The goal of this paper is to advance the theory of chronic and traumatic stressors that have been identified as type III traumas in the trauma developmentally-based framework (DBTF) and use it to investigate the mental and physical health effects of such traumas on impacted individuals and groups. Participants were 438 Palestinian adolescents from the West Bank who had been exposed to a number of types of trauma including chronic intergroup violence. The age of participants in the sample ranged from 12 to 19 with a mean of 15.66 and SD of 1.43. The sample included 54.6% males, 52.3% resided in cities, 44.4% resided in villages, while 3.2% resided in refugee camps. The study utilized a measure for cumulative traumas that is based on the DBTF and measures of post-traumatic stress disorder (PTSD), cumulative trauma related disorders (CTD), depression, anxiety, collective annihilation anxiety (AA), identity salience, and fear of death. The results of partial correlation and path analyses indicated that continuous traumatic stress was a significant predictor of mental health. The analyses also indicated that poverty predicted identity salience and AA that mediated their negative effects on physical and mental health of Palestinian adolescents. The relevance of these results to peace, social and clinical psychology was discussed.
These results suggest that memory reactivation prior to exposure therapy did not have an impact on clinical measures but may enhance the effect of exposure therapy at the physiological level.
Measures that screen for mental health in multiple traumatized populations (e.g., refugees, minorities, mental health patients, prison inmates) lack theoretical clarity that makes it difficult to develop a measure that has robust psychometrics. The paper proposes cumulative trauma disorders (CTD) model and develops a scale that measures the concept and can be used as a general mental health screening tool in such populations. The measure has been tested on two studies: on representative community sample of Iraqi refugees in Michigan and on a clinic sample of refugees. Further, the measure was used on samples of Iraqi refugee and African American adolescents, West Bank and Gaza in Palestinian territories, as well as a mental health screening tool in some centers that screen refugees and torture survivors in US. The measure has been found to have high alpha and test-retest reliability, good construct, concurrent, discriminative and predictive validity in the two main samples and on all the studies and centers that utilized it. The measure can be used as a general mental health screening tool for adult and adolescent in public health settings in different cultures, as well as for refugees, torture survivors, and highly traumatized populations.
To clarify the effects of torture trauma and its components on PTSD and other mental health conditions, we investigated the relationship between measures for PTSD, Cumulative trauma disorders CTD, cumulative life trauma, torture and torture severity in a sample of 326 torture survivors. Hierarchical multiple regressions found no significant association between torture and PTSD. However, when we examined the effects of different types of torture we found witnessing and sexual tortures were significant predictors of PTSD and CTD. Path analysis results found that torture trauma and its severity may not be predicative of PTSD; but it is highly predictive of the more complex syndromes of CTD. The implications of the results for treating torture survivors were discussed. One of the important findings is the potential effects of torture on decreased re-experiencing and emotional numbness. Torture trauma may be too emotionally and physically painful experience that tends to be suppressed decreasing re-experiencing and increasing dissociation.
The study explores the effects of gender discrimination GD as type III trauma in 359, (160 females and 199 males) torture survivors. Data includes measures of GD and other traumas, PTSD and cumulative trauma disorders CTD. GD found to decrease PTSD symptoms in males favoring mental health status of males, and increase CTD symptoms in females. GD mediated the effects of personal identity traumas on PTSD and CTD symptoms of psychosis/dissociation; executive function deficits, and suicidality. The results highlight GD as type III trauma that contributes to the mental health differences between males and females.
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