Parenting with PTSD: A Review of Research on the Influence of PTSD on Parent-Child Functioning in Military and Veteran Families.

Suzannah K Creech,Gabriela Misca

doi:10.3389/fpsyg.2017.01101

Abstract

Posttraumatic stress disorder (PTSD) is strongly associated with exposure to war related trauma in military and veteran populations. In growing recognition that PTSD may influence and be influenced by social support and family systems, research has begun to explore the effects that war related trauma and the ensuing PTSD may have on varied aspects of close relationship and family functioning. Far less research, however, has examined the influence of war-related PTSD on parent-child functioning in this population. This paper provides a timely review of emergent literature to examine the impacts that PTSD may have on parenting behaviors and children’s outcomes with a focus on studies of military and veterans of international conflicts since post-9/11. The review sheds light on the pathways through which PTSD may impact parent-child relationships, and proposes the cognitive-behavioral interpersonal theory of PTSD as a theoretical formulation and extends this to parenting/children. The review identifies the strengths and limitations in the extant research and proposes directions for future research and methodological practice to better capture the complex interplay of PTSD and parenting in military and veteran families.

Highlights

The prevalence of posttraumatic stress disorder (PTSD) in samples of United States military service members and veterans who deployed to the wars in Iraq and Afghanistan has recently been estimated to be as high as 23% (Fulton et al, 2015)
With regard to parenting outcomes, the studies reviewed indicated there is an association between parental PTSD symptoms in male military service members or veterans with self-reported parent-child functioning difficulties (Sayers et al, 2009; Allen et al, 2010; Khaylis et al, 2011)
Consistent with the cognitive-behavioral interpersonal theory of PTSD (C-BIT) model’s emphasis on the deleterious impacts of emotional disturbances on family functioning, new research indicates symptoms of depression may play an important role in parentchild functioning after deployment (Blow et al, 2013; Mustillo et al, 2014; Yablonsky et al, 2016)

Summary

INTRODUCTION

The prevalence of posttraumatic stress disorder (PTSD) in samples of United States military service members and veterans who deployed to the wars in Iraq and Afghanistan has recently been estimated to be as high as 23% (Fulton et al, 2015). We are not aware of prior extensions of this theory to parent-child functioning, we argue that the processes implicated in the association between PTSD and intimate relationship functioning are applicable to parent-child functioning (see Figure 1) Within this model, behavioral avoidance and accommodation refer to the process through which PTSD avoidance symptoms are negatively reinforcing and thereby maintain trauma-related distress (e.g., Monson et al, 2012). Some veterans describe negative evaluations of themselves as parents, feelings of unworthiness as a parent, and alienation or detachment from their children (Sherman et al, 2016) Emotional disturbances such as blunted positive emotions and increased anger, shame, guilt, and sadness are common to PTSD are thought to further impair family processes through disruptions to closeness, positive emotional experiences and emotional expression (Monson et al, 2012). Parents with PTSD were more likely to report moderate and severe physical aggression with their children (Leen-Feldner et al, 2011), and the emotional numbing symptoms of PTSD were predictive of parent-child aggression (Lauterbach et al, 2007)

Study design

Findings

CONCLUSION