Introduction
The phenomenon of PTSD is not as uncommon in military families as one might have believed it to be. Due to the precious exposure to multiple traumatic occurrences, military veterans receive powerful trauma that defines their interactions with their family members to a significant extent (Solomon et al., 1992). As a result, the probability of the specified health issue to become an intergenerational trauma, causing children of veterans to experience PTSD as well, becomes dangerously high (Hardaway, 2004). Moreover, the wives of former military with PTSD symptoms are also highly prone to experiencing family violence and aggression at the hands of their traumatized husbands. As a result, the emergence of secondary traumatization and the related health complications emerges. By introducing the therapies aimed at restoring the relationships in the instances when the threat of aggression is preventable, and isolating veterans’ families form the former in the scenarios that involve the presence of family violence, one will be able to ensure greater safety of the victims that can be reinforced with the introduction of community support.
PTSD and Secondary PTSD Definition
Before proceeding with the analysis, one might want to define the concepts of PTSD and secondary PTSD as the main health concerns to be considered in this paper. According to the existing definition provided in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013), one will be able to locate the problem at its conception and remove it accordingly. According to the DSM-5 definition, PTSD serves as the umbrella term for “Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others” (American Psychiatric Association, 2013). The specified disruptive patterns are likely to affect the families of veterans significantly. In turn, the phenomenon of secondary PTSD can be described as the mental health concern caused by indirect exposure to the possible source of trauma. The described issue may occur as a result of being exposed to the environment that can be characterized as excessively aggressive and hostile. In military families, veterans are the primary audience affected by PTSD and the related mental health issues as a result of their traumatic military experiences. Therefore, catering to the needs of the specified population sin order to prevent the instances of family violence is vital.
PTSD in Military Families: Effects on Family Members
Apart from having a deleterious effect on the well-being of veterans themselves, their PTSD caused by the stressful and traumatic environment in which they have to work also affects their families to a severe extent. Studies show that veteran PTSD leads to unhealthy family relationships that, in turn, create a traumatic environment for children and other family members (Monson et al., 2009). For example, the research by Herzog et al. (2011), which researches the effects of traumatic exposure of troops in the Midwestern Army National Guard unit, specifies that the presence of deep-seated trauma in soldiers affects their families extensively. Namely, due to the presence of traumatic experiences that have not been addressed or treated properly, a large number if the troops that have experienced trauma of fighting in the described environment have been proven to subject their families to domestic abuse in a number of cases (McFarlane, 2009). As a result, children and wives of veterans with PTSD are prone to developing a severe psychological trauma as well.
Similar results are observed in another study, which focuses on children of veterans, who have undergone substantial stress and have developed a trauma over the years of serving in the Army. Cook et al. (2012) defines the observed phenomenon as secondary PTSD, implying that veterans tend to take their frustration, anger, and other negative emotions caused by deep-seated PTSD on their family members, primarily, their children. Emphasizing that the described type of PTSD develops only in the post-deployment stage, Cook et al. (2012) conclude that the development cycle of secondary PTSD is especially difficult to notice since the veterans who have acquired PTSD while serving in the military are typically prone to avoid acknowledging the presence of a health issue. The observed trend can be explained by the stigma that surrounds PTSD. According to Cook et al. (2012, p. 3), “Ironically, those who are most symptomatic are most sensitive to such stigma and, consequently, least likely to seek mental health treatment.” Therefore, the absence of decent and effective support is among the main issues that contribute to the spreading of PTSD effects among veterans, as well as the increase in risks of family members being affected by it.
Since the area in question is rather understudied, the process of developing trauma must be examined closer so that the key factors could be isolated and appropriate strategies could be suggested to alleviate the suffering of victims. Dekel and Goldblatt (2008) mention the mechanism of direct traumatization in their study, explaining that the problems containing emotions, which veteran parents with PTSD often have as a result of their mental health issues, leads to outbursts that, in turn, create traumatizing experiences for their children and other family members, especially their wives. However, the mechanisms of indirect transmission of trauma have just as harmful an effect, causing family members of veterans with PTSD to develop an array of mental health problems (Hardaway, 2004). Moreover, in case indirect transition mechanisms are deployed in the relationships between veterans and their family members, tracking down the changes and the impact that veterans’ behaviors and attitudes produce becomes all the more difficult due to the covert nature of the indirect mechanism (Dekel & Goldblatt, 2008). Therefore, issues such as the structure of a family and the dynamics of relationships within it, affects children of veterans even if there is no direct and explicit aggression observed.
While children are the most vulnerable group in the outlined problem, the wives of the former military are also highly prone to developing secondary PTSD due to the strain in family relationships and the increase in verbal and physical aggression from their husbands. According to the existing evidence on the subject matter provided by the wives of former soldiers with PTSD, the described issue affects women’s mental health severely (Vetwives living with PTSD, 2020). Despite the introduction of therapeutic opportunities for the specified population, wives of soldiers with PTSD still struggle with mental health issues as a response to the increased levels of aggression from their husbands. Therefore, PTSD in former troops leads to similar mental health issues ranging from anxiety to stress to PTSD in their family members, especially wives and children, due to the high rates of exposure to violence and angry outbursts.
Examining some of the less drastic effects of PTSD in veterans on their family members, one should address gradual deterioration of family relationships and the resulting development of mental health concerns. The alienation that children and wives of soldiers with PTSD are likely to experience after being subjected to the outbursts of anger leads to gradual alienation and the development of resentment toward the said family member (Ray & Vanstone, 2009). Therefore, as the study by Ray and Vanstone (2009) concludes, the development of emotional numbing should be seen as the direct impact of PTSD in soldiers on their family members.
Overall, among the main effects that PTSD in veterans has on their family members, one should address the increasing threat of violence and aggression toward children and wives of the former military. Therefore, introducing interventions that could potentially reduce the harm inflicted upon family members by veterans who themselves suffer from the effects of PTSD is critical. Currently, a homogenous approach toward addressing the problem of effects of PTSD in veterans on their relationships with family members is promoted in the nursing setting, which represents a departure from the framework that has been quite common recently.
Strategies for Reducing PTSD in Veterans and Its Effects on Family Members
Children
When managing the issues that families with veterans affected by PTSD are suffering, the needs of children as the most vulnerable group must be prioritized. However, to achieve the goal of creating a safe environment for children of military veterans with PTSD, one has to consider addressing the attitudes of the said veterans as the core factor that the target group cannot escape. Specifically, parent training has recently been suggested as one of the tools for curbing the negative effects of PTSD in veterans on their children. In their study, Piehler et al. (2016) insist that parent training allows educating parents about the effects of their behavior, thus reducing the negative effects that children may suffer. The described framework based on the principal idea of the Cognitive Behavior Therapy (CBT) has the advantage of tackling the problem in a very uninhibited and open manner. As a result, it can potentially remove the core of what induces further development of PTSD and other mental health issues in children of veterans with PTSD.
However, the approach that Phieler et al. (2016) promote has an obvious problem, which is the absence of an impetus for soldiers with PTSD to address healthcare services and develop the behaviors that would assist them in changing their patterns of interactions in the family context. Indeed, persuading an adult individual, who also display clear tendencies toward being overly violent and aggressive, to seek psychological support and healthcare assistance is fraught with multiple negative consequences.
In turn, the paper by Dinshtein et al. (2011) insists that the healing process should start with diagnosing PTSD in children. Afterward, an intervention based on the increased involvement of children into the process of interacting with others should begin (Guzman, 2014). According to the details of the research, the introduction of the measures aimed at secondary prevention of PTSD by means of observing children’s interactions and defining emerging problems will allow addressing the instances when the lack of coping skills in veterans with PTSD makes the management of children’s health needs and the creation of a healthy environment particularly difficult.
The proposed framework recommends that the communication between affected children and healthcare experts should remain consistent (Creech & Misca, 2017). Moreover, the authors also mention the huge value of maintaining the bond between children experiencing the threat of developing PTSD and their caregivers, namely, their parents (Lester et al., 2013). At first glance, the proposed line of actions might seem as unreasonable given the fact that the continuous influence of the said caregivers with PTSD has been the reason for children to develop mental health issues to begin with. However, on further consideration, the specified guideline appears to have quite a lot of weight.
First and most obvious, caregivers, namely, parents, serve as the source of an exceptionally powerful emotional bond for children. In turn, the specified emotional connection is critical when addressing mental health concerns such as PTSD (U.S. Department of Veteran Affairs, 2008). Therefore, reconstructing the specified relationships while ensuring that parents do not harm their children unintentionally is vital to the successful recovery (Berkowitz et al., 2011). Moreover, the role of the parent that has not been subjected to the effects of PTSD in the military, typically, the mother, must be included into the therapy sessions. When offered under the guidance of a mental health expert, parental support provides the platform for developing resilience and managing stress (Lester et al., 2010). Therefore, the integration of parents into the interventions aimed at reducing the extent and severity of PTSD and other mental health issues in children of the specified demographic is vital for the eventual recovery.
Remarkably, the significance of education as the main tool in building an intervention for managing the needs of PTSD veterans’ children has been emphasized profusely in several studies. For example, the research by Berkowitz et al. (2011) mentioned above promotes the application of the psychoeducational approach, which will ostensibly allow veterans with PTSD to acknowledge the presence of a problem in the interaction patterns that they have been displaying and, thus, switch toward healthier methods of communicating with their children. However, the specified change is fraught with numerous complications and obstacles, mostly due to the underresearched nature of PTSD in veterans and the methods of counteracting the negative effects that the specified health concern has on their families. According to Cozza et al. (2014), the present amount of knowledge on the subject matter is far too scarce to build a program for increasing the resilience of children.
Notably, the source of emotional distress and mental health deterioration in children of military servants may does not necessarily have to be connected to family violence, although the latter remains a prevalent factor. Apart form the described issue, the factor such as deployment also produces a plethora of negative effects on children of veterans with PTSD, as a recent study shows (Cozza et al., 2014). Namely, the authors conclude that deployment creates a very unhealthy setting in which children have very few opportunities of developing the required skills and attitudes:
Not only does deployment separate young children from one of the central figures in their lives, but it can also take a psychological toll on at-home parents, adding to their own distress and potentially compromising their parenting. (Cozza et al., 2014, p. 5)
Therefore, as a factor in increasing the propensity toward mental health issues in children, deployment of their parents leads to drastic outcomes. Dekel and Goldblatt (2008) argue that the process of transmitting trauma from parents to children occurs as an intergenerational process and, therefore, is practically unavoidable. Specifically, the authors conclude that the transfer of trauma from veteran fathers to their children occurs as a form of intergenerational trauma, and it is likely to be passed from children to grandchildren as the former become adults. Dekel and Goldblatt (2008) emphasize that the observed tendency is especially prominent in father-son relationship dynamics. Moreover, there are reasons to suggest that the process of intergenerational traumatization occurs even in the extrafamilial system environment, specifically, in the relationships where the bond between participants is excessively strong (Dekel & Goldblatt, 2008). The authors also mention the impaired self-esteem, which spawns multiple issues in children of violent veteran parents. Thus, changes in the relationship paradigm between a child and his or her parent who serves in the military are vital for the prevention and proper management of health concerns that children may experience.
In addition, Cozza et al. (2014) addresses the fact that the subject matter remains highly underresearched and explains that further observations and case studies are needed to examine the children that manage to build resilience in military families. According to the authors, a better understanding of the circumstances in which children of veterans become capable of creating coping mechanisms that allow them retain their mental health will provide the basis for the interventions for assisting those that cannot. For this reason, the introduction of evidence-based practice (EBP) into the target context and observations that will provide crucial data about the behaviors of children of the described demographic will offer vital information for future improvements in healthcare quality.
Remarkably, several assumptions concerning the skills that children need in order to retain their mental health and the ability to cope with stress in the context of families with veteran PTSD parents have already been made. In 2008, a study by Palmer suggested that a theory of risk should be incorporated into the analysis of resilience factors contributing to the management of stress in families with PTSD veteran parents. According to Palmer (2008), the presence of parental stress and psychopathology is the main contributor to the creation of an unhealthy environment for a child and the resulting failure of the parents to create a safe setting for the child’s development. The study also warns about the possibility of perceiving veteran parents as war stereotypes, which would imply denying them their humanity and failing to acknowledge their individual needs. (Palmer, 2008). Therefore, when designing an intervention for children of veterans with PTSD, one should ensure that the specifics of relationships within the target family are identified and that the challenges that veteran parents are undergoing are well understood and taken into account while shaping the intervention model.
Partners
While children are typically viewed as the primary victims of aggression shown by parents with PTSD, their partners are also in a highly vulnerable position. Women in heterosexual relationships are affected particularly strongly by violence and aggression due to the biological differences and the physical advantage that male partners have over female ones (Waysman, 1993). As a result, the problem of PTSD in military families becomes especially poignant and urgent. However, even in the scenarios that do not involve physical violence, the presence of emotional aggression and verbal abuse is likely to have a massive toll on wives of veterans with PTSD. Indeed, research shows that the wives of PTSD military veterans are exposed to an excruciating amount of threat: “Wives from conflict-oriented families consistently reported the highest level of symptomatology” (Waysman et al., 1993, p. 111). Even in the scenarios that do not involve direct physical abuse, the presence of imminent danger affects women’s well-being drastically, causing them to acquire a range of mental health issues ranging from stress to PTSD to depression and, in the worst-case scenarios, suicidal ideation (Monson et al., 2009). Therefore, interventions aimed at reducing the extent of threat and providing the wives of military veterans with enough support and resources is critical.
Understandably, there are nuances to the specified observations since the homogeneity in behaviors across the specified types of families is rather superficial, whereas the presence of unique factors driving the relationships within the specified settings is quite ample. In the same study, Waysman et al. (1993) report that the extent of mental health mismanagement deviates significantly depending on the standards of interaction and the rigidity of the hierarchy within the target household, including conflict-oriented, rigid-moral, and midrange family types.
While physical and emotional abuse that the partners of veterans with PTSD may experience are admittedly the most deplorable and tragic outcomes of the discussed phenomenon, other negative outcomes also deserve to be mentioned. For instance, the divorce rate are typically much higher in the families pf veterans with PTSD, as the study by Monson et al. (2009) clarifies. Moreover, apart from increased divorce rates, the overall deterioration of relationships and the loss of its essential components such as trust and respect leads to the partners experiencing major relationship problems. The specified issues may range from intimate issues to the inability of understanding each other in a broader sense and losing the link that used to serve as the bond between the couple in their marriage (De Pedro et al., 2011). The authors warn that the described outcomes may lead to a painful divorce or deeply unsatisfying family life that will make all of its members, including not only the husband and the wife but also their children, extraordinarily miserable (Monson et al., 2009). In turn, the perpetual state of misery and discontent serves as the breeding ground for multiple mental health issues. Therefore, an intervention based on acknowledging the presence of a PTSD and unhealthy coping mechanisms that veterans have developed over time must be provided to address the needs of all those involved. Although family members, namely, children and wives, must be seen as the primary victims in the described scenario, veterans also need to be examined as people with PTSD and the related mental health concerns that must be addressed to increase the quality of veterans’ lives and give them an opportunity to create healthier relationships with their loved ones.
Assessment
Notably, the task of identifying the presence of negative effects of parenting choices made by veterans with PTSD has become excessively difficult due to the lack of information that child support services may retrieve and that is needed for a corresponding therapeutic action. Therefore, the existing tools for locating the problem of negative influence exerted by veterans with PTSD on their children, spouses, and other family members is needed.
Moreover, as emphasized above, in the cases that involve a strong emotional bond between a parent and a child, particularly, where a veteran father is capable of change and the relationships between a parent and a child can be amended, the introduction of parent training is recommended. Specifically, Piehler et al. (2018) advise parental training as the solution to the dilemma between relocating a child to a foster family, thus severing his or her bond with the family. Since the option that involves a divorce may also be unavailable for multiple reasons, the introduction of therapy as an option is central to the management of the described issue.
In addition, it is worth noting that veterans with PTSD may also be highly inclined toward restoring trust-based, positive relationships with their family members. However, due to the need to involve an expert in the process of therapy, as well as the failure to recognize a problem to begin with, veterans with PTSD are in need for the support of a competent expert to disentangle the problem at hand and introduce a tool for managing relationships in a peaceful, non-threatening, and nonviolent way. For this reason, the introduction of a family-centered prevention intervention aimed at reducing the threat of negative effects that veterans with PTSD may exert on their family members, especially children, is vital. Lester et al. (2012) specify the need to incorporate the framework that allows for an open dialogue between veterans and their families, thus creating the basis for cooperation and mutual support. The authors suggest the Families OverComing Under Stress program or a similar tool for evaluating the extent of distress under which family members currently are, as well as determining possible solutions that would allow managing the needs of all parties involved. In addition, the solution involving a family-based intervention has proven to be an adequate response to the scenario in which the threat of PTSD development in children of veterans is only starting to emerge (Lester et al., 2012). The provided commentary suggests the promotion of family-based learning and the development of resilience:
The model provides individual and family level training in resiliency skills and builds on existing family strengths and increases family cohesion, communication, and support and the maintenance of consistent care routines in the home – all core characteristics of resilient families. (Lester et al., 2012, p. 53)
Therefore, there are options for addressing the dissipating family relationships in the context that suggests high levels of distress and the threat of violence. Remarkably, the proposed strategy allows recognizing the fact that veterans with PTSD, in turn, need healthcare support as the emans of managing their emotions and establishing better and healthier relationships with their families. Thus, the humanity of veterans as patients who need assistance and who can be rehabilitated is recognized.
At the same time, bearing in mind that the needs of children and wives of veterans as two most vulnerable groups must be prioritized in the specified situation. Therefore, the introduction of an intervention can only be seen as sensible in the environment that suggests opportunities for improving relationships between parents and children.. In other scenarios, strategies for addressing mental health issues in children that have been affected by aggression from their veteran fathers must be administered in the setting devoid of any stress factors.
In turn, in the scenarios that show the presence of hope for improvement, the introduction of a parental locus of control is currently utilized as one of the solutions to the described conflict. Namely, the study by Lester et al. (2013) develops the idea of the locus of control by suggesting the methods associated with the personal management of the PTSD issue in veterans. The identified approach based on increasing people’s agency and providing them with multiple opportunities for taking more active participation in their own recovery can be considered a more recent development in the therapeutic community. While the described approach toward handling the needs of people with PTSD, particularly, veterans, proves itself as very effective, it suggests that the patient is fully aware of his or her condition and can make decisions that will be informed and geared toward faster recovery.
However, the existing studies show, the specified outcome is not always the case since a wide range of people tend to have quite a different reaction to the observed situation. The lack of focus on the opportunities for addressing not only the needs of children but also the concerns voiced by their parents shows that the process of transforming people has also been quite prominent (Monson et al., 2009). Thus, a cohesive framework for managing the need of children of veterans with PTSD, who have developed mental health concerns as well due to the ongoing abuse. The paper by Lester and Bursch (2011) allows considering the specified threat by creating premises under which the development of risks is minimized. Namely, the research indicates that the incorporation of strategies for building resilience in families with veterans diagnosed with PTSD have much greater rates of successfully addressing the problem of aggression among veterans. The specified outcome, while being unique, implies that the creation of a homogenous strategy for addressing the needs of veterans with PTSD can be created.
The reconsideration of the role that each of the parties involved plays in the described change is what makes the proposed solution especially valuable as a treatment tool. Apart from assisting the children and wives that have suffered at the hands of a veteran who has problems controlling his or her emotions, the described scenario also involves rather accurate portrayal of the issues within a family that struggles with mental health concerns. Namely, imposing the emotional labor of reconciling with the husband, who has shown abusive tendencies, could be seen as ethically questionable on part of the therapist. Nonetheless, the proposed solution allows meeting the needs of children whose lives have been affected by living with a parent showing violent tendencies due to the presence of an untreated PTSD.
When considering the issues that affect the target demographic to the greatest extent, one must mention the fact that there is a consistent lack of support for women and children that have been affected by husbands’ violent outbursts caused by PTSD inflicted upon them by their military past. Therefore, creating the communities that would allow women and children living in the described conditions to develop resilience and manage their situation with the maximum utility by considering the opportunities for therapy and the support of healthcare providers is central (Kudler & Porter, 2013). Overall, the idea of supporting the victims of family violence caused by the presence of PTSD in one of the parents, who has a record of military service, must be one of the key priorities for healthcare experts and, particularly, the healthcare providers who seek to address the levels of PTSD and mental health issues within the community. With the integration of techniques that will help to create a system of support for the victims of veterans’ family violence caused by PTSD, the chance at reducing the effects of veterans’ PTSD on the development of mental health problems in children and wives will be minimized.
Conclusion and Recommendations
Due to the unwillingness to recognize a problem or the lack of understanding of the subject matter to acknowledge it, veterans with PTSD fail to address their mental health concerns, instead, transferring their trauma to their children, wives, and other family members and creating an intergenerational trauma. Therefore, interventions aimed at allowing veterans to explore and address their trauma, as well as support systems for their children and wives, who suffer from outbursts of violence, must be created. The latter issue takes the priority due to the detrimental effects that domestic violence caused and reinforced by PTSD in veterans has on children and wives. Specifically, it is crucial to detect the issue of violence in families with PTSD veterans, introducing timely support before vulnerable family members are affected. After the preventive measures are taken, opportunities for assisting venetians in exploring and managing their trauma, with the following option of restoring the emotional connection with their family members, must be created in the contemporary healthcare settings.
It is highly recommended to focus on preventing the instances of family violence caused by veterans with PTSD by building awareness and introducing support systems for the specified population. The proposed change will allow veterans suffering from PTSD to heal and experience change that will condition them to become more responsive to the needs of their family members and more functioning as a part of a family unit.
Moreover, extensive therapy is suggested as the mechanism for assisting the victims of domestic violence and abuse, primarily, children and wives of veterans with PTSD. Given the fact that the specified vulnerable groups are also predisposed to the development of mental health issues due to the exposure to violent outbursts from PTSD veterans, it is crucial for their wives, children, and other family members to receive support. Furthermore, in the worst-case scenario, protection for the threat of abuse that they have been experiencing at the hands of the veteran who has been affected severely by PTSD is indispensable. According to Lincoln et al. (2008), the described situation of parental violence and abuse is particularly aggravating if there is the history of mental health issues. Therefore, it is essential to pay particularly strong attention to the situations that may involve family violence in the families of veterans with PTSD, who have children with mental health issues or related health concerns. The resulting change in the well-being of children, veterans’ wives, and the rest of family members subjected to the threat of secondary PTSD development is expected to be spectacular.
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