Elsevier

Clinical Psychology Review

Volume 29, Issue 8, December 2009, Pages 707-714
Clinical Psychology Review

Military-related PTSD and intimate relationships: From description to theory-driven research and intervention development

https://doi.org/10.1016/j.cpr.2009.09.002Get rights and content

Abstract

Military operations in Iraq and Afghanistan have brought heightened awareness of military related PTSD, as well as the intimate relationship problems that accompany the disorder and can influence the course of veterans' trauma recovery. In this paper, we review recent research that documents the association between PTSD and intimate relationship problems in the most recent cohort of returning veterans and also synthesize research on prior eras of veterans and their intimate relationships in order to inform future research and treatment efforts with recently returned veterans and their families. We highlight the need for more theoretically-driven research that can account for the likely reciprocally causal association between PTSD and intimate relationship problems to advance understanding and inform prevention and treatment efforts for veterans and their families. Future research directions are offered to advance this field of study.

Introduction

Our military involvements in Iraq and Afghanistan, Operations Enduring Freedom and Iraqi Freedom (OEF/OIF), have raised awareness about the individual mental health consequences, such as posttraumatic stress disorder (PTSD), that can arise from traumatic stress exposure during the course of military deployment. At the same time, the scientific and lay communities have become more attuned to the family issues that surround a veteran when s/he returns with PTSD, as well as the individual and familial effects that are likely reciprocally related to the veteran's trauma recovery. This paper reviews recent research documenting the intimate relationship problems related to PTSD in OEF/OIF veterans and their intimate partners. We also synthesize research on prior eras of veterans and their intimate relationships and briefly review intervention efforts that have involved veterans' intimate partners. A next crucial step in advancing the study of veterans' PTSD and intimate relationship functioning is to develop and test theoretical models that can account for the well-established association between this individual psychopathology and relationship problems. We conclude the paper by reviewing these efforts and offering suggestions to improve the understanding and treatment of problems in both areas.

Section snippets

Military-related PTSD and intimate relationship problems

Research with combat veterans and their families from different countries and prior eras has long documented the strong association between PTSD and family relationship problems (see Galovski & Lyons, 2004 for review). These studies consistently reveal that veterans diagnosed with chronic PTSD, compared with those exposed to military-related trauma but not diagnosed with the disorder, and their romantic partners report more numerous and severe relationship problems and generally poorer family

Brief review of treatment outcome efforts involving intimate partners

Based on research with veterans from prior eras, the type of couple therapy with the most evidence supporting its efficacy for individual psychopathology and the relationship problems associated with these problems is behavioral/cognitive-behavioral therapy, hereafter collectively referred to as Behavioral Conjoint Therapies (BCT) because of their historical behavioral roots. There have been two completed controlled trials of conjoint therapy for PTSD in general, and both of them involved a

Advancing theory accounting for PTSD and intimate relationship problems

There have been a few constructs and fewer theories put forth to account for the well-documented association between PTSD and intimate relationship problems. We believe that study of the connection between PTSD and intimate relationship functioning is sorely in need of theory development and testing to further understanding of these associations and ultimately advance prevention and treatments efforts aimed at both areas. These constructs/theories can be broadly classified based on their

Future directions

There are a number of questions that remain unanswered about PTSD and the myriad of intimate relationship maladies that co-occur with it. We believe that one of the foremost challenges in this field is the refinement of theories that can account for the likely interacting and recursive effects of these individual and couple-level problems. Well-articulated theories will also need to take into account the developmental course of PTSD and intimate relationship functioning. Prospective research

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