Vietnam Combat Veterans with PTSD: Analysis of Marital and Cohabitating Adjustment By EDWARD M. CARROLL, DRUE BARRETT RUEGER, DAVID W. FOY and CLYDE P. DONAHOE, JR. INTRODUCTION The 3rd edition of the DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (DSM-III) includes combat related stress disorder within the diagnostic category of Posttraumatic Stress Disorder (PTSD). Prior studies have focused on (a) delineating the extent and severity of symptomatology and maladjustment among Vietnam veterans...(b) addressing the controversial issue of etiological factors....and (c) identifying reliable methods of assessment. Most of this research illuminates the individual psychological problems of Vietnam veterans, whereas only limited attention has been given to the interpersonal aspects of the disorder. However, there is a good reason for a closer examination of the interpersonal concomitant of PTSD among combat veterans. Wilson found that combat veterans reported more difficulty with intimacy and social conflict than did noncombat Vietnam veterans and non-Vietnam veterans. Penk et. al. found that combat veterans compared to noncombat veterans, reported symptoms consistent with a diagnosis of PTSD, including more difficulties with emotional expressiveness, temper control, trust and marital problems. In a study by Roberts et. al. veterans seeking help for substance abuse and those with symptoms of PTSD were compared to non-PTSD combat veterans and noncombat veterans on measures of social adjustment. Problems with intimacy and sociability were found characteristic of veterans with PTSD. Higher scores on certain scales of the Minnesota Multiphasic Personality Inventory were also associated with the PTSD group. Previous research indicates that PTSD veterans might have difficulty functioning in a dyadic relationship. We chose to investigate a) perceived degree of intimacy in the relationship, b) expressiveness and self-disclosure c) expression of hostility and d) general dyadic adjustment. Previous research in this area has failed to control for pre-military adjustment or to cross validate subject's self-report of premilitary history. We checked these with the report of a close relative, a sibling if at all possible. We checked with brothers and sisters because we felt that they would be more likely to know if the veteran had been having adjustment or substance abuse problems. VALIDITY CHECKS Veterans were required to bring or mail in a copy of their DD214 to the researchers. 80% of the subjects complied. Of the 80%, 100% who had represented themselves as Vietnam veterans were in fact confirmed as Vietnam veterans. 100% were also found to be truthful about areas of overseas service and medals won. The majority of veterans (75% positive PTSD and 89% negative PTSD) were confirmed as combat veterans. In fact, the researchers report that more might have been confirmed as combat veterans but that no information about combat experience appeared on the DD214. This could have been due to not receiving a combat decoration or inadequately recorded information. RESULTS The PTSD positive group was compared with the PTSD negative and minimal combat groups on measures of relationship adjustment using multivariate analysis of variance (MANOVA). In comparing the Positive and Negative groups on the criterion measures, the results were significant at the p < .03 level. When comparing the Positive and Minimal Combat Exposure groups the differences were significant at the level of p < .001. [The first result is usually considered significant by researchers and the second result is usually considered highly significant by researchers.] Comparisons comparing Minimal Combat Exposure vets and the PTSD Negative group were not significant. This was expected. Thus as groups there were significant differences between the Positive and Negative PTSD groups and the Positive and Minimal Combat Exposure group. Veterans with PTSD did NOT report less frequent intimate activity and affectionate behavior with their partners as compared to the PTSD Negative group or the Minimal Combat group. Also, the PTSD Positive group did not need to make itself look better or worse than the other two groups. The PTSD positive group did report significantly less verbal involvement with their mates on both days that were typical and days that were stressful. The PTSD positive group also reported a lower level of general self-disclosure than the other two groups. PTSD positive veterans reported higher levels of general hostility and physical aggression toward their partners than did the PTSD negative veterans. There was no significant difference of the expression of general hostility between PTSD positive veterans and Minimal Combat groups. PTSD veterans also reported significantly higher levels of physical aggression than PTSD Negative veterans , but again there was no difference between the PTSD Positive group and the Minimal Combat group. PTSD Positive veterans reported lower levels of adjustment, consensus and cohesion in a dyadic relationship than did the other two groups. These findings supported the hypothesis that PTSD Positive veterans would evidence greater relationship maladjustment than would other Vietnam Veterans. The results on the Consensus and Cohesion subscales paralleled the findings on the Expression of Hostility and Expressiveness measures, which indicated greater conflict and less partner involvement associated with the relationships of PTSD positive veterans. Furthermore, the authors attempted to test the discriminant function posited by Foy et. al. (1984) A discriminant function is a set of traits or circumstances which are claimed to be able to discriminant or predict differences between the groups under study. Thus if a person knew how an individual stood on an issue or to what degree s/he held a psychological trait the discriminant function would tell you how often you would be correct in predicting his/her membership in particular group. Foy's discriminant function or set of variables are: tension/anxiety disgust alcohol abuse suicidal thoughts hostility marital problems depression irritability On average, one could predict the membership in either the PTSD positive or PTSD negative group with these variables, 75.4% of the time. One could predict membership in the PTSD positive group with these variables 59% of the time and the PTSD negative group 83.7% of the time. The PTSD positive and the PTSD negative groups did NOT differ significantly on the Premilitary Adjustment Index. Even when scores on this index were taken into account in performing statistical operations, no significant difference could be found. DISCUSSION It was found that help seeking Vietnam Veterans with PTSD differ from PTSD negative and minimal combat veterans in being less self-disclosing and expressive to their partners, and in having greater difficulty adjusting to marital and cohabiting relationships. In addition, the results indicate that the combat veterans with PTSD are more expressive of hostility and prone to physical aggression than are the PTSD-negative combat veterans. These difference do not appear to be attributable to premilitary adjustment, demographic variables, socially desirable or undesirable response styles, or to the presence of a dyadic member with psychological problems. Combat selection factors could not account for the differences between PTSD positive and PTSD negative combat veterans. The present findings generally support the DSM-III definition of PTSD as including components of constricted responsiveness and reduced involvement with the external world. Also, the results are in concert with other studies that indicate poor social involvement and interpersonal difficulties among Vietnam combat veterans and survivors of other traumatic experiences such as major floods and tornadoes. However, the present findings show that the presence of PTSD is more strongly associated with problematic social functioning than with combat experience per se. This means that variables associated with social functioning are more strongly, statistically, related to PTSD than is combat experience, per se. When compared to other groups PTSD positive veterans groups have shown a higher incidence of more serious symptomatology and specific types of interpersonal maladjustment. Previous reports that combat veterans have more difficulty than others in expressing positive emotions were NOT supported in this study. Furthermore combat veterans were not found to be less affectionate than noncombat groups. This contradicts the DSM-III. This does not mean that PTSD positive veterans do not have this difficulty. It only means that they are not distinguishable from other clinical groups on this trait. The authors think that the reason affectionate behavioral differences could not be found in this study is because all three groups under study showed a limited range in frequencies of affectionate and intimate behavior. Affectionate and intimate behaviors are characteristically low for these groups. PTSD positive veterans do report and are in fact troubled by higher and more undesirable levels of arousal and depression. This highlights the connection between PTSD and marital difficulties. PTSD positive veterans also expressed more hostility and physical aggression toward partners than did PTSD negative veterans. These results indicate that marital therapy or relationship oriented resources would be of particular help to veterans. It should be also noted that veterans may under utilize or completely reject socially and psychologically helpful resources. It would also be quite helpful in the initial stages of a relationship to assess the degree of combat exposure and PTSD symptomatology especially in relationship to family and relationship situations.