The interpersonal implications of PTSD and complex PTSD: The role of disturbances in self-organization

Rahel Bachem, Yafit Levin, Gadi Zerach, Marylene Cloitre, Zahava Solomon

Research output: Contribution to journalArticlepeer-review


Background: In the aftermath of trauma not only the primary traumatized survivors’ mental health is affected but often also their significant others. The current study explores the specific associations of ICD-11 symptoms of posttraumatic stress disorder (PTSD) and disturbances in self organization (DSO) for secondary traumatic stress and dyadic adjustment among both spouses. Methods: Male Israeli veterans and their wives (N = 216) were assessed 30 years after the war. Primary PTSD/DSO symptoms of the veterans and secondary posttraumatic stress symptoms (secondary PTSS)/DSO of the wives were assessed. Actor Partner Independence Modelling (APIM) evaluated the differential effects of PTSD and DSO for trauma transmission and dyadic adjustment. Results: While veterans’ primary PTSD only related to secondary PTSS of the wives, the veterans’ DSO predicted the wives’ secondary PTSS as well as DSO. Moreover, the APIM revealed that the primary and secondary DSO of both partners were associated with dyadic adjustment while their PTSD symptoms were not. Limitations: The cross-sectional data did not allow to identify directional or causal effects and DSO symptoms were not assessed with an ICD-specific instrument as such scales did not exist at the time of data collection. Conclusions: ICD-11 DSO symptoms seem to drive the transmission of posttraumatic stress among spouses to a more significant extent than PTSD symptoms. As DSO are also strongly implicated in decreased dyadic adjustment, they are valuable targets for couple therapy after one spouse experienced severe trauma, both in order to prevent interpersonal trauma transfer as well as to enhance dyadic adjustment.

Original languageEnglish
Pages (from-to)149-156
Number of pages8
JournalJournal of Affective Disorders
StatePublished - 1 Jul 2021


  • Actor Partner Independence Modelling (APIM)
  • Complex posttraumatic stress disorder
  • Disturbances in self organization
  • Dyadic adjustment
  • Trauma transmission


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