Article

Impostorism, Subjective Age, and Perceived Health among Aging Veterans

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  • College of Management
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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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... Weak correlations were found between the impostor phenomenon and histrionic personality disorder as well as extraversion, which is inconsistent with the notion that impostors desire social attention and approval but is consistent with how impostors can genuinely feel fraudulent. Ross and Krukowski (2003) (Lahav et al., 2020). Social anxiety has been found to affect impostors as well (Kolligian & Sternberg, 1991;Oleson et al., 2000). ...
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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.
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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.
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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.
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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.
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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.
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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.
Article
Objective: War captivity includes a unique constellation of simultaneous somatic and interpersonal assaults. This raises questions about the link between attachment and somatic complaints among ex-prisoners of war (ex-POWs). Although the attachment literature assumes that attachment affects somatic complaints and not vice versa, to date no empirical studies assess the association between the two variables over time. In this article we prospectively examine the association between attachment and somatic complaints over time among ex-POWs and comparable veterans. Method: The current study included two groups of male Israeli veterans of the 1973 Yom Kippur War: ex-POWs and comparable veterans who were not taken captive. Both groups were assessed via self-report measures at three times: T1 (1991), T2 (2003), and T3 (2008)-18, 30, and 35 years after the war, respectively. Results: Ex-POWs reported higher levels of somatic complaints and attachment insecurities. These levels increased over time compared to combatant veterans. Moreover, while there was a unidirectional influence of somatic complaints on attachment security over time among combatant veterans, this relationship was bidirectional among ex-POWs. Conclusions: The present study suggests that the combined physical and interpersonal assaults experienced during captivity have adverse effects on combatants and on attachment security, even three decades later. More important, in ex-POWs the relationship between these domains appears to be interactive and mutual, with one reinforcing the other, and vice versa.
Chapter
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.
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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.
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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.
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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.
Article
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.
Article
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.
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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.
Article
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.
Article
Hegemonic masculinities are at the top of the gender hierarchy and exist in relation to subordinated gender constructs. Traditional constructions of hegemonic masculinities include risk-taking, self-discipline, physical toughness and/or muscular development, aggression, violence, emotional control, and overt heterosexual desire. Using a grounded theory approach, 43 men were interviewed focusing on the process of hegemonic masculinities construction (n = 25 pre-active duty Reserve Officer Training Corps members and n = 18 Delayed Entry Program men). By casting non-military personal (i.e., civilians) and service members of different branches (i.e., Army, Navy, Marines, Air Force), different occupational specialties (i.e., infantry, artillery, supply, etc.), and different rank (officer versus enlisted) as less physically able, self-disciplined, willing to take risks, emotionally controlled, and/or intelligent, pre-active duty servicemen discursively dominate others. The end result is that men create hierarchies that subordinate others while simultaneously placing their own perceived characteristics in positions of symbolic dominance.
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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.
Article
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.
Article
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.