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Impostorism, Subjective Age, and Perceived Health among Aging Veterans
Abstract
Rationale:
Aging veterans often suffer from increased vulnerability, manifested among other things in old subjective age and poor perceived health. Though research has documented the contribution of trauma related variables to these negative appraisals, their associations with impostorism (i.e., the subjective experience that one is less adequate than others perceive) remain unexamined.
Objective:
Filling this gap, this study explored the relations between impostorism and subjective age and perceived health among aging combat veterans.
Method:
The study was conducted among 146 Israeli veterans of the 1973 Yom Kippur War. Participants were assessed for combat exposure, Posttraumatic Stress Disorder (PTSD) symptoms, and health-related behaviors during middle adulthood (1991; T1), and for subjective age, perceived health, impostorism, PTSD symptoms, and depressive symptoms during old age (2018; T2).
Results:
The veterans' impostorism was associated with relatively old subjective age and poor perceived health, above and beyond the effects of age, health-related behaviors, combat exposure, depressive symptoms, and PTSD symptoms.
Conclusions:
The current results suggest that impostorism may contribute to veterans' stress and negatively affect their evaluations regarding age and health.
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Background: The nature of the reciprocal relationships between posttraumatic stress disorder (PTSD) symptoms, proportional subjective age, and their effects on successful aging are important issues that have been so far under-studied. Clarifying the relationships between these variables has many theoretical and practical implications for the understanding of how individuals age in the shadow of traumatic exposure.
Objective: The present study examined the reciprocal relationships between PTSD symptoms and proportional subjective age in a longitudinal design, and how these variables predict successful aging.
Method: Using in-region random digit dialling, we collected a stratified sample of community-dwelling older adults residing in the south of Israel. Of that sample, 132 midlife and older adults (T1 age range = 50–87, mean age = 65.84, SD = 9.12) were interviewed three times across a period of two years and four months (2014–2016). Participants completed measures of PTSD symptoms and proportional subjective age in the first two interviews (T1 and T2) and successful aging indices in the third interview (T3). PTSD symptoms and proportional subjective age measured at both T1 and T2 served as predictors and outcomes in a cross-lagged model and as predictors of successful aging at T3.
Results: T1 PTSD symptoms predicted an older proportional subjective age at T2, whereas the reverse relationship (i.e. T1 proportional subjective age to T2 PTSD symptoms) was non-significant. Moreover, higher PTSD symptoms and an older proportional subjective age at T2 predicted lower successful aging at T3.
Conclusions: In addition to clarifying the temporal sequencing of PTSD and proportional subjective age, the study further suggests that PTSD and proportional subjective age identity could each render midlife and older adults more susceptible to less successful aging. Accordingly, we advocate to further explore the mechanisms underlining these complicated relationships.
Background: Subjective age (SA) is an indicator of aging that has been empirically associated with health impediments and hindered longevity. Studies show that adverse life events may result in relatively older SA, but have not addressed the differential contribution of life events across the lifespan and the course of posttraumatic psychopathology on the SA of aging survivors of extreme trauma.
Objective: Filling this gap, the current study explored the differential contribution of (1) adverse experiences in various life-stages and (2) trajectories of posttraumatic stress disorder (PTSD) to the prediction of SA in a sample of former prisoners-of-war as they enter old age. Method: A cohort of Israeli former prisoners-of-war of the 1973 Yom Kippur War (N = 103) was assessed at four points throughout four decades after the war. A linear hierarchical regression was utilized to assess the contribution of negative life events during childhood, participation in other wars, combat exposure, suffering in captivity, life events since the war and the trajectories of PTSD for predicting SA 42-years post-repatriation.
Results: Lifespan adversity explained 50% of the variance in SA, with trajectories of PTSD making the largest contribution, followed by life events since the war. Negative life events in childhood added to the explained variance only when PTSD trajectories were accounted for. Exposure to combat, participation in additional wars and the severity of specific experiences during captivity did not reach significance, though the latter marginally contributed to the explained variance (p = .069).
Conclusions: This study demonstrates the importance of considering the prolongation of posttraumatic psychopathology together with life adversities and their differential implications when addressing SA after extreme trauma. The findings suggest that early life adversity may be a latent factor that increases vulnerability to posttraumatic premature aging processes.
Clance (1978) first identified the Impostor Phenomenon in therapeutic sessions with highly successful women who attributed achievements to external factors even in the presence of evidence to the contrary. These individuals, believing themselves unworthy of promotions, recognition and rewards, saw themselves as frauds. Those dealing with impostor tendencies put a considerable amount of pressure on themselves to maintain the façade and as such are known to exhibit high levels of perfectionism and workaholic behaviors. This article reviews the definition and traits associated with the Impostor Phenomenon with a focus on incidence and impact in higher education.
Objective:
To replicate and expand upon the relationship of somatic symptoms and posttraumatic stress disorder (PTSD) by comparing symptoms among service eras in US Veterans.
Method:
Data were collected from 226 Vietnam and 132 Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans who were referred to a Veterans Affairs (VA) hospital PTSD outpatient clinic between 2005 and 2013. Veterans were administered self-report inventories and a clinical interview to measure somatic symptoms and PTSD severity. A subset of Veterans (n=185) screening positive for PTSD were administered the Clinician Administered PTSD Scale (CAPS) to measure PTSD severity. Multiple moderated linear regressions were used to examine the influence of service era on the relationship between somatic and PTSD symptoms.
Results:
There were no significant differences between service eras in pain severity, pain interference, and total somatic symptoms reported. Vietnam Veterans were more likely to report limb/join pain (p<.05), fainting (p<.01), and shortness of breath (p<.001), whereas OIF/OEF Veterans were more likely to complain of headaches (p<.001). A significant interaction effect occurred between service era and dizziness (p<.05) and chest pain (p<.01), with OIF/OEF Veterans reporting higher levels of these symptoms significantly more likely than Vietnam Veterans to also experience more severe PTSD.
Conclusion:
Findings are consistent with previous research demonstrating the relationship of somatic symptoms and PTSD across service eras but provide additional data concerning similarities and differences of somatic symptoms between eras. Potential explanations for observed service era differences in somatic symptoms are discussed.
In the Impostor Phenomenon (IP), people who are objectively competent and successful report feeling secretly inadequate and fear detection of their incompetence. The IP has typically been studied using personality scales, but recent research has raised concerns about conceptualizing the IP as a personality trait. In the present work we approached the IP instead as an affective experience that can arise in anyone in response to certain evocative situations. Undergraduates (N = 122) described experiences in which they felt like impostors. Qualitative and quantitative analyses showed impostor episodes to be widely experienced and related to certain situational factors such as the relative status of the perceiver. Additionally, IP personality scales are shown to predict some features of people's impostor experiences. Results are discussed in light of IP theory and research as well as self-verification theory.
The combat veteran paradox proposes that most changes individuals experience resulting from combat exposure are normal, and not indicative of a mental health disorder. Yet, because of the number and complexities of these changes, the combat veteran paradox states that combat veterans who are healthy can benefit from counseling. Counseling should focus on helping the combat veteran understand how combat experiences might influence their thoughts, emotions and behaviors. Counseling can also help combat veterans understand the numerous paradoxes often experienced during and after deployment. Combat veterans also encounter numerous dilemmas, most prominent being the military mental health dilemmas, consisting of multiple double binds imposed on the combat veteran by their partner, the military culture, and him/herself; all of which impede the combat veteran from receiving much needed mental health care support. If left unchecked, these can lead to more significant mental health issues requiring professional intervention. Veteran helping organizations also face dilemmas and paradoxes, which are important to understand to ensure veterans receive maximum care and assistance. Although many dilemmas are unavoidable and many paradoxes unsolvable, a holistic approach to understanding and ameliorating veteran paradoxes and dilemmas is necessary to optimize the veterans transition home. There are also similarities between combat trauma and other types of trauma, and between the military and other occupations with inherent danger. Recognizing these will further aid in the development of interventions that will allow trauma survivors to thrive and grow after traumatic events.
Background:
Although a large body of literature has linked posttraumatic stress disorder (PTSD) with poor physical health among older veterans, less is known regarding the association between PTSD and health among relatively younger cohorts of veterans.
Objective:
The current study examined the association between PTSD and self-reported health among a sample of veterans who served in the recent conflicts in Iraq and Afghanistan.
Method:
Veterans (N = 1030) who served in the wars in Iraq and Afghanistan completed measures of PTSD symptom severity and self-rated health between September 2009 and February 2010. Analyses examined the association between PTSD symptoms and health outcomes.
Results:
In analyses adjusted for age, sex, race, and combat exposure, PTSD symptom severity was positively related to the number of health conditions and health symptoms reported (ps<0.001). Additionally, in analyses adjusted for age, sex, race, combat exposure, number of health conditions, and number of health symptoms, PTSD symptom severity was associated with an increased likelihood of rating one's health as poor or fair and an increased likelihood of reporting that one's physical health limits participation in activities (ps<0.001).
Conclusion:
These findings suggest that, consistent with previous research, PTSD symptom severity has a broad negative effect on physical health among veterans of the Iraq and Afghanistan era. Health promotion among veterans with PTSD may help attenuate risk of physical health consequences.
The notion of the heterogeneity of aging goes along with the awareness that every person experiences aging differently. Over the past years, scholars have emphasized that the assessment of these subjective experiences of aging contributes to our understanding of a range of psychological and physiological processes and outcomes among older adults. One construct frequently used in this context is subjective age, that is, how old or young a person feels. Subjective age has been shown to be an important correlate as well as a predictor of markers of successful aging such as well-being, health, and longevity. However, less is known about the antecedents of subjective age and the mechanisms underlying the relationship between feeling younger and positive developmental outcomes. This article briefly summarizes and critically evaluates the empirical evidence on this topic, and makes suggestions for how to address and potentially overcome currently existing theoretical, methodological, and psychometric challenges. Based on the discussion of these challenges, the paper provides directions for future research by outlining underexplored topics such as intraindividual variability and determinants of subjective age, the match between objective age indicators and subjective age, and how subjective age maps on behavior and functioning.
Proposed as a theory of motivation, the basic tenet of conservation of resources (COR) theory is that humans are motivated to protect their current resources and acquire new resources. Despite its recent popularity in the organizational behavior literature, several criticisms of the theory have emerged, primarily related to the central concept of resources. In this review, we address concerns regarding the conceptualization, conservation, acquisition, fluctuation, and measurement of resources. We highlight gaps in the COR literature that can be addressed by integrating research from other areas of psychology and management. In this manner, we hope to push the COR literature forward by resolving several concerns and providing suggestions for future research that might address other concerns.
The impostor phenomenon (IP) is a feeling of incompetence and inadequacy despite evidence to the contrary. Feelings of impostorism are associated with poor psychological functioning, including psychological distress and low self-esteem. Though particularly salient in college students, samples of African American college students have rarely been studied. The present study seeks to address this gap by investigating impostorism’s associations with psychological distress and self-esteem in an African American college student sample. We hypothesized that higher impostorism predicts higher psychological distress, and that higher impostorism predicts lower self-esteem. One hundred and twelve participants completed online measures of impostorism, psychological distress, and self-esteem. Using simple linear regression analyses, the results supported both hypotheses – higher impostorism predicted higher psychological distress and higher impostorism predicted lower self-esteem. The findings may be useful for mental health professionals working with African American college students to decrease the impact of imposter feelings on self-esteem, psychological distress, and academic performance.
Evidence is accumulating on the effects of subjective aging-that is, how individuals perceive their own aging process-on health and survival in later life. The goal of this article is to synthesize findings of existing longitudinal studies through a meta-analysis. A systematic search in PsycInfo, Web of Science, Scopus, and Pubmed resulted in 19 longitudinal studies reporting effects of subjective aging on health, health behaviors, and longevity. The authors combine the outcomes reported in these studies using a random effects meta-analysis, assuming that there would be differences in effect sizes across studies. The meta-analysis resulted in an overall significant effect of subjective aging (likelihood ratio = 1.429; 95% confidence interval = 1.273-1.604; p < .001). The analyses revealed heterogeneity, with stronger effects for studies with a shorter period of follow-up, for studies of health versus survival, for studies with younger participants (average age of the studies varies between 57 and 85 years with a median of 63 years), and for studies in welfare systems where state provisions of welfare are minimal. However, effects did not vary either across different operationalizations of subjective aging or by study quality. Subjective aging has a small significant effect on health, health behaviors, and survival. Further theoretical conceptualizations and empirical studies are needed to determine how subjective aging contributes to health and survival. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Are the negative thought patterns and self-doubt associated with the Imposter Phenomenon similar to the negative thought patterns and self-doubt that many individuals who have mild depression experience? If so, it is reasonable to believe that a relation between depression and the Imposter Phenomenon (IP) exists. The relation between the IP and depression among college students was examined. Results of a Pearson product-moment correlation yielded a positive correlation between the IP and BDI-II scores. Additionally, a Multivariate Analysis of Variance (MANOVA) using the IP scores and BDI scores as the dependent variables, with sex serving as the independent variable, revealed that men and women differ significantly on the combined dependent variables of IP and BDI scores. More specifically, the main effect between sex and IP score indicates that women have higher IP scores than men. However, the effect between sex and BDI was not statistically significant. Lastly, the implications of these findings are discussed.
Psychology has increasingly turned to the study of psychosocial resources in the examination of well-being. How resources are being studied and resource models that have been proffered are considered, and an attempt is made to examine elements that bridge across models. As resource models span health, community, cognitive, and clinical psychology, the question is raised of whether there is overuse of the resource metaphor or whether there exists some underlying principles that can be gleaned and incorporated to advance research. The contribution of resources for understanding multicultural and pan-historical adaptation in the face of challenge is considered. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
We use two studies to explore how individuals manage perceptions of impostorism as they train for their future careers. Drawing on interviews with 20 professionals in training, our qualitative analysis uncovered various tactics (both constructive and maladaptive) used by these individuals to cope with perceived impostorism. Among these tactics, seeking social support from individuals outside of their program peer group (e.g., professors, family, friends, and significant others) appeared to be more effective in dampening perceptions of impostorism than seeking support from peers within their program. We use Conservation of Resources Theory (COR) to develop testable hypotheses about this observed relationship between different sources of social support and perceptions of impostorism, and find support for this pattern of results in a group of 213 professionals in training. We also discuss the implications for research on impostorism, COR, social support, and early career entry.
Rationale:
Poor subjective physical health and loneliness are among the most detrimental ramifications of trauma. Indeed, substantial research has examined the link between subjective physical health and loneliness, mainly focusing on how loneliness leads to poorer physical health. However, the effects of poor subjective physical health on loneliness, as well as the reciprocal effects of these two factors, have scarcely been examined. Even less is known regarding the course of these mutual effects among individuals who have been exposed to trauma.
Objective:
The current investigation examines the reciprocal effects of subjective physical health and loneliness among a group of war veterans over four decades.
Methods:
Two-hundred and seventy-four Israeli veterans from the 1973 Yom- Kippur War reported self-rated health (SRH), somatization and loneliness at 1991 (T1), 2003 (T2), 2008 (T3) and 2015 (T4). An autoregressive cross-lagged (ARCL) modeling strategy was employed to test the bidirectional relationship between subjective health and loneliness.
Results:
The results showed that from T1 to T2, loneliness predicted subjective physical health. However, from T2 to T3, and from T3 to T4, subjective physical health predicted loneliness. PTSD moderated the association between loneliness and subjective physical health.
Conclusion:
The findings show a novel pattern of influences, demonstrating that the reciprocal effects of subjective physical health and loneliness change over time. The findings imply that subjective health and interpersonal experiences are inherently connected.
Objective:
Although it is well-established that posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are associated with physical health difficulties among U.S. veterans, the incremental burden of having both disorders relative to either one alone remains largely unknown. The goal of this study was to provide the first population-based characterization of the burden of medical illness associated with PTSD, MDD, and their comorbidity among U.S. veterans.
Methods:
Data were from National Health and Resilience in Veterans Study, a nationally representative survey of U.S. veterans (n = 2732). Analyses (a) examined the magnitude of medical comorbidity and disability associated with PTSD, MDD, and co-occurring PTSD/MDD; and (b) compared physical functioning by PTSD/MDD status.
Results:
After adjusting for sociodemographic characteristics and substance use disorders, veterans with comorbid PTSD/MDD were more likely to be diagnosed with heart disease, migraine, fibromyalgia, and rheumatoid arthritis compared to those with MDD-only. Conversely, they were at greater odds of being diagnosed with hypercholesterolemia and hypertension relative to those with PTSD-only. Comorbid PTSD/MDD status was associated with approximately three times greater odds of disability compared to MDD alone. Veterans with co-occurring PTSD/MDD and PTSD-only exhibited worse physical functioning than those with MDD-only.
Conclusion:
Findings indicate that veterans with co-occurring PTSD/MDD represent a high-risk group for cardiovascular disease and other health problems, and therefore deserve careful attention from healthcare systems. Further research is needed to investigate mechanisms underlying associations between PTSD/MDD and physical health morbidities, as well as whether treatment of PTSD/MDD can reduce risk for comorbid medical conditions.
Background
Few longitudinal studies have investigated the potentially dynamic relationship between Posttraumatic Stress Disorder (PTSD) and physical functioning, and the number of follow-up timepoints have been limited. We evaluated whether PTSD symptoms predicted future physical functioning and vice versa using five assessments over four years.
Methods
Data was used from a longitudinal cohort of 695 participants recruited from Veteran Affairs medical outpatient clinics who experienced a traumatic event. PTSD symptom severity was assessed annually with the PTSD Checklist (PCL). Physical functioning was measured with the 10-item subscale of the SF-36. An autoregressive cross-lagged panel model was used to determine the temporal associations between PTSD and physical functioning, adjusting for age, sex, ethnicity, education and employment. Comorbidities and health behaviors were added to assess their roles in the relationship.
Results
Greater PTSD symptom severity predicted worse physical functioning the following year (average β = –0.10, P <0.001), where a 10-point increase in PCL score predicted a 0.3-point decline in physical function score over one year. Similarly, better physical functioning also predicted reduced PTSD severity the following year, but to a smaller magnitude (average β = –0.04, P = .003). The pattern of effects was similar after controlling for comorbidities and health behaviors.
Limitations
Both primary variables relied on self-report, and generalizability may be limited by the mostly male Veteran sample.
Conclusions
Our results support a bidirectional, but unequal, relationship between PTSD and physical functioning over time. They also highlight the importance of long-term control of PTSD symptoms in preventing functional decline.
Impostor phenomenon or “impostorism” refers to the experience of high-achieving individuals (particularly women) who, despite being successful, attribute their accomplishments to luck, and fear being exposed as frauds. In the current study, we examined the association between impostorism and graduate student self-efficacy, perceptions of the research-training environment, and attitudes toward academic persistence of 224 women completing a science, technology, engineering, and mathematics (STEM)-related doctoral degree. As hypothesized, participants who identified more strongly with impostor characteristics reported a lower sense of self-efficacy, more negative views of their academic context, and more pessimistic outlooks toward attaining their doctorate. However, results from a multiple mediation analysis revealed that women’s levels of self-efficacy and perceptions of their doctoral environment accounted for the effects of impostorism on their attitudes about academic persistence. Also, the relation between impostorism and persistence attitudes strengthened as numerical representation of women in a STEM program increased. Results illuminate the potential role STEM departments can have on students’ persistence by developing early opportunities for research collaborations and fostering an early sense of accomplishment. Parents and teachers might also draw from our findings to develop strategies to inoculate younger students from the insidious effects of gender-based stereotypes.
Aim: To explore the concept of impostorism as applied to nursing and other disciplines.
Background: Impostorism has not been well defined or studied in nursing. Researchers have not studied connections between new graduate role transition stress and impostorism, despite evidence that nursing students experience impostorism during undergraduate studies.
Design: Rodgers’ evolutionary concept analysis
Data Sources: Databases included Academic Search Complete, CINAHL, Health and Psychosocial Instruments, Health Source: Nursing/Academic Edition, MEDLINE, PsycARTICLES, Psychology and Behavioral Sciences Collection, PsycINFO, SocINDEX, and Dissertations and Theses databases.
Review Methods: All nursing-specific citations were included in the literature sample. Of the remaining non-nursing citations, stratified random sampling provided 28 non-nursing citations. Additional purposive sampling of seminal impostorism publications resulted in 46 resources for analysis.
Results: Concept analysis revealed that key attributes of impostorism include fear of failure and difficulty accepting praise. Impostorism antecedents relate to personality, attribution, family, workplace, and sociodemographic variables. Following concept analysis, a conceptual definition emerges of impostorism as a subjective, inaccurate self-assessment involving feelings of intellectual and professional incompetence and fraudulence despite external evidence of success.
Conclusions: Impostorism has undergone evolutionary changes in various disciplines. However, the nursing discipline needs more research related to nurses’ experiences with impostorism in the workplace.
This study presents a culturally informed model of the impostor phenomenon construct for Black graduate students who attend predominantly White universities. The impostor phenomenon is an internal sense of intellectual fraudulence and a tendency to attribute success to external factors, such as luck. However, the original construct was conceptualized with a sample of White individuals and may not capture the culturally relevant factors for Black graduate students such as race or racial discrimination. Furthermore, only one empirical study investigates impostor feelings in Black graduate students. The current study addresses these gaps by using focus groups to qualitatively investigate the impostor phenomenon in 12 Black graduate students. Inductive thematic analysis revealed five themes (Awareness of Low Racial Representation, Questioning Intelligence, Expectations, Psychosocial Costs, and Explaining Success Externally) and multiple subthemes. The findings extend the original construct, contribute to a culturally informed framework for understanding the impostor phenomenon in Black graduate students, and have implications for theory, educators, clinicians, and researchers.
Proper analysis and reporting of incomplete data continues to be a challenging task for practitioners from various research areas. Recently Nguyen, Strazdins, Nicholson and Cooklin (NSNC; 2018) evaluated the impact of complete case analysis and multiple imputation in studies of parental employment and health. Their work joins interdisciplinary efforts to educate and motivate scientists across the research community to use principled statistical methods when analyzing incomplete data. Although we fully support and encourage work in parallel to NSNC's, we also think that further actions should be taken by the research community to improve current practices. In this commentary, we discuss some aspects and misconceptions related to analysis of incomplete data, in particular multiple imputation. In our view, the missing data problem is part of a larger problem of research reproducibility and replicability today. Thus, we believe that improving analysis and reporting of incomplete data will make reproducibility and replicability efforts easier. We also provide a brief checklist of recommendations which could be used by members of the scientific community, including practitioners, journal editors, and reviewers to set higher publication standards.
Objectives:
Exposure to captivity increases the risk for multiple disturbances that may intensify during old age. In later phases of life, former-prisoners-of-war (ex-POWs) may suffer from depression as well as from accelerated aging, manifested in older subjective age and leukocyte telomere shortening. The current study assesses the link between these varied facets of increased vulnerability during old age and explores (a) the associations between subjective age and telomere length; (b) the mediating role of changes in subjective age over time within the associations between depression and telomere length.
Methods:
Eighty eight ex-POWs were assessed prospectively 30 (T1), 35 (T2) and 45 (T3) years after the 1973 Israeli Yom-Kippur War. Depression was assessed at T1; subjective age was assessed at T2 and T3; and telomere length and control variables were assessed at T3.
Results:
Older subjective age at T3 was associated with concurrent shorter telomeres, beyond the effect of chronological age. Change in subjective age between T2 and T3 mediated the relations between depression at T1 and shorter telomeres at T3 beyond the effects of control variables.
Discussion:
Findings suggest that the detrimental ramifications of accelerated subjective age involve premature cellular senesces, and may explain the relation between depression and accelerated aging processes among trauma victims. Hence, clinical interventions may seek to address accelerated subjective age among trauma survivors who suffer from depression.
Several studies have shown the relationship between symptoms of posttraumatic stress disorder (PTSD), somatic symptoms, and the mediating effect of depression and anxiety. The following study was conducted to investigate the relationship between PTSD symptoms and somatic complaints through underlying symptoms of depression and anxiety. The participants of the study were 2,799 veterans who were examined after a 6-month deployment. They were assessed using the PTSD Checklist (PCL-5) and Patient Health Questionnaire (PHQ) for depression, anxiety, and somatic complaints. To check the indirect effect of PTSD on somatic complaints through depression and anxiety, mediation model 4 (parallel mediation) of the SPSS PROCESS macro was used. There was a significant total indirect effect of PTSD through depression and anxiety on somatic complaints, b = 0.14, 95% confidence interval (CI) [0.12, 0.16], from which an indirect effect of PTSD on somatic complaints through depression was b = 0.08, 95% CI [0.06, 0.10], and through anxiety it equaled b = 0.06, 95% CI [0.04, 0.07]. The ratio of indirect to total effect was 0.66, 95% CI [0.59, 0.75]. The present study helps us to understand the role of depression and anxiety symptoms when the symptoms of PTSD and somatic complaints are present. These new findings may have implications for the management as well as treatment of PTSD because they recognize the importance of symptoms of anxiety and depression when somatic complaints are present.
Background
While both full and subthreshold posttraumatic stress disorder (PTSD) may be linked to physical conditions, contemporary population-based data on these associations in military veterans are scarce. Further, little is known about how component aspects of PTSD, which is a heterogeneous disorder, may relate to physical conditions in this population.
Methods
Data were analyzed from a population-based sample of 3,157 U.S. military veterans who participated in the 2011 National Health and Resilience in Veterans Study. Multivariable logistic regression analyses evaluated associations between full and subthreshold PTSD, and physical conditions.
Results
A total 6.1% of the sample met screening criteria for full PTSD and 9.0% for subthreshold PTSD. Both full and subthreshold PTSD were associated with increased odds of sleep disorder (adjusted odds ratio [AOR]=3.52 and 2.10, respectively) and respiratory conditions (AOR=2.60 and 1.87, respectively). Full PTSD was additionally associated with increased odds of osteoporosis or osteopenia (AOR=2.72) and migraine (AOR=1.91), while subthreshold PTSD only was associated with increased odds of diabetes (AOR=1.42). Analyses of PTSD symptom clusters revealed that all of these associations were primarily driven by dysphoric arousal symptoms, which are characterized by sleep difficulties, anger/irritability, and concentration problems.
Limitations
The study used self-report measures for health conditions and DSM-IV diagnostic criteria for PTSD.
Conclusion
Results of this study provide a characterization of physical conditions associated with full and subthreshold PTSD in U.S. military veterans. They highlight the potential importance of PTSD dysphoric arousal in risk models of certain physical conditions in this population.
Background:
Few studies have longitudinally examined predictors of posttraumatic stress disorder (PTSD) in a nationally representative sample of US veterans. We examined predictors of warzone-related PTSD over a 25-year span using data from the National Vietnam Veterans Longitudinal Study (NVVLS).
Methods:
The NVVLS is a follow-up study of Vietnam theater veterans (N = 699) previously assessed in the National Vietnam Veterans Readjustment Study (NVVRS), a large national-probability study conducted in the late 1980s. We examined the ability of 22 premilitary, warzone, and postmilitary variables to predict current warzone-related PTSD symptom severity and PTSD symptom change in male theater veterans participating in the NVVLS. Data included a self-report Health Questionnaire survey and a computer-assisted telephone Health Interview Survey. Primary outcomes were self-reported PTSD symptoms assessed by the PTSD Checklist for DSM-5 (PCL 5) and Mississippi PTSD Scale (M-PTSD).
Results:
Predictors of current PTSD symptoms most robust in hierarchical multivariable models were African-American race, lower education level, negative homecoming reception, lower current social support, and greater past-year stress. PTSD symptoms remained largely stable over time, and symptom exacerbation was predicted by African-American race, lower education level, younger age at entry into Vietnam, greater combat exposure, lower current social support, and greater past-year stressors.
Conclusions:
Findings confirm the robustness of a select set of risk factors for warzone-related PTSD, establishing that these factors can predict PTSD symptom severity and symptom change up to 40 years postdeployment.
The smile is a universally recognized facial expression generally associated with happiness. However, this may not always be the case and discerning the difference is surprisingly difficult. Enjoyment smiles involve the involuntary contraction of the orbicularis oculi, which lifts the cheeks and narrows the eyes, and the zygomaticus major, which raises the lip corners. Nonenjoyment smiles only use the zygomaticus major (Frank & Ekman, 1993). In the current study, participants watched Facial Action Coding System (FACS) coded videos of smiles and were asked whether they believed the smiles were real or fake. Tobii X120 eye-tracking software was used to determine the most focused upon facial muscle when interpreting the smiles. It was estimated that the majority of participants would perform at a level slightly above chance, achieve an average of 60% accuracy, and pay most attention to the zygomaticus major (Ekman & Friesen, 1982; Frank, Ekman & Friesen, 1993). Results indicated that the majority of the participants performed significantly above chance, with an average 65% accuracy, and focused on the orbicularis oculi. These findings suggest that the ability to detect smiles is increasing and people tend to look at the eyes rather than the mouth during a smile.
This study investigated whether impostor feelings would both moderate and mediate the relationship between perceived discrimination and mental health in a sample of diverse ethnic minority college students (106 African Americans, 102 Asian Americans, 108 Latino/a Americans) at an urban public university. African American students reported higher perceived discrimination than Asian American and Latino/a American students, while no racial/ethnic group differences were reported for impostor feelings. Analyses revealed that among African American students, high levels of impostor feelings moderated the perceived discrimination and depression relationship and mediated the perceived discrimination and anxiety relationship. Among Asian American students, impostor feelings mediated the relationship between perceived discrimination and both depression and anxiety. Among Latino/a American students low levels of impostor feelings moderated the relationship between perceived discrimination and both depression and anxiety, and partially mediated the relationship between perceived discrimination and anxiety. Multigroup path analyses revealed a significantly stronger impact of impostor feelings on depression among African American students and a stronger impact of perceived discrimination on impostor feelings among African American and Latino/a American students. Clinical implications and future research directions are discussed.
This longitudinal study assesses the trajectories of depressive symptoms and subjective age and the mediating role of guilt in the association between them. Two groups of aging Israeli combat veterans ( age = 57), 128 ex-prisoners of war (ex-POWs), and 106 comparable combat veterans (controls), were assessed at 3 times: 18 (Time 1 [T1]), 30 (Time 2 [T2]), and 35 (Time 3 [T3]) years after the war. They filled out self-report questionnaires on depression, guilt, and subjective age. Results revealed that significantly more ex-POWs had chronic or delayed clinical levels of depressive symptoms than did controls and that chronic and delayed depressive symptoms were associated with a higher subjective age at T3. Furthermore, the path between depressive symptoms at T1 for predicting subjective age at T3 was fully explained by levels of guilt-distress at T2. Although the mediation effect was found in both study groups, it was significantly stronger among ex-POWs than among controls. These findings suggest that not only is depression a long-term sequela of traumatic stress, it is also a risk factor for psychological aging among war veterans. Furthermore, guilt-distress appears to play an important role in advancing subjective age, especially among ex-POWs. (PsycINFO Database Record
An older age identity is related to higher posttraumatic stress disorder (PTSD) symptoms. However, in relating to PTSD symptoms, an older subjective age can interact with other major perceptions of aging, such as the subjective nearness to death, reflecting how close or far people experience themselves to be from their death. We examined this possible interaction effect on PTSD symptoms in two samples. Sample 1 included 1,268 respondents exposed to missile attacks during the 2014 Israel-Gaza conflict. Sample 2 included 628 respondents exposed to terrorist attacks during the 2015 escalation in the Israeli-Palestinian conflict. Findings from both samples showed that after controlling for level of exposure and background characteristics, an older subjective age and perceiving death as near had an interactive effect on PTSD symptoms. While the combination of feeling older and nearer to death was related to the highest ratings of PTSD symptoms, effects of subjective age on PTSD symptoms were mitigated by perceiving death as far. These findings emphasize the importance of an integrative view of two time perspectives - one that focuses on time since birth and another that concerns time left until death - which can be conceptualized as reflecting psychological resources vis-à-vis adversity.
The aim of this research was to explore the connection between subjective age and positive orientation in old age. A group of 194 seniors were examined using the Positivity Scale, the Rosenberg Self-esteem Scale, and the Satisfaction with Life Scale. The results revealed that a majority of the sample reported younger subjective age.Hierarchical regression analysis indicated that subjective age was a significantly stronger predictor of positive orientation, satisfaction with life, and self-esteem than chronological age, and it also had a unique explanatory power above and beyond self-reported health functioning. It was found that chronological age as a single predictor did not have any meaning in defining the variance of psychological variables among older adults.
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.
The recent economic recession has led many organizations to downsize, or eliminate positions, in an effort to cut labor costs and improve profitability. Survivors may suddenly find themselves over-rewarded, or prematurely promoted, into one or more vacant positions. One negative consequence of over-reward in particular, impostor phenomenon, may present significant challenges at both the individual and organizational level. Thus, the purpose of this chapter is to examine the consequences and coping strategies of survivors who perceive themselves as over-rewarded and under-qualified for a job. Hobfoll's Conservation of Resources Theory (COR) serves as this study's framework to explicate the outcomes associated with impostor feelings and how impostors cope with their perceived inadequacy. Specifically, we propose that impostor feelings will be positively related to emotional exhaustion. To deal with the exhaustion, impostors may rely on coping strategies in order to master the additional internal and external demands created by feelings of impostorism. The type of strategy used by impostors to cope with the exhaustion is influenced by the level of perceived social support. That is, impostors who perceive higher levels of support will resort to active coping while those who perceive lower levels of support will resort to avoidant coping.Managerial implications and directions for future research are offered.
About a decade ago we proposed the notion of late-onset stress symptomatology, to characterize the later-life emergence of symptoms related to early-life warzone trauma among aging combat Veterans. We hypothesized that aging-related challenges (role transition and loss, death of family members and friends, physical and cognitive decline) might lead to increased reminiscence, and possibly distress, among Veterans who had previously dealt successfully with earlier traumatic events. Recently, we have reexamined our earlier ideas, to better reflect our developing understanding of this phenomenon, and to incorporate more contemporary perspectives on posttraumatic growth and resilience. As a result, we have broadened our conceptualization to later-adulthood trauma reengagement (LATR). We suggest that in later life many combat Veterans confront and rework their wartime memories in an effort to find meaning and build coherence. Through reminiscence, life review, and wrestling with issues such as integrity versus despair, they intentionally reengage with experiences they avoided or managed successfully earlier in life, perhaps without resolution or integration. This article links LATR to classic gerontologic notions, and elaborates how the LATR process can lead positively to personal growth or negatively to increased symptomatology. We also address the role of preventive intervention in enhancing positive outcomes for Veterans who reengage with their wartime memories in later life.
In this article, we review the psychology of hero development and hero worship. We propose that heroes and hero narratives fulfill important cognitive and emotional needs, including the need for wisdom, meaning, hope, inspiration, and growth. We propose a framework called the heroic leadership dynamic (HLD) to explain how need-based heroism shifts over time, from our initial attraction to heroes to later retention or repudiation of heroes. Central to the HLD is idea that hero narratives fulfill both epistemic and energizing functions. Hero stories provide epistemic benefits by providing scripts for prosocial action, by revealing fundamental truths about human existence, by unpacking life paradoxes, and by cultivating emotional intelligence. To energize us, heroes promote moral elevation, heal psychic wounds, inspire psychological growth, and exude charisma. We discuss the implications of our framework for theory and research on heroism, leadership processes, and positive psychology.
Older veterans are the largest cohort served by the U.S. Department of Veterans Affairs (VA). The aim of this study was to examine mental health service utilization among older veterans recently diagnosed with posttraumatic stress disorder (PTSD), with an interest in sociodemographic and clinical characteristics related to receipt and type of mental health treatment.
VA National administrative data set and pharmacy records.
VA Healthcare System.
The sample comprised 96,249 veterans aged 50+ years who received a new diagnosis of PTSD between fiscal years 2008-2011.
Demographic/clinical characteristics and treatment variables (receipt of mental health treatment; number of days before first appointment; receipt of psychotherapy, medication, or combination treatment; type of medication; number of psychotherapy visits) were assessed and relations were examined using logistic, negative binomial, and Cox regressions.
The majority of older veterans with newly diagnosed PTSD received at least one follow-up mental health visit. Increasing age was associated with decreased odds of receipt of any type of mental health treatment, and psychiatric comorbidities and greater number of medical appointments were associated with increased odds of treatment. Among veterans who received treatment, increased age was associated with decreased odds of receiving both psychotherapy and pharmacotherapy, decreased number of psychotherapy visits, and increased waiting times.
Among older veterans recently diagnosed with PTSD in the VA healthcare system, older individuals, particularly those over 80 years old, are at risk of not receiving timely and appropriate mental health treatment, indicating targeted outreach to this population could be helpful in improving care.
Published by Elsevier Inc.
This study explores how US veterans who suffer from mental health problems navigate between two primary statuses: national hero and mental patient. The analysis reveals a more nuanced understanding than previous research, which has focused on a simple negative association between positive veteran identity and stigma. Qualitative evidence collected in a work-therapy program for veterans demonstrates that the status of mental patient became salient in peer-group activities, where it engendered a sense of solidarity and mutual empathy, and in interactions outside the mental health care facility, where it involved a sense of stigma. The status of being a national hero emerged in interactions with casual visitors from whom material contributions were sought, but did not reinforce a sense of positive veteran identity because veterans were aware of its instrumental nature. When leaving the program, a strong sense of stigma emerged despite the possibility of embracing the veteran identity.
The Impostor Phenomenon was identified from clinical observations during therapeutic sessions with high achieving women by Dr Pauline Clance. Despite objective evidence of success, these women had a pervasive psychological experience believing that they were intellectual frauds and feared being recognised as impostors. They suffered from anxiety, fear of failure and dissatisfaction with life. This article reviews definitions and characteristics of trait Impostorism, some antecedents, such as personality and family achievement environment and psychological distress as a consequence of Impostorism.
Posttraumatic stress disorder is often diagnosed with other mental health problems, particularly depression. Although PTSD comorbidity has been associated with more severe and chronic symptomology, relationships among commonly co-occurring disorders are not well understood. The purpose of this study was to review the literature regarding the development of depression comorbid with combat-related PTSD among military personnel. We summarize results of commonly tested hypotheses about the etiology of PTSD and depression comorbidity, including (1) causal hypotheses, (2) common factor hypotheses, and (3) potential confounds. Evidence suggests that PTSD may be a causal risk factor for subsequent depression; however, associations are likely complex, involving bidirectional causality, common risk factors, and common vulnerabilities. The unique nature of PTSD-depression comorbidity in the context of military deployment and combat exposure is emphasized. Implications of our results for clinical practice and future research are discussed.
This qualitative study seeks to extend the existing body of scholarly literature on returned veteran civilian reintegration by exploring "hero" and "Post-Traumatic Stress Disorder" narratives. The character of the hero, as a social construct located within hegemonic notions of masculinity, is widely portrayed and believed to possess highly prized, extraordinary, almost superhuman personal qualities. However, this widely disseminated belief stands at odds with some of the stories returned veterans tell. This qualitative study explores and illuminates the enigmatic intersectionality of hero and PTSD narratives.
Extant hero and PTSD narratives contain paradoxical implicit meanings embedded within them. The hero is understood to be fearless, strong, independent, and physically and emotionally tough. PTSD, on the other hand, implies personal deficiencies, enervation, dependence, diffidence, and other personal shortcomings. The apparent contradictions between these two cultural narratives elucidate how hero narrative are founded less in the lived reality as experienced by returned veterans and more in socially circulating stories about returned combat veterans as disembodied people. Most problematic is the tendency for widely circulating stories about them as the hero character to disguise the reality of day-to-day life as returned combat veterans live it. Through narrative analysis it is revealed that the popular cultural image of veterans as strong, independent, and courageous "warriors" may conflict with reality as lived by combat veterans. Paradoxically, however, returned combat veterans may employ the hero narrative in making sense of themselves. As a result, returned combat veterans may find it difficult to act in ways inconsistent with the hero narrative, such as asking for help, admitting a damaging personal problem, exacerbating the civilian reintegration experience and potentially significantly lowering returned combat veterans' quality of life. This problem may be especially salient for veterans experiencing symptoms of PTSD who may feel trapped between two the cultural narratives of hero and victim.
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Extensive attention has been paid over the past three decades to the stressors involved in training in the health professions. Although empirical studies have identified demographic subgroups of students most likely to become distressed during training, less research has been carried out to evaluate the impact of students' personality characteristics on their adjustment. Severe perfectionism is one such personality trait that has been shown to increase the risk for anxiety and depressive disorders in other populations. Another set of personality traits linked to increased psychological problems has been labelled the `impostor phenomenon', which occurs when high achieving individuals chronically question their abilities and fear that others will discover them to be intellectual frauds. Both perfectionism and the impostor phenomenon would seem to be pertinent factors in the adjustment of health professional students; however, these character traits have not been empirically examined in this population. In the present study psychological distress, perfectionism and impostor feelings were assessed in 477 medical, dental, nursing and pharmacy students. Consistent with previous reports, the results showed that a higher than expected percentage of students (27·5%) were currently experiencing psychiatric levels of distress. Strong associations were found between current psychological distress, perfectionism and impostor feelings within each programme and these character traits were stronger predictors of psychological adjustment than most of the demographic variables associated previously with distress in health professional students. Implications for future research, limitations of this study and clinical recommendations are discussed.
This article examines modes of theorizing about war in two contemporary literatures: on war and gender and on the changing nature of war. Both these literatures make a connection between masculinity and war. The article argues that, on examination, the link between masculinity and war does not depend on the substantive meanings of either masculinity or war, or on a causal or constitutive relation between the two; rather, masculinity is linked to war because the formal, relational properties of masculinity provide a framework through which war can be rendered both intelligible and acceptable as a social practice and institution.
Numerous studies have emphasized a stable relationship between subjective age and health. However, few longitudinal studies exist and these have normally tested only one causal pathway. The present study investigated the direction of effects between subjective age and different health dimensions in 3,038 participants of the German Ageing Survey, aged 40 years and older. Cross-sectionally, subjective age correlated with all health dimensions studied. Longitudinally, subjective age predicted physical, mental, and self-rated health, whereas the reverse effect was found only for self-rated health. Subjective age thus seems to be an important resource for preserving health in the second half of life.
