Families in the Shadow of Traumatic Experiences: Negative World Assumptions and Family Relationships.

World assumptions (WAs) are cognitive schemas concerning an individual's views of themselves, the world, and others. Although it is well established that WAs are negatively distorted by trauma exposure and strongly associated with posttraumatic psychopathology, the potential impact of WAs on close interpersonal relationships remains largely uninvestigated. The current study explored the implications of veterans' and their spouses' WAs on their marital and parental relationships. Male Israeli veterans (N = 213) from the 1973 Yom Kippur War and their wives were assessed for WAs, marital adjustment, and positive parenting 35-37 years postwar. Analyses included actor-partner interdependence modeling with mediators (APIMem) and were conducted separately for the three domains of WAs: world benevolence, world meaningfulness, and self-worth. The results indicated that both husbands' and wives' lower scores for all domain-specific WA scales were associated with lower scores on measures of marital adjustment and positive parenting. Lower scores for both spouses on scales measuring world benevolence and self-worth were associated with a spillover from lower marital adjustment to lower positive parenting. Finally, associations between one spouse's lower WA scores and the other spouse's spillover from lower marital adjustment to lower positive parenting (i.e., cross-spillover effects) were identified for wives' world benevolence ratings and husbands' self-worth, ds = 0.14-0.72. These results point to the detrimental ramifications of negative WAs on family relationships and the dynamics between the marital and parental family subsystems.

Impostorism, subjective age, and perceived health among aging veterans.

RATIONALE: Aging veterans often suffer from increased vulnerability, manifested among other things in old subjective age and poor perceived health. Though research has documented the contribution of trauma related variables to these negative appraisals, their associations with impostorism (i.e., the subjective experience that one is less adequate than others perceive) remain unexamined. OBJECTIVE: Filling this gap, this study explored the relations between impostorism and subjective age and perceived health among aging combat veterans. METHOD: The study was conducted among 146 Israeli veterans of the 1973 Yom Kippur War. Participants were assessed for combat exposure, Posttraumatic Stress Disorder (PTSD) symptoms, and health-related behaviors during middle adulthood (1991; T1), and for subjective age, perceived health, impostorism, PTSD symptoms, and depressive symptoms during old age (2018; T2). RESULTS: The veterans' impostorism was associated with relatively old subjective age and poor perceived health, above and beyond the effects of age, health-related behaviors, combat exposure, depressive symptoms, and PTSD symptoms. CONCLUSIONS: The current results suggest that impostorism may contribute to veterans' stress and negatively affect their evaluations regarding age and health.

Psychiatric distress among aging decorated and non-decorated veterans: The role of impostorism and loneliness.

Objectives: The aging process may be affected by negative life events as well as social factors. Though psychological aspects of the aging process in veterans have been the focus of considerable research, decorated veterans have been scarcely investigated in this domain. The current study sought to assess psychiatric distress (PD) levels among aging decorated and non-decorated veterans' (DVs and n-DVs, respectively) and examine its association with the maladaptive perception that others will identify a high-achieving person as an impostor (i.e. impostorism) and perceived social isolation (i.e. loneliness).Methods: Two groups of Israeli veterans of the 1973 Yom Kippur War, DVs (n = 75) and n-DVs (n = 73), were assessed for PD and combat exposure in middle adulthood (1991; T1); in later life (2018; T2) they were assessed for negative life events, impostorism, loneliness and PD.Results: Impostorism, loneliness and PD were all inter-correlated. DVs evinced less PD at T1 and T2 than n-DVs but similar levels of impostorism and loneliness at T2. Nevertheless, negative life events, impostorism and loneliness explained PD at T2, with loneliness being more significant, especially among the n-DVs. Combat exposure did not explain variances in late-life PD.Conclusion: Aging DVs seem to be less vulnerable to late-life PD than n-DVs, and impostorism and loneliness may be important factors in this respect. Being the first study to investigate aging DVs' mental health and impostorism among aging veterans, the findings further underscore the clinical imperative of psychosocial factors in understanding aging veterans' mental health.

Telomere Length and Depression Among Ex-Prisoners of War: The Role of Subjective Age.

OBJECTIVES: Exposure to captivity increases the risk for multiple disturbances that may intensify during old age. In later phases of life, former-prisoners-of-war (ex-POWs) may suffer from depression as well as from accelerated aging, manifested in older subjective age and leukocyte telomere shortening. The current study assesses the link between these varied facets of increased vulnerability during old age and explores (a) the associations between subjective age and telomere length; (b) the mediating role of changes in subjective age over time within the associations between depression and telomere length. METHODS: Eighty-eight ex-POWs were assessed prospectively 30 (T1), 35 (T2), and 45 (T3) years after the 1973 Israeli Yom-Kippur War. Depression was assessed at T1; subjective age was assessed at T2 and T3; and telomere length and control variables were assessed at T3. RESULTS: Older subjective age at T3 was associated with concurrent shorter telomeres, beyond the effect of chronological age. Change in subjective age between T2 and T3 mediated the relations between depression at T1 and shorter telomeres at T3 beyond the effects of control variables. DISCUSSION: Findings suggest that the detrimental ramifications of accelerated subjective age involve premature cellular senesces, and may explain the relation between depression and accelerated aging processes among trauma victims. Hence, clinical interventions may seek to address accelerated subjective age among trauma survivors who suffer from depression.

Loneliness and subjective physical health among war veterans: Long term reciprocal effects.

RATIONALE: Poor subjective physical health and loneliness are among the most detrimental ramifications of trauma. Indeed, substantial research has examined the link between subjective physical health and loneliness, mainly focusing on how loneliness leads to poorer physical health. However, the effects of poor subjective physical health on loneliness, as well as the reciprocal effects of these two factors, have scarcely been examined. Even less is known regarding the course of these mutual effects among individuals who have been exposed to trauma. OBJECTIVE: The current investigation examines the reciprocal effects of subjective physical health and loneliness among a group of war veterans over four decades. METHODS: Two-hundred and seventy-four Israeli veterans from the 1973 Yom- Kippur War reported self-rated health (SRH), somatization and loneliness at 1991 (T1), 2003 (T2), 2008 (T3) and 2015 (T4). An autoregressive cross-lagged (ARCL) modeling strategy was employed to test the bidirectional relationship between subjective health and loneliness. RESULTS: The results showed that from T1 to T2, loneliness predicted subjective physical health. However, from T2 to T3, and from T3 to T4, subjective physical health predicted loneliness. PTSD moderated the association between loneliness and subjective physical health. CONCLUSION: The findings show a novel pattern of influences, demonstrating that the reciprocal effects of subjective physical health and loneliness change over time. The findings imply that subjective health and interpersonal experiences are inherently connected.

Short-term effects of crisis response planning on optimism in a U.S. Army sample.

AIM: This study examined the short-term effects of a brief crisis intervention on optimism of acutely suicidal soldiers. METHODS: U.S. Soldiers (N = 97) presenting for an emergency mental health appointment in a military emergency department or behavioural health clinic were randomly assigned to treatment as usual standard crisis response plan, or enhanced crisis response plan (E-CRP). This study is used a subsample of the original clinical trial (n = 64) for those who completed self-report measures of optimism (Life Orientation Test-Revised) prior to receiving any intervention and a secondary self-report assessment one-month following the intervention. RESULTS: Results indicate that individuals with low baseline optimism who received the E-CRP had significant increases in optimism 1 month post-intervention. CONCLUSION: This provides evidence that discussing a patient's reasons for living during a CRP increases optimism in those high-risk patients with the lowest baseline optimism.

What doesn't kill you makes you feel older: lifespan adversity and its association with subjective age among former prisoners of war.

Background: Subjective age (SA) is an indicator of aging that has been empirically associated with health impediments and hindered longevity. Studies show that adverse life events may result in relatively older SA, but have not addressed the differential contribution of life events across the lifespan and the course of posttraumatic psychopathology on the SA of aging survivors of extreme trauma. Objective: Filling this gap, the current study explored the differential contribution of (1) adverse experiences in various life-stages and (2) trajectories of posttraumatic stress disorder (PTSD) to the prediction of SA in a sample of former prisoners-of-war as they enter old age. Method: A cohort of Israeli former prisoners-of-war of the 1973 Yom Kippur War (N = 103) was assessed at four points throughout four decades after the war. A linear hierarchical regression was utilized to assess the contribution of negative life events during childhood, participation in other wars, combat exposure, suffering in captivity, life events since the war and the trajectories of PTSD for predicting SA 42-years post-repatriation. Results: Lifespan adversity explained 50% of the variance in SA, with trajectories of PTSD making the largest contribution, followed by life events since the war. Negative life events in childhood added to the explained variance only when PTSD trajectories were accounted for. Exposure to combat, participation in additional wars and the severity of specific experiences during captivity did not reach significance, though the latter marginally contributed to the explained variance (p = .069). Conclusions: This study demonstrates the importance of considering the prolongation of posttraumatic psychopathology together with life adversities and their differential implications when addressing SA after extreme trauma. The findings suggest that early life adversity may be a latent factor that increases vulnerability to posttraumatic premature aging processes.

Antecedentes: La edad subjetiva (ES) es un indicador de envejecimiento que se ha asociado empíricamente con problemas de salud y longevidad difícil. Estudios muestran que los eventos de vida adversos pueden resultar en una ES relativamente mayor, pero no han evaluado la contribución diferencial de los eventos de vida en la esperanza de vida y el curso de psicopatología postraumática en la ES de sobrevivientes de trauma extremo en etapa de envejecimiento.Objetivo: Para llenar este espacio, el presente estudio exploró la contribución diferencial de, a) experiencias adversas en varios estadios de vida y b) trayectorias de trastorno de estrés postraumático (TEPT) en la predicción de ES en una muestra de ex prisioneros de guerra en edades avanzadas.Método: se evaluó una cohorte de israelíes ex prisioneros de guerra de la Guerra Yom Kippur de 1973 (N = 103) en cuatro puntos a lo largo de cuatro décadas tras la guerra. Se utilizó una regresión jerárquica para evaluar la contribución de eventos de vida negativos durante la infancia, participación en otras guerras, exposición a combate, sufrimiento en cautiverio, eventos de vida desde la guerra y las trayectorias de TEPT para predicción de ES 42 años post-repatriación.Resultados: La adversidad a lo largo de la vida explicó el 50% de la varianza en ES, con trayectorias de TEPT haciendo la mayor contribución, seguidas por eventos de vida desde la guerra. Eventos de vida negativos en la infancia se agregan a la varianza explicada sólo cuando las trayectorias de TEPT fueron consideradas. Exposición a combate, participación en guerras adicionales y la severidad de experiencias específicas durante el cautiverio no alcanzaron significancia, aunque esto último contribuyó marginalmente a la varianza explicada (p = .069).Conclusiones: este estudio demuestra la importancia de considerar la prolongación de la psicopatología postraumática junto a adversidades en la vida y sus implicaciones diferenciales al evaluar la ES después de trauma extremo. Estos hallazgos sugieren que adversidades tempranas en la vida pueden ser un factor latente que aumenta la vulnerabilidad a procesos de envejecimiento prematuro.

Longitudinal Development of Primary and Secondary Posttraumatic Growth in Aging Veterans and Their Wives: Domain-Specific Trajectories.

Posttraumatic growth (PTG), the positive psychological transformations that follow traumatic events, affects both direct survivors (primary PTG) and their significant others (secondary PTG). Though primary and secondary PTG have been widely investigated in the literature, their long-term trajectories decades after a traumatic event, especially as survivors enter older age, remain largely uninvestigated. Furthermore, it remains contested whether PTG adds up to a monolithic construct or rather consists of relatively independent components. Addressing these issues, we assessed a sample of Israeli male veterans from the 1973 Yom Kippur war (N = 349) and their wives (N = 156) at three time points over the course of nearly three decades. Both the veterans (primary survivors) and their wives (secondary survivors) reported PTG relating to the veterans' experiences during the war and/or captivity. Latent growth mixture modeling was conducted to identify trajectories of PTG on the five subscales of the Posttraumatic Growth Inventory. Long-term trajectories of PTG followed heterogeneous patterns of fluctuation over time and particularly as participants entered older age. On most subscales, decreasing PTG scores were evident, a trend that was more pronounced among the primary survivors than the secondary survivors as primary and secondary PTG fluctuate considerably in the long-term and seem to decrease as individuals enter older age. Furthermore, it would seem that PTG should not be considered a holistic concept but rather a conglomeration of positive changes. Implications of the findings are discussed within the context of limitations and potential intervening factors.

Perceived social support, loneliness, and later life telomere length following wartime captivity.

OBJECTIVES: Telomere length (TL) is a robust indicator of cellular aging. TL erosion has been associated with exposure to social and traumatic stressors. Loneliness and perceived social support are strongly linked to increased morbidity and mortality, but have yet to be investigated in relation to TL after extreme stress. The present study examined whether loneliness and lack of perceived social support following wartime captivity may be associated with TL as repatriated prisoners of war (ex-POWs) enter old age and contribute to its prediction. METHOD: A cohort of Israeli ex-POWs from the 1973 Yom Kippur War (n = 83) were assessed. Questionnaires were utilized to assess loneliness and perceived social support 18 years after the repatriation (T1), and Southern blotting was used to measure TL 24 years later (T2). A zero-order Pearson correlation test and a hierarchical regression analysis were utilized in order to examine the research questions. RESULTS: Loneliness and lack of perceived social support each significantly predicted shorter TL in later life, and together added 25.8% to the overall explained variance. CONCLUSIONS: This is the first study to empirically demonstrate that loneliness and lack of perceived social support in early adulthood may be associated with shorter TL during transition to old age in a population that has endured extreme stress. Although the study design precludes causal inferences, several psychobiological mechanisms may explain the findings. The potential clinical significance of social deficits for longevity and heath in related populations is therefore addressed, and an agenda for future investigations is suggested. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Growing Apart: A Longitudinal Assessment of the Relation Between Post-traumatic Growth and Loneliness Among Combat Veterans.

The aftermath of war-related trauma may entail psychological devastation and is typically accompanied by various deleterious phenomena. These include, but are not limited to, high rates of loneliness. However, trauma may also result in positive outcomes such as personal, spiritual, and relational prosperity, which are typically considered under the conceptual framework of post-traumatic growth (PTG). PTG may theoretically contribute to either loneliness amelioration (e.g., via increasing one's appreciation of close relationships) or exacerbation (e.g., by increasing one's sense of undergoing experiences that others do not share). Loneliness, on the other hand, may potentially hinder PTG by fostering negative social cognitions and behaviors, or otherwise lead to personal growth. The relations between the two phenomena, however, have yet to be investigated. Filling this gap, the current study examined the aforementioned potentialities by utilizing an autoregressive cross-lagged modeling strategy (ARCL) with a cohort of 260 Israeli combat veterans assessed 30, 35, and 42 years after their participation in the 1973 Yom Kippur War. Results indicated that higher rates of PTG were consistently related to higher rates of loneliness both cross-sectionally and longitudinally. Loneliness, however, did not longitudinally predict PTG rates. It is suggested that these findings may be understood in light of the observation that veterans' loneliness is primarily related to the experience of being experientially out of sync with people who have not endured war experiences. It is suggested that this experiential loneliness may include not only the negative but also the positive ramifications of undergoing such traumas (i.e., PTG). We, therefore, argue that while PTG may include authentic positive transformations it may also lead to more negative ramifications, and these should be identified and addressed by researchers and clinicians alike. Thus, as study limitations are acknowledged, clinical implications, and future research directions are suggested.

Traumatic stress and cellular senescence: The role of war-captivity and homecoming stressors in later life telomere length.

BACKGROUND: Telomere length (TL) serves as a biomarker of cellular senescence and is a robust predictor of mortality. The association between traumatic stress and TL erosion is rapidly realized, as are the complexities of this relation that include links to posttraumatic stress disorder (PTSD), depression, and psychosocial factors. Nevertheless, the relation between specific stressors in early adulthood and TL in later life, specifically among populations that have undergone extreme stress in early adulthood are largely uninvestigated. METHOD: Examining 99 Israeli former prisoners of war (ex-POWs) 18 and 42 years after repatriation, the current study investigated the role that specific stressors during captivity (i.e., physical abuse, nourishment deprivation and solitary confinement) and homecoming (i.e., received social-support, loss of place in the family, loneliness and sense of being accused) play in predicting TL 42 years post-repatriation. Intercorrelations analysis and a hierarchical linear regression were utilized. Variables that have been empirically associated with TL: age, BMI, physical activity, smoking, substance abuse, negative life events since repatriation, depression and PTSD symptoms were controlled for in the regression. RESULTS: Solitary confinement during captivity, and loss of place in the family, loneliness and being accused at homecoming predicted shorter telomeres in later life. The remaining stressors did not significantly predict TL. CONCLUSION: These findings suggest that an adequate understanding of TL after trauma must consider the unique contributions of specific types of stressors across the lifespan, and particularly account for interpersonal deficits. The findings may inform preventive interventions aimed at improving ex-POWs' longevity and well-being.

Psychiatric reactions to continuous traumatic stress: A Latent Profile Analysis of two Israeli samples.

Many individuals worldwide are exposed to continuous traumatic stress (CTS). However, the psychiatric sequela of CTS and the relevance of posttraumatic stress disorder (PTSD) diagnostic criteria in this situation have yet to be determined. Filling this gap, the present study assessed psychiatric reactions to CTS and the relationship between such reactions and functional impairment among two representative samples of adults exposed to ongoing shelling over 6 (n=387) and 9 years (n=468). Assessment included PTSD symptomatology (i.e., intrusion, avoidance, hyperarousal), anxiety, somatization, and depression. Profile categorization aimed to underscore variations in symptom clustering and severity, and determine whether or not a profile is dominated by PTSD symptoms. Latent Profile analyses (LPA) of sample I revealed four distinct symptoms profiles: (1) 'symptomatically resilient'; (2) 'symptomatically low-moderate'; (3) 'symptomatically moderate-high'; and (4) 'symptomatically overall high'. LPA of sample II revealed three distinct symptoms profiles: (1) 'symptomatically resilient'; (2) 'symptomatically low-moderate'; (3) "symptomatically moderate-high". Moreover, profile variation was implicated in dysfunction. Consistent with studies focusing on single trauma exposure, the findings revealed that the most prevalent profile was the symptomatically resilient, indicating that most people exposed to CTS seem to evince a scarce number of psychiatric symptoms. Moreover, reactions to CTS proved broader than the existing PTSD symptomatology. Examining symptom dominance and severity in relation to impairment and dysfunction, and clinical considerations are discussed.

Self-Disclosing Trauma and Post-Traumatic Stress Symptoms in Couples: A Longitudinal Study.

OBJECTIVE: Most research concerning the implications of self-disclosure on trauma's aftermath has focused on the salubrious effects disclosure may foster for the primary victim. However, the manner in which recipients of disclosure are symptomatically affected by it remains unexamined. Of particular interest are spouses who are often the primary support providers and are therefore susceptible to secondary traumatization. Assessing posttraumatic stress symptoms (PTSS) and self-disclosure among traumatized veterans and their wives, the current longitudinal study begins to fill this gap in the literature. METHOD: A total of 220 couples consisting of Israeli veterans, of whom 128 were former prisoners of war (ex-POWs) and 92 were combatants, and their wives were examined. PTSS and self-disclosure of both partners were assessed 30 and 35 years after the war using the Posttraumatic Stress Disorder Inventory (PTSD-I; Solomon et al., 1993) and the Self-Disclosure Index (SDI; Miller, Berg, & Archer, 1983), respectively. Analyses included Pearson intercorrelations analyses and four stepwise hierarchical multiple regression analyses. RESULTS: Findings indicated that increments in veterans' disclosure are not only consistently associated with the reduction of their wives' PTSS but may also explain and predict some of the change in the wives' PTSS over time. However, such a longitudinal effect was not evident concerning the veterans' PTSS. CONCLUSION: Traumatized ex-POWs' and combatants' self-disclosure within the marital relationship may contribute to the amelioration of their wives' secondary traumatization, and thus may be a goal worth pursuing in therapy. However, more research is needed to further understand this relation.

Posttraumatic stress symptoms and marital adjustment among Israeli combat veterans: The role of loneliness and attachment.

OBJECTIVE: War trauma may foster ramifications for marital relationships. Veterans may feel that no one can understand them and thus impact their relationships. The current study aims to shed light on the role that posttraumatic stress symptoms (PTSS), loneliness, and attachment orientations may play in marital adjustment among combat veterans. METHOD: Participants were 504 veterans who served in the Lebanon War in 1982. RESULTS: Analysis revealed that higher PTSS levels were related to lower marital adjustment and that the indirect path of this relation through loneliness was significant. Furthermore, attachment orientations moderated the direct link between PTSS and marital adjustment, but failed to moderate the indirect effect through loneliness. CONCLUSIONS: A sense of isolation should be addressed in therapy, as well as the interpersonal expectations of the veteran. (PsycINFO Database Record

Traumatization, Loneliness, and Suicidal Ideation among Former Prisoners of War: A Longitudinally Assessed Sequential Mediation Model.

Although highly researched among veterans, the underlying mechanisms of suicidal ideation (SI) among former prisoners of war (ex-POWs), especially in the long-term, have rarely been investigated. Furthermore, while posttraumatic stress symptoms (PTSS) and loneliness have been individually associated with veteran SI, and both may be differentially implicated by captivity versus war traumas, the interplay between them has yet to be examined. Filling this gap, the current longitudinal study examined a hypothetical sequential model wherein war captivity, compared with combat-induced trauma, is implicated in worse PTSS, which is then implicated in worse loneliness and PTSS, which together may explain subsequent SI. Two groups of Israeli veterans of the 1973 Yom Kippur War, 163 ex-POWs and 185 matched non-captive veterans were assessed 18 (T1) and 30 (T2) years after the war. Analyses indicated that compared with war, captivity was implicated in worse PTSS, which was implicated in worse loneliness, and these worked in tandem to implicate SI. Loneliness, however, was not directly affected by the type of trauma, nor was its relation to SI linked to its implication in subsequent PTSS. These results may inform future research and clinical practice as the study underscores the importance of both PTSS and loneliness in ex-POWs' long-term SI.

Couple Forgiveness and its Moderating Role in the Intergenerational Transmission of Veterans' Posttraumatic Stress Symptoms.

This study examined the moderating effect couple forgiveness (as perceived by the wives/mothers) may have on the intergenerational transmission of posttraumatic stress symptoms (PTSS) among families of combat veterans and former prisoners of war (ex-POWs). The sample included 123 (79 ex-POWs and 44 control combatants) Israeli father-mother-adult offspring triads. Self-report measures were administered at 2008 to veterans, at 2010-2011 to wives, and at 2013-2014 to offspring. The findings indicated that ex-POWs' PTSS were positively related to their offspring's PTSS, while couple forgiveness buffered this effect, particularly, and detrimentally, when couple forgiveness was low. These findings imply that apprehending the quality of the forgiving atmosphere within the marital relationship may be important for understanding the apparatus of intergenerational transmissions of trauma.

Keeping a healthy distance: Self-differentiation and perceived health among ex-prisoners-of-war's wives.

OBJECTIVE: War captivity may affect spouses of former-prisoners-of-war (ex-POWs) in many ways, including posttraumatic stress symptoms (PTSS) and somatic difficulties manifested in negative perceived health. This is generally known as secondary traumatization. Theory suggests that development of secondary traumatization occurs through the relationship with the primary trauma survivor Figley (1986) , thus implying that the ability to keep balanced emotional distance in the relationship may play a pivotal role. Notwithstanding, the contribution of self-differentiation to secondary somatic disturbances remains largely uninvestigated. The current study fills this gap. METHODS: Ex-POWs' wives (n=143) and control former-combatants' wives (n=102), were assessed prospectively 30 (T1) and 38 (T2) years after the 1973 Yom Kippur War. Self-differentiation and PTSS were assessed at both time-points, while perceived health measures were assessed at T2. RESULTS: Wives of ex-POWs endorsed higher PTSS, lower self-differentiation and negative perceived health, compared to control wives. Indirect exposure to war captivity was related to low self-differentiation and elevated PTSS, which predicted negative perceived health. Furthermore, self-differentiation characterized by fusion-with-others fully mediated the relation between indirect exposure to war captivity and perceived health, beyond the effects of PTSS as a mechanism. CONCLUSION: Results suggest that tendencies towards fusion-with-others within the marital relationship, act as a risk factor not only for psychological distress but also for somatic distress among secondary trauma survivors. Hence, clinical interventions may seek to improve indirect trauma survivor's self-differentiation capacities, thus potentially facilitating the prevention of secondary somatic distress.

Does one size fit all? Nosological, clinical, and scientific implications of variations in PTSD Criterion A.

Posttraumatic stress disorder (PTSD) is a psychiatric pathology wherein the precipitating traumatic event is essential for diagnostic eligibility (Criterion A). This link is substantiated throughout PTSD's development as a diagnosis. However, while traumatic events may vary considerably, this variation currently bears nearly no implications for psychiatric nosology. Consequently, PTSD remains a semi-unified diagnostic construct, consisting of no Criterion-A-determined subtypes of adult PTSD. The question addressed by the current paper is then does one size truly fit all? Making an argument for the negative, the paper briefly reviews complex PTSD (CPTSD), ongoing traumatic stress response (OTSR), and cumulative traumas, all of which are exemplars wherein Criterion A specification is crucial for understanding the emerging symptomatology and for devising appropriate interventions. Indicating several overlooked discrepancies in the PTSD literature, the paper urges for the necessity of a more fine-grained differential diagnostic subtyping of PTSD, wherein posttraumatic reactions are more closely associated with their precipitating traumatic events. The paper concludes by suggesting diagnostic, clinical and societal implications, as well as proposing directions for future research.

Attachment in detachment: The positive role of caregivers in POWs' dissociative hallucinations.

Humans are social creatures and therefore exhibit a pervasive need for others. Hence, when benevolent human contact is scarce, this dearth may be compensated imaginatively. War captivity is an extreme example of such deprivation and one wherein dissociative hallucinations have been exhibited. Although hallucinations may serve to virtually summon benevolent others and thus provide the prisoner of war (POW) with a platform for compensation, the contents of such hallucinations have yet to be investigated. The current qualitative study is the first to examine whether the content of such hallucinations may harbor positive effects. Guided by the notion that people search for compensation in lack of companionship, we scrutinized testimonies of former POWs for accounts of hallucinatory experiences. A narrative analysis was utilized in an attempt to understand the meaning of the hallucinations for the POW. Findings reveal that benevolent figures and concomitant acts of care are exhibited in war captivity hallucinatory experiences. Thus, it is argued that the content of such hallucinations may be protective. These findings are discussed in light of the literature concerning peritraumatic dissociative experiences. In addition, attachment theory is suggested as a plausible framework for understanding these findings. Finally, limitations of the study are discussed, and future researched is suggested.

Loneliness and isolation in life-stories of Israeli veterans of combat and captivity.

Loneliness holds detrimental ramifications for health and well-being. Nevertheless, loneliness references in the literature addressing combat-related trauma are few. Consequentially, the qualities and characteristics of such experiences in these posttraumatic realities remain uninvestigated empirically. In the current qualitative study we began filling this gap in the literature. We utilized thematic content analysis of life-stories of 19 combat veterans and 7 ex-POWs that have given testimony at the Israel Trauma Center for Victims of Terror and War (NATAL). Our findings suggest that the loneliness in the contexts at hand is primarily characterized by a sense of experiential isolation, rather than social, emotional, or existential. This is the sensation that due to the extraordinary nature of traumatic experiences the fulfillment of needs such as empathy and intersubjectivity may be unattainable. Integrating our findings with existing interdisciplinary literature regarding social sharing, trauma, and loneliness, we discuss implications for clinical interventions and further research.