Is the war really over? A 20-year longitudinal study on trajectories of suicidal ideation and posttraumatic stress symptoms following combat

Combat stress reaction (CSR) has widespread long-term consequences, including profound psychopathology in the form of posttraumatic stress disorder (PTSD). Studies have established the link between combat, PTSD, and suicidality. However, little is known about the temporal course of suicidal ideation (SI) in general, specifically among war veterans. We aimed to trace the trajectories of SI in the aftermath of war and to explore the role of CSR and PTSD in SI trajectories. Israeli veterans with CSR (n=164) and a matched control group (NCSR, n=111) were assessed, using self-report measures at three points over the course of 20 years. Veterans with CSR reported significantly higher levels of SI, compared to the NCSR group at all measurement points. Among veterans with CSR, SI increased 2 years after the war and then decreased 20 years following the war. This pattern was particularly characteristic of veterans with chronic PTSD. The results indicate that CSR is a strong predictor of subsequent PTSD and suicidality. These findings highlight the importance of prevention and treatment efforts for these traumatized veterans, who are at risk for suicide even 20 years after the end of the war.

Self-Disclosing Trauma and Post-Traumatic Stress Symptoms in Couples: A Longitudinal Study

OBJECTIVE

Most research concerning the implications of self-disclosure on trauma's aftermath has focused on the salubrious effects disclosure may foster for the primary victim. However, the manner in which recipients of disclosure are symptomatically affected by it remains unexamined. Of particular interest are spouses who are often the primary support providers and are therefore susceptible to secondary traumatization. Assessing posttraumatic stress symptoms (PTSS) and self-disclosure among traumatized veterans and their wives, the current longitudinal study begins to fill this gap in the literature.

METHOD

A total of 220 couples consisting of Israeli veterans, of whom 128 were former prisoners of war (ex-POWs) and 92 were combatants, and their wives were examined. PTSS and self-disclosure of both partners were assessed 30 and 35 years after the war using the Posttraumatic Stress Disorder Inventory (PTSD-I; Solomon et al., 1993) and the Self-Disclosure Index (SDI; Miller, Berg, & Archer, 1983), respectively. Analyses included Pearson intercorrelations analyses and four stepwise hierarchical multiple regression analyses.

RESULTS

Findings indicated that increments in veterans' disclosure are not only consistently associated with the reduction of their wives' PTSS but may also explain and predict some of the change in the wives' PTSS over time. However, such a longitudinal effect was not evident concerning the veterans' PTSS.

CONCLUSION

Traumatized ex-POWs' and combatants' self-disclosure within the marital relationship may contribute to the amelioration of their wives' secondary traumatization, and thus may be a goal worth pursuing in therapy. However, more research is needed to further understand this relation.

Evidence of complex posttraumatic stress disorder (CPTSD) across populations with prolonged trauma of varying interpersonal intensity and ages of exposure

The ICD-11 proposes different types of prolonged trauma as risk factors for complex PTSD (CPTSD). However, CPTSD's construct validity has only been examined in childhood abuse, and single trauma exposure samples. Thus, the extent to which CPTSD applies to other repeatedly traumatized populations is unknown. This study examined ICD-11's PTSD and CPTSD across populations with prolonged trauma of varying interpersonal intensity and ages of exposure, including: 1) childhood sexual abuse, 2) adulthood trauma of severe interpersonal intensity (refugees and ex-prisoners of war), and 3) adulthood trauma of mild interpersonal intensity (military veterans, and mental health workers). In support of the proposal, latent class analysis (N = 820) identified, a 4-class solution representing "PTSD", "CPTSD", and "non-pathological" classes, but also an "Anxiety symptoms" class, and an alternative 5-class solution, with a "Dissociative PTSD-subtype" class. ICD-11's CPTSD was not exclusively associated with childhood abuse, but also with exposure to adulthood trauma of severe interpersonal intensity. Furthermore, all types of prolonged trauma were equally associated with the "Anxiety symptoms" class. Finally, of all the classes, the "CPTSD" class was associated with the highest frequency of work-related functional impairment, indicating an association between the severity of prolonged trauma exposure and the level of posttraumatic residues.

Indirect Exposure to Captivity Details Is Not Related to Posttraumatic Stress Symptoms Among the Spouses and Offspring of Former Prisoners of War

Indirect exposure to the aversive details of the primary victim's traumatic event(s) has been introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) as a new event criterion (Criterion A4). However, this new criterion has been criticized for its significant emphasis on the exposure to trauma "details" or trauma narrative. This study assessed the associations between reported exposure to details about captivity and posttraumatic stress symptoms (PTSS) among 2 groups of family members of former prisoners of war (ex-POWs): spouses (n = 115) and adult offspring (n = 78). Results show that in both groups exposure to details regarding captivity was not significantly related to the severity of total PTSS and specifically, high levels of exposure to captivity details were related to lower avoidance symptoms among ex-POWs' spouses. Among offspring, exposure to paternal behaviors stemming from the fathers' posttraumatic stress disorder was related to PTSS, above and beyond negative life events, quality of relationship with the father, and exposure to captivity details (R² = .34). These results suggest that behavioral displays of the fathers' posttraumatic symptoms, rather than the recounting of trauma-related details, is related to PTSS among ex-POWs' offspring.

Keeping a healthy distance: Self-differentiation and perceived health among ex-prisoners-of-war's wives

OBJECTIVE

War captivity may affect spouses of former-prisoners-of-war (ex-POWs) in many ways, including posttraumatic stress symptoms (PTSS) and somatic difficulties manifested in negative perceived health. This is generally known as secondary traumatization. Theory suggests that development of secondary traumatization occurs through the relationship with the primary trauma survivor Figley (1986) , thus implying that the ability to keep balanced emotional distance in the relationship may play a pivotal role. Notwithstanding, the contribution of self-differentiation to secondary somatic disturbances remains largely uninvestigated. The current study fills this gap.

METHODS

Ex-POWs' wives (n=143) and control former-combatants' wives (n=102), were assessed prospectively 30 (T1) and 38 (T2) years after the 1973 Yom Kippur War. Self-differentiation and PTSS were assessed at both time-points, while perceived health measures were assessed at T2.

RESULTS

Wives of ex-POWs endorsed higher PTSS, lower self-differentiation and negative perceived health, compared to control wives. Indirect exposure to war captivity was related to low self-differentiation and elevated PTSS, which predicted negative perceived health. Furthermore, self-differentiation characterized by fusion-with-others fully mediated the relation between indirect exposure to war captivity and perceived health, beyond the effects of PTSS as a mechanism.

CONCLUSION

Results suggest that tendencies towards fusion-with-others within the marital relationship, act as a risk factor not only for psychological distress but also for somatic distress among secondary trauma survivors. Hence, clinical interventions may seek to improve indirect trauma survivor's self-differentiation capacities, thus potentially facilitating the prevention of secondary somatic distress.

Lower subjective life expectancy in later life is a risk factor for posttraumatic stress symptoms among trauma survivors

OBJECTIVE

These studies examined whether exposure to traumatic events at different stages of life would predict posttraumatic stress symptoms (PTSS) in old age. Furthermore, the regulating role of perceptions that relate to one's future time horizons (subjective life expectancy, SLE) and age (subjective age) were also examined.

METHOD AND RESULTS

It was hypothesized that exposure to trauma would predict more PTSS, and that this association would be moderated by SLE and subjective age, so that for those with higher SLE and a younger subjective age, exposure to trauma will have a weaker association with PTSS. Study 1 (N = 294) revealed that among Israeli war veterans (mean age 57), those who experienced the trauma of war captivity in the Yom Kippur War reported higher PTSS than comparable veterans, and that the relationship between captivity and PTSS was weaker for those with a higher SLE. Study 2 (N = 339), which was based on older adults who were currently exposed to ongoing rocket fire in the south of Israel (mean age 65), revealed the same pattern of findings: Exposure to rocket fire predicted more PTSS, but this relationship was weaker among those with a higher SLE. Subjective age did not reveal a moderation effect.

CONCLUSIONS

These findings suggest that different traumatic experiences, whether belonging to one's past or whether currently ongoing, predict PTSS in later life. Moreover, it appears that subjective time horizons until death, but not subjective age since birth, can buffer against the negative effect of the trauma. (PsycINFO Database Record

Guilt as a mediator between depressive symptoms and subjective age: A 17-year longitudinal study of Israeli ex-prisoners of war

This longitudinal study assesses the trajectories of depressive symptoms and subjective age and the mediating role of guilt in the association between them. Two groups of aging Israeli combat veterans (M age = 57), 128 ex-prisoners of war (ex-POWs), and 106 comparable combat veterans (controls), were assessed at 3 times: 18 (Time 1 [T1]), 30 (Time 2 [T2]), and 35 (Time 3 [T3]) years after the war. They filled out self-report questionnaires on depression, guilt, and subjective age. Results revealed that significantly more ex-POWs had chronic or delayed clinical levels of depressive symptoms than did controls and that chronic and delayed depressive symptoms were associated with a higher subjective age at T3. Furthermore, the path between depressive symptoms at T1 for predicting subjective age at T3 was fully explained by levels of guilt-distress at T2. Although the mediation effect was found in both study groups, it was significantly stronger among ex-POWs than among controls. These findings suggest that not only is depression a long-term sequela of traumatic stress, it is also a risk factor for psychological aging among war veterans. Furthermore, guilt-distress appears to play an important role in advancing subjective age, especially among ex-POWs. (PsycINFO Database Record

Patterns of Complicated Grief among Bereaved Parents

This study assessed patterns of grief reactions and their adaptiveness, among bereaved parents, who had lost an adult child during military service. The prevalence of the various reactions and their associations with psychosocial adjustment and risk-related factors were examined. Eighty-five bereaved parents filled out a battery of questionnaires 2.5 years after their loss. Type of grief reaction (absence, delayed, prolonged, and resolved) was identified utilizing the Texas Revised Inventory of Grief (TIG). In addition, psychiatric symptomatology, psychosocial functioning, and sociodemographic background were examined. Results indicated that prolonged grief reactions and absence of grief were the most prevalent variants. Absent and delayed grief reactions were associated with lower levels of psychosocial adjustment compared with prolonged grief reaction. Level of education, religious attitudes, and the circumstances of the loss were associated with the type of grief reaction. The findings of this study demonstrate the complexity of defining certain reactions as complicated. The identification of absence of grief and delayed grief reactions as being complicated is supported, but the inclusion of prolonged grief reaction as a complicated maladaptive reaction should be reconsidered.

Fear of Personal Death among Physicians

Many studies have tried to explain why professionals experience difficulty when dealing with, and in treating efficiently, situations connected with death. We studied levels of fear of personal death among physicians and addressed two questions: Does exposure to death on professional and personal levels affect the level of fear of personal death which physicians experience? Is there a relationship between personality variables, represented by the repression-sensitization dimension, and level of fear of personal death? A sample of 233 physicians who specialized in oncology, internal medicine, surgery, psychiatry, and pediatrics was studied. Results revealed no differences in level of fear of personal death of physicians according to specialization, but those who had been exposed to death on the personal level feared less in relation to their own death. With respect to the personality variable, tendency to sensitization, it was found that those who were sensitized exhibited a higher level of fear of their own death compared to those who were repressive. Of the various demographic variables examined, it was found that those with many years of professional experience, who were relatively older, who were nonobservant religiously, and who were in good health had lower levels of personal fear of death.

PTSD symptoms lead to modification in the memory of the trauma: a prospective study of former prisoners of war

OBJECTIVE

With the growing interest in the role of trauma memory in posttraumatic stress disorder (PTSD), this prospective study examined long-term changes in memory and the bidirectional relationship between symptoms of PTSD and trauma memory.

METHOD

A sample of Israeli former prisoners of the 1973 Yom Kippur War (N = 103) was assessed in 1991 and in 2008. Participants' PTSD symptom clusters, measured by the PTSD Inventory, and recollections of subjective and objective exposure during captivity, measured by a self-report questionnaire, were assessed at both times. Data on prewar and postwar negative life events and psychotherapy were also collected.

RESULTS

Repeated-measures analysis revealed that participants' recollections were increasingly negative over time (P < .001). Applying an autoregressive cross-lagged modeling strategy showed that the PTSD symptoms of hyperarousal facilitated subsequent amplifications in their recollections (P < .01).

CONCLUSIONS

These findings challenge the accuracy of reports of traumatic experiences and show that PTSD symptoms, in part, lead to the formation of more negative recollections over time. The findings suggest that the original memory is repeatedly updated under the influence of the individual's emotional state. The findings are discussed in the context of the reconsolidation theory of memory.

Can guilt lead to psychological growth following trauma exposure?

With the growing interest in posttraumatic growth (PTG) and its predictors, this study examined the relationship between trauma-related guilt and PTG in a sample of veterans over time. Self-reported guilt, PTG, and posttraumatic stress disorder (PTSD) symptoms were measured in combat veterans and prisoners of war (POWs). Positive correlations were found between guilt, PTSD, and PTG levels. Hierarchical regression revealed that initial guilt levels predicted subsequent PTG controlling for initial PTSD in combat veterans but not in POWs. The findings suggest that posttraumatic growth can be facilitated by trauma-related guilt, underscoring the complex relationship between positive and negative trauma outcomes.

Posttraumatic growth and perceived health: The role of posttraumatic stress symptoms

The contested discourse regarding the nature of posttraumatic growth (PTG) includes 2 main competitive claims. The first argues that PTG reflects authentic positive transformation while the second posits that PTG reflects illusory defenses that could be maladaptive in the long run. The present study assesses these competing claims by investigating secondary PTG in relation to the somatic domain. Specifically, this study investigates: (a) the association between PTG, and perceived health (PH), as measured by 3 indices of somatic complaints, self-rated health (SRH) and a number of health problems; (b) the association between PTG, posttraumatic stress symptoms (PTSS) and PH over time; and (c) the mediating role of PTSS between PTG and PH, among wives of former prisoners of war (ex-POWs) and wives of control veterans. Assessments were conducted 30 (T1) and 38 (T2) years after the Yom Kippur War. Results showed that wives of ex-POWs endorsed higher PTSS, higher PTG and poorer PH, compared to control wives. Higher PTG was associated with higher PTSS and poorer PH. PTG at T1 predicted an increase in PTSS between T1 and T2, which in turn was correlated with poorer PH. PTSS at T2 as well as changes in PTSS from T1 to T2 mediated the association between T1 PTG and T2 PH measures. The present findings imply that PTG might have negative implications on PH through the amplification of PTSS, among secondary trauma victims. It seems that although spouses of trauma victims describe benefits resulting from vicarious trauma exposures, their body indicates differently. (PsycINFO Database Record

PTSD symptoms and marital adjustment among ex-POWs' wives

This study prospectively assessed the implications of war captivity and former prisoners of war's (ex-POWs) posttraumatic stress disorder (PTSD) and PTSD trajectory on their wives' marital adjustment, adjusting for their secondary traumatization (ST). Results show that marital adjustment of the wives of ex-POWs with PTSD (N = 66) was lower compared to wives of ex-POWs (N = 37) and combat veterans (N = 55) without PTSD symptoms. Investigating the possible mechanism underlying the lower marital adjustment, via a mediating model, indicated that husbands' PTSD symptoms mediated the association between captivity and the wives' marital adjustment. Moreover, husbands' PTSD trajectories assessed over 17 years were implicated in their wives' marital adjustment; wives of ex-POWs with chronic PTSD reported lower marital adjustment compared to wives of resilient ex-POWs. The substantial novelty was revealed in prospective deterioration found in dyadic adjustment among wives of ex-POWs with delayed PTSD, but not for wives of chronic or resilient ex-POWs. Implications for research and practice are discussed.

Low levels of posttraumatic stress symptoms and psychiatric symptomatology among third-generation Holocaust survivors whose fathers were war veterans

There is an ongoing debate regarding the intergenerational transmission of Holocaust trauma to the third generation (TGH). However, due to the rareness of this population, there are no studies that have examined TGH individuals whose fathers were also victims of war-related trauma and captivity. This prospective study aimed to assess the role of parents' Holocaust background, fathers' posttraumatic stress symptoms (PTSS), and adult offspring's anxiety sensitivity (AS) in adult offspring's PTSS and psychiatric symptomatology. A sample of 123 Israeli father-child dyads (42 TGH and 71 non-TGH), that included 80 former prisoners of war (ex-POWs) dyads and a comparison group of 44 veteran dyads, completed AS, PTSS and psychiatric symptomatology self-report measures. Fathers were assessed 17 years following the Yom Kippur War (T1: 2008) while offspring took part in T2 (2013-2014). Surprisingly, results show that TGH participants reported lower levels of PTSS and psychiatric symptomatology than non-TGH participants, regardless of their fathers' captivity status. Interestingly, a moderated mediation analysis indicated that offspring's AS mediated the association between Holocaust background and participants' PTSS and psychiatric symptomatology, only among ex-POWs' offspring. This study provides evidence for relatively lower levels of PTSS and psychiatric symptomatology among TGH individuals whose fathers were war veterans. Ex-POWs' adult offspring who are grandchildren of Holocaust survivors reported lower levels of AS that was related to lower levels of PTSS and psychiatric symptomatology.

The role of fathers' psychopathology in the intergenerational transmission of captivity trauma: A twenty three-year longitudinal study

BACKGROUND

The aversive impact of combat and parents' combat-induced posttraumatic stress disorder (PTSD) on young children has been examined in a few studies. However, the long-term toll of war captivity on the secondary traumatization (ST) of adult offspring remains unknown. This study aimed to assess the longitudinal associations between former prisoners of war (ex-POWs), PTSD, depressive symptoms and their adult offsprings ST.

METHOD

A sample of 134 Israeli father-child dyads (80 ex-POWs dyads and a comparison group of 44 veterans'dyads) completed self-report measures. The fathers participated in three waves of measurements following the Yom Kippur War (T1: 1991, T2: 2003, and T3: 2008), while the offspring took part in T4 (2013).

RESULTS

Offspring of ex-POWs with PTSD at T3 reported more ST symptoms than offspring of ex-POWs without PTSD and controls. Ex-POWs' PTSD hyper-arousal symptom cluster at T3 was positively related to offsprings ST avoidance symptom cluster. Offspring of ex-POWs with chronic and delayed PTSD trajectories reported more ST symptoms than offspring of ex-POWS and controls with resilient trajectories. Ex-POWs' PTSD and depression symptoms at T1, T2 and T3 mediated the link between war captivity (groups) and offsprings ST in T4.

LIMITATIONS

The use of self-report measures that did not cover the entire span of 40 years since the war, might may bias the results.

CONCLUSIONS

The intergenerational transmission of captivity related trauma following the Yom Kippur War was exemplified. ST symptoms among ex-POWs' adult offspring are closely related to their father' PTSD and related depressive symptom comorbidity.

Posttraumatic Growth and Shattered World Assumptions Among Ex-POWs: The Role of Dissociation

OBJECTIVE

The controversy regarding the nature of posttraumatic growth (PTG) includes two main competing claims: one which argues that PTG reflects authentic positive changes and the other which argues that PTG reflects illusionary defenses. The former also suggests that PTG evolves from shattered world assumptions (WAs) and that the co-occurrence of high PTG and negative WAs among trauma survivors reflects reconstruction of an integrative belief system. The present study aimed to test these claims by investigating, for the first time, the mediating role of dissociation in the relation between PTG and WAs.

METHOD

Former prisoners of war (ex-POWs; n = 158) and comparable controls (n = 106) were assessed 38 years after the Yom Kippur War.

RESULTS

Ex-POWs endorsed more negative WAs and higher PTG and dissociation compared to controls. Ex-POWs with posttraumatic stress disorder (PTSD) endorsed negative WAs and a higher magnitude of PTG and dissociation, compared to both ex-POWs without PTSD and controls. WAs were negatively correlated with dissociation and positively correlated with PTG. PTG was positively correlated with dissociation. Moreover, dissociation fully mediated the association between WAs and PTG.

CONCLUSION

These findings imply that PTG might reflect illusory defenses and raise questions regarding the integration between the co-occurrence of high PTG and negative WAs among trauma survivors.

Suicidal Ideation Among Wives of Former Prisoners of War: A Longitudinal Dyadic Study

OBJECTIVES

The associations between posttraumatic stress disorder (PTSD) and suicidal ideation (SI) among ex-prisoners of war (ex-POWs) has recently been exemplified. Several studies have revealed the toll of war captivity in the secondary traumatization (ST) of ex-POWs' wives. This study aimed to assess SI among ex-POWs' wives and the longitudinal associations between their husbands' PTSD and their own ST.

METHOD

A sample of 233 Israeli couples (142 ex-POW couples and a comparison group of 91 veteran couples) completed self-report measures of PTSD symptoms, SI, and depression at two time points: T1 (2003) and T2 (2008), 30 and 37 years after the 1973 Yom Kippur War.

RESULTS

Among control wives, although not among ex-POWs' wives, the more ST symptoms they reported, the higher their level of SI. Furthermore, for both research groups, husbands' PTSD and wives' ST were positively associated with their own levels of SI, respectively. Autoregressive cross-legged (ARCL) analysis demonstrated that SI at T1 predicted ST at T2 among control wives but not among ex-POWs' wives. Surprisingly, an actor-partner interdependence modeling (APIM) analysis revealed, only among ex-POWs' couples, that the more the husbands suffered from PTSD and SI, the more moderate the increase of the wives' SI was between T1 and T2, thus, leading to better outcomes in terms of the wives' SI.

CONCLUSIONS

Ex-POWs' posttraumatic distress is longitudinally related to their spouses' ST and SI. Clinical implications of these findings of the relations between captivity trauma and suicidality for veteran couples are discussed.

Adolescents on the Front Line: Exposure to Shelling Via Television and the Parental Role

OBJECTIVES

Research suggests that exposure to traumatic content via television inadvertently increases posttraumatic stress symptoms (PTSS) as well as psychological distress, especially among adolescent viewers. The aim of the current study was to assess the effect of news consumption on PTSS and general distress among adolescents who live in a war area, as well as to examine the role of parents as intermediaries of news broadcasting.

METHOD

A total of 65 adolescents who live in a war zone filled out the Child Post Traumatic Stress Reaction Index, the Brief Symptoms Inventory, and a scale measuring the level of real-life exposure, news broadcast consumption, and parents as intermediaries of news broadcasting.

RESULTS

A main effect for real-life exposure on both PTSS and general distress was revealed. Interestingly, a three-way interaction between real-life exposure, television exposure, and parents as intermediators was found for general distress. Only under low real-life exposure did parents as intermediaries buffer the effect of television exposure on general distress.

CONCLUSIONS

Parental intermediation of news broadcasting of traumatic events, especially in situations of continuous, real-life exposure, is essential.

A Relational Model for the Intergenerational Transmission of Captivity Trauma: A 23-Year Longitudinal Study

OBJECTIVES

The aversive, long-term toll of war captivity and fathers' combat-induced posttraumatic stress disorder (PTSD) on adult offspring's secondary traumatization (ST) has been recently exemplified. However, the study of potential mechanisms of the intergenerational transmission of trauma to offspring is still lacking. This prospective study aimed to assess the role of fathers' PTSD symptoms (PTSS), paternal parenting, and adult offspring's attachment insecurities in adult offspring's PTSS.

METHOD

A sample of 124 Israeli father-child dyads (80 ex-POW dyads and a comparison group of 44 veteran dyads) completed self-report measures. The fathers participated in three waves of measurements following the Yom Kippur War (T1: 1991, T2: 2003, T3: 2008), while the offspring took part in T4 (2013).

RESULTS

Offspring of ex-POWs with PTSD at T3 reported more PTSS and higher levels of attachment insecurities than offspring of ex-POWs without PTSD and controls at T4. Fathers' proximity to the children and sensitivity to the children's needs were negatively related. Offspring's attachment insecurities were positively related to offspring's PTSS. Importantly, serial multiple mediation model results show that war captivity increased the level of the fathers' PTSD at T2 and T3, which in turn decreased the level of the fathers' parenting at T3, and thereby increased the level of offspring's attachment avoidance at T4, which by its own merit was related to higher levels of adult offspring's PTSS.

CONCLUSIONS

The mechanisms of the intergenerational transmission of captivity-related trauma of veterans' PTSD and paternal parenting, through offspring's attachment insecurities and offspring's PTSS, was exemplified.

Attachment in detachment: The positive role of caregivers in POWs' dissociative hallucinations

Humans are social creatures and therefore exhibit a pervasive need for others. Hence, when benevolent human contact is scarce, this dearth may be compensated imaginatively. War captivity is an extreme example of such deprivation and one wherein dissociative hallucinations have been exhibited. Although hallucinations may serve to virtually summon benevolent others and thus provide the prisoner of war (POW) with a platform for compensation, the contents of such hallucinations have yet to be investigated. The current qualitative study is the first to examine whether the content of such hallucinations may harbor positive effects. Guided by the notion that people search for compensation in lack of companionship, we scrutinized testimonies of former POWs for accounts of hallucinatory experiences. A narrative analysis was utilized in an attempt to understand the meaning of the hallucinations for the POW. Findings reveal that benevolent figures and concomitant acts of care are exhibited in war captivity hallucinatory experiences. Thus, it is argued that the content of such hallucinations may be protective. These findings are discussed in light of the literature concerning peritraumatic dissociative experiences. In addition, attachment theory is suggested as a plausible framework for understanding these findings. Finally, limitations of the study are discussed, and future researched is suggested.

Posttraumatic growth among spouses of combat veterans: Adaptive or maladaptive for adjustment?

We examined the relationship between posttraumatic growth (PTG) and distress in spouses of trauma survivors. A sample of spouses of combat veterans of the 1973 Yom Kippur War were assessed using questionnaires pertaining to PTG, depression, anxiety, and posttraumatic stress, in 2004 and 2011. Applying cross-lagged modeling strategy, higher PTG levels predicted higher depression and anxiety levels above and beyond initial distress. Thus, psychological growth in spouses of survivors appears to signify subsequent distress.

Attachment security and pain--The disrupting effect of captivity and PTSS

The present study assesses the possible disruption effect of posttraumatic stress symptoms (PTSS) with regard to the protective role of attachment on pain, among ex-POWs. While secure attachment seems to serve as a buffer, decreasing the perception of pain, this function may be disrupted by PTSS. The study sample included 104 subjects who were combat veterans of the 1973 Yom Kippur War comprising of 60 male ex-prisoners of war (ex-POWs) and 44 comparable male combat veterans. Both attachment and pain were investigated experimentally in the laboratory and via questionnaires. We found that ex-POWs showed higher levels of clinical pain and attachment insecurities compared to controls. Moreover, attachment avoidance and soothing effect of attachment (SEA) were both associated with lower levels of clinical pain. Most importantly, PTSS moderated the associations between attachment and pain, as well as the mediation role of attachment between captivity and pain. The results imply that although attachment can be an important resource for coping with pain, it can be severely disrupted by PTSS among trauma survivors.