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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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Crombach A, Rukundo-Zeller AC, Vukojevic V, Nandi C, Bambonye M, de Quervain DJF, Papassotiropoulos A, Elbert T. Differential methylation of linoleic acid pathway genes is associated with PTSD symptoms - a longitudinal study with Burundian soldiers returning from a war zone. Transl Psychiatry 2024; 14:32. [PMID: 38238325 PMCID: PMC10796347 DOI: 10.1038/s41398-024-02757-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 01/22/2024] Open
Abstract
Soldiers may be exposed to traumatic stress during combat deployment and thus are at risk for developing posttraumatic stress disorder (PTSD). Genetic and epigenetic evidence suggests that PTSD is linked to forming stress-related memories. In the current study, we investigated post-deployment associations of PTSD symptoms with differential DNA methylation in a sample of Burundian soldiers returning from the African Union Mission in Somalia's war zone. We used a matched longitudinal study design to explore epigenetic changes associated with PTSD symptoms in N = 191 participants. PTSD symptoms and saliva samples were collected at 1-3 (t1) and 9-14 months (t2) after the return of the soldiers to their home base. Individuals with either worsening or improving PTSD symptoms were matched for age, stressful, traumatic and self-perpetrated events prior to the post-assessment, traumatic and violent experiences between the post- and the follow-up assessment, and violence experienced during childhood. A mixed model analysis was conducted to identify top nominally significantly differentially methylated genes, which were then used to perform a gene enrichment analysis. The linoleic acid metabolism pathway was significantly associated with post-deployment PTSD symptoms, after accounting for multiple comparisons. Linoleic acid has been linked to memory and immune related processes in previous research. Our findings suggest that differential methylation of linoleic acid pathway genes is associated with PTSD and thus may merit closer inspection as a possible mediator of resilience.
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Affiliation(s)
- Anselm Crombach
- Department of Psychology, Clinical Child and Adolescent Psychology and Psychotherapy, Saarland University,, Saarbrücken, Germany.
- Department of Psychology, Université Lumière de Bujumbura, Bujumbura, Burundi.
| | - Anja C Rukundo-Zeller
- Department of Psychology, Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
| | - Vanja Vukojevic
- Department of Biomedicine, Research Cluster Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Corina Nandi
- Department of Psychology, Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
| | - Manassé Bambonye
- Department of Psychology, Université Lumière de Bujumbura, Bujumbura, Burundi
| | - Dominique J-F de Quervain
- Department of Biomedicine, Research Cluster Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Andreas Papassotiropoulos
- Department of Biomedicine, Research Cluster Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Thomas Elbert
- Department of Psychology, Université Lumière de Bujumbura, Bujumbura, Burundi
- Department of Psychology, Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
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3
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Robjant K, Schmitt S, Carleial S, Elbert T, Abreu L, Chibashimba A, Hinkel H, Hoeffler A, Rukundo Zeller AC, Rockstroh B, Koebach A. NETfacts: An integrated intervention at the individual and collective level to treat communities affected by organized violence. Proc Natl Acad Sci U S A 2022; 119:e2204698119. [PMID: 36306329 PMCID: PMC9636916 DOI: 10.1073/pnas.2204698119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022] Open
Abstract
War and crises affect mental health, social attitudes, and cultural norms, which can exacerbate the state of long-term insecurity. With decades of armed conflict, the Democratic Republic of Congo is one example, and violence has become normalized in civilian settings. In this study, we tested the effectiveness of the NETfacts health system, an integrated model of evidence-based individual trauma treatment (Narrative Exposure Therapy [NET]) and a trauma-informed community-based intervention (NETfacts). Alongside changes in mental health outcomes (posttraumatic stress disorder, depression, social disapproval, and shame) we also investigated change in attitudes, including rape myth acceptance, stigmatization of survivors of sexual violence, and skepticism about the reintegration of former combatants. To test whether the additional community intervention is superior to individual NET alone, we implemented a randomized controlled design with six villages and interviewed a sample of 1,066 community members. Our results demonstrate that the NETfacts health system in comparison with NET alone more effectively reduced rape myth acceptance and with it ongoing victimization and perpetration. Community members of the NETfacts group also presented with less stigmatizing attitudes against survivors of sexual violence. Skepticism about the reintegration of former combatants declined in both groups. NETfacts appears to have increased motivation to engage in individual treatment. Synergizing the healing effects of individual and collective trauma exposure, the NETfacts health system appears to be an effective and scalable approach to correct degrading or ignominious norms and restore functioning and mental health in postconflict communities.
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Affiliation(s)
- Katy Robjant
- Nongovernment organization vivo international e.V., 78430 Konstanz, Germany
| | - Sabine Schmitt
- Nongovernment organization vivo international e.V., 78430 Konstanz, Germany
| | - Samuel Carleial
- Department of Psychology, Clinical and Neuropsychology, University of Konstanz, 78457 Konstanz, Germany
| | - Thomas Elbert
- Nongovernment organization vivo international e.V., 78430 Konstanz, Germany
- Department of Psychology, Clinical and Neuropsychology, University of Konstanz, 78457 Konstanz, Germany
| | - Liliana Abreu
- Department of Politics and Administration, Development, University of Konstanz, 78457 Konstanz, Germany
| | - Amani Chibashimba
- Nongovernment organization vivo international e.V., 78430 Konstanz, Germany
| | | | - Anke Hoeffler
- Department of Politics and Administration, Development, University of Konstanz, 78457 Konstanz, Germany
| | - Anja C. Rukundo Zeller
- Nongovernment organization vivo international e.V., 78430 Konstanz, Germany
- Department of Psychology, Clinical and Neuropsychology, University of Konstanz, 78457 Konstanz, Germany
| | - Brigitte Rockstroh
- Nongovernment organization vivo international e.V., 78430 Konstanz, Germany
| | - Anke Koebach
- Nongovernment organization vivo international e.V., 78430 Konstanz, Germany
- Department of Psychology, Clinical and Neuropsychology, University of Konstanz, 78457 Konstanz, Germany
- Department of Politics and Administration, Development, University of Konstanz, 78457 Konstanz, Germany
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4
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Baez S, Trujillo N, Hurtado E, Ortiz-Ayala A, Calvache MR, Quishpe RC, Ibanez A. The Dynamics of Implicit Intergroup Biases of Victims and Ex-combatants in Post-conflict Scenarios. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP9295-NP9319. [PMID: 33336601 DOI: 10.1177/0886260520983258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Strong group identities arise in intergroup conflict scenarios and perpetuate sectarian violence even in post-conflict scenarios. In particular, out-group negative implicit associations are predictors of decreased intergroup forgiveness, as well as increased distrust and aggression against the out-group. Thus, the presence of implicit intergroup (i.e., ex-combatants and victims) biases seems to be a relevant factor in post-conflict scenarios. Here, we aimed to explore whether negative biases toward the out-group are boosted by (a) previous exposure to conflict violence or (b) identification with an armed violent group. One hundred and twenty-eight participants, 65 ex-combatants from Colombian guerrillas and 63 victims of the armed conflict, were assessed with a modified version of the implicit association test (IAT). Our results revealed that the victim group showed a significant negative bias against ex-combatants. However, no bias toward the out-group (i.e., victims) or in-group favoritism was observed in the ex-combatant group. Similarly, we found that IAT scores were not associated with sociodemographical variables (i.e., sex, years of education, or type of dwelling), the levels of combat exposure, victimization armed-conflict-related experiences, or child abuse antecedents. Our results showed an unexpected lack of in-group bias in ex-combatants, potentially triggered by the effect of current demobilization and reintegration processes. Thus, negative associations with the out-group will persist in the framework of societal condemnation of the out-group. In contrast, these negative biases will tend to be abolished when entering in conflict with larger societal reintegration processes. The results reinforce the idea that reintegration may benefit from interventions at the societal level, including all actors of the conflict. In addition, our findings highlight the importance of implementing victim interventions aimed at reducing stigma and revengeful actions in spaces of collective disarmament.
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Affiliation(s)
| | - Natalia Trujillo
- GISAME, Facultad Nacional de Salud Pública, Universidad de Antioquia (UdeA), Medellín, Colombia
| | | | | | | | | | - Agustin Ibanez
- Universidad de San Andrés, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Universidad Autónoma del Caribe, Barranquilla, Colombia
- Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago de Chile, Chile
- Global Brain Health Institute, University of California San Francisco (UCSF), CA, United States
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5
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Spohrs J, Prost M, Ulrich M, Plener PL, Bindila L, Abler B. Endocannabinoid system reactivity during stress processing in healthy humans. Biol Psychol 2022; 169:108281. [DOI: 10.1016/j.biopsycho.2022.108281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 01/10/2023]
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Schöne M, Seidenbecher S, Kaufmann J, Antonucci LA, Frodl T, Koutsouleris N, Schiltz K, Bogerts B. Appetitive aggression is associated with lateralized activation in nucleus accumbens. Psychiatry Res Neuroimaging 2022; 319:111425. [PMID: 34891023 DOI: 10.1016/j.pscychresns.2021.111425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/14/2021] [Accepted: 12/02/2021] [Indexed: 12/01/2022]
Abstract
Aggression can have a hedonistic aspect in predisposed individuals labeled as appetitive aggression. The present study investigates the neurobiological correlates of this appetitive type of aggression in non-clinical samples from community. Applying functional magnet resonance imaging (fMRI), we tested whether 20 martial artists compared to 26 controls had a higher activation in the nucleus accumbens (NAcc), a central part of the dopaminergic, mesolimbic reward system. Subjects had to watch violent vs. neutral pictures representing appetitive aggression. The affinity towards hedonistic violence was assessed by the Appetitive and Facilitative Aggression Scale (AFAS). Furthermore, the subjects rated all the pictures with regard to how pleasant and violent they were. The martial artists reported a higher AFAS-score and a more positive perception of violent pictures. On the neural level, across all subjects, there was a significant positive correlation between the AFAS-score and the activation in the left NAcc and an inverse association with the activation of the right NAcc when watching violent compared to neutral pictures. This lateralization effect indicates a different processing of hedonistic aspects of aggression in the two hemispheres.
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Affiliation(s)
- Maria Schöne
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany; Salus Institute, Salus gGmbH, Magdeburg, Germany.
| | - Stephanie Seidenbecher
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany; Salus Institute, Salus gGmbH, Magdeburg, Germany
| | - Jörn Kaufmann
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Linda Antonella Antonucci
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany; Department of Education, Psychology, Communication, University of Bari Aldo Moro, Bari, Italy
| | - 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, Otto-von-Guericke University, Magdeburg, Germany; Department of Psychiatry, Psychotherapy, and Psychosomatic, RWTH-University, Aachen, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Kolja Schiltz
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany; Department of Forensic Psychiatry, Mental Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Bernhard Bogerts
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany; Salus Institute, Salus gGmbH, Magdeburg, Germany
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7
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Alleyne-Green B, Kulick A, Grocher K, Betancourt TS. Physical and Sexual Violence Experienced by Male War-Affected Youth: Implications for Post-Conflict Functioning and Intimate Relationships. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP4874-NP4890. [PMID: 30141718 DOI: 10.1177/0886260518792963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study explored the association between war violence exposure during armed conflict and intimate partner violence (IPV) victimization, and the impact of positive community and family reintegration on IPV among a sample (N = 92) of war-affected male youth, post-conflict Sierra Leone. Trained Sierra Leonean researchers conducted face-to-face interviews with youth and their caregivers. Results indicate that exposure to violence during armed conflict as well as community and family reintegration were negatively associated with psychological IPV perpetration. Community reintegration was negatively associated with physical IPV. Sexual victimization was negatively associated with sexual IPV perpetration, whereas physical victimization had positive association. More research needs to be done on male war-affected youth as victims of physical, psychological, and sexual violence during conflict and the impact this has on the quality of their intimate relationships, occurrence of IPV in those relationships (as victims in addition to being perpetrators), and their community reintegration.
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Affiliation(s)
| | - Alex Kulick
- University of California, Santa Barbara, USA
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8
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Weierstall R, Crombach A, Nandi C, Bambonyé M, Probst T, Pryss R. Effective Adoption of Tablets for Psychodiagnostic Assessments in Rural Burundi: Evidence for the Usability and Validity of Mobile Technology in the Example of Differentiating Symptom Profiles in AMISOM Soldiers 1 Year After Deployment. Front Public Health 2021; 9:490604. [PMID: 33937159 PMCID: PMC8083058 DOI: 10.3389/fpubh.2021.490604] [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] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 03/19/2021] [Indexed: 11/13/2022] Open
Abstract
Research on the use of mobile technology in health sciences has identified several advantages of so-called mHealth (mobile health) applications. Tablet-supported clinical assessments are becoming more and more prominent in clinical applications, even in low-income countries. The present study used tablet computers for assessments of clinical symptom profiles in a sample of Burundian AMISOM soldiers (i.e., African Union Mission to Somalia; a mission approved by the UN). The study aimed to demonstrate the feasibility of mHealth-supported assessments in field research in Burundi. The study was conducted in a resource-poor setting, in which tablet computers are predestined to gather data in an efficient and reliable manner. The overall goal was to prove the validity of the obtained data as well as the feasibility of the chosen study setting. Four hundred sixty-three soldiers of the AMISOM forces were investigated after return from a 1-year military mission in Somalia. Symptoms of posttraumatic stress disorder (PTSD) and depression were assessed. The used data-driven approach based on a latent profile analysis revealed the following four distinct groups, which are based on the soldiers' PTSD and depression symptom profiles: Class 1: moderate PTSD, Class 2: moderate depression, Class 3: low overall symptoms, and Class 4: high overall symptoms. Overall, the four identified classes of soldiers differed significantly in their PTSD and depression scores. The study clearly demonstrates that tablet-supported assessments can provide a useful application of mobile technology in large-scale studies, especially in resource-poor settings. Based on the data collected for the study at hand, it was possible to differentiate different sub-groups of soldiers with distinct symptom profiles, proving the statistical validity of the gathered data. Finally, advantages and challenges for the application of mobile technology in a resource-poor setting are outlined and discussed.
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Affiliation(s)
| | - Anselm Crombach
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Department of Clinical Psychology, University Lumière de Bujumbura, Bujumbura, Burundi
| | - Corina Nandi
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Manassé Bambonyé
- Department of Clinical Psychology, University Lumière de Bujumbura, Bujumbura, Burundi
| | - Thomas Probst
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems, LA, Austria
| | - Rüdiger Pryss
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
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9
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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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10
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Xulu KR, Womersley JS, Sommer J, Hinsberger M, Elbert T, Weierstall R, Kaminer D, Malan-Müller S, Seedat S, Hemmings SMJ. DNA methylation and psychotherapy response in trauma-exposed men with appetitive aggression. Psychiatry Res 2021; 295:113608. [PMID: 33290938 DOI: 10.1016/j.psychres.2020.113608] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 11/25/2020] [Indexed: 12/15/2022]
Abstract
Exposure to violence can lead to appetitive aggression (AA), the positive feeling and fascination associated with violence, and posttraumatic stress disorder (PTSD), characterised by hyperarousal, reexperience and feelings of ongoing threat. Psychotherapeutic interventions may act via DNA methylation, an environmentally sensitive epigenetic mechanism that can influence gene expression. We investigated epigenetic signatures of psychotherapy for PTSD and AA symptoms in South African men with chronic trauma exposure. Participants were assigned to one of three groups: narrative exposure therapy for forensic offender rehabilitation (FORNET), cognitive behavioural therapy or waiting list control (n = 9-10/group). Participants provided saliva and completed the Appetitive Aggression Scale and PTSD Symptom Severity Index at baseline, 8-month and 16-month follow-up. The relationship, over time, between methylation in 22 gene promoter region sites, symptom scores, and treatment was assessed using linear mixed models. Compared to baseline, PTSD and AA symptom severity were significantly reduced at 8 and 16 months, respectively, in the FORNET group. Increased methylation of genes implicated in dopaminergic neurotransmission (NR4A2) and synaptic plasticity (AUTS2) was associated with reduced PTSD symptom severity in participants receiving FORNET. Analyses across participants revealed a proportional relationship between AA and methylation of TFAM, a gene involved in mitochondrial biosynthesis.
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Affiliation(s)
- Khethelo R Xulu
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Jacqueline S Womersley
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa; South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Jessica Sommer
- Department of Psychology, University of Konstanz, Konstanz, Germany.
| | | | - Thomas Elbert
- Department of Psychology, University of Konstanz, Konstanz, Germany.
| | - Roland Weierstall
- Department of Psychology, University of Konstanz, Konstanz, Germany; Clinical Psychology & Psychotherapy, Medical School Hamburg, Hamburg, Germany.
| | - Debbie Kaminer
- Department of Psychology, University of Cape Town, Cape Town, South Africa.
| | - Stefanie Malan-Müller
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa; South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Sian M J Hemmings
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa; South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
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11
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Siehl S, Robjant K, Crombach A. Systematic review and meta-analyses of the long-term efficacy of narrative exposure therapy for adults, children and perpetrators. Psychother Res 2020; 31:695-710. [PMID: 33205713 DOI: 10.1080/10503307.2020.1847345] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective: Narrative Exposure Therapy (NET) is a short-term trauma-focused intervention originally developed for treating survivors of war and torture. The neurobiological theoretical foundations of NET would suggest that the approach should have long term beneficial effects. We tested this assumption and also provided an extensive overview of all NET studies for adults, for children (KIDNET), and for perpetrators (Forensic Offender Rehabilitation NET; FORNET).Method: Following a systematic literature review, we conducted meta-analyses with all studies that had control conditions, and with all Randomized Controlled Trials (RCTs). We assessed between-groups short- (< 6 months) and long-term (≥ 6 months) effect sizes for symptoms of posttraumatic stress disorder (PTSD) and depression.Results: In a total of 56 studies from 30 countries comparing 1370 participants treated with NET to 1055 controls, we found large between group effect sizes regarding the reduction of PTSD symptoms in favor of NET. Analyses of RCTs with active controls yielded small to medium effect sizes in the short-term, and large effect sizes in the long-term.Conclusions: NET, KIDNET, and FORNET yield beneficial and sustainable treatment results for severely traumatized individuals living in adverse circumstances. Studies in highly developed health care systems comparing NET with other evidence-based trauma-focused interventions are needed.
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Affiliation(s)
- Sebastian Siehl
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany.,Graduate School of Economic and Social Sciences, University of Mannheim, Mannheim, Germany.,Non-Governmental Organization vivo international e.V., Konstanz, Germany
| | - Katy Robjant
- Non-Governmental Organization vivo international e.V., Konstanz, Germany
| | - Anselm Crombach
- Non-Governmental Organization vivo international e.V., Konstanz, Germany.,Department of Psychology at the University of Konstanz, Experimental Clinical Psychology with a Teaching Focus on Clinical Psychology of Childhood and Adolescence.,Non-Governmental Organization Psychologues sans Frontières, Burundi, Bujumbura, Burundi.,Department of Clinical Psychology, Université Lumière de Bujumbura, Bujumbura, Burundi
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Zeller AC, Conrad D, Schneider A, Behnke A, Pfeiffer A, Blum GF, Wilker S, Elbert T, Kolassa I. A combination of combat experience, early abduction, and severe traumatization fuels appetitive aggression and violence among abductees of rebel war in Northern Uganda. Aggress Behav 2020; 46:465-475. [PMID: 32643160 DOI: 10.1002/ab.21914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 11/10/2022]
Abstract
Individuals who perpetrate violence may likely perceive violence as appealing and infliction of violence to derive pleasure is termed as appetitive aggression. Individuals who were abducted as children into an armed group often experience a higher number of traumatic event types, that is traumatic load and are usually socialized in a violence-endorsing environment. This study aims to investigate the interaction between age at initial abduction with that of traumatic load, and their influence on appetitive aggression along with perpetration of violent acts by former members of an armed rebel group of both sexes. Semi-structured interviews were conducted among a target group of formerly abducted rebel-war survivors (including participants with and without combat experience) from Northern Uganda. Participants included 596 women and 570 men with N = 1,166 (Mage = 32.58, SDage = 9.76, range: 18-80 years). We conducted robust linear regression models to investigate the influence of age at initial abduction, traumatic load, combat experience, and biological sex on appetitive aggression as well as their perpetrated violent acts. Our study shows, appetitive aggression and the number of perpetrated violent acts were specifically increased in individuals who were abducted young, experienced several traumatic events in their lifetime, and with previous combat experience. For perpetrated violence men showed increased levels whereas for appetitive aggression the association was independent of biological sex. Therefore, early abducted individuals with a higher traumatic load, who have combat experience, need to be given special intervention to prevent any further violence.
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Affiliation(s)
- Anja C. Zeller
- Clinical Psychology and Neuropsychology, Department of Psychology University of Konstanz Konstanz Germany
- vivo international e.V. Konstanz Germany
| | - Daniela Conrad
- Clinical Psychology and Neuropsychology, Department of Psychology University of Konstanz Konstanz Germany
- Department of Clinical and Biological Psychology, Institute of Psychology and Education Ulm University Ulm Germany
| | - Anna Schneider
- vivo international e.V. Konstanz Germany
- Department of Clinical and Biological Psychology, Institute of Psychology and Education Ulm University Ulm Germany
| | - Alexander Behnke
- Department of Clinical and Biological Psychology, Institute of Psychology and Education Ulm University Ulm Germany
| | | | - Gerrit F. Blum
- Institute of Psychology and Education Ulm University Ulm Germany
| | - Sarah Wilker
- vivo international e.V. Konstanz Germany
- Department of Clinical and Biological Psychology, Institute of Psychology and Education Ulm University Ulm Germany
| | - Thomas Elbert
- Clinical Psychology and Neuropsychology, Department of Psychology University of Konstanz Konstanz Germany
- vivo international e.V. Konstanz Germany
| | - Iris‐Tatjana Kolassa
- vivo international e.V. Konstanz Germany
- Department of Clinical and Biological Psychology, Institute of Psychology and Education Ulm University Ulm Germany
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13
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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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14
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Nandi C, Crombach A, Elbert T, Bambonye M, Pryss R, Schobel J, Weierstall‐Pust R. The cycle of violence as a function of PTSD and appetitive aggression: A longitudinal study with Burundian soldiers. Aggress Behav 2020; 46:391-399. [PMID: 32363661 DOI: 10.1002/ab.21895] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 11/10/2022]
Abstract
During deployment, soldiers face situations in which they are not only exposed to violence but also have to perpetrate it themselves. This study investigates the role of soldiers' levels of posttraumatic stress disorder (PTSD) symptoms and appetitive aggression, that is, a lust for violence, for their engaging in violence during deployment. Furthermore, factors during deployment influencing the level of PTSD symptoms and appetitive aggression after deployment were examined for a better comprehension of the maintenance of violence. Semi-structured interviews were conducted with 468 Burundian soldiers before and after a 1-year deployment to Somalia. To predict violent acts during deployment (perideployment) as well as appetitive aggression and PTSD symptom severity after deployment (postdeployment), structural equation modeling was utilized. Results showed that the number of violent acts perideployment was predicted by the level of appetitive aggression and by the severity of PTSD hyperarousal symptoms predeployment. In addition to its association with the predeployment level, appetitive aggression postdeployment was predicted by violent acts and trauma exposure perideployment as well as positively associated with unit support. PTSD symptom severity postdeployment was predicted by the severity of PTSD avoidance symptoms predeployment and trauma exposure perideployment, and negatively associated with unit support. This prospective study reveals the importance of appetitive aggression and PTSD hyperarousal symptoms for the engagement in violent acts during deployment, while simultaneously demonstrating how these phenomena may develop in mutually reinforcing cycles in a war setting.
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Affiliation(s)
- Corina Nandi
- Department of PsychologyUniversity of Konstanz Konstanz Germany
| | - Anselm Crombach
- Department of PsychologyUniversity of Konstanz Konstanz Germany
- Department of PsychologyUniversity Lumière Bujumbura Burundi
| | - Thomas Elbert
- Department of PsychologyUniversity of Konstanz Konstanz Germany
- Department of PsychologyUniversity Lumière Bujumbura Burundi
| | | | - Rüdiger Pryss
- Institute of Clinical Epidemiology and Biometry, University of Würzburg Würzburg Germany
| | - Johannes Schobel
- Institute of Databases and Information Systems, University of Ulm Ulm Germany
| | - Roland Weierstall‐Pust
- Dr. Amelung Private Clinic for Psychiatry, Psychotherapy, and Psychosomatics Königstein im Taunus Germany
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15
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Robjant K, Koebach A, Schmitt S, Chibashimba A, Carleial S, Elbert T. The treatment of posttraumatic stress symptoms and aggression in female former child soldiers using adapted Narrative Exposure therapy – a RCT in Eastern Democratic Republic of Congo. Behav Res Ther 2019; 123:103482. [DOI: 10.1016/j.brat.2019.103482] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 08/31/2019] [Accepted: 09/24/2019] [Indexed: 12/22/2022]
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16
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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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17
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Crombach A, Siehl S. Impact and cultural acceptance of the Narrative Exposure Therapy in the aftermath of a natural disaster in Burundi. BMC Psychiatry 2018; 18:233. [PMID: 30021559 PMCID: PMC6052646 DOI: 10.1186/s12888-018-1799-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 06/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the aftermath of natural disasters, affected populations are at risk of suffering from trauma-related mental health disorders such as posttraumatic stress disorder (PTSD) or depression. Particularly in poor post-conflict regions, these mental disorders have the potential to impair the ability of individuals to move on with their lives. We aimed to evaluate the feasibility, cultural acceptance, and effect of a trauma-focused psychotherapy, Narrative Exposure Therapy (NET), in the aftermath of a flood disaster in Burundi. METHODS Fifty-one individuals who were living in emergency camps overseen by the Burundian Red Cross in the aftermath of a flood disaster, and who had lost homes and close relatives, were invited to participate in semi-structured diagnostic interviews. Trained Burundian psychology students conducted these interviews, and six sessions of NET were offered to the 15 individuals most affected by trauma-related symptoms. An additional group of psychology students, blind to the treatment conditions, conducted three and 9 months follow-ups with them including also 25 participants who had reported significant but less severe trauma-related symptoms, assessing mental health symptoms, acceptance of NET, stigmatization due to trauma symptoms, and participants' economic well-being. RESULTS Between baseline and 9-months post-intervention assessment, symptoms of PTSD (Hedges' g = 3.44) and depression (Hedges' g = 1.88) improved significantly within participants who received NET and within those who received no treatment (Hedges' gPTSD = 2.55; Hedges' gdepression = 0.72). Furthermore, those who received NET felt less stigmatized by their participation in the intervention than by the trauma-related mental health symptoms they experienced. Overall, participants reported that they would be willing to forego as much as 1 month's worth of income in exchange for receiving trauma-focused interventions in the months following the disaster. CONCLUSIONS Individuals severely affected by trauma-related mental health symptoms might benefit significantly from NET in the aftermath of natural disasters, while less affected individuals seem to recover spontaneously. Despite significant challenges conducting NET in emergency camps in the aftermath of natural disaster in a post-conflict country, such interventions are feasible, appreciated and might have long-lasting impacts on the lives of survivors if conducted with due respect to participants' privacy. TRIAL REGISTRATION UKCR2014 , the 19.06.2014, retrospectively registered.
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Affiliation(s)
- Anselm Crombach
- Department of Psychology, University of Konstanz, Konstanz, Germany. .,Department of Psychology, University Lumière of Bujumbura, Bujumbura, Burundi. .,Non-Governmental Organization Psychologues sans Frontières Burundi, Bujumbura, Burundi. .,Non-Governmental Organization vivo international e.V., Konstanz, Germany.
| | - Sebastian Siehl
- Non-Governmental Organization vivo international e.V., Konstanz, Germany ,0000 0001 2190 4373grid.7700.0Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany ,0000 0001 0943 599Xgrid.5601.2Graduate School of Economic and Social Sciences, University of Mannheim, Mannheim, Germany
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18
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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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19
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Yousufzai MIUA, Harmatz ES, Shah M, Malik MO, Goosens KA. Ghrelin is a persistent biomarker for chronic stress exposure in adolescent rats and humans. Transl Psychiatry 2018; 8:74. [PMID: 29643360 PMCID: PMC5895712 DOI: 10.1038/s41398-018-0135-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/09/2018] [Accepted: 02/18/2018] [Indexed: 12/19/2022] Open
Abstract
Prolonged stressor exposure in adolescence enhances the risk of developing stress-sensitive mental illnesses, including posttraumatic stress disorder (PTSD), for many years following exposure cessation, but the biological underpinnings of this long-term vulnerability are unknown. We show that severe stressor exposure increased circulating levels of the hormone acyl-ghrelin in adolescent rats for at least 130 days and in adolescent humans for at least 4.5 years. Using a rodent model of longitudinal PTSD vulnerability in which rodents with a history of stressor exposure during adolescence display enhanced fear in response to fear conditioning administered weeks after stressor exposure ends, we show that systemic delivery of a ghrelin receptor antagonist for 4 weeks surrounding stressor exposure (2 weeks during and 2 weeks following) prevented stress-enhanced fear memory. These data suggest that protracted exposure to elevated acyl-ghrelin levels mediates a persistent vulnerability to stress-enhanced fear after stressor exposure ends.
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Affiliation(s)
- Muhammad I. ul Akbar Yousufzai
- grid.444779.dDepartment of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Elia S. Harmatz
- McGovern Institute for Brain Research & Department of Brain and Cognitive Sciences, 77 Massachusetts Ave, Cambridge, MA 02139 USA
| | - Mohsin Shah
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan.
| | - Muhammad O. Malik
- grid.444779.dDepartment of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Ki A. Goosens
- 0000 0004 0386 9924grid.32224.35Department of Neurology, Massachusetts General Hospital, 114 16th Street, Charlestown, MA 02129 USA
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20
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Moran JK, Crombach A, Elbert T, Nandi C, Bambonyé M, Wienbruch C, Lommen U, Weierstall R. The individual contribution of DSM 5 symptom clusters of PTSD, life events, and childhood adversity to frontal oscillatory brain asymmetry in a large sample of active combatants. Biol Psychol 2017; 129:305-313. [PMID: 28958482 PMCID: PMC5678498 DOI: 10.1016/j.biopsycho.2017.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 08/14/2017] [Accepted: 09/23/2017] [Indexed: 12/11/2022]
Abstract
Post-Traumatic Stress Disorder (PTSD) has been linked to deviations in lateralized frontal functional oscillatory activity. This is possibly because left and right DLPFC have differential roles in regulating both memory and stress response, which are both dysfunctional in PTSD. However, previous results are heterogeneous, and could be attributable to individual symptom clusters, traumatic or aggressive life events, early life stress, or the interaction of these factors. In a large sample of active combatants (N=401), we regressed these factors on frontal electroencephalography (EEG) asymmetry across 5 frequency bands (delta: 2-4Hz; theta: 4-8Hz; alpha: 8-12Hz; beta: 12-24Hz; gamma: 24-48Hz). Negative cognition and mood was associated with stronger relative left delta and theta band power. Traumatic life events showed stronger right alpha and beta band power. Traumatic life events in interaction with hyperarousal predicted stronger relative right left-right imbalance (theta, alpha, and beta bands), whereas childhood adversity, in interaction with negative cognition and mood, predicted stronger relative left left-right imbalance (delta, theta, alpha and beta bands). The contribution of lateralized DLPFC dysfunction to PTSD is thus dependent on the individual complexities of subsymptom clusters and life history, and future studies need to take these factors into account.
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Affiliation(s)
- James K Moran
- Department of Psychology, University of Konstanz, Konstanz, Baden-Württemberg, Germany; Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Berlin, Germany.
| | - Anselm Crombach
- Department of Psychology, University of Konstanz, Konstanz, Baden-Württemberg, Germany; Department of Psychology, University Lumière of Bujumbura, Burundi
| | - Thomas Elbert
- Department of Psychology, University of Konstanz, Konstanz, Baden-Württemberg, Germany; Department of Psychology, University Lumière of Bujumbura, Burundi
| | - Corina Nandi
- Department of Psychology, University of Konstanz, Konstanz, Baden-Württemberg, Germany
| | - Manassé Bambonyé
- Department of Psychology, University Lumière of Bujumbura, Burundi
| | - Christian Wienbruch
- Department of Psychology, University of Konstanz, Konstanz, Baden-Württemberg, Germany
| | - Ursula Lommen
- Department of Psychology, University of Konstanz, Konstanz, Baden-Württemberg, Germany
| | - Roland Weierstall
- Department of Psychology, University of Konstanz, Konstanz, Baden-Württemberg, Germany; MSH Medical School Hamburg, University of Applied Sciences and Medical University, Germany
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21
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Bluemke M, Crombach A, Hecker T, Schalinski I, Elbert T, Weierstall R. Is the Implicit Association Test for Aggressive Attitudes a Measure for Attraction to Violence or Traumatization? ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2017. [DOI: 10.1027/2151-2604/a000281] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Traumatic exposure is particularly devastating for those who, at a young age, have become combatants or experienced massive adversity after abduction by armed movements. We investigated the impact of traumatic stressors on psychopathology among war-affected young men of Northern Uganda, including former child soldiers. Adaptation to violent environments and coping with trauma-related symptoms often result in an increasing appetite for violence. We analyze implicit attitudes toward violence, assessed by an Implicit Association Test (IAT), among 64 male participants. Implicit attitudes varied as a function of the number of experienced traumatic event types and committed offense types. As the number of traumatic experiences and violence exposure increased, more appetitive aggression was reported, whereas the IAT indicated increasingly negative implicit attitudes toward aggression. The IAT was also the strongest predictor of cortisol levels. Diffusion-model analysis was the best way to demonstrate IAT validity. Implicit measures revealed the trauma-related changes of cognitive structures.
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Affiliation(s)
- Matthias Bluemke
- Department of Survey Design and Methodology, GESIS – Leibniz-Institute for the Social Sciences, Mannheim, Germany
- Psychological Institute, University of Heidelberg, Germany
| | | | - Tobias Hecker
- Department of Psychology, Bielefeld University, Germany
| | | | - Thomas Elbert
- Department of Psychology, University of Konstanz, Germany
| | - Roland Weierstall
- MSH Medical School Hamburg, University of Applied Sciences and Medical University, Hamburg, Germany
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22
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Augsburger M, Meyer-Parlapanis D, Elbert T, Nandi C, Bambonye M, Crombach A. Succumbing to the Call of Violence - Sex-Linked Development of Appetitive Aggression in Relation to Familial and Organized Violence. Front Psychol 2017; 8:751. [PMID: 28536553 PMCID: PMC5422546 DOI: 10.3389/fpsyg.2017.00751] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 04/25/2017] [Indexed: 11/13/2022] Open
Abstract
Appetitive aggression is the attraction to violent behavior, which can peak in the experience of a combat high. In various war and conflict scenarios, members of armed groups have reported developing a desire to hunt and even kill humans. More recently, we reported that the phenomenon has also been observed in female ex-combatants with varying participation in warfare. Despite recent investigations on risk factors for appetitive aggression, sex-specific pathways in the development of appetitive aggression have not yet been delineated. This study investigated moderation effects of sex on previously identified risk factors for appetitive aggression by means of regression analyses in a sample of individuals with varying degrees of warfare participation (overall sample, n = 602). First examining a sample characterized by backgrounds heterogeneous in both sociodemographic data and war experiences, the analysis was then replicated in a subsample of fighters active during the civil war (combatant sample, n = 109). In both samples, regression analyses revealed significant moderation effects of sex. Childhood maltreatment and traumatic events had positive associations on the development of appetitive aggression for males but a negative (childhood maltreatment) or no (traumatic events) association for females. Perpetrated events were more strongly correlated with appetitive aggression for females than for males. This pattern was pronounced for the combatant sample. These results are in favor of sex-linked pathways. In both sexes, appetitive aggression may have evolved as a biologically prepared response to cruel environments but might develop along different trajectories. The current study highlights the need for addressing appetitive aggression in order to support peace-building processes and emphasizes sex specific starting-points.
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Affiliation(s)
- Mareike Augsburger
- Department of Psychology, University of KonstanzKonstanz, Germany.,Department of Psychology, University of ZurichZurich, Switzerland
| | | | - Thomas Elbert
- Department of Psychology, University of KonstanzKonstanz, Germany.,Department of Psychology, Université Lumière de BujumburaBujumbura, Burundi
| | - Corina Nandi
- Department of Psychology, University of KonstanzKonstanz, Germany
| | - Manassé Bambonye
- Department of Psychology, Université Lumière de BujumburaBujumbura, Burundi
| | - Anselm Crombach
- Department of Psychology, University of KonstanzKonstanz, Germany.,Department of Psychology, Université Lumière de BujumburaBujumbura, Burundi
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Ainamani HE, Elbert T, Olema DK, Hecker T. PTSD symptom severity relates to cognitive and psycho-social dysfunctioning - a study with Congolese refugees in Uganda. Eur J Psychotraumatol 2017; 8:1283086. [PMID: 28326164 PMCID: PMC5328389 DOI: 10.1080/20008198.2017.1283086] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/07/2016] [Accepted: 12/03/2016] [Indexed: 10/26/2022] Open
Abstract
Background: In the ongoing conflict in the Democratic Republic of the Congo (DRC), civilians have been heavily exposed to traumatic stressors. Traumatizing experiences cumulatively heighten the risk for trauma-related disorders, and with it affect cognitive and psycho-social functioning. Objectives: We aimed at investigating the association between trauma-related disorders and cognitive and psycho-social functioning and hypothesized that PTSD symptom severity would negatively correlate with executive functioning, working memory and psycho-social functioning in everyday life. Method: In total, 323 Congolese refugees (mean age: 31.3 years) who arrived in the Ugandan Nakivale refugee settlement after January 2012 were assessed regarding their exposure to traumatic events, PTSD symptom severity (posttraumatic symptom scale interview), executive functioning (Tower of London), working memory performance (Corsi block tapping task) and psycho-social dysfunctioning (Luo functioning scale). Results: Hierarchical regression analyses indicated a significant negative association between PTSD symptom severity and working memory (β = -0.32, p < 0.001), as well as executive functions (β = -0.19, p = 0.003). Furthermore, the impairment of psycho-social functioning in everyday life was positively related with PTSD symptom severity (β = 0.70, p < 0.001), and negatively with executive functioning (β = -0.15, p = 0.003). However, working memory performance was not significantly related to psycho-social dysfunctioning (β = 0.09, p > 0.05). Conclusion: Trauma survivors not only suffer from the core PTSD symptoms but also from impaired cognitive functioning. PTSD symptom severity seems furthermore to be related to impaired psycho-social functioning. Our findings suggest that trauma-related mental health problems may heighten the risk for poverty and lack of prospect and further aggravate the consequences of war and conflict.
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Affiliation(s)
- Herbert E Ainamani
- Department of Psychology, Mbarara University of Science and Technology, Mbarara, Uganda; Department of Psychology, Bishop Stuart University, Mbarara, Uganda
| | - Thomas Elbert
- Department of Psychology, Mbarara University of Science and Technology, Mbarara, Uganda; Department of Psychology, University of Konstanz, Konstanz, Germany
| | - David K Olema
- Department of Psychology, Mbarara University of Science and Technology , Mbarara , Uganda
| | - Tobias Hecker
- Department of Psychology, University of Zurich , Zurich , Switzerland
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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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Augsburger M, Meyer-Parlapanis D, Bambonye M, Elbert T, Crombach A. Appetitive Aggression and Adverse Childhood Experiences Shape Violent Behavior in Females Formerly Associated with Combat. Front Psychol 2015; 6:1756. [PMID: 26635666 PMCID: PMC4646969 DOI: 10.3389/fpsyg.2015.01756] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/02/2015] [Indexed: 11/13/2022] Open
Abstract
This study investigated the impact of violent experiences during childhood, posttraumatic stress disorder (PTSD) and appetitive aggression on everyday violent behavior in Burundian females with varying participation in war. Moreover, group differences in trauma-related and aggression variables were expected. Appetitive aggression describes the perception of violence perpetration as fascinating and appealing and is a common phenomenon in former combatants. Semi-structured interviews were conducted with 158 females, either former combatants, supporters of armed forces or civilians during the civil war in Burundi. The PTSD Symptom Scale Interview was used to assess PTSD symptom severity, the Appetitive Aggression Scale to measure appetitive aggression and the Domestic and Community Violence Checklist to assess both childhood maltreatment and recent aggressive behavior. Former combatants had experienced more traumatic events, perpetrated more violence and reported higher levels of appetitive aggression than supporters and civilians. They also suffered more severely from PTSD symptoms than civilians but not than supporters. The groups did not differ regarding childhood maltreatment. Both appetitive aggression and childhood violence predicted ongoing aggressive behavior, whereas the latter outperformed PTSD symptom severity. These findings support current research showing that adverse childhood experiences and a positive attitude toward aggression serve as the basis for aggressive behavior and promote an ongoing cycle of violence in post-conflict regions. Female members of armed groups are in need of demobilization procedures including trauma-related care and interventions addressing appetitive aggression.
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Affiliation(s)
| | | | | | - Thomas Elbert
- Department of Psychology, University of Konstanz Konstanz, Germany ; Department of Psychology, University Lumière Bujumbura, Burundi
| | - Anselm Crombach
- Department of Psychology, University of Konstanz Konstanz, Germany ; Department of Psychology, University Lumière Bujumbura, Burundi
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26
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Crombach A, Bambonyé M. Intergenerational violence in Burundi: Experienced childhood maltreatment increases the risk of abusive child rearing and intimate partner violence. Eur J Psychotraumatol 2015; 6:26995. [PMID: 26679146 PMCID: PMC4696461 DOI: 10.3402/ejpt.v6.26995] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 10/19/2015] [Accepted: 11/01/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Experiencing abuse during childhood affects the psychological well-being of individuals throughout their lives and may even influence their offspring by enhancing the likelihood of an intergenerational transmission of violence. Understanding the effects of childhood maltreatment on child-rearing practices and intimate partner violence might be of particular importance to overcome the consequences of violent conflicts in African societies. OBJECTIVE Using Burundi as an example, we aimed to explore the associations between childhood maltreatment, intimate partner violence, perceived partner intimidation, gender and the probability of violently acting out against one's own children or romantic partner. METHODS Amongst a sample of 141 men and 141 women in the capital of Burundi, we identified those who had biological children and those who lived or had lived in relationships. Using culturally appropriate instruments, we enquired about their exposure to childhood maltreatment and partner violence as well as their inclinations to act out violently. RESULTS We found that childhood maltreatment and perceived partner intimidation were strong predictors for the perpetration of violence against children. Moreover, we found that women were more likely to use violence against children if they experienced partner violence and less likely to resort to violence if they felt intimidated. Men were more likely to perpetrate violence against their partner. Childhood maltreatment was again a strong predictor. The more women experienced partner violence, the more they fought back. CONCLUSIONS Childhood maltreatment is a strong predictor for domestic violence and has to be addressed to interrupt the cycle of violence in post-conflict countries.
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Affiliation(s)
- Anselm Crombach
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Department of Clinical Psychology, University Lumière of Bujumbura, Bujumbura, Burundi.,NGO Vivo International e.V., Konstanz, Germany;
| | - Manassé Bambonyé
- Department of Clinical Psychology, University Lumière of Bujumbura, Bujumbura, Burundi
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27
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Affiliation(s)
- Vedat Şar
- Koç University School of Medicine (KUSOM), Istanbul, Turkey.,European Society for Traumatic Stress Studies (ESTSS), 2013-2015 Diemen, The Netherlands.,International Society for the Study of Trauma and Dissociation (ISSTD), 2008-2009 McLean, Washington DC, USA;
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