PSYCH  Vol.6 No.5 , April 2015
Effects of Developmental Abuse and Symptom Suppression among Traumatized Veterans
Author(s) John J. Whelan*
ABSTRACT
While much of the research on military posttraumatic stress disorder (PTSD) focuses on warzone reactions, a burgeoning literature highlights complex relationships between childhood adversity and adult-onset PTSD. However, conceptual efforts to delineate the effects of childhood abuse on treatment trajectories for traumatized military veterans are lacking. This study compared trauma and psychological symptom profiles for developmentally abused and non-abused Canadian Forces (CF) veterans (N = 108) diagnosed with operational PTSD. Subscale scores from the Detailed Assessment of PTSD Scale (DAPS) and the Personality Assessment Inventory (PAI) were submitted to MANOVA. The analysis resulted in a composite variable reflecting’ symptom suppression efforts’ that separated abused veterans (n = 55) from non-abused veterans (n = 53). Post hoc analyses showed significant differences between the abused sub-groups (i.e., physical and sexual abuse [n = 15]; physical abuse only [n = 17]; sexual abuse only [n = 23]) and the non-abused group. Veterans with abuse histories had higher symptom suppression scores, reflecting higher levels of substance abuse, post-traumatic dissociation, interpersonal mistrust, as well as, lower depression and PTSD impairment scores. Implications for clinicians and an alternative intervention for treating traumatized military personnel with histories of developmental abuse are discussed.

Cite this paper
Whelan, J. (2015). Effects of Developmental Abuse and Symptom Suppression among Traumatized Veterans. Psychology, 6, 540-548. doi: 10.4236/psych.2015.65052.
References
[1]   Baker, D. G., Nievergelt, C. M., & Risbrough, V. B. (2009). Posttraumatic Stress Disorder: Emerging Concepts of Pharmacotherapy. Expert Opinion Emergent Drugs, 14, 251-272.
http://dx.doi.org/10.1517/14728210902972494

[2]   Barrera, T. L., Mott, J. M., Hofstein, R. F., & Teng, E. J. (2013). A Meta-Analytic Review of Exposure in Group Cognitive Behavioral Therapy for Posttraumatic Stress Disorder. Clinical Psychology Review, 33, 24-32.
http://dx.doi.org/10.1016/j.cpr.2012.09.005

[3]   Blake, D., Weathers, F., Nagy, L., Kaloupek, D., Klaumenzer, G., Charney,… Buckley, T. C. (2000). Instruction Manual: Clinician-Administered PTSD Scale (CAPS). West Haven: National Center for Posttraumatic Stress Disorder Behavioral Science Division, Boston Neurosciences Division.

[4]   Briere, J. (2001). DAPS—Detailed Assessment of Posttraumatic Stress Professional Manual. Odessa, FL: Psychological Assessment Resources.

[5]   Brown, P. J., Stout, R. L., & Mueller, T. (1999). Substance Use Disorder and Posttraumatic Stress Disorder Comorbidity: Addiction and Psychiatric Treatment Rates. Psychology of Addictive Behaviors, 13, 115-122.
http://dx.doi.org/10.1037/0893-164X.13.2.115

[6]   Busuttil, W. (2006). The Development of a 90-Day Residential Program for the Treatment of Complex Posttraumatic Stress Disorder. Journal of Aggression, Maltreatment, & Trauma, 12, 29-55.
http://dx.doi.org/10.1300/J146v12n01_03

[7]   Cabrera, O. A., Hoge, C. W., Bliese, P. D., Castro, C. A., & Messer, S. C. (2007). Childhood Adversity and Combat as Predictors of Depression and Post-Traumatic Stress in Deployed Troops. American Journal of Preventative Medicine, 33, 77-82.
http://dx.doi.org/10.1016/j.amepre.2007.03.019

[8]   Evren, C., Sar, V., Dalbudak, E., Oncu, F., & Cakmak, D. (2009). Social Anxiety and Dissociation among Male Patients with Alcohol Dependency. Psychiatry Research, 165, 273-280.
http://dx.doi.org/10.1016/j.psychres.2007.10.016

[9]   Evren, C., Sar, V., Dalbudak, E., Cetin, R., Durkaya, M., Evren, B., & Celik, S. (2011). Lifetime PTSD and Quality of Life among Alcohol-Dependent Men: Impact of Childhood Emotional Abuse and Dissociation. Psychiatry Research, 186, 85-90.
http://dx.doi.org/10.1016/j.psychres.2010.07.004

[10]   Felitti, V. J., & Anda, R. F. (2010). The Relationship of Adverse Childhood Experiences to Adult Health, Well-Being, Social Function, and Healthcare, In R. Lanius, E. Vermetten, & C. Pain (Eds.). The Impact of Early Life Trauma on Health and Disease; The Hidden Epidemic (pp. 77-87). New York: Cambridge University Press.

[11]   Forbes, D., Fletcher, S., Phelps, A., Wade, D., Creamer, M., & O’Donnell, M. (2013). Impact of Combat and Non-Military Trauma Exposure on Symptom Reduction Following Treatment for Veterans with Posttraumatic Stress Disorder. Psychiatry Research, 206, 33-36.
http://dx.doi.org/10.1016/j.psychres.2012.09.037

[12]   Frewen, P. A., Pain, C., Dozois, D. J., & Lanius, R. A. (2006). Alexithymia in PTSD: Psychometric and fMRI Studies. Annals of the New York Academy of Science, 1071, 397-400.
http://dx.doi.org/10.1196/annals.1364.029

[13]   IBM Corp. Released 2011. IBM Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.

[14]   Keller, S. M., Zoeller, L. A., & Feeny, N. C. (2010). Understanding Factors Associated with Early Therapeutic Alliance in PTSD Treatment: Adherence, Childhood Sexual Abuse History, and Social Support. Journal of Consulting and Clinical Psychology, 78, 974-979.
http://dx.doi.org/10.1037/a0020758

[15]   Kitchiner, N. J., Roberts, N. P., Wilcox, D., & Bisson, J. I. (2012). Systematic Review and Meta-Analysis of Psychosocial Interventions for Veterans of Military. European Journal of Psychotraumatology, 3, 1-16.
http://dx.doi.org/10.3402/ejpt.v3i0.19267

[16]   Klemanski, D. H., Mennin, D. S., Borelli, J. L., Morrissey, P. M., & Aikins, D. E. (2012). Emotion-Related Regulatory Difficulties Contribute to Negative Psychological Outcomes in Active-Duty Iraq War Soldiers with and without Posttraumatic Stress Disorder. Depression and Anxiety, 29, 621-628.
http://dx.doi.org/10.1002/da.21914

[17]   Kozaric-Kovacic, D. (2008). Psychopharmacotherapy of Posttraumatic Stress Disorder. Croatian Medical Journal, 49, 459-475.
http://dx.doi.org/10.3325/cmj.2008.4.459

[18]   Lieberman, M. D. (2013). Social: Why Our Brains Are Wired to Connect. New York: Crown Publishers.

[19]   Mikulak, A. (2012). Embattled Childhoods May Be the Real Trauma for Soldiers with PTSD.
http://www.sciencedaily.com/releases/2012/11/121119140625.htm.

[20]   Morey, L. C. (1991). Personality Assessment Inventory Professional Manual. Lutz, FL: Psychological Assessment Resources.

[21]   Morey, L. C. (2008). PAI Software Portfolio, Version 3. Lutz, FL: Psychological Assessment Resources.

[22]   Nilamadhab, K. (2011). Cognitive behavioral Therapy for the Treatment of Post-Traumatic Stress Disorder: A Review. Neuropsychiatric Disease and Treatment, 7, 167-181.

[23]   Norman, S. B., Tate, S. R., Anderson, K. G., & Brown, S. A. (2007). Do Trauma History and PTSD Symptoms Influence Addiction Relapse Context? Drug and Alcohol Dependence, 90, 89-96.
http://dx.doi.org/10.1016/j.drugalcdep.2007.03.002

[24]   Owens, G. P., Dashevsky, B., Chard, K. M., Mohamed, S., Haji, U., Heppner, P. S., & Baker, D. G. (2009). The Relationship between Childhood Trauma, Combat Exposure, and Posttraumatic Stress Disorder in Male Veterans. Military Psychology, 21, 114-125.
http://dx.doi.org/10.1080/08995600802574530

[25]   Pagano, R. G. (1997). Understanding Statistics in the Behavioral Sciences (3rd ed.). New York: West Publishing Co.

[26]   Rademaker, A. R., Vermetten, E., & Kleber, R. J. (2009). Multimodal Exposure-Based Group Treatment for Peacekeepers with PTSD: A Preliminary Evaluation. Military Psychology, 21, 482-496.
http://dx.doi.org/10.1080/08995600903206420

[27]   Ravindran, L. N., & Stein, M. B. (2009). Pharmacotherapy of PTSD: Premises, Principles, and Priorities. Brain Research, 13, 24-39.
http://dx.doi.org/10.1016/j.brainres.2009.03.037

[28]   Ready, D. J., Thomas, K. R., Worley, V., Backschieder, A. G., Harvey, L. C., Baltzell, D., & Rothbaum, B. O. (2008). A Field Test of Group-Based Exposure Therapy with War-Related Posttraumatic Stress Disorder. Journal of Traumatic Stress, 21, 150-157.
http://dx.doi.org/10.1002/jts.20326

[29]   Ready, D. J., Vega, E. M., Worley, V., & Bradley, B. (2012). Combining Group-Based Exposure Therapy with Prolonged Exposure to Treat U.S. Vietnam Veterans with PTSD: A Case Study. Journal of Traumatic Stress, 25, 574-577.
http://dx.doi.org/10.1002/jts.21734

[30]   Schafer, I., Langeland, W., Hissbach, J., Luedecke, M., Ohlmeier, M., Chodzinski, C. et al., TRAUMAB-Study Group (2010). Childhood Trauma and Dissociation in Patients with Alcohol Dependence, Drug Dependence, or Both—A Multi-Center Study. Drug and Alcohol Dependence, 109, 84-89.
http://dx.doi.org/10.1016/j.drugalcdep.2009.12.012

[31]   Schafer, I., Reininghausa, U., Langeland, W., Vossa, A., Ziegera, N., Haasena, C., & Karowa, A. (2007). Dissociative Symptoms in Alcohol-Dependent Patients: Associations with Childhood Trauma and Substance Abuse Characteristics. Comprehensive Psychiatry, 48, 539-545.
http://dx.doi.org/10.1016/j.comppsych.2007.05.013

[32]   Schottenbauer, M. A., Glass, C. R., Arnkoff, D. B., & Gray, S. H. (2008). Contributions of Psychodynamic Approaches to Treatment of PTSD and Trauma: A Review of the Empirical Treatment and Psychopathology Literature. Psychiatry, 71, 13-34.
http://dx.doi.org/10.1521/psyc.2008.71.1.13

[33]   Schumacher, J. A., Coffey, S. F., &Stasiewicz, P. R. (2006). Symptom Severity: Alcohol Craving, and Age of Trauma Onset in Childhood and Adolescent Trauma Survivors with Comorbid Alcohol Dependence and Posttraumatic Stress Disorder. American Journal on Addictions, 15, 422-425.
http://dx.doi.org/10.1080/10550490600996355

[34]   Seifert, A. E., Polusny, M. A., & Murdoch, M. (2011). The Association between Childhood Physical and Sexual Abuse and Functioning and Psychiatric Symptoms in a Sample of U.S. Army Soldiers. Military Medicine, 176, 176-181.
http://dx.doi.org/10.7205/MILMED-D-10-00038

[35]   Sharpless, B. A., & Barber, J. P. (2011). A Clinician’s Guide to PTSD Treatments for Returning Veterans. Professional Psychology Research and Practice, 42, 8-15.
http://dx.doi.org/10.1037/a0022351

[36]   Solomon, Z., Zur-Noah, S., Horesh, D., Zerach, G., & Keinan, G. (2008). The Contribution of Stressful Life Events throughout the Life Cycle to Combat-Induced Psychopathology. Journal of Traumatic Stress, 21, 318-325.
http://dx.doi.org/10.1002/jts.20340

[37]   Somer, E. (2003). Prediction of Abstinence from Heroin Addiction by Childhood Trauma, Dissociation, and Extent of Psychosocial Treatment. Addiction Research and Theory, 11, 339-348.
http://dx.doi.org/10.1080/1606635031000141102

[38]   Tabachnick, B. G., & Fidell, L. S. (2006). Using Multivariate Statistics (5th ed). Boston, MA: Allyn and Bacon.

[39]   Thompson, J., MacLean, M. B., Van Til, L., Sweet, J., Poirier, A., & Pedlar, D. (2011). Survey on Transition to Civilian Life: Report on Regular Force Veterans. Research Directorate, Veterans Affairs Canada, and Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa.

[40]   Van Voorhees, E. E., Dedert, E. A., Calhoun, P. S., Brancu, M., Runnals, J., VA Mid-Atlantic MIRECC Workgroup, & Beckham, J. C. (2012). Childhood Trauma Exposure in Iraq and Afghanistan War Era Veterans: Implications for Posttraumatic Stress Disorder Symptoms and Adult Functional Social Support. Child Abuse & Neglect, 36, 423-432.
http://dx.doi.org/10.1016/j.chiabu.2012.03.004

[41]   Wampold, B. E., Imel, Z. E., Laska, K. M., Benish, S., Miller, S. D., Fluckiger, C. et al. (2010). Determining What Works in the Treatment of PTSD. Clinical Psychology Review, 30, 923-933.
http://dx.doi.org/10.1016/j.cpr.2010.06.005

[42]   Whelan, J. J. (2013a). Exploring the Relationships between Untreated Adverse Childhood Events and Substance Abuse, and Their Impact on PTSD Relapse Rates among Canadian Military Veterans. In A. B. Aiken, & A. H. Belanger (Eds.), Beyond the Line: Military and Veteran Health Research (pp. 180-195). Kingston, ON: McGill-Queen’s University Press.

[43]   Whelan, J. J. (2013b). Description and Treatment Outcomes for the Trauma Relapse Prevention Group (TRPG) Program. Poster presented at the annual conference of the Canadian Institute on Military and Veteran Health Research, Edmonton, AB.

[44]   Zucker, M., Spinazzola, J., Blaustein, M., & van der Kolk, B. A. (2006). Dissociative Symptomatology in Posttraumatic Stress Disorder and Disorders of Extreme Stress. Journal of Trauma & Dissociation, 7, 19-31.
http://dx.doi.org/10.1300/J229v07n01_03

 
 
Top