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Secondary Traumatization and Differentiation Among the Wives of Former POWs: A Reciprocal Association: Secondary Traumatization and Differentiation
Abstract
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.
... 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). Furthermore, a mutual association was found over time between self-differentiation and PTSD-symptoms, in which low self-differentiation predicted higher PTSD-symptoms and vice versa (Lahav, Levin, Bensimon, Kanat-Maymon, & Solomon, 2017). ...
... Self-differentiation, thought to be a stable feature, which could be changed through intervention (Bowen, 1978), enhanced with increased intimacy (Rizkalla & Rahav, 2016), and undermined by trauma exposure (Dekel, 2010;Lahav et al., 2017), PTSD-symptoms (Lahav et al., 2019(Lahav et al., , 2016, and poor wellbeing (Jankowski & Sandage, 2012;Skowron & Friedlander, 1998). Selfdifferentiation's role as a protective factor in this study's findings, a mediator between positive and negative outcomes, was supported in the literature with findings of its mediation of the associations between stress exposure and STS-symptoms (Zerach, 2015) and wellbeing (Jankowski & Sandage, 2012), perceived psychological distress (Krycak et al., 2012) and indirect exposure to war captivity and perceived health (Lahav et al., 2016). ...
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.
... These associations were adjusted also for other war-veteran risk factors, such as severity of combat exposure, involvement in the harming civilians and/or prisoners, and prewar vulnerability for psychological problems. Lahav et al. [20] studied whether or not (i) the moderating influences of indirect exposure to captivity in the association between husbands' posttraumatic symptoms and wives' posttraumatic symptoms and differentiation; and (ii) the observed directionality of the association between wives' differentiation and posttraumatic symptoms were altered over time. They observed an effect of indirect exposure to captivity that moderated the associations between husbands' posttraumatic symptoms and wives' posttraumatic symptoms, as well as an association between the wives' differentiation and PTSS over time that was bidirectional, suggesting a "vicious cycle" between posttraumatic symptoms and differentiation. ...
... Severity of PTSD symptom profiles were additionally observed to be connected to impaired psycho-social functioning implying that traumarelated mental health problems may elevates the risk for povertymisery and preclusion of well-being prospects that aggravate further the consequences of war and conflict. A longitudinal study performed 30 and 38 years following the Yom Kippur war in the middle-east indicated that the wives of ex-POWs endorsed higher PTSS compared to wives of controls [20]. Wives of ex-POWs with PTSD expressed greater levels of posttraumatic stress symptoms and higher attachment avoidance behavior compared with wives of ex-POWs exhibiting PTSD and a control group with associations between posttraumatic stress symptoms and attachment insecurities. ...
... Studies conducted among the same sample of ex-POWs' wives also found that low self-differentiation predicted high distress (e.g., [26]). Furthermore, a mutual association between self-differentiation and PTSS was found over time, whereby low self-differentiation predicted higher PTSS and vice versa [33]. ...
... The implications of wives' self-differentiation might have a unique contribution in explaining perceived health. Moreover, the mutual association between self-differentiation and PTSS [33] suggests that self-differentiation might complementarily act as a mechanism which operates alongside PTSS. In light of the realizations above, we hypothesize the following: ...
... Many studies assessed factors that predict the level of PTSD symptoms or presence of probable PTSD among family members. Higher levels of PTSD symptoms or presence of probable PTSD among informal supporters in military samples appeared to be significantly and positively associated with partner's suicidal ideation , presence of PTSD or PTSD severity in survivor (Ahmadi et al., 201;Bramsen et al., 2002;Dekel et al., 2016Dekel et al., , 2018Dirkzwager et al., 2005;Greene et al., 2014;Koić et al., 2002;Mohammadi et al., 2018), duration of survivor's symptoms (Ahmadi et al., 2011), degree of exposure to survivor physical aggression (Dekel & Solomon, 2006), level of affective empathy (Dekel et al., 2018), partner's own trauma history (Al-Turkait & Ohaeri, 2008;Dekel et al., 2018), partner's fusion with the survivor (Dekel, 2010;Lahav et al., 2017), partner's anxious and avoidant attachment (Ein-Dor et al., 2010;Lahav et al., 2016), partner's feelings of ambiguous loss (Dekel et al., 2016), and length of marriage (Frančišković et al., 2007). Only two studies of military couples found that veterans' trauma history was not associated with partner's PTSD symptom levels (Wolf et al., 2013) or presence of probable PTSD in partners (Al-Turkait & Ohaeri, 2008). ...
The present narrative review examined quantitative and qualitative research on family members who support survivors of trauma or abuse. Studies included in the present review were found in peer-reviewed journal articles, available in English, published between 1980 and 2019, and focused specifically on the experiences of adult familial supporters of adult trauma and abuse survivors. A search of PsychInfo and Google Scholar identified 136 relevant articles, and analysis of their content generated the following categories: individual-level impacts (i.e., quality of psychological health, burden, secondary traumatic stress, quality of physical health, and positive impacts), interpersonal and environmental level impacts (i.e., quality of relationships with survivors, navigating environment, maltreatment and safety, and social impacts), and other experiences (i.e., social roles, needs, coping strategies, and sociocultural context). Findings indicate that the majority of existing studies examined the experiences of family members of adult survivors of military trauma. Results of the review suggest that family supporters of adult trauma and abuse survivors generally experience physical, emotional, cognitive, behavioral, social, safety, and relational impacts. Implications of review findings and directions for future research are discussed.
... Bensimon, Kanat-Maymon, & Solomon, 2017;Zerach et al., 2015), it seems to be somewhat disregarded from the TBI literature. The current findings provide initial evidence for this phenomenon among close relatives of individuals who sustained a sTBI. ...
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.
Background
Spouses of ex-combatants often experience psychological distress due to sharing their lives with a partner who endured traumatic experiences, a phenomenon known as “secondary traumatization”. Self-differentiation is the emotional distance one takes, while keeping an amount of togetherness with significant others. The couple's relationship and self-differentiation can impact the manner and expanse of secondary traumatization experienced by the spouse.
Objective
This study aimed to examine the role of marital adjustment and self-differentiation (an enmeshed vs detached differentiation style), in secondary traumatization among spouses of ex-combatants.
Methods
This study is part of a longitudinal study examining psychological implications of war among Israeli ex-combatants and their spouses. Overall, 267 spouses have been assessed three times (2003;2011;2016). Participants completed self-report questionnaires evaluating secondary PTSD (SPS), general psychiatric distress (GPD), self-differentiation and dyadic adjustment (DAS). Cross-path models were used to assess associations between the variables longitudinally.
Results
Associations were found between both self-differentiation and dyadic adjustment and SPS and GPD. Path models showed that fusion\cutoff differentiation predicted more SPS\GPD over time and vice-versa. Furthermore, dyadic adjustment mediated the association between fusion\cutoff differentiation and SPS\GPD. In other words, fusion\cutoff differentiation in time 1 predicted dyadic adjustment in time 2, which in turn predicted SPS\GPD in time 3.
Conclusions
Our results can be interpreted in conjunction with original theories about secondary traumatization, emphasizing the importance of keeping a balanced emotional distance in the marital relationship as a way of reducing distress and PTSD symptoms following traumatic events.
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.
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.
Spouses of former prisoners-of-war (ex-POWs) are at risk for Posttraumatic Stress Symptoms (PTSS) and marital distress. This longitudinal study assessed the implications of PTSS and self-differentiation in sexual satisfaction among 90 ex-POWs' spouses and 75 matched combatants' spouses of the 1973 Yom-Kippur War. Standardized questionnaires were used. Ex-POWs' spouses had elevated PTSS and imbalanced self-differentiation. PTSS were associated with poorer self-differentiation and lower sexual satisfaction. Imbalanced self-differentiation mediated the association between PTSS and sexual satisfaction. The findings imply that PTSS and imbalanced self-differentiation contribute to low sexual satisfaction among spouses of primary trauma survivors.
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).
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
The current study explored whether differentiation of self and family communication styles were protective factors of secondary traumatic stress (STS). A sample of 215 Jewish Americans/Canadians whose families emigrated from Europe prior to or after World War II completed an online survey consisting of self-report measures. Four groups were created based on the participants' Holocaust background and demographics: Second generation (2G; n = 77) and third generation (3G; n = 52), who self identified as having at least one parent or grandparent, respectively, who is/was a Holocaust survivor, and a matched control group for each generation (n = 50; n = 36, respectively) consisting of Jewish Americans/Canadians of European descent with no direct relatives who were Holocaust survivors. 2G and 3G referenced the Holocaust as the traumatic event on the STS measure, while the control group referenced non-Holocaust events. Results showed that levels of STS were generally within the normal range for all groups; however, 2G and 3G reported significantly higher levels of STS, lower levels of differentiation of self, and poorer family communication compared to their control groups. Greater differentiation of self and better family communication were associated with lower levels of STS. Differences between groups were consistent with other studies suggesting a mixture of resilience and vulnerability factors among 2G and 3G.
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.
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)
The assessment of mediation in dyadic data is an important issue if researchers are to test process models. Using an extended version of the actor–partner interdependence model the estimation and testing of mediation is complex, especially when dyad members are distinguishable (e.g., heterosexual couples). We show how the complexity of the model can be reduced by assuming specific dyadic patterns. Using structural equation modeling, we demonstrate how specific mediating effects and contrasts among effects can be tested by phantom models that permit point and bootstrap interval estimates. We illustrate the assessment of mediation and the strategies to simplify the model using data from heterosexual couples.
The PTSD Inventory, a self-report diagnostic questionnaire based on DSM-III criteria, was revised to meet the more recent DSM-III-R criteria. This study examined the validity of the revised inventory relative to a structured clinical interview (SCID) and the Impact of Events Scale (IES). Results showed a high degree of concordance between the instruments, supporting the use of the more standardized, easy to administer and economical PTSD Inventory.
Long-term responses to captivity trauma were measured in a national sample of American former prisoners of war. Their responses included negative affect, positive affect, and somatic symptoms as assessed by the Cornell Medical Index in 1967 and the Center for Epidemiological Study Depression Scale in 1985. These responses were strongly associated with captivity trauma (as indexed by captivity weight loss, torture, and disease) and resilience (as indexed by age and education at capture). Symptoms reported in 1967 were related to symptoms reported in 1985, suggesting symptom stability. These results are consistent with a model of trauma response that incorporates both trauma exposure and individual resilience. The findings are interpreted within a theoretical view of trauma response as adaptive when viewed from an evolutionary perspective.
This study has two aims. First, it assesses the implication of husbands' post-traumatic stress disorder (PTSD) and post-concussion syndrome (PC) on their wives' sense of burden and emotional distress. The second aim was to examine the implication of the women's separation-individuation on their adjustment. Sixty women participated in study: 20 women married to war veterans diagnosed as suffering to PTSD, 20 women married to war veterans suffering from PC, and 20 women married to healthy controls. Data was collected using self report questionnaires assessing psychiatric symptomatology, caregiver burden and psychological separation-individuation. Results indicate that women from both research groups suffer from higher levels of burden and distress than controls. The level of separation-individuation was found to be correlated to levels of burden and distress. The complex implications of living with a traumatized spouse are discussed.
Two classes of modern missing data procedures, maximum likelihood (ML) and multiple imputation (MI), tend to yield similar results when implemented in comparable ways. In either approach, it is possible to include auxiliary variables solely for the purpose of improving the missing data procedure. A simulation was presented to assess the potential costs and benefits of a restrictive strategy, which makes minimal use of auxiliary variables, versus an inclusive strategy, which makes liberal use of such variables. The simulation showed that the inclusive strategy is to be greatly preferred. With an inclusive strategy not only is there a reduced chance of inadvertently omitting an important cause of missingness, there is also the possibility of noticeable gains in terms of increased efficiency and reduced bias, with only minor costs. As implemented in currently available software, the ML approach tends to encourage the use of a restrictive strategy, whereas the MI approach makes it relatively simple to use an inclusive strategy.
We investigated relationships among prewar, wartime, and postwar factors and posttraumatic stress disorder (PTSD) severity in a community sample of 160 former prisoners of war (POWs). Data were collected from structured clinical interviews, self-report questionnaires, and military service records. POW camp trauma was most predictive of PTSD severity, followed by a refined postwar Social Support variable: Interpersonal Connection. Prewar conduct disorder behavior was positively predictive of PTSD and negatively predictive of Interpersonal Connection. Combat exposure and age at capture were also predictive of PTSD. Prewar family closeness was not a significant predictor of PTSD but was predictive of postwar Interpersonal Connection. This study provides further empirical evidence that trauma, when sufficiently severe, is the most significant predictor of PTSD severity.
In this study, the authors examined the marital adjustment, spousal aggression, and sexual satisfaction of prisoners of war (POWs) 3 decades after their release. More specifically, the authors examined the extent to which impaired marital relations among former POWs are an outcome of their captivity or of the posttraumatic stress disorder (PTSD) that some of them developed. The authors compared 25 former POWs with PTSD, 85 former POWs without PTSD, and 104 control veterans. The findings reveal that the marital problems of former POWs are more related to PTSD than to their captivity. PTSD is related to decreased marital satisfaction, increased verbal aggression, and heightened sexual dissatisfaction among former POWs.
This study examined the association of posttraumatic stress disorder (PTSD) with the quality of intimate relationships among present-day male World War II ex-prisoners of war (POWs). Ex-POWs had considerable marital stability; those with PTSD were no less likely to be in an intimate relationship. Ex-POWs in an intimate relationship who had PTSD (N=125 ) were compared with ex-POWs in a relationship who did not have PTSD (N=206). Marital functioning was within a range expected for persons without traumatic exposure. Yet, over 30% of those with PTSD reported relationship problems compared with only 11% of those without PTSD. Ex-POWs with PTSD reported poorer adjustment and communication with their partners and more difficulties with intimacy. Emotional numbing was significantly associated with relationship difficulties independent of other symptom complexes and severity of PTSD. Implications for clinical practice are discussed.
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.
Objectives:
To assess the long-term effects of the prisoner of war (POW) experience on U.S. World War II (WWII) veterans.
Design:
Exploratory study.
Setting:
Participants were recruited through the Hines Veterans Affairs Hospital; a POW reunion in Orlando, Florida; and the WWII veterans periodical, "The QUAN."
Participants:
One hundred fifty-seven American military veterans who were former WWII POWs.
Measurments:
Participants completed a mailed survey describing their POW experiences, POW effects on subsequent psychological and physical well-being, and ways in which these experiences shaped major decisions in their lives.
Results:
Participants from the European and Pacific theaters reported that their captivity during WWII affected their long-term emotional well-being. Both groups reported high rates of reflection, dreaming, and flashbacks pertaining to their POW experiences, but Pacific theater POWs did so at higher rates in the present than in the past. Large portions of both groups reported greater rumination on POW experiences after retirement. Finally, 16.6% of participants met the requirements of a current, clinical diagnosis of posttraumatic stress disorder (PTSD) based on the Mississippi PTSD scale, with PTSD rates in Pacific theater POWs (34%) three times those of European theater POWs (12%).
Conclusion:
Traumatic memories and clinical levels of PTSD persist for WWII POWs as long as 65 years after their captivity. Additionally, rumination about these experiences, including flashbacks and persistent nightmares, may increase after retirement, particularly for those held in the Pacific theater. These findings inform the current therapeutic needs of this elderly population and future generations of POWs from other military conflicts.
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.
It is argued that P-values and the tests based upon them give unsatisfactory results, especially in large samples. It is shown that, in regression, when there are many candidate independent variables, standard variable selection procedures can give very misleading results. Also, by selecting a single model, they ignore model uncertainty and so underestimate the uncertainty about quantities of interest. The Bayesian approach to hypothesis testing, model selection, and accounting for model uncertainty is presented. Implementing this is straightforward through the use of the simple and accurate BIC approximation, and it can be done using the output from standard software. Specific results are presented for most of the types of model commonly used in sociology. It is shown that this approach overcomes the difficulties with P-values and standard model selection procedures based on them. It also allows easy comparison of nonnested models, and permits the quantification of the evidence for a null hypothesis of interest, such as a convergence theory or a hypothesis about societal norms.
Evidence suggests that posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are associated with poorer physical health among U.S. veterans who served in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF). No research of which we are aware has examined the independent and interactive effects of PTSD and SUD on medical comorbidity among OEF/OIF veterans. This cross-sectional study examined medical record data of female and male OEF/OIF veterans with ≥ 2 Veterans Affairs primary care visits (N = 73,720). Gender-stratified logistic regression analyses, adjusted for sociodemographic factors, were used to examine the association of PTSD, SUD, and their interaction on the odds of medical diagnoses. PTSD was associated with increased odds of medical diagnoses in 9 of the 11 medical categories among both women and men, range of odds ratios (ORs) ranged from 1.07 to 2.29. Substance use disorders were associated with increased odds of 2 of the 11 medical categories among women and 3 of the 11 medical categories among men; ORs ranged from 1.20 to 1.74. No significant interactions between PTSD and SUD were detected for women or men. Overall, findings suggest that PTSD had a stronger association with medical comorbidity (in total and across various medical condition categories) than SUD among female and male OEF/OIF veterans.
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.
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.
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.
Differentiation of self is a concept that has been used interchangeably with the similar concepts of individuation and psychological differentiation. The construction of a sound empirical knowledge base for differentiation of self has been hindered by the lack of conceptual-operational fit found in many studies. Using a modification of the concept analysis approach proposed by Walker and Avant (1988), a detailed description of differentiation of self is presented, delineating it from similar concepts. Differentiation of self is defined as the ability to distinguish between thoughts and feelings in an emotional relationship system. As the cornerstone concept in the Bowen theory (1985b), knowledge about differentiation of self has important clinical implications for nurses and other health professionals who strive to improve the assessment and intervention process in their work with individuals and families.
This study examined the relationship between posttraumatic stress (PTS) symptoms and particular aspects of emotion regulation difficulties among trauma-exposed individuals. Participants were an ethnically diverse sample of 108 undergraduates from an urban university. PTS symptom severity was found to be associated with lack of emotional acceptance, difficulty engaging in goal-directed behavior when upset, impulse-control difficulties, limited access to effective emotion regulation strategies, and lack of emotional clarity. Further, overall difficulties in emotion regulation were associated with PTS symptom severity, controlling for negative affect. Finally, individuals exhibiting PTS symptoms indicative of a PTSD diagnosis reported greater difficulties with emotion regulation than those reporting PTS symptoms at a subthreshold level. The implications of these findings for research and treatment are discussed.
PROCESS: A versatile computational tool for observed variable mediation moderation and conditional process modeling
- A F Hayes
Hayes, A. F. (2012). PROCESS: A versatile computational tool for observed
variable mediation, moderation, and conditional process modeling. Retrieved from http://www.afhayes.com/public/process2012.pdf
Differentiation of the self: Measurement and contribution to marital adjustment (Unpublished doctoral dissertation)
- Z Appel
Appel, Z. (1996). Differentiation of the self: Measurement and contribution to
marital adjustment (Unpublished doctoral dissertation). Tel Aviv University,
Israel.