Romantic relationship dissolutions are significantly associated with posttraumatic stress symptoms as compared to a DSM-5 Criterion A event: a case-case–control comparison

ABSTRACT

Background: Non-marital romantic relationship dissolutions (RRDs) are common among emerging adult students (EAS) and may result in severe distress and suicidality. However, studies on RRDs in youth are limited to mental health sequelae of depression and prolonged grief. Little is known about the association between RRDs and posttraumatic stress symptoms (PTSS), and how this compares to posttraumatic stress symptoms following a traumatogenic event.

Objective: We aimed to determine the association between RRDs and PTSS in an EAS sample; and how this compared to the association between posttraumatic stress symptoms and a Diagnostic and Statistical Manual 5th edition (DSM-5) traumatic event.

Method: University students (N = 2,022; female = 71.1%; 18–25 years) completed a demographic and relationship questionnaire, the Life Events Checklist, the Adverse Childhood Experiences questionnaire, and the Posttraumatic Stress Checklist (PCL). We compared EAS with an RRD (n = 886) or a DSM-5 criterion A traumatic event (n = 592) against a control group (n = 544) exposed to a non-traumatic stressful life event. Utilising ANOVAs and Pearson’s correlations we determined demographic and clinical variables associated with PTSS. ANCOVA and stepwise hierarchical regression analyses were used to determine between-group differences in PTSS.

Results: Total trauma exposure and adverse childhood experiences, sex, monthly income, sexual orientation, and attachment style were significantly associated with PTSS. The RRD group had significantly higher PCL scores compared to the DSM and control groups. The mean PCL scores for both the RRD and DSM groups were above the cut-off score of 33, consistent with a probable posttraumatic stress disorder diagnosis. Significantly more RRD participants (72.9%) scored above the cut-off score of 33 than DSM-5 Trauma Group participants (55.4%).

Conclusion: An RRD is a potentially traumatic event and is significantly associated with PTSS, similar to a posttraumatic stress disorder diagnosis.

HIGHLIGHTS

• Students may experience non-marital romantic relationship breakups as very painful, with various negative psychological, physical, and academic consequences. However, their painful experiences are often trivialised as something to ‘just get over’ and not acknowledged as potentially traumatic. Yet, using an attachment theory framework, breakups can be reconceptualised as subjectively traumatic.

• We explored the differences in posttraumatic stress symptoms of students who experienced a breakup, a traumatic event (as defined in psychiatry), and other non-traumatic life events. Students who experienced a breakup reported significantly highly posttraumatic stress symptoms.

• Acknowledging students’ pain following a self-defined traumatic breakup can increase help-seeking behaviour and reduce the risk of intergenerational attachment trauma. Our findings warrant further research of breakups as potentially traumatogenic events.

Antecedentes: Las disoluciones de relaciones románticas no matrimoniales (RRD en su sigla en inglés) son comunes entre los estudiantes adultos emergentes (EAS en su sigla en inglés) y pueden provocar angustia grave y tendencias suicidas. Sin embargo, los estudios sobre RRD en jóvenes se limitan a las secuelas de salud mental de la depresión y el duelo prolongado. Se sabe poco sobre la asociación entre los RRD y los síntomas de estrés postraumático (PTSS en su sigla en inglés), y cómo se compara esto con los síntomas de estrés postraumático después de un evento traumatogénico.

Objetivo: Nuestro objetivo fue determinar la asociación entre RRD y PTSS en una muestra de EAS; así como también cómo se compara esto con la asociación entre los síntomas de estrés postraumático y un evento traumático de la quinta edición del Manual Diagnóstico y Estadístico (DSM-5).

Método: Estudiantes universitarios (N = 2,022; mujeres = 71.1%; 18–25 años) completaron un cuestionario demográfico y de relaciones, la Lista de Verificación de Eventos Vitales, el cuestionario de Experiencias Adversas en la Infancia y la Lista de Verificación de Estrés Postraumático (PCL). Comparamos EAS con un RRD (n = 886) o un evento traumático del criterio A del DSM-5 (n = 592) contra un grupo de control (n = 544) expuesto a eventos de vida estresantes no traumáticos. Utilizando ANOVA y correlaciones de Pearson, determinamos variables demográficas y clínicas asociadas con PTSS. Se utilizó ANCOVA y análisis de regresión jerárquica paso a paso para determinar las diferencias de PTSS entre grupos.

Resultados: La exposición total al trauma y la infancia adversa experimentada, el sexo, los ingresos mensuales, la orientación sexual y el estilo de apego se asociaron significativamente con PTSS. El grupo RRD tuvo puntuaciones PCL significativamente más altas en comparación con los grupos DSM y control. Las puntuaciones PCL medias para los grupos RRD y DSM estuvieron por encima de la puntuación límite de 33, lo que concuerda con un diagnóstico probable de trastorno de estrés postraumático. Significativamente más participantes de RRD (72.9%) puntuaron por encima de 33 puntos que los participantes del Grupo de Trauma del DSM-5 (55.4%).

Conclusión: Un RRD es un evento potencialmente traumático y está significativamente asociado con PTSS, similar a un diagnóstico de trastorno de estrés postraumático.

背景：非婚姻恋爱关系破裂（RRD）在新成年学生（EAS）中很常见，可能导致严重的痛苦和自杀倾向。 然而，对青少年 RRD 的研究仅限于抑郁和延长哀伤的心理健康后遗症。人们对 RRD 与创伤后应激症状 (PTSS) 之间的关联以及其与创伤性事件后的创伤后应激症状的比较知之甚少。

目的：我们旨在确定 EAS 样本中 RRD 与 PTSS 之间的关联； 以及这个关联与创伤后应激症状与一项诊断和统计手册第五版 (DSM-5) 创伤事件之间的关联进行比较。

方法：大学生（N = 2,022；女性 = 71.1%；18–25 岁）完成了人口统计和关系问卷、生活事件清单、不良童年经历问卷和创伤后压力清单 (PCL)。 我们将有RRD的 EAS组 (n = 886) 或有DSM-5 标准 A 创伤性事件的EAS组 (n = 592) 与暴露于非创伤性压力生活事件的对照组 (n = 544) 进行比较。利用方差分析和皮尔逊相关性，我们确定了与 PTSS 相关的人口统计和临床变量。使用协方差分析和逐步分层回归分析来确定PTSS的组间差异。

结果：总创伤暴露和不良童年经历、性别、月收入、性取向和依恋方式与 PTSS 显著相关。与 DSM 组和对照组相比，RRD 组的 PCL 评分显著更高。 RRD 组和 DSM 组的平均 PCL 分数均高于 33 分的临界分数与可能的创伤后应激障碍诊断一致。 得分高于 33 分的 RRD 参与者 (72.9%) 显著多于 DSM-5 创伤组参与者 (55.4%)。

结论：RRD 是一种潜在的创伤事件，与 PTSS 显著相关，类似于创伤后应激障碍的诊断。

KEYWORDS:

• Attachment
• breakup
• emerging adults
• non-marital
• posttraumatic stress disorder
• South Africa
• university students

PALABRAS CLAVE:

• Apego
• ruptura
• adultos emergentes
• pareja
• trastorno de estrés postraumático
• Sudáfrica
• estudiantes universitarios

关键词:

• 依恋
• 分手
• 新成年人
• 非婚姻
• 创伤后应激障碍
• 南非
• 大学生

Acknowledgements

AvdW and SS conceptualised the overall study. AvdW collected the data, conducted the data analysis, and was involved in all aspects of writing the article. MK assisted with data analysis and contributed to writing the article. AR serves as co-supervisor to AvdW and contributed to writing the article. Similarly, EL serves as co-supervisor to AvdW and contributed to writing the article. Lastly, SS serves as main supervisor to AvdW and contributed to writing the article.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data used are available from the first author upon reasonable request.

Notes

1 It should be noted that in terms of RRDs specifically, various factors related to the relationship and dissolution of the relationship may influence levels of distress or PTSS. This includes who initiated the breakup e.g., (Akbari et al., 2022), whether the breakup was expected or not e.g., (Attridge et al., 1995), reasons for the breakup, the duration e.g., (Dailey et al., 2020) and perceived closeness of the relationship prior to dissolution, the breakup strategy, and feeling betrayed by the ex-partner e.g., (Koessler et al., 2019). However, since these influences are unique to those exposed to an RRD, they were not considered in the present analysis but have been reported separately.

2 Ideally, we would have used a more comprehensive assessment of attachment (e.g., Experience in Close Relationships scale). However, due to the already extensive nature of the online survey (including the Inventory of Complicated Grief and the Breakup Distress scale not reported on in this article), we opted to use Hazan and Shaver’s (1987) widely used single self-report measure for romantic attachment style.

Additional information

Funding

This research is supported by the South African Research Chair in PTSD (SARChI UID 64811) hosted by the Stellenbosch University, funded by the Department of Science and Innovation (DSI), and administered by the National Research Foundation (NRF). Additionally, the first author was awarded the NRF Thuthuka grant (no. 121995); the South African Medical Research Council Bongani Mayosi National Health Scholars Programme (2021–2023 financial year) through its Division of Research Capacity Development; Prof HW Truter scholarship (2020/2021); and Harry Crossley Foundation Faculty of Medicine and Health Sciences (FMHS) funding (2018) in support of her PhD Research. The content hereof is the sole responsibility of the authors and does not necessarily represent the official views of the funders.