Abstract
Trauma survivors who suffer from posttraumatic stress symptoms (PTSS) are known to experience impairments in sexual satisfaction. However, the negative effects of PTSS are not limited to the primary survivors, as they can lead to secondary PTSS in their spouses as well. The implications of secondary PTSS in the sexuality of couples remain unknown. This study aimed to investigate whether specific symptom clusters of PTSS (i.e., intrusions, hyperarousal, and avoidance) are implicated in the sexual satisfaction of couples. We assessed a sample of primarily exposed Israeli veterans from the Yom Kippur War and their wives who had been secondarily exposed (N = 191). The dyadic data were analyzed in an Actor–Partner Independence Model. When scrutinizing specific PTSS clusters, the husbands’ avoidance related to their own sexual satisfaction. The wives’ hyperarousal related to their own and their spouses’ sexual satisfaction, whereas their intrusions were associated only with their husbands’ sexual satisfaction. In conclusion, PTSS in one spouse is related to both spouses’ sexual satisfaction; it is therefore recommended that clinicians adopt a dyadic approach when delivering interventions.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
As the ISS assesses multiple aspects of a sexual relationship, we reanalyzed the APIM model with a single item from the scale (Item 3: “Sex is fun for my partner and me”). The model showed a poor fit, χ2(1) = 19.59 p < .001, CFI = .97, NFI = .97, TLI = .21, RMSEA = .31 (CI 90% .20, .44). However, the effects were similar to the effects in the main model, with one minor difference. Wives higher levels of avoidance were associated with husbands’ higher levels of sexual dissatisfaction to the extent of a trend. Wives hyperarousal was not associated with the veterans’ sexual dissatisfaction.
References
Ackerman, R. A., Ledermann, T., & Kenny, D. A. (2016). Power analysis for the actor-partner interdependence model. Unpublished manuscript. Retrieved January 5, 2020, from https://robert-ackerman.shinyapps.io/APIMPowerR/.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Press.
Arbuckle, J. L. (2012). IBM SPSS Amos 21 user’s guide. Chicago: Small Waters Corporation.
Arbuckle, J. L. (2014). Amos 23.0 user’s guide. Chicago: IBM SPSS.
Badour, C. L., Gros, D. F., Szafranski, D. D., & Acierno, R. (2016). Sexual problems predict PTSD and depression symptom change among male OEF/OIF veterans completing exposure therapy. Psychiatry,79(4), 403–417. https://doi.org/10.1080/00332747.2016.1142774.
Bandalos, D. L. (2009). The effects of item parceling on goodness-of-fit and parameter estimate bias in structural equation modeling. Structural Equation Modeling,9(1), 78–102. https://doi.org/10.1207/S15328007SEM0901_5.
Bandalos, D. L., & Finney, S. J. (2001). Item parceling issues in structural equation modeling. In G. A. Marcoulides & R. E. Schumacker (Eds.), New developments and techniques in structural equation modeling (pp. 269–296). Mahwah, NJ: Lawrence Erlbaum Associates Inc.
Barlow, D. H. (1986). Causes of sexual dysfunction: The role of anxiety and cognitive interference. Journal of Consulting and Clinical Psychology,54(2), 140–148. https://doi.org/10.1037/0022-006X.54.2.140.
Birkley, E. L., Eckhardt, C. I., & Dykstra, R. E. (2016). Posttraumatic stress disorder symptoms, intimate partner violence, and relationship functioning: A meta-analytic review. Journal of Traumatic Stress,29, 397–405. https://doi.org/10.1002/jts.22129.
Breyer, B. N., Fang, S. C., Seal, K. H., Ranganathan, G., Marx, B. P., Keane, T. M., & Rosen, R. C. (2016). Sexual health in male and female Iraq and Afghanistan US war veterans with and without PTSD: Findings from the VALOR Cohort. Journal of Traumatic Stress,29(3), 229–236. https://doi.org/10.1002/jts.22097.
Brotto, L. A., Seal, B. N., & Rellini, A. (2012). Pilot study of a brief cognitive behavioral versus mindfulness-based intervention for women with sexual distress and a history of childhood sexual abuse. Journal of Sex and Marital Therapy,38(1), 1–27. https://doi.org/10.1080/0092623X.2011.569636.
Campbell, S. B., & Renshaw, K. D. (2013). PTSD symptoms, disclosure, and relationship distress: Explorations of mediation and associations over time. Journal of Anxiety Disorders,27(5), 494–502. https://doi.org/10.1016/j.janxdis.2013.06.007.
Canevello, A., Michels, V., & Hilaire, N. (2016). Supporting close others’ growth after trauma: The role of responsiveness in romantic partners’ mutual posttraumatic growth. Psychological Trauma: Theory, Research, Practice, and Policy,8(3), 334–342. https://doi.org/10.1037/tra0000084.
Chao, J.-K., Lin, Y.-C., Ma, M.-C., Lai, C.-J., Ku, Y.-C., Kuo, W.-H., & Chao, I.-C. (2011). Relationship among sexual desire, sexual satisfaction, and quality of life in middle-aged and older adults. Journal of Sex and Marital Therapy,37(5), 386–403. https://doi.org/10.1080/0092623X.2011.607051.
Chivers, M. L., & Brotto, L. A. (2017). Controversies of women’s sexual arousal and desire. European Psychologist,22(1), 5–26. https://doi.org/10.1027/1016-9040.
Coffman, D. L., MacCallum, R. C., Coffman, D. L., & MacCallum, R. C. (2010). Using parcels to convert path analysis models into latent variable models. Multivariate Behavioral Research,40(2), 235–259. https://doi.org/10.1207/s15327906mbr4002.
Collins, L. M. M., Schafer, J. L. L., & Kam, C.-M. M. (2001). A comparison of inclusive and restrictive strategies in modern missing data procedures. Psychological Methods, 6(4), 330–351. https://doi.org/10.1037/1082-989X.6.4.330.
Cook, J. M., Riggs, D. S., Thompson, R., Coyne, J. C., & Sheikh, J. I. (2004). Posttraumatic stress disorder and current relationship functioning among World War II ex-prisoners of war. Journal of Family Psychology,18(1), 36–45. https://doi.org/10.1037/0893-3200.18.1.36.
Davison, S. L., Bell, R. J., LaChina, M., Holden, S. L., & Davis, S. R. (2009). The relationship between self-reported sexual satisfaction and general well-being in women. Journal of Sexual Medicine,6(10), 2690–2697. https://doi.org/10.1111/j.1743-6109.2009.01406.x.
De Silva, P. (2001). Impact of trauma on sexual functioning and sexual relationships. Sexual and Relationship Therapy,16(3), 269–278. https://doi.org/10.1080/14681990123900.
Dekel, R., Goldblatt, H., Keidar, M., Solomon, Z., & Polliack, M. (2005). Being a wife of a veteran with posttraumatic stress disorder. Family Relations,54(1), 24–36. https://doi.org/10.1111/j.0197-6664.2005.00003.x.
Dekel, R., Levinstein, Y., Siegel, A., Fridkin, S., & Svetlitzky, V. (2016). Secondary traumatization of partners of war veterans: The role of boundary ambiguity. Journal of Family Psychology,30(1), 63–71. https://doi.org/10.1037/fam0000163.
Dekel, R., & Monson, C. M. (2010). Military-related post-traumatic stress disorder and family relations: Current knowledge and future directions. Aggression and Violent Behavior,15(4), 303–309. https://doi.org/10.1016/j.avb.2010.03.001.
Dekel, R., & Solomon, Z. (2006). Marital relations among former prisoners of war: Contribution of posttraumatic stress disorder, aggression, and sexual satisfaction. Journal of Family Psychology,20(4), 709–712. https://doi.org/10.1037/0893-3200.20.4.709.
Dekel, R., & Solomon, Z. (2007). Secondary traumatization among wives of war veterans with PTSD. In C. R. Figley & W. P. Nash (Eds.), Combat stress injury: Theory, research, and management (pp. 137–157). New York, NY: Routledge/Taylor & Francis Group. https://doi.org/10.4324/9780203943694.
Delamater, J., Hyde, J. S., Fong, M., Delamater, J., & Hyde, J. S. (2008). Sexual satisfaction in the seventh decade of life. Journal of Sex & Marital Therapy,34(5), 439–454. https://doi.org/10.1080/00926230802156251.
DiMauro, J., Renshaw, K. D., & Blais, R. K. (2018). Sexual vs non-sexual trauma, sexual satisfaction and function, and mental health in female veterans. Journal of Trauma and Dissociation,19(4), 403–416. https://doi.org/10.1080/15299732.2018.1451975.
Evans, L., McHugh, T., Hopwood, M., & Watt, C. (2003). Chronic posttraumatic stress disorder and family functioning of Vietnam veterans and their partners. Australian and New Zealand Journal of Psychiatry,37, 765–772. https://doi.org/10.1080/j.1440-1614.2003.01267.x.
Eysenck, M. W., Sánchez-Fuentes, M., Santos-Iglesias, P., & Carlos, J. (2014). A systematic review of sexual satisfaction. International Journal of Clinical and Health Psychology,14(1), 67–75. https://doi.org/10.1016/S1697-2600(14)70038-9.
Fallis, E. E., Rehman, U. S., Woody, E. Z., & Purdon, C. (2016). The longitudinal association of relationship satisfaction and sexual satisfaction in long-term relationships. Journal of Family Psychology,30(7), 822–831. https://doi.org/10.1037/fam0000205.
Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods,39(2), 175–191. https://doi.org/10.3758/BF03193146.
Figley, C. R. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York: Brunner/Mazel.
Fisher, W. I., Sliwinski, J. R., Johnson, A. K., Yu, A., & Elkins, G. R. (2013). Hypnotic relaxation therapy improves sexual health in postmenopausal women with moderate to severe hot flashes. Presented at the meeting of the American Psychological Association.
Gadassi, R., Bar-Nahum, L. E., Newhouse, S., Anderson, R., Heiman, J. R., Rafaeli, E., & Janssen, E. (2016). Perceived partner responsiveness mediates the association between sexual and marital satisfaction: A daily diary study in newlywed couples. Archives of Sexual Behavior,45(1), 109–120. https://doi.org/10.1007/s10508-014-0448-2.
Greene, T., Lahav, Y., Bronstein, I., & Solomon, Z. (2014). The role of ex-POWs’ PTSD symptoms and trajectories in wives’ secondary traumatization. Journal of Family Psychology,28(5), 666–674. https://doi.org/10.1037/a0037848.
Gribbons, B. C., & Hocevar, D. (1998). Levels of aggregation in higher level confirmatory factor analysis: Application for academic self-concept. Structural Equation Modeling: A Multidisciplinary Journal,5(4), 377–390. https://doi.org/10.1080/10705519809540113.
Guy, H. (1995). Joy, intimacy and sexuality among second generation of Holocaust survivors. Master's Thesis, Tel Aviv University.
Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling,6(1), 1–55. https://doi.org/10.1080/10705519909540118.
Hudson, W. W., Harrison, D. F., & Crosscup, P. C. (1981). A short-form scale to measure sexual discord in dyadic relationships. Journal of Sex Research,17(2), 157–174. https://doi.org/10.1080/00224498109551110.
Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. New York, NY: Hyperion. https://doi.org/10.1016/0005-7967(95)90133-7.
Kenny, D., Kashy, D., Cook, W., & Simpson, J. (2006). Dyadic data analysis. New York, NY: Guilford.
Lawrance, K., & Byers, E. S. (1998). Interpersonal exchange model of sexual satisfaction questionnaire. In C. M. Davis, W. L. Yarber, & R. Bauserman (Eds.), Sexuality related measures: A compendium (pp. 514–519). Thousand Oaks, CA: Sage.
Levin, Y., Bachem, R., & Solomon, Z. (2016). Traumatization, marital adjustment, and parenting among veterans and their spouses: A longitudinal study of reciprocal relations. Family Process,56(4), 926–942. https://doi.org/10.1111/famp.12257.
Little, R. J. A. (1988). A test of missing completely at random for multivariate data with missing values. Journal of the American Statistical Association,83(404), 1198–1202. https://doi.org/10.1080/01621459.1988.10478722.
Lorenz, T. A., Harte, C. B., Hamilton, L. D., & Meston, C. M. (2012). Evidence for a curvilinear relationship between sympathetic nervous system activation and women’s physiological sexual arousal. Psychophysiology,49(1), 111–117. https://doi.org/10.1111/j.1469-8986.2011.01285.x.
Ludick, M., & Figley, C. R. (2017). Toward a mechanism for secondary trauma induction and reduction: Reimagining a theory of secondary traumatic stress. Traumatology,23(1), 112–123. https://doi.org/10.1037/trm0000096.
MacNeil, S., & Byers, E. S. (2005). Dyadic assessment of sexual self-disclosure and sexual satisfaction in heterosexual dating couples. Journal of Social and Personal Relationships,22(2), 169–181. https://doi.org/10.1177/0265407505050942.
Mark, K. P., Herbenick, D., Fortenberry, J. D., Sanders, S., & Reece, M. (2014). A psychometric comparison of three scales and a single-item measure to assess sexual satisfaction. Journal of Sex Research,51(2), 159–169. https://doi.org/10.1080/00224499.2013.816261.
McIntyre-Smith, A., Cyr, K. S., King, L., St. Cyr, K., & King, L. (2015). Sexual functioning among a cohort of treatment-seeking Canadian military personnel and veterans with psychiatric conditions. Military Medicine,180(7), 817–824. https://doi.org/10.7205/MILMED-D-14-00125.
Miller, M. W., Wolf, E. J., Reardon, A. F., Harrington, K. M., Ryabchenko, K., Castillo, D., … Heyman, R. E. (2013). PTSD and conflict behavior between veterans and their intimate partners. Journal of Anxiety Disorders,27(2), 240–251. https://doi.org/10.1016/j.janxdis.2013.02.005.
Monson, C. M., Taft, C. T., & Fredman, S. J. (2009). Military-related PTSD and intimate relationships: From description to theory-driven research and intervention development. Clinical Psychology Review,29(8), 707–714. https://doi.org/10.1016/j.cpr.2009.09.002.
Nelson-Goff, B. S., & Smith, D. B. (2005). Systemic traumatic stress: The couple adaptation to traumatic stress model. Journal of Marital and Family Therapy,31(2), 145–157. https://doi.org/10.1111/j.1752-0606.2005.tb01552.x.
Nunnink, S. E., Goldwaser, G., Afari, N., Nievergelt, C. M., & Baker, D. G. (2010). The role of emotional numbing in sexual functioning among veterans of the Iraq and Afghanistan wars. Military Medicine,175(6), 424–428.
Pascoal, P. M., Byers, E. S., Alvarez, M.-J., Santos-Iglesias, P., Nobre, P. J., Pereira, C. R., & Laan, E. (2018). A dyadic approach to understanding the link between sexual functioning and sexual satisfaction in heterosexual couples. Journal of Sex Research,55(9), 1155–1166. https://doi.org/10.1080/00224499.2017.1373267.
Pepping, C. A., Cronin, T. J., Lyons, A., & Caldwell, J. G. (2018). The effects of mindfulness on sexual outcomes: The role of emotion regulation. Archives of Sexual Behavior,47(6), 1601–1612. https://doi.org/10.1007/s10508-017-1127-x.
Renshaw, K. D., Campbell, S. B., Meis, L., & Erbes, C. (2014). Gender differences in the associations of PTSD symptom clusters with relationship distress in U.S. Vietnam veterans and their partners. Journal of Traumatic Stress,27, 283–290. https://doi.org/10.1002/jts.
Rubin, H., & Campbell, L. (2012). Day-to-day changes in intimacy predict heightened relationship passion, sexual occurrence, and sexual satisfaction: A dyadic diary analysis. Social Psychological and Personality Science,3(2), 224–231. https://doi.org/10.1177/1948550611416520.
Schnurr, P. P., Lunney, C. A., Bovin, M. J., & Marx, B. P. (2009). Posttraumatic stress disorder and quality of life: Extension of findings to veterans of the wars in Iraq and Afghanistan. Clinical Psychology Review,29(8), 727–735. https://doi.org/10.1016/j.cpr.2009.08.006.
Solomon, Z., Benbenishty, R., Neria, Y., Abramowitz, M., Ginzburg, K., & Ohry, A. (1993). Assessment of PTSD: Validation of the revised PTSD Inventory. Israel Journal of Psychiatry and Related Sciences,30(2), 110–115.
Solomon, Z., Dekel, R., & Zerach, G. (2008). The relationships between posttraumatic stress symptom clusters and marital intimacy among war veterans. Journal of Family Psychology,22(5), 659–666. https://doi.org/10.1037/a0013596.
Solomon, Z., & Horesh, D. (2007). Changes in diagnostic criteria for PTSD: Implications from two prospective longitudinal studies. American Journal of Orthopsychiatry,77(2), 182–188. https://doi.org/10.1037/0002-9432.77.2.182.
Solomon, Z., Horesh, D., Ein-Dor, T., & Ohry, A. (2012). Predictors of PTSD trajectories following captivity: A 35-year longitudinal study. Psychiatry Research,199(3), 188–194. https://doi.org/10.1016/j.psychres.2012.03.035.
Stephenson, K. R. (2019). Exploring the role of sexual avoidance in male sexual dysfunction. Journal of Sex Research. https://doi.org/10.1080/00224499.2019.1663480.
Štulhofer, A., Ferreira, L. C., & Landripet, I. (2014). Emotional intimacy, sexual desire, and sexual satisfaction among partnered heterosexual men. Sexual and Relationship Therapy,29(2), 229–244. https://doi.org/10.1080/14681994.2013.870335.
Sundin, J., Fear, N. T., Iversen, A., Rona, R. J., & Wessely, S. (2010). PTSD after deployment to Iraq: Conflicting rates, conflicting claims. Psychological Medicine,40(3), 367–382. https://doi.org/10.1017/S0033291709990791.
Taft, C. T., Kaloupek, D. G., Schumm, J. A., Marshall, A. D., Panuzio, J., King, D. W., & Keane, T. M. (2007). Posttraumatic stress disorder symptoms, physiological reactivity, alcohol problems, and aggression among military veterans. Journal of Abnormal Psychology,116(3), 498–507. https://doi.org/10.1037/0021-843X.116.3.498.
Tanielian, T., Jaycox, L. H., Adamson, D. M., Burnam, M. A., Burns, R. M., Caldarone, L. B., & Yochelson, M. R. (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica, CA: RAND Center for Military Health Policy Research.
Tran, J. K., Dunckel, G., & Teng, E. J. (2015). Sexual dysfunction in veterans with post-traumatic stress disorder. Journal of Sexual Medicine,12(4), 847–855. https://doi.org/10.1111/jsm.12823.
Velten, J., Margraf, J., Chivers, M. L., & Brotto, L. A. (2018). Effects of a mindfulness task on women’s sexual response. Journal of Sex Research,55(6), 747–757. https://doi.org/10.1080/00224499.2017.1408768.
Woloski-Wruble, A. C., Oliel, Y., Leefsma, M., & Hochner-Celnikier, D. (2010). Sexual activities, sexual and life satisfaction, and successful aging in women. Journal of Sexual Medicine,7(7), 2401–2410. https://doi.org/10.1111/j.1743-6109.2010.01747.x.
World Health Organization. (2015). Sexual health, human rights and the law. Geneva: Author. https://doi.org/10.1080/17441692.2014.986175.
Yehuda, R., Lehrner, A., & Rosenbaum, T. Y. (2015). PTSD and sexual dysfunction in men and women. Journal of Sexual Medicine,12(5), 1107–1119. https://doi.org/10.1111/jsm.12856.
Yoo, H., Bartle-Haring, S., Day, R. D., & Gangamma, R. (2014). Couple communication, emotional and sexual intimacy, and relationship satisfaction. Journal of Sex and Marital Therapy,40(4), 275–293. https://doi.org/10.1080/0092623X.2012.751072.
Zerach, G., Anat, B. D., Solomon, Z., & Heruti, R. (2010). Posttraumatic symptoms, marital intimacy, dyadic adjustment, and sexual satisfaction among ex-prisoners of war. Journal of Sexual Medicine,7(8), 2739–2749. https://doi.org/10.1111/j.1743-6109.2010.01784.x.
Zhang, Y., Gan, Y., & Cham, H. (2007). Perfectionism, academic burnout and engagement among Chinese college students: A structural equation modeling analysis. Personality and Individual Differences,43(6), 1529–1540. https://doi.org/10.1016/j.paid.2007.04.010.
Zoladz, P. R., & Diamond, D. M. (2013). Current status on behavioral and biological markers of PTSD: A search for clarity in a conflicting literature. Neuroscience and Biobehavioral Reviews,37(5), 860–895. https://doi.org/10.1016/j.neubiorev.2013.03.024.
Acknowledgment
Rahel Bachem and Yafit Levin shared first authors.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Informed Consent
All participants gave written informed consent before participating in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Bachem, R., Levin, Y. & Solomon, Z. Posttraumatic Stress and Sexual Satisfaction in Husbands and Wives: A Dyadic Analysis. Arch Sex Behav 49, 1533–1543 (2020). https://doi.org/10.1007/s10508-020-01680-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10508-020-01680-4