Partner accommodation of PTSD symptoms involves modifying one’s behavior in response to the PTSD symptoms of a loved one. Examples include avoiding triggering situations, taking on extra responsibilities, or not expressing one’s own feelings.
While often well-intentioned, accommodation can inadvertently maintain PTSD symptoms and cause distress for both partners. Studying accommodation from both partners’ perspectives can provide insights for prevention, assessment, and couples-based PTSD interventions.
Kenny, J. J., Allen, E., Renshaw, K., Bhalla, A., & Fredman, S. J. (2022). Two perspectives on accommodation of PTSD symptoms: Partners versus service members. Couple and Family Psychology: Research and Practice, 11(4), 273–289. https://doi.org/10.1037/cfp0000184
Key Points
- This study examined service members’ (SMs) and partners’ perceptions of the frequency of and distress regarding partner accommodation of SM PTSD symptoms in a nonclinical sample of Army couples.
- SM and partner reports of partner accommodation frequency were significantly correlated and did not differ on average, but there were differences for certain specific accommodative behaviors.
- Partners reported higher overall distress about engaging in accommodation compared to SMs’ distress about the partners’ accommodation.
- Partner accommodation, from both SM and partner perspectives, correlated with higher SM PTSD symptoms, hostility, and depression in both partners and lower relationship satisfaction in both partners.
- Partners’ accommodation frequency uniquely predicted their own lower relationship satisfaction, controlling for other factors, whereas SM perception of partner accommodation frequency did not uniquely predict SM relationship satisfaction.
Rationale
Prior research has found that partner accommodation of PTSD symptoms, as reported by the partner, is associated with greater PTSD severity and individual and relationship distress in couples with one partner diagnosed with PTSD (Fredman et al., 2014).
However, little is known about how the trauma survivors themselves perceive the frequency and impact of their partners’ accommodative behaviors compared to partner reports.
Obtaining reports from both members of the couple can provide insight into how accommodation manifests and is experienced in military couples following deployment, even in a nonclinical sample.
This study addresses this gap by directly comparing SM and partner perceptions of accommodation frequency and associated distress in a sample of male SM-female partner Army couples.
Method
The study used a cross-sectional survey design.
Male Army SMs and their female partners completed measures of perceived frequency of the female partner’s accommodation to the male SM’s PTSD symptoms and distress related to the accommodation.
They also completed measures of PTSD symptoms, depression, hostility, and relationship satisfaction.
Procedure
Army couples consisting of a recently deployed male SM and a civilian female partner were recruited online.
259 couples with complete data were included. Both partners completed an online survey containing the study measures.
Sample
Participants were 259 male Army SMs and their female civilian partners. SMs were an average age of 31 and partners 30. 98% were married. 80% were White, 10% Hispanic, 5% Black, 5% other. 98.5% of SMs had an OEF/OIF deployment.
Measures
- SORTS (completed by female partner): 14-item self-report of frequency of and distress regarding own accommodation of SM PTSD symptoms
- PO-SORTS (completed by SM): Adaptation of SORTS to assess SM perception of partner’s accommodative behaviors and own distress
- PCL-M: 17-item SM self-report of PTSD symptoms
- PCL-M collateral version: Partner report of perceptions of SM’s PTSD symptoms
- DASS-21 depression subscale: Completed by both partners regarding own depressive symptoms
- BSI hostility subscale: Completed by both partners regarding own hostility
- CSI-4: Completed by both partners regarding own relationship satisfaction
Results
- SM and partner reports of accommodation frequency were correlated (r = .44) and did not differ on average. Some differences emerged for specific behaviors.
- Partners reported higher overall distress about engaging in accommodation vs. SMs’ distress about partners’ accommodation.
- Both SM and partner perceptions of accommodation frequency correlated with higher SM PTSD symptoms, hostility, and depression in both partners and lower relationship satisfaction in both partners.
- Partner accommodation frequency uniquely predicted partner relationship satisfaction, when controlling for other factors. SM perception of partner accommodation did not uniquely predict SM relationship satisfaction.
Insight
This study provides new insight into how both members of military couples perceive the manifestation and impact of partner accommodation of PTSD symptoms.
While SM and partner perceptions converged in many respects, the results suggest accommodation is more distressing for the partner engaging in it than for the SM being accommodated, on average.
Item-level differences point to potential mismatches in perceptions of certain accommodative behaviors that could be clinically relevant to explore.
The findings extend prior work by demonstrating that the frequency of accommodation relates to a range of individual and relational difficulties for both partners, even in a nonclinical sample with subclinical PTSD symptoms on average. This underscores the importance of partner accommodation as a potential intervention target.
Further research could explore other factors that influence levels of accommodation and associated distress, such as beliefs about accommodation, chronicity of symptoms, reasons/motivations for accommodating, and how perceptual differences between partners relate to outcomes.
Longitudinal research could examine patterns of accommodation and outcomes over time.
Strengths
- Included both partners’ perspectives on accommodation
- Examined accommodation in relation to both individual and dyadic adjustment
- Assessed convergence and divergence of partner reports at both scale and item level
- Oversampled for presence of some PTSD symptoms
- Used psychometrically sound measures
Limitations
- Cross-sectional design precludes causal conclusions
- Sample lacked diversity in race/ethnicity, sexual orientation, military status, and couple composition, limiting generalizability
- Recruitment and data collection occurred entirely online
- Did not require a PTSD diagnosis for inclusion
Clinical Implications
The present study supports collecting reports on partner accommodation of PTSD symptoms from both members of the couple in clinical and research settings.
While patient-only reports can inform case conceptualization when the partner is unavailable, obtaining both perspectives allows for a more comprehensive understanding of how accommodation manifests and impacts the couple.
Comparing partners’ reports can reveal meaningful similarities and differences. For example, this study found differences in perceived frequency of accommodation, possibly related to symptom/behavior overtness, and differences in distress, with partners engaging in accommodation being more distressed than those being accommodated.
In couples therapy, assessing partners’ perceptions of accommodation frequency and distress can guide psychoeducation, treatment monitoring, and exploration of discrepancies.
Partners can learn supportive strategies that don’t maintain PTSD symptoms. Cognitive-Behavioral Conjoint Therapy for PTSD targets accommodation and has been shown to decrease partner accommodation in both traditional and abbreviated formats.
References
Fredman, S. J., Vorstenbosch, V., Wagner, A. C., Macdonald, A., & Monson, C. M. (2014). Partner accommodation in posttraumatic stress disorder: Initial testing of the Significant Others’ Responses to Trauma Scale (SORTS). Journal of Anxiety Disorders, 28(4), 372–381. https://doi.org/10.1016/j.janxdis.2014.04.001
Keep Learning
Questions for class discussion of this paper:
- What are some potential reasons why partners may be more distressed about engaging in accommodation compared to SMs’ distress about receiving accommodation? How might gender roles and military culture factor in?
- The study found that partner accommodation related to individual and relationship distress even in a nonclinical sample with generally low PTSD symptoms. What are the implications of this finding for prevention and early intervention efforts with military couples?
- What other factors besides PTSD symptom severity do you think could influence the level of accommodation a partner engages in and the associated distress for both partners?
- Why might there be differences in SM and partner perceptions of the frequency of certain accommodative behaviors? How could exploring these differences potentially benefit the couple?
- How could gathering data from both partners about accommodation inform clinical assessment and treatment planning for couples with one partner experiencing PTSD? What are some specific ways this information could be used in therapy?
