Zahava solomon | Tel Aviv University (original) (raw)

Papers by Zahava solomon

Research paper thumbnail of A Longitudinal Study of Secondary Posttraumatic Growth in Wives of Ex-POWs

Psychiatry, 2015

The current study aimed to investigate (a) "secondary" posttraumatic growth (PTG) in wi... more The current study aimed to investigate (a) "secondary" posttraumatic growth (PTG) in wives of former prisoners of war (ex-POWs) and its association to husbands' captivity, husbands' posttraumatic stress disorder (PTSD), and husbands' PTSD trajectories; and (b) the bidirectional relationships over time between wives' posttraumatic stress symptoms (PTSS) and PTG. The study compared 116 wives of Israeli ex-POWs from the 1973 Yom Kippur War with 56 wives of a matched control group of non-POW combat veterans. Wives were divided into groups according to husbands' captivity status, husbands' PTSD status, and husbands' PTSD trajectories; and ANOVAs and MANOVAs were conducted to assess group differences in PTSS and PTG, both cross-sectionally and longitudinally. Autoregressive cross-lag modeling was also used to assess bidirectional relationships between wives' PTSS and PTG over time. Wives of ex-POWs with PTSD reported significantly higher PTG compa...

Research paper thumbnail of Relationship Between Posttraumatic Stress Disorder and Self-Reported Physical Symptoms in Persian Gulf War Veterans

Archives of Internal Medicine, 1997

ABSTRACT

Research paper thumbnail of Veterans’ Offspring’s Personality Traits and the Intergenerational Transmission of Posttraumatic Stress Symptoms

Journal of Child and Family Studies, 2017

Following war and war captivity, many combat veterans and former prisoners of war (ex-POWs) may s... more Following war and war captivity, many combat veterans and former prisoners of war (ex-POWs) may suffer from posttraumatic psychopathologies, and these may be transmitted to their offspring. Though there are considerable individual differences between offspring in this respect, the mechanisms underlying such differences remain unclear. The current longitudinal study examined the role that veterans' offspring's Big Five personality traits may play within this intergenerational transmission. One hundred and twenty-three dyads consisting of veterans (79 ex-POWs and 44 combat veterans) and their adult offspring were examined. Fathers' posttraumatic stress symptoms (PTSS) and global psychiatric distress (GD) were assessed 30 and 35 years after the war, and offspring's PTSS, GD, and Big Five personality traits were assessed 40 years after the war. Findings indicate that veterans' psychopathologies were associated with those of their offspring. Furthermore, analyses revealed significant positive associations between offspring's psychopathologies and their Neuroticism, and negative associations with their Agreeableness and Conscientiousness. Finally, a mediation effect was found wherein the fathers' PTSS and GD were related to their offspring's Neuroticism levels, and the offspring's Neuroticism was related to their PTSS and GD levels. These findings suggest that offspring's personality traits may indeed play a role in the transmission of posttraumatic psychopathologies from veterans to their offspring, and may explain individual differences in this respect. Specifically, high levels of Neuroticism may place offspring at risk for secondary traumatization. Possible explanations and limitations are discussed, and future research directions are suggested.

Research paper thumbnail of Growing Apart: A Longitudinal Assessment of the Relation Between Post-traumatic Growth and Loneliness Among Combat Veterans

Frontiers in Psychology, 2018

The aftermath of war-related trauma may entail psychological devastation and is typically accompa... more The aftermath of war-related trauma may entail psychological devastation and is typically accompanied by various deleterious phenomena. These include, but are not limited to, high rates of loneliness. However, trauma may also result in positive outcomes such as personal, spiritual, and relational prosperity, which are typically considered under the conceptual framework of post-traumatic growth (PTG). PTG may theoretically contribute to either loneliness amelioration (e.g., via increasing one's appreciation of close relationships) or exacerbation (e.g., by increasing one's sense of undergoing experiences that others do not share). Loneliness, on the other hand, may potentially hinder PTG by fostering negative social cognitions and behaviors, or otherwise lead to personal growth. The relations between the two phenomena, however, have yet to be investigated. Filling this gap, the current study examined the aforementioned potentialities by utilizing an autoregressive cross-lagged modeling strategy (ARCL) with a cohort of 260 Israeli combat veterans assessed 30, 35, and 42 years after their participation in the 1973 Yom Kippur War. Results indicated that higher rates of PTG were consistently related to higher rates of loneliness both cross-sectionally and longitudinally. Loneliness, however, did not longitudinally predict PTG rates. It is suggested that these findings may be understood in light of the observation that veterans' loneliness is primarily related to the experience of being experientially out of sync with people who have not endured war experiences. It is suggested that this experiential loneliness may include not only the negative but also the positive ramifications of undergoing such traumas (i.e., PTG). We, therefore, argue that while PTG may include authentic positive transformations it may also lead to more negative ramifications, and these should be identified and addressed by researchers and clinicians alike. Thus, as study limitations are acknowledged, clinical implications, and future research directions are suggested.

Research paper thumbnail of What doesn’t kill you makes you feel older: lifespan adversity and its association with subjective age among former prisoners of war

European Journal of Psychotraumatology, 2019

Background: Subjective age (SA) is an indicator of aging that has been empirically associated wit... more Background: Subjective age (SA) is an indicator of aging that has been empirically associated with health impediments and hindered longevity. Studies show that adverse life events may result in relatively older SA, but have not addressed the differential contribution of life events across the lifespan and the course of posttraumatic psychopathology on the SA of aging survivors of extreme trauma. Objective: Filling this gap, the current study explored the differential contribution of (1) adverse experiences in various life-stages and (2) trajectories of posttraumatic stress disorder (PTSD) to the prediction of SA in a sample of former prisoners-of-war as they enter old age. Method: A cohort of Israeli former prisoners-of-war of the 1973 Yom Kippur War (N = 103) was assessed at four points throughout four decades after the war. A linear hierarchical regression was utilized to assess the contribution of negative life events during childhood, participation in other wars, combat exposure, suffering in captivity, life events since the war and the trajectories of PTSD for predicting SA 42-years post-repatriation. Results: Lifespan adversity explained 50% of the variance in SA, with trajectories of PTSD making the largest contribution, followed by life events since the war. Negative life events in childhood added to the explained variance only when PTSD trajectories were accounted for. Exposure to combat, participation in additional wars and the severity of specific experiences during captivity did not reach significance, though the latter marginally contributed to the explained variance (p = .069). Conclusions: This study demonstrates the importance of considering the prolongation of posttraumatic psychopathology together with life adversities and their differential implications when addressing SA after extreme trauma. The findings suggest that early life adversity may be a latent factor that increases vulnerability to posttraumatic premature aging processes.

Research paper thumbnail of Traumatization, Loneliness, and Suicidal Ideation among Former Prisoners of War: A Longitudinally Assessed Sequential Mediation Model

Frontiers in Psychiatry, 2017

Although highly researched among veterans, the underlying mechanisms of suicidal ideation (SI) am... more Although highly researched among veterans, the underlying mechanisms of suicidal ideation (SI) among former prisoners of war (ex-POWs), especially in the long-term, have rarely been investigated. Furthermore, while posttraumatic stress symptoms (PTSS) and loneliness have been individually associated with veteran SI, and both may be differentially implicated by captivity versus war traumas, the interplay between them has yet to be examined. Filling this gap, the current longitudinal study examined a hypothetical sequential model wherein war captivity, compared with combat-induced trauma, is implicated in worse PTSS, which is then implicated in worse loneliness and PTSS, which together may explain subsequent SI. Two groups of Israeli veterans of the 1973 Yom Kippur War, 163 ex-POWs and 185 matched non-captive veterans were assessed 18 (T1) and 30 (T2) years after the war. Analyses indicated that compared with war, captivity was implicated in worse PTSS, which was implicated in worse loneliness, and these worked in tandem to implicate SI. Loneliness, however, was not directly affected by the type of trauma, nor was its relation to SI linked to its implication in subsequent PTSS. These results may inform future research and clinical practice as the study underscores the importance of both PTSS and loneliness in ex-POWs' long-term SI.

Research paper thumbnail of Double Jeopardy: The Effect of Multiple Secondary Trauma Exposure on Subjective Age

Journal of Loss and Trauma, 2019

The present study investigates whether secondary traumatization (i.e., family history of Holocaus... more The present study investigates whether secondary traumatization (i.e., family history of Holocaust survival and secondary exposure to captivity) is implicated in subjective age. Women exposed to different levels of secondary traumatization (N ¼ 177) were assessed. Analyses of variance (ANOVAs) revealed that a Holocaust background and husband's captivity had a marginally significant positive effect on age appearance. Women with a Holocaust background whose husbands were held captive reported older interest age, indicating double jeopardy for older subjective age when two sources of secondary traumatization are present. A similar trend existed for behavior age. Possible explanations for these complex findings of risk and resilience are discussed.

Research paper thumbnail of The Implication of Combat Stress and PTSD Trajectories in Metabolic Syndrome and Elevated C-Reactive Protein Levels: A Longitudinal Study

The Journal of clinical psychiatry

This study sheds light on the importance of long-term follow-up of trauma survivors, posttraumati... more This study sheds light on the importance of long-term follow-up of trauma survivors, posttraumatic stress disorder (PTSD) trajectories, and early detection of health risk factors in trauma survivors. The present study prospectively assessed the following over 23 years: (1) the association of psychological and physiologic stress during captivity with elevated C-reactive protein (CRP) levels and metabolic syndrome (MetS), which includes hypertension; elevated levels of insulin, triglycerides, and fasting glucose; decreased levels of high-density lipoprotein cholesterol; and obesity and (2) the implication of PTSD trajectories in elevated CRP levels and MetS. Measurements were taken in 1991, 2003, 2008, and 2015. Participants were 116 Israeli combat veterans of the 1973 Yom Kippur War (of these, 101 were former prisoners of war [ex-POWs] and 15 were comparable controls). The medical assessments relevant for this study were body mass index, fasting blood glucose levels, and diabetes, bl...

Research paper thumbnail of Hardiness and sensation seeking as potential predictors of former prisoners of wars' posttraumatic stress symptoms trajectories over a 17-year period

Journal of affective disorders, Jan 15, 2017

Little is known about trajectories of posttraumatic stress symptoms (PTSS) among former prisoners... more Little is known about trajectories of posttraumatic stress symptoms (PTSS) among former prisoners of war (ex-POWs) and the predictors of those trajectories. This study aimed to assess long-term PTSS trajectories among ex-POWs and comparable veterans and the role of hardiness and sensation seeking in predicting PTSS trajectory. A sample of 189 Israeli ex-POWs and 160 comparable combatants participated in a 17 year longitudinal study with three waves of measurements following the 1973 Yom Kippur War (T1: 1991, T2: 2003, T3: 2008). Participants completed validated self-report measures. Latent growth mixture modeling (LGMM) identified four longitudinal PTSS trajectories. Among ex-POWs, the majority of participants were classified in trajectories with "low-increasing" or "medium-increasing" levels of PTSS. Among the comparable veterans, however, the majority of participants were classified in a trajectory with "low" levels of PTSS. Ex-POWs with high levels o...

Research paper thumbnail of Couple Forgiveness and its Moderating Role in the Intergenerational Transmission of Veterans' Posttraumatic Stress Symptoms

Journal of marital and family therapy, Jan 18, 2016

This study examined the moderating effect couple forgiveness (as perceived by the wives/mothers) ... more This study examined the moderating effect couple forgiveness (as perceived by the wives/mothers) may have on the intergenerational transmission of posttraumatic stress symptoms (PTSS) among families of combat veterans and former prisoners of war (ex-POWs). The sample included 123 (79 ex-POWs and 44 control combatants) Israeli father-mother-adult offspring triads. Self-report measures were administered at 2008 to veterans, at 2010-2011 to wives, and at 2013-2014 to offspring. The findings indicated that ex-POWs' PTSS were positively related to their offspring's PTSS, while couple forgiveness buffered this effect, particularly, and detrimentally, when couple forgiveness was low. These findings imply that apprehending the quality of the forgiving atmosphere within the marital relationship may be important for understanding the apparatus of intergenerational transmissions of trauma.

Research paper thumbnail of Posttraumatic Stress Symptoms and Marital Adjustment Among Israeli Combat Veterans: The Role of Loneliness and Attachment

Psychological trauma : theory, research, practice and policy, Jan 16, 2017

War trauma may foster ramifications for marital relationships. Veterans may feel that no one can ... more War trauma may foster ramifications for marital relationships. Veterans may feel that no one can understand them and thus impact their relationships. The current study aims to shed light on the role that posttraumatic stress symptoms (PTSS), loneliness, and attachment orientations may play in marital adjustment among combat veterans. Participants were 504 veterans who served in the Lebanon War in 1982. Analysis revealed that higher PTSS levels were related to lower marital adjustment and that the indirect path of this relation through loneliness was significant. Furthermore, attachment orientations moderated the direct link between PTSS and marital adjustment, but failed to moderate the indirect effect through loneliness. A sense of isolation should be addressed in therapy, as well as the interpersonal expectations of the veteran. (PsycINFO Database Record

Research paper thumbnail of Auditory hallucinations and PTSD in ex-POWS

Journal of trauma & dissociation : the official journal of the International Society for the Study of Dissociation (ISSD), Jan 5, 2016

Literature has suggested that auditory hallucinations might be prevalent in the general populatio... more Literature has suggested that auditory hallucinations might be prevalent in the general population and could be linked to the experience of trauma. This prospective study examines the prevalence of auditory hallucinations in trauma survivors and its association with posttraumatic stress disorder (PTSD) symptoms, over time. Former prisoners of war (ex-POWs) from the 1973 Yom Kippur War (n = 99) with and without PTSD and comparable veterans (n = 103) were assessed twice, in 1991 (T1) and 2003 (T2) in regard to auditory hallucinations and PTSD symptoms. Findings indicated that ex-POWs who suffered from PTSD reported higher levels of auditory hallucinations at T2 as well as increased hallucinations over time, compared to ex-POWs without PTSD and combatants who did not endure captivity. The relation between PTSD and auditory hallucinations was unidirectional, so that the PTSD overall score at T1 predicted an increase in auditory hallucinations between T1 and T2, but not vice versa. Asses...

Research paper thumbnail of Self-Disclosing Trauma and Post-Traumatic Stress Symptoms in Couples: A Longitudinal Study

Psychiatry, 2017

Most research concerning the implications of self-disclosure on trauma's aftermath has focuse... more Most research concerning the implications of self-disclosure on trauma's aftermath has focused on the salubrious effects disclosure may foster for the primary victim. However, the manner in which recipients of disclosure are symptomatically affected by it remains unexamined. Of particular interest are spouses who are often the primary support providers and are therefore susceptible to secondary traumatization. Assessing posttraumatic stress symptoms (PTSS) and self-disclosure among traumatized veterans and their wives, the current longitudinal study begins to fill this gap in the literature. A total of 220 couples consisting of Israeli veterans, of whom 128 were former prisoners of war (ex-POWs) and 92 were combatants, and their wives were examined. PTSS and self-disclosure of both partners were assessed 30 and 35 years after the war using the Posttraumatic Stress Disorder Inventory (PTSD-I; Solomon et al., 1993) and the Self-Disclosure Index (SDI; Miller, Berg, & Archer, 1983),...

Research paper thumbnail of Keeping a healthy distance: Self-differentiation and perceived health among ex-prisoners-of-war's wives

Journal of Psychosomatic Research, 2016

War captivity may affect spouses of former-prisoners-of-war (ex-POWs) in many ways, including pos... more War captivity may affect spouses of former-prisoners-of-war (ex-POWs) in many ways, including posttraumatic stress symptoms (PTSS) and somatic difficulties manifested in negative perceived health. This is generally known as secondary traumatization. Theory suggests that development of secondary traumatization occurs through the relationship with the primary trauma survivor Figley (1986) , thus implying that the ability to keep balanced emotional distance in the relationship may play a pivotal role. Notwithstanding, the contribution of self-differentiation to secondary somatic disturbances remains largely uninvestigated. The current study fills this gap. Methods: Ex-POWs' wives (n = 143) and control former-combatants' wives (n = 102), were assessed prospectively 30 (T1) and 38 (T2) years after the 1973 Yom Kippur War. Self-differentiation and PTSS were assessed at both time-points, while perceived health measures were assessed at T2. Results: Wives of ex-POWs endorsed higher PTSS, lower self-differentiation and negative perceived health, compared to control wives. Indirect exposure to war captivity was related to low self-differentiation and elevated PTSS, which predicted negative perceived health. Furthermore, self-differentiation characterized by fusionwith-others fully mediated the relation between indirect exposure to war captivity and perceived health, beyond the effects of PTSS as a mechanism. Conclusion: Results suggest that tendencies towards fusion-with-others within the marital relationship, act as a risk factor not only for psychological distress but also for somatic distress among secondary trauma survivors. Hence, clinical interventions may seek to improve indirect trauma survivor's self-differentiation capacities, thus potentially facilitating the prevention of secondary somatic distress.

Research paper thumbnail of Somatic Complaints and Attachment in Former Prisoners of War: A Longitudinal Study

Psychiatry, 2015

War captivity includes a unique constellation of simultaneous somatic and interpersonal assaults.... more War captivity includes a unique constellation of simultaneous somatic and interpersonal assaults. This raises questions about the link between attachment and somatic complaints among ex-prisoners of war (ex-POWs). Although the attachment literature assumes that attachment affects somatic complaints and not vice versa, to date no empirical studies assess the association between the two variables over time. In this article we prospectively examine the association between attachment and somatic complaints over time among ex-POWs and comparable veterans. Method: The current study included two groups of male Israeli veterans of the 1973 Yom Kippur War: ex-POWs and comparable veterans who were not taken captive. Both groups were assessed via self-report measures at three times: T1 (1991), T2 (2003), and T3 (2008)-18, 30, and 35 years after the war, respectively. Results: Ex-POWs reported higher levels of somatic complaints and attachment insecurities. These levels increased over time compared to combatant veterans. Moreover, while there was a unidirectional influence of somatic complaints on attachment security over time among combatant veterans, this relationship was bidirectional among ex-POWs. Conclusions: The present study suggests that the combined physical and interpersonal assaults experienced during captivity have adverse effects on combatants and on attachment security, even three decades later. More important, in ex-POWs the relationship between these domains appears to be interactive and mutual, with one reinforcing the other, and vice versa. War captivity is an extremely traumatic experience that exposes the victim to multiple prolonged stressors. Prisoners of war (POWs) are often subjected to harsh physical and psychological abuse by means of humiliation, torture, and severe deprivation of basic needs (i.e., food, water, sleep) (e.g., Herman, 1992). This assemblage of somatic and interpersonal assaults raises questions regarding the implications of war captivity in both domains as well as regarding the associations between somatic and interpersonal aspects among ex-POWs. The present study assesses these questions with respect to somatic complaints and attachment.

Research paper thumbnail of Attachment security and pain - The disrupting effect of captivity and PTSS

Journal of psychosomatic research, 2015

The present study assesses the possible disruption effect of posttraumatic stress symptoms (PTSS)... more The present study assesses the possible disruption effect of posttraumatic stress symptoms (PTSS) with regard to the protective role of attachment on pain, among ex-POWs. While secure attachment seems to serve as a buffer, decreasing the perception of pain, this function may be disrupted by PTSS. The study sample included 104 subjects who were combat veterans of the 1973 Yom Kippur War comprising of 60 male ex-prisoners of war (ex-POWs) and 44 comparable male combat veterans. Both attachment and pain were investigated experimentally in the laboratory and via questionnaires. We found that ex-POWs showed higher levels of clinical pain and attachment insecurities compared to controls. Moreover, attachment avoidance and soothing effect of attachment (SEA) were both associated with lower levels of clinical pain. Most importantly, PTSS moderated the associations between attachment and pain, as well as the mediation role of attachment between captivity and pain. The results imply that alth...

Research paper thumbnail of Secondary traumatization and attachment among wives of former POWs: a longitudinal study

Attachment & human development, Jan 16, 2015

The aim of the present study was to examine the directionality of the association between post-tr... more The aim of the present study was to examine the directionality of the association between post-traumatic stress symptoms (PTSS) and attachment insecurities across time among indirect trauma survivors. Wives of former prisoners of war (ex-POWs), with and without post-traumatic stress disorder (PTSD), and comparable controls were assessed 30 (T1) and 38 (T2) years after the Yom Kippur War. As expected, wives of ex-POWs endorsed higher PTSS compared to wives of controls. Wives of ex-POWs with PTSD endorsed higher PTSS and higher attachment avoidance compared to wives of ex-POWs without PTSD and controls. There were significant associations between PTSS and attachment insecurities. Contrary to the hypothesis, the relationship between PTSS and attachment insecurities among wives of ex-POWs was unidirectional, with attachment anxiety at T1 predicting PTSS at T2, and not vice versa. Results indicate that attachment anxiety might act as a risk factor for secondary traumatic reactions.

Research paper thumbnail of PTSD, resilience and posttraumatic growth among ex-prisoners of war and combat veterans

The Israel journal of psychiatry and related sciences, 2013

Past studies have shown that adversity may yield various salutogenic outcomes. two constructs tha... more Past studies have shown that adversity may yield various salutogenic outcomes. two constructs that have been at the center of this scientific investigation are resilience and posttraumatic growth (PTG). the present study aims to clarify the relations between posttraumatic stress symptoms, resilience and PTG among israeli war veterans. the sample includes former prisoners of war (ex-POWs) (n=103) and comparable veterans (n=106) of the 1973 Yom Kippur War. the veterans were assessed twice: 18 and 30 years after the war with self-report questionnaires. resilience, defined as the absence of posttraumatic symptoms, and PTG are negatively correlated. resilient ex- POWs and veterans reported the lowest levels of PTG when compared to participants diagnosed with clinical and sub-clinical posttraumatic stress disorder (PtSd). Furthermore, PTG dimensions were found to be the most differentiating factor between study groups, followed by war exposure measures and clinical reports of depression a...

Research paper thumbnail of Elaboration on posttraumatic stress disorder diagnostic criteria: a factor analytic study of PTSD exposure to war or terror

The Israel journal of psychiatry and related sciences, 2013

In societies facing prolonged exposure to war and terror, empirical research provides mixed suppo... more In societies facing prolonged exposure to war and terror, empirical research provides mixed support for the posttraumatic stress disorder (PTSD) symptom clusters groupings identified by the Diagnostic and Statistical Manual (DSM-IV-TR) as re-experiencing the event, avoidance and emotional numbing, and hyperarousal. This study examines the validity of the PTSD symptom clusters in elements of Israeli society exposed to man-made trauma. Survivors (N=2,198) of seven different war and terror-related traumas were assessed using a DSM-IV-TR based PTSD inventory. Four confirmatory factor analytic models were compared. The most acceptable model was a correlated model consisting of four factors of re-experiencing, avoidance, emotional numbing, and hyperarousal. DSM-IV-TR avoidance empirically split into active avoidance and emotional numbing. These results corroborate knowledge and suggest that in Israel, where stressors are ongoing, the PTSD symptom clusters may be reformulated in DSM-5 to c...

Research paper thumbnail of Posttraumatic growth and posttraumatic distress: A longitudinal study

This longitudinal study examined the course and bidirectional relation between posttraumatic dist... more This longitudinal study examined the course and bidirectional relation between posttraumatic distress and posttraumatic growth (PTG). A sample of Israeli ex-prisoners of war and matched controls were followed over 17 years. Participants' posttraumatic stress disorder (PTSD), depression, and anxiety symptoms were measured at three time-points. PTG was assessed twice. Applying an autoregressive cross-lagged modeling strategy, initial PTSD predicted subsequent PTG above and beyond PTG stability, but not vice versa. Cross-lagged relations of PTG to depression and anxiety were not significant. Moreover, analysis of PTG trajectory revealed that individuals with PTSD reported higher PTG levels across times than those without PTSD. Thus, growth is facilitated and maintained by endorsement rather than absence of PTSD. The findings are discussed in the context of the illusionary versus adaptive notion of PTG.

Research paper thumbnail of A Longitudinal Study of Secondary Posttraumatic Growth in Wives of Ex-POWs

Psychiatry, 2015

The current study aimed to investigate (a) "secondary" posttraumatic growth (PTG) in wi... more The current study aimed to investigate (a) "secondary" posttraumatic growth (PTG) in wives of former prisoners of war (ex-POWs) and its association to husbands' captivity, husbands' posttraumatic stress disorder (PTSD), and husbands' PTSD trajectories; and (b) the bidirectional relationships over time between wives' posttraumatic stress symptoms (PTSS) and PTG. The study compared 116 wives of Israeli ex-POWs from the 1973 Yom Kippur War with 56 wives of a matched control group of non-POW combat veterans. Wives were divided into groups according to husbands' captivity status, husbands' PTSD status, and husbands' PTSD trajectories; and ANOVAs and MANOVAs were conducted to assess group differences in PTSS and PTG, both cross-sectionally and longitudinally. Autoregressive cross-lag modeling was also used to assess bidirectional relationships between wives' PTSS and PTG over time. Wives of ex-POWs with PTSD reported significantly higher PTG compa...

Research paper thumbnail of Relationship Between Posttraumatic Stress Disorder and Self-Reported Physical Symptoms in Persian Gulf War Veterans

Archives of Internal Medicine, 1997

ABSTRACT

Research paper thumbnail of Veterans’ Offspring’s Personality Traits and the Intergenerational Transmission of Posttraumatic Stress Symptoms

Journal of Child and Family Studies, 2017

Following war and war captivity, many combat veterans and former prisoners of war (ex-POWs) may s... more Following war and war captivity, many combat veterans and former prisoners of war (ex-POWs) may suffer from posttraumatic psychopathologies, and these may be transmitted to their offspring. Though there are considerable individual differences between offspring in this respect, the mechanisms underlying such differences remain unclear. The current longitudinal study examined the role that veterans' offspring's Big Five personality traits may play within this intergenerational transmission. One hundred and twenty-three dyads consisting of veterans (79 ex-POWs and 44 combat veterans) and their adult offspring were examined. Fathers' posttraumatic stress symptoms (PTSS) and global psychiatric distress (GD) were assessed 30 and 35 years after the war, and offspring's PTSS, GD, and Big Five personality traits were assessed 40 years after the war. Findings indicate that veterans' psychopathologies were associated with those of their offspring. Furthermore, analyses revealed significant positive associations between offspring's psychopathologies and their Neuroticism, and negative associations with their Agreeableness and Conscientiousness. Finally, a mediation effect was found wherein the fathers' PTSS and GD were related to their offspring's Neuroticism levels, and the offspring's Neuroticism was related to their PTSS and GD levels. These findings suggest that offspring's personality traits may indeed play a role in the transmission of posttraumatic psychopathologies from veterans to their offspring, and may explain individual differences in this respect. Specifically, high levels of Neuroticism may place offspring at risk for secondary traumatization. Possible explanations and limitations are discussed, and future research directions are suggested.

Research paper thumbnail of Growing Apart: A Longitudinal Assessment of the Relation Between Post-traumatic Growth and Loneliness Among Combat Veterans

Frontiers in Psychology, 2018

The aftermath of war-related trauma may entail psychological devastation and is typically accompa... more The aftermath of war-related trauma may entail psychological devastation and is typically accompanied by various deleterious phenomena. These include, but are not limited to, high rates of loneliness. However, trauma may also result in positive outcomes such as personal, spiritual, and relational prosperity, which are typically considered under the conceptual framework of post-traumatic growth (PTG). PTG may theoretically contribute to either loneliness amelioration (e.g., via increasing one's appreciation of close relationships) or exacerbation (e.g., by increasing one's sense of undergoing experiences that others do not share). Loneliness, on the other hand, may potentially hinder PTG by fostering negative social cognitions and behaviors, or otherwise lead to personal growth. The relations between the two phenomena, however, have yet to be investigated. Filling this gap, the current study examined the aforementioned potentialities by utilizing an autoregressive cross-lagged modeling strategy (ARCL) with a cohort of 260 Israeli combat veterans assessed 30, 35, and 42 years after their participation in the 1973 Yom Kippur War. Results indicated that higher rates of PTG were consistently related to higher rates of loneliness both cross-sectionally and longitudinally. Loneliness, however, did not longitudinally predict PTG rates. It is suggested that these findings may be understood in light of the observation that veterans' loneliness is primarily related to the experience of being experientially out of sync with people who have not endured war experiences. It is suggested that this experiential loneliness may include not only the negative but also the positive ramifications of undergoing such traumas (i.e., PTG). We, therefore, argue that while PTG may include authentic positive transformations it may also lead to more negative ramifications, and these should be identified and addressed by researchers and clinicians alike. Thus, as study limitations are acknowledged, clinical implications, and future research directions are suggested.

Research paper thumbnail of What doesn’t kill you makes you feel older: lifespan adversity and its association with subjective age among former prisoners of war

European Journal of Psychotraumatology, 2019

Background: Subjective age (SA) is an indicator of aging that has been empirically associated wit... more Background: Subjective age (SA) is an indicator of aging that has been empirically associated with health impediments and hindered longevity. Studies show that adverse life events may result in relatively older SA, but have not addressed the differential contribution of life events across the lifespan and the course of posttraumatic psychopathology on the SA of aging survivors of extreme trauma. Objective: Filling this gap, the current study explored the differential contribution of (1) adverse experiences in various life-stages and (2) trajectories of posttraumatic stress disorder (PTSD) to the prediction of SA in a sample of former prisoners-of-war as they enter old age. Method: A cohort of Israeli former prisoners-of-war of the 1973 Yom Kippur War (N = 103) was assessed at four points throughout four decades after the war. A linear hierarchical regression was utilized to assess the contribution of negative life events during childhood, participation in other wars, combat exposure, suffering in captivity, life events since the war and the trajectories of PTSD for predicting SA 42-years post-repatriation. Results: Lifespan adversity explained 50% of the variance in SA, with trajectories of PTSD making the largest contribution, followed by life events since the war. Negative life events in childhood added to the explained variance only when PTSD trajectories were accounted for. Exposure to combat, participation in additional wars and the severity of specific experiences during captivity did not reach significance, though the latter marginally contributed to the explained variance (p = .069). Conclusions: This study demonstrates the importance of considering the prolongation of posttraumatic psychopathology together with life adversities and their differential implications when addressing SA after extreme trauma. The findings suggest that early life adversity may be a latent factor that increases vulnerability to posttraumatic premature aging processes.

Research paper thumbnail of Traumatization, Loneliness, and Suicidal Ideation among Former Prisoners of War: A Longitudinally Assessed Sequential Mediation Model

Frontiers in Psychiatry, 2017

Although highly researched among veterans, the underlying mechanisms of suicidal ideation (SI) am... more Although highly researched among veterans, the underlying mechanisms of suicidal ideation (SI) among former prisoners of war (ex-POWs), especially in the long-term, have rarely been investigated. Furthermore, while posttraumatic stress symptoms (PTSS) and loneliness have been individually associated with veteran SI, and both may be differentially implicated by captivity versus war traumas, the interplay between them has yet to be examined. Filling this gap, the current longitudinal study examined a hypothetical sequential model wherein war captivity, compared with combat-induced trauma, is implicated in worse PTSS, which is then implicated in worse loneliness and PTSS, which together may explain subsequent SI. Two groups of Israeli veterans of the 1973 Yom Kippur War, 163 ex-POWs and 185 matched non-captive veterans were assessed 18 (T1) and 30 (T2) years after the war. Analyses indicated that compared with war, captivity was implicated in worse PTSS, which was implicated in worse loneliness, and these worked in tandem to implicate SI. Loneliness, however, was not directly affected by the type of trauma, nor was its relation to SI linked to its implication in subsequent PTSS. These results may inform future research and clinical practice as the study underscores the importance of both PTSS and loneliness in ex-POWs' long-term SI.

Research paper thumbnail of Double Jeopardy: The Effect of Multiple Secondary Trauma Exposure on Subjective Age

Journal of Loss and Trauma, 2019

The present study investigates whether secondary traumatization (i.e., family history of Holocaus... more The present study investigates whether secondary traumatization (i.e., family history of Holocaust survival and secondary exposure to captivity) is implicated in subjective age. Women exposed to different levels of secondary traumatization (N ¼ 177) were assessed. Analyses of variance (ANOVAs) revealed that a Holocaust background and husband's captivity had a marginally significant positive effect on age appearance. Women with a Holocaust background whose husbands were held captive reported older interest age, indicating double jeopardy for older subjective age when two sources of secondary traumatization are present. A similar trend existed for behavior age. Possible explanations for these complex findings of risk and resilience are discussed.

Research paper thumbnail of The Implication of Combat Stress and PTSD Trajectories in Metabolic Syndrome and Elevated C-Reactive Protein Levels: A Longitudinal Study

The Journal of clinical psychiatry

This study sheds light on the importance of long-term follow-up of trauma survivors, posttraumati... more This study sheds light on the importance of long-term follow-up of trauma survivors, posttraumatic stress disorder (PTSD) trajectories, and early detection of health risk factors in trauma survivors. The present study prospectively assessed the following over 23 years: (1) the association of psychological and physiologic stress during captivity with elevated C-reactive protein (CRP) levels and metabolic syndrome (MetS), which includes hypertension; elevated levels of insulin, triglycerides, and fasting glucose; decreased levels of high-density lipoprotein cholesterol; and obesity and (2) the implication of PTSD trajectories in elevated CRP levels and MetS. Measurements were taken in 1991, 2003, 2008, and 2015. Participants were 116 Israeli combat veterans of the 1973 Yom Kippur War (of these, 101 were former prisoners of war [ex-POWs] and 15 were comparable controls). The medical assessments relevant for this study were body mass index, fasting blood glucose levels, and diabetes, bl...

Research paper thumbnail of Hardiness and sensation seeking as potential predictors of former prisoners of wars' posttraumatic stress symptoms trajectories over a 17-year period

Journal of affective disorders, Jan 15, 2017

Little is known about trajectories of posttraumatic stress symptoms (PTSS) among former prisoners... more Little is known about trajectories of posttraumatic stress symptoms (PTSS) among former prisoners of war (ex-POWs) and the predictors of those trajectories. This study aimed to assess long-term PTSS trajectories among ex-POWs and comparable veterans and the role of hardiness and sensation seeking in predicting PTSS trajectory. A sample of 189 Israeli ex-POWs and 160 comparable combatants participated in a 17 year longitudinal study with three waves of measurements following the 1973 Yom Kippur War (T1: 1991, T2: 2003, T3: 2008). Participants completed validated self-report measures. Latent growth mixture modeling (LGMM) identified four longitudinal PTSS trajectories. Among ex-POWs, the majority of participants were classified in trajectories with "low-increasing" or "medium-increasing" levels of PTSS. Among the comparable veterans, however, the majority of participants were classified in a trajectory with "low" levels of PTSS. Ex-POWs with high levels o...

Research paper thumbnail of Couple Forgiveness and its Moderating Role in the Intergenerational Transmission of Veterans' Posttraumatic Stress Symptoms

Journal of marital and family therapy, Jan 18, 2016

This study examined the moderating effect couple forgiveness (as perceived by the wives/mothers) ... more This study examined the moderating effect couple forgiveness (as perceived by the wives/mothers) may have on the intergenerational transmission of posttraumatic stress symptoms (PTSS) among families of combat veterans and former prisoners of war (ex-POWs). The sample included 123 (79 ex-POWs and 44 control combatants) Israeli father-mother-adult offspring triads. Self-report measures were administered at 2008 to veterans, at 2010-2011 to wives, and at 2013-2014 to offspring. The findings indicated that ex-POWs' PTSS were positively related to their offspring's PTSS, while couple forgiveness buffered this effect, particularly, and detrimentally, when couple forgiveness was low. These findings imply that apprehending the quality of the forgiving atmosphere within the marital relationship may be important for understanding the apparatus of intergenerational transmissions of trauma.

Research paper thumbnail of Posttraumatic Stress Symptoms and Marital Adjustment Among Israeli Combat Veterans: The Role of Loneliness and Attachment

Psychological trauma : theory, research, practice and policy, Jan 16, 2017

War trauma may foster ramifications for marital relationships. Veterans may feel that no one can ... more War trauma may foster ramifications for marital relationships. Veterans may feel that no one can understand them and thus impact their relationships. The current study aims to shed light on the role that posttraumatic stress symptoms (PTSS), loneliness, and attachment orientations may play in marital adjustment among combat veterans. Participants were 504 veterans who served in the Lebanon War in 1982. Analysis revealed that higher PTSS levels were related to lower marital adjustment and that the indirect path of this relation through loneliness was significant. Furthermore, attachment orientations moderated the direct link between PTSS and marital adjustment, but failed to moderate the indirect effect through loneliness. A sense of isolation should be addressed in therapy, as well as the interpersonal expectations of the veteran. (PsycINFO Database Record

Research paper thumbnail of Auditory hallucinations and PTSD in ex-POWS

Journal of trauma & dissociation : the official journal of the International Society for the Study of Dissociation (ISSD), Jan 5, 2016

Literature has suggested that auditory hallucinations might be prevalent in the general populatio... more Literature has suggested that auditory hallucinations might be prevalent in the general population and could be linked to the experience of trauma. This prospective study examines the prevalence of auditory hallucinations in trauma survivors and its association with posttraumatic stress disorder (PTSD) symptoms, over time. Former prisoners of war (ex-POWs) from the 1973 Yom Kippur War (n = 99) with and without PTSD and comparable veterans (n = 103) were assessed twice, in 1991 (T1) and 2003 (T2) in regard to auditory hallucinations and PTSD symptoms. Findings indicated that ex-POWs who suffered from PTSD reported higher levels of auditory hallucinations at T2 as well as increased hallucinations over time, compared to ex-POWs without PTSD and combatants who did not endure captivity. The relation between PTSD and auditory hallucinations was unidirectional, so that the PTSD overall score at T1 predicted an increase in auditory hallucinations between T1 and T2, but not vice versa. Asses...

Research paper thumbnail of Self-Disclosing Trauma and Post-Traumatic Stress Symptoms in Couples: A Longitudinal Study

Psychiatry, 2017

Most research concerning the implications of self-disclosure on trauma's aftermath has focuse... more Most research concerning the implications of self-disclosure on trauma's aftermath has focused on the salubrious effects disclosure may foster for the primary victim. However, the manner in which recipients of disclosure are symptomatically affected by it remains unexamined. Of particular interest are spouses who are often the primary support providers and are therefore susceptible to secondary traumatization. Assessing posttraumatic stress symptoms (PTSS) and self-disclosure among traumatized veterans and their wives, the current longitudinal study begins to fill this gap in the literature. A total of 220 couples consisting of Israeli veterans, of whom 128 were former prisoners of war (ex-POWs) and 92 were combatants, and their wives were examined. PTSS and self-disclosure of both partners were assessed 30 and 35 years after the war using the Posttraumatic Stress Disorder Inventory (PTSD-I; Solomon et al., 1993) and the Self-Disclosure Index (SDI; Miller, Berg, & Archer, 1983),...

Research paper thumbnail of Keeping a healthy distance: Self-differentiation and perceived health among ex-prisoners-of-war's wives

Journal of Psychosomatic Research, 2016

War captivity may affect spouses of former-prisoners-of-war (ex-POWs) in many ways, including pos... more War captivity may affect spouses of former-prisoners-of-war (ex-POWs) in many ways, including posttraumatic stress symptoms (PTSS) and somatic difficulties manifested in negative perceived health. This is generally known as secondary traumatization. Theory suggests that development of secondary traumatization occurs through the relationship with the primary trauma survivor Figley (1986) , thus implying that the ability to keep balanced emotional distance in the relationship may play a pivotal role. Notwithstanding, the contribution of self-differentiation to secondary somatic disturbances remains largely uninvestigated. The current study fills this gap. Methods: Ex-POWs' wives (n = 143) and control former-combatants' wives (n = 102), were assessed prospectively 30 (T1) and 38 (T2) years after the 1973 Yom Kippur War. Self-differentiation and PTSS were assessed at both time-points, while perceived health measures were assessed at T2. Results: Wives of ex-POWs endorsed higher PTSS, lower self-differentiation and negative perceived health, compared to control wives. Indirect exposure to war captivity was related to low self-differentiation and elevated PTSS, which predicted negative perceived health. Furthermore, self-differentiation characterized by fusionwith-others fully mediated the relation between indirect exposure to war captivity and perceived health, beyond the effects of PTSS as a mechanism. Conclusion: Results suggest that tendencies towards fusion-with-others within the marital relationship, act as a risk factor not only for psychological distress but also for somatic distress among secondary trauma survivors. Hence, clinical interventions may seek to improve indirect trauma survivor's self-differentiation capacities, thus potentially facilitating the prevention of secondary somatic distress.

Research paper thumbnail of Somatic Complaints and Attachment in Former Prisoners of War: A Longitudinal Study

Psychiatry, 2015

War captivity includes a unique constellation of simultaneous somatic and interpersonal assaults.... more War captivity includes a unique constellation of simultaneous somatic and interpersonal assaults. This raises questions about the link between attachment and somatic complaints among ex-prisoners of war (ex-POWs). Although the attachment literature assumes that attachment affects somatic complaints and not vice versa, to date no empirical studies assess the association between the two variables over time. In this article we prospectively examine the association between attachment and somatic complaints over time among ex-POWs and comparable veterans. Method: The current study included two groups of male Israeli veterans of the 1973 Yom Kippur War: ex-POWs and comparable veterans who were not taken captive. Both groups were assessed via self-report measures at three times: T1 (1991), T2 (2003), and T3 (2008)-18, 30, and 35 years after the war, respectively. Results: Ex-POWs reported higher levels of somatic complaints and attachment insecurities. These levels increased over time compared to combatant veterans. Moreover, while there was a unidirectional influence of somatic complaints on attachment security over time among combatant veterans, this relationship was bidirectional among ex-POWs. Conclusions: The present study suggests that the combined physical and interpersonal assaults experienced during captivity have adverse effects on combatants and on attachment security, even three decades later. More important, in ex-POWs the relationship between these domains appears to be interactive and mutual, with one reinforcing the other, and vice versa. War captivity is an extremely traumatic experience that exposes the victim to multiple prolonged stressors. Prisoners of war (POWs) are often subjected to harsh physical and psychological abuse by means of humiliation, torture, and severe deprivation of basic needs (i.e., food, water, sleep) (e.g., Herman, 1992). This assemblage of somatic and interpersonal assaults raises questions regarding the implications of war captivity in both domains as well as regarding the associations between somatic and interpersonal aspects among ex-POWs. The present study assesses these questions with respect to somatic complaints and attachment.

Research paper thumbnail of Attachment security and pain - The disrupting effect of captivity and PTSS

Journal of psychosomatic research, 2015

The present study assesses the possible disruption effect of posttraumatic stress symptoms (PTSS)... more The present study assesses the possible disruption effect of posttraumatic stress symptoms (PTSS) with regard to the protective role of attachment on pain, among ex-POWs. While secure attachment seems to serve as a buffer, decreasing the perception of pain, this function may be disrupted by PTSS. The study sample included 104 subjects who were combat veterans of the 1973 Yom Kippur War comprising of 60 male ex-prisoners of war (ex-POWs) and 44 comparable male combat veterans. Both attachment and pain were investigated experimentally in the laboratory and via questionnaires. We found that ex-POWs showed higher levels of clinical pain and attachment insecurities compared to controls. Moreover, attachment avoidance and soothing effect of attachment (SEA) were both associated with lower levels of clinical pain. Most importantly, PTSS moderated the associations between attachment and pain, as well as the mediation role of attachment between captivity and pain. The results imply that alth...

Research paper thumbnail of Secondary traumatization and attachment among wives of former POWs: a longitudinal study

Attachment & human development, Jan 16, 2015

The aim of the present study was to examine the directionality of the association between post-tr... more The aim of the present study was to examine the directionality of the association between post-traumatic stress symptoms (PTSS) and attachment insecurities across time among indirect trauma survivors. Wives of former prisoners of war (ex-POWs), with and without post-traumatic stress disorder (PTSD), and comparable controls were assessed 30 (T1) and 38 (T2) years after the Yom Kippur War. As expected, wives of ex-POWs endorsed higher PTSS compared to wives of controls. Wives of ex-POWs with PTSD endorsed higher PTSS and higher attachment avoidance compared to wives of ex-POWs without PTSD and controls. There were significant associations between PTSS and attachment insecurities. Contrary to the hypothesis, the relationship between PTSS and attachment insecurities among wives of ex-POWs was unidirectional, with attachment anxiety at T1 predicting PTSS at T2, and not vice versa. Results indicate that attachment anxiety might act as a risk factor for secondary traumatic reactions.

Research paper thumbnail of PTSD, resilience and posttraumatic growth among ex-prisoners of war and combat veterans

The Israel journal of psychiatry and related sciences, 2013

Past studies have shown that adversity may yield various salutogenic outcomes. two constructs tha... more Past studies have shown that adversity may yield various salutogenic outcomes. two constructs that have been at the center of this scientific investigation are resilience and posttraumatic growth (PTG). the present study aims to clarify the relations between posttraumatic stress symptoms, resilience and PTG among israeli war veterans. the sample includes former prisoners of war (ex-POWs) (n=103) and comparable veterans (n=106) of the 1973 Yom Kippur War. the veterans were assessed twice: 18 and 30 years after the war with self-report questionnaires. resilience, defined as the absence of posttraumatic symptoms, and PTG are negatively correlated. resilient ex- POWs and veterans reported the lowest levels of PTG when compared to participants diagnosed with clinical and sub-clinical posttraumatic stress disorder (PtSd). Furthermore, PTG dimensions were found to be the most differentiating factor between study groups, followed by war exposure measures and clinical reports of depression a...

Research paper thumbnail of Elaboration on posttraumatic stress disorder diagnostic criteria: a factor analytic study of PTSD exposure to war or terror

The Israel journal of psychiatry and related sciences, 2013

In societies facing prolonged exposure to war and terror, empirical research provides mixed suppo... more In societies facing prolonged exposure to war and terror, empirical research provides mixed support for the posttraumatic stress disorder (PTSD) symptom clusters groupings identified by the Diagnostic and Statistical Manual (DSM-IV-TR) as re-experiencing the event, avoidance and emotional numbing, and hyperarousal. This study examines the validity of the PTSD symptom clusters in elements of Israeli society exposed to man-made trauma. Survivors (N=2,198) of seven different war and terror-related traumas were assessed using a DSM-IV-TR based PTSD inventory. Four confirmatory factor analytic models were compared. The most acceptable model was a correlated model consisting of four factors of re-experiencing, avoidance, emotional numbing, and hyperarousal. DSM-IV-TR avoidance empirically split into active avoidance and emotional numbing. These results corroborate knowledge and suggest that in Israel, where stressors are ongoing, the PTSD symptom clusters may be reformulated in DSM-5 to c...

Research paper thumbnail of Posttraumatic growth and posttraumatic distress: A longitudinal study

This longitudinal study examined the course and bidirectional relation between posttraumatic dist... more This longitudinal study examined the course and bidirectional relation between posttraumatic distress and posttraumatic growth (PTG). A sample of Israeli ex-prisoners of war and matched controls were followed over 17 years. Participants' posttraumatic stress disorder (PTSD), depression, and anxiety symptoms were measured at three time-points. PTG was assessed twice. Applying an autoregressive cross-lagged modeling strategy, initial PTSD predicted subsequent PTG above and beyond PTG stability, but not vice versa. Cross-lagged relations of PTG to depression and anxiety were not significant. Moreover, analysis of PTG trajectory revealed that individuals with PTSD reported higher PTG levels across times than those without PTSD. Thus, growth is facilitated and maintained by endorsement rather than absence of PTSD. The findings are discussed in the context of the illusionary versus adaptive notion of PTG.