Rachel Dekel

Complex trauma of war captivity: a prospective study of attachment and post-traumatic stress disorder.

BACKGROUND Victims of war captivity sometimes suffer from complex post-traumatic stress disorder (PTSD), a unique form of PTSD that entails various alterations in personality. These alterations may involve changes in attachment orientation. METHOD The sample comprised two groups of veterans from the 1973 Yom Kippur War: 103 ex-prisoners of war (ex-POWs) and 106 comparable control veterans. They were assessed at two points in time, 18 years and 30 years after the war. RESULTS Ex-POWs suffered from more post-traumatic symptoms than controls at both measurements points and these symptoms increased only among ex-POWs from Time 1 to Time 2. In addition, both attachment anxiety and attachment avoidance increased with time among ex-POWs, whereas they decreased slightly or remained stable among controls. Finally, the increases in attachment anxiety and avoidance were positively associated with the increase in post-traumatic symptoms among both study groups. Further analyses indicated that early PTSD symptoms predicted later attachment better than early attachment predicted later PTSD symptoms. CONCLUSIONS The results suggest that: (1) complex traumas are implicated in attachment orientations and PTSD symptoms even many years after captivity; (2) there is an increase in attachment insecurities (anxiety, avoidance) and an increase in PTSD symptoms decades after the captivity; (3) and post-traumatic stress symptoms predict attachment orientations better than attachment orientations predict an increase in PTSD symptoms.

The relationships between posttraumatic stress symptom clusters and marital intimacy among war veterans

This study examined (a) the relationships between posttraumatic stress disorder (PTSD) symptom clusters and marital intimacy among Israeli war veterans and (b) the role of self-disclosure and verbal violence in mediating the effects of PTSD avoidance and hyperarousal symptoms on marital intimacy. The sample consisted of 219 participants divided into 2 groups: ex-prisoners of war (ex-POWs; N = 125) and a comparison group of veterans who fought in the same war but were not held in captivity (N = 94). Ex-POWs displayed higher levels of PTSD symptoms and verbal violence and lower levels of self-disclosure than did controls. Although ex-POWs and controls did not differ in level of marital intimacy, they did, however, present a different pattern of relationships between PTSD clusters and intimacy. In ex-POWs, self-disclosure mediated the relations between PTSD avoidance and marital intimacy. Verbal aggression was also found via indirect effect of hyperarousal on marital intimacy. The results point to the importance of self-disclosure and verbal violence as interpersonal mechanisms for the relations between posttraumatic symptoms on marital intimacy of ex-POWs.

Intimate Partner and General Aggression Perpetration Among Combat Veterans Presenting to a Posttraumatic Stress Disorder Clinic

This study examined rates and correlates of intimate partner and general aggression perpetration among 236 male combat veterans seeking services in a Veterans Affairs posttraumatic stress disorder (PTSD) clinic. Approximately 33% of those in an intimate relationship reported perpetrating partner physical aggression in the previous year, and 91% reported partner psychological aggression. Comparable rates were found for general aggression perpetration among partnered and nonpartnered veterans. PTSD symptoms as well as symptoms of depression were associated with aggression across subgroups and forms of aggression, and PTSD symptoms reflecting arousal and lack of control were generally the strongest predictor of aggression. Findings indicate a need for additional aggression screening and intervention development for this population, and highlight the targeting of heightened arousal and lack of behavioral control in aggression interventions.

World Assumptions and Combat-Related Posttraumatic Stress Disorder

The authors examined the association between (a) personal world assumptions and (b) combat stress reactions (CSRs), posttraumatic stress disorder (PTSD), and PTSDs course among three groups of Israeli veterans: 109 veterans who suffered from CSR on the battlefield, 98 decorated veterans, and 189 control participants. Participants completed standardized questionnaires that measured PTSD and world assumption. Both CSR and chronic PTSD were associated with lower levels of self-worth and beliefs about the benevolence of people. In addition, the authors found a linear association between self-worth perceptions and levels of mental status. The authors examined the results of the study considering the extraordinary characteristics and meaning of war.

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.

Emotional distress and marital adjustment of caregivers: contribution of level of impairment and appraised burden

The study examined the relative contribution of both the husbands impairment and the caregivers sense of burden to the caregiver level of emotional distress and marital adjustment. Two hundred and fifteen veterans with posttraumatic stress disorder (PTSD) and their wives participated in the study. Data were collected using self-report questionnaires and a series of clinical interviews with the veterans and their wives. Results indicated that spouses of PTSD veterans suffer from a higher level of emotional distress and a lower level of marital adjustment than the general population. Their level of distress is more closely associated with perceived caregiver burden than with the level of the veterans’ impairment. The discussion highlights some cross-cultural similarities of the findings and the clinical and empirical implications of the study.

Sense of Coherence, Ways of Coping, and Well Being of Married and Divorced Mothers

The study examines sense of coherence and ways of coping as personality resources capable of helping divorced mothers deal with the divorce crisis. The findings show that although mothers from two parent families enjoy a higher sense of well being than divorced mothers, the well being of both groups was predicted by sense of coherence. They also show that mothers with higher sense of coherence used more effective coping strategies and derived more benefit from the strategies they used. The married and divorced mothers have a similar sense of coherence level. More study is needed to ascertain precisely how sense of coherence contributes to well being, as well as to the choice and effectiveness of coping strategies.

An eighteen-year follow-up study of Israeli prisoners of war and combat veterans.

The current study assesses the psychological and psychiatric aftermath of war captivity; 164 Israeli ex-POWs and 189 comparable controls were assessed for posttraumatic stress disorder, intrusion and avoidance tendencies, and generalized psychiatric symptomatology 18 years after the war. Findings indicated that trauma-related psychopathology and general psychiatric symptomatology were more prevalent among POWs than among their matched controls. In addition, captivity experience, social support at homecoming, and, above all, sociodemographic and military factors were found to be strongly correlated with the outcome measures. Theoretical and clinical implications of the aftermath of captivity are discussed.

Ways of coping and sense of belonging in the face of a continuous threat.

This study examined the contribution of ways of coping and sense of belonging to stress responses among students in a conflict zone. Students at a college situated in an area exposed to continuous threat were divided according to their place of residence: locations inside and outside of the conflict zone. Rate of posttraumatic stress disorder (PTSD) was similar to rates in previous studies conducted among Israelis who had been exposed to terror. Acceptance as a way of coping and sense of belonging contributed to reducing PTSD symptoms, whereas use of alcohol and seeking support contributed to increasing stress responses. The discussion examines the results in light of the literature on ways of coping and sense of belonging in the face of continuous threat.

Posttraumatic stress symptoms and fear of intimacy among treated and non-treated survivors who were children during the Holocaust.

Abstract.Background:This study examines the longterm consequences of the Holocaust on child survivors as implicated in PTSD residues and fears of intimacy.Method:Participants were 43 Holocaust child survivors who received psychotherapy, 48 participants who also went through the Holocaust as children, but did not receive psychotherapy, and 43 Israeli-born participants who did not directly experience the Holocaust. Data regarding PTSD, fear of intimacy, and exposure-related variables were gathered via standardized self-report questionnaires.Results:The findings show that both treated and non-treated survivors reported significantly higher levels of post-traumatic residues than the non-Holocaust controls, while the treated survivors reported higher levels than the non-treated ones. Treated survivors also differed from the other two groups in their levels of fear of intimacy. In addition, survivors who had been in concentration camps reported significantly more PTSD symptoms than survivors who had been in hiding. Two alternative interpretations are offered. No differences were found in the fear of intimacy of those who survived in the different settings.Conclusions:The findings point to the long-lasting impact of the Holocaust experience on child survivors, although they also demonstrate wide variability in survivors’ long-term adjustment that should be further explored.