The Effect of Marital Adjustment on the Association between Police Officers' Traumatic Distress and Trauma Disclosure

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ABSTRACT

This study investigated the influence of relationship adjustment on the association between police distress and police trauma disclosure to partners. One hundred and three Victorian police officers and their intimate partners completed measures assessing trauma exposure, posttraumatic stress disorder (PTSD) symptomatology (PCL), and relationship characteristics (FAM-III-Dyadic Relationships Scale). Partners also completed a 32-item instrument assessing characteristics of disclosure--inhibition, negative, and positive emotional disclosure, as well as causal, and insight disclosure--pertaining to the most upsetting event experienced by their police officer spouse at work. Results indicated that officers were more likely to disclose negative emotions when the level of traumatic stress was elevated, especially if their partners do not solve problems effectively or demonstrate resiliency, but nevertheless exhibit consistency, predictability and flexibility. In addition, officers were more likely to withhold information when their traumatic stress was pronounced, particularly they shared concordant values and norms with their partner. These findings reflect the complexity of traumatic stress, relationship functioning and disclosure and the heterogeneity of interactions between these phenomena. Future research warranted to clarify these associations.

People speak to others about their emotional reactions to upsetting experiences, and this behaviour increases concomitantly with the degree of disruptiveness of the event (Luminet, Bouts, Delie, Manstead, & Rim e, 2000; Rim e, Philippot, Boca, & Mesquita, 1992), except when shame and guilt are involved (Finkenauer & Rime, 1998). Over the past two decades a considerable body of research has demonstrated a range of positive physical and psychological health benefits from induced written or verbal disclosure of traumatic experiences (see reviews by Frisina, Borod, & Lepore, 2004; Smyth, 1998) for healthy individuals (Pennebaker, Kiecolt-Glaser, & Glaser, 1988; Petrie, Booth, Pennebaker, Davison, & Thomas, 1995), patients with chronic illnesses (Petrie, Fontanilla, Thomas, Booth, & Pennebaker, 2004; Smyth, Stone, Hurewitz, & Kaell, 1999), as well as marginalized individuals (de Vicente, Munoz, Perez-Santos, & Santos-Olmo, 2004; Richards, Beal, Seagal, & Pennebaker, 2000).

Certain characteristics of disclosure have been observed as relevant to positive outcomes. Emotional expression is necessary, but insufficient, for health benefits. Furthermore, use of cognitive words, indicative of reflection and insight, and enabling a coherent restructuring of the traumatic memories have been associated with greater health benefits (Pennebaker & Beall, 1986; Pennebaker & Francis, 1996). Several theories have been proposed to explain the health benefits of the expressive writing paradigm: inhibition-confrontation (Pennebaker, 1989), cognitive adaptation (Park & Blumberg, 2002; Smyth, True, & Souto, 2001), and exposure/ emotional processing (Sloan & Marx, 2004). Yet, none of these accounts has convincingly explained its utility in all circumstances, possibly because the technique operates on multiple levels: cognitive, emotional, social, and biological (Pennebaker, 2004).

For example, although recent findings by Sloan, Marx, and Epstein (2005) support the exposure/emotional processing model, which posits that repeated exposure to traumatic memories--through disclosure--induces high emotional arousal that gradually habituates over subsequent sessions, the authors acknowledge that other mechanisms--such as cognitive restructuring--may operate simultaneously. However, testing more than one mechanism simultaneously is problematic, because the various manipulations might interact with one another and complicate interpretations.

Fewer studies have examined naturalistic disclosure, and the findings have been equivocal. For example, for one group of peacekeepers surveyed post-deployment, trauma disclosure alleviated posttraumatic stress disorder (PTSD) symptoms (Bolton, Glenn, Orsillo, Roemer, & Litz, 2003). Conversely, the degree to which another group of military personnel had talked to friends, significant others, and co-workers was not linked to reduced PTSD but was associated with lower levels of depression and other psychiatric symptoms (Ursano, Fullerton, Vance, & Wang, 2000). Reactions to disclosure can influence outcomes. In some instances, negative social reactions to the disclosures related to more pronounced PTSD symptoms (Ullman & Filipas, 2001).

Although more disturbing events augment the likelihood of emotional disclosure, willingness to disclose and the ability to experience and express a range of emotions both diminish in individuals who experience PTSD (Carroll, Rueger, Foy, & Donahoe, 1985; McFarlane & Bookless, 2001). Moreover, these affective difficulties may present as increased anger and violence (Byrne & Riggs, 1996), intimacy deficits, as well as interpersonal problems (Biddle, Elliott, Creamer, Forbes, & Devilly, 2002; MacDonald, Chamberlain, Long, & Flett, 1999; McFarlane & Bookless, 2001). Greater PTSD symptomatology has been linked with self-reported relationship dysfunction in groups of veterans and their partners (Dekel, Solomon, & Bleich, 2005; MacDonald et al., 1999). Clinicians and researchers have repeatedly identified the emotional numbing component of PTSD as a major, often primary, factor interfering with quality relationship functioning after combat trauma (Cook, Riggs, Thompson, Coyne, & Sheikh, 2004; MacDonald et al., 1999; Matsakis, 1996; Riggs, Byrne, Weathers, & Litz, 1998; Wilson & Kurtz, 1997). Alternatively, the symptoms and associated behaviors of PTSD may alter the family environment, which in turn may contribute to the maintenance of the husband's disorder (Waysman, Mikulincer, Solomon, & Weisenberg, 1993).

There is strong evidence for the importance of social, particularly emotional, support in trauma recovery. Indeed, inadequate social support predicts both the development and chronicity of PTSD (Brewin, Andrews, & Valentine, 2000; Ozer, Best, Lipsey, & Weiss, 2003). This relationship is complex, with the effect of social support apparently increasing over time since trauma exposure (Ozer et al., 2003). Clinical research with veterans has suggested that partners, as primary support providers, must understand both the experiences and symptomatology of the PTSD-diagnosed veterans to provide adequate assistance (Biddle et al., 2002).

However, in addition to experiencing relationship distress, partners may also suffer psychological distress from the effects of living with PTSD. Psychological symptoms reported by partners of trauma survivors, particularly veterans, include anxiety, irritability, impaired self-esteem, somatization, depression, anger, sleep difficulties, and emotional withdrawal (Matsakis, 1996; Westerink & Giarratano, 1999). For some partners, perceived caregiver burden related more to their distress than did the level of the veterans' impairment (Dekel et al., 2005). Hence, the effectiveness of partners' social support may be compromised; or partners may become unwilling to provide support. An unsupportive relationship can impede the success of PTSD treatment (Tarrier, Sommerfield, & Pilgrim, 1999).

Evidence indicates that partners are able to identify a considerable degree of trauma survivors' PTSD symptoms. Moderate concordance between self-reports of PTSD-diagnosed veterans and their …