Social Reactions to IPV Disclosure and PTSD Symptom Severity: Assessing Avoidant Coping as a Mediator

Abstract

Women’s experiences of negative social reactions to disclosure of intimate partner violence (IPV) victimization have been linked to greater posttraumatic stress disorder (PTSD) symptom severity. However, research has not identified factors that may explain this association. The goal of the current study was to extend research in this area by elucidating the potential mediating role of avoidant coping in the relations among negative and positive social reactions to IPV disclosure and PTSD symptom severity. Participants were 173 community women currently experiencing IPV who disclosed their victimization to another individual (M age = 36.31, 65.9% African American). Findings revealed that IPV-victimized women who experienced greater negative social reactions to IPV endorsed higher levels of avoidant coping and greater PTSD symptom severity. Moreover, avoidant coping was found to mediate the negative social reactions–PTSD symptom severity association. Results highlight the relevance of avoidant coping to the link between negative social reactions to IPV disclosure and PTSD symptom severity, and suggest that prevention and intervention efforts targeting avoidant coping may be useful in reducing PTSD symptom severity among IPV-exposed women who experience negative social reactions to IPV disclosure.

Keywords

intimate partner violence negative social reactions positive social reactions disclosure avoidant coping posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is one of the most prevalent mental health consequences affecting victims of intimate partner violence (IPV), with rates up to 12 times the national average (Golding, 1999). PTSD is characterized by intrusion (e.g., intrusive thoughts and memories, nightmares, flashbacks), avoidance (e.g., avoidance of trauma-related cues), cognitive/affective (e.g., self-blame, restricted range of affect, negative trauma-related emotions), and hyperarousal (e.g., hypervigilance, exaggerated startle response) symptoms following exposure to a traumatic event (American Psychiatric Association [APA], 2013). IPV-related PTSD is associated with a broad range of negative health correlates, including physical (e.g., chronic pain, headaches, digestive issues; Coker, Smith, Bethea, King, & McKeown, 2000) and mental (e.g., PTSD and depressive symptoms; Weiss et al., 2017) health problems and risky health behaviors (e.g., risky sexual behavior, substance use, deliberate self-harm; Weiss et al., 2017). Moreover, most IPV-victimized women exhibit significant impairment in functioning related to posttraumatic stress (Criterion G for PTSD in the Diagnostic and Statistical Manual of Mental Disorders; 5th ed.; DSM-5; APA, 2013; for example, impairment in social and occupational functioning), even when full diagnostic criteria for the disorder are not met (Hellmuth, Jaquier, Swan, & Sullivan, 2014). Given that PTSD is prevalent among IPV-victimized women and associated with deleterious outcomes, it is important to identify factors that may contribute to PTSD symptom severity in this population.

Many IPV-victimized women choose to talk about their victimization—or “disclose” it—to people in their support networks (see Sylaska & Edwards, 2014, for a review). How recipients of these disclosures respond both verbally and nonverbally to victims (i.e., social reactions) has been shown to be related to women’s well-being (for reviews, see Ullman, 1999, 2010). Social reactions are generally divided into categories of positive and negative reactions such as believing, validating the victims’ experiences and disbelieving, blaming the victim, respectively (for reviews, see Ullman, 1999, 2010). Most of the empirical research on victimization disclosure and social reactions has been conducted specific to sexual assault disclosure (e.g., Littleton, 2010; Orchowski, Untied, & Gidycz, 2013; Ullman, Filipas, Townsend, & Starzynski, 2006; Ullman, Starzynski, Long, Mason, & Long, 2008; Ullman, Townsend, Filipas, & Starzynski, 2007). Among the handful of studies examining social reactions to IPV disclosure, negative social reactions were positively related to PTSD symptom severity (Edwards, Dardis, Sylaska, & Gidycz, 2015; Flicker, Cerulli, Swogger, & Talbot, 2012; Levendosky et al., 2004). Conversely, investigations examining the link between positive social reactions to IPV disclosure and PTSD have revealed mixed findings, with two studies finding that positive social reactions were not significantly related to PTSD symptom severity (Flicker et al., 2012; Levendosky et al., 2004) and a third showing that positive social reactions were related to greater PTSD symptom severity (Edwards et al., 2015). Collectively, this research suggests that further examination of positive social reactions to IPV disclosure is needed.

Given some evidence for a relation between social reactions to IPV disclosure and PTSD symptom severity, an important next step for treatment development and refinement is to identify variables that may explain (i.e., mediate) this association (Kazdin, 2004; Kazdin & Nock, 2003). Stress, appraisal, and coping theory identifies coping as a key mediator of stressful person-environment interactions and their short- and long-term outcomes (Lazarus & Folkman, 1984). According to this theory, the social reactions a woman experiences in response to her disclosure of IPV are associated with the coping methods she utilizes to manage distress stemming from her IPV victimization. Specifically, a woman who experiences negative social reactions to IPV disclosure is more likely to use avoidant coping (e.g., physical and psychological withdraw), whereas a woman who experiences positive social reactions to IPV disclosure is more likely to use nonavoidant coping (e.g., physical and psychological approach). For instance, according to Ullman et al. (2007) and Ullman and Peter-Hagene (2014), negative social reactions to IPV disclosure may lead victims to avoid further negative reactions in an attempt to escape the negative feelings those reactions evoked (e.g., shame, sadness, betrayal). By disengaging from these social-support and help-seeking behaviors, victims prevent themselves from accessing resources that would encourage more adaptive coping strategies. In line with this literature, using a cross-sectional design, Sullivan, Schroeder, Dudley, and Dixon (2010) examined the relations among coping and social reactions to disclosure of IPV among IPV-victimized women. Avoidant coping was significantly positively related to negative social reactions to IPV disclosure, whereas nonavoidant coping (i.e., social support and problem solving) was significantly related to positive social reactions to IPV disclosure. While preliminary, findings of this study suggest that IPV-victimized women may be more likely to use avoidant coping strategies following IPV disclosure if they experience negative social reactions and less likely to use avoidant coping strategies following IPV disclosure if they experience positive social reactions.

The above-mentioned literature provides support for links between social reactions to IPV disclosure and both PTSD symptom severity and avoidant coping. However, investigations have yet to explore whether levels of avoidant coping explain relations between negative and positive social reactions to IPV disclosure and PTSD symptom severity. This is a key limitation given evidence that greater avoidant coping is related to PTSD symptom severity among IPV-victimized women (e.g., Arias & Pape, 1999; Flanagan, Jaquier, Overstreet, Swan, & Sullivan, 2014; Krause, Kaltman, Goodman, & Dutton, 2008; Lilly & Graham-Bermann, 2010). For instance, Arias and Pape (1999) found that greater emotion-focused coping (including avoidant coping) was associated with greater PTSD symptom severity among IPV-victimized women. Likewise, results of Krause et al. (2008) indicate that avoidant coping predicts PTSD symptom severity over 1 year among IPV-victimized women. Indeed, these aforementioned findings map on to theoretical accounts of PTSD. Specifically, avoidant coping may be related to PTSD symptom severity among IPV-victimized women because it interferes with psychological mechanisms that underlie PTSD, including the processing of traumatic memories, habituation to the aversive emotions associated with these memories, and extinction of trauma-related fear responses (Foa & Kozak, 1986; Foa & Rothbaum, 1998; Keane & Barlow, 2002).

Extending extant research, and grounded in stress and coping theory, the current study aims to explore the relations among negative and positive social reactions to IPV disclosure and PTSD symptom severity as well as examine the potential mediating role of avoidant coping in these associations. We expected that negative social reactions to IPV disclosure would be positively correlated with PTSD symptom severity. Moreover, we expected that greater use of avoidant coping would mediate this relation, such that women who experienced more negative reactions to IPV disclosure would engage in more avoidant coping, and in turn report greater PTSD symptom severity. No a priori hypotheses were made regarding the association between positive social reactions to IPV disclosure and PTSD symptom severity (direct or indirect through avoidant coping). Although existing research has shown that social support can act as a buffer against negative mental health outcomes—including PTSD symptom severity—for victims of IPV (Coker et al., 2002), mixed findings have been detected regarding the link between positive social reactions to IPV disclosure in particular and PTSD symptom severity (Edwards et al., 2015; Flicker et al., 2012; Levendosky et al., 2004).

Method

Participants and Procedures

Data were collected as part of a larger study examining the relationships among IPV, posttraumatic stress, substance use, and sexual risk among community women experiencing physical victimization in their current relationships. All procedures were reviewed and approved by the Institutional Review Board at the authors’ university. Participants were recruited from an urban community in the northeast. Recruitment flyers advertised the opportunity to participate in a “Women’s Relationship Study” and were posted in hair and nail salons, community health centers, grocery stores, and laundromats. Women who responded to the flyers were screened for eligibility over the phone. Eligibility criteria for the larger study were as follows: (a) female sex, (b) 18 years of age or older, (c) reporting physical victimization by a male partner during past 6 months, (d) continuous partner contact (i.e., saw their partner at least twice weekly with no more than 2 weeks apart during the previous month), and (e) a monthly household income of no greater than US$4,200.

Women who met eligibility criteria were invited to participate in the larger study. After providing written informed consent, women completed an in-person, semistructured, computer-assisted interview administered by trained master- or doctoral-level female research associates or postdoctoral fellows in private offices to protect participants’ safety and confidentiality. Women were subsequently debriefed, remunerated US$45, and provided with a list of community resources.

Of the 212 participants in the final sample, 173 women reported that they disclosed their IPV to at least one person. Given that the purpose of this study is to examine social reactions to women’s IPV disclosure, this subsample of 173 women was used in the current study. Women ranged in age from 18 to 58 (M = 36.31, SD = 10.48). In terms of racial/ethnic background, 65.9% (n = 114) of women self-identified as African American, 19.7% (n = 34) as White, and 14.5% (n = 25) as another or multiple racial backgrounds, and 18 women (10.4%) identified as Latina. Most women (65.9%; n = 114) were unemployed for at least 1 month prior to the study, whereas 26.6% (n = 46) and 7.5% (n = 13) reported working part- or full-time, respectively. The mean annual household income was US$13,029.14 (SD = US$10,213.73) and the mean education was 12.14 years (SD = 1.55). Most of the women (82.7%; n = 143) reported that they were not married, 13.3% (n = 23) were married, and 4.0% (n = 7) were separated or divorced. More than half (56.6%; n = 98) were living with their partner. Women reported seeing their partner an average of 6.19 days a week (SD = 1.41). Mean years in the current relationship was 6.36 years (ranging from 6 months to 33 years; SD = 6.25 years).

Measures

Social reactions

Social reactions to IPV disclosure were assessed using an adapted version of the 48-item Social Reactions Questionnaire (SRQ; Ullman, 2000). The original SRQ consists of positive and negative social reactions to women’s disclosure of sexual assault. Sullivan et al. (2010) adapted this measure to assess social reactions specific to disclosures of IPV. Specifically, instructions were revised to ask women to indicate how often they experienced each of the listed responses from disclosure recipients after women told the recipients about the IPV victimization in their current relationships. A factor analysis of the 48 SRQ items was conducted. The analysis suggested 17 items for positive social reactions to disclosure and 22 items for negative social reactions to disclosure. Four additional items were removed from the positive social reactions scale to improve its internal consistency. The reliability coefficient for the 13-item positive social reactions scale was α = .88 and for the 22-item negative social reactions scale was α = .89. Consistent with Sullivan et al., 13 items were used to assess positive social reactions (e.g., “Saw your side of things and did not make judgments”) to IPV disclosure and 22 to assess negative social reactions to IPV disclosure (“Told you that you could have done more to prevent this experience from occurring”). Responses were rated on a scale from 0 (never) to 4 (always). Items were summed with higher scores representing greater negative and positive social reactions to IPV disclosure. Cronbach’s alphas were .88 and .89 for the negative and positive social reactions to IPV disclosure scales.

Avoidant coping

Avoidant coping was assessed using the 11-item avoidant coping subscale of the Coping Strategies Indicator (CSI; Amirkhan, 1990). The CSI was modified in the current study to assess the strategies women used to cope with conflict in their current intimate relationship (e.g., “Avoided being with people in general”). To orient participants to coping strategies they used to deal with a recent conflict in their current intimate relationships, they were instructed to describe a conflict with their partner in the past 6 months that was important to them and caused them to worry. Responses were rated on a scale from 1 (not at all) to 3 (a lot). Items were summed with higher scores representing greater use of avoidant coping. Cronbach’s alpha was .75 for the avoidant coping subscale.

PTSD symptom severity

PTSD symptom severity was assessed with the Posttraumatic Stress Diagnostic Scale (PDS; Foa, Cashman, Jaycox, & Perry, 1997). Items assess the severity of re-experiencing, avoidance, and hyperarousal Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; APA, 1994) PTSD symptoms in the past 30 days (e.g., “How often have you had upsetting thoughts or images about the times when your partner did hurtful or violent things to you that came into your head when you didn’t want them to?”). To the extent that it was possible, PTSD symptom severity was assessed in relation to IPV by the current male partner. Responses were rated on a scale from 0 (not at all or only one time) to 3 (five or more times a week/almost always). Items were summed with higher scores representing greater PTSD symptom severity. Cronbach’s α = .90 for the PTSD symptom severity scale.

IPV

Physical IPV was measured by 12 items from the Revised Conflict Tactics Scale (CTS-2; Straus, Hamby, & Warren, 2003). Psychological and sexual IPV were measured by the 59-item Psychological Maltreatment of Women (PMWI; Tolman, 1999) and 10-item Sexual Experiences Survey (SES; Koss & Oros, 1982), respectively, because these measures assess psychological and sexual IPV more comprehensively than the CTS-2 (e.g., the PMWI assesses dominance/isolation and the SES measures sexual coercion using drugs/alcohol). A referent time period of 6 months was used to assess physical (e.g., “Partner punched or hit me with something that could hurt”), psychological (e.g., “Partner called me names”), and sexual (e.g., “Partner made you have sex when you didn’t want to by using force, like twisting your arm or holding you down, or by threatening to use force”) IPV. Response options for the CTS and SES were coded as follows: 0 (never), 1 (once in the past 6 months), 2 (twice in the past 6 months), 4 (3-5 times in the past 6 months), 8 (6-10 times in the past 6 months), 11 (more than 10 times in the past 6 months), and 0 (not in the past 6 months but it happened before). Responses for the PMWI were rated on a scale from 1 (never) to 5 (very frequently). Cronbach’s alphas were .90, .96, and .89 for the physical, psychological, and sexual IPV scores, respectively. Higher mean scores on the CTS-2, PMWI, and SES can be interpreted as greater frequency/severity of physical, psychological, and sexual IPV, respectively.

Demographic and relationship characteristics

All participants reported demographic information for age, race/ethnicity, household income, employment, and education. Participants also provided relationship information, including duration, cohabitation, and partner contact.

Data Analysis

To identify potential covariates, a series of ANOVAs and correlational analyses were conducted to explore the impact of demographic (i.e., age, race/ethnicity, household income, employment, and education) and relationship (i.e., living with partner, mean days of face-to-face contact, mean years in the relationship, and severity of physical, psychological, and sexual victimization) characteristics on PTSD symptom severity. Pearson product-moment and partial correlations (controlling for identified covariates) were then calculated to examine the intercorrelations among the primary study variables.

Next, mediation analyses were conducted (Preacher & Hayes, 2004) to explore the potential underlying role of avoidant coping (i.e., the mediating variable) in the relation between negative and positive social reactions to IPV disclosure (i.e., the independent variables) and PTSD symptom severity (i.e., the dependent variable). The bootstrap method was used to estimate the standard errors of parameter estimates and the bias-corrected confidence intervals of the indirect effects (MacKinnon, Lockwood, Hoffman, West, & Sheets, 2002; Preacher & Hayes, 2004). The bias-corrected confidence interval is based on a nonparametric resampling procedure that has been recommended when estimating confidence intervals of the mediated effect due to the adjustment it applies over a large number of bootstrapped samples (Efron, 1987). The mediated effect is significant if the 95% confidence interval does not contain zero (Preacher & Hayes, 2004). In this study, 1,000 bootstrap samples were used to derive estimates of the indirect effect.

Results

Preliminary Analyses

In the present study, all women reported physical (M = 37.54, SD = 48.44, CTS-2 scores ranging from 1 to 209) and psychological (M = 130.31, SD = 34.48, PMWI scores ranging from 63 to 223) IPV. The majority of women (60.1%) reported sexual IPV (M = 10.42, SD = 25.89, SES scores ranging from 0 to 173). Fifty-one (29.5%) women met DSM-IV diagnostic criteria for PTSD (i.e., the presence of a Criterion A traumatic event; at least one re-experiencing symptom, three avoidance/numbing symptoms, and two hyperarousal symptoms; duration of at least 1 month; and impairment in at least two areas of functioning), with PTSD symptom severity scores ranging from 0 to 45 (M = 16.93, SD = 10.49).

PTSD symptom severity was significantly associated with mean days of face-to-face partner contact (r = .16, p = .04) and severity of physical (r = .43, p < .001), psychological (r = .53, p < .001), and sexual (r = .30, p < .001) IPV. To examine the effects of social reactions to IPV disclosure and avoidant coping on PTSD symptom severity above and beyond demographic and relationship covariates, subsequent analyses controlled for mean days of face-to-face contact and physical, psychological, and sexual IPV.

Descriptive data and intercorrelations (zero-order and partial) among the primary study variables are presented in Table 1. Significant positive relations were detected among PTSD symptom severity and negative social reactions to IPV disclosure and avoidant coping at zero-order and when controlling for demographic and relationship covariates. Moreover, negative social reactions to IPV disclosure were significantly positively associated with avoidant coping at zero-order and when controlling for demographic and relationship covariates.

Table 1.

Descriptive Data and Interrelations Among Social Reactions to IPV Disclosure, Avoidant Coping, and PTSD Symptom Severity.

	1	4	5	6	M	SD
1. Negative social reactions	—	−.15^†	.26**	.33***	16.95	12.11
2. Positive social reactions	−.22**	—	.09	.10	31.29	9.41
3. Avoidant coping	.16*	.06	—	.42***	24.03	4.32
4. PTSD symptom severity	.19*	.03	.26**	—	16.93	10.49

Note. Zero-order correlations appear above the diagonal and partial correlations appear below the diagonal. IPV = intimate partner violence; PTSD = posttraumatic stress disorder.

†

p < .06. *p < .05. **p ≤ .01. ***p ≤ .001.

Primary Analyses

First, analyses were conducted to examine whether avoidant coping accounted for the relation between negative social reactions to IPV disclosure and PTSD symptom severity when controlling for relevant confounds. As shown in Table 2, IPV-victimized women who reported more negative social reactions also reported using more avoidant coping (β = .16, p = .04). Avoidant coping, in turn, predicted greater PTSD symptom severity (β = .22, p = .002). To examine the role of avoidant coping in the relation between negative social reactions and PTSD symptom severity, the indirect effect also was examined. Findings revealed a significant indirect effect of negative social reactions on PTSD symptom severity through avoidant coping (indirect effect = .03, p < .05). Although the direct effect of negative social reactions on PTSD symptom severity remained significant, it reduced in magnitude (βs from .17 to .13).

Table 2.

Summary of Mediation Analyses Examining the Role of Avoidant Coping in the Relations Among Types of Social Reactions to Intimate Partner Violence Disclosure and PTSD Symptom Severity (N = 212).

IV	Effect of IV on Avoidant Coping	Effect of M on PTSD Symptom Severity	Total Effect	Direct Effect	Indirect Effect
IV	(a)	(b)	(c)	(c’)	(a × b)	95% CI
Negative social reactions	0.16* (0.08)	0.22** (0.07)	0.17* (0.07)	0.13* (0.07)	0.03* (0.02)	[0.01, 0.09]
Positive social reactions	0.04 (0.07)	0.23** (0.07)	0.03 (0.06)	0.02 (0.06)	0.02 (0.02)	[–0.02, 0.04]

Note. A total of 1,000 bootstrap samples. Total effect = relation between the IV and PTSD symptom severity not accounting for avoidant coping (i.e., the unmediated model). Direct effect = relation between the IV and PTSD symptom severity accounting for avoidant coping (i.e., the mediated model). Indirect effect = the amount of reduction in the effect of the IV on PTSD symptom severity due to avoidant coping (i.e., the amount of mediation). All coefficients are reported as standardized estimates. PTSD = posttraumatic stress disorder; IV = independent variable; CI = confidence interval.

p < .05 **p ≤ .01. ***p ≤ .001.

Analyses were then conducted to examine whether avoidant coping accounted for the relation between positive social reactions to IPV disclosure and PTSD symptom severity when controlling for relevant confounds. As shown in Table 2, positive social reactions were not significantly related to avoidant coping (β = .04, p = .54) or PTSD symptom severity (β = .03, p = .64), and the indirect effect of positive social reactions on PTSD symptom severity through avoidant coping also was nonsignificant (indirect effect = .01, p > .05)¹.

Discussion

Given the high prevalence rates of PTSD among IPV-victimized women (Golding, 1999), it is important for research to pinpoint specific factors that influence PTSD symptom severity in this population. Prior literature suggests that the types of social reactions women experience following IPV disclosure may be associated with their PTSD symptom severity (Edwards et al., 2015; Flicker et al., 2012; Levendosky et al., 2004). The goal of this study was to extend research by examining the potential mediating role of avoidant coping in this association. In the current study, IPV-victimized women who reported greater negative social reactions to IPV endorsed higher levels of avoidant coping and greater PTSD symptom severity. Moreover, avoidant coping was found to mediate the associations between negative social reactions to IPV disclosure and PTSD symptom severity, such that negative social reactions to IPV disclosure were related to higher levels of avoidant coping, which in turn predicted greater PTSD symptom severity. These findings provide further support for a link between negative social reactions to IPV disclosure and PTSD symptom severity, as well as underscore the underlying role of avoidant coping in this association.

One key finding was that avoidant coping was found to mediate the relation between negative social reactions to IPV disclosure and PTSD symptom severity. This result highlights avoidant coping as one potential target for prevention and intervention efforts aimed at reducing PTSD symptom severity among IPV-victimized women. Specifically, our findings suggest that treatments aimed at reducing avoidant coping, such as emotion regulation group therapy (Gratz, Tull, & Levy, 2014), which teaches women approach and distraction strategies to replace avoidant strategies, may attenuate the link between negative social reactions to IPV disclosure and PTSD symptom severity. It is also important that potential disclosure recipients be taught how to avoid negative reactions to victims’ disclosures of IPV. Indeed, the recently Supporting Survivors and Self (SSS) intervention was developed to teach informal supports how to respond in ways that are positive and not negative (Edwards & Ullman, 2016). Moreover, the SSS intervention teaches informal supports how to cope with their own distress in nonavoidant ways and how to model healthy, nonavoidant coping for victims who disclose to them. Research would benefit from examining whether other dimensions of negative (e.g., victim blame, treat differently) and positive (e.g., tangible aid/information support, emotional support, belief) social reactions to sexual assault disclosure (see Relyea & Ullman, 2015; Ullman, 2000) are relevant to IPV disclosure. Furthermore, although our findings suggest that negative social reactions to IPV disclosure are indirectly related to PTSD symptom severity through avoidant coping, the direct effect of negative social reactions to IPV disclosure on PTSD symptom severity remained significant. This suggests the need for future research that explores other relevant factors that may explain this association.

Although it may seem contradictory that positive reactions to IPV disclosure were not associated with lower levels of avoidant coping or reduced PTSD symptom severity, these findings are not entirely unexpected given mixed findings regarding the influence of positive social reactions to IPV on coping and PTSD symptom severity in the literature (Edwards et al., 2015; Flicker et al., 2012; Levendosky et al., 2004). There may be something qualitatively different about IPV-victimized women who receive more positive social reactions to IPV disclosure. For instance, IPV-victimized women who receive more positive social reactions to IPV disclosure may experience more severe and frequent IPV, and thus these positive reactions may have limited effect on their severity of PTSD symptoms. Indeed, it has been suggested that women who experience more severe assault may be more likely to disclosure this assault to formal and informal supports (Ullman & Peter-Hagene, 2014), and women who disclose assault are more likely to receive both negative and positive reactions from others (Ullman, 2010). Alternatively, Edwards et al. (2015) suggested that positive social reactions may be unrelated to PTSD symptom severity because victims who disclose IPV do so with the anticipation of receiving positive social reactions. Because positive reactions are expected, they may have little impact on PTSD symptom severity, whereas women who disclose experiences of IPV are likely not doing so in anticipation of negative or unhelpful social reactions, which could thus lead to more detrimental impacts than positive social reactions. Along these lines, Littleton (2010) suggested that negative social reactions may be more salient to poor victim adjustment than positive social reactions given that individuals tend to assign more weight to negative judgments and experiences than positive ones. Finally, it has been suggested that positive social reactions to IPV disclosure may be indirectly related to PTSD symptom severity through other factors. For instance, Ullman et al. (2014) found that positive social reactions to sexual assault disclosure predicted greater perceived control over recovery, which in turn was related to lower PTSD symptom severity. Thus, women’s perceptions about their ability to manage their recovery may be key to understanding how positive reactions to assault disclosure relate to PTSD symptom severity. Future research aimed at elucidating the role of perceived control over recovery (and other potential mediators) in the relation between positive reactions to IPV disclosure and PTSD symptom severity among IPV-victimized women is needed.

While this study contributes to the growing body of literature on social reactions to IPV disclosure and PTSD symptom severity, findings must be interpreted in light of its limitations. First, the cross-sectional and correlational nature of the data precludes determination of the precise nature and direction of the relations examined here. For instance, although stress and coping theory would suggest that the types of social reactions that women experience following IPV disclosure are associated with the coping methods they utilize to manage their IPV-related distress (Lazarus & Folkman, 1984), it is also possible that avoidant coping is a precurrsor, not an outcome, of social reactions to IPV disclosure (consistent with suggestions by Sullivan et al., 2010). For example, women who use avoidant coping strategies to manage their victimization may be seen as doing little to resolve their problems and thus be reacted to more negatively. Indeed, Sullivan et al. (2010) found that more severe physical and psychological IPV were related to greater avoidant coping, which in turn was related to greater negative social reactions to IPV disclosure, whereas more severe sexual IPV was related to greater social support coping, which in turn was related to greater positive social reactions to IPV disclosure. Prospective, longitudinal studies are needed to examine the precise nature and direction of the relations among social reactions to IPV disclosure, avoidant coping, and PTSD symptom severity. For instance, studies utilizing experience sampling methods may inform whether negative social reactions to IPV disclosure immediately precede or follow avoidant coping or whether this relation is reciprocal. Second, our study relied exclusively on women’s self-reports, which may be influenced by their willingness and ability to report accurately. Third, the sources to whom IPV-victimized women disclosed were not identified, and future studies might find it useful to differentiate between informal and formal sources of support to gain a more nuanced understanding of how social reaction to IPV disclosure impact IPV-victimized women so that the development of interventions can be more targeted. Fourth, the current study examined the role of one coping strategy—avoidant coping—in the relation between negative and positive social reactions to IPV disclosure and PTSD symptom severity given evidence for a robust association between avoidant coping and PTSD symptoms severity among IPV-victimized women (e.g., Arias & Pape, 1999; Flanagan et al., 2014; Krause et al., 2008; Lilly & Graham-Bermann, 2010). Future research is needed to examine the potential influence of other coping strategies (e.g., cognitive reappraisal, acceptance, social support, religious). Finally, although our focus on IPV-victimized women in an urban community may be considered a strength of this study, our findings cannot be assumed to generalize to other IPV populations (e.g., women in same-sex relationships or shelter settings, men). Given evidence to suggest that bidirectional aggression is the most common pattern of IPV (see Archer, 2000, for a meta-analytic review), it is likely that women—at times—disclosed both victimization and aggression to their social supports. However, very little is known about women’s disclosure of IPV perpetration (in general or in the context of their victimization in particular). It will be important for future studies to assess social reactions to women’s disclosure of IPV perpetration as well as examine whether social reactions to women’s disclosure of IPV perpetration relates to their avoidant coping and PTSD symptom severity. Investigations are also needed to explore the potential role of IPV revictimization on the relations examined here given evidence that women who experience more severe and frequent IPV are more likely to disclose (Sylaska & Edwards, 2014). Finally, we focused on women in heterosexual relationships because (a) the dynamics in homosexual and bisexual IPV-relationships are unique and contradict theories that have been developed in the context of heterosexual relationships (Johnson & Ferraro, 2000) and (b) for victims who are lesbian, gay, bisexual, trans, and queer (LGBTQ), social supports may also be reacting to the stigma of being LGBTQ, which would require specific attention in the design of the study. Future studies should examine the relations among social reactions to IPV, avoidant coping, and PTSD symptom severity among women who identify as LGBTQ.

Despite these limitations, findings of the present study extend previous research on the relation between social reactions to IPV disclosure and PTSD symptom severity. Specifically, results indicate that negative social reactions to IPV disclosure are associated with more severe PTSD symptoms, and that avoidant coping mediates this relation. These findings highlight the critical need for interventions that (a) integrate nonavoidant strategies for managing negative social reactions and (b) target victims’ informal and formal support networks to reduce the extent to which victims receive negative social reactions to IPV disclosures.

Attention to Diversity

The current study utilized a sample that was diverse with regard to race/ethnicity and age. Moreover, we included individuals who were bilingual—but in Spanish only. Specifically, the protocol was developed in English and Spanish and Spanish versions of the measures were translated by a bilingual, bicultural member of the research team and back-translated by a bilingual, bicultural consultant according to standard procedures (Brislin, 1970). Regarding gender, we chose to focus exclusively on IPV-victimized women given their significantly higher prevalence rates of current (38%) and lifetime (72%) PTSD compared with male victims of IPV (16% and 31% for current and lifetime PTSD, respectively; Dansky, Byrne, & Brady, 1999). Furthermore, because the dynamics of IPV in same-sex relationships are unique (Johnson & Ferraro, 2000), we restricted our sample to women in heterosexual intimate relationships. In addition, consistent with our inclusion criteria (i.e., monthly household income of no greater than US$4,200, determined a priori to methodologically control for the differential access to and utilization of resources associated with income, which in turn, could affect study outcomes), income for many of the women in the study was low. Future research is needed to examine the relations among social reactions to IPV disclosure, avoidant coping, and PTSD symptoms among samples that exhibit greater diversity in gender, sexual orientation, and socioeconomic status.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The research described here was supported, in part, by grants from the National Institutes of Health (R03DA017668; T32DA019426; K23DA039327; L30DA038349).

Notes

Author Biographies

Jennifer N. Schackner is a graduate student at the Boston College School of Social Work. Her research interests are broadly focused on understanding the mechanisms of change in mindfulness-based treatments for anxiety, depression, and trauma-related disorders.

Nicole H. Weiss, PhD, is an assistant professor in the Department of Psychology at the University of Rhode Island. Her clinical and research interests focus on the role of emotion dysregulation in posttraumatic stress disorder (PTSD) and related risky, self-destructive, and health compromising behaviors, most notably substance use and HIV/sexual risk. Specifically, her work aims to clarify the role of emotion dysregulation in the development and maintenance of PTSD, as well as explore whether maladaptive ways of responding to negative and positive emotions heighten involvement in risky, self-destructive, and health compromising behaviors among individuals with PTSD.

Katie M. Edwards, PhD, is an assistant professor of psychology and women’s studies and faculty affiliate of Prevention Innovations Research Center and the Carsey School of Public Policy at the University of New Hampshire (UNH). Her interdisciplinary program of research focuses broadly on better understanding the causes and consequences of interpersonal violence, primarily intimate partner violence (IPV) and sexual assault (SA) among adolescents and emerging adults. Specific areas of current research focus on risk and protective factors for IPV and SA perpetration and victimization and factors that facilitate or hinder bystander action in situations of IPV and SA; disclosure, leaving, and recovery processes among survivors of IPV and SA; and individuals’ reactions to participating in IPV and SA research. She uses these research data to develop, implement, and evaluate IPV and SA prevention, intervention, and policy efforts.

Tami P. Sullivan, PhD, is an associate professor in the Department of Psychiatry at the Yale University School of Medicine and the Director of Family Violence Research and Programs. Her program of research focuses on individual- and system-level factors that affect the mental and physical health of women victims of IPV. At the individual level, she focuses on advancing knowledge of IPV, posttraumatic stress, substance use, and HIV/sexual risk—as well as other co-occurring problems. At the system-level, she focuses on understanding the capacity of systems (e.g., criminal justice system) to meet the unique needs of IPV-exposed women.

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