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Domestic Abuse and Forgiveness among Military Spouses
Journal of Aggression, Maltreatment & Trauma
Abstract
Living with veterans who suffer from post-traumatic stress disorder (PTSD) is associated with elevated distress in spouses. Moreover, military spouses are at an elevated risk for domestic abuse, which might exacerbate their plight. Forgiveness is posited to have a healing effect for individuals, both in general as well as in the context of marital relations. Yet, the outcomes of forgiveness under conditions of ongoing abuse are not well understood. The current study fills this gap. Military spouses (n = 245) were assessed 30 (T1) and 38 (T2) years after the 1973 Yom-Kippur War. Abuse inflicted upon the spouses, spouses’ forgiveness, spouses’ distress (self-rated health and psychiatric symptomatology) and veterans’ PTSD symptoms were assessed. Domestic abuse was associated with spouses’ distress beyond the effect of the veterans’ PTSD. Furthermore, domestic abuse moderated the associations between forgiveness and distress. Whereas forgiveness predicted reduced distress among spouses who reported a lower frequency of domestic abuse, its effects were non-significant among spouses who reported a higher frequency of domestic abuse. Results imply that the protective effect of forgiveness dissolves in the face of an elevated frequency of ongoing abuse and that promoting forgiveness as a part of psychotherapy for individuals who undergo abuse might be ineffective.
... "Cualquier acercamiento terapéutico que insiste en la necesidad de perdón ha caído una y otra vez en la trampa de negar al niño el espacio para mostrar el dolor de la infancia (…) es un intento de cerrar la herida antes de limpiarla o curarla" (Casey, 1998, p. 229). Además, el perdón prematuro puede contribuir a perpetuar la dinámica de abuso y dependencia; el abuso prolongado en una relación crea unas interacciones complejas, coercitivas, entre la víctima y el abusador, que combina la violencia y la dependencia (Lahav et al., 2019), no es una relación entre iguales, hay en toda relación de abuso un desequilibrio de poder. Un perdón mal entendido puede debilitar aún más la capacidad de protegerse de la víctima, la parte menos poderosa de la relación, hacerla más vulnerable y facilitar la prolongación del abuso. ...
... Esta experiencia cumple varias funciones en la psicología de la víctima. En primer lugar, los sentimientos negativos, además de ser adaptativos ante los ataques o amenazas, tienen una función de alarma, de aviso de peligro, ayudando a la persona a movilizarse para protegerse (Lahav et al., 2019). Es decir, cumplen una función de ayuda a la protección personal. ...
... Estas formas de entender el perdón no liberan del abuso; sólo lo perpetúan y suponen una falta de consideración hacia la víctima y su dolor. El abuso prolongado en una relación crea interacciones coercitivas complejas entre la víctima y el abusador, combinando violencia y dependencia (Lahav et al., 2019); mantener conceptos erróneos sobre el perdón puede debilitar aún más la capacidad de la víctima para protegerse haciéndola más vulnerable y facilitando la continuación del abuso. ...
La conveniencia o no de plantear a las víctimas la posibilidad de trabajar sobre el perdón como forma de superar el dolor de la experiencia vivida y sus consecuencias es una cuestión controvertida. Las dinámicas de presión hacia el perdón hacen más probable la revictimización y transmiten tanto culpa como un mensaje de minimización de su dolor. Un perdón mal entendido puede debilitar aún más la capacidad de protegerse de la víctima, hacerla más vulnerable y facilitar la prolongación del abuso. El objetivo de este artículo es revisar las condiciones para que el perdón sea una herramienta psicológica al servicio de la salud mental de las víctimas. El perdón es un concepto complejo, con múltiples dimensiones y posibilidades, y puede ofrecer a las víctimas un valioso recurso para superar su dolor, aunque no es esencial para el proceso de sanación de una víctima.
... Any therapeutic approach that insists on the need for forgiveness has time and again fallen into the trap of denying the child the space to show childhood pain (...) it is an attempt to close the wound before cleaning or healing it" (Casey, 1998, p. 229). In addition, premature forgiveness may contribute to perpetuate the dynamics of abuse and dependency; prolonged abuse in a relationship creates complex, coercive interactions between victim and abuser, combining violence and dependency (Lahav et al., 2019). It is not a relationship between equals; there is in every abusive relationship a power imbalance. ...
... This experience serves several functions in the psychology of the victim. First, negative feelings, in addition to being adaptive in the face of attacks or threats, have an alarm function, warning of danger, helping the person to mobilize to protect themselves (Lahav et al., 2019). That is, they serve the function of supporting personal protection. ...
... These understandings of forgiveness do not liberate from abuse; they only perpetuate it and imply a lack of consideration for the victim and his or her pain. Prolonged abuse in a relationship creates complex coercive interactions between victim and abuser, combining violence and dependency (Lahav et al., 2019). Maintaining misconceptions about forgiveness can further weaken the victim's ability to protect him-or herself by making him or her more vulnerable and facilitating the continuation of abuse. ...
Whether or not it is appropriate to offer victims the possibility of working on forgiveness to overcome the pain of
the lived experience and its consequences is a controversial issue. The pressure to forgive makes revictimization more likely and transmits guilt and a message of minimizing the victims’ pain. A misunderstanding of forgiveness can further weaken the victim’s ability to protect him- or herself, make him or her more vulnerable, and make it easier for the abuse to continue. This paper aims to review the conditions for forgiveness to be a psychological tool for the mental health of the victims. Forgiveness is a complex concept with multiple dimensions and possibilities, and it can offer victims a valuable resource for overcoming their pain. However, it is not essential to the victim’s healing process.
... Findings revealed that psychological and physical aggression perpetrated by spouses tended to decline among partners who were less forgiving, but remained relatively stable for those partners who were more forgiving of their spouse. In another study focusing on mental and physical health symptom outcomes, Lahav et al. 11 found that the effect of forgiveness in protecting against distress among military spouses who experienced lower levels of partner abuse was absent at higher levels of abuse. Importantly, few studies have examined links between forgiveness and IPV in low-and middle-income regions (such as those in Africa) where prevalence estimates of IPV among women are typically high. ...
... In contrast to the partial forgiveness group, those in the complete forgiveness group were found to be at reduced risk of psychological distress at lower levels of psychological abuse, but at increased risk of distress at higher levels of abuse. These findings resonate with previous research that has identified divergent implications of forgiveness for the mental health of victims of abuse 11 , particularly the notion that the protective effects of forgiveness may be eroded by abuse that occurs in continuing romantic relationships. ...
Forgiveness frequently occurs in a relational context and is a key ingredient for restoring and maintaining intimate relationships. Yet, certain interpersonal dynamics that sometimes motivate forgiveness (e.g. abuse) have the potential to adversely affect well-being, especially when ongoing exploitation occurs. In this study, we examined the role of forgiveness in moderating relations between psychological abuse and indicators of psychological distress in a sample of community-based South African women currently in a heterosexual romantic relationship. Participants (n=515) completed measures of decisional and emotional forgiveness of their partner, psychological abuse committed by their current partner during the course of the relationship, and depression, anxiety, and stress. Latent profile analysis identified two subgroups characterised by differing levels of forgiveness: partial forgiveness (high decisional forgiveness and moderate emotional forgiveness) and complete forgiveness (high decisional and emotional forgiveness). Regression analyses revealed that the relations of psychological abuse with depression and stress, but not anxiety, were moderated by ‘forgiveness of partner’. The complete forgiveness group scored lower on depression and stress when psychological abuse was lower, but higher on each outcome when psychological abuse was higher. The findings suggest that there may be conditions in which forgiveness of partner may promote or undermine the mental health of women who experience abuse perpetrated by their current partner.
Significance:
• Whereas women in continuing romantic relationships generally sought neither to avoid or seek revenge on their partners (i.e. decisional forgiveness), distinct subgroups were characterised by more or less reduction of negative emotions (i.e. emotional forgiveness).
• Within the context of continuing romantic relationships, the mental health benefits that ordinarily accompany more thorough processing of unforgiveness may be eroded when victims are exposed to severe levels of potentially ongoing psychological abuse.
... . For victims, IPV may result in deleterious, even deadly outcomes, as in cases of violent attacks ending in femicide or suicide (World Health Organization, 2021). Additionally, research has found IPV to have diverse negative implications for survivors' physical and mental health, such as higher frequencies of chronic pain and sleeping difficulties, as well as elevated depression, anxiety, guilt, dissociation, and trauma-related symptomatology (Beydoun et al., 2012;Campbell, 2002;Dekel et al., 2019;Devries et al., 2013;Lahav et al., 2018Lahav et al., , 2019Lahav et al., , 2020Siegel et al., 2022;Taft et al., 2011). ...
Intimate partner violence (IPV) is a global health concern that is known to result in a plethora of detrimental outcomes, among them trauma-related symptoms. According to the betrayal trauma theory, these outcomes may be rooted not only in the abusive partner’s betrayal but also in institutional betrayal, namely institutions’ failure to fulfill their obligations to provide safety, resources, and protection to IPV victims/survivors. Yet, thus far, research on institutional betrayal has been focused on survivors of abuse that occurred within an institutional context. This study aimed to explore the implications of institutional betrayal for trauma-related symptoms among survivors of IPV, while broadening the scope of institutional betrayal and exploring institutional betrayal in relation to varied contexts. An online survey was conducted among Israeli female adults using self-report measures. The sample consisted of 117 IPV survivors, Mage = 39.35 (SD = 7.9), who reported involvement of various institutions around their IPV. Regression models indicated that institutional betrayal had a unique effect in explaining all four clusters of trauma-related symptoms. The risk for clinically significant trauma-related symptoms increased by 3% (OR = 1.03) for each increase in institutional betrayal, after controlling for income, having children with the abusive partner, degree of IPV exposure, and being abused by multiple partners. The present results suggest that institutional betrayal can be a retraumatizing experience, amplifying trauma-related distress in IPV survivors.
... The WHO found that IPV affects approximately 641 million women globally, making it the most prevalent form of violence against women (WHO, 2021). IPV has a range of effects on the victimized partner, including but not limited to physical injury, suicidality, depression, anxiety, substance use, posttraumatic stress disorder (PTSD), selfharm, sexually transmitted diseases, and injury to reproductive health (Beck et al., 2016;Kubany & Watson, 2002;Lahav, Renshaw, & Solomon, 2019;Lahav et al., 2018;Willie et al., 2018;Wilson et al., 2021). ...
This study explored the relation between guilt and identification with the aggressor (IWA) and the moderating role of IWA in the relation between intimate partner violence (IPV) and guilt. An online survey was conducted among a convenience sample of 700 women. IPV survivors demonstrated elevated guilt, and IWA was related to guilt. Furthermore, IWA moderated the relation between IPV and guilt: Among participants with low IWA levels, IPV was unrelated to guilt, but among participants with high IWA levels, IPV was related to guilt. These findings suggest that IWA may be a key element in explaining guilt among IPV survivors.
... In particular, war captivity seems to be an extreme interpersonal traumatic experience that includes systematic humiliation, deprivation, and torture (Herman, 2015) and may have lingering effects. Such burdens may be related to the negative effect of the caregiver role (Greene et al., 2014) and ex-POWs' spouses' increased responsibility for household and family maintenance in terms of earning money, raising and supporting children, and taking on other familial tasks (Lahav et al., 2019). Coupled with a decrease in marital quality (e.g., Renshaw & Caska, 2012) and the fact that research suggests that women may be more susceptible to heightened secondary traumatization than men (Baum et al., 2014), spouses of war veterans and ex-POWs face stressful demands from diverse and multiple converging sources. ...
The current longitudinal study focused on predicting depression among spouses of former Israeli war veterans (combat veterans or ex-prisoners of war [ex-POWs]). The research examined the direct and moderating role of secondary trauma related to their husbands’ war-related experiences, stress related to being exposed to intimate partner violence in their relationship, being a second-generation Holocaust (SGH) survivor, and the effects of additional stressful life events (SLEs) since the end of the war. Wives of ex-POWs and combat veterans (N = 129) participated in two time measurements. Spouses of ex-POWs were found to be at higher risk of depression and psychological violence. Psychological violence was a risk factor for depression. The three-way interaction among psychological violence, being a SGH survivor, and experiencing SLEs was significant. In addition, experiencing earlier stressful events had a protective effect. The findings suggest that the association between early exposure and additive exposure through life is a complex iteration of factors and does not necessarily follow the vulnerability perspective.
... As such, current rates might be even higher (Mazza et al., 2020). The implications of IPV are far-reaching for women's mental and physical health, and include increased health problems such as injury, chronic pain, and physical difficulties (Campbell, 2002;Coker et al., 2000;Tiwari et al., 2008), posttraumatic stress disorder (PTSD), depression, anxiety, and suicide attempts (Blasco-Ros et al., 2010;Breiding et al., 2014;Caldwell et al., 2012;Campbell, 2002;Dekel et al., 2019;Lahav et al., 2018;Lahav et al., 2019a;Pico-Alfonso et al., 2006;Taft et al., 2011;Tiwari et al., 2008). ...
... As such, current rates might be even higher (Mazza et al., 2020). The implications of IPV are far-reaching for women's mental and physical health, and include increased health problems such as injury, chronic pain, and physical difficulties (Campbell, 2002;Coker et al., 2000;Tiwari et al., 2008), posttraumatic stress disorder (PTSD), depression, anxiety, and suicide attempts (Blasco-Ros et al., 2010;Breiding et al., 2014;Caldwell et al., 2012;Campbell, 2002;Dekel et al., 2019;Lahav et al., 2018;Lahav et al., 2019a;Pico-Alfonso et al., 2006;Taft et al., 2011;Tiwari et al., 2008). ...
Study questions: Although most women who are subjected to intimate partner violence attempt to leave their abusive partners, many return, and resultantly are at risk for even greater violence. Research to date has documented relations between several factors (income and economic dependence, frequency of intimate partner violence (IPV), fear of violence escalations, history of childhood abuse, and post-traumatic stress disorder symptoms) and women’s returning to their abusive partners. Nevertheless, the contribution of women’s emotional bonds with their violent partners, known as identification with the aggressor (IWA), in explaining their perceived likelihood of going back to the relationship, has remained unclear. Subjects: The current study, conducted among 258 Israeli women who had left their violent partners, aimed to fill this void. Methods: An online survey was conducted. Demographic variables, history of childhood abuse, frequency of IPV, economic dependence on former partner, fear of future violence escalation, post-traumatic stress disorder symptoms, IWA, and perceived likelihood of returning to the relationship, were assessed via self-report questionnaire. Findings: Results indicated that two aspects of IWA—becoming hyper-sensitive to the perpetrator and adopting the perpetrator’s experience—were related to women’s perceived likelihood of returning to the relationship. Furthermore, a logistic regression analysis indicated that only two factors—income and becoming hyper-sensitive to the perpetrator—uniquely contributed to explaining the likelihood of returning to abusive partners. Major implications: The current findings suggest that women’s tendency to be highly attuned to their partners’ feelings and needs, as a part of IWA, may impede their ability to permanently leave abusive relationships.
... The ramifications of IPV are multifaceted. These consist of detrimental physical conditions (Campbell, 2002;Coker et al., 2000;Tiwari et al., 2008) and mental health difficulties, including but not limited to trauma-related distress and depression (Campbell, 2002;Dekel et al., 2019;Lahav et al., 2018;Lahav et al., 2019a;Taft et al., 2011). Evidence has suggested that 31%-84% of IPV survivors meet the criteria for posttraumatic stress disorder (PTSD; M. A. Dutton, 2009;Jones et al., 2001;Silva et al., 1997) and that PTSD symptoms are not limited to the time of abuse, and may continue many years after separating from the abusive partners (Woods, 2000). ...
Intimate partner violence (IPV) is a global health problem that often results in a variety of mental health detriments,
including trauma-related distress and depressive symptoms. According to the trauma literature, IPV victims
may develop strong bonds with their perpetrators – a phenomenon known as identification with the aggressor
(IWA) – in order to survive the abuse. Yet, this defensive reaction may endure after the abuse has ended, and
may adversely affect victims' mental health. Nevertheless, research exploring these suppositions is lacking. Filling
this void, this study investigated IWA in light of current versus past IPV as well as the relations between IWA,
trauma-related distress, and depressive symptoms among a convenience sample of 297 women. Of them, 68 and
229 participants reported being subjected to IPV at present or in the past, respectively. Results indicated that
whereas participants who reported current IPV had elevated trauma-related distress and depressive symptoms
compared to participants who reported past IPV, no differences were found in IWA levels between the groups.
Identification with the aggressor was related to trauma-related distress and depressive symptoms. Furthermore,
IWA had a unique contribution in explaining trauma-related distress and depressive symptoms above and beyond
background characteristics and IPV features. The findings of the current study suggest that IWA may mirror
the unique relational dynamics that characterize IPV, which continue to exist even after the abuse ends, and may
be implicated in IPV survivors’ psychological distress.
... The interpersonal imprint of captivity may undermine the ex-POWs' capacity to trust others as well as to engage in and maintain close intimate relationships with others (Zerach, Anat, Solomon, & Heruti, 2010). They often experience aggression as victims in captivity, which can lead to the POWs' uncontrollable outbursts of violence at a later date (Lahav, Renshaw, & Solomon, 2019). ...
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.
... It has also been emphasized that forgiveness may risk further abuse and could be harmful , especially when the perpetrator does not show remorse, the abuse is severe, or the episodes of violence are recent (e.g., Worthington & Drinkard, 2000). Since the effects of forgiveness on distress among victims of domestic abuse may be shaped by the frequency of abuse (Lahav et al., 2019), in our model we controlled for the levels of violence. Some studies suggest that forgiveness may be less advantageous for women living in an abusive relationship as it may potentially increase the risk of returning to an abusive partner, and may result in similar or even increased levels of violence over the years (Gilbert & Gordon, 2017;Gordon et al., 2004;McNulty, 2011;McNulty & Hellmuth, 2008;McNulty & Russell, 2016;Murphy, 2005). ...
The aim of this study was to examine psychological and relational variables such as dependence, forgiveness (both in their positive and negative dimensions), and hope that may explain why women reconciliate with abusive partners. We administered a questionnaire to women victims of violence. Relational dependence was indirectly associated with greater intentions to return to the violent partner via benevolent forgiveness and hope of a change in the partner. The positive dimension of forgiveness (benevolence) could represent a phase of the cycle of violence, during which the hope for change in the partner can increase the probability of reconciliation.
... McNulty (2010b) observed a similar finding where forgiveness has resulted in increased likelihood of the partner reoffending and increased aggression towards their spouses (McNulty, 2011), whereas partners who were not forgiven decreased their aggression towards their spouses. Lahav et al., (2019) demonstrate that forgiveness loses its protective factor the higher the level DA experienced. While forgiveness is generally seen as a positive outcome, it has limitations as noted in Fincham and Beach's (2002) studies. ...
... McNulty (2010b) observed a similar finding where forgiveness has resulted in increased likelihood of the partner reoffending and increased aggression towards their spouses (McNulty, 2011), whereas partners who were not forgiven decreased their aggression towards their spouses. Lahav et al., (2019) demonstrate that forgiveness loses its protective factor the higher the level DA experienced. While forgiveness is generally seen as a positive outcome, it has limitations as noted in Fincham and Beach's (2002) studies. ...
... These ways of understanding forgiveness do not free one from abuse; they only perpetuate it and facilitate future disrespect and a lack of consideration toward the victim. Prolonged abuse in a relationship creates complex, coercive interactions between the victim and the abuser, combining violence, and dependency (Lahav et al., 2019); misconceptions of forgiveness can further weaken a victim's ability to protect themselves, thereby making them more vulnerable, and facilitating the continuation of the abuse. You cannot truly forgive if you cannot freely forgive (Tracy, 1999), and this does not happen until the circle of victimization and helplessness in which the victim lived has been broken, and then they can move from victim to survivor. ...
Raising the possibility of forgiveness in child sexual abuse is a delicate matter. At times, forgiveness has been used by abusers as a way of guaranteeing the victim's silence. The pressure by the community on the victim to forgive can be understood as contempt for his or her suffering, as a way of detracting from the seriousness or importance of the abuser's behavior, or as a way of releasing him from responsibility or from deserved punishment, making revictimization more likely. However, these consequences appear when misconceptions of forgiveness arise. Forgiveness is a complex concept, with multiple dimensions and possibilities, and can offer the victim a valuable resource for overcoming their pain. Numerous studies have collected the positive effects of forgiveness on victims of sexual abuse. Forgiveness can be proposed as a tool to help and heal the pain and suffering of victims of child sexual abuse, but great care needs to be taken when making the proposal to avoid transmitting any kind of moral obligation and keeping in mind a concept of forgiveness that respects justice and protect the victim. Forgiveness is a right, never a ‘must’.
... Discussing their role in perpetrating acts of sexual violence, the men in Jeffrey & Barata's study reinforce heteronormative notions of dominance that reside in the modern discourses of consent in higher education environments (Jeffrey & Barata, 2018). Similarly Zavala & Melander's work on Police Officers with domestic violence histories and Lahav & Renshaw's work on violence in marriages that include military spouses both highlight the ways that in remembering violence in intimacy, it comes to be justified through normative ideas of manliness as requiring particular forms of social control and privilege (Lahav, Renshaw, & Solomon, 2018;Zavala and Melander, 2018). ...
The 13 articles in this special issue draw from the experience of women and men in Australia, Canada, Denmark, India, Micronesia, Sierra Leone, Tanzania, Vietnam, and the US to shed light on the complex problem of accounting for Intimate Partner Sexual Violence (IPSV) in a globalizing world. As a collection, the articles draw from qualitative methodologies in social science and humanities privileging local narratives drawn through interviews, focus groups, participant observation and historical surveys. This special issue presents articles from multiple disciplinary vantage points that seek to bring to the fore insight drawn from the close reading of sexual violence in varied global cultural contexts. The collection of articles challenges the idea that there is a universal way to understand and measure IPSV. Together the articles demonstrate key elements of the disconnect between local understandings and the assumed universality of concepts that undergird most sexual violence research. Congruent with our previous work, the challenge of the work in the cross-cultural perspective taken by this special issue lies in the acknowledgement that the ways we account for and define sexual violence in intimate (dating, cohabiting and marital) relationships is culturally-situated and must be contextualized as such. This cross-cultural perspective values the conceptual insight that can be drawn from cultural difference and pushes against a homogenization of notions of sexual violence in studies within global societies as well as those that work to compare them.
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).
IMPORTANCE The long-term course of readjustment problems in military personnel has not been evaluated in a nationally representative sample. The National Vietnam Veterans Longitudinal Study (NVVLS) is a congressionally mandated assessment of Vietnam veterans who underwent previous assessment in the National Vietnam Veterans Readjustment Study (NVVRS). OBJECTIVE To determine the prevalence, course, and comorbidities of war-zone posttraumatic stress disorder (PTSD) across a 25-year interval.
Psychology after World War II became a science largely devoted to healing. It concentrated on repairing damage using a disease model of human functioning. This almost exclusive attention to pathology neglected the idea of a fulfilled individual and a thriving community, and it neglected the possibility that building strength is the most potent weapon in the arsenal of therapy. The aim of positive psychology is to catalyze a change in psychology from a preoccupation only with repairing the worst things in life to also building the best qualities in life. To redress the previous imbalance, we must bring the building of strength to the forefront in the treatment and prevention of mental illness.
Betrayal trauma theory suggests that psychogenic amnesia is an adaptive response to childhood abuse. When a parent or other powerful figure violates a fundamental ethic of human relationships, victims may need to remain unaware of the trauma not to reduce suffering but rather to promote survival. Amnesia enables the child to maintain an attachment with a figure vital to survival, development, and thriving. Analysis of evolutionary pressures, mental modules, social cognitions, and developmental needs suggests that the degree to which the most fundamental human ethics are violated can influence the nature, form, and processes of trauma and responses to trauma.
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)
Identifying the factors that contribute to ongoing intimate partner abuse (IPA) among survivors of childhood abuse is essential to developing appropriate interventions. The current study assessed prospectively whether childhood betrayal trauma (BT) history and women’s potential dependence on their perpetrators (unemployment, number of children below 13) increased women’s risk of ongoing victimization, while controlling for trauma-related symptoms (PTSD, depression, dissociation). Women survivors of IPA (N = 190) from an urban U.S. city were recruited based on an IPA incident reported to the police. At the initial interview, women reported on childhood betrayal trauma experiences, their employment status, number of children, and current trauma-related symptoms. Women returned 6 months later and reported on ongoing events of victimization (physical, sexual, psychological aggression, and injury) in their relationships with the initial IPA perpetrator. Results showed that higher levels of childhood BT were associated with ongoing victimization over the course of 6 months. Women’s unemployment status predicted greater physical and sexual aggression and injuries. Higher levels of depression and lower levels of PTSD symptoms were also associated with increases in physical, sexual, and psychological aggression, and bodily injury. The findings have important implications for interventions by demonstrating the need to process women’s betrayal trauma experiences, target depression symptoms, and increase women’s economic opportunities to prevent further victimization.
Inner conflict over whether to allow the psychic wound to heal in survivors of incest and domestic violence is based on the client's unconscious belief that full recovery from the trauma would exonerate the perpetrator and be disloyal to other victims. A discussion of treatment issues addresses the role of the therapist in detecting signs of accusatory suffering and in respecting the survivor's striving toward health. Issues of client anger, misperceptions, and poor self-esteem are addressed as well as client healing. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In all, 39 participants (19 male, 20 female) were classified as either happy (n = 19) or unhappy (n = 20) with a relationship. Baseline salivary cortisol was measured. Participants imagined (for a 5-min duration) scenes typical of their relationship, and salivary cortisol was measured again. Participants in unhappy relationships had higher cortisol reactivity (indicating higher stress) following the imagery. Cortisol reactivity was predicted by relationship variables (high love and liking for the partner, high happiness with the relationship) and personality variables (high forgivingness, low trait anger). Personality had an indirect effect through the relationship variables. Physical health was predicted by personality variables. Mental health was predicted by both personality and relationship variables. Implications of these results for counseling health psychology are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Estimating the relative importance of habitat loss and fragmentation is necessary to estimate the potential benefits of specific
management actions and to ensure that limited conservation resources are used efficiently. However, estimating relative effects
is complicated because the two processes are highly correlated. Previous studies have used a wide variety of statistical methods
to separate their effects and we speculated that the published results may have been influenced by the methods used. We used
simulations to determine whether, under identical conditions, the following 7 methods generate different estimates of relative
importance for realistically correlated landscape predictors: residual regression, model or variable selection, averaged coefficients
from all supported models, summed Akaike weights, classical variance partitioning, hierarchical variance partitioning, and
a multiple regression model with no adjustments for collinearity. We found that different methods generated different rankings
of the predictors and that some metrics were strongly biased. Residual regression and variance partitioning were highly biased
by correlations among predictors and the bias depended on the direction of a predictor’s effect (positive vs. negative). Our
results suggest that many efforts to deal with the correlation between amount and fragmentation may have done more harm than
good. If confounding effects are controlled and adequate thought is given to the ecological mechanisms behind modeled predictors,
then standardized partial regression coefficients are unbiased estimates of the relative importance of amount and fragmentation,
even when predictors are highly correlated.
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.
This chapter describes self-esteem and provides an overview of existing perspectives on self-esteem. Self-esteem is a sociometer, essentially an internal monitor of the degree to which one is valued or devalued as a relational partner. The chapter evaluates a series of specific, testable hypotheses about self-esteem and examines laboratory and other findings in relevance to the sociometer theory and its specific hypotheses. This sociometer theory also reinterprets several interpersonal phenomena that have been explained previously in terms of the self-esteem motive. In specific, self-esteem refers to a person's appraisal of his or her value. Global self-esteem denotes a global value judgment about the self, whereas domain-specific self-esteem involves appraisals of one's value in a particular area. Self-esteem is an affectively laden self-evaluation. Self-evaluations are in turn assessments of one's behavior or attributes along evaluative dimensions. Some self-evaluations are dispassionate. whereas others are affectively laden. Self-esteem focuses primarily on individual differences in dispositional or trait self-esteem.
Forgiveness is a variable closely related to religiousness and spirituality that has been hypothesized to be protective of mental and physical health. However, we do not clearly understand which aspects of forgiveness are most clearly associated with health outcomes, and the conditions under which these relationships occur. This study used national probability data to systematically examine age differences in the association between forgiveness, religiousness/ spirituality, and respondent reports of mental and physical health. Results showed age differences in the levels of forgiveness of others and feeling forgiven by God. In both cases, middle and old age adults showed higher levels of these forms of forgiveness than young adults. Furthermore, the relationship between forgiveness of others and respondent reports of mental and physical health varies by age. Forgiveness of others was more strongly related to self-reported mental and physical health for middle and old age adults than for young adults. Peer Reviewed http://deepblue.lib.umich.edu/bitstream/2027.42/44638/1/10804_2004_Article_341950.pdf
This study examined relations between aspects of family functioning and positive and negative dimensions of forgiveness. Increased understanding of one's partner and decreased anger about betrayal characterize positive forgiveness, whereas experiences such as holding a grudge and desiring revenge indicate negative forgiveness. The sample included 87 wives and 74 husbands who reported experiencing a significant betrayal, their partners, and their adolescent children. Analyses of reported forgiveness revealed that more negative forgiveness was associated with lower marital satisfaction for husbands and wives; trust partially mediated this relationship for husbands and wives. Greater positive forgiveness reported by husbands and wives predicted their own reports of a stronger parenting alliance, whereas greater negative forgiveness reported by husbands and wives predicted their spouses' reports of a weaker parenting alliance. For wives, more negative forgiveness also predicted higher levels of children's perceived parental conflict, and parents' reported conflict mediated this association for wives. Findings suggest that forgiveness of a marital betrayal is significantly associated with marital satisfaction, the parenting alliance, and children's perceptions of parental marital functioning.
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.
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.
Four studies examine the construct validity of the Tendency to Forgive Scale (TTF), a brief measure of dispositional forgiveness. Study 1 showed that romantic partners' ratings of targets converged with targets' self-ratings, and Study 2 demonstrated that higher scores on the TTF were associated with lower offense accessibility. Study 3 examined the TTF's relation to self-reported depression symptoms, both independent of and interacting with attitudes toward forgiveness and dispositional vengeance. Lower TTF scores were associated with higher degrees of depression, especially for individuals with positive attitudes toward forgiveness or those low in dispositional vengeance, although neither of these latter variables displayed significant zero-order relations with depression. Finally, Study 4 examined relations between the TTF, dispositional empathy, another recent measure of dispositional forgiveness, and the dimensions of the Big Five, providing both convergent and discriminant validity evidence for the TTF.
Recent findings indicate that college women's forgiveness of hypothetical dating violence was predictive of their hypothetical decisions to stay in the relationship. This study was designed to evaluate the role of forgiveness in women's intentions to return to their partners from a domestic violence shelter. A sample of 121 women residing in both urban and rural domestic violence shelters filled out a series of questionnaires evaluating demographic information, severity of violence, attributions for violence, psychological constraints (or investment), and forgiveness of the partner. Forgiveness was found to predict intention to return to partner over and above the other variables studied. These findings suggest that the degree to which women are willing to "move on" from the abuse and to let go of their anger toward their partners may play a significant role in their intention to remain in a relationship with their partners.
This study examined relationships between posttraumatic stress disorder (PTSD) symptoms and parenting satisfaction. Total PTSD severity scores and avoidance and emotional numbing symptoms were significantly associated with parenting satisfaction. These associations remained significant even after controlling for partner violence, major depression, and alcohol abuse/dependence. Results suggest that higher levels of PTSD symptoms and avoidance and emotional numbing symptoms in particular may have a deleterious effect on parent-child relationship satisfaction.
The purpose of the study was to evaluate the long-term (20-year) effectiveness of frontline treatment provided to combat stress reaction casualties.
A longitudinal quasi-experimental design was employed. Participants were combat stress reaction casualties of the 1982 Lebanon War who received frontline treatment (N=79), comparable combat stress reaction casualties who did not receive frontline treatment (N=156), and matched soldiers who did not experience combat stress reaction (N=194). Subjects were asked which of the frontline treatment principles (proximity, immediacy, expectancy) were applied in their treatment, whether or not they returned to their unit after frontline treatment, and if so, whether they returned before or after they felt completely recovered. Outcome assessments included measures of posttraumatic and psychiatric symptoms and of social functioning.
Twenty years after the war, traumatized soldiers who received frontline treatment had lower rates of posttraumatic and psychiatric symptoms, experienced less loneliness, and reported better social functioning than similarly traumatized soldiers who did not receive frontline treatment. In addition, a cumulative effect of application of frontline treatment principles was documented: the more principles applied, the stronger the effect on psychiatric outcomes.
Frontline treatment is associated with improved outcomes even two decades after its application. This treatment may also be effective for nonmilitary precursors of posttraumatic stress disorder.
The investigators proposed that transgression-related interpersonal motivations result from 3 psychological parameters: forbearance (abstinence from avoidance and revenge motivations, and maintenance of benevolence), trend forgiveness (reductions in avoidance and revenge, and increases in benevolence), and temporary forgiveness (transient reductions in avoidance and revenge, and transient increases in benevolence). In 2 studies, the investigators examined this 3-parameter model. Initial ratings of transgression severity and empathy were directly related to forbearance but not trend forgiveness. Initial responsibility attributions were inversely related to forbearance but directly related to trend forgiveness. When people experienced high empathy and low responsibility attributions, they also tended to experience temporary forgiveness. The distinctiveness of each of these 3 parameters underscores the importance of studying forgiveness temporally.
The purpose of this investigation was to test a multivariate family model in order to gain insight into the consequences of male-perpetrated marital violence, specifically the effects of this violence on the wife's mental health and their children's behavior problems. Data from 260 male veteran-female partner dyads who had one or more children were drawn from the National Vietnam Veterans Readjustment Study and analyzed using structural equation modeling techniques. The five latent variables in the structural model were the husband's report of family functioning, the wife's report of family functioning, husband-to-wife marital violence, wife's psychological distress, and child behavior problems. In the structural model of best fit, male-perpetrated marital violence was associated with the wife's level of psychological distress. However, most of this association flowed indirectly through the intermediary variable of wife's assessment of family functioning. Additionally, the wife's psychological distress was the sole path that linked marital violence to the child's behavior. A series of follow-up analyses revealed that these findings were invariant across child behavior problem type (i.e., internalizing vs. externalizing problems) and child gender. These findings suggest that interparental violence does impact children, but that it does so through its effect on the psychological state of the mother. Accordingly, these findings reinforce the importance of programs that provide services to women and their children who are living in violent households.
The long-term course of readjustment problems in military personnel has not been evaluated in a nationally representative sample. The National Vietnam Veterans Longitudinal Study (NVVLS) is a congressionally mandated assessment of Vietnam veterans who underwent previous assessment in the National Vietnam Veterans Readjustment Study (NVVRS).
To determine the prevalence, course, and comorbidities of war-zone posttraumatic stress disorder (PTSD) across a 25-year interval.
The NVVLS survey consisted of a self-report health questionnaire (n = 1409), a computer-assisted telephone survey health interview (n = 1279), and a telephone clinical interview (n = 400) in a representative national sample of veterans who served in the Vietnam theater of operations (theater veterans) from July 3, 2012, through May 17, 2013. Of 2348 NVVRS participants, 1920 were alive at the outset of the NVVLS, and 81 died during recruitment; 1450 of the remaining 1839 (78.8%) participated in at least 1 NVVLS study phase. Data analysis was performed from May 18, 2013, through January 9, 2015, with further analyses continued through April 13, 2015.
Study instruments included the Mississippi Scale for Combat-Related PTSD, PTSD Checklist for DSM-IV supplemented with PTSD Checklist for DSM-5 items (PCL-5+), Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), and Structured Clinical Interview for DSM-IV, Nonpatient Version.
Among male theater veterans, we estimated a prevalence (95% CI) of 4.5% (1.7%-7.3%) based on CAPS-5 criteria for a current PTSD diagnosis; 10.8% (6.5%-15.1%) based on CAPS-5 full plus subthreshold PTSD; and 11.2% (8.3%-14.2%) based on PCL-5+ criteria for current war-zone PTSD. Among female veterans, estimates were 6.1% (1.8%-10.3%), 8.7% (3.8%-13.6%), and 6.6% (3.5%-9.6%), respectively. The PCL-5+ prevalence (95% CI) of current non-war-zone PTSD was 4.6% (2.6%-6.6%) in male and 5.1% (2.3%-8.0%) in female theater veterans. Comorbid major depression occurred in 36.7% (95% CI, 6.2%-67.2%) of veterans with current war-zone PTSD. With regard to the course of PTSD, 16.0% of theater veterans reported an increase and 7.6% reported a decrease of greater than 20 points in Mississippi Scale for Combat-Related PTSD symptoms. The prevalence (95% CI) of current PCL-5+-derived PTSD in study respondents was 1.2% (0.0%-3.0%) for male and 3.9% (0.0%-8.1%) for female Vietnam veterans.
Approximately 271 000 Vietnam theater veterans have current full PTSD plus subthreshold war-zone PTSD, one-third of whom have current major depressive disorder, 40 or more years after the war. These findings underscore the need for mental health services for many decades for veterans with PTSD symptoms.
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.
Many areas of women's health, including battering, suffer from conceptual and methodological deficits. This article uses the “measurement trap” (Graham & Campbell, 1991), a set of conditions defined by lack of information resulting from a narrow conceptualization of the problem, poor existing data sources, inappropriate outcome indicators, and limited measurement techniques, as a framework for describing how current approaches to conceptualizing and measuring battering hamper research and program efforts in the field of domestic violence. We then describe an alternative conceptualization-and-measurement approach that is based on battered women's experiences. We argue that an experiential approach, which grounds measurement in women's lived experiences, improves our ability to conduct research that correctly identifies, monitors, and explains the epidemiology of this phenomenon and provides a solid basis for policy and program development.
Development of research on intrafamily conflict and violence requires both conceptual clarity and measures of the concepts. The introduction to this paper therefore seeks to clarify and distinguish the concepts of "conflict," "conflict of interest," "hostility," and "violence." The main part of the paper describes the Conflict Tactics (CT) Scales. The CT Scales are designed to measure the use of Reasoning, Verbal Aggression, and Violence within the family. Information is presented on the following aspects of this instrument: theoretical rational, acceptability to respondents, scoring, factor structure, reliability, validity, and norms for a nationally representative sample of 2,143 couples.
Using self-report assessments, from a positive psychology framework, we examined recently-married couples for potential sex-related differences in (1) overall marital forgiveness, (2) perceptions of partner's forgiveness, and (3) relationships between sex, marital satisfaction, marital forgiveness, and self-reported mental health. Participants were 311 community-based couples married less than a year. Men reported more marital forgiveness in the marriage and more empathy toward their spouse after a still-troublesome transgression than did females. Furthermore, females perceived their male partners as being more forgiving of them than male partners perceived their female partners’ forgiveness. Marital satisfaction, severity of hurts, and sex accounted for variance in marital forgiveness. Sex, severity of hurts, frequency of transgressions, marital satisfaction, and marital forgiveness accounted for variance in mental health symptoms.
This chapter focuses on the potential health consequences and correlates of unforgiveness, the reduction of unforgiveness, and forgiveness. Religion is treated as a variable that affects a pro-virtue constellation of personality characteristics (both directly through individual beliefs and values and indirectly through culture), and its effects on unforgiveness and forgiveness have been particularly considered. Religion also affects health through individual behavior in relationships and through the value religions place on relationships. The pivotal nature of unforgiveness and forgiveness can explain some religion–health connections and suggest physiological mechanisms for this connection. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The purpose of this study was to develop a valid and reliable instrument to measure forgiveness in the intergenerational family. In the final scale the contructs were defined as: (1) realization, (2) recognition, (3) reparation, (4), restitution, and (5) resolution. A detailed four-step procedure was used to provide the scale with construct, content and predictive validity. This paper describes a four-stage process to develop the scale, data supporting the validity and reliability of the scale, and the final version of the instrument.
There is strong evidence that anger and violence are prevalent problems in Vietnam combat veterans with posttraumatic stress disorder, and a summary of relevant empirical studies is presented. However, the pathways responsible for development and perpetuation of anger and violence in this clinical population have been unidentified. Available information processing and neurobiological models regarding how anger and aggression may be dysregulated in response to trauma are reviewed. Anger and interpersonal violence in Vietnam veterans with PTSD may have a distinct etiology and maintenance compared to other disorders, and may be directly related to neurobiological and trauma-related factors. Although anger has not yet been directly modeled in accordance with theories of PTSD, these models may provide frameworks for investigating how anger may be associated with the development and maintenance of PTSD. Additional suggestions for future research are offered.
Despite a burgeoning literature that documents numerous positive implications of forgiveness, scholars know very little about the potential negative implications of forgiveness. In particular, the tendency to express forgiveness may lead offenders to feel free to offend again by removing unwanted consequences for their behavior (e.g., anger, criticism, rejection, loneliness) that would otherwise discourage reoffending. Consistent with this possibility, the current longitudinal study of newlywed couples revealed a positive association between spouses' reports of their tendencies to express forgiveness to their partners and those partners' reports of psychological and physical aggression. Specifically, although spouses who reported being relatively more forgiving experienced psychological and physical aggression that remained stable over the first 4 years of marriage, spouses who reported being relatively less forgiving experienced declines in both forms of aggression over time. These findings join just a few others in demonstrating that forgiveness is not a panacea.
Spouses of combat veterans with posttraumatic stress disorder (PTSD) experience elevated psychological distress. Recent research indicates that spouses' perceptions of burden may be one mechanism of such distress, but there are several gaps in this literature. No research has examined perceived burden in relation to symptoms other than PTSD or subclinical levels of psychological distress, and very little research has focused on characteristics of spouses that may be related to their perceptions of burden. The current study examined these variables in 130 spouses of reserve component troops deployed during Operations Enduring/Iraqi Freedom. Spouses' burden was positively associated with symptoms of PTSD, depression, and anxiety in service members, regardless of clinical severity. Moreover, burden fully mediated the relation between each type of symptom and spouses' own psychological distress. Furthermore, levels of burden were significantly related to spouses' neuroticism, avoidant coping, and self-efficacy, but only avoidant coping remained a significant predictor of burden when accounting for service members' distress. These results suggest that a broad range of service members' symptoms are related to spouses' burden and distress, and although individual characteristics of spouses may be related to their perceptions of burden, service members' symptoms play a primary role.
Synopsis
The Symptom Check List (SCL-90R) is a self-report questionnaire which is designed to be suitable for use as a psychiatric case-finding instrument, as a measure of symptom severity, and as a descriptive measure of psychopathology. Scores obtained using the instrument were compared with those obtained from the investigator-based interview, the Present State Examination, in two samples of patients: a sample of patients with chronic physical disease (diabetes mellitus) and a sample of patients with bulimia nervosa. There was good agreement between the two methods of measurement in both samples, suggesting that the SCL-90R performs well in the assessment of neurotic symptoms.
Research methodology using only one spouse to report for the couple has been questioned. Szinovacz (1983) reported higher rates of violence when both spouses responded to six items on Straus's Conflict Tactics Scale (CTS). The purpose of this study was to replicate her methodology by using all items measuring severe violence in the latest CTS scale with 94 military couples, to see if couple reports of violence indicated higher rates of violence compared to individual spouses' reports. Results were similar to Szinovacz's findings, and support the advisability of using both spouses to report violence in marriages.
Intimate partner violence, which describes physical or sexual assault, or both, of a spouse or sexual intimate, is a common health-care issue. In this article, I have reviewed research on the mental and physical health sequelae of such violence. Increased health problems such as injury, chronic pain, gastrointestinal, and gynaecological signs including sexually-transmitted diseases, depression, and post-traumatic stress disorder are well documented by controlled research in abused women in various settings. Intimate partner violence has been noted in 3-13% of pregnancies in many studies from around the world, and is associated with detrimental outcomes to mothers and infants. I recommend increased assessment and interventions for intimate partner violence in health-care settings.
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.
Caregiver burden and psychological distress were examined in a sample of 71 partners of Vietnam War combat veterans. Partners of patients (n = 51) diagnosed with posttraumatic stress disorder (PTSD) experienced more caregiver burden and had poorer psychological adjustment than did partners of veterans without PTSD (n = 20). Among PTSD caregivers, patient PTSD symptom severity and level of interpersonal violence were associated with increased caregiver burden. When accounting for patient PTSD symptom severity, hostility, presence of major depression, level of interpersonal violence, and health complaints, only PTSD severity was uniquely associated with caregiver burden. Caregiver sociodemographic factors including age, race, education, and the availability of social support, did not moderate the relationship between PTSD symptom severity and caregiver burden. Caregiver burden was strongly related to spouse psychological adjustment.
Using structural equation modeling, we examined the impact of early-life stressors, war-zone stressors, and PTSD symptom severity on partner's reports of recent male-perpetrated intimate partner violence (IPV) among 376 Vietnam veteran couples. Results indicated that several variables demonstrated direct relationships with IPV, including relationship quality with mother, war-zone stressor variables, and PTSD symptom severity. Importantly, retrospective reports of a stressful early family life, childhood antisocial behavior, and war-zone stressors were indirectly associated with IPV via PTSD. One of our 2 war-zone stressor variables, perceived threat, had both direct and indirect (through PTSD) relationships with IPV. Experiencing PTSD symptoms as a result of previous trauma appears to increase an individual's risk for perpetrating IPV. Implications for research and treatment are discussed.
Domestic violence rates among veterans with posttraumatic stress disorder (PTSD) are higher than those of the general population. Individuals who have been diagnosed with PTSD who seek couples therapy with their partners constitute an understudied population. Self-report measures of domestic violence, relationship satisfaction, and intimacy were administered at intake to 179 couples seeking relationship therapy at a Veterans Affairs clinic. Couples in which the veteran was diagnosed with combat-related PTSD were compared with two other groups based on the veteran's primary diagnosis (depression, adjustment disorder/V-code). Both the PTSD- and depression-diagnosed veterans perpetrated more violence than did those with adjustment/V-code diagnoses. Domestic violence rates among depressed and PTSD-diagnosed veterans were much higher than those found in previous research. Implications for assessment and treatment are discussed.
Psychological distress among cohabitating female partners of combat veterans with posttraumatic stress disorder (PTSD) was examined in a cross-sectional study using a modified version of the Health Belief Model. A convenience sample of 89 cohabitating female partners of male veterans in outpatient PTSD treatment was interviewed by telephone using a structured interview. Partners endorsed high levels of psychological distress with elevations on clinical scales at or exceeding the 90th percentile. Severe levels of overall psychological distress, depression, and suicidal ideation were prevalent among partners. Multivariate analyses revealed that perceived threat, recent mental health treatment, and level of involvement with veterans predicted global partner psychological distress. Partner burden was predicted by partner self-efficacy, perceived threat, barriers to mental health treatment, and partner treatment engagement. These findings are compelling since they demonstrate that partners of veterans with combat-related PTSD experience significant levels of emotional distress that warrant clinical attention. Psychological distress and partner burden were each associated with a unique combination of predictors, suggesting that although these constructs are related, they have distinct correlates and potentially different implications within the family environment. Future research should examine these constructs separately using causal modeling analyses to identify modifiable targets for interventions to reduce psychological distress among partners of individuals with PTSD.