Narrative Coherence and the Trauma Experience: An Exploratory Mixed-Method Analysis
Freer, Benjamin D., Whitt-Woosley, Adrienne, Sprang, Ginny, Violence and Victims
The current study examines trauma narratives from 28 survivors of interpersonal violence. A mixed-method approach assessed coherence and explored narrative characteristics among differentially exposed groups. The quantitative analysis revealed: (1) exposure to repetitive interpersonal violence was described with greater perception of severity and emotional tone than single interpersonal violence episodes, and (2) exposure to interpersonal violence in childhood was described with greater emotional tone than exposure to interpersonal violence in adulthood. The qualitative analysis revealed: (1) traumatic events were connected to proceeding adverse experiences, (2) attempted avoidance of memories of the violence, (3) an altered view of the self, and (4) lacked recognition that the violence was abnormal. The study supports the "dose-response relationship" of trauma exposure, and the life-altering, transformative nature of trauma exposure.
Keywords: interpersonal violence; trauma narrative; post-traumatic stress; chronicity; time of first trauma
Research on traumatic stress and the impact of trauma exposure on individual wellbeing has focused primarily on quantitative examinations and diagnostic profiles. Some of this empirical work has focused on epidemiological surveys of rates of posttraumatic stress in populations exposed to different traumatic events (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995; Perrin et al., 2007; Thompson, Gottesman, & Zalewski, 2006) or post-traumatic stress disorder (PTSD) symptoms only. Less attention has been given to sub-threshold reactions or the meaning that individuals attach to their traumatic experiences. Narrative analysis requires a combination of perspectives best achieved through a mixed method investigation.
An estimated 89% of adults have experienced some type of traumatic event (i.e., interpersonal violence, natural disasters, life-threatening accidents, witnessing physical violence) during their lifetime (Breslau, Davis, Andrecki, Federman, & Anthony, 1998). Studies conducted with survivors of childhood abuse have found that early experiences of violent physical and sexual abuse (perpetrated within the family) predicted significant symptoms of posttraumatic stress, depression and dissociation in adulthood (Carlson et al., 2001). Familial violence is associated with a violation of trust that can have a long-term impact on a child's ability to form meaningful relationships as an adult, and can interfere with healthy self-development (Bostock, Plumpton, & Pratt, 2009). Studies conducted with adult survivors of intimate partner violence reveal that 47% reported high levels of posttraumatic stress symptoms. Furthermore, these reactions were positively correlated with multiple experiences of abuse (Vogel & Marshall, 2001).
The psychological impact of interpersonal violence is further understood in terms of a "dose-response relationship," which stipulates that as the intensity or severity of exposure increases, symptom levels or the probability of psychological disorder increase (Norris, 2002). This phenomenon has implications for events of enormous scale and those in which the duration of exposure was especially long or intense for trauma survivors. This also relates to findings that multiple exposures to traumatic events, carry greater risk for psychological distress than exposure to a single episode, acute stressor. This is an especially potent finding when the traumatic event was perpetrated in the context of an interpersonal relationship (as opposed to stranger or acquaintance initiated events; Briere, 2004; Green et al., 2000; Schumm, Briggs-Phillips, & Hobfoll, 2006). This highlights the higher levels of risk of adverse outcomes experienced by individuals with complex or chronic trauma histories. A mixed-method approach that allows for qualitative exploration of this phenomenon may be better suited for a closer examination of individual differences among trauma survivors. …