Anselm Crombach

When combat prevents PTSD symptoms--results from a survey with former child soldiers in Northern Uganda.

BackgroundHuman beings from time immemorial have eradicated neighbouring tribes, languages, religions, and cultures. In war and crisis, the cumulative exposure to traumatic stress constitutes a predictor of the development of post traumatic stress disorder (PTSD). However, homicide has evolved as a profitable strategy in man, leading to greater reproductive success. Thus, an evolutionary advantage of perpetrating violence would be eliminated if the exposure to aggressive acts would traumatize the perpetrator. We argue that perpetrating violence could actually ‘immunize’ a person against adverse effects of traumatic stressors, significantly reducing the risk of developing PTSD.MethodsWe surveyed 42 former child soldiers in Northern Uganda that have all been abducted by the Lord Resistance Army (LRA) as well as 41 non-abducted controls.ResultsLinear regression analyses revealed a dose–response effect between the exposure to traumatic events and the Posttraumatic Diagnostic Scale (PDS) sum score. However, the vulnerability to develop trauma related symptoms was reduced in those with higher scores on the Appetitive Aggression Scale (AAS). This effect was more pronounced in the formerly abducted group.ConclusionsWe conclude that attraction to aggression when being exposed to the victim’s struggling can lead to a substantial risk-reduction for developing PTSD.

The benefits of aggressive traits: a study with current and former street children in Burundi.

Aggressive behavior in children and youths is commonly associated with exposure to violence and maltreatment. Consequently, aggressive behavior has often been explained as a form of reactive behavior in response to violence-inflicted mental suffering. However, perpetrating violence can become appealing, fascinating and exciting, i.e., may acquire appetitive, self-rewarding aspects. We postulated that this appetitive form of aggression reduces the vulnerability for developing Posttraumatic Stress Disorder (PTSD) in insecure and violent environments. Furthermore we investigated the extent to which reactive aggression and appetitive aggression account for recent violent behavior in children and youths. We conducted semi-structured interviews in a sample of 112 children and youths (Mage=15.9 years) recruited from the streets, families and a residential center for vulnerable children in Burundi. We investigated the cumulative exposure to traumatic events and to domestic and community violence, assessed the recently committed offenses, the severity of PTSD symptoms, and the potential for reactive and appetitive aggression. Reactive aggression was positively related to PTSD, whilst appetitive aggression was negatively related to PTSD. Children higher in appetitive aggression were also more likely to display violent behavior. These results suggest that an appetitive perception of violence may be an useful adaption to insecure and violent living conditions reducing the vulnerability of children for trauma-related mental disorders. However, positive feelings experienced through violent or cruel behavior are also an important risk factor for ongoing aggressive behavior and therefore need to be considered in prevention strategies.

Controlling Offensive Behavior Using Narrative Exposure Therapy A Randomized Controlled Trial of Former Street Children

Insecure and violent environments foster two different forms of aggressive behavior: reactive aggressive responding, such as fearful or angry impulsive behavior to perceived threats, and appetitive aggression, which encompasses violence-related feelings of power, excitement, and pleasure. We tested whether forensic offender rehabilitation narrative exposure therapy (FORNET; five sessions) would reduce involvement in everyday violence and produce beneficial effects for mental and physical health. In a Burundian residential center for former street children, we identified a subset of 32 male youths (mean age = 17 years) who scored highly in appetitive aggression. We conducted a randomized controlled trial by assigning matched pairs to receive either FORNET or treatment as usual. During the follow-up (4–7 months after completing treatment), the 16 youths who received FORNET reported having committed significantly fewer offenses (Hedges’s g = 0.62) and presented with fewer physical-health complaints (Hedges’s g = 0.56) than did their matched control participants.

Social status and the desire to resort to violence: using the example of Uganda's former child soldiers

Committing violent acts can be appealing, fascinating, exciting, and addictive (i.e., appetitive). Cultural settings that accept violence as a means to power and success promote this appetitive form of aggression. Former child soldiers of Uganda with military rank reported committing a greater variety of violent acts compared to those without rank. They experienced aggressive behavior as more positive than both those without rank and controls who had never been involved in armed groups. The relation between the number of individually committed offense types and appetitive aggression is weaker in former child soldiers without rank compared to those with rank. This indicates that the potential for rapid development of appetitive aggression is rewarded with higher social status in war-afflicted communities.

Predictors of posttraumatic stress and appetitive aggression in active soldiers and former combatants

Background During the period between 1993 and 2005, the people of Burundi were trapped within a violent civil war. In post-conflict regions, symptoms of posttraumatic stress disorder (PTSD) were found to be widespread. At the same time, combatants often reported having perceived committing violence as exciting and appealing, an experience referred to as appetitive aggression. Both of these phenomena hamper the building of a functional and peaceful society. Objective This study aims to investigate the factors that are associated with the level of PTSD and appetitive aggression in former and still active combatants. Methods Semi-structured interviews were conducted with 948 male Burundians: 556 active soldiers and 392 ex-combatants. PTSD symptom severity was assessed using the PTSD Symptom Scale Interview, while appetitive aggression was assessed using the Appetitive Aggression Scale. Results Linear regression analyses revealed that the number of traumatic events, childhood maltreatment, and their interaction predicted PTSD symptom severity, whereas self-committed violence did not. The number of traumatic events and self-committed violence were associated with appetitive aggression. Childhood maltreatment alone was not associated with appetitive aggression; however, its interaction with self-committed violence did predict appetitive aggression. When controlling for predictors, ex-combatants reported a higher degree of PTSD symptomatology, whereas active soldiers reported a higher degree of appetitive aggression. Conclusion We conclude that childhood maltreatment is an additional, significant risk factor that exacerbates the psychological consequences of violent conflicts. Self-committed violence may not necessarily engender trauma-related disorders, but is highly related to appetitive aggression.

Intergenerational violence in Burundi: Experienced childhood maltreatment increases the risk of abusive child rearing and intimate partner violence

Background Experiencing abuse during childhood affects the psychological well-being of individuals throughout their lives and may even influence their offspring by enhancing the likelihood of an intergenerational transmission of violence. Understanding the effects of childhood maltreatment on child-rearing practices and intimate partner violence might be of particular importance to overcome the consequences of violent conflicts in African societies. Objective Using Burundi as an example, we aimed to explore the associations between childhood maltreatment, intimate partner violence, perceived partner intimidation, gender and the probability of violently acting out against ones own children or romantic partner. Methods Amongst a sample of 141 men and 141 women in the capital of Burundi, we identified those who had biological children and those who lived or had lived in relationships. Using culturally appropriate instruments, we enquired about their exposure to childhood maltreatment and partner violence as well as their inclinations to act out violently. Results We found that childhood maltreatment and perceived partner intimidation were strong predictors for the perpetration of violence against children. Moreover, we found that women were more likely to use violence against children if they experienced partner violence and less likely to resort to violence if they felt intimidated. Men were more likely to perpetrate violence against their partner. Childhood maltreatment was again a strong predictor. The more women experienced partner violence, the more they fought back. Conclusions Childhood maltreatment is a strong predictor for domestic violence and has to be addressed to interrupt the cycle of violence in post-conflict countries.

Treating Traumatized Offenders and Veterans by Means of Narrative Exposure Therapy

Violent offenders and soldiers are at high risk of developing appetitive aggression and trauma-related disorders, which reduce successful integration into societies. Narrative exposure therapy (NET) for forensic offender rehabilitation (FORNET) aims at reducing symptoms of traumatic stress (e.g., posttraumatic stress disorder) and controlling readiness for aggressive behavior. It follows the logic of the evidence-based trauma-focused NET with special emphasis on violent acts in past and future behavior. In NET, the therapist guides the client by means of exposure through his traumatic experiences in chronological order linking the negative emotions, such as fear, shame, and disgust, to the past context and integrating the traumatic experiences into the autobiographical memory. During FORNET, we also encourage verbalization of any positive emotions and experiences linked to past violent and aggressive behaviors. This recall of positive emotions (linked to the there and then) is contrasted with feelings that emerge during the narration process (here and now). In this way, the therapist helps the client to anchor the whole range of sensory and bodily experiences, cognitions, and emotions to the contextual cues. Over the process of the therapy, we support the client to begin the role change from a violent offender to a citizen, who is capable of living a non-violent and socially adjusted life. Finally, the client develops visions and wishes for the future to support a successful integration into society. Several studies with veterans and violent youths have proven the feasibility of FORNET, found evidence of a positive outcome (recovered mental health, fewer offenses committed, less drug intake, and improved integration into civil society), and highlighted the importance of addressing the whole range of experiences while treating violent offenders or veterans.

A study on reintegration of street children in Burundi: experienced violence and maltreatment are associated with mental health impairments and impeded educational progress

Street children are exposed to violence, and subsist in poor and generally precarious conditions. In conflict regions, institutional care facilities are often the only well established way to care for vulnerable children. Providing access to school education is considered to be key to allow successful integration into society. However, adverse effects of psychological disorders may pose another serious obstacle. In semi-structured interviews in a sample of 112 Burundian male youths (mean age = 15.9 years), we assessed exposure to traumatic stressors, regularly and recently occurring violence as well as prevalence of posttraumatic stress disorder (PTSD), depression, substance dependence, suicidal risk, and progress in school. Former street children (n = 32) and other vulnerable children (n = 50) in a residential center were compared to children living in the streets (n = 15) or with families (n = 15). While the children living in the center were less regularly exposed to violence and reported less substance dependence than street children, PTSD symptoms were common among the former street children. Furthermore, we provided empirical evidence that for the children living in the center, recently experienced violence – mostly minor physical conflicts, psychological violence and neglect – was associated with increased PTSD symptomatology and impeded progress in school. In a population of children who experienced many traumatic incidences and a lot of violence, even minor violent events may trigger and reinforce PTSD symptoms. Hence controlling exposure to violence and addressing mental ill-health in vulnerable children is mandatory for reintegration.

Predicting domestic and community violence by soldiers living in a conflict region.

Objective: Past research revealed war trauma and posttraumatic stress disorder (PTSD) symptoms as potential predictors for domestic and community violence in crisis regions and among soldiers in different armed conflicts. The impact of family violence and other adversities experienced in childhood as well as of a combat-enhanced appeal for aggressive behavior (appetitive aggression) remains to be specified. Method: In the present study, the authors separately predicted violence against children, intimate partner violence and community violence in 381 Burundian soldiers returning from foreign deployment and living in a post- conflict region. Using path analysis, they aimed to disentangle the independent contributions and pathways of the following variables: Exposure to war trauma and childhood familial violence, PTSD and depression symptom severity, and appetitive aggression. Results: Childhood familial violence had an independent effect on all contexts of violence and was the only significant predictor for violence against the soldiers’ own children. Intimate partner violence was additionally predicted by depression symptom severity, while community violence was additionally predicted by PTSD symptom severity and appetitive aggression. Conclusions: Besides war-related mental ill-health and appetitive aggression, violent experiences during childhood development must not be overlooked as a factor fueling the cycle of violence in conflict regions.

Appetitive Aggression in Women: Comparing Male and Female War Combatants

Appetitive aggression refers to positive feelings being associated with the perpetration of violent behavior and has been shown to provide resilience against the development of PTSD in combatants returning from the battlefield. Until this point, appetitive aggression has been primarily researched in males. This study investigates appetitive aggression in females. Female and male combatants and civilians from Burundi were assessed for levels of appetitive aggression. In contrast to non-combatants, no sex difference in appetitive aggression could be detected for combatants. Furthermore, each of the female and male combatant groups displayed substantially higher levels of appetitive aggression than each of the male and female civilian control groups. This study demonstrates that in violent contexts, such as armed conflict, in which individuals perpetrate numerous aggressive acts against others, the likelihood for an experience of appetitive aggression increases- regardless of whether the individuals are male or female.