Secondary Post-Traumatic Stress Disorder
Secondary post-traumatic stress disorder (SPTSD) is a psychological disorder experienced by individuals who interact with or are close to victims of post-traumatic stress disorder (PTSD). The main difference between SPTSD and PTSD is that PTSD affects persons who directly experience traumatic events such as abuse, violence, or war, whereas SPTSD influences family members and caregivers of PTSD patients. In this regard, the point of distinction between the two is the mechanism of exposure to trauma; PTSD is caused by direct contact, whereas SPTSD occurs through indirect experience.
The phenomenon of PTSD is quite hard to define since it manifests itself in a variety of ways in patients. The most comprehensive definition of secondary post-traumatic stress disorder was offered by Ogbeide et al. (2020), who defined it as a “debilitating condition that impacts anywhere from 2 to 39% of primary care patients” (p. 1). It is not surprising that psychologists were taking interest in SPTSD in the nineties; it was the aftermath of the Gulf War and the point at which psychologists were coming to terms with the full extent of the trauma suffered by Vietnam veterans. The existence of SPTSD became apparent as caregivers of returning servicemen started to suffer the psychological and emotional problems associated with exposure to violence. Researchers have established the reality of SPTSD by noting that the condition is typically experienced by the family members and caregivers of veterans who had suffered first-hand traumatic experiences in war (Brown et al., 2016). This recognition emphasizes the growing awareness in the field of psychology not only of the reality of secondary post-traumatic stress disorder but also of its seriousness.
The study of SPTSD has historically focused on the experiences of individuals with close contact with war veterans. According to Brown et al. (2016), the common contention in the existing literature on the subject is that primary PTSD is the direct consequence of prolonged exposure to threats, such as violence, during combat. The author adds that it is estimated that as many as two to three times more deployed servicemen and veterans suffer from the symptoms of primary PTSD than the civilian population. Researchers also estimate that approximately 11 to 20% of the servicemen deployed to Iraq and Afghanistan, 15% of the Vietnam War combatants, and 12% of those who served in the Gulf War, were diagnosed with PTSD (Ogbeide et al., 2020). This data provides the basis for explaining the prevalence of secondary PTSD among family members and caregivers of military men returning from war.
The general explanation based on self-reported interviews is that family members and caregivers start to experience the same emotional trauma suffered by patients or loved ones who had been to war (Brown et al., 2016). Psychologists have also distinguished between secondary PTSD and a related notion referred to as “compassion fatigue,” this concept applies to caregivers, such as social workers and clinicians, who are in a helping position to provide support for victims of post-traumatic stress disorder but also result in suffering trauma themselves (Brown et al., 2016). It is therefore different from secondary PTSD, which typically applies to family members of victims of primary PTSD.
The study of the occurrence of secondary PTSD in a given population is sometimes hampered by the similarity of the negative symptoms of both primary PTSD and secondary PTSD. For instance, researchers have established that both cases present with symptoms like distressing emotions, functional impairment, and intrusive images (Brown et al., 2016). One problem that the authors encounter in this regard is determining when PTSD symptoms can solely be attributed to direct and first-hand exposure to traumatic experiences, and when PTSD symptoms may be linked to indirect experiences. The challenge, in this case, is proper diagnosis, whereby PTSD symptoms are attributed to the wrong cause. For example, the source of the health concern might be incorrectly defined as secondary PTSD simply because a close family member is a war veteran with PTSD. On the other hand, it might be that in reality, the person is himself or herself a victim of abuse or violence in the past.
Prevalence of Secondary Post-Traumatic Stress Disorder in Military Families in the United States
Understandably, the United States is the leading country in secondary PTSD cases, owing to its involvement in several conflicts around the world. For example, in the post-World-War-Two era, no other country has been involved in as many wars as the United States. Indeed, a case might be made that beginning with Vietnam, through the Gulf War and the invasion of Iraq, the U.S is always involved in one conflict or another (Brown et al., 2016). These observations are supported by research data explaining why PTSD and, consequently, secondary PTSD are prevalent in the United States.
In recent times, there is a significant drop in the number of newly married couples with children. According to the available data, 43% of the veterans with PTSD and related psychological traumas were married and with children (U.S. Department of Defense, 2019). This translates to approximately 12% to 25% of veterans with families having PTSD and requiring assistance in managing relationships with their families (U.S. Department of Defense, 2019). The U.S. Department of Veteran Affairs (2019) explains that, in addition to the impediments to family relationships that PTSD in veteran parents entails, approximately 80% of soldiers with children return home emotionally and psychologically changed, thus altering the patterns of their relationships with children and other family members forever. Nonetheless, the vast majority of veterans are eager to put any effort into mending their relationships with family members (U.S. Department of Defense, 2019). These figures provide the empirical data that researchers utilize to explain why a large number of secondary PTSD is reported in military families.
The fact that a significant number of American servicemen suffer PTSD as a result of exposure to violence explains why secondary PTSD is observed among their family members and caregivers. Carmassi et al. (2020) found that individuals who had long-term and close relationships with war veterans with PTSD also developed PTSD-like symptoms, which include anxiety, chronic stress, and depression. These findings raise concerns about the reality of intergenerational transmission of the effects of traumatic experiences to spouses and children. For instance, secondary PTSD has been attributed to the impairment of children in terms of their emotional and cognitive development, as well as to marital discord (Brown et al., 2016). These negative outcomes are a result of the inability of soldiers with PTSD to cooperate well with their spouses and children or to become violent towards close family members.
Researchers have tried to explain why victims of war-related PTSD find it difficult to cooperate with close family members, resulting in spouses and children developing secondary PTSD symptoms. Bickel et al. (2020) discovered that victims of primary PTSD experienced symptoms such as detachment from others, emotional numbing, and loss of interest in activities. These symptoms in turn contributed to relationship stress, hindering emotional connection to intimate/caring relationships with one’s spouses and children (Bickel et al., 2020). These findings imply that war-related PTSD affects military families in far-reaching ways, which can potentially lead to family breakups, abuse, and negligence of childcare responsibilities. For instance, studies by Foli et al. (2018) and Paley et al. (2013) found that a parent’s trauma interfered with their parenting capabilities and child-parent relationships. These findings emphasize the importance of considering the family impact of PTSD when providing care to war veterans.
The recurring pattern from the above discussion is that proximity to and close contact with victims of war-related violence is the leading cause of secondary PTSD in military families. It is for this reason that spouses are more likely to suffer secondary PTSD when they associate their symptoms with a veteran’s war-related trauma, rather than personal experiences of direct exposure to violence (Gerlock et al., 2016). In a study that explored the relationship between PTSD and relationship quality in National Guard families, the researchers established a direct correlation between military service and poor family relationships (Bickel et al., 2020). In the study, the researchers surveyed 310 soldiers one month before deployment, and three months after returning from Iraq. The result showed that post-deployment PTSD was attributed to poor relationships with spouses (Bickel et al., 2020). The findings established that secondary PTSD can develop in spouses of active servicemen as a result of relationship dissatisfaction.
Combat-related PTSD has also been linked to higher levels of psychological distress among spouses of active servicemen. Fear et al. (2018) investigated this link in a study consisting of a sample of married war veterans. Results from the self-reports of serving husbands and their civilian wives showed that war-related PTSD led to low levels of marital satisfaction and poor bonding (Fear et al., 2018). In comparison, the researchers found that among military couples who had not been deployed, there were higher levels of marital satisfaction and relationship confidence.
Researchers have attributed the high prevalence of secondary PTSD among spouses of active servicemen to the fact that spouses are the ones who carry the burden of PTSD symptoms. Since spouses are the closest persons to a veteran with PTSD, they are the first to be affected by the veteran’s mental issues. In addition, nurses and other caregivers with a direct relationship with PTSD patients are also at high risk of developing secondary PTSD. The impact on caregivers (compassion fatigue) arises from their attempt to relate and empathize with the patient’s experiences.
Effect of PTSD on Families of Servicemen
A family is regarded as a system in which one family member’s experience affects others. The Figley trauma transmission model stipulates that family members often try to empathize with the suffering of another member (Abolmaali & Gavasaraee, 2015). Consequently, they project the PTSD victim’s suffering to themselves, and as a result develop symptoms similar to those of the PTSD patient. This phenomenon explains the similarity between the symptoms suffered by victims of primary PTSD and those of family members diagnosed with secondary PTSD.
Other studies that have focused on the children of war veterans have also revealed poor child development and academic performance. In one study, Mustillo et al. (2016) examined the effect of a parent’s deployment on the children’s well-being. Using semi-structured interviews involving teachers, the researchers found that the children of deployed parents showed poor academic results and emotional states (Mustillo et al., 2016). These findings were supported by another study by Lester et al. (2017), which investigated the home experiences of children of active service parents. Results from self-reports by the children and their parents showed that children with at least one active-duty parent were more likely to suffer anxiety compared to those with non-serving parents.
To conclude, secondary Post-Traumatic Stress Disorder is a psychological condition observed in the family members and caregivers of victims of primary Post-Traumatic Stress Disorder. Secondary PTSD is distinguished from primary PTSD in terms of the mechanism of exposure to trauma. Whereas victims of primary PTSD are affected by direct exposure to traumatic experiences such as war and violence, secondary PTSD is attributed to indirect exposure. This phenomenon is common among military families, due to the high prevalence of combat-related PSTD in war veterans. In the United States, for example, the country’s frequent involvement in conflicts around the world means that a large number of servicemen are exposed to violence. As a result, PTSD cases tend to be higher in the US, which in turn contributes to the prevalence of secondary PTSD in military families (Brown et al., 2016). The findings from past studies suggest that the family members of combat victims of PTSD, including their caregivers, are at higher risk of developing secondary PTSD-like symptoms. Accordingly, there is a need for support services geared toward helping victims of combat-related PTSD to also include family members and caregivers.
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