A Dual-Model of Posttraumatic Stress and Posttraumatic Growth in a Community Sample of Female Conflict-Related Sexual Violence Survivors from Bosnia and Herzegovina

Background: Posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) are known psychological outcomes that can co-occur in the aftermath of a traumatic event. However, it is less clear how these outcomes interact – particularly for female survivors of conflict-related sexual violence (CRSV) – and to what extent intermediary factors play a role in this relationship. Methods: In a sample of 192 war survivors from Bosnia & Herzegovina (n = 104 experienced CRSV, n = 88 did not), a structural equation model (LISREL 8.8) tested CRSV as a traumatic event, 'positive reinterpretation' (as a strategy of approach coping) and 'behavioural disengagement' (as a strategy of avoidance coping), and PTSD and PTG as psychosocial outcomes. A difference in the mechanisms by which PTG and PTSD interact in the two subgroups was hypothesised, given the differences in the nature of the trauma they experienced. Results: Through multiple indirect relationships, results showed that CRSV survivors respond to their trauma with both PTSD and PTG, suggesting a dual PTSDPTG mechanism. As for coping strategies, positive reinterpretation predicted greater PTG, and behavioural disengagement predicted greater PTSD. In the sample of nonsexual violence survivors, positive reinterpretation also remained a significant predictor of PTG. Conclusions: Positive reinterpretation as a coping strategy appears to be a stable characteristic that independently predicts PTG, irrespective of trauma type. Mental health professionals should take into account this mechanism when addressing the needs of CRSV survivors, but also war survivors more generally. Reframing traumatic events and post-trauma sequalae during treatment could lead to PTG and enhance recovery.