WASHINGTON — Can some good eventually come from coping with high levels of psychological stress? Or, does PTSD not only affect returning troops but also their families for generations to come?
As researchers grapple with helping troops deal with PTSD, they also are exploring concepts like “intergenerational PTSD” and “post-traumatic growth.”
Post-traumatic growth is the positive psychological change experienced as a result of a significant struggle with challenging life circumstances.
“After being in the combat zone or multiple deployments, most warriors bounce back, but some emerge even stronger and better,” said clinical psychologist Darlene Powell Garlington, PhD, at a recent DCoE webinar on the topic. “Psychologist calls this post-traumatic growth.”
Intergenerational PTSD affects not only individuals with the disorder, but also their children and grandchildren.
Garlington said post-traumatic growth goes beyond the ability to simply resist and not be damaged by highly stressful circumstances. While “resiliency,” is “bouncing back” from a situation, post-traumatic growth is becoming stronger after tough circumstances, Garlington said. For both, she said, supportive relationships in and outside of the family are critical.
The term “post-traumatic growth” was first coined in the 1990s by Richard Tedeschi, PhD, a psychology professor at the University of North Carolina at Charlotte, and co-author of the “Handbook of Post-traumatic Growth.”
The general understanding that suffering and distress can potentially yield positive change is thousands of years old, according to Garlington, who noted that it is a theme in ancient spiritual and religious traditions, literature and philosophy. Still, she points out, the concept remains a very controversial topic “with inconsistent research results and heated debates.”
In her presentation, she cited research with former prisoners of war who spent as long as eight years in Vietnam’s infamous “Hanoi Hilton” prison; most of them experienced positive growth from the experience (and a PTSD rate of only 4%); and those who experienced the worst trauma reported the most personal growth in the decades after their release.
Garlington also pointed to J.R. Martinez, a former soldier who is the winner on the TV show “Dancing with the Stars” this season. In 2003, Martinez survived serious burns over much of his body while serving in Iraq. In addition to his television appearances, he works to inspire troops to overcome their injuries. “He went through anxiety, he went through depression, but then he grew stronger from his experience and now visits military bases around the country to encourage other warriors to live a full life,” she said.
The process of finding “a new normal” is based on the ability to accept the present reality in the aftermath of trauma, Garlington said.
“The extent to which post-traumatic growth occurs is contingent upon our ability to do this,” explained Garlington, who added, “Although there may be high levels of psychological distress and emotional reaction, individuals and families as a system can grow from trauma.”
The Post-traumatic Growth Inventory (PTGI) is the standardized inventory most often used to measure growth that follows a traumatic life event, she said. It is a 21-item, self-report inventory that uses a six-point Likert scale to measure positive outcomes that result from traumatic experiences.
Concerns have been raised about the utility of the Post-traumatic Growth Inventory Instrument, however. Some researchers have suggested that what is called growth in many studies may not be growth at all.
According to Garlington, what is needed is “valid and reliable metrics and outcome measures” to see how many servicemembers perceive their war experience as post- traumatic growth, compared with those who experience PTSD.”
Intergenerational PTSD Research
Research also is somewhat inconclusive in “intergenerational PTSD,” defined as the “transmission of the experience and the symptoms related to trauma exposure to those within the exposed person’s environment,” according to DCoE clinical psychologist Anita Brown, PhD. “Other terms used to describe this is secondary traumatization, secondary traumatic stress, co-victimization, secondary survival, traumatic countertransference and vicarious traumatization.”
Studies of Holocaust survivor family members have produced a literature base examining the transmission of trauma to family members. Overall, an analysis of nonclinical studies failed to confirm increased rates of psychopathology in the children of Holocaust survivors, compared with matched control groups, Brown said.
On the other hand, studies examining clinical populations of the children of Holocaust survivors found that this second generation presented difficulties in coping with stress and a higher vulnerability to PTSD as compared with other populations experiencing distress.
Moving forward, research is needed on topics such as secondary traumatization among children of war veterans who are not clinical populations and to examine representative samples of veterans using qualitative and longitudinal designs, according to Brown. In addition, research is needed on risk factors for child vulnerabilities for PTSD, among other areas.