Severe war-related trauma and personality pathology: a case-control study

Abstract

BackgroundExposure to war-related trauma has long been recognised to have an adverse effect on mental health. We attempted to investigate whether people who have clinically significant personality-related problems 15 years after a war are more likely to have been exposed to severe war-related trauma than those who do not have significant personality difficulties.MethodsA case –control study was conducted in southern Croatia, fifteen years after the 1991–1995 war. We recruited 268 participants: 182 cases who scored positively on the International Personality Disorder Examination scale (IPDE), and 86 controls who were IPDE negative. Severity of war-related trauma was assessed according to the 17 items on the Harvard Trauma Questionnaire (HTQ) trauma event scale, which were considered to be of severe (catastrophic) nature based on the ICD-10 description of catastrophic trauma and the opinion of trauma experts. All participants also completed measures of mental health (depression, anxiety and PTSD), social functioning and current substance misuse.ResultsCases (IPDE positive) were eight times more likely to report exposure to severe war-related trauma than controls. This association increased after adjustments for demographic factors (OR = 10.1, 95% CI 5.0 to 20.4). The types of severe trauma most frequently reported were either the participants’own life being in direct danger or witnessing extreme violence inflicted on others or the result of violence towards others (murder, torture, seeing burned or disfigured bodies). Prevalences of depression, anxiety and PTSD were high among IPDE positive participants 15 years after exposure to war trauma. Their level of interpersonal dysfunction was considerably higher than that in controls (OR = 10.39, 95% CI 3.51 to 30.75). Alcohol consumption in cases was significantly higher with a mean of 14.24 units per week (sd = 11.03) when compared to controls whose mean number of alcohol units was 9.24 (sd = 7.25), t (73) = 2.16, p < 0.05, mean difference 4.99 (95% CI = 0.39 to 9.60). Similarly, a significantly higher number of cases reported current substance misuse (8.2% vs. 0.0%) X2 (1, n = 268) = 7.51, p < 0.05).ConclusionExposure to severe war-related trauma is a risk factor for interpersonal dysfunction15 years after people were exposed to an armed conflict. These findings have implications for assessing and meeting the long-term mental health needs of people in war-affected regions. Further research needs to be done to increase our understanding about the relationship between severe war trauma and personality related problems.

Pre‐migration traumatic experiences, post‐migration perceived discrimination and substance use among Russian and Kurdish migrants—a population‐based study

“…(8) Experienced some other form of horrible violence?’, with answer options ‘yes’/‘no’ . These items were selected from the Harvard Trauma Questionnaire (HTQ), a validated instrument for measuring exposure to severe traumatic events . A dichotomous combination variable was formed: ‘yes’ included answer ‘yes’ to any of the eight items .…”

Lasting personality pathology following exposure to severe trauma in adulthood: retrospective cohort study

“…The methods including the recruitment process have been described in detail elsewhere [17]. Briefly, in this case-control study [17] cases met the threshold for significant personality-related problems using the International Personality Disorder Examination (IPDE) [18] whilst controls did not. Out of 268 patients who participated in the original case-control study [17], 182 patients met the threshold for having significant personality pathology.…”

“…Briefly, in this case-control study [17] cases met the threshold for significant personality-related problems using the International Personality Disorder Examination (IPDE) [18] whilst controls did not. Out of 268 patients who participated in the original case-control study [17], 182 patients met the threshold for having significant personality pathology. High levels of exposure to severe war trauma among the local population in the region of Southern Croatia 15 years prior to data collection, made this an appropriate setting in which to examine whether these experiences are associated with late-onset personality pathology or they are a consequence of pre-trauma personality disorder.…”

“…As we were interested in studying the exposure to severe trauma and its impact on potential personality change in adults, and in the absence of an established definition of this concept, we have decided to define severe (catastrophic) trauma based on the ICD-10 description of catastrophic stress (WHO, 1992) and the findings from a survey of trauma experts [23]. This process of defining the catastrophic trauma has been described in detail elsewhere [17]. Briefly, it was assumed that severe (catastrophic) trauma would involve prolonged exposure to life-threatening circumstances with imminent possibility of being killed (for example exposure to war trauma, concentration camp experience, being tortured, hostage situations and sexual assault).…”

“…Two authors (JM and MC) independently assessed 47-items of HTQ trauma events (Part I) and selected those items in the HTQ that they thought would meet the criteria for severe trauma resolving any disagreements by further discussions. Out of the 47 war-related traumatic events listed in the Harvard Trauma Questionnaire, 17 items (36%) were considered to be of the severity that could be described as ‘severe war-related trauma’ [17].…”