Transgenerational Transmission of Trauma: Psychiatric Evaluation of Offspring of Former “Comfort Women,” Survivors of the Japanese Military Sexual Slavery during World War II

Abstract

“Comfort women” are survivors of sexual slavery by the Imperial Japanese Army during World War II, who endured extensive trauma including massive rape and physical torture. While previous studies have been focused on the trauma of the survivors themselves, the effects of the trauma on the offspring has never been evaluated before. In this article, we reviewed the first study on the offspring of former “comfort women” and aimed to detect the evidence of transgenerational transmission of trauma. In-depth psychiatric interviews and the Structured Clinical Interview for DSM-5 Axis I Disorders were conducted with six offspring of former “comfort women.” Among the six participants, five suffered from at least one psychiatric disorder including major depressive disorder, panic disorder, posttraumatic stress disorder, adjustment disorder, insomnia disorder, somatic symptom disorder, and alcohol use disorder. Participants showed similar shame and hyperarousal symptoms as their mothers regarding stimuli related to the “comfort woman” issue. Increased irritability, problems with aggression control, negative worldview, and low self-esteem were evident in the children of mothers with posttraumatic stress disorder. Finding evidence of transgenerational transmission of trauma in offspring of “comfort women” is important. Future studies should include more samples and adopt a more objective method.

Role of Putative Epigenetic Mechanisms in the Intergenerational Transmission of Trauma Effects in “Comfort Women” Survivor Offspring

“…It has been reported that higher HPA axis reactivity with lower expression of 11β-HSD2 mRNA in placenta is shown by female offspring exposed to prenatal stressors, as compared with male offspring exposed to similar stressors. Thus, the differences in clinical manifestations of case A /C (female) and case B (male) in the findings of Lee et al [1] can be partly explained.…”

“…The article on the intergenerational transmission of trauma effects in the offspring of “comfort women” survivors by Lee et al [1], published in the March 2019 issue of Psychiatry Investigation , has yielded important findings. Because the “comfort women” survivors were exposed to extreme trauma, including rape, sexual torture, physical trauma, starvation, death threats, and witnessing of others being tortured and/or killed as Japanese military sexual slaves during the Second World War, all of them had post-traumatic stress disorder (PTSD) throughout their lifetimes and some had complex PTSD [2].…”

“…Because the “comfort women” survivors were exposed to extreme trauma, including rape, sexual torture, physical trauma, starvation, death threats, and witnessing of others being tortured and/or killed as Japanese military sexual slaves during the Second World War, all of them had post-traumatic stress disorder (PTSD) throughout their lifetimes and some had complex PTSD [2]. According to the findings of the study by Lee et al [1], among the six offspring of “comfort women” survivors, case A presented depression, panic attack, insomnia, and aggression; case B presented delinquent behavior in high school and anger outbursts; and case C presented self-blame, suicidal ideation, somatic symptoms, and sleeping problems. Thus, this study provides evidence regarding the intergenerational transmission of trauma effects in the offspring of “comfort women” survivors.…”

“…Cluster analysis has shown that maternal PTSD is associated with higher levels of depressive symptoms and anxiety, and lower level of perceived emotional health, while paternal PTSD is associated with higher level of childhood trauma and lower level of attachment [4]. This differential association between parental gender and GR-1 F promoter methylation and clinical indicators of offspring may be partly explained by the psychiatric manifestations and their diversity of the “comfort women” survivor offspring [1].…”

“…It has been reported that maternal age during the Holocaust is an independent influencing factor for urinary cortisol levels and cortisol metabolism in adult offspring, whose mothers were children during the Second World War [3]. A potential hypothesis for the effects of preconception maternal trauma may be proposed from the personal history of case C in the findings of Lee et al [1] During the pregnancy with case C, at bumping into a soldier, her mother had a re-experience and arousal without any additional significant exposures to trauma. Thus, it is speculated that preconception trauma exposure-induced prenatal re-experience and arousal might be associated with the epigenetic modifications in fetoplacental environment.…”