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PTSD transmission: a review of secondary traumatization in Holocaust survivor families

Canadian Psychology, Nov 1998 by Williams-Keeler, Lyn, McCarrey, Michael, Baranowsky, Anna B, Young, Marta, Johnson-Douglas, Sue

Abstract

Posttraumatic Stress Disorder (PTSD) provides a common language for diagnoses and assessment of trauma victims, including Holocaust survivors. Many of these survivors established post-war families and it is here that we began to witness the possibility of trauma transmission. Parental communication regarding the Holocaust, often characterized by obsessive re-telling or all-consuming silence, and strong family ties are implicated in the theoretical literature on trauma transmission. Terms such as vicarious, empathic, and secondary traumatization have been used to describe intergenerational trauma transmission. The crucial emergent question is whether a secondary PTSD syndrome, reflected in the current PTSD symptomology, is being transmitted from one generation to the next. There is evidence in the literature to support this hypothesis and a call is made for rigorous empirical studies as the test.

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Resume

Le syndrome de stress post-traumatique (SSP) fournit le langage permettant de poser des diagnostics et d'effectuer des evaluations dans le cas de victimes de traumatismes, y compris les survivants de l'Holocauste. Un grand nombre de ces personnes ont fonde des families apres la guerre, et c'est dans ces familles que nous avons commence a constater la possibilite de transmission des traumatismes. Le message des parents sur l'Holocauste, qui consiste souvent a raconter l'experience de facon obsessive ou a garder un silence absolu sur la question, et les liens familiaux serres sont mentionnes comme facteurs dans les documents theoriques sur la transmission des traumatismes. Des termes tels que traumatisme indirect, traumatisme empathique et traumatisme secondaire ont ete utilises pour decrire la transmission des traumatismes entre les generations. Il est maintenant essentiel de savoir si un syndrome de stress post-traumatique secondaire, dont la symptomatologie actuelle du SSP laisse entrevoir l'existence, est transmis d'une generation a la suivante. Les documents sur la question contiennent des renseignements a l'appui de cette hypothese, et on recommande que des etudes empiriques rigoureuses soient effectuees pour la confirmer.

The diagnostic criteria for PTSD established in the DSM-IV provides a standardized means of assessing the effects of trauma. Concentration Camp Syndrome, Survivor Syndrome, Postincarceration Late Injury and Concentration Camp Neurosis among other terms were precursors to what is currently known as Posttraumatic Stress Disorder. In this article, PTSD will be used as an umbrella term encompassing earlier terms such as Survivor Syndrome. Regardless of the term used, extensive evidence exists suggesting that large numbers of Holocaust survivors suffered and continue to suffer from their traumatic experiences. Theories of trauma transmission from survivor to offspring have been proposed in psychological literature, but the exact nature of what is transmitted has gained little attention. Various researchers have suggested that since many Holocaust survivors suffer from PTSD, their offspring will also suffer from a syndrome of similar dimensions with diminished proportions (Barocas & Barocas, 1973, 1979; Solomon, 1990). In the following article, trauma will be described in terms of the PTSD diagnostic criteria from the DSM-IV (APA, 1994). The primary focus of this article is to report upon literature-based evidence of PTSD symptom transmission in the second generation. Secondarily, a case for empirically based research further exploring this topic will be advanced.

PTSD in Holocaust Survivors

Much definitive evidence has become available acknowledging the occurrence of PTSD in large numbers of Holocaust survivors (Berger, 1975; Chodoff, 1970; Eaton, Sigal, & Weinfeld, 1982; Eissler, 1967; Hunter, 1988; Krystal, 1968; Rosenbloom, 1988; Rubenstein, Cutter, & Templer, 1989). In 1962, Eitinger described common effects of concentration camps on 100 prisoners 15 years after liberation. Some survivors were simply unable to feel, while others had the paradoxical response of euphoria mixed with emotional numbness. Remarkably, most survivors resumed work almost immediately after repatriation despite severe physical and emotional impairment. Eitinger used the term "concentration camp syndrome" to describe a series of symptoms notably similar to those currently known as PTSD that he found to be present in approximately 85% of his sample group.

In 1975, Matussek used physical exams and psychiatric interviews to determine the effects of traumatic experiences on Jewish concentration camp survivors. Again, survivors reported a series of symptoms that were akin to the current PTSD constellation. It is likely that up to 52.5% of this sample would have met current PTSD criteria. Kuch and Cox (1992) re-examined 124 German files of Jewish Holocaust survivors. They concluded that 46% would have met the PTSD indicators based on the DSM-III-R criteria. The tattooed survivors of Auschwitz were three times as likely to meet the PTSD diagnostic criteria and had a greater number of symptoms than those surviving the Holocaust as a Jew in Europe suffering Nazi pursuit, but not in a concentration camp.

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PTSD transmission: a review of secondary traumatization in Holocaust survivor families

Canadian Psychology, Nov 1998 by Williams-Keeler, Lyn, McCarrey, Michael, Baranowsky, Anna B, Young, Marta, Johnson-Douglas, Sue

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