Posttraumatic stress disorder (PTSD) frequently occurs in female rape and physical assault victims. Within one week of these traumas, female sexual assault victims (up to 94%) and physical assault victims (71%) have been found to meet the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised
; American Psychiatric Association, 1987
) symptom criteria for PTSD (omitting Criterion E, which requires >1 month duration of symptoms; Riggs, Rothbaum, & Foa, 1995
; Rothbaum, Foa, Riggs, Murdock, & Walsh, 1992
). By 3 months after the assault, these numbers diminish to 47% of sexual assault victims and 21% of physical assault victims, indicating that although PTSD exists at high rates for these types of victims, a large percentage of people naturally recover from traumatic events. This research indicates that the presence of a trauma alone is not sufficient for a person to develop PTSD; instead, it is likely that a range of factors contribute to the failure of recovery. Factors such as personality characteristics of the victim (Schnurr, Friedman, & Rosenberg, 1993
), the relationship between the perpetrator and the victim (Leahy, Pretty, & Tenenbaum, 2004
; Lucenko, Gold, & Cott, 2000
), peritraumatic reactions such as dissociation and other responses (Birmes et al., 2003
; Kaysen, Morris, Rizvi, & Resick, 2005
), as well as different approaches to managing the effects of trauma (for a review, see Resick, 2001
) have all been shown to play a role in the maintenance of PTSD symptomatology.
How one copes and responds after a trauma may provide valuable information on risk and resiliency factors in PTSD, although research in this area is surprisingly limited. Coping strategies utilized to deal with the effects of a trauma can be broadly categorized as cognitive or behavioral (Waldrop & Resick, 2004
), as well as effective or ineffective in reducing distress (Resick, 2001
). Cognitive strategies involve attempts to change the way one thinks about a situation, such as cognitive restructuring, wishful thinking, self-blame, and self-criticism, as a means of reducing distress about the situation or an attempt to make meaning of it. Behavioral strategies are observable actions one takes as an attempt to reduce the impact of stress, including withdrawing from others, or conversely seeking social support, and problem-avoidance.
Theories of PTSD (e.g., Ehlers & Clark, 2000
; Foa & Kozak, 1986
; Mowrer, 1960
), have focused on the importance of escape and avoidance in preventing natural recovery and maintaining the symptoms of PTSD. For example, Foa and Kozak (1986)
have proposed that, following traumatic events, people develop a fear network in which traumatic reminders and strong fear responses occur frequently. To decrease the intensity and frequency of these intrusive reminders, the person copes through avoidance of these stimuli, which ultimately leads to failure to process the fear responses effectively and the maintenance of PTSD symptoms. Social cognitive theorists, such as Benight and Bandura (2004)
, suggest that resource loss after experiencing trauma (Hobfoll, 1991
) leads to a loss of perceived self-efficacy and avoidant coping. Resick (2001
has also described how coping through avoidance maintains distress because the affected person does not receive corrective information from others regarding any distorted beliefs about the event and does not have an opportunity to process emotions emanating from the event.
Consistent with these theories, research that has examined the relationship between coping strategies and PTSD has consistently found that avoidant coping strategies are associated with increased PTSD symptomatology after various traumatic events. Such events include motor vehicle accidents (Bryant & Harvey, 1995
), child sexual abuse (Coffey, Leitenberg, Henning, Turner, & Bennett, 1996
), adult sexual assault (Gibson & Leitenberg, 2001
), and adult physical assault (Valentiner, Foa, Riggs, & Gershuny, 1996
). Similarly, a more recent study showed that avoidant coping was related to increased PTSD symptoms in a sample of female domestic violence survivors (Street, Gibson, & Holohan, 2005
Two studies have demonstrated that coping differs as a function of assault type. Valentiner et al. (1996)
found that rape victims had higher levels of both wishful thinking and PTSD severity than physical assault victims at 3 months after the assault. A study conducted with recent female sexual and physical assault victims showed that levels of dissociation after trauma, which has been conceptualized as a form of avoidant coping (see Wagner & Linehan, 1998
), declined over the course of the 3-month study (Dancu, Riggs, Hearst-Ikeda, Shoyer, & Foa, 1996
). However, dissociation scores were only significantly related to PTSD diagnosis and symptom severity in the physical assault victims. These results indicate some potential differences in coping strategies between sexual and physical assault victims.
Coping strategies have also been investigated by perpetrator status in one study. In a sample of female sexual assault victims, sexual distress following the trauma was more common for women whose perpetrator was an intimate, whereas fear and anxiety were more common characteristics when the perpetrator was unknown to the victim (Ullman & Siegel, 1993
). Additionally, women assaulted by a stranger were more likely to talk about the assault with others than women who had known the perpetrator. Aside from these two specific differences, there were few differences in psychological sequelae and social support seeking by victim–perpetrator relationship.
Despite this growing body of research on coping strategies and PTSD, there are a number of problems with existing studies that limit their generalizability and applicability. Waldrop and Resick (2004)
in their review of coping literature determined that cross-sectional methodology was the central limitation of past coping research. To our knowledge, all of the existing research on coping strategies after trauma have employed cross-sectional analyses or have asked participants to provide retrospective data covering large periods. Therefore, it is impossible to draw any conclusions about the causal influences of coping strategies on the development of (or resilience to) PTSD.
Cross-sectional analyses also fail to take into account the dynamic nature of these processes and PTSD symptomatology. Rather than conceptualizing coping and response strategies as static entities, it seems more likely that they change over time as the person adapts (or fails to adapt) after the trauma. In the current study, this oversight is addressed by examining changes in coping strategies among recent female rape and physical assault victims over a 3-month period, and their relationship to changes in PTSD symptomatology. Changes in coping and PTSD symptoms were also examined as both a function of assault type (sexual vs. physical assault) and perpetrator status (known vs. stranger) to better understand the role that these variables play in posttrauma psychological distress. We hypothesize that increases in certain adaptive strategies such as problem solving, cognitive restructuring, social support, and expressed emotion will be linked to greater improvements in PTSD symptomatology, whereas increases in maladaptive forms of coping such as problem avoidance, wishful thinking, social withdrawal, and self-criticism will be linked to less improvement over time.