Findings indicate that women seeking help for intimate partner aggression experience heightened levels of negative physical health symptoms. On average, participants endorsed experiencing 24 of the 58 (41%) symptoms on the modified PILL at least every month, and 22 of the 54 (41%) original PILL items. These rates are very high relative to other studies using the unmodified PILL. For example, Richards, Beal, Seagal, and Pennebaker (2000)
reported a 27% symptom endorsement rate in their psychiatric sample, and Bennett, Smith, and Gallacher (1996)
reported a 20% symptom endorsement rate among hospital patients admitted for myocardial infarction. Taken together with findings of associations between partner aggression measures and physical health symptoms, the data are consistent with previous studies demonstrating a strong link between relationship aggression and poorer physical health (Campbell, 2002
Results of the SEM analyses supported the hypothesis that both physical and psychological aggression would be fully mediated by PTSD symptoms. Consistent with prior studies among other trauma groups (e.g., Taft et al., 1999
), PTSD symptoms were strongly associated with physical health and served as an important variable with respect to explaining the effects of trauma on physical health. The data suggest that both physical and psychological aggression exert their damaging health effects primarily through their relationship to PTSD symptomatology.
For the most part, the negative affect variables did not mediate the PTSD–physical health relationship, with anger/irritability representing an exception to this pattern. These findings run counter to one study (Sutherland et al., 2002
) in which depression severity partially accounted for the association between stress and physical health among a community sample of women, half of whom had experienced intimate partner physical aggression. Findings also appear at odds with the notion that depression and anxiety partially account for the association between PTSD symptoms and physical health (Schnurr & Green, 2004
). However, little or no prior research has examined the indirect effect of PTSD symptoms on health through negative affect variables, and few studies have examined the three negative affect variables of interest together in the same model. Associations commonly found between anxiety, depression severity, and physical health may be at least partially accounted for by PTSD symptoms and anger/irritability.
The mechanisms whereby anger/irritability may lead to poorer physical health among battered women deserve more careful study. One possible explanation for these findings derives from psychosocial vulnerability models that hypothesize lower levels of social support and more stressful life events among those experiencing problems with anger (Smith, 1992
). Low social support has consistently been associated with higher PTSD symptoms among those exposed to trauma (King, King, Fairbank, Keane, & Adams, 1998
) and poorer physical health (Kimerling & Calhoun, 1994
). It is also plausible that those with anger dysregulation problems represent a group who experience more chronic, unremitting PTSD symptoms and therefore experience poorer health. Research among crime victims has shown that those with elevated levels of anger benefit less from PTSD treatment (e.g., Foa, Riggs, Massie, & Yarczower, 1995
Results highlight the importance of health screening and patient education efforts in settings serving women who have experienced relationship aggression (Sutherland et al., 2002
). The provision of information regarding the common health-related sequelae of trauma and PTSD and how to avoid such problems may ameliorate these negative consequences of victimization. Results further suggest that interventions targeting PTSD symptoms may lead to improved physical health among victims of relationship aggression. Some preliminary evidence from undergraduate samples indicates that the disclosure and processing of traumatic material is associated with long-term decreases in health problems (Pennebaker & Beall, 1986
Several unexamined variables may help to explain the direct association found between PTSD symptoms and physical health. Many theoretical models hold that PTSD symptoms lead to health problems through health risk behaviors such as poor sleep and diet, lack of exercise, low health care utilization, poor adherence to medical regimens, and substance use (Schnurr & Green, 2004
). Physiological reactivity, which accompanies PTSD (Carson et al., 2000
), has also been hypothesized as a mechanism for poorer health (Sirois & Burg, 2003
). Several other biological factors have been linked with PTSD and proposed to serve as mechanisms for poor health among those exposed to trauma, such as alterations in neurotransmitter and neuroendocrine activity in the adrenergic and hypothalamic–pituitary–adrenal systems, immune system activity abnormalities, and sleep dysregulation (Friedman & McEwen, 2004
The use of cross-sectional data limits our ability to draw causal conclusions. It is possible that physical health symptoms influenced the reporting of psychological symptoms, possibly inflating obtained associations. It is also possible that the effects of some variables may only be evidenced when examined over time. Prospective studies are clearly needed to more fully understand the relationships among study variables. Another limitation was our reliance on self-reports of physical health and psychopathology. Factors such as symptom exaggeration, mislabeling of symptoms, and somatization may inflate associations between PTSD symptoms and physical health symptoms (Schnurr & Green, 2004
). Our focus on health symptoms may have also affected associations among study variables, because symptom measures typically contain items that may reflect symptoms of anxiety or depression (e.g., dizziness, insomnia; Sutherland et al., 2002
). Future research should supplement self-report symptom measures with objective measures of physical health functioning. Finally, participants experiencing less frequent and severe physical aggression were excluded from this study. Such exclusion may have lead to the relatively higher levels of aggression victimization reported in this sample relative to prior research in this area (e.g., Sutherland et al., 2002
). The degree to which current study findings can be generalized to those experiencing lower levels of physical aggression is unknown. This exclusion may have also lead to reduced variability in the physical aggression variable and a deflation of obtained associations.
Despite these caveats, this investigation represents an important initial step in documenting the associations between intimate partner aggression, PTSD symptoms, and physical health symptoms among a sample of women seeking help for relationship aggression. Results suggest that PTSD symptoms operate as a mediator with respect to the association between relationship aggression and poorer health, and PTSD may exert its impact on health in part through its association with higher levels of anger/irritability. It is hoped that findings from this investigation will stimulate further research in this area of inquiry, and more complex theoretical models will be specified and empirically tested.