A Dual-Model of Posttraumatic Stress and Posttraumatic Growth in a Community Sample of Female Conflict-Related Sexual Violence Survivors from Bosnia & Herzegovina

Abstract

Background: 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. Less clear however, is how these outcomes interact – particularly for female survivors of conflict-related sexual violence (CRSV) – and to what extent intermediary factors such as coping play a role in this relationship. Methods: In a sample of 192 survivors of the 1990s conflict in Bosnia & Herzegovina; of whom 104 experienced CRSV, and 88 who did not, a structural equation model was tested using LISREL 8.8 that included 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. It was hypothesised that there would be differences in the mechanisms by which PTG and PTSD interact in the two subgroups, given the differences in the nature of the trauma they experienced. Results: Through multiple indirect relationships, results showed that CRSV survivors respond to their trauma with both PTSD and PTG, substantiating a dual PTSD-PTG mechanism, as opposed to a single spectrum with these outcomes at the poles. With regard to coping strategies, positive reinterpretation predicted greater PTG, and behavioural disengagement predicted greater PTSD. In the sample of non-sexual violence survivors, positive reinterpretation also remained a significant predictor of PTG. Conclusions: Findings suggest that positive reinterpretation as a coping strategy appears to be a stable characteristic that independently predicts PTG, irrespective of trauma type. Mental health care professionals should take into account this specific 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 greater PTG and enhance recovery.