Bad luck comes in three's: a narrative investigation of the impact of multiple traumatic events

Although the understanding of trauma has evolved significantly over time, contemporary approaches to trauma focus on the traumatic event as central to the diagnosis of Post Traumatic Stress Disorder (PTSD). This directs attention away from the unique characteristics the person contributes to the expression of post-trauma symptoms. In this thesis trauma is examined within a framework which incorporates the characteristics of the person along with the event, with specific focus on the impact of multiple traumatic events. The empirical research for the thesis was conducted as three interrelated studies. The same sample of 100 respondents (20 men & 80 women) participated in each study by completing self-report and narrative measures along with measures of trauma experiences and responses. Each person had experienced three or more events that they defined as traumatic. Three levels of investigation were conducted according to McAdams’ (1995, 1996) tripartite model of personality. Level I, Dispositional Traits, addressed the more global and stable aspects of personality that explain consistency in people’s behaviours. Levels II (Characteristic Adaptations) and III (Life Stories) of personality distinguish this model from traditional trait theories by enabling the nuances of human individuality to be examined in conjunction with more stable characteristics. The greater malleability of Levels II and III meant dimensions such as well-being and general symptom expression could be examined to understand the impact of a series of traumatic events across the lifespan. Study 1 looked at the role of Dispositional Traits (Level I) and Characteristic Adaptations (Level II) as predictors of the post-trauma response both in general and in terms of the PTSD symptom clusters. Core features of the expression of post-trauma reactions were identified as dispositional Anxiety and Depression; well-being factors of Environmental Mastery and Positive Relationships with Others; and the general symptom of Hostility. As expected, idiosyncratic patterns of prediction were evident for each of the three PTSD symptom clusters which differed to the predictors of overall PTSD scores. This highlights the importance of exploring trauma at a specific symptom level as well as the overall diagnostic level of PTSD. In addition, full mediation effects showed the importance of considering the contribution of input variables other than dispositions to the development of post-trauma symptoms, especially lowered Environmental Mastery that was found to be a core factor in each symptom level. Study 2 examined Characteristic Adaptations (Level II) and explored the adaptive processes of individuals who have experienced multiple traumatic events. As generally expected, people identified in the High Distress typologies were more vulnerable to PTSD symptoms, lower Psychological Well-Being and more General Symptoms. In contrast, the Repressor group illustrated little ill-effect from their multiple traumatic experiences on self-report. This was in line with previous literature which generally suggests that Repressors suppress the experience of the event to protect themselves from negative impact. Furthering the notion of the need to investigate both person and event variables in trauma, it was concluded that post-trauma symptom development is related to the basic adaptive style of the individual and is not simply due to particular events. Study 3 incorporated narrative measures to examine Level three of personality, the Storied Self. The narration of traumatic events was explored, with particular focus on the Repressor group. This group was also utilised as an exemplar to examine consistency between self-report and narrative data. In general, and contrary to previous literature, people in the Repressor group were able to provide detailed accounts of their traumatic events and, although reporting in terms of symptoms, provided detailed descriptions of the negative aspects of the events. This illustrates the inconsistency between self-report and narrative data in relation to the impact of multiple traumas. It is argued that the Repressor group regulates negative impact not through denial of the event itself, as previously suggested, but by producing an account of the event including themselves as observers of something traumatic. In combination, findings from the three studies allow the proposal of a non-linear model of multiple traumatic events. This model is event-motivated and incorporates all three levels of personality proposed by McAdams. Both person and event variables are considered of equal importance in understanding and treating multiple trauma related responses. It is argued that multiple traumatic experiences are influenced by factors that go beyond the event itself and that the meaning one makes of the event, before, during and after the event, is as crucial to understanding trauma as the more traditional self-report factors. By taking this approach a traumatic event is not left in isolation but is part of the dynamic process of a person’s life experiences and the general nature of that person. In this sense, multiple traumatic experiences can be included in models of trauma. Future research would benefit from examining the interaction between person and event factors, particularly by using people with multiple traumatic experiences as this has been shown to access patterns of interaction between person and event factors. Further investigation of response to multiple traumatic events will also be of benefit by furthering knowledge on sub-groupings of different response styles and determining how people incorporate event experiences in particular ways. In addition, as narrative accounts were found to extend self-report information research incorporating both forms of data collection would extend understanding not only of the impact of multiple traumatic experiences but also about the meaning of those events to the person. Finally, further examination of the non-linear model of multiple trauma that accommodates the three levels of personality along with event factors, will allow self-report and narrative data to better inform research and treatment strategies.