Regular Articles Vulnerability to Posttraumatic Stress Disorder in Adult Offspring of Holocaust Survivors Rachel Yehuda, Ph.D., James Schmeidler, Ph.D., Milton Wainberg, M.D., Karen Binder-Brynes, Ph.D., and Tamar Duvdevani, B.A.
Objective: There has been considerable controversy regarding the impact of the Holocaust on the second generation, but few empirical data are available that systematically document trauma exposure and psychiatric disorder in these individuals. To obtain such data, the authors examined the prevalence of stress and exposure to trauma, current and lifetime posttraumatic stress disorder (PTSD), and other psychiatric diagnoses in a group of adult offspring of Holocaust survivors (N=100) and a demographically similar comparison group (N=44). Method: Subjects were recruited from both community and clinical populations and were evaluated with the use of structured clinical instruments. Stress and trauma history were evaluated with the Antonovsky Life Crises Scale and the Trauma History Questionnaire, PTSD was diagnosed with the Clinician Administered PTSD Scale, and other psychiatric disorders were evaluated according to the Structured Clinical Interview for DSM-IV. Results: The data show that although adult offspring of Holocaust survivors did not experience more traumatic events, they had a greater prevalence of current and lifetime PTSD and other psychiatric diagnoses than the demographically similar comparison subjects. This was true in both community and clinical subjects. Conclusions: The findings demonstrate an increased vulnerability to PTSD and other psychiatric disorders among offspring of Holocaust survivors, thus identifying adult offspring as a possible highrisk group within which to explore the individual differences that constitute risk factors for PTSD. (Am J Psychiatry 1998; 155:1163–1171)
W
ith few exceptions, the literature on adult offspring of Holocaust survivors is divided into two camps: descriptions of the adverse effects of the Holocaust on the second generation and failures to find such effects. Initial reports described an unusually high incidence of depression, anxiety, conduct disorder, personality problems, inadequate maturity, excessive dependence, and poor coping in the children of Holocaust survivors (1–5). In addition, offspring of Holocaust survivors were described as having a general fraReceived Sept. 29, 1997; revisions received Jan. 12 and Feb. 27, 1998; accepted April 15, 1998. From the Traumatic Stress Studies Program, Department of Psychiatry, Mount Sinai School of Medicine, Bronx VA Medical Center. Address reprint requests to Dr. Yehuda, Department of Psychiatry, 116A, Bronx VA Medical Center, 130 West Kingsbridge Rd., Bronx, NY 10468;
[email protected] (e-mail).
Am J Psychiatry 155:9, September 1998
gility and vulnerability to stress (6–8). Barocas and Barocas (6) commented not only on the alarming number of children of survivors seeking and requiring help but also on the striking resemblance between symptoms of the children and those of the parents. They described offspring of Holocaust survivors as “showing symptoms that would be expected if they actually lived through the Holocaust.” Rosenheck and Nathan (9), in their study of children of Vietnam combat veterans, also observed that children of trauma survivors display symptoms of posttraumatic stress disorder (PTSD). Implicit in the literature mentioned above is the attribution of psychiatric problems in the children of trauma survivors to the parental trauma. However, the literature has been ambiguous about whether symptoms in offspring are due to the indirect exposure to traumatic material as described by the parents (which 1163
PTSD IN OFFSPRING OF HOLOCAUST SURVIVORS
could fit DSM-IV criterion A[1]: being confronted with information about threats to the parents’ lives) or, TABLE 1. Stress and Trauma History of Offspring of Holocaust Survivors and Comparison Subjects Total Sample (N=144) Comparison Subjects (N=44)
Analysis
Measure
Mean
SD
Mean
SD
t
df
p
Life crises scorea Crime High magnitude Low magnitude Sexual abuse High magnitude Low magnitude Combat/war Natural disaster Car accident Other events High magnitude Low magnitude Total trauma score
2.09
2.25
5.32
3.17
6.85
107.4
