PTSD symptoms, disclosure, and relationship distress: explorations of mediation and associations over time

Sarah B Campbell, Keith D Renshaw, Sarah B Campbell, Keith D Renshaw

Abstract

Emotional numbing symptoms of posttraumatic stress disorder (PTSD) are negatively associated with relationship satisfaction in combat veterans and their romantic partners. Many speculate that one mechanism of this association may be decreased disclosure by veterans, but previous studies lacked appropriate data to test this hypothesis. In a sample of 224 OIF/OEF-era National Guard service members (SMs) and 214 of their romantic partners, we measured SMs' PTSD symptoms. Four to six months later, we assessed both partners' reports of SMs' emotional disclosure and both partners' relationship satisfaction (83 SMs and 91 partners completed Time 2). In a path analysis, SMs' emotional numbing was negatively associated with their later relationship satisfaction. Furthermore, SMs' emotional numbing was negatively associated with both partners' reports of SMs' emotional disclosure. Finally, SMs' emotional numbing exerted significant or nearly significant indirect effects on both partners' relationship satisfaction via decreased emotional disclosure. The findings demonstrated the importance of accounting for both partners' perceptions when studying couple functioning in the context of PTSD or treating PTSD via conjoint intervention.

Keywords: Communication; Marital relationship; Military personnel; Posttraumatic; Stress disorders.

Copyright © 2013 Elsevier Ltd. All rights reserved.

Figures

Fig. 1.
Fig. 1.
Path model examining associations of service members’ Time 1 total PTSD symptom severity with service members’ and partners’ Time 2 relationship satisfaction. Standardized path estimates are shown. *p < .05. **p < .01. ***p < .001.
Fig. 2.
Fig. 2.
Path model examining associations of service members’ Time 1 PTSD symptom cluster severity with service members’ and partners’ Time 2 relationship satisfaction. Standardized path estimates are shown. *p < .05. **p < .01. ***p < .001.
Fig. 3.
Fig. 3.
Path model examining service members’ report of and partners’ perceptions of service members’ Time 2 deployment-related emotional disclosure as mediators of the associations of service members’ Time 1 emotional numbing with service members’ and partners’ Time 2 relationship satisfaction. Standardized path estimates are shown. *p < .05. **p < .01. ***p < .001.

References

    1. Afifi TD, Joseph A, & Aldeis D (2012). The standards for openness hypothesis: Why women find (conflict) avoidance more dissatisfying than men. Journal of Social and Personal Relationships, 29(1), 102–125. 10.1177/0265407511420193
    1. Afifi TD, McManus T, Steuber K, & Coho A (2009). Verbal avoidance and dissatisfaction in intimate conflict situations. Human Communication Research, 35(3), 357–383. 10.1111/j.1468-2958.2009.01355.x
    1. Allen ES, Rhoades GK, Stanley SM, & Markman HJ (2010). Hitting home: Relationships between recent deployment, posttraumatic stress symptoms, and marital functioning for Army couples. Journal of Family Psychology, 24(3), 280–288. 10.1037/a0019405
    1. American Psychiatric Association, (1994). Diagnostic and statistical manual of mental disorders: DSM-IV (4th ed.). Washington, DC: Author.
    1. American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
    1. Armour C, Carragher N, & Elhai JD (2013). Assessing the fit of the dysphoric arousal model across two nationally representative epidemiological surveys: The Australian NSMHWB and the United States NESARC. Journal of Anxiety Disorders, 27(1), 109–115. 10.1016/j.janxdis.2012.10.006
    1. Armour C, Elhai JD, Richardson D, Ractliffe K, Wang L, & Elklit A (2012). Assessing a five factor model of PTSD: Is dysphoric arousal a unique PTSD construct showing differential relationships with anxiety and depression? Journal of Anxiety Disorders, 26(2), 368–376. 10.1016/j.janxdis.2011.12.002
    1. Bliese PD, Wright KM, Adler AB, Cabrera O, Castro CA, & Hoge CW (2008). Validating the primary care posttraumatic stress disorder screen and the posttraumatic stress disorder checklist with soldiers returning from combat. Journal of Consulting and Clinical Psychology, 76(2), 272–281. 10.1037/0022-006X.76.2.272
    1. Bollen KA, & Stine RA (1993). Bootstrapping goodness-of-fit measures in structural equation models. In: Bollen KA, & Long JS (Eds.), Testing Structural Equation Models (pp. 111–135). Newberry Park, CA: Sage.
    1. Bolton EE, Glenn DM, Orsillo S, Roemer L, & Litz BT (2003). The relationship between self-disclosure and symptoms of posttraumatic stress disorder in peacekeepers deployed to Somalia. Journal of Traumatic Stress, 16(3), 203–210. 10.1023/A:1023754820991
    1. Bradford SA, Feeney JA, & Campbell L (2002). Links between attachment orientations and dispositional and diary – based measures of disclosure in dating couples: A study of actor and partner effects. Personal Relationships, 9(4), 491–506. 10.1111/1475-6811.00031
    1. Campbell SB, & Renshaw KD (2012). Distress in spouses of Vietnam veterans: Associations with communication about deployment experiences. Journal of Family Psychology, 26(1), 18–25. 10.1037/a0026680
    1. Carroll EM, Rueger DB, Foy DW, & Donahoe CP (1985). Vietnam combat veterans with posttraumatic stress disorder: Analysis of marital and cohabitating adjustment. Journal of Abnormal Psychology, 94(3), 329–337. 10.1037/0021-843X.94.3.329
    1. Cook JM, Riggs DS, Thompson R, Coyne JC, & Sheikh JI (2004). Posttraumatic stress disorder and current relationship functioning among World War II ex-prisoners of war. Journal of Family Psychology, 18(1), 36–45. 10.1037/0893-3200.18.1.36
    1. Dekel R, Goldblatt H, Keidar M, Solomon Z, & Polliack M (2005). Being a wife of a veteran with posttraumatic stress disorder. Family Relations, 54(1), 24–36. 10.1111/j.0197-6664.2005.00003.x
    1. DOD Task Force on Mental Health. (2007). An achievable vision: Report of the DoD task force on mental health. Falls Church, VA: Defense Health Board.
    1. Elhai JD, Biehn TL, Armour C, Klopper JJ, Frueh B, & Palmieri PA (2011). Evidence for a unique PTSD construct represented by PTSD’s D1–D3 symptoms. Journal of Anxiety Disorders, 25(3), 340–345. 10.1016/j.janxdis.2010.10.007
    1. Erbes CR, Meis LA, Polusny MA, & Compton JS (2011). Couple adjustment and posttraumatic stress disorder symptoms in National Guard veterans of the Iraq war. Journal of Family Psychology, 25(4), 479–487. 10.1037/a0024007
    1. Erbes CR, Meis LA, Polusny MA, Compton JS, & Wadsworth SM (2012). An examination of PTSD symptoms and relationship functioning in U.S. soldiers of the Iraq war over time. Journal of Traumatic Stress, 25(2), 187–190. 10.1002/jts.21689
    1. Erbes CR, Polusny MA, MacDermid S, & Compton JS (2008). Couple therapy with combat veterans and their partners. Journal of Clinical Psychology, 64(8), 972–983. 10.1002/jclp.20521
    1. Evans L, Cowlishaw S, Forbes D, Parslow R, & Lewis V (2010). Longitudinal analyses of family functioning in veterans and their partners across treatment. Journal of Consulting and Clinical Psychology, 78(5), 611–622. 10.1037/a0020457
    1. Evans L, Cowlishaw S, & Hopwood M (2009). Family functioning predicts outcomes for veterans in treatment for chronic posttraumatic stress disorder. Journal of Family Psychology, 23(4), 531–539. 10.1037/a0015877
    1. Evans L, McHugh T, Hopwood M, & Watt C (2003). Chronic posttraumatic stress disorder and family functioning of Vietnam veterans and their partners. Australian and New Zealand Journal of Psychiatry, 37(6), 765–772. 10.1080/j.1440-1614.2003.01267.x
    1. Fredman SJ, Monson CM, & Adair KC (2011). Implementing cognitive-behavioral conjoint therapy for PTSD with the newest generation of veterans and their partners. Cognitive and Behavioral Practice, 18(1), 120–130. 10.1016/j.cbpra.2009.06.007
    1. Gerlock A, Grimesey J, & Sayre G (2012). Caregiver, IPV victim, or both: The complex dynamics of intimate relationships for treatment-seeking veterans with posttraumatic stress disorder. Veterans, PTSD, and building community/VA partnerships to support women and couples experiencing IPV. Presented at the National Conference on Health and Domestic VIolence, San Francisco, CA.
    1. Gottman JM, Gottman JS, & Atkins CL (2011). The Comprehensive Soldier Fitness Program: Family skills component. American Psychologist, 66(1), 52–57. 10.1037/a0021706
    1. Hendrick SS (1988). A generic measure of relationship satisfaction. Journal of Marriage and Family, 50(1), 93–98. 10.2307/352430
    1. Hendrick SS, Dicke A, & Hendrick C (1998). The Relationship Assessment Scale. Journal of Social and Personal Relationships, 15(1), 137–142. 10.1177/0265407598151009
    1. Hendrix CC, Erdmann MA, & Briggs K (1998). Impact of Vietnam veterans’ arousal and avoidance on spouses’ perceptions of family life. American Journal of Family Therapy, 26(2), 115–128.
    1. Hoyt T, Pasupathi M, Smith BW, Yeater EA, Kay VS, & Tooley E (2010). Disclosure of emotional events in groups at risk for posttraumatic stress disorder. International Journal of Stress Management, 17(1), 78–95. 10.1037/a0017453
    1. Hu L, & Bentler PM (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. 10.1080/10705519909540118
    1. Kenny DA, Kashy DA, & Cook WL (2006). Dyadic Data Analysis (1st ed.). The Guilford Press.
    1. King DW, King LA, & Vogt DS (2003). Manual for the Deployment Risk and Resilience Inventory (DRRI): A collection of measures for studying deployment-related experiences of military veterans. Boston: National Center for PTSD.
    1. King LA, King DW, Vogt DS, Knight J, & Samper RE (2006). Deployment Risk and Resilience Inventory: A collection of measures for studying deployment-related experiences of military personnel and veterans. Military Psychology, 18(2), 89–120.
    1. King DW, Leskin GA, King LA, & Weathers FW (1998). Confirmatory factor analysis of the clinician-administered PTSD Scale: Evidence for the dimensionality of posttraumatic stress disorder. Psychological Assessment, 10(2), 90–96. 10.1037/1040-3590.10.2.90
    1. Koenen KC, Stellman JM, Stellman SD, & Sommer JF Jr. (2003). Risk factors for course of posttraumtic stress disorder among Vietnam veterans: A 14-year follow up of American legionnaires. Journal of Consulting and Clinical Psychology, 71(6), 980–986. 10.1037/0022-006X.71.6.980
    1. Lambert JE, Engh R, Hasbun A, & Holzer J (2012). Impact of posttraumatic stress disorder on the relationship quality and psychological distress of intimate partners: A meta-analytic review. Journal of Family Psychology, 26, 729–737.
    1. Laurenceau J-P, Barrett LF, & Rovine MJ (2005). The interpersonal process model of intimacy in marriage: A daily-diary and multilevel modeling approach. Journal of Family Psychology, 19(2), 314–323. 10.1037/0893-3200.19.2.314
    1. Lev-Wiesel R, & Amir M (2001). Secondary traumatic stress, psychological distress, sharing of traumatic reminisces, and marital quality among spouses of Holocaust child survivors. Journal of Marital and Family Therapy, 27(4), 433–444. 10.1111/j.1752-0606.2001.tb00338.x
    1. Lewis M, Lamson A, & Leseuer B (2012). Health dynamics of military and veteran couples: A biopsychorelational overview. Contemporary Family Therapy, 1–18. 10.1007/s10591-012-9193-7
    1. Lunney CA, & Schnurr PP (2007). Domains of quality of life and symptoms in male veterans treated for posttraumatic stress disorder. Journal of Traumatic Stress, 20(6), 955–964. 10.1002/jts.20269
    1. Marsh HW, Hau K-T, & Wen Z (2004). In search of golden rules: Comment on hypothesis-testing approaches to setting cutoff values for fit indexes and dangers in overgeneralizing Hu and Bentler’s (1999) findings. Structural Equation Modeling: A Multidisciplinary Journal, 11(3), 320–341. 10.1207/s15328007sem1103_2
    1. Marshall RD, Olfson M, Hellman F, Blanco C, Guardino M, & Streuning EL (2001). Comorbidity, impairment, and suicidality in subthreshold PTSD. The American Journal of Psychiatry, 158, 1467–1473.
    1. Monson CM, Schnurr PP, Stevens SP, & Guthrie KA (2004). Cognitive – behavioral couple’s treatment for posttraumatic stress disorder: Initial findings. Journal of Traumatic Stress, 17(4), 341–344. 10.1023/B:JOTS.0000038483.69570.5b
    1. Pennebaker JW, & Susman JR (1988). Disclosure of traumas and psychosomatic processes. Social Science & Medicine, 26(3), 327–332, doi:16/0277–9536(88)90397–8.
    1. Pratt EM, Brief DJ, & Keane TM (2006). Recent advances in psychological assessment of adults with posttraumatic stress disorder. In: Follette VM, & Ruzek JI (Eds.), Cognitive-behavioral therapies for trauma (2nd ed., pp. 34–61). New York, NY: Guilford Press.
    1. Pietrzak RH, Tsai J, Harpaz-Rotem I, Whealin JM, & Southwick SM (2012). Support for a novel five-factor model of posttraumatic stress symptoms in three independent samples of Iraq/Afghanistan veterans: A confirmatory factor analytic study. Journal of Psychiatric Research, 46(3), 317–322. 10.1016/j.jpsychires.2011.11.013
    1. Preacher K, & Hayes A (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, 36(4), 717–731. 10.3758/BF03206553
    1. Preacher K, & Hayes A (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879–891. 10.3758/BRM.40.3.879
    1. Reis HT, & Shaver P (1988). Intimacy as an interpersonal process. In: Duck S, Hay DF, Hobfoll SE, Ickes W, & Montgomery BM (Eds.), Handbook of personal relationships: Theory, research, and interventions (pp. 367–389). Oxford, England: John Wiley and Sons.
    1. Renshaw KD, & Campbell SB (2011). Combat veterans’ symptoms of PTSD and partners’ distress: The role of partners’ perceptions of veterans’ deployment experiences. Journal of Family Psychology, 25(6), 953–962. 10.1037/a0025871
    1. Renshaw KD, McKnight P, Caska CM, & Blais RK (2011). The utility of the relationship assessment scale in multiple types of relationships. Journal of Social and Personal Relationships, 28(4), 435–447. 10.1177/0265407510377850
    1. Renshaw KD, Rodebaugh TL, & Rodrigues CS (2010). Psychological and marital distress in spouses of Vietnam veterans: Importance of spouses’ perceptions. Journal of Anxiety Disorders, 24(7), 743–750. 10.1016/j.janxdis.2010.05.007
    1. Renshaw KD, Rodrigues CS, & Jones DH (2008). Psychological symptoms and marital satisfaction in spouses of operation Iraqi freedom veterans: Relationships with spouses’ perceptions of veterans’ experiences and symptoms. Journal of Family Psychology, 22(4), 586–594. 10.1037/0893-3200.22.3.586
    1. Riggs DS, Byrne CA, Weathers FW, & Litz BT (1998). The quality of the intimate relationships of male Vietnam veterans: Problems associated with posttraumatic stress disorder. Journal of Traumatic Stress, 11(1), 87–101. 10.1023/A:1024409200155
    1. Rodrigues CS (2012). Dyadic examination of posttraumatic stress symptoms, relationship satisfaction, and potential mediators in military couples. Unpublished doctoral dissertation. Salt Lake City, Utah: Department of Psychology, University of Utah.
    1. Savarese VW, Suvak MK, King LA, & King DW (2001). Relationships among alcohol use, hyperarousal, and marital abuse and violence in Vietnam veterans. Journal of Traumatic Stress, 14, 717–732. 10.1023/A:1013038021175
    1. Seal KH, Metzler TJ, Gima KS, Bertenthal D, Maguen S, & Marmar CR (2009). Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs Health Care, 2002–2008. American Journal of Public Health, 99(9), 1651–1658. 10.2105/AJPH.2008.150284
    1. Simms LJ, Watson D, & Doebbelling BN (2002). Confirmatory factor analyses of posttraumatic stress symptoms in deployed and nondeployed veterans of the Gulf War. Journal of Abnormal Psychology, 111(4), 637–647. 10.1037/0021-843X.111.4.637
    1. Solomon Z, Dekel R, & Zerach G (2008). The relationships between posttraumatic stress symptom clusters and marital intimacy among war veterans. Journal of Family Psychology, 22(5), 659–666. 10.1037/a0013596
    1. Stein MB, Walker JR, Hazen AL, & Forde DR (1997). Full and partial posttraumatic stress disorder: Findings from a community survey. The American Journal of Psychiatry, 154, 1114–1119.
    1. Taft CT, Schumm JA, Panuzio J, & Proctor SP (2008). An examination of family adjustment among Operation Desert Storm veterans. Journal of Consulting and Clinical Psychology, 76(4), 648–656. 10.1037/a0012576
    1. Weathers FW, Litz BT, Herman DS, Huska JA, & Keane TM (1993). The PTSD checklist (PCL): Reliability, validity, and diagnostic utility. In Presented at the annual meeting of the International Society for Traumatic Stress Studies San Antonio, TX.

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