The Struggle to Grow: Profiles of Posttrauma Adaptation Among Veterans Exposed to Combat Related Trauma

Background and Purpose. There is a growing recognition that adaptation following traumatic events is a complex, nuanced, and dynamic process that results in a diverse range of adaptation trajectories including: (1) predominately symptomatic (e.g. posttraumatic stress disorder; PTSD); (2) resilience; and (3) posttraumatic growth (i.e. positive psychological gains following trauma; PTG) to name a few. However, there are inconsistencies in the literature regarding the relationship among these trajectories, in particular the complex relationship between distress and growth. The current study aims to clarify the relationship among these adaptation profiles, with particular attention to the interaction between growth and distress. Methods. Using secondary data to conduct latent profile mixture modeling in a sample of Israeli male military veterans (N = 448), we identified four distinct profiles of post-combat adaptation. These profiles were developed based on the level of endorsement to the following indicators: (1) total PTG (Posttraumatic Growth Inventory; Tedeschi & Calhoun, 1996); (2) use of positive cognitive emotion regulation strategies (The Cognitive Emotion Regulation Questionnaire; Garnefski & Kraaij, 2006); as well as (3) meeting diagnostic criteria for PTSD on four symptom subscales- avoidance, hyper arousal, re-experiencing, and functional impairment (The Posttraumatic Stress Diagnostic Scale; Foa, Cashman, Jaycox, & Perry, 1997). The goodness of fit statistics for the two, three, four, and five class models were compared using the following goodness of fit indicators: AIC, BIC, entropy values, the Lo-Mendell Rubin likelihood ratio test, and the bootstrapped likelihood ratio test. Based on the comparative model fit indices and the interpretability of the classes the four class model was selected as the best fitting model. Results. The four latent classes are characterized as: (1) Distressed (n=25, 5.58%); (2) Resistant (n = 35, 7.81%); (3) Resilient (n= 138, 30.80%); and (4) Struggling (n = 250, 55.80%). The distressed subgroup is characterized by a high probability of endorsing PTSD diagnostic criteria. Conversely, the resistant class is characterized by a low probability of endorsing PTSD symptomology. The resilient and struggling latent classes both reported slightly above average levels of PTG. Interestingly, the struggling latent class was differentiated from the resilient group as this profile also had a high probability of endorsing all four PTSD diagnostic criteria. Conclusion. These findings suggest that posttrauma adaptation reflects heterogeneous profiles based on a complex combination of growth, distress, and coping indicators. Further we suggest that the inconsistencies noted in previous literature may reflect different profiles of adaptation. Indeed this study identifies a group of veterans reporting only PTSD symptomology, only PTG, and simultaneous reports of PTSD and PTG. Implications and future research. The policies surrounding trauma informed care are determined by narrow definitions of posttrauma adaptation. These findings suggest the current definitions could be extended beyond PTSD to encompass a more holistic picture of trauma adaptation.  Further, these findings highlight the importance of tailored clinical interventions that focus on the unique characteristics of adaptation profiles. Future research may work to identify predictors of latent class membership, and the implications of membership within these profiles over the life course.