Ibrahim A. Kira

Measuring Cumulative Trauma Dose, Types, and Profiles Using a Development-Based Taxonomy of Traumas

This study presents a new short scale for measuring cumulative trauma dose, types, and profiles that is based on the APA (American Psychological Association) trauma Group (currently division 56) definition of trauma and a new, two-way development-based taxonomy of trauma. The new measure was tested using a sample of 501 Iraqi refugees who are one of the most traumatized groups. The following six salient factors were found: collective identity, family, personal identity, interdependence or secondary, man-made or nature-made survival, and abandonment types of traumas. The study provided evidence of adequate reliability; construct, convergent, divergent and predictive validity of the new scale and provided partial confirmation of the validity of the development-based taxonomy of traumas. A new method was introduced to measure trauma types and profiles and their differential association with different symptom configurations and health disorders. The newly developed measure can be used in clinical trauma-infor...

Taxonomy of Trauma and Trauma Assessment

A review of the theory of trauma as a special case of stress response theory, two different classifications/taxonomies of traumas emerge. Each taxonomy describes a different dimension of the traumatic event. The first taxonomy, areas of individual functioning, includes five types: Attachment trauma, autonomy or identity trauma, interdependence trauma, achievement or self-actualization trauma, and survival trauma. The second classification is based on experiential objective external criteria and includes two main categories: Factitious or trauma-like and real traumatic events. The first happens in one step transmission from one to one or more persons. The second get transmitted in multiple steps or cross-generationally. Traumas can get transmitted cross generationally in two venues: through family or collectively. Collective transmission of traumas happens in two contexts: historical and social structural. Direct traumas (person-made), on the other hand, is divided into two types: Simple (type I) and compl...

Etiology and Treatment of Post-Cumulative Traumatic Stress Disorders in Different Cultures

Developments in the theories of identity, culture, and traumatology enrich our cross-cultural understanding of mental health dynamics, case conceptualization, and developing effective intervention models to help victims of complex and cumulative traumas especially in different cultures and minority populations. Identity traumas, along with preidentity and nonidentity traumas, contribute to forming cultures. On the other hand, cultures may contribute to delivering some types of culture- and social-made serious traumatic conditions that can be transferred cross-generationally, such as poverty and caste systems. Most current interventions are designed to help with single trauma and ignore the cumulative trauma dynamics as well the collective identity and culture-specific traumas. This understanding entails revising our culturally limited and single-trauma-based interventions to help clients who belong to different cultures or to minority victims of culture- and social-made traumas as well as those who are vi...

The dynamics of cumulative trauma and trauma types in adults patients with psychiatric disorders: two cross-cultural studies

There is an intricate divide between three major valid paradigms in studying traumatic processes: The psychiatric paradigm that focused mostly on the survival types of traumas and on posttraumatic ...

The Effects of Gender Discrimination on Refugee Torture Survivors: A Cross-Cultural Traumatology Perspective

Trauma developmental theory identifies gender discrimination (GD) as a type of persistent, ongoing trauma that has the potential for serious, negative effects on mental health. This study was conducted to examine the potential role of GD in the development of cumulative trauma disorders (CTD) and symptoms of posttraumatic stress disorder (PTSD) as well as the role of GD in mediating the effects of other traumas on these disorders. The sample included 160 female torture survivors from more than 30 countries. Measures of PTSD, CTD, and types of trauma exposure were acquired as part of a larger study on refugee torture survivors. Structural equation modeling was used to test several plausible models for the direct and indirect effects of GD on PTSD and CTD, within the context of other trauma exposure. Results suggest that GD mediates the effects of identity traumas on CTD and PTSD. GD also had direct effects on CTD, including relationships with dissociation, suicidality, and deficits in executive function. GD did not appear to directly influence the development of PTSD. The implications of these results for assessment and treatment of women’s trauma-related disorders as well as strategies for their prevention are discussed.

Torture Assessment and Treatment: The Wraparound Approach

The paper explores the dimensions of torture trauma, its assessment and treatment. Simple PTSD does not account for the potential effects of torture. I propose a modified model of complex PTSD or cumulative trauma disorders that describes more the effects of torture. Most of the current evidence-based treatments for PTSD do not work with torture. A wraparound approach that proved its success with different kinds of cumulative traumas has been modified to fit torture treatment. Wraparound is multi-systemic and ecologically valid. It is conducted by community treatment teams that include community liaison and therapeutic case management teams. They provide community support and networking as well as direct treatment to the survivor and his family members. Social support is an important component of the wraparound process.

The Effects of Perceived Discrimination and Backlash on Iraqi Refugees’ Mental and Physical Health

The effects of discrimination and the post-9/11 backlash on Iraqi refugees have not yet been fully examined. The present study aimed to adapt a scale of the perceived backlash (BTS; a modified version of the Race Related Stressors Scale), and measure its relationships with Cumulative Trauma Dose (CTD), Post-traumatic Stress Disorder (PTSD), and health. The BTS was found to have high reliability; and construct, convergent, divergent, and predictive validities. The BTS predicted PTSD and poor health after controlling for the cumulative effects of other reported life traumas. The BTS correlated significantly with neurological, respiratory, digestive and blood disorders, and non-life-threatening illnesses. The results provided evidence for the validity of the trauma model of backlash and discrimination and its importance in the treatment of Iraqi refugees.

The Dynamics of Posttraumatic Growth Across Different Trauma Types in a Palestinian Sample

A Palestinian sample was used to explore the dynamics of posttraumatic growth (PTG) across different trauma types. Cumulative trauma, posttraumatic stress disorder, depression, anxiety, PTG, and stress-related growth (SRG) measures were administered. As predicted, only type I traumas were associated with PTG. Type II traumas were not associated with PTG, while type III collective identity traumas were negatively associated with PTG. Results indicated that PTG was not a significant predictor of any mental health symptoms and that PTG is different from SRG, which seems to describe growth in non-traumatic situations. The results suggest that it is important to analyze trauma profiles rather than single trauma.

Cumulative Tertiary Appraisals of Traumatic Events Across Cultures: Two Studies

Two studies compared the effects of cumulative trauma (CT) with those of cumulative negative (CNTA) and cumulative positive tertiary appraisals (CPTA). The first study was conducted with an adult clinical population in the U.S. (N = 399), while the second study was conducted with adolescent students in Gaza (N = 422). Among the effects found were that path analysis with comulative trauma, positive tertiary appraisal, and cumulative negative tertiary appraisals as independent variables and mental health measures as dependent variables, in both samples, found that CNTA and CPTA had direct positive and direct negative effects, respectively, on PTSD, depression, and anxiety. However, CT, independent from appraisals, had direct effects in producing the more complicated symptom clusters of cumulative trauma disorders.

The Traumatogenic Dynamics of Internalized Stigma of Mental Illness Among Arab American, Muslim, and Refugee Clients.

Understanding the dynamics of mental health stigma through existing frameworks, especially in minorities with higher stigma, is problematic. There is a need to reconceptualize stigma, particularly in highly traumatized groups. The current study examines the validity of a new development-based trauma framework that conceptualizes stigma as a type III chronic trauma that contributes to negative mental health effects. This framework proposes that public stigma is a unique chronic traumatic stress that mediates the effects of similar trauma types in mental health patients. To test this proposition, this study explores the relationships between internalized stigma of mental illness (ISMI), different trauma types, and posttrauma spectrum disorders. ISMI, posttraumatic stress disorder, other posttrauma spectrum disorders, and cumulative trauma measures were administered to a sample of 399 mental health patients that included Arab (82%), Muslim (84%), and refugee (31%), as well as American patients (18%). Age in the sample ranged from 18 to 76 years (M = 39.66, SD = 11.45), with 53.5% males. Hierarchical multiple regression, t tests, and path analyses were conducted. Results indicated that ISMI predicted posttraumatic stress disorder and other posttrauma spectrum disorders after controlling for cumulative trauma. ISMI was associated with other chronic collective identity traumas. While Arab Americans, Muslims, and refugees had higher ISMI scores than other Americans, the elevated chronic trauma levels of these groups were significant predictors of these differences. The results provide evidence to support ISMI traumatology model. Implications of the results for treating victims of ISMI, especially Arab Americans, Muslims and refugees are discussed.