Parenting in individuals with and without PTSD: The effect of attachment, distress, and posttraumatic growth.

Over recent decades, there has been extensive research on the impact of post-traumatic stress disorder on a range of psychological factors and negative behaviors, and more recently on positive responses and growth following a traumatic event. Although there is an awareness of the clinical implications of posttraumatic stress disorder on parenting, few empirical studies have addressed this issue. Those studies that have examined it, have indicated that there is significant damage to the parenting of people with PTSD. However, these studies concentrated mainly on combat soldiers, who were consequently diagnosed with post-traumatic stress disorder, and not in individuals from the community, who have experienced a range of traumatic events

The purpose of this study was to examine the perception of parenting in people with posttraumatic stress disorder, who are parents of children aged 2-18, both fathers and mothers, who have experienced diverse traumatic events. Parenting was examined in this study using two variables: parental behavior and parenting satisfaction. The study group was compared to a control group, parents without post-traumatic stress disorder, who were matched on background characteristics. The main hypothesis was that parents with post-traumatic stress disorder would show more negative parental behavior, and lower parenting satisfaction, than parents without post-traumatic stress disorder. Also, it was hypothesized that more severe symptoms of post-traumatic stress disorder would be related to more negative parenting behavior and lower parenting satisfaction. In addition, a further hypothesis was that the parent’s trauma history, and their attachment style would be related to study variables. Finally, the study examined whether depression and post-traumatic growth mediated the relationship between post-traumatic stress disorder and parental behavior and parenting satisfaction.

The study population included 94 parents of children aged 2-18, of whom half met criteria for posttraumatic stress disorder, and half were a control group who did not meet criteria for posttraumatic stress disorder; groups were matched for gender, age, age of the child, education level and family status. Parents with posttraumatic stress disorder were identified through three main psychiatric out-patient clinics, Hadassah Ein Kerem, Jerusalem, Ichilov, Tel Aviv, and Hillel Yafe, Hadera. In addition, the study questionnaires were available through a website, that was specially built for the study, and was made available via internet groups.  The control group was recruited via a snowball method, and subjects either filled in questionnaires on paper, or via the online research site. Questionnaires included:  parental behavior (APQ-9; Elgar, Waschbusch, Dadds, & Sigvaldason, 2007), parenting satisfaction questionnaire (Parenting Satisfaction; Kurdek & Fine, 1991), posttraumatic symptoms questionnaire (PDS, Foa, Cashman , Jaycox, & Perry, 1997), posttraumatic growth questionnaire (PTGI; Tedeschi & Calhoun, 1996), attachment styles questionnaire (ECR, Brennan, Clark & ​​Shaver, 1998), depression (BDI-II, Beck, Steer , & Brown, 1996), and a demographic questionnaire.

Findings indicate group differences regarding parenting satisfaction, traumatic history, attachment style, depression and post-traumatic growth. Hypotheses related to parental behavior were partially confirmed, with a significant difference between groups in terms of  inconsistent discipline. In addition, as has been hypothesized, severity of posttraumatic symptoms was related to more inconsistent discipline of the parents and lower parenting satisfaction. The study also confirmed the hypothesis that more traumatic events in the past were related to more inconsistent discipline of the parents and lower parenting satisfaction. As for attachment style, findings suggest that avoidant and anxious parenting styles, were related to more inconsistent discipline of the parents and lower parenting satisfaction. However, no relationship was found between attachment style and parental behavior. The findings also indicate that the higher the level of depression, then inconsistent discipline of the parents and parenting satisfaction were lower. However, contrary to expectation, the results of the study indicate that as higher post-traumatic growth was related to lower satisfaction with parenting.

Further to this, in accordance with the research hypotheses, the findings of this study indicate that depressive symptoms partially mediate the relationship between the severity of posttraumatic stress disorder and parenting satisfaction. However, contrary to expectations, depression and post-traumatic growth did not mediate between the severity of PTSD symptoms and parental behavior, and post-traumatic growth was not found to mediate between the severity of PTSD symptoms and parenting satisfaction. These findings indicate that PTSD symptoms are related to parental behavior, without the mediation of depression and post-traumatic growth. In addition, depression is important in contributing to the relationship between symptoms of PTSD and parenting satisfaction. Finally, in examinating the relative impact of the research variables in explaining parental behavior the results indicate that the difference between the groups with and without parental PTSD predicts the inconsistency of parental discipline. In addition, examinating the relative impact of the research variables in explaining parenting satisfaction, the results indicate that depression and characteristics of attachment, avoidant style predicted lower parenting satisfaction.

Examining the relative contribution of the research variables inconsistency in discipline is that the difference between the groups with and without parental PTSD predicts the inconsistency of parental discipline. Also examining the relative contribution of the variables of parenting satisfaction research indicates that characteristics of depression and attachment style did, predict lower satisfaction with parenting.

This study contributes to theoretical, research and clinical knowledge regarding the consequences of PTSD on parenting. The current study expanded and deepened the existing limited theoretical knowledge about the parenting of people with posttraumatic stress disorder, and the meaning lots of post-traumatic stress disorder, as well as the associated stress disorder trauma growth side. These findings show the importance of clinical awareness regarding the implications of PTSD on parents, as well as on the whole family system, including young children. It also indicates the need to develop prevention and treatment programs for parents and other family members, emphasizing the potential negative consequences of PTSD, along with growth and development. In addition, the reality in which children grow up with a parent dealing with PTSD, which is characterized by  symptoms such as avoiding negative emotions, irritability and outbursts of anger, may put the population of children of these parents at risk. Hence there is great importance for research that could assist these children, and furthermore, to prevent the transfer of trauma to future generations.