Eli Somer

Impact of exposure to war stress on exacerbations of multiple sclerosis.

To assess the relation between stress caused by the perils of rocket attack on civilian centers in northern Israel during the 2006 war between Hezbollah and Israel and multiple sclerosis (MS) exacerbations.

Terrorism, distress and coping: High versus low impact regions and direct versus indirect civilian exposure

Abstract The 2001–2002 terror campaign against Israels heartland was an unprecedented string of deadly bombing attacks against Israeli civilians. The violence touched the lives of countless Israelis and has negatively affected the general mood of many. The objective of this investigation was to assess the level of exposure to terrorism for individuals residing in the affected areas and to examine psychological responses and ways of coping during the peak of the violence. A random sample of 327 adults, purposely over-sampled from the hardest-hit areas, was surveyed. Although citizens residing in the most severely hit locales were also those who suffered most from posttraumatic symptoms, the effects of major national trauma were not limited to those directly exposed to it. These results suggest that objective measures of exposure or loss may not be sensitive predictors of reactive distress. Acceptance of the situation and its uncontrollability was both the most commonly used way of coping employed and the only effective one.

Validation of the Hebrew version of the Dissociative Experiences Scale (H-DES) in Israel

Abstract Ob jec tives : The pur pose of this re search was to ex plore the va lid ity of the con cept of dis so ci a tion as mea sured by a He brew version of the Dissociative Ex pe ri ences Scale (H-DES) in Is rael. De sign: The first study ex am ined the re li abil ity and va lid ity of the H-DES by as sess ing 340 con sec u tive ad mis sions to an Is raeli out pa tient clinic, and 290 nonclin i cal sub jects. The sec ond study ex plored the construct va lid ity of the con cept of dis so ci a tion by study ing re la tion ships be tween re ported past traumatization and cur rent lev els of dis so ci a tion among a dif fer ent co hort of 70 women Is raeli out pa tients. Re sults: The H-DES has good testre test and split-half re li abil ity in clin i cal and nonclin i cal sub jects, and is in ter nally con sis tent. Its con vergent va lid ity with the MMPI 2 Philips Dis so ci a tion Scale is good, and it has good cri te rionre lated va lid ity with DSM-IV dissociative dis or der di ag no ses. The con cept of dis so ci a tion as mea sured in Is rael by the H-DES has high re li abil ity and va lid ity. Con clu sions : The re li able iden ti fi ca tion of dis sociative ex pe ri ences in Is rael as well as in sev eral cul tures out side North Amer ica sup ports dis soci a tion as a valid psy cho log i cal con struct with wide spread cross cul tural ap pli ca bil ity. This study con tra dicts claims that dis so ci a tion is merely a pass ing North Amer i can pro fes sional fash ion.

Are children exposed to interparental violence being psychologically maltreated

Research on childhood witnessing of interparental violence is reviewed. Evidence is presented as to the severe developmental damages the witnessing covictims often sustain. These include: depression, anxiety, cognitive problems, delinquency, and proneness to violence and victimization. Parental failure to shield children from such traumatizing experiences constitutes child maltreatment in that it exposes the victims to (a) terrorizing, and (b) missocializing by corrupting models. Psychological maltreatment is even more potentially damaging than direct physical abuse or neglect alone. In light of the ambiguity in defining caregiver acts of psychological maltreatment, cases in which children have regularly watched wife battering are easier to identify than other forms of psychological maltreatment. Child protection agencies must give priority to responding to cases of psychological maltreatment of children.

Managing terror: Differences between Jews and Arabs in Israel

Using telephone surveys, we examined exposure to terror, coping, and mental health response in randomly selected Jewish-Israelis (n = 100) and Arab-Israelis (n = 100) living in five Israeli cities affected by terrorism. Jewish-Israelis and Arab-Israelis were randomly selected for study participation and completed telephone surveys in May 2002, following an extended string of terror attacks and hostilities. Although terrorism is designed to target Jewish-Israelis, the rates of exposure were similar in the two groups. Arab-Israelis reported using a wider array of coping strategies, yet also endorsed more frequent PTSD and more severe depression symptoms than Jewish-Israelis. We examined a variety of demographic, ethnic, and religious predictors of different coping styles and found varying results. For example, acceptance coping was best predicted by Arab-Israeli ethnicity, being female, greater religiosity, and lower education. Predictors of mental health response to terror were also examined, with Arab-Israeli ethnicity, being female, adaptation coping and collaborative coping best predicting PTSD and depression symptoms. Arab-Israelis may not have the same access to overarching sources of patriotic support that are readily available to their Jewish compatriots, and civilian and economic inequity experienced by the Arab minority may add to a sense of diminished resources. Our findings justify outreach efforts to overlooked minorities at risk for posttraumatic distress. Women seem to be at particular risk for the development of mental health symptoms following terrorism, which should also be noted for outreach purposes.

PREDICTION OF ABSTINENCE FROM HEROIN ADDICTION BY CHILDHOOD TRAUMA, DISSOCIATION, AND EXTENT OF PSYCHOSOCIAL TREATMENT

This study is an investigation of trauma and dissociation in 93 Israeli patients recovering from drug use disorder. The respondents showed more emotional, physical and sexual traumatization than consecutive admissions to an Israeli outpatient stress clinic, and their levels of dissociation were similar to those previously measured in Israeli patients diagnosed with Posttraumatic Stress Disorder and Acute Stress Disorder. It was posited that the level of trauma-related dissociation can make an independent contribution to explaining variance in recovery from a drug use disorder. The finding of structural equation analyses supported this model and suggests that childhood traumatization is related to the proclivity of chemically-dependent respondents to participate in psychosocial treatment and that duration of psychosocial treatment can positively predict duration of abstinence. Dissociation levels made an independent negative contribution to the prediction of abstinence. While our findings imply that tenacity in treatment could be a sustaining process associated with abstinence from drug use, they also suggest that without a thorough resolution of trauma-related dissociation, optimal treatment outcome is compromised.

BusWorld: Designing a Virtual Environment for Post-Traumatic Stress Disorder in Israel: A Protocol

A number of carefully controlled studies have documented the effectiveness of traditional imaginal exposure for the treatment of post-traumatic stress disorder (PTSD). Virtual reality (VR) exposure therapy is based on a similar logic but rather than self-generating imagery, patients wear a VR helmet and go into a three-dimensional (3-D) computer generated virtual world to help them gain access to their memory of the traumatic event. Recent preliminary research has shown that some patients who fail to respond to traditional therapy benefit from virtual reality exposure therapy, presumably because VR helps the patient become emotionally engaged while recollecting/recounting/re-interpreting/emotionally processing what happened during the traumatic event. The present paper presents a brief overview of a new VR World we developed to provide virtual reality therapy for terrorist bus bombing victims in Israel, and a brief description of our research protocol and measures (for details, see www.vrpain.com).

Stambali: Dissociative Possession and Trance in a Tunisian Healing Dance

This study investigated Stambali, a Tunisian trance-dance practiced in Israel as a healing and a demon exorcism ritual by Jewish-Tunisian immigrants. The authors observed the ritual and conducted semi-structured ethnographic interviews with key informants. Content analysis revealed that Stambali is practiced for prophylactic reasons (e.g. repelling the ‘evil eye’), for the promotion of personal well-being, and as a form of crisis intervention. Crisis was often construed by our informants as the punitive action of demons, and the ritual aimed at appeasing them. Communication with the possessing demons was facilitated through a kinetic trance induction, produced by an ascending tempo of rhythmic music and a corresponding increased speed of the participant’s movements of head and extremities. The experience was characterized by the emergence of dissociated eroticism and aggression, and terminated in a convulsive loss of consciousness. Stambali is discussed in terms of externalization and disowning of intrapsychic conflicts by oppressed women with few options for protest.

Clandestine psychopathology: unrecognized dissociative disorders in inpatient psychiatry.

Surveys among Israeli mental health professionals found that almost half of them doubt the validity of dissociative disorders (DD) and have no experience in either diagnosing or treating DD patients. These findings, in line with arguments that DDs are socially construed North American phenomena, call for the need to investigate it in Israel. Eighty-one psychiatric inpatients were screened for dissociative pathology. Participants categorized as having low levels of dissociation (n = 26) and those demonstrating high levels of dissociation (n = 22) were asked to participate in a Structured Clinical Interview for the DSM—Dissociative Disorders—Revised. One-quarter of all participants were identified as having probable dissociative psychopathology. Based on the Structured Clinical Interview for the DSM—Dissociative Disorders—Revised, estimates of DD range between 12 and 21%. None of the participants had any indication of a DD diagnosis in their medical records. Diagnosis of personality disorder and psychiatric comorbidity were related to the likelihood of a DD diagnosis and its severity.

Dissociative Phenomena Among Recovering Heroin Users and Their Relationship to Duration of Abstinence

ABSTRACT This study is an investigation of trauma and dissociation in 100 Israeli recovering patients with drug use disorder. The respondents showed more emotional, physical and sexual traumatization than an Israeli clinical sample, and their levels of dissociation were similar to those previously measured in Israeli patients diagnosed with Posttraumatic Stress Disorder and Acute Stress Disorder (Somer, Dolgin, & Saadon, 2001). Male respondents with higher trauma scores were more likely to report dissociative experiences during their drug use (chemical dissociation). Drug-free high-dissociators were more likely to report depersonalizing and derealizing experiences when they had been using drugs. Stronger dissociative experiences during drug-use related to more psychological distress during inter-use craving. A relationship between psychological distress during inter-use craving and psychological dissociation measured in a detoxified state was also established. Length of abstinence from illicit substances was best predicted by lower levels of psychogenic dissociation and by longer durations of psychosocial treatment. While findings imply that tenacity in treatment could be a sustaining process associated with abstinence from drug use, they also suggest that without a thorough resolution of trauma-related dissociation, successful treatment outcome is less likely.