Effect of physical health
RESEARCHERS HAVE recently begun to examine the impact of psychological responses to trauma, specifically, posttraumatic stress disorder (PTSD) symptomatology, on health. For women, a significant positive correlation has been reported between the severity of PTSD symptoms and physical health problems in victims of sexual assault and veterans of war (Kimerling et al 2000 and Zoellner et al 2000). However, there is a paucity of research examining the relationship between PTSD, PTSD symptom clusters, and physical health in women who have left an intimate abusive relationship. Moreover, although there is some research that examines the physical and psychological effects of lifetime trauma, seldom do these investigations separate violent from nonviolent trauma. The purposes of this research were to examine the relationships between violent and nonviolent trauma, posttraumatic stress disorder and its symptom clusters of avoidance, intrusion/re-experiencing, and hyperarousal, and self-reported physical health symptoms in postabused women.
Review of literature
Research has shown that intimately abused women experience serious physical health problems requiring medical, trauma, or gynecologic treatment (Campbell and Alford 1989; Follingstad et al 1991; Golding et al 1997 and Tollestrup et al 1999), and psychological/emotional health problems, including depression (Campbell 1989; Dienemann et al 2000 and Jack and Dill 1992), substance abuse (Curry 1998 and McFarlane et al 1996), and PTSD (Astin et al 1995; Houskamp and Foy 1991; Kemp et al 1995; Saunders 1994 and Woods 2000). Battered women experience both acute physical injuries and long-term health problems (Bergman and Brismar 1991; Eby et al 1995 and Plichta 1996). Campbell, J.C. and Soeken, K.L., 1999. Women’s responses to battering: A test of the model. Research in Nursing & Health 22, pp. 49–58. View Record in Scopus | Cited By in Scopus (29)Campbell and Soeken (1999a) found both direct and indirect effects of intimate abuse on women’s health. Additional research has shown that these physical health symptoms and problems remained significant even after controlling for age, ethnicity, and stress (Campbell & Soeken, 1999b). Although this previous research extends knowledge about intimate partner violence and physical health problems in women, it is not known whether all types of trauma have a similar impact on physical health symptoms or whether trauma has a cumulative effect on health outcomes over the life course.
Abused and postabused women, that is, those who have left an intimately abusive relationship, have been shown to experience PTSD. In a meta-analysis of 11 studies Golding (1999) reported that 31% to 84.4% of women who experienced intimate partner violence met PTSD criteria. In a study of 52 postabused women, 44% to 66% of the women were experiencing PTSD symptoms depending on measure, even though they had been out of the intimately abusive relationship approximately nine years (Woods, 2000).
Research with predominately male combat veterans has found that persons with PTSD are at increased risk of morbidity and mortality (Beckman et al 1998; Boscarino 1997 and Schnurr and Spiro 1999). Moreover, the more severe the PTSD symptoms, the greater the physical health problems experienced by trauma survivors (Kimerling et al 2000 and Zoellner et al 2000). Although combat exposure had an indirect effect on the physical health of an aging population of male combat veterans, PTSD had a direct effect on the respondent’s self-report of poor health status (Schnurr & Spiro, 1999). Similarly, Taft, Stern, King, and King (1999) found that PTSD had a direct effect on the physical health of 1,632 male and female Vietnam veterans. Wagner, Wolfe, Rotnitsky, and colleagues (2000) reported that the degree of PTSD symptoms at initial assessment was predictive of health problems over time in 2,301 male and female Gulf War veterans. Although these research finding support relationships between PTSD and physical health, other empirical evidence suggests that specific PTSD symptom clusters have differential relationships with health outcomes.
In a study of 52 female war veterans, Kimerling, Clum, and Wolfe (2000) reported that the hyperarousal cluster was a significant predictor of variance in physical health complaints (beta = .73). Zoellner, Goodwin, and Foa (2000) theorized that chronic hyperarousal may be related to physical symptoms in 76 female victims of sexual assault. However, Zoellner et al.’s results only supported that re-experiencing (intrusion) explained a significant portion of the variance in physical health when negative life events and depression were statistically controlled. These mixed findings suggest that research should examine the effect of the PTSD symptom clusters on physical health across all trauma survivor populations.
Multiple factors have been identified as influencing the development of PTSD in trauma survivor groups, including the magnitude and duration of the traumatic event and a history of multiple traumas. Zaidi and Foy (1994) found a significant correlation between childhood physical abuse and combat-related PTSD. These results are consistent with Bremner, J.D., Southwick, S.M., Johnson, D.R., Yehuda, R. and Chaney, D.S., 1993. Childhood physical abuse and combat-related posttraumatic stress disorder in Vietnam veterans. American Journal of Psychiatry 150, pp. 235–239. View Record in Scopus | Cited By in Scopus (216)Bremner, Southwick, Johnson et al.’s (1993) findings that history of childhood physical and/or sexual assault was associated with combat-related PTSD after controlling for level of combat exposure in male veterans. Bremner et al. (1993) theorized that exposure to trauma during childhood may increase vulnerability to future stress and result in long-term neurobiological changes in the stress response.
Tags: Physical health