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Van Voorhees EE, Dillon KH, Crombach A, Beaver T, Kelton K, Wortmann JH, Visn-Mid-Atlantic Mirecc Workgroup, Nieuwsma J. Enjoying the violence of war: Association with posttraumatic symptomatology in U.S. combat veterans. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2024; 16:618-625. [PMID: 37384480 PMCID: PMC10755059 DOI: 10.1037/tra0001530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
OBJECTIVE Engaging in war-related violence can have a devastating impact on military personnel, with research suggesting that injuring or killing others can contribute to posttraumatic stress disorder (PTSD), depression, and moral injury. However, there is also evidence that perpetrating violence in war can become pleasurable to a substantial number of combatants and that developing this "appetitive" form of aggression can diminish PTSD severity. Secondary analyses were conducted on data from a study of moral injury in U.S., Iraq, and Afghanistan combat veterans, to examine the impact of recognizing that one enjoyed war-related violence on outcomes of PTSD, depression, and trauma-related guilt. METHOD Three multiple regression models evaluated the impact of endorsing the item, "I came to realize during the war that I enjoyed violence" on PTSD, depression, and trauma-related guilt, after controlling for age, gender, and combat exposure. RESULTS Results indicated that enjoying violence was positively associated with PTSD, β (SE) = 15.86 (3.02), p < .001, depression, β (SE) = 5.41 (0.98), p < .001, and guilt, β (SE) = 0.20 (0.08), p < .05. Enjoying violence moderated the relationship between combat exposure and PTSD symptoms, β (SE) = -0.28 (0.15), p < .05, such that there was a decrease in the strength of the relationship between combat exposure and PTSD in the presence of endorsing having enjoyed violence. CONCLUSIONS Implications for understanding the impact of combat experiences on postdeployment adjustment, and for applying this understanding to effectively treating posttraumatic symptomatology, are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | - Jennifer H Wortmann
- Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC)
| | | | - Jason Nieuwsma
- Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC)
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2
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Kiro L, Zak M, Chernyshov O. Structure and dynamics of the course of chronic non-infectious somatic diseases in patients during war events on the territory of Ukraine. BMC Public Health 2023; 23:1464. [PMID: 37525148 PMCID: PMC10391885 DOI: 10.1186/s12889-023-16394-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/26/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND The work studied and compared the dynamics of changes in the course of hypertension, type 2 diabetes, and somatized disorders in Ukrainian population, in the 1st period before war (October 2021 - February 2022) and 2nd period during the war (March -July 2022). The choice of the study of the above-mentioned nosology is due, first of all, to the increase in cases of referrals to outpatient doctors regarding hypertensive crises, the increase in the frequency of patients' complaints about the lability of glycemic indicators during routine monitoring of glucose levels with ambulatory glucometers, the appearance of chronic pain syndrome of unspecified pathology with the beginning of war events. METHODS 272 people were examined in Mykolaiv Region (Ukraine). The patients were divided into three clinical groups: 1st group - 90 people patients with arterial hypertension; 2nd group - 92 people with type 2 diabetes; the 3rd group - 90 people with somatiform disorders. RESULTS In the patients of the 1st group during the 2nd period, amount of people with hypertension of the 1st stage increased in 1.8 times (p = 0.0412), with 2nd stage hypertension increased in 2 times (p = 0.0491) and 3rd stage hypertension increased in 2.5 times (p = 0.0391); somatized disorders in 3rd group also increased in 4.1 times (p = 0.001 < 0.05); in 2nd group recorded an increase in HbA1c by 0.99 ± 0.57 mmol/l (p = 1.795e-07 < 0.05), in comparison with the indicators for the 1st observation period. CONCLUSIONS The war events in Ukraine not only changed the life of every Ukrainian, but also had a significant impact on the dynamics and structure of chronic somatic diseases, in particular due to an increase in patient referrals for hypertensive crises, exacerbations of type 2 diabetes, somatized disorders, and chronic pain syndrome of unknown etiology. Considering these results, it is important to increase the equipment of regional primary care centers with antihypertensive, hypoglycemic and sedative drugs.
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Affiliation(s)
- Liudmyla Kiro
- Department of Therapeutic Disciplines, Institute of Medicine of Petro Mohyla Black Sea National University, Mykolaiv, Ukraine.
| | - Maksym Zak
- Department of Therapeutic Disciplines, Institute of Medicine of Petro Mohyla Black Sea National University, Mykolaiv, Ukraine
| | - Oleh Chernyshov
- Department of Pediatric and Surgical Disciplines, Institute of Medicine of Petro Mohyla Black Sea National University, Mykolaiv, Ukraine
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3
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Moran JK, Jesuthasan J, Schalinski I, Kurmeyer C, Oertelt-Prigione S, Abels I, Stangier U, Starck A, Gutermann J, Zier U, Wollny A, Richter K, Krüger A, Schouler-Ocak M. Traumatic Life Events and Association With Depression, Anxiety, and Somatization Symptoms in Female Refugees. JAMA Netw Open 2023; 6:e2324511. [PMID: 37471088 PMCID: PMC10359962 DOI: 10.1001/jamanetworkopen.2023.24511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/04/2023] [Indexed: 07/21/2023] Open
Abstract
Importance Different types of traumatic life events have varying impacts on symptoms of depression, anxiety, and somatization. For women from areas of the world experiencing war and humanitarian crises, who have experienced cumulative trauma exposure during war and forced migration, it is not known whether cumulative trauma or particular events have the greatest impact on symptoms. Objective To examine which traumatic life events are associated with depression, anxiety, and somatization symptoms, compared with the cumulative amount, in a sample of female refugees. Design, Setting, and Participants For this cross-sectional study, data were collected in 2016 as a part of The Study on Female Refugees. The current analysis was conducted in 2022 to 2023. This multicenter study covered 5 provinces in Germany. Participants were recruited at reception centers for refugees. Women volunteered to participate and to be interviewed after information seminars at the different centers. Exposure Traumatic life events experienced by refugees from areas of the world experiencing war and humanitarian crises. Main Outcomes and Measures Demographic variables (age, country of origin, religion, education, relationship status, and children), traumatic and adverse life events, and self-reported depression, anxiety, and somatization symptoms were measured. Random forest regressions simultaneously examined the importance of these variables on symptom scores. Follow-up exploratory mediation models tested potential associative pathways between the identified variables of importance. Results For the final sample of 620 refugee women (mean [SD] age, 32.34 [10.35] years), family violence was most associated with depression (mean [SD] variable of importance [VIM], 2.93 [0.09]), anxiety (mean [SD] VIM, 4.15 [0.11]), and somatization (mean [SD] VIM, 3.99 [0.15]), even though it was less common than other traumatic experiences, including war, accidents, hunger, or lack of housing. Other factors, such as childhood sexual abuse, injury, near-death experiences, and lack of access to health care, were also important. Follow-up analyses showed partial mediation effects between these factors in their association with symptoms, supporting the unique importance of family violence in understanding mental health. Conclusions and Relevance The findings of this cross-sectional study of refugee women who experienced multiple severe traumas related to war in their home countries and danger encountered during their migration suggest that family violence was key to their current mental health problems. Culturally sensitive assessment and treatment need to place special emphasis on these family dynamics.
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Affiliation(s)
- James Kenneth Moran
- Department of Psychiatry and Psychotherapy, Multisensory Integration Lab, Charité Universitätsmedizin, St Hedwig Hospital, Berlin, Germany
| | - Jenny Jesuthasan
- Psychiatric University Clinic Charité, St Hedwig Hospital, Berlin, Germany
| | - Inga Schalinski
- Universität der Bundeswehr München, Department of Human Sciences, Institute of Psychology, Munich, Germany
| | - Christine Kurmeyer
- Office of the Equal Opportunities Officer, Charité–Universitätsmedizin, Berlin, Germany
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- AG 10 Sex- and Gender-Sensitive Medicine, Medical Faculty OWL, University of Bielefeld, Bielefeld, Germany
| | - Ingar Abels
- Office of the Equal Opportunities Officer, Charité–Universitätsmedizin, Berlin, Germany
| | - Ulrich Stangier
- Clinical Psychology and Psychotherapy, Department of Psychology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Annabelle Starck
- Clinical Psychology and Psychotherapy, Department of Psychology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Jana Gutermann
- Clinical Psychology and Psychotherapy, Department of Psychology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Ulrike Zier
- Institute of Occupational, Social, and Environmental Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Now with Ministry of Science and Health of Rhineland-Palatinate, Mainz, Germany
| | - Anja Wollny
- Institute of General Practice, University Medical Center Rostock, Rostock, Germany
| | - Knejinja Richter
- CuraMed Tagesklinik Nürnberg, Nuremberg, Germany
- Technische Hochschule Nürnberg, Nuremberg, Germany
| | - Antje Krüger
- Institute of General Practice, University Medical Center Rostock, Rostock, Germany
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4
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Schmitt S, Robjant K, Koebach A. When reintegration fails: Stigmatization drives the ongoing violence of ex-combatants in Eastern Democratic Republic of the Congo. Brain Behav 2021; 11:e02156. [PMID: 33942549 PMCID: PMC8213920 DOI: 10.1002/brb3.2156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/01/2021] [Accepted: 03/29/2021] [Indexed: 11/20/2022] Open
Abstract
Reintegration of ex-combatants involves multiple challenges. In addition to the trauma-related psychological sequelae, social obstacles in the community can aggravate psychopathological aggressive tendencies and lead to the continuation of violence in civilian life. However, the association between others' negative attitudes and ex-combatants' ongoing perpetration of violence remains largely unexplored. Between September 2018 and May 2019, we assessed a representative community sample of adults in Eastern DR Congo (N = 1,058) and measured trauma exposure, perpetration, mental health problems (PTSD, depression, and appetitive aggression), perceived stigma (shame, perceived lack of social acknowledgement), experienced stigma, and skepticism toward reintegration with ex-combatants. Male ex-combatants (12%, n = 129) had more past trauma and violence perpetration than other community members and a greater number of recent conflicts (including both victimization and perpetration) within the community and with strangers/organized violence. They reported more experienced stigma, more severe PTSD symptoms but were less skeptical about reintegration. Ex-combatants' ongoing violence was predicted by an interplay of the community's skepticism toward reintegration and ex-combatants' perceived and recently experienced stigma (often attributed to the armed group history) and mental health problems, in addition to lifetime traumatization. These findings promote the need for combined interventions that address individual mental health problems including aggression and collective discriminatory attitudes and behaviors.
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Affiliation(s)
- Sabine Schmitt
- Department of PsychologyUniversity of KonstanzKonstanzGermany
- Non‐Governmental Organization Vivo InternationalKonstanzGermany
| | - Katy Robjant
- Department of PsychologyUniversity of KonstanzKonstanzGermany
- Non‐Governmental Organization Vivo InternationalKonstanzGermany
| | - Anke Koebach
- Department of PsychologyUniversity of KonstanzKonstanzGermany
- Non‐Governmental Organization Vivo InternationalKonstanzGermany
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Santamaría-García H, Baez S, Aponte-Canencio DM, Pasciarello GO, Donnelly-Kehoe PA, Maggiotti G, Matallana D, Hesse E, Neely A, Zapata JG, Chiong W, Levy J, Decety J, Ibáñez A. Uncovering social-contextual and individual mental health factors associated with violence via computational inference. PATTERNS (NEW YORK, N.Y.) 2021; 2:100176. [PMID: 33659906 PMCID: PMC7892360 DOI: 10.1016/j.patter.2020.100176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/21/2020] [Accepted: 11/30/2020] [Indexed: 01/13/2023]
Abstract
The identification of human violence determinants has sparked multiple questions from different academic fields. Innovative methodological assessments of the weight and interaction of multiple determinants are still required. Here, we examine multiple features potentially associated with confessed acts of violence in ex-members of illegal armed groups in Colombia (N = 26,349) through deep learning and feature-derived machine learning. We assessed 162 social-contextual and individual mental health potential predictors of historical data regarding consequentialist, appetitive, retaliative, and reactive domains of violence. Deep learning yields high accuracy using the full set of determinants. Progressive feature elimination revealed that contextual factors were more important than individual factors. Combined social network adversities, membership identification, and normalization of violence were among the more accurate social-contextual factors. To a lesser extent the best individual factors were personality traits (borderline, paranoid, and antisocial) and psychiatric symptoms. The results provide a population-based computational classification regarding historical assessments of violence in vulnerable populations.
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Affiliation(s)
- Hernando Santamaría-García
- Doctorado de Neurociencias, Departamentos de Psiquiatría y Fisiología, Pontificia Universidad Javeriana, Bogotá, Colombia
- Centro de Memoria y Cognición Intellectus, Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Diego Mauricio Aponte-Canencio
- Universidad Externado de Colombia, Bogotá, Colombia
- Agencia para la Reincorporación y la Normalización (ARN), Bogotá, Colombia
- Department of Neuroscience and Biomedical Engineering, Aalto University, Finland
| | - Guido Orlando Pasciarello
- Multimedia Signal Processing Group–Neuroimage Division, French-Argentine International Center for Information and Systems Sciences (CIFASIS)–National Scientific and Technical Research Council (CONICET), Rosario, Argentina
- Laboratory of Neuroimaging and Neuroscience (LANEN), INECO Foundation Rosario, Rosario, Argentina
| | - Patricio Andrés Donnelly-Kehoe
- Multimedia Signal Processing Group–Neuroimage Division, French-Argentine International Center for Information and Systems Sciences (CIFASIS)–National Scientific and Technical Research Council (CONICET), Rosario, Argentina
- Laboratory of Neuroimaging and Neuroscience (LANEN), INECO Foundation Rosario, Rosario, Argentina
| | | | - Diana Matallana
- Doctorado de Neurociencias, Departamentos de Psiquiatría y Fisiología, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Eugenia Hesse
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Argentina
| | - Alejandra Neely
- Latin American Institute for Brain Health (BrainLat), Center for Social and Cognitive Neuroscience (CSCN), Universidad Adolfo Ibáñez, Santiago de Chile, Chile
| | | | - Winston Chiong
- UCSF Weill Institute for Neurosciences, San Francisco, CA, USA
| | - Jonathan Levy
- Baruch Ivcher School of Psychology, Interdisciplinary Center Herzliya (IDC), Israel
- Department of Neuroscience and Biomedical Engineering, Aalto University, Finland
| | | | - Agustín Ibáñez
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Argentina
- Latin American Institute for Brain Health (BrainLat), Center for Social and Cognitive Neuroscience (CSCN), Universidad Adolfo Ibáñez, Santiago de Chile, Chile
- Universidad Autónoma del Caribe, Barranquilla, Colombia
- Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), San Francisco, CA, USA
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6
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Koebach A, Robjant K. NETfacts: a community intervention integrating trauma treatment at the individual and collective level. Eur J Psychotraumatol 2021; 12:1992962. [PMID: 34868485 PMCID: PMC8635579 DOI: 10.1080/20008198.2021.1992962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The aim of this article is to present a research-based rationale for NETfacts, a newly developed integrated approach at the individual and the community level in order to mitigate the mental and social sequelae of war and crisis. To this end, we provide a selective review of relevant literature from neuroscience, clinical psychology, and social science. In psychotraumatology, individual avoidance describes the effort to prevent exposure to trauma reminders. Among patients with post-traumatic stress disorder (PTSD), this becomes pathological, exacerbating distress and preventing recovery. This silence resonates in traumatized communities and consequently taboo builds - ultimately to the advantage of the perpetrators. The resulting collective avoidance leads to a fragmented collective memory about trauma or human rights violations in the community so that a shared account of the group's history becomes impossible. The deficient collective memory promotes ambiguous truths and anxiety, enabling a reactive construction of safety based on selective information that leads to an endorsement of extreme opinions. Ongoing insecurity, violence and crime lead to increasing anxiety and fear. The self-interest of the perpetrators and the abnormal behaviour of survivors leads to an escalation in stigma and social exclusion resulting in the prevention or limitation of community exposure to traumatic material, i.e., to reduce tension and protect the construction of safety. The exposure to and recognition of traumatic facts subject to avoidance is key to a coherent collective memory and sense of communion, and to prevent further cycles of violence. The NETfacts health system combines individual and community-based intervention to treat the structure of memory at both the individual and collective levels. Abbreviations: NET: narrative exposure therapy; FORNET: narrative exposure therapy for forensic offender rehabilitation; NETfacts: facts derived from narrative exposure therapy.
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Affiliation(s)
- Anke Koebach
- University of Konstanz, Department of Psychology; and Department of Politics and Public Administation, Konstanz, Germany.,NGO vivo international, Konstanz, Germany
| | - Katy Robjant
- University of Konstanz, Department of Psychology; and Department of Politics and Public Administation, Konstanz, Germany
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7
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Robjant K, Schmitt S, Chibashimba A, Carleial S, Elbert T, Koebach A. Trauma, Aggression, and Post Conflict Perpetration of Community Violence in Female Former Child Soldiers-A Study in Eastern DR Congo. Front Psychiatry 2020; 11:533357. [PMID: 33132929 PMCID: PMC7574907 DOI: 10.3389/fpsyt.2020.533357] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/13/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Former combatants are exposed to multiple traumatic stressors during conflict situations and usually participate in perpetration of violence. Ongoing perpetration of violence in post conflict areas, linked to mental health problems and appetitive aggression, destabilises peace keeping efforts. The aim of this study is to investigate lifetime exposure to violence and the relationship between this exposure and mental health and current violent behaviour in a sample of female former child soldiers with a history of perpetration of violence in Eastern DR Congo. METHODS 98 female former child soldiers who had been abducted and forcibly recruited during the M23 insurgency (2012-2014) were assessed for lifetime exposure to trauma including perpetration of violence, clinical outcomes (PTSD and appetitive aggression), and current violent behaviour. RESULTS Female former child soldiers had been exposed to extremely high levels of trauma including perpetration of violence and presented with high levels of mental health problems. Linear regression models showed that current violent behaviour was predicted by both PTSD and appetitive aggression. CONCLUSIONS Trauma exposure predicts ongoing perpetration of violence post conflict via the resulting mental health problems. The findings imply that if PTSD and appetitive aggression symptoms are successfully treated, ongoing violent behaviour in the community post conflict will also decrease.
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Affiliation(s)
- Katy Robjant
- Department of Psychology, University of Konstanz, Konstanz, Germany
- vivo international e.V., Konstanz, Germany
| | - Sabine Schmitt
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Amani Chibashimba
- Department of Psychology, University of Konstanz, Konstanz, Germany
- vivo international e.V., Konstanz, Germany
| | - Samuel Carleial
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Thomas Elbert
- Department of Psychology, University of Konstanz, Konstanz, Germany
- vivo international e.V., Konstanz, Germany
| | - Anke Koebach
- Department of Psychology, University of Konstanz, Konstanz, Germany
- vivo international e.V., Konstanz, Germany
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8
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Long-term effects of psychotherapy in a context of continuous community and gang violence: changes in aggressive attitude in high-risk South African adolescents. Behav Cogn Psychother 2019; 48:1-13. [PMID: 31148534 DOI: 10.1017/s1352465819000365] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Post-traumatic stress but also aggressive attitudes and behaviour can be found in adolescents living in a context of ongoing community and gang violence in the low-income urban areas of Cape Town, South Africa. AIMS We investigated the long-term effects (15-20 months after therapy) of (a) Narrative Exposure Therapy for Forensic Offender Rehabilitation (FORNET) and (b) the cognitive behavioural intervention 'Thinking for a Change' (CBT) on post-traumatic stress disorder (PTSD) and aggression compared with a waiting list. METHOD Fifty-four young males participated in the treatment trial, of which 17 completed the FORNET intervention, 11 the CBT intervention, and 26 were on a waiting list. The primary outcome was the change score for the Appetitive Aggression Scale; secondary outcomes were the PTSD Symptom Scale-Interview change scores, and the number of perpetrated violent event types. RESULTS The reduction in scores for PTSD that had been observed in FORNET completers at the first follow-up were still significant at the second long-term follow-up (Cohen's d = 0.86). In this treatment arm (FORNET), the scores for appetitive aggression were also significantly reduced (Cohen's d = 1.00). There were no significant changes observed for CBT or for the waiting list. CONCLUSIONS The study indicates that FORNET can successfully reduce post-traumatic stress as well as the attraction to violence even for individuals living under conditions of continuous traumatic stress.
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Schöne M, Seidenbecher S, Tozzi L, Kaufmann J, Griep H, Fenker D, Frodl T, Bogerts B, Schiltz K. Neurobiological correlates of violence perception in martial artists. Brain Behav 2019; 9:e01276. [PMID: 30907076 PMCID: PMC6520304 DOI: 10.1002/brb3.1276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 03/08/2019] [Accepted: 03/08/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The direct exertion as well as the visual perception of violence can have a hedonistic effect and elicit positive arousal in predisposed individuals. This appetitive aspect of aggression in healthy subjects has been neglected in psychiatric research so far. METHODS Using functional magnetic resonance imaging, we tested whether subjects trained in sports with a violent component (martial arts) show altered brain responses in reward-associated brain areas when compared to controls. Sixteen martial artists (e.g., boxing, mixed martial arts) and 24 controls watched violent versus neutral pictures while performing a cognitive cover task. Subjects' aggressiveness was assessed by the aggressiveness factors questionnaire (FAF). RESULTS While watching violent pictures, martial artists had a stronger activation in the left amygdala than controls. Within the martial artist group however, there was an inverse correlation between activation in the left amygdala and degree of aggressiveness. CONCLUSIONS Higher amygdala activation while watching violent pictures might reflect that perception of violence conveys increased salience to martial artists as compared to controls. The inverse correlation between amygdala activation and aggressiveness within the martial artist group might be explained by the assumption that the more aggressive martial artists may be more accustomed to violent situations leading to a down-modulation of amygdala activation. Appetitive aggression should be taken into account as a factor contributing to violence.
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Affiliation(s)
- Maria Schöne
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany.,Salus-Institute, Magdeburg, Germany
| | - Stephanie Seidenbecher
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany.,Salus-Institute, Magdeburg, Germany
| | - Leonardo Tozzi
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany.,Department of Psychiatry and Institute of Neuroscience, Dublin, Ireland.,Department of Psychiatry and Behavioral Science, Stanford University, Stanford, California
| | - Jörn Kaufmann
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Hendrik Griep
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Daniela Fenker
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany
| | - Thomas Frodl
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany.,Department of Psychiatry and Institute of Neuroscience, Dublin, Ireland.,Center for Behavioral Brain Sciences, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases, Magdeburg, Germany
| | - Bernhard Bogerts
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany.,Salus-Institute, Magdeburg, Germany
| | - Kolja Schiltz
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany.,Department of Forensic Psychiatry, Psychiatric Hospital of the University of Munich, Munich, Germany
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10
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Baez S, Santamaría-García H, Ibáñez A. Disarming Ex-Combatants' Minds: Toward Situated Reintegration Process in Post-conflict Colombia. Front Psychol 2019; 10:73. [PMID: 30761041 PMCID: PMC6361777 DOI: 10.3389/fpsyg.2019.00073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/10/2019] [Indexed: 01/23/2023] Open
Abstract
Collective violence in the context of armed conflict impacts the economy, health systems, and social stability of affected countries. This is considered a complex phenomenon with interwoven biological, psychological, social, cultural, and political factors. However, most of the research on this topic still lacks suitable established integrative approaches to assess multilevel perspectives. Social, cognitive and affective mental processes (SCAMP) are critical factors that should be considered in multilevel approaches. In this article, we critically discuss some of the classically isolated approaches used in violence research, the absence of successful interventions for ex-combatants reintegration, and the specific neglect of SCAMP in these interventions. We present the case of post-conflict Colombia as a unique opportunity to study the different roots of collective violence, and we call for a more robust and situated approach to understanding of and intervention in this multifaceted phenomenon. In addition, we suggest a two-stage approach for addressing ex-combatants’ reintegration programs, which considers the situated nature of post-conflict scenarios and the urgent need for evidence-based interventions. This approach focuses on the comprehensive scientific assessment of specific factors involved in violence exposure and the subsequent design of successful interventions. The implementation of this approach will contribute to the effective reintegration of individuals who have been exposed to extreme violence for more than 50 years.
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Affiliation(s)
- Sandra Baez
- Departamento de Psicología, Universidad de los Andes, Bogotá, Colombia
| | - Hernando Santamaría-García
- Centro de Memoria y Cognición, Intellectus-Hospital Universitario San Ignacio, Bogotá, Colombia.,Physiology and Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Agustín Ibáñez
- Laboratory of Experimental Psychology and Neuroscience, Institute of Cognitive and Translational Neuroscience, INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council, Buenos Aires, Argentina.,Center for Social and Cognitive Neuroscience, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile.,Universidad Autónoma del Caribe, Barranquilla, Colombia.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia
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11
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How 'The Urge to Kill' Feels: Articulations of Emic 'Appetitive Aggression' Experiences Among Former Forcefully Recruited Children and Youth in the Acholi Region of Northern Uganda. Cult Med Psychiatry 2018; 42:419-448. [PMID: 29151235 DOI: 10.1007/s11013-017-9557-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Based on 10 months of fieldwork in the Acholi region of northern Uganda among youth and adults who were forcefully recruited into the Lord's Resistance Army (LRA) during the war, this article provides qualitative details to research on 'appetitive aggression.' Through two case-stories the article unfolds first person articulations of how 'appetitive aggression' is experienced as 'the urge to kill' and how it relates to the emic Acholi spiritual concept of 'cen'; a local Luo expression used to describe places and human beings possessed by evil spirits. The analysis illuminates what the individual and social implications of 'the urge to kill' and 'cen' entail for two Acholi men; first in a militia and then in a civil post-war context. The analysis then relates these findings to soldier experiences across cultures and time periods. While our analysis supports the findings in 'appetitive aggression' studies that appetitive aggression serves as a resilient protective factor against developing post-traumatic stress disorder (PTSD), this study documents that once the former forcefully recruited return to civilian life, 'appetitive aggression' and 'the urge to kill' precipitate individual and at times lethal social and moral complications in a fragile post-war community. Thus, the article argues that appetitive aggression and the emic perceptions and experiences of it among the local population are essential to consider in studies, processes and programs targeting demobilization, rehabilitation, reconciliation and re-integration.
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Aleyasin H, Flanigan ME, Russo SJ. Neurocircuitry of aggression and aggression seeking behavior: nose poking into brain circuitry controlling aggression. Curr Opin Neurobiol 2018; 49:184-191. [PMID: 29524848 PMCID: PMC5935264 DOI: 10.1016/j.conb.2018.02.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 12/21/2017] [Accepted: 02/20/2018] [Indexed: 11/27/2022]
Abstract
Aggression is an innate behavior that helps individuals succeed in environments with limited resources. Over the past few decades, neurobiologists have identified neural circuits that promote and modulate aggression; however, far less is known regarding the motivational processes that drive aggression. Recent research suggests that aggression can activate reward centers in the brain to promote positive valence. Here, we review major recent findings regarding neural circuits that regulate aggression, with an emphasis on those regions involved in the rewarding or reinforcing properties of aggressive behavior.
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Affiliation(s)
- Hossein Aleyasin
- Fishberg Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Meghan E Flanigan
- Fishberg Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Scott J Russo
- Fishberg Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
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Hourani LL, Williams J, Lattimore PK, Trudeau JV, Van Dorn RA. Psychological Model of Military Aggressive Behavior: Findings From Population-Based Surveys. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Laurel L. Hourani
- Social Policy, Health & Economics Research, RTI International, Durham, North Carolina
| | - Jason Williams
- Social Policy, Health & Economics Research, RTI International, Durham, North Carolina
| | - Pamela K. Lattimore
- Social Policy, Health & Economics Research, RTI International, Durham, North Carolina
| | - James V. Trudeau
- Social Policy, Health & Economics Research, RTI International, Durham, North Carolina
| | - Richard A. Van Dorn
- Social Policy, Health & Economics Research, RTI International, Durham, North Carolina
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Köbach A, Schaal S, Hecker T, Elbert T. Psychotherapeutic Intervention in the Demobilization Process: Addressing Combat-related Mental Injuries with Narrative Exposure in a First and Second Dissemination Stage. Clin Psychol Psychother 2017; 24:807-825. [PMID: 26676201 PMCID: PMC5573918 DOI: 10.1002/cpp.1986] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 08/10/2015] [Accepted: 09/21/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND Depending on the exposure to traumatic stressors and combat, 20% to 50% of ex-combatants present with trauma-related disorders, and more than half of the members of armed groups have a proclivity to violence. Therefore, psychotherapeutic assistance should address both, trauma-related suffering and the lowered threshold for aggressive behaviour. OBJECTIVE Supporting the demobilization process of ex-combatants in the eastern DR-Congo, we implemented a version of Narrative Exposure Therapy adapted for Forensic Offender Rehabilitation (FORNET). METHOD In two successive dissemination stages (DS), local counsellors conducted FORNET. In DS1, they were trained by clinical experts, and in DS2, the by then experienced counsellors trained and supervised a second group of local counsellors (DS2). The training consisted of a 3-week workshop covering theoretical concepts and practical therapeutic skills. In DS1 and DS2, a total of 98 demobilizing combatants received an intervention; treatment-as-usual served as the control condition. Posttraumatic stress disorder, appetitive aggression, depression severity and drug dependence were assessed prior to the intervention and 6 and 12 months later; additionally, we assessed reintegration success. RESULTS Six months post-intervention, FORNET significantly reduced Posttraumatic stress disorder symptoms but had less effect on the trait of appetitive aggression; moreover, beneficial effects were found for depression severity and drug dependence as well as for reintegration indices. Treatment gains were retained at 12 months. CONCLUSIONS Individuals without previous training in psychotherapy can learn to effectively apply the brief intervention FORNET and support the demobilization process in ongoing conflicts. The study suggests that it is possible to pass down psychotherapeutic techniques over generations of counsellors. © 2015 The Authors. Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd. KEY PRACTITIONER MESSAGE Posttraumatic stress symptoms, depression and clinically relevant levels of drug dependence can effectively be reduced with a version of Narrative Exposure Therapy (NET) adapted for Forensic Offender Rehabilitation (FORNET). The intervention is effective in the context of ongoing conflict. Individuals without previous training in psychotherapy can learn to effectively apply the brief intervention FORNET. It is possible to pass down psychotherapeutic techniques like FORNET over generations of counsellors. Psychotherapeutic interventions like FORNET may facilitate the transition to peace in war-torn regions.
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Affiliation(s)
- Anke Köbach
- Department of PsychologyUniversity of KonstanzKonstanzGermany
- vivo internationalKonstanzGermany
| | - Susanne Schaal
- vivo internationalKonstanzGermany
- Department of PsychologyUniversity of UlmUlmGermany
| | - Tobias Hecker
- vivo internationalKonstanzGermany
- Department of PsychologyUniversity of ZürichZürichSwitzerland
| | - Thomas Elbert
- Department of PsychologyUniversity of KonstanzKonstanzGermany
- vivo internationalKonstanzGermany
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Augsburger M, Elbert T. When do traumatic experiences alter risk-taking behavior? A machine learning analysis of reports from refugees. PLoS One 2017; 12:e0177617. [PMID: 28498865 PMCID: PMC5428957 DOI: 10.1371/journal.pone.0177617] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 04/28/2017] [Indexed: 11/19/2022] Open
Abstract
Exposure to traumatic stressors and subsequent trauma-related mental changes may alter a person's risk-taking behavior. It is unclear whether this relationship depends on the specific types of traumatic experiences. Moreover, the association has never been tested in displaced individuals with substantial levels of traumatic experiences. The present study assessed risk-taking behavior in 56 displaced individuals by means of the balloon analogue risk task (BART). Exposure to traumatic events, symptoms of posttraumatic stress disorder and depression were assessed by means of semi-structured interviews. Using a novel statistical approach (stochastic gradient boosting machines), we analyzed predictors of risk-taking behavior. Exposure to organized violence was associated with less risk-taking, as indicated by fewer adjusted pumps in the BART, as was the reported experience of physical abuse and neglect, emotional abuse, and peer violence in childhood. However, civil traumatic stressors, as well as other events during childhood were associated with lower risk taking. This suggests that the association between global risk-taking behavior and exposure to traumatic stress depends on the particular type of the stressors that have been experienced.
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Affiliation(s)
- Mareike Augsburger
- Department of Psychology, University of Konstanz, Konstanz, Germany
- NGO vivo international e.V., Allensbach, Germany
- Department of Psychology, University of Zurich, Zurich, Switzerland
- * E-mail:
| | - Thomas Elbert
- Department of Psychology, University of Konstanz, Konstanz, Germany
- NGO vivo international e.V., Allensbach, Germany
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Wegrzyn M, Westphal S, Kissler J. In your face: the biased judgement of fear-anger expressions in violent offenders. BMC Psychol 2017; 5:16. [PMID: 28499409 PMCID: PMC5429544 DOI: 10.1186/s40359-017-0186-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 04/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Why is it that certain violent criminals repeatedly find themselves engaged in brawls? Many inmates report having felt provoked or threatened by their victims, which might be due to a tendency to ascribe malicious intentions when faced with ambiguous social signals, termed hostile attribution bias. METHODS The present study presented morphed fear-anger faces to prison inmates with a history of violent crimes, a history of child sexual abuse, and to matched controls form the general population. Participants performed a fear-anger decision task. Analyses compared both response frequencies and measures derived from psychophysical functions fitted to the data. In addition, a test to distinguish basic facial expressions and questionnaires for aggression, psychopathy and personality disorders were administered. RESULTS Violent offenders present with a reliable hostile attribution bias, in that they rate ambiguous fear-anger expressions as more angry, compared to both the control population and perpetrators of child sexual abuse. Psychometric functions show a lowered threshold to detect anger in violent offenders compared to the general population. This effect is especially pronounced for male faces, correlates with self-reported aggression and presents in absence of a general emotion recognition impairment. CONCLUSIONS The results indicate that a hostile attribution, related to individual level of aggression and pronounced for male faces, might be one mechanism mediating physical violence.
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Affiliation(s)
- Martin Wegrzyn
- Department of Psychology, Bielefeld University, Postfach 10 01 31, 33501 Bielefeld, Germany
- Center of Excellence Cognitive Interaction Technology (CITEC), Bielefeld University, Bielefeld, Germany
| | - Sina Westphal
- Department of Psychology, Bielefeld University, Postfach 10 01 31, 33501 Bielefeld, Germany
| | - Johanna Kissler
- Department of Psychology, Bielefeld University, Postfach 10 01 31, 33501 Bielefeld, Germany
- Center of Excellence Cognitive Interaction Technology (CITEC), Bielefeld University, Bielefeld, Germany
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Sommer J, Hinsberger M, Elbert T, Holtzhausen L, Kaminer D, Seedat S, Madikane S, Weierstall R. The interplay between trauma, substance abuse and appetitive aggression and its relation to criminal activity among high-risk males in South Africa. Addict Behav 2017; 64:29-34. [PMID: 27540760 PMCID: PMC5102240 DOI: 10.1016/j.addbeh.2016.08.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 07/04/2016] [Accepted: 08/09/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND In persistently unsafe environments, the cumulative exposure to violence predicts not only the development of posttraumatic stress disorder (PTSD), but also of increased aggression and violent outbursts. Substance use disorders interact with these developments, as drug consumption may blunt symptoms and also reduce the threshold for violent acts. Investigating the interplay between these variables and the possible cumulative effect of drug abuse on the attraction to cruelty is a crucial step in understanding the cycle of violence and developing intervention programs that address this cycle in violence-troubled communities such as low-income urban areas in South Africa. METHODS Young males at risk (N=290) were recruited through a reintegration center for offenders in Cape Town. We assessed types of traumatic events experienced, PTSD symptom severity, appetitive aggression, committed offenses and patterns of drug abuse prior to the perpetration of violence. RESULTS Path-analyses confirmed a positive relationship between exposure to traumatic events and PTSD symptom severity, appetitive aggression, the number of committed offenses and drug abuse prior to violence. PTSD symptoms were positively associated with the propensity toward aggression. Furthermore, more severe drug abuse was related to higher attraction to violence and more committed offenses. CONCLUSIONS We conclude that like exposure to violence, drug abuse may play a key role in the attraction to aggression and criminal acts. Measures of violence prevention and psychotherapeutic interventions for trauma-related suffering may not be effective without enduring drug abuse rehabilitation.
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Affiliation(s)
- Jessica Sommer
- Department of Clinical Psychology, University of Konstanz, Germany.
| | | | - Thomas Elbert
- Department of Clinical Psychology, University of Konstanz, Germany.
| | - Leon Holtzhausen
- Department of Social Development, University of Cape Town, South Africa.
| | - Debra Kaminer
- Department of Psychology, University of Cape Town, South Africa.
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, South Africa.
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Conrad D, Wilker S, Pfeiffer A, Lingenfelder B, Ebalu T, Lanzinger H, Elbert T, Kolassa IT, Kolassa S. Does trauma event type matter in the assessment of traumatic load? Eur J Psychotraumatol 2017; 8:1344079. [PMID: 28804594 PMCID: PMC5533143 DOI: 10.1080/20008198.2017.1344079] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 06/05/2017] [Indexed: 11/05/2022] Open
Abstract
Background: The likelihood of developing Posttraumatic Stress Disorder (PTSD) depends on the interaction of individual risk factors and cumulative traumatic experiences. Hence, the identification of individual susceptibility factors warrants precise quantification of trauma exposure. Previous research indicated that some traumatic events may have more severe influences on mental health than others; thus, the assessment of traumatic load may be improved by weighting event list items rather than calculating the simple sum score. Objective: We compared two statistical methods, Random Forests using Conditional Interference (RF-CI) and Least Absolute Shrinkage and Selection Operator (LASSO), based on their ability to rank traumatic experiences according to their importance for predicting lifetime PTSD. Methods: Statistical models were initially fitted in a sample of N1 = 441 survivors of the Northern Ugandan rebel war. The ability to correctly predict lifetime PTSD was then tested in an independent sample of N2 = 211, and subsequently compared with predictions by the simple sum score of different traumatic event types experienced. Results: Results indicate that RF-CI and LASSO allow for a ranking of traumatic events according to their predictive importance for lifetime PTSD. Moreover, RF-CI showed slightly better prediction accuracy than the simple sum score, followed by LASSO when comparing prediction results in the validation sample. Conclusion: Given the expense in time and calculation effort by RF-CI and LASSO, and the relatively low increase in prediction accuracy by RF-CI, we recommend using the simple sum score to measure the environmental factor traumatic load, e.g., in analyses of gene × environment interactions.
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Affiliation(s)
- Daniela Conrad
- Clinical Psychology and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany.,Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Sarah Wilker
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Anett Pfeiffer
- Clinical Psychology and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Birke Lingenfelder
- Clinical Psychology and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | | | - Hartmut Lanzinger
- Institute of Number Theory and Probability Theory, Ulm University, Ulm, Germany
| | - Thomas Elbert
- Clinical Psychology and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Iris-Tatjana Kolassa
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
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Meyer-Parlapanis D, Weierstall R, Nandi C, Bambonyé M, Elbert T, Crombach A. Appetitive Aggression in Women: Comparing Male and Female War Combatants. Front Psychol 2016; 6:1972. [PMID: 26779084 PMCID: PMC4700207 DOI: 10.3389/fpsyg.2015.01972] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 12/09/2015] [Indexed: 02/04/2023] Open
Abstract
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.
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Affiliation(s)
| | | | - Corina Nandi
- Department of Psychology, University of Konstanz Konstanz, Germany
| | - Manassé Bambonyé
- Department of Clinical Psychology, Université Lumière Bujumbura, Burundi
| | - Thomas Elbert
- Department of Psychology, University of Konstanz Konstanz, Germany
| | - Anselm Crombach
- Department of Psychology, University of KonstanzKonstanz, Germany; Department of Clinical Psychology, Université LumièreBujumbura, Burundi
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Hinsberger M, Sommer J, Kaminer D, Holtzhausen L, Weierstall R, Seedat S, Madikane S, Elbert T. Perpetuating the cycle of violence in South African low-income communities: attraction to violence in young men exposed to continuous threat. Eur J Psychotraumatol 2016; 7:29099. [PMID: 26747683 PMCID: PMC4706593 DOI: 10.3402/ejpt.v7.29099] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 12/08/2015] [Accepted: 12/11/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Life in the low-income urban communities of South Africa is imprinted by a cycle of violence in which young males predominantly are in the roles of both victim and perpetrator. There is some evidence that adolescents who show an attraction to cruelty can display high levels of psychosocial functioning despite the presence of posttraumatic stress symptoms. However, the role of appetitive aggression in the context of ongoing threats and daily hassles is not yet fully understood. OBJECTIVE In this study, we examine the role of attraction to violence in areas of continuous traumatic stress exposure and its effect on posttraumatic stress disorder (PTSD) severity and violence perpetration. METHOD A sample of 290 young males from two low-income Cape Town communities was surveyed. We assessed appetitive aggression with the Appetitive Aggression Scale (AAS), PTSD symptoms with the PTSD Symptom Scale-Interview, the number of witnessed and self-experienced traumatic event types with an adaptation of the Child Exposure to Community Violence questionnaire, and the number of perpetrated violence event types with an adapted offence checklist from the AAS. RESULTS Appetitive aggression scores were predicted by witnessed as well as self-experienced traumatic events. Higher appetitive aggression scores resulted in higher levels of PTSD severity and perpetrated violence. CONCLUSIONS Young males living in the low-income areas of South Africa may develop an attraction to cruelty in response to exposure to violence. Their willingness to fight in turn can increase the likelihood of continued violent behaviour. In contrast to previous research from postconflict areas, appetitive aggression and engagement in violence do not prevent the development of PTSD, but are instead associated with higher levels of posttraumatic stress. PTSD symptoms such as avoidance and hyperarousal, as well as an attraction to cruelty and thus the willingness to fight, might support survival in areas of ongoing conflict, but at the same time they could fuel the cycle of violence.
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Affiliation(s)
- Martina Hinsberger
- Department of Psychology, University of Konstanz, Reichenau, Konstanz, Germany;
| | - Jessica Sommer
- Department of Psychology, University of Konstanz, Reichenau, Konstanz, Germany
| | - Debra Kaminer
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Leon Holtzhausen
- Department of Social Development, University of Cape Town, Cape Town, South Africa
| | - Roland Weierstall
- Department of Psychology, University of Konstanz, Reichenau, Konstanz, Germany.,Clinical Psychology and Psychotherapy, Medical School Hamburg, Hamburg, Germany
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | | | - Thomas Elbert
- Department of Psychology, University of Konstanz, Reichenau, Konstanz, Germany
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Köbach A, Nandi C, Crombach A, Bambonyé M, Westner B, Elbert T. Violent Offending Promotes Appetitive Aggression Rather than Posttraumatic Stress-A Replication Study with Burundian Ex-Combatants. Front Psychol 2015; 6:1755. [PMID: 26696913 PMCID: PMC4672083 DOI: 10.3389/fpsyg.2015.01755] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 11/02/2015] [Indexed: 11/13/2022] Open
Abstract
Research has identified appetitive aggression, i.e., the perception of committed, violent acts as appealing, exciting and fascinating, as a common phenomenon within populations living in precarious and violent circumstances. Investigating demobilized soldiers in the Democratic Republic of Congo (DRC) demonstrated that violent offending is associated with appetitive aggression and not necessarily with symptoms of posttraumatic stress. In the present study, we sought to replicate these results in an independent and larger sample of demobilized soldiers from Burundi. As with the Congolese ex-combatants, random forest regression revealed that the number of lifetime perpetrated violent acts is the most important predictor of appetitive aggression and the number of lifetime experienced traumatic events is the main predictor for posttraumatic stress. Perpetrated violent acts with salient cues of hunting (pursuing the victim, the sight of blood, etc.) were most predictive for perceiving violent cues appealingly after demobilization. Moreover, the association of violent acts and appetitive aggression as well as traumatic events and posttraumatic stress remains strong even years after demobilization. Patterns of traumatic events and perpetrated acts as predictors for posttraumatic stress and appetitive aggression seem to be robust among different samples of ex-combatants who fought in civil wars. Psychotherapeutic interventions that address these complementary facets of combat-related disorders—namely, posttraumatic stress and appetitive aggression—are indispensable for a successful reintegration of those who fought in armed conflicts and to achieve a successful transition to peace.
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Affiliation(s)
- Anke Köbach
- Clinical and Neuropsychology Group, Department of Psychology, University of Konstanz Konstanz, Germany ; Vivo International Konstanz, Germany
| | - Corina Nandi
- Clinical and Neuropsychology Group, Department of Psychology, University of Konstanz Konstanz, Germany
| | - Anselm Crombach
- Clinical and Neuropsychology Group, Department of Psychology, University of Konstanz Konstanz, Germany ; Vivo International Konstanz, Germany ; Department of Clinical Psychology, Université Lumière de Bujumbura Bujumbura, Burundi
| | - Manassé Bambonyé
- Department of Clinical Psychology, Université Lumière de Bujumbura Bujumbura, Burundi
| | - Britta Westner
- Clinical and Neuropsychology Group, Department of Psychology, University of Konstanz Konstanz, Germany
| | - Thomas Elbert
- Clinical and Neuropsychology Group, Department of Psychology, University of Konstanz Konstanz, Germany ; Vivo International Konstanz, Germany ; Department of Clinical Psychology, Université Lumière de Bujumbura Bujumbura, Burundi
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Köbach A, Elbert T. Sensitive Periods for Developing a Robust Trait of Appetitive Aggression. Front Psychiatry 2015; 6:144. [PMID: 26528191 PMCID: PMC4602097 DOI: 10.3389/fpsyt.2015.00144] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 09/22/2015] [Indexed: 01/03/2023] Open
Abstract
Violent behavior can be intrinsically rewarding; especially combatants fighting in current civil wars present with elevated traits of appetitive aggression. The majority of these fighters were recruited as children or adolescents. In the present study, we test whether there is a developmental period where combatants are sensitive for developing a robust trait of appetitive aggression. We investigated 95 combatants in their demobilization process that were recruited at different ages in the Kivu regions of the eastern Democratic Republic of Congo. Using random forest with conditional inference trees, we identified recruitment at the ages from 16 and 17 years as being predictive of the level of appetitive aggression; the number of lifetime, perpetrated acts was the most important predictor. We conclude that high levels of appetitive aggression develop in ex-combatants, especially in those recruited during their middle to late teenage, which is a developmental period marked by a natural inclination to exercise physical force. Consequently, ex-combatants may remain vulnerable for aggressive behavior patterns and re-recruitment unless they are provided alternative strategies for dealing with their aggression.
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Affiliation(s)
- Anke Köbach
- Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
- vivo international, Konstanz, Germany
| | - Thomas Elbert
- Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
- vivo international, Konstanz, Germany
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Hecker T, Hermenau K, Crombach A, Elbert T. Treating Traumatized Offenders and Veterans by Means of Narrative Exposure Therapy. Front Psychiatry 2015; 6:80. [PMID: 26157395 PMCID: PMC4475792 DOI: 10.3389/fpsyt.2015.00080] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 05/14/2015] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- Tobias Hecker
- Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland
- Vivo International (www.vivo.org)
| | - Katharin Hermenau
- Vivo International (www.vivo.org)
- Department of Psychology, Division of Clinical Neuropsychology, University of Konstanz, Konstanz, Germany
| | - Anselm Crombach
- Vivo International (www.vivo.org)
- Department of Psychology, Division of Clinical Neuropsychology, University of Konstanz, Konstanz, Germany
| | - Thomas Elbert
- Vivo International (www.vivo.org)
- Department of Psychology, Division of Clinical Neuropsychology, University of Konstanz, Konstanz, Germany
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