Distress overtolerance among firefighters: Associations with posttraumatic stress

Firefighters experience heightened rates of posttraumatic stress disorder (PTSD) symptoms compared to the general population. Nascent literature has identified distress overtolerance (DO; i.e., the tendency to persist through extremely high levels of distress despite harmful consequences) as a construct of potential relevance to PTSD symptomatology, though empirical research is lacking. The present study examined incremental associations between DO subscales (Capacity for Harm: persevering through distress despite its effect on 1's wellbeing; Fear of Negative Evaluation: persisting through distress due to a fear of being negatively evaluated by others should they quit) and PTSD symptom severity and symptom cluster severity (i.e., intrusion, avoidance, negative alterations in cognitions and mood [NACM], arousal and reactivity) among firefighters.

Participants included 282 trauma-exposed firefighters (91.8% male, M_age = 40.4, SD = 9.6). Covariates included years in the fire service, trauma load (i.e., number of trauma exposure types), and negative affect.

Results indicated that Capacity for Harm was a significant incremental correlate of total PTSD symptom severity (ΔR² = .045, p = .004), NACM symptoms (ΔR² = .061, p < .001), and arousal/reactivity symptoms (ΔR² = .047, p = .005). Fear of Negative Evaluation was not significantly related to any criterion variables.

Further work examining DO-PTSD relations is necessary to inform intervention and policy for the fire service. (PsycInfo Database Record (c) 2023 APA, all rights reserved).