The Effect of PTSD on family relationship among Asian American - Research Proposal Example

Literature Review Post Traumatic Stress Disorder or PTSD, is a set of symptoms that are developed in response to intense anxity associated with psychological stressful events like therat of death, physical harm, sexual assualt on self or on close others, being part of disasters, drug addiction and illness (Brunet, Akerib and Birmes, 2007). PTSD may also develop as a result of bullying or being abused. In addition to exposure to traumatic events in life, the development of PTSD is dependent on the severty of the trauma, the biological make up of the individual, the experiences of the childhood (Schnurr, Lunney and Sengupta, 2004) and the existence of social bonds (Charuvastra and Cloitre, 2009). PTSD is more enduring than simple anxiety response and may manifest in the form of the victim having nightmares or flashbacks, inability to sleep or rest, anger and hyper vigilance (Yehuda et al, 2002). Moreover, the PTSD symptoms may become apparent months after the actual event and usually last longer than 30 days. While there are several causes of PTSD, there are also several impacts on the functioning of the individual suffering from PTSD. For example, research has found that parents who have suffered from violent trauma are prone to exposing their children to violence in the form of multi-media or television content, thus increasing their children’s chances of developing PTSD themselves in future (Clarke et al, 2007). The criteria for diagnosis of PSTD has been identified by Diagnostic and Statistical Manual of Mental Disorders IV Text Revision (DSM-IV-TR), as exposure to classified traumatic events, Persistantly experiencing the trauma in the form of flashbacks or nightmares, symptoms of increased arousal, overall syptoms persisting for more than 1 month and lack of normal functioning (American Psychiatric Association, 1994). However, there are several additional and different elements that are used to assesss the existance of PSTD. These include assessing the individual on his responses like becoming numb to emotions, avoiding remembring the event, difficulty in concentration, anger and inability to sleep or relax (Ehlers, Bisson and Clark, 2010; Foa, Keane and Friedman, 2000). It can be seen from the above discussion that PSTD is closely related to emotional numbing which in turn may affect the interaction between people within a family or affect the overall functioning of a relationship. The prevalance of PSTD is around 3.5% or adult population and 4% among adolescents and young adults in 13 to 18 years. Also, 1.3% of the adult Americans and 1.4 adolescents are diagnsed for severere symptoms of PSTD (National Institute of Mental Health, 2011). Figure 1: Percentage of Adult American Population with PTSD (Source: National Institute of Mental Health, 2011) Figure 2: Percentage of Adolescent American Population with PTSD (Source: National Institute of Mental Health, 2011) Figure 3: Percentage of American Population by Gender and Age with PTSD (Source: National Institute of Mental Health, 2011) However, a break up of the PSTD in terms of racial or ethnic background is not available. There is evidence from other research that the incidence of PSTD is relatively higher than the normal population among the South Asians in America (Breslau et al, 2005). However, there is also research that indicates that less use of mental health services by Asian Americans (Chu and Sue, 2011). These findings can be read together to imply that there is both lack of research in the incidence of PSTD among Asian Americans and also a reluctance among this sub group to avail of the mental health services. The current literature on mental health issues related to the Asian Americans indicates that there is a low usage of mental health services among this group of people. A low usage is however, not indicative of a low need for the service, but, it reflects the fact that mental health services may not be adequate for the Asian Americans, or they may not have access to these due to diverse reasons like language barriers, cultural differences and stigma and shame that is attached to seeking mental health services in their culture (Foa and Cashman, 1997). There is a large amount of research in the context of the United States that highlights the fact that Asian Americans are less likely to seek out mental health services (Kearney, Draper, & Baron, 2005). A research done by Wang et al. (2005) found that the reported use of mental health services by the Asians is just 28% of all the probable cases, while for the overall population it is 54%. In addition, there is lack of research on the family dynamics of victims suffering from PTSD. While emotional numbing is a recognized symptom of PTSD (Marx and Sloan, 2002), and also emotional numbing is seen as a sign of the onset of emotional numbing (Romer et al, 2001) the impact that PTSD may have on the family or the relationship due to the emotional numbing is not a well studied topic (Marx and Sloan, 2002). Most of the research that is available is based on studying emotional numbing in victims of assault s or war veterans (Tull and Roemer, 2003).However, the implications of emotional numbing are expected to impact the effectivenes of the victim to function in his relationships. Most of the research that is available is from war veterans in this context. For example, a research conducted involving PTSD diagnosed war veterans and non-PTSD war veterans found that the Veitnam War veterans who had PTSD divorced more, had more than two divorces and also had shorter relationships (Sloan, 2004). Another similar study used partners of PTSD veterans and compared to the partners of non-PTSD veterans and found the partners of the first group suffered from low satisfaction and happiness and felt themselves near to breaking point (Slone and Friedman, 2008). The reasons for these marital problems have been traced to PTSD symptoms like anger and numbing. There is lack of research on the relationship between PTSD and family functioning in the general population as well as for the Asian American sub group. There is also a lack of research in the specific relationship of PTSD and emotional distance that is cited as the reason for marital problems (Slone and Friedman, 2008). 2. Bowen Family System Theory The Bowen Family System Theory considers a family as an emotional unit and the dynamics of the family as being affected by emotional interdependence and connectivity. There are eight elements of the theory as discussed below. Differentiation of Self This is a basic element of the Bowen theory and it discusses the development of the concept of ‘self’ which is reflected by independence and lower emotonal intensity. People who have less differentiated self are more dependent on the acceptance of the others and may exhibit lack of rationality or independent decision making. People who have an evolved differentiation of self are able to take control of their emotions, think rationally and contribute effectively to the family. Triangulation Triangulation is a concept that is closely related to family dynamics in times of conflicts and tensions. It involves three family members, two of whom may form temporary close relationships with each other leaving the third one as the outsider and feeling isolated. The relationships can be juggled with any one person being marked as an outsider, and it helps in reducing anxiety but never leads to a resolution of the problem. Sibling Position According to the Bowen theory, the position of birth plays a role in the attitudes and personalities that spouses manifest later on in their marriage. This is because, people who are first born have leadership qualities while last borns may have dependent attitude, and these may be carried out marital life creating conflicts and leading to clinical issues. Nuclear Family Emotional System A nuclar family is considered as one where both the parents live together, or where there is a single parent with kids, or a step parent in the family. According to the Bowen Theory, the nuclear families exhibit 4 relationship patterns which could lead to the development of stress and clinical symptoms in the members. These relationship patterns are affected by the people’s own attitudes and opinions about themselves. Marital Conflict–In case of conflict and tensions, the spouses externalize their anxiety into the relationship with their spouse. The focus is not on self but on what is wrong with the spouse who is considered as the source of all the anxiety. Dysfunction in Spouse – Here, one of the spouses is controlled and influenced by the other to the extent that this spouse begins to feel redundant to the relationship and also loses self esteem Impairment of Children – The spouses tend to over-indulge in children in order to avoid direct confrontation with each other. Emotional Distance – The spouses distance themselves emotionally in order to avoid confrontations and to reduce anxiety. The above relationship pattern results in temporarily alleviating anxiety but leads to suppression of feelings and may cause clinical problems. Emotional Cut-off As i the case of emotional distance between the spouses, there can also be an attempt to cut off emotionally from the extended family (parents of adults) in order to avoid unresolved conflicts with them. Family Projection Process The family projects and focuses on one child by apprehending that the child suffers from a problem and deciding on a course of action to rectify the problem. However, this over focus and attention makes the child become needy, reactive and less self-goal oriented. Multigenerational Transmission Process This element states that families affect how differenciated the children feel, which in turn leads to their adjustment issues in their marriage. What is more, the process is repeated with the next generation and so on. Henec, the affect on marriage and marital problems mat lie in a process that started generations away. Societal Emotional Process This is a related element of the theory that postulates that the regression is society – due to recession, increasing competition, two career households, and proliferation of drug abuse among young adults – affects the family dynamics. Parents are criticized for lack of time for their kids and hence they end up focusing more intensely on one or more of their children leading to psychological problems. In ordinary circumstances, the family can work as a close knit unit and the interconnectivity between memebrs leads to comfort and peace.However, in the case of stress or tensions (as in the case of PSTD or life events like birth of a child, change in job), the dynamics are affected by changes in functionality of one person that is reciprocated with changes in the other members. 3. Research Questions The literature review has revealed that there is lack of research on the subject of exploring the impact of PTSD on family in the general population. In addition, it is seen that there is no research or direct statistics on the incidence of PTSD in the context of Asian Americans, and also no research on the impact of PTSD on the family in terms of emotional distance in this sub group. As such, the current research questions are: 1. What is the relationship between PTSD and family relationships in a nuclear family system? 2. How is diagnosis of PTSD related to presence of emotional distance between spouses? The research hypothesis therefore is: H: PTSD leads to emotional distance 4. Research Methodology The research is conducted using primary method of data collection where a sample of 35 Asian Americans is considered. The sample is selected in a random manner from among the general population of Asian Americans in the area of Broklyn???NY.??. The researcher contaced the local clinics to get some background data on Asian American victims of PTSD and then followed up through calls to the selected victims. The research is conducted using a survey method where the researchers are asked to provide their choice of responses on two sets of questionnaires – the PTSD diagnosis questionnaire that is available from online version of the Hopkins System Checklist (Foa and Cashman,1997) (Appendix A); and the Marital Conflict/Emotional Distance section of the Nuclear Family Functioning Scale (Appendix B). The responses on both the scales are coded on a Likert style scale ranging from 1 to 5. The code list for each question for both the questionnaires is presented in Appendix 3. The scores for the two questionnaires are correlated in order to assess if there is a direct relationship between PTSD and occurrence of marital conflict and emotional distance. This research therefore helps in highlighting the need to study the linkages between PTSD and family systems and provides the pathways to approach the problem using the Family System questionnaires. Conclusions Discussion and Significance of the Study The responses from the PTSD questionnaire and from the Marital Conflict Emotional Distance section of the Nuclear Family Functioning Scale were correlated and a correlaton coefficient of 0.401 was obtained. The correlation coefficient is substantially higher and this leads to the conclusion that the research hypothesis: “H: PTSD leads to emotional distance” is true. The current research has therefore provided evidence to relate PTSD to family problems, specifically to the emotional distance between spouses among the general population. As already mentioned in the context of the literature review, there is a lack of research done on victims in the general population (majority of available research being on war veterans and their families) and in the population of Asian American sub groups, hence the current research expects to fill this gap in literature. Limitations of the Study The study suffered from the limitation that only 35 respondents could participate in the research, thus limiting the scope of the findings. It is expected that a large scale research, using several cities and clinics across the US is can provide more relevant and expansive data on the relationship between PTSD and emotional distance in family. Appendix A: Questionnaire for PTSD (Taken from: Foa and Cashman, 1997) Appendix B: Nuclear Family Functioning Scale (Souce: Klever, 2001) The Nuclear Family Functioning Scale Theoretical Concept Components of the Concept Symptomatic Outcomes Nuclear Family Emotional Process Husband/Wife Physical Number of health Reciprocal Problems Functioning Number of medications Number of days sick Is the problem chronic or ongoing? Degree of limitation from the health Problem Number of doctor visits for a health Problem Percentage of current weight above or below ideal weight Inpatient hospitalization for a health problem Emotional Number of emotional Problems Number of medications Months with an emotional problem Is the problem ongoing? Degree of limitation from emotional Problem Outpatient therapy or Counselling Percentage of time feeling sad, anxious or worried, and angry Inpatient or partial hospitalization for an emotional Problem Social Illegal behaviour Number of close Friends Alcohol or drug Problem Degree of Irresponsibility at work Number of hours involved in the Community Percentage of time bills are paid on time or without Penalty Marital Distance Percentage of Distance and thoughts and and Conflict feelings told to Conflict Spouse Percentage of time differences are dealt with openly Percentage of interaction that is Conflictual Percentage of conflicts that lead to problem solving or understanding Degree of focus on spouse's weakness or problems Frequency of humor Frequency of thoughts of divorce Separation Counseling for a marital problem Child Focus Physical Number of health problems Number of medications Is the child over/ underweight? Is the problem ongoing? Degree of limitation Number of days sick Inpatient hospitalization Emotional Number of emotional problems Is the problem ongoing? Number of medications Inpatient or partial hospitalization Number of months with an emotional problem Outpatient therapy or counseling Degree of limitation Amount of time a day fussy, crying, or irritable Social Frequency of trouble or discipline problems at school or day care Ability to get along with friends Involvement in a community group or extracurricular activity Problem related to the law, alcohol, drugs, or sexual behavior References: American Psychiatric Association.(1994). Diagnostic and statistical manual of mental disorders, quick reference. Washington, D.C.: American Psychiatric Association. Bowen Theory. (nd). Retrieved from: http://www.thebowencenter.org/pages/theory.html Breslau, J., Kendler, K. S., Su, M., Gaxiola-Aguilar, S., & Kessler, R. C. (2005). 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