Journal of Traumatic Stress, Vol. 16, No. 1, February 2003, pp.

107112 ( C 2003)

Family Functioning, Coping, and Psychological Adjustment in Victims and Their Families Following Kidnapping1
Carmen Elvira Navia2,3 and Marcela Ossa2

This study examines the psychological aftereffects of economic extortive kidnapping on families during captivity, and on kidnapped individuals and family members, 24, 58, and 915 months after the release. Fifty-ve kidnapped and released individuals and 158 family members were evaluated through CAPS-DX, SCL90-R, FAD, F-COPES, and a family interview. Captivity was the most stressful period with the highest CAPS and general distress scores. There were no signicant differences in psychological distress or in PTSD between the 3 time groups after the release or between kidnapped individuals and their relatives. Correlations among family functioning, coping, and psychological adjustment, during captivity and after the release were analyzed.
KEY WORDS: kidnapping; family; PTSD; coping.

Kidnapping is one of the several expressions of sociopolitical violence in Colombia. According to Police Department and Pa s Libre Foundation (Monthly Statistical Bulletin), over the past two decades the number of annual reported kidnappings increased 1,600%, going from 227 in 1987 to 3,706 during 2000. According to Colombian law, any person who is retained against his/her will is considered kidnapped (Law 40, 1993). Economical Extortive Kidnapping (EEK) is a particular type of this crime, involving the delinquents request for money in exchange for the kidnapped individuals freedom. Kidnapping victims are suddenly deprived of their freedom, withdrawn from their environment, and subjected to their captors arbitrary decisions and wishes. In EEK, families are also exposed to what characterizes a traumatic situation: powerlessness and disruption (Kleber & Brom, 1992). They are constantly threatened by captors, who menace them with killing their relatives if they do not
1 This

paper is part of a quantitative and qualitative study on individual and family aftereffects of kidnapping. 2 Pa s Libre Foundation, Bogot a, Colombia. 3 To whom correspondence should be addressed at Diagonal 88 No. 27-42, Bogot a, Colombia, e-mail: cnavia@col-online. com.

get the ransom being asked for (Navia & Ossa, 2000b). Families are a source of support for the kidnapped individual while suffering the traumatic effects of this event. They are suddenly confronted with a situation that disrupts their lives and menaces their usual coping mechanisms. Family roles, relationships, affection, communication, values, and beliefs change (Figley, 1989). The scarce research available on EEK has mainly focused on determining its effects on the kidnapped person. Meluk and Trujillo (1993) found that victims reported symptoms of PTSD immediately after the release, but these disappeared 3 months later. In a case study, Arias and Sep ulveda (1993) found that the psychological effects of kidnapping went beyond PTSD. According to Rorschach results of three cases, there were symptoms of hostility, anxiety, depression, paranoid ideation, hypochondria, and phobias 3 and 4 years after the release. However, the absence of standardized measures, the small size of samples, and the difculties inherent in retrospective self-report studies make these conclusions tentative. According to McCubbin, Thompson, and McCubbin (1996), family-coping and problem-solving strategies, as well as family resources, such as communication, support, and exibility, help families undergo a crisis. Although the role of family resources in recovering after kidnapping 107
0894-9867/03/0200-0107/1
C

2003 International Society for Traumatic Stress Studies

108 has not been studied, research on combat-related psychopathology has shown that family interaction is related to posttraumatic adjustment (Hendin & Hass-Pollinger, 1981; McCubbin, Dahl, Lester, & Ross, 1975). Solomon, Mikulincer, Freid, and Wosner (1987) found that family expressiveness and cohesion correlated with the presence of PTSD in Israel soldiers who fought in the front line during the Lebanon war. Soldiers from families who allowed them to express their experiences and offered support presented less PTSD symptoms. Accumulated evidence has shown that individual coping mediates between stressful events and psychological distress (Joseph, Williams, & Yule, 1997). Studies on coping with trauma have found that problem-solving strategies, emphasizing the positive, and nding meaning to the traumatic event are associated with the absence of PTSD (Charlton & Thompson, 1996; Fairbank, Hansen, & Fitterling, 1991), anxiety, and other psychiatric disorders (Mikulincer & Florian, 1996). Avoidance has been related to high levels of psychological distress (Charlton & Thompson, 1996) and PTSD, in victims of trauma (Biro, Zdenka, & Gvrilov, 1997). A considerable body of evidence has also shown that social support may help people undergo stressful situations. Greater social support has been associated with better adjustment in combat veterans, rape victims, and victims of civilian disasters (Joseph et al., 1997). Given the scarce research on EEK and the increasing number of victims in Colombia, this study is an attempt to explore in a systematic manner the psychopathological aftereffects of EEK, on kidnapped individuals and their families. First, we determined the frequency of PTSD symptoms in family members while a family member remained in captivity, as well as the frequency of PTSD symptoms in kidnapped individuals and their families after release. Besides, we proposed the following hypothesis: (1) because families were also traumatized by EEK, we hypothesized that there would be no signicant differences in psychological aftereffects between kidnapped individuals and their family relatives; (2) the great stress that characterizes captivity led us to propose that psychological distress and PTSD in family members would be signicantly higher during captivity than after the release; (3) according to self-report studies (Arias & Sep ulveda, 1993; Meluk & Trujillo, 1993), we hypothesized that PTSD symptoms would decrease 3 months after the release, whereas other indexes of psychological distress would remain a year after, in kidnapped individuals as well as in their family relatives; (4) according to research results on family resources and adaptation posttrauma (Hendin & HassPollinger, 1981; McsCubbin et al., 1975; Solomon et al., 1987), we proposed that family functioning and coping

Navia and Ossa would be related to psychological adaptation. Better family communication, family affective involvement and support would be associated with less psychological distress and PTSD, during captivity as well as after the release. Family passive appraisal would be associated with PTSD and psychological distress, while reappraisal, social, and family support with less PTSD and psychological distress. Method Participants Families invited to participate in this study were contacted through Pa s Libre Foundations database of kidnapped individuals. From November 1998 to February 2000, we found 192 EEK cases of Colombian adult individuals that met the time criteria for the study. One hundred and thirty-seven (71.35%) families could be reached, 55 (28.65%) had moved and could not be contacted. Eightytwo (59.85%) accepted to participate and the other 55 either could not gather the family for the interview (23.35%) or refused to participate (16.8%). Ten families were excluded from the nal sample because some of their members did not have complete sets of data. The nal sample included four groups of families: 18 living the captivity of one of its members and the other 54 in three groups according to the time after the release (24, 58, and 9 15 months; see Table 1). There were 213 people in total; 55 kidnapped individuals that had already been released by the captors, and 158 family members either from the nuclear family (82.3%), the extended family (16.5%), or people external to the family such as anc es (1.2%). Fifty-three percent were women and 47% men, with an average age of 38 years (range = 1373). The families came from different regions in Colombia, and they were middle-to-upper class. The majority of the kidnappings were carried out by guerrillas (91.8%); 2.7% by common delinquents, individuals who did not belong to any subversive group; 1.4% by both (guerrillas and common delinquents); and 4.1% by unknown authors. On average, kidnapping victims lasted 112.7 days under captivity (range = 1435 days).
Table 1. Number of Persons in Each Group of the Sample Months after release Captivity Direct victims Family members Total
a With

24 19 43 62

58 18 39 57

915 18 31 49

(18)a 46 46

no data because they were in captivity.

Adjustment Following Kidnapping Procedure Families who fullled the criteria for the sample (either living the captivity of an adult relative or whose relative had been released 24, 58, or 915 months before) were contacted by phone and sent a letter explaining the general purpose of the study and an informed consent form. Those who accepted were scheduled for a family interview with all the members of the nuclear family and other extensive family members directly involved in the negotiation of the kidnapping. Each interview was recorded and it lasted approximately 2.5 hr. The CAPS interview and the self-administered tests were done in individual sessions with each member. We present here the quantitative results of the study and the analysis with the CAPS interview and the self-administered tests.

109 & Cohen, 1990) and as a research instrument in outcome psychotherapy research (Derogatis, 1994). The Global Severity Index was used as a measure of psychological distress in the analysis presented in this paper. The CAPS-DX, a structured interview, was used to assess each of the PTSD symptoms dened by the DSMIV, as well as some related aspects such as survivors guilt, reduction in awareness of ones surroundings, and depersonalization. Interrater correlations for total scores were between r = .95 and r = .99. Families experience during and after kidnapping, attributions, specic coping mechanisms, beliefs, and family values were explored through a semistructured family interview.

Results Instruments Validated Spanish versions of all the instruments were used. The FAD (Family Assessment Device), developed by Epstein, Baldwin, and Bishop (1982), was used to assess six aspects of family functioning: problem solving, communication, roles, affective responsiveness, affective involvement, behavior control, and general functioning. The FAD has been one of the most studied family measures, and it has a high reliability index (.92; Wilson & Kurtz, 1997). FAD scales are scored in a reversed direction, and scores range from 1.00 (healthy functioning) to 4.00 (unhealthy functioning). Family coping was assessed with The Family Crisis Oriented Personal Evaluation Scale (F-COPES), designed by McCubbin, Olson, and Larsen (1981). This scale measures ve family-coping strategies: reframing, seeking spiritual support, acquiring social support, mobilizing family to acquire and accept help, and passive appraisal or avoidance. Its reliability and internal consistency indexes are between .63 and .86. Psychological distress was assessed by the SCL90R, a self-report inventory that measures psychological symptoms during the week previous to application. The test evaluates nine primary symptom dimensions (somatization, obsessivecompulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism), and it gives three global distress indexes. It has satisfactory internal consistency reliability, with coefcients ranging from a low of .79 for paranoid ideation to a high of .90 for depression (Horowitz, Rosenberg, Baer, Ureno, & Villasenor, 1988). It has been used as a diagnostic instrument in different contexts (Derogatis & Meyer, 1979; Swett, Surrey, During the relatives captivity, 39.1% of family members had PTSD. After the release, 19.6% of family members and 29.1% of kidnapped individuals had this disorder. The average of general distress for relatives during captivity indicated psychological disturbance ( M = 64.08; SD = 9.37). After the release the average of general distress was on the upper side of the normal range for both, family members ( M = 61.41; SD = 10.96) and kidnapped individuals ( M = 62.32; SD = 13.60). CAPS and SCL90-R general scores of family members during captivity and after the release were compared using PROC MIXED in SAS. The Satterthwaite option for calculating degrees of freedom was used to account for within-family clustering. Time was introduced in the model as the xed effect, the family as the random effect, and the total scores in CAPS and SCL90-R as dependent variables. The parameters were estimated through the REML method. The results showed that family members CAPS scores during captivity ( M = 40.13; SD = 0.78) were signicantly higher than those after the release, F (3, 60) = 3.57, p < .01. There were signicant differences between the group of family members during captivity and those 24 ( M = 22.31; SD = 22.99), t (54) = 3.15, p < .01, and 58 ( M = 26.97; SD = 21.01) months after the release, t (55.7) = 2.28, p < .05. The CAPS mean of the group 915 months after the release ( M = 29.85; SD = 23.80) did not differ signicantly from the mean of family members during captivity, t (64.5) = 1.73, ns. There were no signicant differences in general distress between the four groups. The same method and option in PROC MIXED, mentioned previously, were used to compare CAPS and SCL90-R general scores of the three groups after the release and the two kinds of victims (family members and

110
Table 2. Means, Standard Deviations, and F Ratios of CAPS and SCL90-R General Scores According to Time After the Release and Kind of Victim Dependent variable CAPS Fixed effect Months after release 24 58 915 Kind of victim Kidnapped individuals Family member M 27.29 30.12 26.81 29.53 26.62 SD 22.96 23.64 21.98 0.90 23.40 22.47 1, 117 62.30 61.54 13.60 10.96 F 0.17 df 2, 52.6 61.70 63.04 61.02 12.33 11.45 11.86 0.19 1, 113 M General distress SD F 0.23 df 2, 46.8

Navia and Ossa

Note. CAPS = Clinician-Administered PTSD Scale. p < .05. p < .01. p < .001.

kidnapped individuals). The three groups after the release (24, 58, and 915 months) and the kind of victim were introduced as xed effects, and the family as the random effect. There were no signicant differences between the three time groups after the release, either in CAPS or in general distress (Table 2). Family members and kidnapped individuals did not differ in either dependent variable (Table 2). The interaction between time after the release and type of victim was not signicant either for CAPS, F (1, 117) = 1.93, ns, or for psychological distress, F (2, 113) = 2.01, ns. Family Functioning, Coping, and Psychological Adaptation To cope with the effect of within-family clustering, correlations were ran with a random sample of one member of each family. There were the same number of people from each time group and the same number of victims and family members. CAPS scores of family members during captivity did not correlate with any of the family variables measured by the FAD. General distress correlated positively with family roles, behavior control, and general

family functioning (see Table 3). After the release, CAPS scores correlated positively with affective responsiveness, affective involvement, and behavior control (see Table 3). General distress correlated positively with communication, affective involvement, affective responsiveness, and behavior control (Table 3). Because lower scores in FAD scales indicate a healthier family functioning, positive correlations showed that a better family functioning was related with psychological adaptation. During captivity, none of the family coping mechanisms evaluated by F-COPES correlated with CAPS or with general distress. After the release, general distress correlated negatively with passive appraisal, r = .27, p < .05. Because a lower score in this specic F-COPES scale means that the family uses passive appraisal more frequently, the negative correlation indicated that those families that were more passive showed a greater psychological distress. Discussion As it was hypothesized, there were no signicant differences in PTSD and general distress between family

Table 3. Correlations Among CAPS Total Scores, SCL90-R General Distress, and FAD Scales, During Captivity (n = 18) and After Release (n = 54) 1 1. CAPS 2. General distress 3. Problem solving 4. Communication 5. Roles 6. Affective responsiveness 7. Affective involvement 8. Behavior control 9. General family functioning .42 .21 .31 .43 .25 .41 .35 .46 2 .67 .06 .12 .52 .22 .45 .52 .50 3 .08 .16 .74 .64 .55 .41 .50 .52 4 .20 .32 .53 .57 .66 .49 .39 .61 5 .05 .18 .22 .62 .44 .68 .81 .68 6 .31 .37 .24 .68 .54 .36 .51 .53 7 .30 .37 8 .29 .45 .27 .57 .45 .43 .51 .74 9 .09 .21 .56 .82 .67 .60 .57 .50

.04 .55 .64 .46 .62 .73

Note. Correlations during captivity below the diagonal and after release above. p < .05 . p < .01. p < .001.

Adjustment Following Kidnapping members and kidnapping victims after the release. Kidnapping was as traumatic for families as for actual victims; they faced a virtual captivity in which they were trapped by constant threats made by captors who appeared randomly throughout the negotiation. The captors threats and intimidation gave families a sense of being constantly observed and monitored (Navia & Ossa, 2000b). Contrary to what has been found in other studies (Solomon, 1988; Solomon et al., 1987), psychological distress and PTSD in family members were due to the traumatic experience, not due to the presence of PTSD symptoms in the kidnapped person. It was possible to identify two distinct moments in EEK: captivity and postrelease adaptation. The rst one starts with the kidnapping. Families and kidnapped individuals are exposed to a chronic trauma (Herman, 1992) that no one knows when it is going to end. The release marks the beginning of the postrelease adaptation. As it was predicted, the highest CAPS and psychological distress scores were found during captivity. Families were under constant stress and had no means to manage it. They felt like in a roller coaster going from despair to hope, happiness and depression (Navia & Ossa, 2000a). The release seemed to close this period. CAPS scores 24 and 58 months after release were lower than those during captivity. As families stated, the release was like a resurrection. What was salient during these rst months was the idea that all the suffering was over, blurring the consequences of the kidnapping (Navia & Ossa, 2000a). Contrary to what was reported by Meluk and Trujillo (1993), we did not nd differences in PTSD and psychological distress between the three groups after the release. This might suggest that, even though some periods after the release were more critical than others, PTSD and psychological distress after EEK seemed to remain constant throughout the 1st year. Nevertheless, the cross-sectional nature of the study does not allow us to state that people were not working through the traumatic experience. A longitudinal study would provide a better picture to understand the assimilation process after the traumatic event. Because it was possible to reach the majority of the families contained in one of the most complete kidnapping databases in Colombia, the sample was representative of EEK cases. However, the negative psychological impact of EEK could have been underestimated given that families were free to participate and some might have refused because they were having too much trouble handling the experience. As it was hypothesized, family functioning was related with psychological adaptation. During captivity, those families that provided clear rules and standards of behavior, and established patterns for handling family

111 functions, gave their members the sense of control that they lacked over the circumstances. After the release, families were a source of support in helping kidnapped individuals undergo the experience of EEK. As it was found by Solomon et al. (1987), people from cohesive family systems that showed interest over each others concerns and that let their members share their feelings presented less PTSD and psychological distress after kidnapping. During captivity, family coping did not correlate with psychological adjustment. In an uncontrollable situation such as this one, in which families could not manage the source of stress, none of the family coping mechanisms were useful in helping them to deal with the situation in an adaptive manner. Neither family internal coping mechanisms, such as reframing or passive appraisal, nor external support, helped them deal with it. Contrary to what has been found in other trauma studies (Joseph et al., 1997), social support and other external coping mechanisms, through which families acquire help outside the nuclear system (McCubbin et al., 1996), were not related to psychological adaptation after the release. EEK shatters families trust in their environment and at the same time, the constant presence of kidnapping in our society in addition to the overall impunity, confront families with the sad conviction that there are no social guarantees for them, that there is no justice, and that no institution will take responsibility for the harm done and for their safety (Navia & Ossa, 2001). Therefore, the family becomes the only reliable source of support and safety. As it was hypothesized, the internal family-coping mechanism of passive appraisal was related to psychological distress after the release. Because this scale measures the families tendency to avoid confronting stressful situations, it can be stated that avoidance hinders psychological adjustment after EEK. According to Horowitz (1992), avoidance blocks the assimilation of the traumatic experience leaving it encapsulated in a traumatic memory that may cause PTSD or other symptoms. In sum, EEKs impact affects not only those who were the ones deprived from their freedom, but also their families. Studies focusing only on kidnapped individuals underestimate the real impact of EEK and that should be taken into account in future research. Besides, results point personal and family variables, plus the nature of the social context, as factors that may help or hinder adaptation. Future research need to focus on how these elements interact together. Acknowledgments This paper was supported by grants from Colciencias and Pa s Libre Foundation. Gabriel Antonio Vallejo

112 performed the statistical analyses. We thank the Statistics Department of the National University (Bogot a Colombia) for advising the student and for letting us use the SAS. References
Arias, B., & Sep ulveda, M. I. (1993). Implicaciones individuales del secuestro desde una perspectiva psicol ogica. Unpublished BA Thesis, Universidad de Los Andes, Bogot a, Colombia. Biro, M., Zdenka, N., & Gvrilov, V. (1997). Coping strategies in PTSD. Behavioral and Cognitive Psychotherapy, 25, 365369. Charlton, P. F. C., & Thompson, J. A. (1996). Ways of coping with psychological distress after trauma. British Journal of Clinical Psychology, 35, 517530. Derogatis, L. R. (1994). SCL90-R Symptom Checklist90-R. Administration, scoring, and procedure manual. Minneapolis: National Computer Systems, Inc. Derogatis, L. R., & Meyer, J. K. (1979). A psychological prole of the sexual dysfunctions. Archives of Sexual Behavior, 8, 201223. Epstein, N. B., Baldwin, L. M., & Bishop, D. S. (1982). Family Assessment Device. Providence: The Brown University/Rhode Island Hospital Family Research Program. Fairbank, J. A., Hansen, D. J., & Fitterling, J. M. (1991). Patterns of appraisal and coping across different stressor conditions among former prisoners of war with and without posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 59, 274281. Figley, C. R. (1989). Helping traumatized families. San Francisco: Jossey-Bass. Hendin, H., & Haas-Pollinger, A. (1981). Wounds of war: The psychological aftermath of combat in Vietnam. New York: Basic Books. Herman, J. (1992). Trauma and recovery. New York: Basic Books. Horowitz, M. J. (1992). Stress response syndromes. New York: Jason Aronson. Horowitz, M. J., Rosenberg, S. E., Baer, B. A., Ureno, G., & Villasenor, V. S. (1988). Inventory of interpersonal problems: Psychometric properties and clinical applications. Journal of Consulting and Clinical Psychology, 56, 885892. Joseph, S., Williams, R., & Yule, W. (1997). Understanding posttraumatic stress. A psychosocial perspective on PTSD and treatment. New York: Wiley. Kleber, R. J., & Brom, D., in collaboration with Defares, P. B. (1992). Coping with trauma: Theory, prevention and treatment. Amsterdam: Swets and Zeitlinger International.

Navia and Ossa

Law 40. (1993). Marco jur dico y jurisprudencial contra el secuestro. (1997). Bogot a: Programa para la Defensa de la Libertad Personal. McCubbin, H. I., Dahl, B., Lester, G., & Ross, B. (1975). The returned prisoner of war: Factors in family reintegration. Journal of Marriage and the Family, 37, 471478. McCubbin, H. I., Olson, D. & Larsen, A. (1981). Family crisis oriented personal evaluation scales (F COPES). In H. I. McCubbin, A. I. Thompson, & M. A. McCubbin (Eds.), Family assessment: Resiliency, coping, and adaptationInventories for research and practice (pp. 455508). Madison: University of Wisconsin System. McCubbin, H. I., Thompson, A. I., & McCubbin, M. A. (1996). Family assessment: Resiliency, coping, and adaptationInventories for research and practice. Madison: University of Wisconsin System. Meluk, E., & Trujillo, N. (1993). Aspectos psicol ogicos individuales y familiares en el secuestro. Unpublished manuscript, Pa s Libre, Bogot a, Colombia. Mikulincer, M., & Florian, V. (1996). Coping and adaptation to trauma and loss. In M. Zeidner & N. S. Endler (Eds.), Handbook of coping: Theory, research, and applications (pp. 554572). New York: Wiley. Monthly Statistical Bulletin. Bogot a: Pa s Libre. (Based on data from Pa s Libre, Gaulas, and Fondelibertad). Navia, C. E., & Ossa, M. (2000a). Familia y secuestro: Efectos psicol ogicos y familiares. proceso de readaptaci on y superaci on del evento traum atico. Unpublished technical report, Colciencias, Bogot a, Colombia. Navia, C. E., & Ossa, M. (2000b). Sometimiento y libertad. Bogot a, Colombia: Fundaci on Pa s Libre y Colciencias. Navia, C. E., & Ossa, M. (2001). E1 secuestro un trauma psicosocial. Revista de Estudios Sociales, 9, 6774. Solomon, Z. (1988). Somatic complaints, stress reaction and posttraumatic stress disorder: A three year follow up study. Behavioral Medicine, 14, 179186. Solomon, Z., Mikulincer, M., Freid, B., & Wosner, Y. (1987). Family characteristics and posttraumatic stress disorder: A follow-up of Israeli combat stress reaction casualties. Family Process, 26, 383 394. Swett, C., Surrey, J., & Cohen, C. (1990). Sexual and physical abuse histories and psychiatric symptoms among male psychiatric outpatients. American Journal of Psychiatry, 147, 632636. Wilson, J., & Kurtz, R. (1997). Assessing posttraumatic stress disorder in couples and families. In J. Wilson & T. Keane (Eds.), Assessing psychological trauma and PTSD (pp. 349395). New York: Guilford Press.