Distress in spouses of service members with symptoms of combat-related PTSD: Secondary traumatic stress or general psychological distress?

Combat-related posttraumatic stress disorder (PTSD) is linked with elevated psychological distress in service members'/veterans' spouses. Researchers use a variety of terms to describe this distress, and recently, secondary traumatic stress and secondary traumatic stress disorder (STS/STSD) have become increasingly commonly used. Although STS/STSD connotes a specific set of symptoms that are linked to service members'/veterans' symptoms, researchers often use general measures of distress or generically worded measures of PTSD symptoms to assess STS/STSD. To determine how often scores on such measures appear to be an accurate reflection of STS/STSD, we examined responses to a measure of PTSD symptoms in 190 wives of male service members with elevated levels of PTSD symptoms. Wives rated their own PTSD symptoms, and then answered questions about their attributions for the symptoms they endorsed. Fewer than 20% of wives who endorsed symptoms on the PTSD measure attributed these symptoms completely to their husbands' military experiences. Moreover, compared with wives who attributed symptoms only to events in their own lives, wives who attributed symptoms completely or partially to their husbands' military experiences had a greater overlap between some of their responses on the PTSD measure and their responses to a measure of general psychological distress. These results suggest that most wives of service members/veterans with PTSD experience generic psychological distress that is not conceptually consistent with STS/STSD, although a subset does appear to endorse a reaction consistent with this construct. Implications of these findings for intervention and research with this vulnerable population are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Secondary traumatization in Dutch couples of World War II survivors.

This study examined whether signs of secondary traumatic stress were present in a community sample of couples who experienced World War II. The authors hypothesized that symptoms of posttraumatic stress disorder (PTSD) in either spouse may be predicted not only by his or her own war experiences but also by the war experiences and posttraumatic symptoms of the partner. Approximately 50 years after the end of World War II, 444 couples from a community sample of elderly Dutch citizens answered a questionnaire. A multilevel regression analysis was performed with symptoms of PTSD as the dependent variable. The most important predictors of PTSD symptoms were the number of war events reported by the participant and the current level of PTSD symptoms of his or her spouse. The results lend empirical support to the notion that posttraumatic stress reactions of both members of a couple are not independent from each other. Several explanations of the findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The development of a couple-based treatment for PTSD in returning veterans.

Military personnel deployed in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) show high levels of emotional distress and posttraumatic stress disorder (PTSD), and these deployment-related problems may be expected to have a devastating impact on their relationships. It is urgent that researchers develop couple-based treatments to reduce PTSD in OEF/OIF veterans and to reduce PTSD-related relationship problems. This article describes the development of a novel couple-based treatment for PTSD, called Structured Approach Therapy (SAT), that uses empathic communication training and stress inoculation procedures to help couples improve their ability to cope with trauma-related anxiety and a multicomponent emotion activation program to help couples reduce emotional numbing. The theoretical basis of the SAT Treatment Model is described, and the various treatment components are presented. The authors recommend that couple-based interventions be used to provide OEF/OIF veterans and their partners with empathic communication skills to discuss their thoughts and feelings about deployment and with dyadic coping skills to confront trauma-related aversive emotions and emotional numbing and return intimacy to their lives. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The implication of combat-induced stress reaction, PTSD, and attachment in parenting among war veterans.

This study examined parental functioning, parental satisfaction, and concern for offspring during their child's military service, among war veterans, some of whom suffered from acute combat-induced stress reaction (CSR) and posttraumatic stress disorder (PTSD). In addition, we examined the additive and interactive contributions of CSR, PTSD and attachment dimensions to parenting measures. The sample consisted of 477 participants divided into two groups: a clinical group of veterans who had been diagnosed with CSR on the battlefield (N = 267), and a matched control group of veterans who did not suffer from CSR (NCSR; N = 210). CSR, PTSD, avoidant-attachment, and anxious-attachment, were all related to lower levels of parental functioning and satisfaction. Veterans who suffered from both CSR and PTSD reported more concern for their offspring during their child's military service compared to veterans with PTSD but without antecedent CSR. Attachment dimensions and specifically attachment-avoidance, made the greatest contribution to parenting measures, followed by posttraumatic symptoms. In addition, attachment-avoidance moderated the relationship between posttraumatic symptoms and parental functioning. Theoretical and clinical implications of these results are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Marital relations among former prisoners of war: Contribution of posttraumatic stress disorder, aggression, and sexual satisfaction.

In this study, the authors examined the marital adjustment, spousal aggression, and sexual satisfaction of prisoners of war (POWs) 3 decades after their release. More specifically, the authors examined the extent to which impaired marital relations among former POWs are an outcome of their captivity or of the posttraumatic stress disorder (PTSD) that some of them developed. The authors compared 25 former POWs with PTSD, 85 former POWs without PTSD, and 104 control veterans. The findings reveal that the marital problems of former POWs are more related to PTSD than to their captivity. PTSD is related to decreased marital satisfaction, increased verbal aggression, and heightened sexual dissatisfaction among former POWs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

PTSD among Israeli former prisoners of war and soldiers with combat stress reaction: a longitudinal study

OBJECTIVE: The aim of this study was to assess the long-term impact of war captivity and combat stress reaction on rates of posttraumatic stress disorder (PTSD) in Israeli veterans of the 1973 Yom Kippur war. METHOD: One hundred sixty-four former prisoners of war (POWs), 112 veterans who had had combat stress reaction, and 184 combat veteran comparison subjects filled out the PTSD Inventory, a self-report scale based on the DSM-III-R criteria for PTSD. The inventory diagnoses past and present PTSD, assesses its intensity, and provides a symptom profile. RESULTS: Thirty-seven percent of the veterans who had had combat stress reaction, 23% of the former POWs, and 14% of the comparison subjects had had diagnosable PTSD at some time in the past. The current rates were 13%, 13%, and 3%, respectively. The results showed different recovery rates over time: almost two-thirds of the veterans with combat stress reaction who had had PTSD in the past recovered, while less than one-half of the POW group showed this improvement. CONCLUSIONS: These findings indicate that small but significant proportions of the POWs and veterans with combat stress reaction were still suffering from PTSD almost two decades after the war. The different recovery rates in the two groups may reflect the differences in duration and severity of stressors, the impact of immediate intervention on long-term adjustment, or both.     

Anxiety disorders and intimate relationships: A study of daily processes in couples.

Although adults with anxiety disorders often report interpersonal distress, the degree to which anxiety is linked to the quality of close relationships remains unclear. The authors examined the relational impact of anxiety by sampling the daily mood and relationship quality of 33 couples in which the wife was diagnosed with an anxiety disorder. Use of a daily process design improved on prior methodologies by capturing relational processes closer to their actual occurrence and in the setting of the diagnosed partner’s anxiety. Analyses revealed significant associations between wives’ daily anxiety and both partners’ perceptions of relationship quality. Associations were moderated by anxiety-specific support. Results also indicated significant concordance between wives’ daily anxiety and husbands’ distress. Concordance was stronger for husbands who reported frequent accommodation of wives’ anxiety symptoms. Findings are discussed in the context of existing evidence on the social costs of anxiety disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of immediate-onset and delayed-onset posttraumatic stress disorder in military veterans.

Differences in symptoms, trauma exposure, dissociative and emotional reactions to trauma, and subsequent life stress in war veterans reporting immediate-onset or delayed-onset posttraumatic stress disorder (PTSD) or no PTSD were investigated. The role of life stress in delayed-onset PTSD was also studied. Retrospective interviews were conducted with 142 United Kingdom veterans receiving a war pension for PTSD or physical disability. Immediate-onset and delayed-onset PTSD were similar in the number and type of symptoms reported at onset, but the delayed-onset group differed in showing a gradual accumulation of symptoms that began earlier and continued throughout their military career. They were more likely to report major depressive disorder and alcohol abuse prior to PTSD onset. Both groups described similar amounts of trauma exposure, but those in the delayed-onset group reported significantly less peritraumatic dissociation, anger, and shame. Veterans with delayed onsets were more likely than veterans with no PTSD to report the presence of a severe life stressor in the year before onset. In conclusion, the results suggest that delayed onsets involve a more general stress sensitivity and a progressive failure to adapt to continued stress exposure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Current and lifetime psychiatric disorders among veterans with war zone-related posttraumatic stress disorder

Previous research has found high rates of psychiatric disorders among veterans with war zone-related posttraumatic stress disorder (PTSD). However, many studies in this area are methodologically limited in ways that preclude unambiguous interpretation of their results. The purpose of this study was to address some of these limitations to clarify the relationship between war zone-related PTSD and other disorders. Participants were 311 male Vietnam theater veterans assessed at the National Center for PTSD at the Boston Veterans Affairs Medical Center. The Clinician-Administered PTSD Scale and the Structured Clinical Interview for DSM-III-R were used to derive current and lifetime diagnoses of PTSD, other axis I disorders (mood, anxiety, substance use, psychotic, and somatoform disorders), and two axis II disorders (borderline and antisocial personality disorders only). Participants also completed several self-report measures of PTSD and general psychopathology. Relative to veterans without PTSD, veterans with PTSD had significantly higher rates of current major depression, bipolar disorder, panic disorder, and social phobia, as well as significantly higher rates of lifetime major depression, panic disorder, social phobia, and obsessive-compulsive disorder. In addition, veterans with PTSD scored significantly higher on all self-report measures of PTSD and general psychopathology. These results provide further evidence that PTSD is associated with high rates of additional psychiatric disorders, particularly mood disorders and other anxiety disorders. The implications of these findings and suggestions about the direction of future research in this area are discussed.     

Assessment of relationship-specific incentive and threat sensitivities: Predicting satisfaction and affect in adult intimate relationships.

Self-report scales assessing relationship-specific incentive and threat sensitivity were created. Initial tests of factor structure and associations with relationship quality were conducted in a sample of persons in intimate relationships (Study 1). Associations with conceptually related measures were examined to determine convergent and discriminant validity in a sample of dating couples (Study 2). Cross-validation of the factor structure was established in engaged couples (Study 3) and in newlywed couples (Study 4). In Study 4, couples also engaged in a laboratory-based threat task (discussion about a significant marital problem) and incentive task (discussion about loving aspects of the partner/marriage). Relationship incentive sensitivity predicted higher positive affect after the incentive task for both husbands and wives. Relationship threat sensitivity predicted greater anxiety in response to the threat laboratory task for wives only. Implications of approach and avoidance motivations in close relationship processes and outcomes are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hitting home: Relationships between recent deployment, posttraumatic stress symptoms, and marital functioning for Army couples.

Using a sample of 434 couples consisting of active duty Army husbands married to civilian wives, relationships between recent deployment, current posttraumatic stress disorder (PTSD) symptoms, and a range of marital outcomes were investigated. Self-reports from both husbands and wives regarding relationship functioning did not differ between couples who were and were not separated due to deployment in the prior year. However, deployment in the past year was related to higher levels of current PTSD symptoms for husbands, and husbands' current PTSD symptoms were associated with lower marital satisfaction, confidence in the relationship, positive bonding between the spouses, parenting alliance, and dedication to the relationship for both husbands and wives. In addition, husbands' current PTSD symptoms were associated with higher levels of negative communication for both husbands and wives, and lower satisfaction with sacrifice for the relationship for husbands. Once positive bonding, negative communication, and parenting alliance were controlled, husband PTSD symptoms no longer significantly predicted marital satisfaction for wives. Husband PTSD symptoms continued to exert a significant, but reduced, unique effect on husband marital satisfaction once these variables were accounted for. The results provide greater understanding of the relationship of deployment/PTSD symptoms and marital functioning and suggest areas for intervention with military couples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The dyadic nature of social information processing in boys' reactive and proactive aggression.

The correlation between boys' social cognitions and their aggressive behavior toward peers was examined as being actor driven, partner driven, or dyadic relationship driven. Eleven groups of 6 familiar boys each (N?=?165 dyads) met for 5 consecutive days to participate in play sessions and social-cognitive interviews. With a variance partitioning procedure, boys' social-cognitive processes were found to vary reliably across their dyadic relationships. Furthermore, mixed models regression analyses indicated that hostile attributional biases toward a particular peer were related to directly observed reactive aggression toward that peer even after controlling for actor and partner effects, suggesting that these phenomena are dyadic or relationship oriented. On the other hand, the relation between outcome expectancies for aggression and the display of proactive aggression appeared to be more actor driven and partner driven that dyadic. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder, anger, and partner abuse among Vietnam combat veterans.

The authors examined interrelationships among posttraumatic stress disorder (PTSD) symptomatology, anger, and partner abuse perpetration among a sample of 60 combat veterans. Compared with PTSD-negative participants, PTSD-positive participants reported higher state anger across time and neutral and trauma prime conditions and higher anger reactivity during the trauma prime condition. PTSD-positive participants also exhibited more anger reactivity during the trauma prime than during the neutral condition. The same pattern of results was not found for anxiety reactivity during trauma memory activation. PTSD symptoms were associated with physical assault and psychological aggression perpetration, and trait anger mediated these relationships. Findings indicate a heightened anger response among PTSD-positive veterans and suggest the salience of dispositional components of anger in abuse perpetration in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk Factors for Partner Violence Among a National Sample of Combat Veterans.

In this study, the authors identified potential risk factors for partner violence perpetration among a subsample (n=109) of men who participated in a national study of Vietnam veterans. Partner violent (PV) men with posttraumatic stress disorder (PTSD) were compared with PV men without PTSD and nonviolent men with PTSD on family-of-origin variables, psychiatric problems, relationship problems, and war-zone factors. PV men with PTSD were the highest of the 3 groups on every risk factor other than childhood abuse. Group contrasts and a classification tree analysis suggest some potential markers and mechanisms for the association between PTSD and partner violence among military veterans and highlight the need for theory development in this area of inquiry. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social medicine expert assessment of post-traumatic stress disorder

The concept of a posttraumatic stress disorder (PTSD) has become important for psychiatric diagnosis and research, particularly following US-american studies on Vietnam war veterans. Recently, studies on traindrivers involved in suicide accidents have shown symptoms of anxiety and depression in more than 30% of concerned drivers and typical symptoms of a PTSD in 15%. Here, we present the case of a traindriver who was involved in 6 suicide accidents within 17 years of traindriving (the average is 2 suicide accidents). Following the 3rd accident, the driver developed increasingly symptoms like anxiety, sleep disturbances, flashbacks and irritability. Following the 6th accident, he has been unable to work. A former expert opinion saw no relationship between the symptoms of the driver and the suicide accidents. Therefore, further information about the concept of a PTSD seems necessary to ensure early psychotherapeutic and pharmacological treatment of patients with such a disorder.     

Ongoing traumatic stress response (OTSR) in Sderot, Israel.

[Correction Notice: An erratum for this article was reported in Vol 41(2) of Professional Psychology: Research and Practice (see record 2010-06890-002). In the article “Ongoing Traumatic Stress Response (OTSR) in Sderot, Israel,” by Diamond, Lipsitz, Fajerman and Rozenblat (Professional Psychology: Research and Practice, 2010, Vol. 41, No. 1., pp. 19–25), due to a production error, the last author’s name was misspelled in the byline and the author note. The correct spelling is Ornit Rozenblat.] In Sderot, a small city in southern Israel, seven years of continuous missile attacks have led to dramatic increases in treatment seeking for anxiety symptoms. For some clients, the clinical picture is consistent with a diagnosis of post traumatic stress disorder (PTSD). For other clients, however, the onset and constellation of symptoms are less typical of PTSD. In these cases, anxiety symptoms seem to evolve gradually and be associated with ongoing, daily stress about imminent attacks, rather than with a discrete, past traumatic event. Much of their avoidance behavior is reality based. They report hyperarousal, severe distress, and loss of control during and immediately following actual missile attacks. However, they are less likely to exhibit reexperiencing symptoms. Furthermore, in contrast to the typical presentation of PTSD, their symptoms tend to diminish dramatically or completely resolve when they are no longer within harm’s way. We suggest that this clinical presentation may be best understood as an ongoing traumatic stress response (OTSR), rather than PTSD or PTSD symptoms. We consider diagnostic features which discriminate between these two phenomena as well as implications for treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Causal attributions of married couples: When do they search for causes? What do they conclude when they do?

Administered an attribution questionnaire and a partner behavior checklist to 20 nondistressed and 22 distressed couples (as determined by a dyadic adjustment scale). Instruments contained indirect and direct probes. Wives were aged 20–59 yrs; husbands were aged 20–61 yrs; 11 distressed couples had been referred to a clinic for marital therapy. Spouses were asked about frequent as well as infrequent relationship events and about partner behaviors that had positive or negative impacts on the recipient. Attributions were coded for content and contribution to the relationship. Results show that husbands in unsatisfying relationships reported more attributional thoughts than did happily married husbands, whereas wives in the 2 groups did not differ. Behaviors having negative impacts elicited more attributional activity than did positive behaviors. Behavioral frequency and impact interacted in ways contrary to predictions. Finally, distressed couples were particularly likely to report distress-maintaining attributions and were particularly unlikely to report relationship-enhancing attributions when compared with their nondistressed counterparts. (40 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychopathology and Marital Satisfaction: The Importance of Evaluating Both Partners.

Using path analysis and hierarchical linear modeling, the authors evaluated the associations between both partners' level of depression and anxiety, as measured by Minnesota Multiphasic Personality Inventory-2 (MMPI-2) content scales, and both partners' level of marital satisfaction among married couples (N = 774) that participated in the MMPI restandardization study (J. N. Butcher, W. G. Dahlstrom, J. R. Graham, A. Tellegen, & B. Kaemmer, 1989). Results indicated that marital satisfaction was predicted by the person's own level of anxiety and depression (i.e., actor effects) and by his or her spouse's level of depression only (i.e., partner effects). Findings also indicated that (a) there were no significant gender differences in the magnitude of effects, (b) depression effects were significantly stronger than anxiety effects, (c) actor effects were significantly stronger than partner effects, and (d) there were interactions between actor and partner effects for depression only. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic Stress Disorder Symptomatology Among Partners of Men in Treatment for Relationship Abuse.

This longitudinal study examined posttraumatic stress disorder (PTSD) symptoms among current and former female partners (N=96) of men participating in a group treatment program for partner abuse perpetrators. Female partner probable PTSD rates, obtained during time points corresponding with pretreatment, posttreatment, and 6-month follow-up for the male clients, were 52%, 34%, and 29%, respectively. Psychological abuse exposure was more strongly and uniquely associated with PTSD symptoms than was physical abuse exposure. Among psychological abuse ratings, denigration, restrictive engulfment, and dominance/intimidation behaviors evidenced the strongest associations with PTSD symptoms. Findings from this study suggest the association between psychological abuse and PTSD is complex and multidetermined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)