Military-related PTSD and intimate relationships: From description to theory-driven research and intervention development
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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National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Avenue (116B-3), Boston, MA 02130, USA.