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

Leventhal and Ontell (1989) reported that survivor offspring rated a number of adjectives as being significantly descriptive (p

Criterion D: Hyperawareness. Criterion D can be described as a "hyperawareness" manifested as sleep disturbance, irritability, poor concentration, and heightened vigilance and alarm. A tendency towards repressed aggression among survivor offspring was noted by Krystal in 1968. He suggested, based on clinical findings, that this repression eventually leads to aggressive outbursts. Krell (1982) also reported on the clinical progress of a survivor offspring showing signs of depression and outbursts of anger. This would provide support for Criterion D-2 (flares of anger and irritability) among survivor offspring.

Bergmann and Jucovy (1982) found that children of Holocaust survivors tend to suffer from superego impairments. This clinical finding was later supported by Gross' (1988) empirical study. Survivor offsprings' 16 Personality Factor Inventory scores were low on ego strength and superego strength scales based on norms. According to Gross, low ego strength scores signal sleep difficulty (D-1), irrational fears (A-2) and the tendency to become irritated (D-2) by others. In another study, survivor offspring rated cautiousness as being significantly descriptive of themselves at the p

Criterion E: Symptom Duration. Criterion E states that the PTSD symptoms (referred to in criteria B, C, D) must be present for longer than one month. There is evidence that survivor offspring carry the emotional burden of their parents for many years (Barocas & Barocas, 1973, 1979; Epstein, 1979; Sigal, DiNicola, & Buonvino, 1988). Some researchers report that adult survivor offspring attend group therapy and seek out other forms of mental health support in numbers that surpass Jewish non-survivor offspring (Axelrod, Schnipper, & Rau, 1980; Rakoff, Sigal, & Epstein, 1966). However, more recently, Sigal and Weinfeld (1989) reported no significant differences between children of survivors and non-survivor offspring in seeking mental health support. Nonetheless, other researchers suggest that the trauma is even carried to a third generation suggesting a long-term psychological sequelae of the Holocaust on future generations (Rakoff, Sigal, & Epstein, 1966; Rubenstein, Cutter, & Templer, 1989; Sigal, DiNicola, & Buonvino, 1988).

Social and Occupational Impairment. Finally, Criterion F asserts that the symptoms must be clinically significant enough to impair functioning of life skills. This relatively new criterion, incorporated as an explicit criterion only since the DSM-IV, plays a lessor diagnostic role than those symptoms captured in criterion B, C, and D. Criterion F was mainly established to reflect upon the impact of combat exposure on war veterans. Although there is some controversy regarding the life-skills functioning of military veterans, a number of studies do suggest that, among this population, we see the tendency for high divorce rates, and occupational unemployment or underemployment (Anderson & Mitchell, 1992; Pavalko & Elder, 1990). In contrast, among Holocaust survivors and their offspring a very different pattern of behavior is displayed, characterized by high educational and occupational aspirations and achievements, as well as stable family and marital lives, and social achievements (Davidson, 1981; Eitinger, 1962; Epstein, 1979; Leventhal & Ontel, 1989; Rosenman & Handelsman, 1990; Sigal & Weinfeld, 1989).