Posttraumatic stress disorder and relationship functioning: A comprehensive review and organizational framework

Abstract

Posttraumatic stress disorder (PTSD) is associated with impairments in relationship functioning. Beyond the abundance of research that has demonstrated this basic link, more recent research has begun to explore possible mediators and moderators of this association. The present paper reviews and synthesizes existing literature in the context of an overarching organizational framework of potential ways in which PTSD impacts relationship functioning. The framework organizes findings in terms of specific elements of PTSD and comorbid conditions, mediators (factors that are posited to explain or account for the association), and moderators (factors that are posited to alter the strength of the association). Specific symptoms of PTSD, comorbid symptoms, and many of the potential mediators explored have extensive overlap, raising questions of possible tautology and redundancy in findings. Some findings suggest that non-specific symptoms, such as depression or anger, account for more variance in relationship impairments than trauma-specific symptoms, such as re-experiencing. Moderators, which are characterized as individual, relational, or environmental in nature, have been the subject of far less research in comparison to other factors. Recommendations for future research and clinical implications of the findings reviewed are also presented.

Associations of warzone veteran mental health with partner mental health and family functioning: Family Foundations Study

“…In support of the latter possibility and consistent with research across military and civilian populations (e.g., Campbell & Renshaw, 2018; Pflieger et al, 2018), WZV PTSD and depression were both associated with partner reports of relatively lower levels of relationship adjustment, family satisfaction, and family communication. In turn, posthoc analyses revealed significant associations between partner mental health (PTSD, depression, anxiety, and problematic alcohol use) and relationship problems, supporting possible dynamic associations among WZV, partner, and family functioning.…”

“…Our findings add to a growing body of research highlighting the interpersonal consequences of WZV psychological distress. PTSD and depression symptoms are associated with both intrapersonal (e.g., behavioral withdrawal, avoidant coping, emotion dysregulation), and interpersonal (e.g., reduced emotional and physical intimacy, lower support provision, communication deficits) processes, which can adversely affect dyadic functioning (e.g., cohesion, conflict, satisfaction), and exacerbate symptoms of depression and anxiety in partners (e.g., Campbell & Renshaw, 2018; Don & Mickelson, 2012; Monson et al, 2010). Continued longitudinal research will help distinguish mechanisms contributing to increased risk of partner mental health diagnoses and relationship problems among military families.…”

“…Our findings also have implications for clinical care at both the individual and couple‐level. Research has suggested that symptoms of both partners (as opposed to one member alone) reciprocally influence the risk of intimate relationship dysfunction (e.g., Creech et al, 2019; Whisman & Uebelacker, 2009), which in turn, may influence the development and course of mental disorders (see Campbell & Renshaw, 2018; Monson et al, 2010). As such, development and evaluation of interventions aimed at alleviating both individual and couple‐level distress may be warranted.…”

“…Psychiatric symptoms among WZVs may also present challenges to relationships. Both military and civilian studies have indicated increased intimate relationship dysfunction, including poorer communication, relationship dissatisfaction, lower family cohesion, and higher intimate partner violence (IPV), among dyads in which one member reports PTSD symptoms (e.g., Campbell & Renshaw, 2018; Lambert, Engh, Hasbun, & Holzer, 2012; Taft, Watkins, Stafford, Street, & Monson, 2011). Compared to current and former service members without PTSD, those with PTSD are more likely to display interpersonal hostility, exhibit fewer affirming behaviors, and convey greater distress‐maintaining attributions toward their partners (Knobloch‐Fedders, Caska‐Wallace, Smith, & Renshaw, 2017; Miller et al, 2013).…”

“…Yet WZV are at increased risk of depressive symptoms, with approximately 15% of OIF/OEF Army soldiers reporting clinically significant depressive symptoms following deployment (Hoge et al, 2004; Lapierre, Schwegler, & LaBauve, 2007). Additionally, evidence that WZV depression may account for more variance in relationship impairment than do trauma‐specific symptoms (Campbell & Renshaw, 2018; Evans et al, 2003) highlights the importance of better understanding the interpersonal cost of depression in military families.…”