ORIGINAL RESEARCH—PSYCHOLOGY
Posttraumatic Symptoms, Marital Intimacy, Dyadic Adjustment, and Sexual Satisfaction among Ex-Prisoners of War
Gadi Zerach PhD,
Ben-David Anat MSW,
Zahava Solomon PhD,
Rafi Heruti MD,
Corresponding Author
Gadi Zerach PhD
Department of Behavioral Sciences, Ariel University Center of Samaria, Ariel, Israel;
Gadi Zerach, PhD, Behavioral Sciences, Ariel University Center of Samaria, Ariel 40700, Israel. Tel: 972-3-6407204; Fax: 972-3-6409182; E-mail: [email protected]Search for more papers by this authorBen-David Anat MSW
School of Social Work, Haifa University, Haifa, Israel;
Search for more papers by this authorZahava Solomon PhD
Bob Shappell School of Social Work, Tel Aviv University, Tel Aviv, Israel;
Search for more papers by this authorGadi Zerach PhD,
Ben-David Anat MSW,
Zahava Solomon PhD,
Rafi Heruti MD,
Corresponding Author
Gadi Zerach PhD
Department of Behavioral Sciences, Ariel University Center of Samaria, Ariel, Israel;
Gadi Zerach, PhD, Behavioral Sciences, Ariel University Center of Samaria, Ariel 40700, Israel. Tel: 972-3-6407204; Fax: 972-3-6409182; E-mail: [email protected]Search for more papers by this authorBen-David Anat MSW
School of Social Work, Haifa University, Haifa, Israel;
Search for more papers by this authorZahava Solomon PhD
Bob Shappell School of Social Work, Tel Aviv University, Tel Aviv, Israel;
Search for more papers by this authorABSTRACT
Introduction. The aversive impact of combat and combat-induced posttraumatic stress disorder (PTSD) on marital intimacy and sexual satisfaction has been examined in several studies. Nevertheless, the toll of war captivity on marital intimacy in relation to dyadic adjustment and sexual satisfaction remains unknown. In particular, the mediating role of marital intimacy in the relationship between PTSD symptoms and dyadic adjustment and between PTSD symptoms and sexual satisfaction has not yet been systematically explored thus far.
Aims. This study aimed to examine the interrelationships of PTSD symptoms, dyadic adjustment, sexual satisfaction, and marital intimacy among ex-prisoners of war (ex-POWs).
Methods. A sample of Israeli veterans ex-POWs (ex-POWs: N = 105) from the 1973 Yom Kippur War and a matched comparison group of veterans who participated in the same war but were not held captive (control: N = 94) were compared in the study variables.
Main Outcome Measures. The PTSD inventory, dyadic adjustment scale, index of sexual satisfaction, and capacity for intimacy questionnaire.
Results. Findings revealed that ex-POWs reported higher levels of PTSD symptoms and lower levels of dyadic adjustment and sexual satisfaction than comparable controls. There were also differences between the groups in the pattern of relations between PTSD symptoms, dyadic adjustment, sexual satisfaction, and marital intimacy. Finally, for ex-POWs, marital intimacy partially mediated the relationships between PTSD symptoms and dyadic adjustment and sexual satisfaction outcome measures.
Conclusions. PTSD symptoms are implicated in marital problems of ex-POWs. A significant relationship was found between the traumatized ex-POW's capacity for intimacy and both their sexual satisfaction and dyadic adjustment. Zerach G, Anat B-D, Solomon Z, and Heruti R. Posttraumatic symptoms, marital intimacy, dyadic adjustment, and sexual satisfaction among ex-prisoners of war. J Sex Med 2010;7:2739–2749.
References
- 1
Hunter EJ.
The Vietnam prisoner of war experience. In: JP Wilson,
B Raphael, eds.
International handbook of traumatic stress syndromes. New York: Plenum Press; 1993: 297–304.
10.1007/978-1-4615-2820-3_24 Google Scholar
- 2
Solomon Z.
Combat stress reaction: The enduring toll of war. New York: Plenum Press; 1993.
10.1007/978-1-4757-2237-6 Google Scholar
- 3 Herman JH. Trauma and recovery. New York: Basic Books; 1992.
- 4 Engdahl BE, Harkness AR, Eberly RE, Page WF, Bielinski J. Structural model of captivity trauma, resilience, and trauma response among former prisoner of war 20–40 years after release. Soc Psychiatry Psychiatr Epidemiol 1993; 28: 109–15.
- 5 Speed N, Engdahl B, Schwartz J, Eberly R. Posttraumatic stress disorder as a consequence of the POW experience. J Nerv Ment Dis 1989; 177: 147–53.
- 6 Sutker PB, Allain AN. Assessment of PTSD and other mental disorders in World War II and Korean conflict POW survivors and combat veterans. Psychol Assess 1996; 8: 18–25.
- 7 Solomon Z, Dekel R. Posttraumatic stress disorder among ex-prisoners of war 18 and 30 years after release. J Clin Psychiatry 2005; 66: 1031–7.
- 8 Ford JD, Shaw D, Sennhauser S, Greaves D. Psychosocial debriefing after Operation Desert Storm: Marital and family assessment and intervention. J Soc Issues 1993; 49: 73–102.
- 9 Taft CT, Pless AP, Stalans LJ, Koenen KC, King LA, King DW. Risk factors for partner violence among a national sample of combat veterans. J Consult Clin Psychol 2005; 73: 151–9.
- 10 Cook JM, Riggs DS, Thompson R, Coyne JC, Sheikh JI. Posttraumatic stress disorder and current relationship functioning among World War II ex-prisoners of war. J Fam Psychol 2004; 18: 36–45.
- 11 Caselli LT, Motta RW. The effects of PTSD and combat levels on Vietnam veterans' perception of child behavior and marital adjustment. J Clin Psychol 1995; 51: 5–12.
- 12 Riggs DS, Byrne CA, Weathers FW, Litz BT. The quality of the intimate relationships of male Vietnam veterans: Problems associated with posttraumatic stress disorder. J Trauma Stress 1998; 11: 87–101.
- 13 Neria Y, Solomon Z, Ginzburg K, Dekel R, Enoch D, Ohry A. Posttraumatic residues of captivity: A follow-up of Israeli ex-prisoners of war. J Clin Psychiatry 2000; 61: 39–46.
- 14 Nice DS, McMillian T, McDonald B. The families of U.S. Navy prisoners of war from Vietnam five years after reunion. J Marriage Fam 1981; 43: 431–7.
- 15 Bernstein M. Conflicts in adjustment: WW-II prisoners of war and their families. In: Y Danieli, ed. International handbook of multigenerational legacies of trauma. New York: Plenum Press; 1998: 119–24.
- 16 Kirkpatrick JS. Human sexuality: A survey of what counselors need to know. Counselor Educ Supervision 1980; 19: 276–82.
- 17 Risen CB. Listening to sexual stories. In: SB Levine, CB Risen, B Candace, SE Althof, eds. Handbook of clinical sexuality for mental health professionals. New York: Brunner-Routledge; 2003: 3–19.
- 18 Hsiu-Chen Y, Frederick O, Lorenz FO, Wickrama KAS, Conger RD. Relationships among sexual satisfaction, marital quality and marital instability at midlife. J Fam Psychol 2006; 20: 339–43.
- 19 Lawrence K, Byers ES. Interpersonal exchange model of sexual satisfaction questionnaire. In: CM Davis, WL Yarber, R Bauserman, eds. Handbook of sexuality related measures. Thousand Oaks, CA: Sage; 1998: 514–9.
- 20 Young M, Luquis R, Denny G, Young T. Correlates of sexual satisfaction in marriage. Can J Hum Sex 1998; 7: 115–28.
- 21 Kaplan HS. The new sex therapy. New York: Brunner/Mazel; 1974.
- 22 Kotler M, Cohen H, Aizenberg D, Matar M, Loewenthal U, Kaplan Z, Miodownik Z, Zemishlany Z. Sexual dysfunction in male posttraumatic stress disorder patients. Psychother Psychosom 2000; 69: 309–15.
- 23 Letourneau EJ, Schewe PA, Frueh BC. Preliminary evaluation of sexual problems in combat veterans with PTSD. J Trauma Stress 1997; 10: 125–32.
- 24 Cosgrove DJ, Gordon Z, Bernie JE, Hami S, Montoya D, Stein MB, Monga M. Sexual dysfunction in combat veterans with posttraumatic stress disorder. San Diego, CA: Division of Urology, University of California, San Diego, Medical Center; 2002.
- 25 Nelson-Goff BS, Smith DB. Systemic traumatic stress: The couple adaptation to traumatic stress model. J Marital Fam Ther 2005; 31: 145–57.
- 26 Moss BF, Schwebel AI. Defining intimacy in romantic relationships. Fam Relat 1993; 42: 31–7.
- 27
Mills B,
Turnbull G.
After trauma: Why assessment of intimacy should be an integral part of medico-legal reports.
J Sex Relat Ther
2001; 16: 299–308.
10.1080/14681990120064531 Google Scholar
- 28 Schaefer MT, Olson DH. Assessing intimacy: The PAIR inventory. J Marital Fam Ther 1981; 7: 47–60.
- 29 Sadovsky R, Nusbaum M. Sexual health inquiry and support is a primary care priority. J Sex Med 2006; 3: 3–11.
- 30 Haning RV, O'Keefe SL, Randall EJ, Kommor MJ, Baker E, Wilson R. Intimacy, orgasm likelihood, and conflict predict sexual satisfaction in heterosexual male and female respondents. J Sex Marital Ther 2007; 33: 93–113.
- 31 Byers ES. Relationship satisfaction and sexual satisfaction: A longitudinal study of individuals in long-term relationships. J Sex Res 2005; 42: 113–8.
- 32
Hordern A,
Street A.
Issues of intimacy and sexuality in the face of cancer: The patient perspective.
Cancer Nurs
2007; 30: 8–11.
10.1097/01.NCC.0000300162.13639.f5 Google Scholar
- 33 Mikulincer M, Florian V, Solomon Z. Marital intimacy, family support, and secondary traumatization: A study of wives of veterans with Combat Stress Reaction. Anxiety Stress Coping 1995; 8: 203–13.
- 34 Cohen E, Dekel R, Solomon Z, Lavie T. Posttraumatic stress symptoms and fear of intimacy among treated and non-treated survivors who were children during the Holocaust. Soc Psychiatry Psychiatr Epidemiol 2003; 38: 611–7.
- 35 Evans L, McHugh T, Hopwood M, Watt C. Chronic posttraumatic stress disorder and family functioning of Vietnam veterans and their partners. Aust N Z J Psychiatry 2003; 37: 722–65.
- 36 Solomon Z, Dekel R, Zerach G. The relationships between posttraumatic symptom clusters and marital intimacy among war veterans. J Fam Psychol 2008; 22: 659–66.
- 37 Barnes ML, Sternberg RJ. A hierarchical model of love and its prediction of satisfaction in close relationships. In: RJ Sternberg, M Hojjat, eds. Satisfaction in close relationships. New York: Guilford; 1997: 79–101.
- 38 Pielage S, Lueijn F, Arrindell WA. Adult attachment, intimacy and psychological distress in a clinical and community sample. Clin Psychol Psychother 2005; 12: 455–64.
- 39 Cordova JV, Gee CB, Warren LZ. Emotional skillfulness in marriage: Intimacy as a mediator of the relationship between emotional skillfulness and marital satisfaction. J Soc Clin Psychol 2005; 24: 218–35.
- 40 Cordova JV, Scott R. Intimacy: A behavioral interpretation. Behav Analyst 2001; 24: 75–86.
- 41 Solomon Z, Benbenishty R, Neria Y, Abramowitz M, Ginzburg K, Ohry A. Assessment of PTSD: Validation of the revised PTSD inventory. Isr J Psychiatry Relat Sci 1993; 2: 110–6.
- 42
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.
10.1176/appi.books.9780890423349 Google Scholar
- 43 Schwarzwald J, Solomon Z, Weisenberg M, Mikulincer M. Validation of the Impact of Events Scale for psychological sequelae of combat. J Consult Clin Psychol 1987; 55: 251–6.
- 44 Solomon Z. Convergent validity of posttraumatic stress disorder (PTSD) diagnosis: Self-report and clinical assessment. Isr J Psychiatry Relat Sci 1988; 25: 46–55.
- 45 Sharabany R. Intimate friendship among kibbutz and city children and its measurement. Doctoral Dissertation, Cornell University; 1974.
- 46 Harsheleg E. Friendship and intimacy among couples. Unpublished Master's thesis, University of Haifa, Haifa, Israel; 1984.
- 47 Cohen E. Holocaust child survivors: Posttraumatic residues, attachment styles, capacity for intimacy and rear of intimacy. Unpublished Master's thesis, Tel-Aviv University, Tel-Aviv, Israel; 1996.
- 48 Spanier GB. Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. J Marriage Fam 1976; 38: 15–28.
- 49 Heyman RE, Sayers SL, Bellack AS. Global marital satisfaction versus marital adjustment: An empirical comparison of three measures. J Fam Psychol 1994; l8: 432–46.
- 50 Mikulincer M, Horesh N, Levy-Shiff R, Manovich R, Shalev J. The contribution of adult attachment style to the adjustment to infertility. Br J Med Psychol 1998; 71: 265–80.
- 51 Horesh N, Fennig S. Perception of spouses and relationships: A matched control study of patients with severe affective disorder in remission and their spouses. J Nerv Ment Dis 2000; 188: 463–6.
- 52 Hudson WW, Harrison DF, Crosscup PC. A short-form scale to measure sexual discord in dyadic relationships. J Sex Res 1981; 17: 157–74.
- 53 Chang L. A psychometric evaluation of 4-point and 6-point Likert-type scales in relation to reliability and validity. Appl Psychol Meas 1994; 18: 205–15.
- 54 Dawes J. Do data characteristics change according to the number of scale points used? An experiment using 5-point, 7-point and 10-point scales. Int J Mark Res 2008; 50: 61–77.
- 55 Hofmeyr DG, Greef AP. The influence of a vasectomy on the marital relationship and sexual satisfaction of the married man. J Sex Marital Ther 2002; 28: 339–51.
- 56 Dekel R, Solomon Z. Marital relations among former POWs: Contribution of PTSD, aggression and sexual satisfaction. J Fam Psychol 2006; 20: 709–12.
- 57 Shrout PE, Bolger N. Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychol Methods 2002; 7: 422–45.
- 58 Baron RM, Kenny DA. The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. J Pers Soc Psychol 1986; 51: 1173–82.
- 59 Kenny DA, Kashy DA, Bolger N. Data analysis in social psychology. In: D Gilbert, ST Fiske, G Lindzey, eds. Handbook of social psychology. New York: McGraw-Hill; 1998: 233–65.
- 60 Galovski T, Lyons J. Psychological sequalae of combat violence: A review of the impact of PTSD on the veteran's family and the possible intervention. Aggress Violent Behav 2004; 9: 477–501.
- 61
Mills B,
Turnbull G.
Broken hearts and mending bodies: The impact of trauma on intimacy.
Sex Relat Ther
2004; 19: 265–89.
10.1080/14681990410001715418 Google Scholar
- 62 Beckham JC, Roodman AA, Barefoot JC, John C, Haney TL. Interpersonal and self-reported hostility among combat veterans with and without posttraumatic stress disorder. J Trauma Stress 1996; 19: 335–42.
- 63 Rosenheck R, Thomson J. “Detoxification” of Vietnam War trauma: A combined family-individual approach. Fam Process 1986; 25: 559–70.
- 64 Feldman LB. Marital conflict & marital intimacy: An integrative psychodynamic–behavioral systematic model. Fam Process 1979; 18: 69–78.
- 65 Costa RM, Brodym S. Women's relationship quality is associated with specifically penile–vaginal intercourse orgasm and frequency. J Sex Marital Ther 2007; 33: 319–27.
- 66 Basson R, Schultz WW. Sexual sequelae of general medical disorders. Lancet 2007; 369: 409–29.
- 67 Nelson-Goff BS, Crow JR, Reisbig MJ, Hamilton S. The impact of individual trauma symptoms of deployed soldiers on relationship satisfaction. J Fam Psychol 2007; 21: 344–53.
- 68 Solomon Z, Dekel R, Zerach G, Horesh D. Differentiation of the self and posttraumatic symptomatology among ex-POWs and their wives. J Marital Fam Ther 2009; 35: 60–73.
