Vulnerability to posttraumatic stress disorder in adult offspring of Holocaust survivors

OBJECTIVE: There has been considerable controversy regarding the impact of the Holocaust on the second generation, but few empirical data are available that systematically document trauma exposure and psychiatric disorder in these individuals. To obtain such data, the authors examined the prevalence of stress and exposure to trauma, current and lifetime posttraumatic stress disorder (PTSD), and other psychiatric diagnoses in a group of adult offspring of Holocaust survivors (N=100) and a demographically similar comparison group (N=44). METHOD: Subjects were recruited from both community and clinical populations and were evaluated with the use of structured clinical instruments. Stress and trauma history were evaluated with the Antonovsky Life Crises Scale and the Trauma History Questionnaire, PTSD was diagnosed with the Clinician Administered PTSD Scale, and other psychiatric disorders were evaluated according to the Structured Clinical Interview for DSM-IV. RESULTS: The data show that although adult offspring of Holocaust survivors did not experience more traumatic events, they had a greater prevalence of current and lifetime PTSD and other psychiatric diagnoses than the demographically similar comparison subjects. This was true in both community and clinical subjects. CONCLUSIONS: The findings demonstrate an increased vulnerability to PTSD and other psychiatric disorders among offspring of Holocaust survivors, thus identifying adult offspring as a possible high-risk group within which to explore the individual differences that constitute risk factors for PTSD.     

Reverberations of the Holocaust fifty years later: Psychology's contributions to understanding persecution and genocide.

The Nazi attempt to annihilate the Jewish people ended over 50 yrs ago, but both public and scholarly interest in the Holocaust remains intense and has a salient psychological component. The Holocaust continues to be the setting for many novels, plays, and films, and is also frequently invoked as a metaphor in policy debates such as in justification of the NATO air attacks against Yugoslavia. Holocaust-related psychological research can serve as a basis for better understanding of subsequent, and perhaps of future, ethnopolitical violence, the focus of the ongoing joint Canadian Psychological Association–American.Psychological Association Ethnopolitical Warfare Initiative. This research includes theories of why people participate in genocide, the analysis of bystander and rescuer behavior, and the development of interventions that may help to prevent or de-escalate ethnic conflicts and to ameliorate their effects. Psychological studies of Holocaust survivors have contributed to our knowledge of posttraumatic stress disorder (PTSD), the transmission of trauma to subsequent generations, and the possibility of coping and recovery after extreme stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive–behavioral therapy for PTSD and depression symptoms reduces risk for future intimate partner violence among interpersonal trauma survivors.

Objective: Women who develop symptoms of posttraumatic stress disorder (PTSD) and depression subsequent to interpersonal trauma are at heightened risk for future intimate partner violence (IPV) victimization. Cognitive–behavioral therapy (CBT) is effective in reducing PTSD and depression symptoms, yet limited research has investigated the effectiveness of CBT in reducing risk for future IPV among interpersonal trauma survivors. Method: This study examined the effect of CBT for PTSD and depressive symptoms on the risk of future IPV victimization in a sample of women survivors of interpersonal violence. The current sample included 150 women diagnosed with PTSD secondary to an array of interpersonal traumatic events; they were participating in a randomized clinical trial of different forms of cognitive processing therapy for the treatment of PTSD. Participants were assessed at 9 time points as part of the larger trial: pretreatment, 6 times during treatment, posttreatment, and 6-month follow-up. Results: As hypothesized, reductions in PTSD and in depressive symptoms during treatment were associated with a decreased likelihood of IPV victimization at a 6-month follow-up even after controlling for recent IPV (i.e., IPV from a current partner within the year prior to beginning the study) and prior interpersonal traumas. Conclusions: These findings highlight the importance of identifying and treating PTSD and depressive symptoms among interpersonal trauma survivors as a method for reducing risk for future IPV. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Health Service Use Predictors Among Trauma Survivors: A Critical Review.

This article had 2 aims: (a) to comprehensively review and synthesize the literature on predictors of health service utilization in survivors of traumatic events and posttraumatic stress disorder (PTSD) patients and (b) to discuss methodological issues in examining service utilization in this population. PsycINFO was searched for relevant articles published through April 2004. Included studies had to primarily sample trauma survivors or PTSD patients and statistically explore health service use determinants. Although some findings conflicted across studies, increased mental health service use was generally related to being female, having a previous trauma history, and having a PTSD diagnosis. Increased medical service use was found among those with a PTSD diagnosis. Methodological recommendations are made for future health service use studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preventing secondary traumatization in the undergraduate classroom: Lessons from theory and clinical practice.

Indirect exposure to traumatic events or to survivors of trauma can itself be traumatizing and lead to symptoms similar to those of posttraumatic stress disorder (PTSD), a phenomenon known as secondary traumatization. Undergraduate students enrolled in courses on trauma are potentially vulnerable to secondary traumatization, although no research on them has been conducted. Literature on trauma therapy and the prevention of secondary traumatization is reviewed and suggestions are made for generalizing those findings to the university classroom. Issues of trauma exposure, safety, education, self-care, empowerment, and social support are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The American Indian Holocaust: healing historical unresolved grief

American Indians experienced massive losses of lives, land, and culture from European contact and colonization resulting in a long legacy of chronic trauma and unresolved grief across generations. This phenomenon, labeled historical unresolved grief, contributes to the current social pathology of high rates of suicide, homicide, domestic violence, child abuse, alcoholism and other social problems among American Indians. The present paper describes the concept of historical unresolved grief and historical trauma among American Indians, outlining the historical as well as present social and political forces which exacerbate it. The abundant literature on Jewish Holocaust survivors and their children is used to delineate the intergenerational transmission of trauma, grief, and the survivor's child complex. Interventions based on traditional American Indian ceremonies and modern western treatment modalities for grieving and healing of those losses are described.     

Lack of Long-Lasting Consequences of Starvation on Eating Pathology in Jewish Holocaust Survivors of Nazi Concentration Camps.

The purpose of the present study was to investigate whether Holocaust survivors will show the same eating pathologies that were found in other participants who had also undergone starvation. Fifty-five Holocaust survivors and 43 matched control participants answered a questionnaire designed to explore eating problems and pathologies described in the literature as lasting for decades after a period of severe food restriction. Confirmation of the survivors' reports was obtained from their children. No significant differences in current eating habits were found between the Holocaust survivors and their matched controls. Prolonged starvation in Holocaust survivors did not lead to disordered eating habits in the sample. These results conflict with the notion that severe starvation consistently leads to food preoccupation and disordered eating. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Screening for posttraumatic stress disorder in a general psychiatric outpatient setting.

Posttraumatic stress disorder (PTSD) may affect survivors of a number of accidents and illnesses, in addition to violence victims and combat veterans. Prior research suggests that PTSD may be underdiagnosed when trauma is not the presenting problem. Thus, a PTSD screening scale might have utility in routine clinical settings. The authors evaluated the screening performance of the Posttraumatic Diagnostic Scale (PDS) in a general psychiatric setting. Results indicated that the PDS performed as well in this setting as it did in the original trauma-focused validation studies, independent of PTSD status as a primary, versus secondary, reason for presenting. A simple cutoff score was adequate for case identification. There were no gender effects, and the scale performed equally well among patients with, versus without, a depressive diagnosis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Causal attributions in posttraumatic stress disorder: Implications for clinical research and practice.

In this paper we seek to illuminate connections among basic research findings in cognition and causal inference, clinical research on the treatment of Posttraumatic Stress Disorder (PTSD), and the practices of clinicians who work with trauma survivors. We examine one particular (and, we believe, important) aspect of PTSD: The creation and maintenance of causal attributions about trauma. We suggest that elements of two principal theories of causal induction (the connectionist model and the "Power PC" causal power model) clarify the role of causal attributions in creating and sustaining the symptoms of PTSD. By exploring the role of causal attributions in creating and sustaining posttraumatic symptoms, we hope to understand better the subjective experience of trauma and its sequelae. We then suggest new directions for clinical research on cognitive restructuring in PTSD patients as well as ideas for optimizing attribution-based therapies for trauma survivors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The transmission of trauma across generations: identification with parental trauma in children of Holocaust survivors

OBJECTIVE: This study examines the phenomenology of intergenerational transmission of trauma with the aim of elucidating the interactional process of transmission within an object relations framework. METHOD: The method consisted of systematic textual analysis of semi-structured interviews with six Jewish women born after the war who were children of concentration camp interned Holocaust survivors. RESULTS: Four superordinate themes were identified: heightened awareness of parents' Holocaust survivor status, parenting style, overidentification with parents' experiences and transmission of fear and mistrust. These were found despite the variation in parental communication. CONCLUSIONS: The data suggest that unconscious processes are at least partially involved in the transmission of trauma. A form of projective identification is proposed as an explanatory mechanism which brings together diverse aspects of the observed phenomena: projection by the parent of Holocaust-related feelings and anxieties into the child; introjection by the child as if she herself had experienced the concentration camps; and return of this input by the child in the form of compliant and solicitous behaviour associated with enmeshment and individuation problems. Further research may establish these phenomena as a particular form of Secondary Traumatic Stress Disorder.     

Review of The legacy of the Holocaust: Psychohistorical themes in the second generation.

Reviews the book, The legacy of the Holocaust: Psychohistorical themes in the second generation by Robert M. Prince (see record 2000-08422-000). The concept that the Holocaust is a unique event in human history has been seriously debated. Is the Holocaust comparable to savage massacres of other groups at other times in civilization? Or is it an event that, because of its enormity, transcends all other barbarities in modern history? If it is unique, then this uniqueness must attach itself to the identity of the children of the survivors of the Holocaust. Prince addresses this issue of identity in this book. Prince identifies three significant sources of influence in the lives of these children: the parents' character style and their relationship with their children, the active participation of the children in imagery from their parents' past, and the cultural context in which the children have been raised. How these influences interweave and transform each other is a major focus of the study. The second focus is the relationship between the children of Holocaust survivors "and the events of history, involving observation of their adaptation to history and anticipation of their effect on it" (p. 15). Prince has undertaken an ambitious project. He has attempted to apply a psychoanalytically-informed methodology to the study of the Holocaust. He offers a scientific approach to the study of the transmission of trauma from one generation to the next. The work raises issues and questions that, it is hoped, will motivate others to continue the inquiry. The book strives to find meaning in response to the unimaginable and the unthinkable acts of mankind. It merits a place in the library of anyone concerned with the Holocaust or interested in psychohistorical explorations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Aleutian Enterprise sinking and posttraumatic stress disorder: Misdiagnosis in clinical and forensic settings.

This study examines the vulnerability of clinicians to overdiagnose posttraumatic stress disorder (PTSD) when survivors of a traumatic event are involved in litigation. 19 of 22 survivors of a marine disaster were seen by mental health professionals while pursuing personal injury claims and received a PTSD diagnosis that was maintained for more than 6 mo. This yielded an incidence rate for chronic PTSD of no less than 86%, a rate in excess of any previously reported in the literature for any type of trauma. The extraordinary incidence rate appeared to be explained, in part, by crew members' reports of attorney advice and symptom sharing. Clinicians are cautioned not to rely on client's self-reports and to consider postincident factors that may influence these reports when clients are involved in litigation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Unresolved attachment, PTSD, and dissociation in women with childhood abuse histories.

The primary objective of this study was to examine unresolved trauma as assessed by the Adult Attachment Interview and current psychiatric symptoms, focusing on posttraumatic stress disorder (PTSD) and dissociation, in a group of adult female childhood abuse survivors. The authors examined psychiatric symptoms and attachment representations in a group with (n = 30) and without (n = 30) abuse-related PTSD. The findings revealed that unresolved trauma carried a 7.5-fold increase in the likelihood of being diagnosed with PTSD and was most strongly associated with PTSD avoidant symptoms rather than dissociative symptoms. The utility of a PTSD framework for understanding unresolved trauma and the role of intentional avoidance of trauma cues in the maintenance of traumatized states of mind are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trauma reactivity, avoidant coping, and PTSD symptoms: A moderating relationship?

In the immediate aftermath of a traumatic event, many individuals experience physiological reactivity in response to reminders of the traumatic event that typically lessens over time. However, an overreliance on avoidant coping strategies may interfere with the natural recovery process, particularly for those who are highly reactive to trauma reminders. In the current investigation, we examined avoidant coping as a moderator of the association between heart rate reactivity to a trauma monologue measured shortly after a traumatic event and severity of posttraumatic stress disorder (PTSD) symptoms measured several months later. Fifty-five female survivors of assault completed PTSD diagnostic interviews and a self-report coping measure and participated in a trauma monologue procedure that included continuous heart rate measurement. These procedures were completed within 1 month of the assault and again 3 months postassault. After we controlled for the effect of initial symptom levels, the interaction of heart rate reactivity to the trauma monologue and avoidant coping measured at Time 1 was associated with PTSD symptom severity at Time 2. Individuals who are relatively highly reliant on avoidant coping strategies and relatively highly reactive to trauma reminders may be at greatest risk of maintaining or potentially increasing their PTSD symptoms within the first few months following the trauma. These findings may help inform early intervention efforts for survivors of traumatic events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neurocognitive function in monozygotic twins discordant for combat exposure: Relationship to posttraumatic stress disorder.

Neuropsychological deficits have been reported among trauma survivors with posttraumatic stress disorder (PTSD). It is often assumed that these cognitive difficulties are toxic consequences of trauma exposure. Alternatively, they may reflect preexisting characteristics that contribute to the likelihood of developing PTSD. To address this possibility, the authors evaluated cognitive performance in monozygotic twin pairs who were discordant for combat exposure. Pairs were grouped according to whether the combat-exposed brother developed PTSD. The combat-unexposed cotwins of combat veterans with PTSD largely displayed the same performance as their brothers, which was significantly lower than that of non-PTSD combat veterans and their brothers. The results support the notion that specific domains of cognitive function may serve as premorbid risk or protective factors in PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The lingering Holocaust: Legacies in lives of descendants of victims and perpetrators.

Many of those who have been subjected to physical and emotional trauma in any of its many horrible guises eventually seek the therapeutic services of professional psychologists. Clinicians who treat survivors of genocide, other kinds of political repression and oppression, physical and sexual abuse, and torture must be skilled in understanding and intervening with this severely distressed population. This article describes the fourth in a series of annual dialogue sessions between Nazi Holocaust victims and perpetrators; all are clinicians with a personal Holocaust legacy. It is hoped that this article will stimulate readers to become more involved and proficient in the treatment of survivors, whether in individual, couple, family, or group therapies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acute stress disorder scale: A self-report measure of acute stress disorder.

The Acute Stress Disorder Scale (ASDS) is a self-report inventory that (a) indexes acute stress disorder (ASD) and (b) predicts posttraumatic stress disorder (PTSD). The ASDS is a 19-item, inventory that is based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV, American Psychiatric Association, 1994) criteria. The ASDS possessed good sensitivity (95%) and specificity (83%) for identifying ASD against the ASD Interview on 99 civilian trauma survivors. Test-retest reliability of the ASDS scores between 2 and 7 days was strong (r? =? .94). The ASDS predicted 91% of bushfire survivors who developed PTSD and 93% of those who did not; one third of those identified by the ASDS as being at risk did not develop PTSD, however. The ASDS shows promise as a screening instrument to identify acutely traumatized individuals who warrant more thorough assessment for risk of PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethnic differences in posttraumatic distress: Hispanics’ symptoms differ in kind and degree.

This longitudinal study of physical injury survivors examined the degree to which Hispanic and non-Hispanic Caucasians reported similar posttraumatic stress disorder (PTSD) symptoms. Adult physical trauma survivors (N = 677) provided information regarding posttraumatic distress by completing an interview-administered version of the PTSD Symptom Checklist (Civilian version) at 3 time points: within days of trauma exposure and again at 6 and 12 months posttrauma. Structural equation modeling with propensity weights was used in analyzing data. Results replicated prior research indicating that Hispanics report greater overall PTSD symptom severity. However, the size of this effect varied significantly across the 17 individual PTSD symptoms, and several symptoms were not reported more highly by Hispanics. Relative to non-Hispanic Caucasians, Hispanics tended to report higher levels of symptoms that could be regarded as exaggerated or intensified cognitive and sensory perceptions (e.g., hypervigilance, flashbacks). In contrast, few differences were observed for symptoms characteristic of impaired psychological functioning (e.g., difficulty concentrating, sleep disturbance). Findings suggest that the pattern of PTSD symptoms experienced most prominently by Hispanics differs in kind and not merely in degree. Results have implications for theory aimed at explaining this ethnic disparity in posttraumatic psychological distress as well as for clinical intervention with trauma-exposed Hispanics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)