Maggie Schauer

Transgenerational impact of intimate partner violence on methylation in the promoter of the glucocorticoid receptor

Prenatal exposure to maternal stress can have lifelong implications for psychological function, such as behavioral problems and even the development of mental illness. Previous research suggests that this is due to transgenerational epigenetic programming of genes operating in the hypothalamic–pituitary–adrenal axis, such as the glucocorticoid receptor (GR). However, it is not known whether intrauterine exposure to maternal stress affects the epigenetic state of these genes beyond infancy. Here, we analyze the methylation status of the GR gene in mothers and their children, at 10–19 years after birth. We combine these data with a retrospective evaluation of maternal exposure to intimate partner violence (IPV). Methylation of the mothers GR gene was not affected by IPV. For the first time, we show that methylation status of the GR gene of adolescent children is influenced by their mothers experience of IPV during pregnancy. As these sustained epigenetic modifications are established in utero, we consider this to be a plausible mechanism by which prenatal stress may program adult psychosocial function.

Psychological trauma and evidence for enhanced vulnerability for posttraumatic stress disorder through previous trauma among West Nile refugees

BackgroundPolitical instability and the civil war in Southern Sudan have resulted in numerous atrocities, mass violence, and forced migration for vast parts of the civilian population in the West Nile region. High exposure to traumatic experiences has been particularly prominent in the Ugandan and Sudanese of the West Nile Region, representing an indication of the psychological strain posed by years of armed conflict.MethodsIn this study the impact of traumatic events on the prevalence and severity of posttraumatic stress disorder (PTSD) in a random sample of 3.339 Ugandan nationals, Sudanese nationals, and Sudanese refugees (1.831 households) of the West Nile region is assessed.ResultsResults show a positive correlation between the number of traumatic events and the number of endorsed PTSD symptoms. Of the 58 respondents who experienced the greatest number of traumatizing experiences, all reported symptoms which met the DSM-IV criteria for PTSD.ConclusionsThere is a clear dose-effect relationship between traumatic exposure and PTSD in the studied populations with high levels of traumatic events. In this context, it is probable that any individual could develop PTSD regardless of other risk-factors once the trauma load reaches a certain threshold.

Narrative exposure therapy for 7- to 16-year-olds: A randomized controlled trial with traumatized refugee children†

The authors examined the effectiveness of narrative exposure therapy for children (KIDNET) in treating posttraumatic stress disorder (PTSD) in refugee children living in exile. Twenty-six children traumatized by organized violence were randomly assigned to KIDNET or to a waiting list. Significant treatment by time interactions on all PTSD-relevant variables indicated that the KIDNET group, but not the controls, showed a clinically significant improvement in symptoms and functioning. Success of the KIDNET group remained stable at 12-month follow-up. This study confirms previous findings that, if left untreated, PTSD in children may persist for an extended period. However, it also shows that it is possible to effectively treat chronic PTSD and restore functioning in traumatized refugee children in only 8 treatment sessions.

Narrative Exposure Therapy as a treatment for child war survivors with posttraumatic stress disorder: Two case reports and a pilot study in an African refugee settlement

BackgroundLittle data exists on the effectiveness of psychological interventions for children with posttraumatic stress disorder (PTSD) that has resulted from exposure to war or conflict-related violence, especially in non-industrialized countries. We created and evaluated the efficacy of KIDNET, a child-friendly version of Narrative Exposure Therapy (NET), as a short-term treatment for children.MethodsSix Somali children suffering from PTSD aged 12–17 years resident in a refugee settlement in Uganda were treated with four to six individual sessions of KIDNET by expert clinicians. Symptoms of PTSD and depression were assessed pre-treatment, post-treatment and at nine months follow-up using the CIDI Sections K and E.ResultsImportant symptom reduction was evident immediately after treatment and treatment outcomes were sustained at the 9-month follow-up. All patients completed therapy, reported functioning gains and could be helped to reconstruct their traumatic experiences into a narrative with the use of illustrative material.ConclusionsNET may be safe and effective to treat children with war related PTSD in the setting of refugee settlements in developing countries.

Fascination violence: on mind and brain of man hunters

Why are savagery and violence so omnipresent among humans? We suggest that hunting behaviour is fascinating and attractive, a desire that makes temporary deprivation from physical needs, pain, sweat, blood and, ultimately, the willingness to kill tolerable and even appetitive. Evolutionary development into the “perversion” of the urge to hunt humans, that is to say the transfer of this hunt to members of one’s own species, has been nurtured by the resultant advantage of personal and social power and dominance. While a breakdown of the inhibition towards intra-specific killing would endanger any animal species, controlled inhibition was enabled in humans in that higher regulatory systems, such as frontal lobe-based executive functions, prevent the involuntary derailment of hunting behaviour. If this control—such as in child soldiers for example—is not learnt, then brutality towards humans remains fascinating and appealing. Blood must flow in order to kill. It is hence an appetitive cue as is the struggling of the victim. Hunting for men, more rarely for women, is fascinating and emotionally arousing with the parallel release of testosterone, serotonin and endorphins, which can produce feelings of euphoria and alleviate pain. Bonding and social rites (e.g. initiation) set up the constraints for both hunting and violent disputes. Children learn which conditions legitimate aggressive behaviour and which not. Big game hunting as well as attack of other communities is more successful in groups—men also perceive it as more pleasurable. This may explain the fascination with gladiatorial combat, violent computer games but as well ritualized forms like football.

Trauma-related impairment in children : a survey in Sri Lankan provinces affected by armed conflict

OBJECTIVES The present study examined traumatic experiences, PTSD, and co-morbid symptoms in relation to neuropsychological and school performance in school children affected by two decades of civil war and unrest. METHOD The epidemiological survey of childrens mental health included a representative sample of 420 school children. Local teachers were trained to administer a translation of the UCLA-PTSD Index Form. The instrument and the epidemiological findings were validated by assessment through clinical expert interview, school grades, and neuropsychological testing in a subsample (N=67). RESULTS Ninety-two percent of the children surveyed had experienced severely traumatizing events such as combat, bombing, shelling, or witnessing the death of a loved one. Twenty-five percent met the criteria for a diagnosis of PTSD. Traumatized children reported lasting interference of experiences with their daily life, which was corroborated by memory testing, scores in school performance and ratings of social withdrawal. Depressive symptoms and poor physical health were frequent in these children. The majority of trained teachers achieved valid results in the structured interviews. CONCLUSION Performance and functioning in children are related to the total load of traumatic events experienced. An important component of psychosocial programs in post-conflict areas should include increasing community-based awareness of the consequences of traumatic stress, both as a preventative measure and as a way of decreasing stigmatization of affected individuals.

Treatment of traumatized victims of war and torture: a randomized controlled comparison of narrative exposure therapy and stress inoculation training.

Background: The aim of the present randomized controlled trial was to compare the outcome of 2 active treatments for posttraumatic stress disorder (PTSD) as a consequence of war and torture: narrative exposure therapy (NET) and stress inoculation training (SIT). Methods: Twenty-eight PTSD patients who had experienced war and torture, most of them asylum seekers, received 10 treatment sessions of either NET or SIT at the Outpatient Clinic for Refugees, University of Konstanz, Germany. Posttests were carried out 4 weeks after treatment, and follow-up tests were performed 6 months and 1 year after treatment. The main outcome measure was the PTSD severity score according to the Clinician-Administered PTSD Scale (CAPS) at each time point. Results: A significant reduction in PTSD severity was found for NET, but not for SIT. A symptom reduction in the NET group occurred between pretest and the 6-month follow-up examination, the effect size being d = 1.42 (for SIT: d = 0.12), and between pretest and the 1-year follow-up, the effect size being d = 1.59 (for SIT: d = 0.19). The rates and scores of major depression and other comorbid disorders did not decrease significantly over time in either of the 2 treatment groups. Conclusions: The results indicate that exposure treatments like NET lead to a significant PTSD symptom reduction even in severely traumatized refugees and asylum seekers.

Childhood adversity, mental ill-health and aggressive behavior in an African orphanage: Changes in response to trauma-focused therapy and the implementation of a new instructional system

BackgroundThe number of orphans in Sub-Saharan Africa is constantly rising. While it is known that family or community care is preferable over institutional care of African orphans, little is known about the quality of care in orphanages and possibilities of improvement.Study 1MethodsExposure to traumatic stress, experiences of violence in the home, school and orphanage, as well as mental ill-health and aggression of 38 children (mean age of M = 8.64 years) living in an orphanage in rural Tanzania were assessed at two time points. The severity of post-traumatic stress disorder symptoms (PTSD), depressive symptoms, and internalizing and externalizing problems were used as indicators of mental ill-health.ResultsViolence experienced in the orphanage correlated more strongly with all indicators of mental ill-health than violence in the former home, school or neighborhood at time point 1. Additionally, violence experienced in the orphanage had a positive relationship with the aggressive behavior of the children at time point 2.Study 2MethodsWith the help of the pre-post assessment of Study 1, the implementation of a new instructional system and psychotherapeutic treatment (KIDNET) for trauma-related illness were evaluated.ResultsIn response to both, a change in the instructional system and psychotherapeutic treatment of PTSD, a massive decline in experienced violence and in the severity of PTSD-symptoms was found, whereas depressive symptoms and internalizing and externalizing problems exhibited little change.ConclusionsThese studies show that violence, especially in the orphanage, can severely contribute to mental ill-health in orphans and that mental health can be improved by implementing a new instructional system and psychotherapeutic treatment in an orphanage. Moreover, the results indicate that the experience of violence in an orphanage also plays a crucial role in aggressive behavior of the orphans.

Screening for Posttraumatic Stress Disorder among Somali ex-combatants: A validation study

BackgroundIn Somalia, a large number of active and former combatants are affected by psychological problems such as Posttraumatic Stress Disorder (PTSD). This disorder impairs their ability to re-integrate into civilian life. However, many screening instruments for Posttraumatic Stress Disorder used in post-conflict settings have limited validity. Here we report on development and validation of a screening tool for PTSD in Somali language with a sample of ex-combatants.MethodsWe adapted the Posttraumatic Diagnostic Scale (PDS) to reflect linguistic and cultural differences within the Somali community so that local interviewers could be trained to administer the scale. For validation purposes, a randomly selected group of 135 Somali ex-combatants was screened by trained local interviewers; 64 of them were then re-assessed by trained clinical psychologists using the Composite International Diagnostic Interview (CIDI) and the Self-Report Questionnaire (SRQ-20).ResultsThe screening instrument showed good internal consistency (Cronbachs α = .86), convergent validity with the CIDI (sensitivity = .90; specificity = .90) as well as concurrent validity: positive cases showed higher SRQ-20 scores, higher prevalence of psychotic symptoms, and higher levels of intake of the local stimulant drug khat. Compared to a single cut-off score, the multi-criteria scoring, in keeping with the DSM-IV, produced more diagnostic specificity.ConclusionThe results provide evidence that our screening instrument is a reliable and valid method to detect PTSD among Somali ex-combatants. A future Disarmament, Demobilization and Reintegration Program in Somalia is recommended to screen for PTSD in order to identify ex-combatants with special psycho-social needs.

Appetitive aggression in former combatants - Derived from the ongoing conflict in DR Congo

Soldiers and combatants often report that committing violence can be appealing, fascinating and exciting (Elbert, Weierstall, & Schauer, 2010). This appetite for aggression was investigated in a sample of 224 former combatants from different armed groups and forces in eastern DRC. In a semistructured interview they were questioned about their military history, exposure to violence and perpetrated violence. Appetitive aggression was assessed with a 15-item-scale (Weierstall & Elbert, 2011), which was successfully implemented in comparable samples (Weierstall, Schalinski, Crombach, Hecker, & Elbert, submitted for publication). A sequential multiple regression was conducted to determine possible predictors of appetitive aggression. Perpetrated violence types, recruitment type, and joining as a child were significant predictors and explained 26% of the variability in appetitive aggression. Duration or military rank within the armed group and exposure to violence did not play a significant role. Thus, combatants reporting high levels of appetitive aggression are characterized by perpetrating a high number of violent acts, joining armed groups on their own accord and as children. Joining an armed group on ones own accord indicates pre-existing appetitive aggression. However, joining young and perpetrating violence on a regular basis seem to intensify the appetite for aggression.