which were associated with higher levels of secondary traumatic stress (Giladi & Bell, 2013). The few studies that assessed differentiation among war-induced trauma survivors and their relatives demonstrated that low differentiation was related to higher PTSS among ex-POWs (Dekel, 2010;Solomon, Dekel, Zerach, & Horesh, 2009) and the spouses of traumatized veterans (Ben-Arzi, Solomon, & Dekel, 2000), as well as higher levels of somatization among the latter (Lahav, Stein, Levin, & Solomon, 2016). ...
Chapter
This chapter reviews some of the findings of a multi-cohort longitudinal study spanning over three decades, focusing on the secondary post-traumatic stress symptoms among adult offspring of Israeli former prisoners of war (POWs) whose fathers were captured by the Egyptians and Syrians during the 1973 Yom Kippur War. The effects of captivity on the ex-POWs’ mental health and parenting as well as its consequential effects on their offspring are examined in the veterans (fathers), their wives (mothers), and their offspring. The chapter discusses offspring characteristics that may render them vulnerable or resilient: (1) gender; (2) the Big Five personality traits: openness, conscientiousness, extroversion, agreeableness, and neuroticism; and (3) differentiation of self. Findings include the strong intergenerational effects of trauma, particularly on sons; very late–onset results of PTSD in the fathers; the possible mediating effects of parental PTSD; and the role of the offspring’s genetic and personality characteristics.
... For example, in a recent study, the second and third generations of Holocaust survivors reported significantly lower levels of differentiation of self, which were associated with higher levels of secondary traumatic stress [103]. The few studies that assessed differentiation among war induced trauma survivors and their relatives demonstrated that low differentiation was related to higher PTSS among ex-POWs [25,104] and the spouses of traumatized veterans [105], as well as higher levels of somatization among the latter [106]. ...
Article
This article examines of the aftermath of war captivity as implicated in the next (second) generation. Capitalizing on findings from a nearly four-decade and four-wave longitudinal study, we present cumulative evidence regarding the psychological and interpersonal ramifications of war captivity for former Israeli prisoners of war (ex-POWs), and underscore the intergenerational effects of both parents — fathers’/ex-POWs’ experiences and their spouses — on their adult offspring. Taking into consideration the relational context of the family system, the article addresses post-traumatic phenomena manifesting among the offspring as impacted by their fathers’ trauma and post-traumatic stress symptoms, their mothers’ secondary traumatic stress, and the complex interaction of familial sub-systems specifically parental functioning. As not all offspring of the traumatized are equally affected. We also assessed offspring characteristics that may render some of them vulnerable or resilient. These included: (1) gender, (2) “The Big Five” personality traits: Openness, Conscientiousness, Extroversion, Agreeableness, and Neuroticism (3) and differentiation of self. Findings indicate the strong intergenerational effects of trauma, particularly on sons; the mediating effects of parental PTSD; and the role of the offspring's personality characteristics. Clinical implications of the findings are discussed.
... Previous findings also documented a similar effect among relatives of traumatized individuals. Specifically, in a study of ex-prisoners of war and their wives, the wives' PTS symptoms predicted their later physical health (Lahav, Stein, & Solomon, 2016;Zerach, Greene, & Solomon, 2015). Further research is needed to examine whether allostatic load is involved in the etiology and maintenance of the implications of sTBI for close relatives. ...
Article
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.
Article
Objective: Severe Traumatic brain injury (sTBI) is accompanied by significant declines in self-rated health (SRH). Although such deteriorations in SRH are related to various consequences of sTBI, the effect of posttraumatic reactions (i.e., PTS symptoms), has been tested insufficiently to date, especially among civilians. The present investigation is based on Trajectories of Recovery After Severe Traumatic brain injury - Matters In families (TRAST-MI), a unique study among civilians with sTBI and their families. Previous research revealed that civilian sTBI has effects beyond the injured patient, influencing their close relatives as well. The aim of this study was to assess the association between PTS symptoms and SRH among patients with civilian sTBI and their close relatives. Methods: Patients with sTBI (assessed by an abbreviated Injury Scale of the head region [HAIS] > 3) and their close relatives participated in TRAST-MI. One hundred and twenty-six patient-relative dyads were assessed at 3, 6, and 12 months after the injury. Results: Multilevel modeling revealed that patients' PTS symptoms were associated with consequent SRH (Slope=0.42; p<.001), and relatives' PTS symptoms were associated with their respective SRH (Slope=0.2; p=.012). Conclusions: The findings of this study reveal that SRH of both patients with sTBI and their relatives are negatively affected by their own PTS symptoms. These findings underline the understanding that sTBI is not merely a medical trauma, but rather a comprehensive psychosocial trauma, which has consequences for the whole family system.
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Introduction: The relationship between resiliency and marital burnout has received both theoretical and empirical support. However, less is known about the mechanisms by which resiliency may influence marital burnout. Aim: The aim of present study was to investigate the mediating role of self-differentiation in the relationship between resiliency and marital burnout among married women in Tehran. Method: The research design was descriptive– correlational, where, 200 participants selected through available sampling. Couple burnout Scale (CBS), Conner and Davidson Resilience Scale (CD-RISC) and Differentiation of Self Inventory (DSI) were coducted to collect data. Then collected data were analyzed using Pearson correlation and path analysis. Results: Path analysis results showed that resiliency had a significant negative direct effect on marital burnout (P
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Objective: War captivity entails severe post-traumatic implications for ex-POWs and their partners. This study examines the role of self-differentiation in secondary traumatization and dyadic adjustment among ex-POWs’ spouses. Methods: 106 spouses of Israeli ex-POWs and 56 matched spouses of ex-combatants completed self-report questionnaires assessing secondary PTSD symptoms (SPS), self-differentiation (fusion, cut-off, balanced), general psychiatric distress (GPD) and dyadic adjustment. Results: Ex-POWs' spouses reported lower dyadic adjustment and higher levels of SPS, GPD, and fusion and cut-off differentiation, compared to ex-combatants' spouses. A “mixed” differentiation style characterized by high levels of both fusion and cut-off was associated with particularly high distress levels. Fusion differentiation moderated the association between SPS/GPD and dyadic adjustment. Conclusion: Self-differentiation plays an important role in post-traumatic spousal relationships. Women showing unstable differentiation may be particularly vulnerable when living with a veteran. Treatments for post-traumatic couples should target dysregulated interpersonal distance and promote adaptive differentiation.
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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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A longitudinal life span model of factors contributing to later-life positive adjustment was tested on 567 American repatriated prisoners from the Vietnam War. This model encompassed demographics at time of capture and attributes assessed after return to the United States (reports of torture and mental distress) and approximately three decades later (later-life stressors, perceived social support, positive appraisal of military experiences, and positive adjustment). Age and education at time of capture and physical torture were associated with repatriation mental distress, which directly predicted poorer adjustment 30 years later. Physical torture also had a salutary effect, enhancing later-life positive appraisal of military experiences. Later-life events were directly and indirectly (through concerns about retirement) associated with positive adjustment. Results suggest that the personal resources of older age and more education and early-life adverse experiences can have cascading effects over the life span to impact well-being in both positive and negative ways.
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HEALTH-related quality of life (HRQL) is increasingly used as an outcome in clinical trials, effectiveness research, and research on quality of care. Factors that have facilitated this increased usage include the accumulating evidence that measures of HRQL are valid and "reliable,"1 the publication of several large clinical trials showing that these outcome measures are responsive to important clinical changes,2-5 and the successful development and testing of shorter instruments that are easier to understand and administer.6-13 Because these measures describe or characterize what the patient has experienced as the result of medical care, they are useful and important supplements to traditional physiological or biological measures of health status. Given this improved ability to assess patients' health status, how can physicians and health care systems intervene to improve HRQL? Implicit in the use of measures of HRQL in clinical trials and in effectiveness research is the concept that clinical
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The aversive impact of combat and parents' combat-induced posttraumatic stress disorder on young children has been examined in a few studies. However, the long-term toll of war captivity on secondary traumatization (ST) and the mediating role of differentiation of the self remain unknown. This study examined ST symptoms and differentiation of the self (DS) among adult children of former prisoners of war (ex-POW's children) who were compared with adult children of comparable veterans (controls' children). Furthermore, I examined the mediating role of DS dimensions in the association between exposure to stress and ST symptoms. Participants were Israeli ex-POW's children (n = 98) and controls' children (n = 90), whose fathers fought in the 1973 Yom Kippur War. Results showed that ex-POW's children reported a higher number of ST symptoms and lower levels of emotional cutoff differentiation compared with controls' children. Emotional cutoff was also found to mediate the association between research group and ST symptoms. Among ex-POW's children, emotional cutoff and emotional reactivity dimensions mediated the association between exposure to stress stemming from fathers' behaviors and ST symptoms. Forty years after the war ended, the experience of living with ex-POWs is associated with ex-POW's children ST symptoms. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
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Differentiation of self involves the capacity to modulate affect, maintain a clear sense of self, and balance intimacy and autonomy in significant relationships. Given the central role of family relationships for individual functioning, the authors tested whether differentiation mediated or moderated relations between college stress and personal adjustment. Differentiation of self partially mediated effects of academic and financial stress and exerted a direct influence on adjustment. Limitations, directions for future research, and implications for counseling are discussed.
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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.
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Reports an error in "The Differentiation of Self Inventory: Development and initial validation" by Elizabeth A. Skowron and Myrna L. Friedlander (Journal of Counseling Psychology, 1998[Jul], Vol 45[3], 235-246). In the January 1998 edition of the Journal of Counseling Psychology (Volume 45, Number 3, p. 246), the key to the Appendix was printed incorrectly. Please see the attached errata for further information. (The following abstract of the original article appeared in record 1998-04269-001.) Despite the importance of Bowen theory (M. Bowen, 1976,1978; M. E. Kerr & Bowen, 1988) in the field of family therapy, there have been relatively few studies to date examining its constructs or propositions. To fill this gap, a self-report instrument, the Differentiation of Self Inventory (DSI) has been developed. The DSI is a multidimensional measure of differentiation that focuses specifically on adults (age 25+), their significant relationships, and current relations with family of origin. Six-hundred and nine adults participated in a series of 3 studies, in which DSI scores—reflecting less emotional reactivity, cutoff, and fusion with others, and a greater ability to take an "I position"—predicted lower chronic anxiety, better psychological adjustment, and greater marital satisfaction. Other results consistent with Bowen theory are discussed, along with the potential contribution of the DSI for testing Bowen theory, as a clinical assessment tool, and as an indicator of psychotherapeutic outcome. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Recent psychotherapy research has investigated the physical reactions of therapists to their clients and the potential utility of these reactions in therapeutic settings. These bodily reactions can range from nausea and genital pain to headaches. They are collectively known as body-centred counter-transference. The current exploratory study used the Egan and Carr (2005) body-centred counter-transference scale to assess the frequency of body-centred counter-transference in a sample of Irish clinical Psychologists (N = 87). The study looked at the relationship between body-centred counter-transference and a variety of other variables (age, number of children, years' post-qualification experience, sick leave, marital status, client session hours per week, clinical supervision, primary client group and therapeutic orientation). The study found no relationship between body-centred counter-transference and any of these variables (p > .05). However, it may be the individual manner in which a therapist engages with and manages the counter-transference manifestation that will determine the effects on the therapist and the therapy.
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Statistical procedures for missing data have vastly improved, yet misconception and unsound practice still abound. The authors frame the missing-data problem, review methods, offer advice, and raise issues that remain unresolved. They clear up common misunderstandings regarding the missing at random (MAR) concept. They summarize the evidence against older procedures and, with few exceptions, discourage their use. They present, in both technical and practical language, 2 general approaches that come highly recommended: maximum likelihood (ML) and Bayesian multiple imputation (MI). Newer developments are discussed, including some for dealing with missing data that are not MAR. Although not yet in the mainstream, these procedures may eventually extend the ML and MI methods that currently represent the state of the art. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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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.
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[Correction Notice: An erratum for this article was reported in Vol 56(4) of Journal of Counseling Psychology (see record 2009-18895-011). In the January 1998 edition of the Journal of Counseling Psychology (Volume 45, Number 3, p. 246), the key to the Appendix was printed incorrectly. Please see the attached errata for further information.] Despite the importance of Bowen theory (M. Bowen, 1976,1978; M. E. Kerr & Bowen, 1988) in the field of family therapy, there have been relatively few studies to date examining its constructs or propositions. To fill this gap, a self-report instrument, the Differentiation of Self Inventory (DSI) has been developed. The DSI is a multidimensional measure of differentiation that focuses specifically on adults (age 25+), their significant relationships, and current relations with family of origin. Six-hundred and nine adults participated in a series of 3 studies, in which DSI scores—reflecting less emotional reactivity, cutoff, and fusion with others, and a greater ability to take an "I position"—predicted lower chronic anxiety, better psychological adjustment, and greater marital satisfaction. Other results consistent with Bowen theory are discussed, along with the potential contribution of the DSI for testing Bowen theory, as a clinical assessment tool, and as an indicator of psychotherapeutic outcome. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The study tested several propositions about an important construct in Bowen's theory of differentiation of self, using an Israeli sample of university students to examine relationships between differentiation of self, social anxiety, and physiological symptoms. The main finding was that family differentiation was negatively correlated with social anxiety (particularly fear of negative evaluation) and physiological symptoms. Results suggest that differentiation is a meaningful construct for Israeli students, and that less differentiated students may be at risk for high levels of social anxiety and symptomatology. They also suggest that therapists should consider various aspects of differentiation when treating a client's social anxiety.
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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.
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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.
Chapter
United States military prisoners of war (POW) held in Southeast Asia from 1964 through 1973 were held longer than any previous group of American POWs—an average of 5 years, compared to the 3 years for World War II POWs, 2 years for those held in North Korea during the late 1950s, and approximately a year for the Pueblo crew (1960s). Those men held the longest in Southeast Asia were imprisoned there for almost 9 years.
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Despite considerable research indicating that spouses of veterans with posttraumatic stress disorder (PTSD) experience appreciable levels of psychological and marital distress, there is little empirical information about the mechanisms by which this distress develops. Given the ongoing military conflicts in Iraq and Afghanistan, and the fact that spouses form a primary support for combat veterans who return from deployments with symptoms of PTSD, a more comprehensive understanding of such mechanisms is critical. In this chapter, we review research that helps explain spouses’ distress from a cognitive-behavioral framework. Relevant veteran behaviors include internalizing behaviors (e.g., emotional withdrawal and avoidance) and externalizing behaviors (e.g., verbal and physical aggression). Although less research exists regarding spousal factors that may contribute to their distress, we review existing knowledge about spouse behaviors (e.g., accommodation of veterans’ symptoms) and cognitions (e.g., perceptions of burden and attributions for veterans’ symptoms). Finally, we provide recommendations for future research in this area.
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A study of POW wives indicates that they are often in need of psychiatric help and that such help is reluctantly offered. Severe, progressive psychological and psychophysiological symptoms are common. Psychological issues centered on themes of desertion, ambiguity of role, repressed anger, sexuality, censure, and social isolation. Separation anxiety, role distortion, and sleep disorders were common in the children; male children were more significantly affected than female children. Recommendations for therapy and rehabilitation of the POW family are made.
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This study explored secondary traumatization among wives of former POWs. Forgiveness and self-differentiation were investigated for their role in wives'mental and marital distress. Participants included wives (N = 82) of former Israeli POWs (18 with PTSD [posttraumatic stress disorder] and 64 without PTSD) and a control group of 72 women whose husbands fought in the war but who were neither POWs nor suffered from PTSD. Compared to the other two groups, wives of former POWs with PTSD reported lower couple forgiveness and self-differentiation. High self-differentiation predicted low emotional and marital distress, whereas high couple forgiveness reduced only marital distress. Self-differentiation moderated the relationships between couple forgiveness and both types of distress. Findings highlight the challenges women face when living with partners with PTSD.
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We investigated the relationships between secondary traumatization, marital adjustment, and self-rated health among wives of former prisoners of war. Participants were Israeli wives of former prisoners of war (N = 116) and a matched control group of wives of combat veterans (N = 56). Wives of former prisoners of war reported worse self-rated health compared to the control group of wives of combat veterans. Wives of former prisoners of war also reported higher levels of secondary traumatization, and marital adjustment moderated the relationship between wives' secondary traumatization and their general health. The experience of living with former prisoners of war who might also suffer from posttraumatic stress disorder is associated with wives' own psychological and self-rated health outcomes.
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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.
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We present the findings from a qualitative study examining the marital perceptions of 9 wives of veterans with posttraumatic stress disorder (PTSD). Data were from a semistructured in-depth focus group interview. Findings reveal how the lives of these women largely revolved around their husbands’ illness. The wives faced constant tension between being drawn into a fusion with their husbands and the struggle to maintain their independence. In addition, the wives identified positive aspects of the marital relationship that granted them strength for current and future coping. Implications for practice are included.
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Differentiation of self from the family of origin is thought to be a significant factor in psychological functioning. Bowen contended that the effects of stress are moderated by differentiation of self, such that high levels of stress would have more impact on individuals lower in differentiation as compared to individuals higher in differentiation in predicting dysfunction. We tested this hypothesis and also assessed the relations among stress, coping, differentiation of self, and dysfunction. Results provided support for Bowen's prediction; differentiation indeed moderated the effects of perceived stress in predicting psychological functioning in expected ways. The interaction of differentiation of self and stress predicted variance in functioning beyond what was accounted for by coping styles, suggesting that although coping and differentiation of self are related, they are not synonymous.
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This review of the literature reveals that veterans' posttraumatic stress disorder (PTSD) following exposure to combat violence affects veterans' familial relationships and the psychological adjustment of family members. Previous study within other trauma populations has conceptualized the negative impact of an individual's traumatic stress on his/her family members as “secondary traumatization.” This review examines the processes by which secondary traumatization occurs within combat veterans' families. Research has identified PTSD as mediating the effect of veterans' combat experience on the family. Veterans' numbing/arousal symptoms are especially predictive of family distress; while, to a lesser extent, veterans' anger is also associated with troubled family relationships and secondary traumatization among family members. Empirical modeling of additional factors involved in secondary traumatization is needed. Marital/family interventions have largely focused on improving relationships and reducing veterans' symptoms, rather than targeting improvements in the psychological well-being of the spouse and children. Interventions directly addressing the needs of significant others, especially spouses, are advocated. The potential for increased effectiveness of PTSD interventions and possible cost-savings attained by improving relationships and reducing caregiver burden are also discussed.
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Presented here is a family theory of emotional illness and its component system of family psychotherapy, which is one of several different theoretical approaches to the family, and one of many different kinds of “family therapy” that have come on the psychiatric scene in little more than one decade. A brief review of the family movement attempts to put this system into a kind of perspective with the overall family movement. Since this system places maximum emphasis on “family” as a theoretical system, the theory has been presented in some detail. The shorter section of family psychotherapy presents both broad principles and specific details about the usefulness of family concepts in clinical practice.
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Hypotheses involving mediation are common in the behavioral sciences. Mediation exists when a predictor affects a dependent variable indirectly through at least one intervening variable, or mediator. Methods to assess mediation involving multiple simultaneous mediators have received little attention in the methodological literature despite a clear need. We provide an overview of simple and multiple mediation and explore three approaches that can be used to investigate indirect processes, as well as methods for contrasting two or more mediators within a single model. We present an illustrative example, assessing and contrasting potential mediators of the relationship between the helpfulness of socialization agents and job satisfaction. We also provide SAS and SPSS macros, as well as Mplus and LISREL syntax, to facilitate the use of these methods in applications.
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While the long-term effects of combat trauma on veterans have been studied extensively, its impact on veterans' wives has yet to be investigated. This study examined the implications of combat-induced psychopathology--wartime combat stress reaction (CSR) and current posttraumatic stress disorder (PTSD)--in a sample of 205 wives of Israeli combat veterans of the 1982 Lebanon war. Results show that both CSR and PTSD were associated with increased psychiatric symptoms in the wives. In addition, current PTSD was particularly found to contribute to impaired social relations among veterans' wives in a broad range of contexts, from inner feelings of loneliness, through impaired marital and family relations, and extending to the wider social network. Implications of these findings for treatment and further research are discussed.
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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.
Article
The authors have encountered many troubled and symptomatic children whose fathers are being treated for PTSD(Posttraumatic stress disorder). They call this process secondary traumatization to indicate the relationship between the fathers' war experience and subsequent stress disorder and their children's problems. The following case report describes a child with symptoms of secondary traumatization.
Article
To characterize incidence of illnesses and injuries from 1979 to 1993 in former naval aviator prisoners of war (POWs) from the Vietnam War and a comparison group of naval aviators from the same war. Cohort analytic study. A US Navy primary care clinic. Volunteer sample consisting of 70 former naval aviator POWs (white men, aged 47 to 69 years in 1993) and a comparison group of 55 naval aviators who served in Vietnam but were not POWs, matched on race, age, marital status, education, rank, year of entry into the navy, and pilot status. Subjects participated in an annual health screening program. This study reports data sampled on a biennial basis from subjects screening both in 1979 and 1993. Medically diagnosed incidence of illness and injury based on a standard protocol. POWs had higher incidence rates than the comparison group did of disorders of the peripheral nervous system (relative risk [RR], 8.4; 95% confidence interval [CI], 2.7-25.9; P<.001), joints (RR, 1.5; 95% CI, 1.2-2.0; P<.006), and back RR, 1.8; 5% CI, 1.0-3.0; P<.037). These findings also were statistically significant according to Kaplan-Meier survival analyses that included 131 (95%) of 138 POWs and 115 (83%) of the 138 members of the comparison group. Survival analyses revealed that, in addition to these disorders, POWs had higher hazard rates of peptic ulcer (P<.01). During captivity, ropes, ratchet handcuffs, leg irons, or stocks were used to put tightly constrictive pressure around the extremities of POWs as a means of torture, resulting in painful ischemia and subsequent neuropathies. Being a former POW was associated with increased cumulative incidence rates of chronic disorders of the peripheral nervous system, joints, and back and an increased hazard rate of peptic ulcer.
Article
Caregiver burden in 58 partners of Vietnam veterans with posttraumatic stress disorder (PTSD) was examined. The relationship between patient PTSD severity and caregiver burden, as well as the effect of several caregiver and patient variables on caregiver psychological status, was evaluated twice, an average of 8 months apart. Patient symptom severity was positively correlated with caregiver burden. Time 1 cross-sectional analysis indicated that greater caregiver burden was associated with greater caregiver psychological distress, dysphoria, and anxiety. Patient symptom severity also contributed to caregiver psychological distress; financial stress contributed to caregiver dysphoria and trait anxiety. Time 2 cross-sectional analyses essentially replicated the Time 1 findings. A third set of analyses examining change scores indicated that changes in caregiver burden for individuals in the sample positively predicted individual changes in caregiver psychological distress, dysphoria, and state anxiety.
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Adaptation in the face of potentially stressful challenges involves activation of neural, neuroendocrine and neuroendocrine-immune mechanisms. This has been called "allostasis" or "stability through change" by Sterling and Eyer (Fisher S., Reason J. (eds): Handbook of Life Stress, Cognition and Health. J. Wiley Ltd. 1988, p. 631), and allostasis is an essential component of maintaining homeostasis. When these adaptive systems are turned on and turned off again efficiently and not too frequently, the body is able to cope effectively with challenges that it might not otherwise survive. However, there are a number of circumstances in which allostatic systems may either be overstimulated or not perform normally, and this condition has been termed "allostatic load" or the price of adaptation (McEwen and Stellar, Arch. Int. Med. 1993; 153: 2093.). Allostatic load can lead to disease over long periods. Types of allostatic load include (1) frequent activation of allostatic systems; (2) failure to shut off allostatic activity after stress; (3) inadequate response of allostatic systems leading to elevated activity of other, normally counter-regulated allostatic systems after stress. Examples will be given for each type of allostatic load from research pertaining to autonomic, CNS, neuroendocrine, and immune system activity. The relationship of allostatic load to genetic and developmental predispositions to disease is also considered.