Partners' ratings of combat veterans' PTSD symptomatology

Posttraumatic Stress Disorder Symptoms, Intimate Partner Violence, and Relationship Functioning: A Meta-Analytic Review

This meta-analysis was the first study of which we are aware to investigate the association between Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000) PTSD symptom clusters and parent, child, family, and marital/partner functioning problems (e.g., intimate partner violence [IPV] and intimacy). Of the 23 studies that met inclusion criteria, the sample was predominantly male (83.8%), Caucasian (65.0%), and from the military (98.9%). The average age was 43.65 years old (SD = 6.27); the average sample size was 397.4 (SD = 416.9; total N = 9,935). PTSD symptom clusters were assessed primarily by self-report (87.0%), with 8.7% using a rating by a clinician. We used fixed analysis following Fisher's r to z transformation and an unbiased weighing and summing of effect sizes within samples and across studies. We found a small association between hyperarousal and IPV (z = .20). We also found two moderate associations for the emotional numbing and avoidance symptom clusters: (a) with parent, child, and family functioning (z = .32, z = .28, respectively); and (b) with intimacy problems (z = .35, z = .42, respectively). We found two large associations for emotional numbing: marital and parent problems (z = .47) and parent, child, and family functioning problems (z = .32, respectively). Our findings suggested that treatments aim to lessen the effect on those who have close relationships with the individual with PTSD.

Relationship distress in partners of combat veterans: the role of partners' perceptions of posttraumatic stress symptoms

Partners of combat veterans with posttraumatic stress disorder report elevated relationship and psychological distress, but little is known about the mechanisms by which such distress develops. In two separate samples, we examined partners' perceptions of veterans' PTSD symptoms, with a specific focus on the simultaneous associations of partners' distress with their perceptions of veterans' reexperiencing, withdrawal/numbing, and hyperarousal symptom clusters. The first sample consisted of 258 partners of Operation Enduring- and Iraqi Freedom-era veterans who completed questionnaires. The second sample consisted of 465 partners of Vietnam-era veterans who completed interviews as part of the National Vietnam Veterans Readjustment Study. In both samples, path analyses revealed that, when examined simultaneously, partners' perceptions of withdrawal/numbing symptoms were associated with greater distress, but perceptions of reexperiencing symptoms were unrelated to psychological distress and significantly associated with lower levels of relationship distress. Given the cross-sectional nature of the data in both samples, there are multiple plausible interpretations of the results. However, the pattern is consistent with an attributional model of partner distress, whereby partners are less distressed when symptoms are more overtly related to an uncontrollable mental illness. Potential clinical implications are discussed.

An examination of general aggression and intimate partner violence in women with posttraumatic stress disorder

Research has documented significant relationships between posttraumatic stress disorder (PTSD), aggression, and intimate partner violence (IPV). Most of these studies have focused on men and measured violence by self-report. This study examined (a) the association between PTSD and general aggression among women, (b) the association between IPV and PTSD among married and/or cohabitating couples, and (c) the concordance between self and collateral reports of IPV. One hundred twenty participants provided information about PTSD symptoms and general aggression toward others, and 43 married and/or cohabitating couples provided information about PTSD and IPV. Women with PTSD reported more general aggression, IPV perpetration, and IPV victimization. Collateral informants of those with and without PTSD did not differ significantly in their report of IPV. Concordance between participants and spouses or partners was low to moderate. These results are discussed within the context of extant IPV literature.

The role of intimate relationships, appraisals of military service, and gender on the development of posttraumatic stress symptoms following Iraq deployment

A retrospective cohort study was conducted to examine risk and protective factors for combat-related posttraumatic stress disorder (PTSD) symptoms reported by soldiers (n = 2,583) at postdeployment. Positive appraisals of military service related negatively, OR = 0.86, 95% CI [0.83, 0.89], to screening positive for presumed PTSD at postdeployment. Decreases in perceived intimate relationship strength from predeployment to postdeployment were positively associated with presumed PTSD at higher, but not lower, levels of combat exposure; this effect, OR = 1.91, 95% CI [1.08, 3.39], was found only for female soldiers. Overall risk for postdeployment presumed PTSD was found to be nearly 2.5 times greater for women, as compared to men. In addition, positive screening rates of anxiety, depression, hazardous alcohol use, and PTSD increased from predeployment to postdeployment, with the most prominent increase found for PTSD.

Psychological and marital distress in spouses of Vietnam veterans: importance of spouses' perceptions

Spouses of combat veterans with PTSD have greater psychological and marital distress than spouses of veterans without PTSD; however, few studies have examined how variables related to the spouses (e.g., cognitions) may play a role in their own distress. The current study examined spouses' perceptions of combat veterans' PTSD symptom severity in 465 spouses of veterans from the National Vietnam Veterans Readjustment Study. Spouses' perceptions of veterans' symptom severity were positively associated with spouses' psychological and marital distress; furthermore, spouses' perceptions fully mediated the effects of veterans' self-reported PTSD severity on spouses' distress. Additionally, for spouses who provided complete data with regard to their perceptions of veterans' PTSD, distress was highest when they perceived high levels of symptoms but veterans reported low levels. These results highlight the importance of interpersonal perceptions in intimate relationships and provide preliminary groundwork for future research on cognitions in spouses of combat veterans with PTSD.

Virtual Reality Exposure Therapy of Combat-Related PTSD: A Case Study Using Psychophysiological Indicators of Outcome

This article describes the treatment by exposure therapy of a Vietnam veteran for PTSD related to his war experiences. There are several unique features of this particular treatment and case report. One, the exposure treatment was delivered in conjunction with virtual reality. The patient was exposed to two virtual Vietnam environments, a virtual Huey helicopter and a virtual landing zone, while engaging in exposure to his most traumatic Vietnam memories. Two, the nature of several of these traumatic memories included guilt over acts that the patient committed in Vietnam, which is often times not considered a good candidate for exposure therapy. Three, psychophysiological monitoring occurred throughout the treatment as well as at pretreatment and posttreatment. His responses to treatment, in terms of guilt, anger, and anxiety, standardized symptom measures at pretreatment and post-treatment and follow-ups of 3 months and 6 months, and psychophysiological responding, are discussed.

Self-reported problems: a comparison between PTSD-diagnosed veterans, their spouses, and clinicians

This study investigated self-reported problems in a sample of help-seeking Vietnam veterans, comparing the veteran's own view with clinician and spouse perspectives, with the aim of examining convergence in reports across different informants. Veterans with PTSD (N = 459) were asked to list and rate their five most serious problems. Spouses and treating clinicians completed the same questionnaire in relation to the veteran. Rates of endorsement for each problem area, and levels of agreement between raters, were calculated. Veterans, spouses, and clinicians were all likely to rate anger as a high priority, with veterans also likely to nominate anxiety and depression. Spouses were likely to nominate more observable behavioural problems such as interpersonal difficulties and avoidance, while clinicians were likely to nominate indications of psychopathology, such as anxiety, depression, and intrusive thoughts. Agreement across raters was generally high, although interpretation of agreement levels was complex.

Partners' ratings of combat veterans' anger

Spouse reports may serve as an important source of collateral information in the assessment of posttraumatic stress disorder (PTSD) and associated behavioral problems. This study examined the concordance of anger reports among 94 combat veterans and their partners. Veterans' scores on subscales of the Multidimensional Anger Inventory were compared with scores on a parallel version completed by partners to assess veterans' anger symptomatology. The study examined whether the concordance between veteran and partner-reported anger is moderated by whether the veteran suffers from PTSD. There was moderate agreement between veterans and their partners on reports of anger and little evidence to suggest that PTSD diagnosis affected the convergence between partner and veteran scores.