Abstract
Background: Posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) are known psychological outcomes that can co-occur in the aftermath of a traumatic event. However, it is less clear how these outcomes interact – particularly for female survivors of conflict-related sexual violence (CRSV) – and to what extent intermediary factors play a role in this relationship.<br/> Methods: In a sample of 192 war survivors from Bosnia & Herzegovina (n = 104 experienced CRSV, n = 88 did not), a structural equation model (LISREL 8.8) tested CRSV as a traumatic event, 'positive reinterpretation' (as a strategy of approach coping) and 'behavioural disengagement' (as a strategy of avoidance coping), and PTSD and PTG as psychosocial outcomes. A difference in the mechanisms by which PTG and PTSD interact in the two subgroups was hypothesised, given the differences in the nature of the trauma they experienced.<br/> Results: Through multiple indirect relationships, results showed that CRSV survivors respond to their trauma with both PTSD and PTG, suggesting a dual PTSDPTG mechanism. As for coping strategies, positive reinterpretation predicted greater PTG, and behavioural disengagement predicted greater PTSD. In the sample of nonsexual violence survivors, positive reinterpretation also remained a significant predictor of PTG.<br/> Conclusions: Positive reinterpretation as a coping strategy appears to be a stable characteristic that independently predicts PTG, irrespective of trauma type. Mental health professionals should take into account this mechanism when addressing the needs of CRSV survivors, but also war survivors more generally. Reframing traumatic events and post-trauma sequalae during treatment could lead to PTG and enhance recovery.
Highlights
Posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) are increasingly acknowledged as psychological outcomes that can co-occur in the aftermath of a traumatic event
The largest proportion of women in both groups were of Bosniak ethnicity, but survivors of sexual violence were significantly older than non-conflict-related sexual violence (CRSV)
Scores on study variables fell in the expected directions: survivors of CRSV were higher in terms of PTSD severity (current PTSD symptomatology above a threshold of >2.5 was detected in 92.3% (n = 96) of CRSVs, and in 27.3% (n = 24) of non-CRSVs), traumatic load and behavioural disengagement; and lower on PTG and positive reinterpretation
Summary
Posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) are increasingly acknowledged as psychological outcomes that can co-occur in the aftermath of a traumatic event. Conclusions: Findings suggest that positive reinterpretation as a coping strategy appears to be a stable characteristic that independently predicts PTG, irrespective of trauma type. The development of posttraumatic growth (PTG) in the aftermath of a traumatic event is a salutary association, and is something that is increasingly investigated across mental health literature There is moderate support for a curvilinear relationship between posttraumatic stress disorder (PTSD) symptomatology and PTG, whereby fewer PTSD symptoms may not be enough stimulation for a person to experience PTG, and a greater number of symptoms may result in additional mental health consequences that prevent the opportunity for PTG (Kleim & Ehlers, 2009; Solomon & Dekel, 2007). Other evidence suggests that adjustment to trauma is a process influenced by factors that pre-date the trauma (e.g. socioeconomic status, family stability, a history of trauma) or psychosocial factors (e.g. personality, coping strategies, social support), as well as event characteristics (e.g. type, intensity, duration of exposure or perceived threat) (Lawrence & Fauerbach, 2003)
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