Sunday, November 8, 2009

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


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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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.

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