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  • Posttraumatic stress disorder and attachment among Croatian War veterans and their wives = Posttravmatska stresna motnja in navezanost med hrvaškimi vojnimi veterani in njihovimi ženami : doctoral dissertation
    Šeremet, Ana
    One of the most common problems for veterans suffering from PTSD is the disturbance of interpersonal relationships or attachments. These types of interpersonal impairments in abilities to love and ... feel loved (unable to have loving feelings, feelings of detachment or estrangement from others, and a sense of foreshortened future) result in significant problems in social, family, sexual, and work functioning. The wives of war veterans are the most vulnerable group after their return from war, and marital relations often become damaged. The interactive nature of the marital relationship, cultural norms, expectations, and a sense of obligation are just some factors that contribute to the wife's increased sensitivity to the stress experienced by her. In addition, wives often "take over" the symptoms of the traumatized person as a result of close emotional connection with and care for that person, thus resulting in the so-called process of secondary traumatization. The main aim of doctoral research was to investigate the relationships between PTSD symptoms, marital relationship quality, and partner attachment in Croatian veterans and their wives. Specifically, we want to investigate the answer to the following research questions: (1) Do veterans with PTSD and their wives have lower marital quality than veterans without PTSD and their wives? (2) Do anxious and avoidant attachment contribute to PTSD symptom levels in veterans and their spouses? Does veterans' anxious and avoidant attachment contribute to their wives' PTSD symptom levels, or does veterans' spouses' anxious and avoidant attachment contribute to veterans' PTSD symptom levels? (3) Are anxious and avoidant attachments a transmission mechanism of PTSD symptoms between the veterans and their spouses? Methodology The sample consisted of two groups: (1) 75 veterans diagnosed with PTSD and their wives and (2) 75 veterans without PTSD diagnosis and their wives. They have answered questions from several questionnaires: The Cognitive non-verbal test (CNT; Sučević et al., 2004), The Combat Exposure Questionnaire (CES; Keane et al., 1989), Posttraumatic Stress Disorder Checklist for DSM-5 -PCL-5 (Weathers et al., 2013), Experiences in close relationship scale (ECR-12; Lafontaine et al., 2015). They also fulfill a sociodemographic questionnaire. Using t-test for independent samples we tested if two groups of veterans and two groups of their wives differ in marital quality. Using dyadic methodology, we have tested four separate actor-partner inderdependence models with anxious/avoidant attachment as a predictor, and symptoms of PTSD as a criteria. At the end, we conducted eight mediation analytes to test direct and indirect effects of anxious and avoidant attachment of an individual partner on the relationship between PTSD symptoms of veterans' wives and PTSD symptoms of veterans, and vice versa. Results and discussion Wives of veterans diagnosed with PTSD report higher levels of PTSD symptoms, higher levels of anxious attachment, and higher levels of marital cohesion than wives of veterans without PTSD diagnosis did. Veterans diagnosed with PTSD report higher levels of PTSD symptoms and higher levels of marital cohesion than veterans without PTSD diagnosis. Although 25 years have passed between the end of the war and our study, and other postwar stressful events may have influenced PTSD, the results of high levels of PTSD symptoms among veterans diagnosed with PTSD, and their wives suggest long-term consequences of war trauma and the existence of chronic PTSD Taking into account the weaknesses and vulnerabilities of their husbands, women alternate between the roles they take on in the family. Family dynamics are generally such that women are careful not to anger them with their behavior, monitor their mood, and take on all responsibilities. It is possible, therefore, that due to the woman's great adaptability to his wishes and activities, veterans with PTSD estimate the degree of cohesion with their spouse higher than veterans without a diagnosis of PTSD. Results from two models which test anxious attachment as a predictor of PTSD symptoms shows a significant dyadic “only actor” pattern for veterans. On the other hand, when it comes to veterans’ wives without PTSD diagnosis, we found significant partner effect. In other words, women's anxious attachment significantly positively predicts their level of PTSD symptoms and their partner's level of PTSD symptoms. Results from two models which test avoidant attachment as a predictor of PTSD symptoms shows a significant dyadic “only actor” pattern for veterans and their wives. Difficulties in emotional regulation during and immediately after a traumatic event are potential mechanisms through which anxious and avoidant attachments can influence the development and maintenance of PTSD symptoms (Mikulincer & Shaver 2012, 13). An indirect effect of veterans' PTSD symptoms on women's PTSD symptoms and an indirect effect of wives’ PTSD symptoms on veterans' PTSD symptoms via wives’ anxious attachment were obtained. Specifically, higher PTSD symptoms in veterans indirectly—through a positive effect on wives’ anxious attachment—contribute to higher PTSD symptoms in wives. That is higher levels of PTSD symptoms in veteran spouses indirectly—through a positive effect on veteran spouses' anxious attachment—contribute to higher PTSD symptoms in veterans. Mediation models that tested the avoidant attachment of veterans or their wives and the anxious attachment of veterans as mediators did not prove to be statistically significant; that is, only direct effects of PTSD symptoms of veterans on PTSD symptoms of their wives were obtained, and vice versa. Significant mediation effect of wives’ anxious attachment could be due to the socialization process and social roles that emphasize women's focus on the relationships, which makes them more empathetic and more sensitive to their partner's behaviour and interpersonal skills behaviour which enables the transmission of PTSD symptoms between herself and her husband. Conclusion The results of our research also provide valuable implications for counseling and psychotherapy work with traumatized individuals. Although 25 years have passed since the war's end, veterans diagnosed with PTSD in the post-war period are currently experiencing very high levels of post-traumatic stress disorder symptoms. The combination of the complex clinical picture of PTSD and high comorbidity with other psychiatric and somatic disorders requires a complex or integrative treatment approach that includes biological, psychological, and social dimensions. Moreover, it is essential to include in the therapeutic work with traumatized individuals the spouses and working on the attachment to the partner. Integrating the concept of partner attachment into the treatment of PTSD can enable positive change in mental models of self and others. Therefore, it is important to pay special attention to the anxious attachment of wife and, in therapeutic work with anxiously attached individuals, to focus on her feeling of helplessness and fear of abandonment, to strengthen more effective emotional regulation, which will then lead to the reduction in the level of PTSD symptoms at the individual level, that is, to the reduction of secondary traumatization of the partner.
    Type of material - dissertation ; adult, serious
    Publication and manufacture - Ljubljana : [A. Šeremet], 2023
    Language - english
    COBISS.SI-ID - 152072963

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    Repository of the University of Ljubljana – RUL

Library/institution City Acronym For loan Other holdings
National and University Library, Ljubljana Ljubljana NUK reading room 1 cop.
not for loan 1 cop.
Theological Faculty, Ljubljana Ljubljana TEOFLJ reading room 1 cop.
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