There is little doubt that trauma exposure and the associated clinical syndrome of posttraumatic stress disorder (PTSD) affect a significant number of individuals [1
], are associated with extensive psychiatric comorbidity [2
], and are linked with impairment across a number of psychosocial domains [4
]. Despite this considerable body of research, the concept of posttraumatic growth, or the possibility that an individual can “grow” psychologically from an adverse life event, has gained increased attention in the past few years [5
]. Although the term used to describe posttraumatic growth has varied across studies (e.g., “perceived benefits,” “positive psychological changes,” “stress-related growth”) [6
], the conceptual aim of measuring growth outcomes typically has been to assess whether individuals can in some way move beyond a premorbid level of functioning following a traumatic event [10
]. Thus, within the posttraumatic growth framework, an adverse experience is viewed as a potential catalyst for positive psychological and interpersonal change.
Studies examining a variety of adverse experiences such as disasters [11
]; child abuse [7
]; accidents [12
]; rape [13
]; cancer [14
]; and bereavement [17
] have found that reports of growth are common. Altogether, these studies generally have revealed up to five categories of growth outcomes reflecting psychological, interpersonal, and life orientation changes [6
]. These categories broadly include, but are not limited to, perceived changes in the self such as greater self-efficacy and self-reliance, changed relationships with others, increased spirituality or changes in life philosophy, heightened awareness of new possibilities, and a greater appreciation of life. Consistent with these categories, researchers have documented increased feelings of self-efficacy among bereaved elderly women [19
]; greater self-trust and self-worth among rape survivors [7
]; strengthened relationships with family members and a better perspective on life among parents of at-risk infants [20
], a perception of being better able to handle future problems among cancer patients [14
]; and an increased appreciation for life and increased religiosity among bereaved spouses and parents [17
Although reports of growth are common, the relationship between growth outcomes and psychological adjustment is unclear. It seems plausible that the ability to derive growth from a traumatic event could serve to ameliorate the negative psychological effects of the trauma. In support of this view, researchers examining a wide range of stressors have documented an inverse relationship between a number of growth domains and measures of adjustment [11
]. However, other studies have yielded mixed support for this relationship [7
], while a third group of studies have failed to find a significant relationship between measures of adjustment and growth [15
]. Clearly, additional efforts are needed to clarify the relationship between growth outcomes and measures of adjustment.
The use of study-specific growth outcomes likely has complicated the effort to examine how psychological growth relates to symptom severity. That is, most of the existing literature has relied on qualitative assessments of perceived benefits such as anecdotal reports during interviews (e.g., [19
]), or general or brief questions about perceived benefits (e.g., [14
]). To date, there are fewer studies examining the relationship between growth outcomes and symptom severity using more formal growth instruments, such as the Posttraumatic Growth Inventory (PTGI), that can generalize across samples [15
]. Furthermore, a number of studies have used events that do not necessarily meet DSM-IV [1
] diagnostic criteria for a traumatic stressor (e.g., [14
]). This is an important conceptual distinction because medical stressors or bereavement may be qualitatively different than the experience of a traumatic stressor such as a sexual or physical assault.
After narrowing growth outcomes studies to those using events likely to meet DSM-IV diagnostic criteria for a traumatic stressor [7
], and to those that included measures of psychopathology [11
], few studies remain. Far fewer studies remain using the PTGI or a measure of growth than can be compared across samples [28
]. Because of the frequency with which treatment-seeking trauma victims present with symptoms of PTSD and depression, the relationship between these disorders and growth outcomes is of interest to clinicians and warrants research attention. That is, it is of interest whether or not growth outcomes serve a protective function in this population, and if so, the effects of fostering such outcomes during the recovery process.
The purpose of the present study is to describe reports of growth and to explore the relationship between growth outcomes and symptom severity using a sample of treatment-seeking female physical and sexual assault victims. Comparisons will be made between posttraumatic growth scores and severity and diagnostic measures of PTSD and depression, and our growth findings will be compared to other samples using the PTGI. This study will expand the previous literature by using DSM-IV defined assault, and by including diagnostic interview measures of depression and PTSD, as well as the PTGI. Furthermore, the treatment-seeking women in this sample are self-identified as distressed and in need of services. Thus, they represent a unique subset of trauma survivors within the growth literature.