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The current study explored the differential association between affective personality type, post-traumatic stress disorder (PTSD) symptom severity, and post-traumatic growth (PTG) in victims of violence (N = 113). Relying on previous research, median cut off-scores on the Positive and Negative Affect Schedule Short Form were used to classify participants as high affective [i.e. high positive affectivity (PA) and high negative affectivity (NA)], self-actualizing (i.e. high PA and low NA), self-destructive (i.e. low PA and high NA) and low affective (i.e. low PA and low NA). Results indicated that the self-destructive and high affective personality styles were strongly associated with increased PTSD symptoms severity. High affective personality type was found to be the only significant predictor of PTG. Results, study limitations and directions for future research were discussed. Copyright © 2010 John Wiley & Sons, Ltd.
An extensive body of research exists regarding the psychosocial aftermath of violent victimization. Many studies have shown that victims of interpersonal violence suffer from psychological distress, such as post-traumatic stress disorder (PTSD) (e.g. Kunst, Winkel, & Bogaerts, in press; Orth, Cahill, Foa, & Maercker, 2008). Previous research suggests that the prevalence of violence-related PTSD approximates 10–15 per cent (see Winkel, 2007). However, individual studies have recorded much higher prevalence rates, with percentages as high as 25 per cent amongst victims recruited through police stations (Wohlfarth, Winkel, & Van den Brink, 2002) and 32 per cent in emergency department samples (Birmes et al., 2003). Other outcomes observed in victims of violence include: symptoms of depression (e.g. Kilpatrick et al., 2003), somatization, hostility, anxiety and phobic anxiety (e.g. Norris & Kaniasty, 1994; Winkel, 2009), decreases in general well being (Denkers, 1996; Denkers & Winkel, 1997) and eating disorders (Brady, 2008).
Along with these negative outcomes, several studies have reported on the positive side of coping with violent victimization (e.g. Borja, Callahan, & Long, 2006; Cobb, Tedeschi, Calhoun, & Cann, 2006), particularly experiences of post-traumatic growth (PTG)—a state of functioning superior to that which existed prior to trauma exposure (e.g. Linley & Joseph, 2004; Tedeschi & Calhoun, 2004; Zoellner & Maercker, 2006). PTG comprises varying domains of personal change, including changes in perception of the self, changes in interpersonal relationships, and changes in philosophy of life (Calhoun & Tedeschi, 1999). The current state-of-the-art seems to suggest that PTG and manifestations of distress following traumatic events are only marginally correlated and thus represent rather separate, independent dimensions of psychological functioning (Zoellner & Maercker, 2006). In other words, PTG is not merely an indicator of well-being.
Individual differences in trait affectivity have been suggested to underlie both adverse and beneficial outcomes of traumatization (e.g. Affleck & Tennen, 1996; Erbes et al., 2005; Frederickson, Tugade, Waugh, & Larkin, 2003; Tedeschi & Calhoun, 1996). NA seems to play an important role in the onset and maintenance of emotional problems following violent victimization (e.g. Kunst, Bogaerts, & Winkel, 2009; Mikkelsen & Einarsen, 2002; Zoellner, Goodwin, & Foa, 2000). NA involves the stable tendency to experience negative emotions (e.g. Watson & Clark, 1984), negative self-evaluations, and over-sensitivity to adverse stimuli (e.g. Watson & Pennebaker, 1989). When exposed to potentially stressful events, people with high levels of NA may be assumed to respond more intensely than others (e.g. Zeidner, 2006). Furthermore, if levels of heightened distress do not automatically resolve within a reasonable amount of time, they are at an increased risk of developing psychiatric disorder. Previous research, although preliminary in nature, indicates that NA is not associated with PTG (e.g. Tedeschi & Calhoun, 1996, 2004; Sheikh, 2004). By contrast, PA reflects one's ability to maintain a positive out-come both over time and across various situations (Cropanzano et al., 1993; Watson, Pennebaker, & Folger, 1987) and has been suggested to act as a determinant of PTG (Park, Cohen, & Murch, 1996; Tedeschi & Calhoun, 2004). PA and NA broadly correspond with the Big Five traits extraversion and anxiety/neuroticism, respectively (Watson, Clark, & Tellegen, 1988). Generally stated, NA and PA seem to be rather weakly correlated with each other (Thompson, 2007; Watson et al., 1988).
Although earlier studies have shown that both NA and PA play an independent role in the process of trauma resolution, research on the explanatory power of configurations of high and low NA and PA values is scarce. Such combinations enable the identification of personality subtypes or cognitive-emotional presymptom profiles (Archer, Adolfsson, & Karlsson, 2008) that are differently related to both positive and negative psychological outcomes (Denollet, 2000; Van Yperen, 2003). Norlander, Bood, and Archer (2002) developed a procedure to create four affective personality styles based on the Positive and Negative Affect Schedule (PANAS; Watson et al., 1988): high affective (i.e. high PA and high NA), self-actualizing (i.e. high PA and low NA), self-destructive (i.e. low PA and high NA), and low affective (i.e. low PA and low NA) personality. In a study of 46 grocery store employees and 44 flying squad policemen (Norlander, Von Schedvin, & Archer, 2005) who had experienced a wide array of negative life events, they investigated, amongst other things, differences in experienced stress, as measured by the Stress and Energy Scale (Kjellberg & Iwanowski, 1989) and PTG between the four personality types. Based on two earlier studies (Bood, Archer, & Norlander, 2004; Norlander, Bood, & Archer, 2002), they hypothesized that self-actualizing individuals would report the lowest levels of distress and the highest levels of PTG. Self-destructive persons were assumed to experience they highest levels of distress and the lowest levels of PTG. In partial support of their expectations, they found that the highest levels of distress were experienced by self-destructive and high affective persons, whereas self-actualizing and low affective persons reported the lowest stress scores. Contrary to expectations, the high affective group scored highest on PTG. An intermediate response was found for the self-actualizing group. The lowest scores were observed for the self-destructive and low affective groups. Presumably, and in line with the view held by several PTG scholars that a certain degree of distress is a prerequisite for PTG to occur (e.g. Tedeschi & Calhoun, 1995, 2004), PA is most likely to induce growth if one is vulnerable to experience distress in the first place. More precisely, the stress high affective individuals are likely to experience in response to trauma exposure is necessary to trigger the process of growth.
Given the aforementioned, the primary purpose of the current study was to explore associations amongst affective personality type, PTSD symptom severity, and PTG in victims of interpersonal violence. To our knowledge, this has never been done before. Building on the observations made by Norlander, Von Schedvin, et al., (2005), it was expected that the self-destructive and high affective personality styles would be associated with increased PTSD symptom severity, while the latter was also expected to be positively associated with PTG. For the self-actualizing group, an association with PTG was expected as well.
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PSS-SR and PTG total scores were not significantly correlated with each other (r = 0.12, p = ns). Thirty participants could be classified as high affective individuals, 34 as self-actualizing, 20 as low affective, and 29 as self-destructive. ANOVAs revealed overall effects for affective personality type on PTSD symptom severity, F(3, 109) = 27.97, p < 0.001, and PTG, F(3, 109) = 2.92, p < 0.05. Post hoc analyses indicated that self-destructive individuals (M = 29.1, SD = 12.1) reported higher symptom levels than high affective (M = 23.0, SD = 9.6, p < 0.05), self-actualizing (M = 8.6, SD = 10.9, p < 0.001), and low affective (M = 8.2, SD = 8.3, p < 0.001) participants. Mean PTG scores for the high affective group (M = 50.7, SD = 27.4) were higher than for the low affective (M = 33.5, SD = 27.9, p < 0.05) and self-destructive (M = 33.4, SD = 22.9, p < 0.025) groups. High affective individuals also reported higher PTG scores than those in the self-actualizing group (M = 46.5, SD = 30.2), although they did not differ significantly from each other. Regression analyses yielded significant positive associations between the self-destructive and high affective personality types and PTSD symptom severity. None of the other variables included in the model was significantly related to PTSD symptom severity (Table I). High affective personality type was the only factor independently related to higher PTG levels (Table II), although a marginal positive effect for self-actualizing personality was found as well (p = 0.08).
Table I. PredictingPTSDsymptomseverity(N = 113)
|Step 1|| ||0.138*|
| Age||0.20*|| |
| Gender||−0.07|| |
| Time since victimization||0.19*|| |
| Sexual violence||−0.04|| |
| Physical assault (severe)||0.12|| |
| Physical assault (minor)||−0.17|| |
| Robbery||0.08|| |
| Compensation level||−0.10|| |
|Step 2|| ||0.341**|
| Age||0.11|| |
| Gender||0.10|| |
| Time since victimization||0.03|| |
| Sexual violence||0.00|| |
| Physical assault (severe)||0.06|| |
| Physical assault (minor)||−0.12|| |
| Robbery||0.00|| |
| Compensation level||−0.07|| |
| Self-destructive||0.63**|| |
| High affective||0.46**|| |
| Self-actualizing||0.00|| |
Table II. Predictingpost-traumaticgrowth(N = 113)
|Step 1|| ||0.065|
| Age||0.06|| |
| Gender||−0.02|| |
| Time since victimization||−0.11|| |
| Sexual violence||0.16|| |
| Physical assault (severe)||0.10|| |
| Physical assault (minor)||−0.03|| |
| Robbery||−0.13|| |
| Compensation level||0.02|| |
|Step 2|| ||0.074*|
| Age||0.05|| |
| Gender||−0.03|| |
| Time since victimization||−0.07|| |
| Sexual violence||0.16|| |
| Physical assault (severe)||0.14|| |
| Physical assault (minor)||−0.01|| |
| Robbery||−0.09|| |
| Compensation level||0.03|| |
| High affective||0.27*|| |
| Self-actualizing||0.22|| |
| Low affective||−0.01|| |
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The present study investigated self-reports of PTSD symptom severity and PTG with regard to affective personality type in a sample of victims of rather heterogeneous categories of interpersonal violence. It intended to build on the work provided by Norlander and colleagues (Bood et al., 2004; Norlander, Johansson, et al., 2002; Norlander, Von Schedvin, et al., 2005), who used PANAS median scores to create four configurations of affective personality: high affective, self-actualizing, low affective, and self-destructive.
In line with many previous studies, PTSD symptom severity and PTG were not correlated with each other. In support of our expectations, and in line with Norlander, Von Schedvin, et al. (2005), results showed that the self-destructive and high affective personality styles were strongly associated with increased PTSD symptom severity in multivariate regression analyses. Mean symptom score values for individuals in these groups even suggested that individuals in these groups are likely to develop symptom levels that lie well beyond the cutoffs proposed to qualify for probable diagnosis of PTSD (Wohlfarth et al., 2003). Also in accordance with Norlander, Von Schedvin, et al. (2005), high affective individuals reported the highest levels of PTG. Moreover, high affective personality type was found to be the only significant predictor of PTG when adjusting for background variables, while self-actualizing personality type was, contrary to expectations, only marginally associated with PTG.
The results further underline the importance of considering configurations of personality traits when studying the psychological aftermath of trauma rather than solely focussing on single personality dimensions. Admittedly, on the one hand, they seem to indicate that NA is a correlate of PTSD symptom severity irrespective of concurrent PA. However, on the other hand, they suggest that PTG will particularly occur if PA is accompanied by NA. The latter is in line with the notion that a certain level of distress is required to enable the experience of PTG (e.g. Tedeschi & Calhoun, 1995, 2004) and may prove to be an important starting-point for future research into the relationship between PTG and PTSD.
As mentioned in the introduction, currently no consensus exists regarding the relationship between PTG and PTSD. Several explanations have been proposed for this lack of consistency (Helgeson, Reynolds, & Tomich, 2006). Most of them refer to the different designs employed by previous studies, including the operationalization of PTG, the types of trauma under investigation, and the failure to test for moderation by third variables (Helgeson et al., 2006; Hobfoll et al., 2007; Zoellner & Maercker, 2006). Based on the current study's results, one might argue that the dominant affective personality style within a particular sample may also determine whether both outcomes are correlated or not. For example, a significant positive correlation would be expected when most study participants qualify as high affective individuals, because in that case most participants combine high PTSD with high PTG scores.
With the exception of a study by Norlander, Von Schedvin, et al. (2005), the finding that self-actualizing individuals reported equally low levels of PTSD symptomatology with participants in the low affective group seems to contrast with several previous studies conducted in non-traumatized samples. Archer, Adrianson, Plancak, and Karlsson (2007), for example, found that the self-actualizing group reported significantly lower levels of anxiety and depression on the Hospital and Anxiety Scale (Zigmund & Snaith, 1983) than each of the other three groups. Similar results were reported by Karlsson and Archer (2007, in press). Slightly different results were reported by Garcia and Siddiqui (2009), who found that self-actualizing individuals reported the highest levels of psychological well-being on a short version of Ryff's Measurement of Psychological Well-Being (Clarke, Marschall, Ryff, & Wheaton, 2001), although they failed to observe a significant difference between self-actualizing and high affective participants. Presumably, under non-stress conditions low affective individuals report higher levels of distress/lower levels of general well-being than those characterized by self-actualizing personality, while equally low symptom levels are reported in response to trauma.
Although highly speculative, one explanation for the incongruence of the current study's results with those found in other studies is that both self-actualizing and low affective subjects are characterized by high internal locus of control and low external control, whereas high affective and self-destructive individuals score low on internal and high on external control (Archer et al., 2008). Internal locus of control involves the belief that forces shaping one's life are largely within one's control, whereas external locus of control comprises the degree to which one conceives the outcome of an event as uncontrollable and due to luck or chance (Rotter, 1966, 1975). Particularly in the aftermath of trauma, when the adverse impact of the event needs to be overcome, high internal and low external locus of control may be assumed to protect against unsuccessful coping (e.g. Bisson, 2007; Hoge, Austin, & Pollack, 2007), possibly irrespective of affective personality type. By contrast, in the absence of trauma exposure or when external stimuli are not salient enough to trigger the autonomic stress response, perceptions of controllability are perhaps not always capable of predicting psychological distress above and beyond dispositional affectivity. Unfortunately, these contentions seem to have gone largely untested in the existing literature. To address this topic in a methodologically proper manner, future studies will need to employ a design that allows exploring the main effects of trauma exposure, affective personality type, and locus of control on PTSD and the interactions between (severity of) trauma exposure and affective personality type/locus of control. Preferably, they also account for religious believes about the controllability of life events (cf. Göral, Kesimci, & Gençöz, 2006; Karanci & Erkam, 2007).
When interpreting the study's results several limitations must be considered though. Firstly, the cross-sectional nature of the collected data does not allow interpretation of the results in terms of cause and effect. Secondly, due to the rather low response rate, findings may not be generalizable to the population of victims applying for compensation. However, at first sight this possibility does not seem to be very likely, since no differences were observed between participants and non-participants on a wide array of background variables. Thirdly, the specific focus on victims applying for state compensation prevents generalization to the general population of victims of violence and other populations. Fourthly, results may have been biased by participants' interest in compensation (cf. Frueh et al., 2003). This was not deemed very likely though, as all of them had received a final decision on their claim.
Despite these limitations, the study was the first to assess the associations between affective personality type, PTSD symptom severity, and PTG. Its results raised several issues which deserve further clarification. In addition to the propositions made above, a topic that may be addressed in future research is how the four affective personality types relate to other concepts. Given their theoretical similarities, it would be worthwhile to determine whether high affective personality overlaps with borderline personality traits. A recent study by McCormick and colleagues (2007), for example, suggests that average PANAS scores for patients diagnosed with borderline personality disorder are high for both NA and PA. Another issue that may be addressed is the similarities between low affectivity and the concepts of apathy and emotional indifference (Peterson & Janssen, 2007) and type C characteristics. Type C individuals deliberately suppress negative emotions and respond passively in the face of distress (Temoshok, 1987). Consequently, one might argue that Type Cs are likely to report low levels of PA and NA on the PANAS. Finally, in line with previous research (e.g. Klein & Shih, 1998), the association between self-destructive personality type and depressive or dysthymic personality traits deserves to be scrutinized.