Trauma and current posttraumatic stress symptoms in elderly German women who experienced wartime rapes in 1945.
ABSTRACT The aim of this study was to determine the persistent trauma impact and significant posttraumatic stress symptoms in a sample of very elderly German women who survived the mass rapes committed by soldiers at the end of World War II. A total of 27 women were recruited, interviewed, and then administered a modified Posttraumatic Diagnostic Scale. They all reported a very severe degree of trauma exposure in 1945; 19% reported significant current posttraumatic stress symptoms indicating a possible posttraumatic stress disorder at the time of the study, and 30% fulfilled the criteria of a current partial posttraumatic stress disorder. The results highlight the necessity for prevention and treatment programs for women exposed to wartime rapes in current conflict settings worldwide, and the need to identify and treat posttraumatic conditions in the elderly generation of all countries exposed to World War II trauma.
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ABSTRACT: The long lasting resilience of individuals and communities affected by mass violence has not been given equal prominence as their suffering. This has often led to psychosocial interventions in post-conflict zones being unresponsive to local realities and ill-equipped to foster local strengths. Responding to the renewed interest in resilience in the field of violence and health, this study examines the resilience and post-traumatic responses of Indigenous Quechua women in the aftermath of the political violence in Peru (1980--2000). A cross-sectional study examined the relationship between resilience, post-traumatic responses, exposure to violence during the conflict and current life stress on 151 Quechua women participants. Purposive and convenience sampling strategies were used for recruitment in Ayacucho, the area most exposed to violence. The study instruments were translated to Quechua and Spanish and cross-culturally validated. Data was analyzed using hierarchical regression analysis. A locally informed trauma questionnaire of local idioms of distress was also included in the analysis. Sixty percent of women (n = 91) were recruited from Ayacucho city and the rest from three rural villages; the mean age was 45 years old. Despite high levels of exposure to violence, only 9.3% of the sample presented a level of symptoms that indicated possible PTSD. Resilience did not contribute to the overall variance of post-traumatic stress related symptoms, which was predicted by past exposure to violence, current life stress, age, and schooling (R2 = .421). Resilience contributed instead to the variance of avoidance symptoms (Stand beta = -.198, t = -2.595, p = 0.010) while not for re-experiencing or arousal symptoms. These findings identified some of the pathways in which resilience and post-traumatic responses interrelate in the aftermath of violence; yet, they also point to the complexity of their relationship, which is not fully explained by linear associations, requiring further examination. Age and gender-sensitive health care is considered critical almost fifteen years after the end of the conflict. The notable resilience of Quechua women---despite exposure to a continuum of violence and social inequalities---also calls for enhanced recognition of women not only as victims of violence but also as complex social actors in the reconstruction of post-conflict societies.Conflict and Health 10/2013; 7(1):21.
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ABSTRACT: The aim of the study was to compare the long-term effects of conflict-related sexual violence experienced at the end of World War II (WWII) with non-sexual WWII trauma (e.g., being exposed to shell shock or physical violence). A total of 27 elderly wartime rape survivors were compared to age- and gender-matched control subjects who were drawn from a larger sample of subjects over 70 years of age who had experienced WWII-related trauma. A modified version of the Posttraumatic Diagnostic Scale was used to assess trauma characteristics and posttraumatic stress disorder (PTSD) symptoms and the Brief Symptom Inventory-18 was used to assess current psychopathology. Additionally, measures of posttraumatic growth (Posttraumatic Growth Inventory) and social acknowledgement as a trauma survivor (Social Acknowledgement Questionnaire) were used to assess two mediating variables in post-trauma conditions of rape victims. Women exposed to conflict-related sexual violence reported greater severity of PTSD-related avoidance and hyperarousal symptoms, as well as anxiety, compared with female long-term survivors of non-sexual WWII trauma. The vast majority (80.9 %) of these women also reported severe sexual problems during their lifetimes relative to 19.0 % of women who experienced non-sexual war trauma. Women exposed to conflict-related sexual violence also reported greater posttraumatic growth, but less social acknowledgement as trauma survivors, compared to survivors of non-sexual war trauma. The results were consistent with emerging neurobiological research, which suggests that different traumas may be differentially associated with long-term posttraumatic sequelae in sexual assault survivors than in other survivor groups and highlights the need to treat (or better prevent) deleterious effects of conflict-related sexual violence in current worldwide crisis zones.Archives of Sexual Behavior 03/2014; · 3.53 Impact Factor
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ABSTRACT: Trauma-focused cognitive behavioral treatments are known to be effective for posttraumatic stress disorder (PTSD) in adults. However, evidence for effective treatments for older persons with PTSD, particularly elderly war trauma survivors, is scarce. In an open trial, 30 survivors of World War II aged 65 to 85 years (mean, 71.73 years; SD, 4.8; n = 17 women) with PTSD symptoms were treated with a Web-based, therapist-assisted cognitive-behavioral/narrative therapy for 6 weeks. Intent-to-treat analyses revealed a significant decrease in PTSD severity scores (Cohen's d = 0.43) and significant improvements on secondary clinical outcomes of quality of life, self-efficacy, and posttraumatic growth from pretreatment to posttreatment. All improvements were maintained at a 3-month follow-up. The attrition rate was low (13.3%), with participants who completed the trial reporting high working alliance and treatment satisfaction. Results of this study suggest that integrative testimonial therapy is a well accepted and potentially effective treatment for older war trauma survivors experiencing PTSD symptoms.The Journal of nervous and mental disease. 08/2014;
Trauma and Current Posttraumatic Stress Symptoms in Elderly
German Women Who Experienced Wartime Rapes in 1945
Philipp Kuwert, MD, Thomas Klauer, PhD, Svenja Eichhorn, Dipl.-Psych., Elena Grundke, Dipl.-Psych.,
Manuela Dudeck, MD, Georg Schomerus, MD, and Harald J. Freyberger, MD
Abstract: The aim of this study was to determine the persistent trauma
impact and significant posttraumatic stress symptoms in a sample of very
elderly German women who survived the mass rapes committed by soldiers
at the end of World War II. A total of 27 women were recruited, interviewed,
and then administered a modified Posttraumatic Diagnostic Scale. They all
reported a very severe degree of trauma exposure in 1945; 19% reported
significant current posttraumatic stress symptoms indicating a possible post-
traumatic stress disorder at the time of the study, and 30% fulfilled the
criteria of a current partial posttraumatic stress disorder. The results highlight
the necessity for prevention and treatment programs for women exposed to
wartime rapes in current conflict settings worldwide, and the need to identify
and treat posttraumatic conditions in the elderly generation of all countries
exposed to World War II trauma.
Key Words: Trauma, PTSD, wartime rape, World War II, sexual
(J Nerv Ment Dis 2010;198: 450–451)
f “Two soldiers hold me, a third one than raped me. And it went on,
at least 5 times. I laid there in my blood, some people helped me to
get off the street . . .” (I.P., 82 years old).
ment, loss of family members, abuse, and starvation (Berman,
2001). More than 90% of war victims are civilians (Unicef, 2009).
Women are extremely vulnerable to traumatic experiences in times
of war and the risk continues even in postwar situations (Shanks and
Schull, 2000). In the 90s, the world was shocked by reports about
systematic and widespread rape in the former Yugoslavia and
Rawanda (Shanks and Schull, 2000). The Lancet published accounts
of wartime rape on some occasions and demanded the development
of clear strategies against sexual violence in conflict (Hargreaves,
2001). However, it can be concluded that sexual violence was, and
is, common in nearly all crisis zones. Most researchers emphasize
the timeless ubiquity of wartime rape, even documented in the Bible
and in Odysseus (Gottschall, 2004). Although there is some research
on different theories about the factors that contribute to the phenom-
ena on the perpetrator’s side, very few papers highlight the victim’s
perspective. A Croatian study group documented posttraumatic
stress disorder (PTSD) and psychopathology in raped women of the
ar is a complex, sequential trauma composed of variable forms
of extreme stress such as violence, fear of death, displace-
1991–95 war (Loncar et al., 2006). In a randomized sample of
Liberian women, 50% of the participants reported war trauma and
15% gave accounts of rape (Swiss et al., 1998). Summarizing the
sparse research literature on the topic, women in conflict zones
suffer from all forms of nonsexual war trauma, and additionally
from sexual violence. Sexual violence in conflict ranges from
singular acts on one side, to systematic, “strategic” mass rape in the
context of ethnic cleansing on the other side, as happened in former
Yugoslavia (Loncar et al., 2006).
At the end of World War II, it is estimated that about 1.4 to
1.9 million German women were raped by invading soldiers (Mess-
erschmidt, 2006; Sander and Johr, 2005). Because of repeated gang
rapes, the total number of rapes was even higher. A total of 10% of
the women committed suicide (Messerschmidt, 2006), whereas the
number of murdered women is not known. Approximately, 200,000
children were conceived by rape (Sander and Johr, 2005). So far, no
study on the posttraumatic burden of the raped German women at
the end of World War II has been published, and probably most of
them are no longer alive. This study focused on the reported
testimonies and current PTSD in elderly German women who are
the long-term survivors of wartime rape in 1945.
Participants were recruited by interviews in the press, pub-
lishing our search for women who experienced wartime rape at the
end of World War II. The study was approved by the ethical
committee of the University of Greifswald and all participants gave
informed consent. Two female interviewers conducted interviews
with the elderly women and administered the Posttraumatic Diag-
nostic Scale (PDS). The PDS represents a 49-item self-report instru-
ment for the assessment of PTSD (Foa et al., 1997). The items
correspond to the criteria A to F of the DSM-IV (American Psychi-
atric Association, 1994), and a diagnosis is very likely if all 6 criteria
are met. Criterion A1 is covered by a checklist of 12 traumatic
events. In case of more than 1 trauma, individuals are asked to refer
to the most distressing event when completing the subsequent
sections including criterion A2, B (intrusions, 5 re-experiencing
symptoms), C (7 avoidance symptoms), and D (5 arousal symp-
toms). The frequency of each of the 17 symptoms in the past month
is rated on a 4-point scale (0 ? not at all or only 1 time; 3 ? 5 or
more times a week/almost always). The duration of the PTSD and
the subsequent impairment in different life areas are finally assessed.
Additionally, the scale allows quantifying the symptom severity by
summing the individual’s responses corresponding to the PTSD
symptom clusters of intrusions, avoidance, and arousal. To differ-
entiate experienced war trauma in more detail, the initial checklist
was enhanced with questions of the Harvard Trauma Questionaire
(Mollica et al., 1992).
A total of 27 women completed the questionnaires. Their
mean age was 80.3 years (SD ? 3 ? 1). The range was from 76 to 89
years at the time of the study. A total of 63% were widowed, 18%
married, 4% divorced, and 15% were single. Seventy percent visited
Department of Psychiatry and Psychotherapy, Ernst-Moritz-Arndt University
Greifswald, Stralsund, Germany.
Supported by Gesellschaft fu ¨r Nervenheilkunde des Landes Mecklenburg Vorpo-
mmern (society for nervous and mental disease Mecklenburg-Vorpommern),
4 thousand €.
Send reprint requests to Philipp Kuwert, MD, Department of Psychiatry and
Psychotherapy, Ernst-Moritz-Arndt University Greifswald, Rostocker Chaus-
see 70, D-18437 Stralsund, Germany. E-mail: email@example.com.
Copyright © 2010 by Lippincott Williams & Wilkins
The Journal of Nervous and Mental Disease • Volume 198, Number 6, June 2010
450 | www.jonmd.com
primary school, 18% high school, 4% other schools, and 8% had no
graduation. Sixty-three percent were displaced persons from the
former eastern territories, such as Eastern Prussia, Pommerania, and
Silesia. Their mean age at the time of wartime rape was 16.7 years
(SD ? 3 ? 2, range: 12–26 years). The women reported a mean of
12.5 rapes (SD ? 15.9). Two women could not remember the
frequency, but reported of having been raped “the whole night
long.” The participants reported an average of 10.8 (SD ? 3 ? 5)
traumatic events during war. Table 1 presents a detailed description
of the reported traumatic events.
According to the PDS, 5 participants (19%) met the DSM-IV
criteria for a current PTSD diagnosis and 8 (30%) fulfilled the
criteria for a partial PTSD as defined by Blanchard and coworkers
(Blanchard et al., 1994). Eighty-one percent of the women reported
of having been impaired in sexuality during their lifetime.
The aim of this study was to assess the amount of trauma and
current posttraumatic stress symptoms in a sample of German
women who survived mass rapes at the end of World War II. The
announcement of the study induced an enormous resonance from the
national and international media, which underlines the public inter-
est in up to now neglected and tabooed aspects of World War II
trauma (Dowling, 2008). In line with the few previous studies on
wartime rape (Loncar et al., 2006; Swiss et al., 1998), we found an
extremely high degree of traumatic impact. The participants were
raped frequently, and in addition to the mass rapes, they experienced
a very broad range of other war-related traumatic events (Table 1).
Nearly half of the elderly women suffered under significant post-
traumatic symptomatology concerning the wartime rapes in 1945.
Most of the few studies on wartime rape did not document
posttraumatic stress symptoms and to our knowledge there is no
study which evaluated such symptomatology in elderly women
exposed to wartime rape several decades ago.
However, several methodological limitations have to be consid-
ered, including the small sample size: Participants were found by the
press, which raises the question of participation bias. On 1 side, the
women could have been interested in participating because of the
awareness of their personal grief; on the other hand, there is evidence
that highly traumatized subjects have difficulties in participating in
research, which could possibly undermine their defenses (Newman and
Kaloupek, 2004). Because of the decades between trauma and assess-
ment, recall bias could be another important limitation. PTSD measures
were based on a self-report screening instrument (PDS) and were not
validated by a structured interview. Although the scale showed good
agreement (82%) with the PTSD module of the Structured Clinical
Interview for DSM Disorders (Foa et al., 1997), PTSD diagnoses based
on the PDS must be considered presumptive.
Despite these limitations, the present study highlights the
long-lasting effect of wartime rape on mental health. It is an ethical
and political task to tackle this specific traumatization of women in
conflict zones worldwide (Hargreaves, 2001). As far as World War
II trauma is concerned, there is an urgent need for treatment
programs adapted to the needs of the elderly generation (Boettche et
American Psychiatric Association (1994) Diagnostic and Statistical Manual of
Mental Disorders (4th ed). Washington (DC): American Psychiatric Press.
Berman H (2001) Children and war: Current understandings and future directions.
Public Health Nurs. 18:243–252.
Blanchard EB, Hickling EJ, Taylor AE, Loos WR, Gerardi RJ (1994) Psycho-
logical morbidity associated with motor vehicle accidents. Behav Res Ther.
Boettche M, Kuwert P, Knaevelsrud C. Treatment approaches of posttraumatic stress
disorder in the elderly: An overview. Psychother Psychosom., Submitted.
Dowling S (2008, October 22) New German study looks at rape trauma 60 years
on. Spiegel Online International.
Foa EB, Cashman L, Jaycox L, Perry K (1997) The validation of a self-report
measure of posttraumatic stress disorder: The posttraumatic diagnostic scale.
Psychol Assess. 9:445–451.
Gottschall J (2004) Explaining wartime rape. J Sex Res. 41:129–136.
Hargreaves S (2001) Rape as a war crime: Putting policy into practice. Lancet.
Loncar M, Medved V, Jovanovic N, Hotujac L (2006) Psychological conse-
quences of rape on women in 1991–1995 war in Croatia and Bosnia and
Herzegovina. Croat Med J. 47:67–75.
Messerschmidt JW (2006) Review symposium: The forgotten victims of World
War II: Masculinities and rape in Berlin, 1945. Violence Against Women.
Mollica RF, Caspi-Yavin Y, Bollini P, Truong T, Tor S, Lavelle J (1992) The
Harvard Trauma Questionnaire. Validating a cross-cultural instrument for
measuring torture, trauma and posttraumatic stress disorder in Indochinese
refugees. J Nerv Ment Dis. 180:111–116.
Newman E, Kaloupek DG (2004) The risks and benefits of participating in
trauma-focused research studies. J Trauma Stress. 17:383–394.
Sander H, Johr B (2005) BeFreier und Befreite. Krieg, Vergewaltigung, Kinder.
Frankfurt/Main (Germany): Fischer Verlag.
Shanks L, Schull MJ (2000) Rape in war: The humanitarian response. CMAJ.
Swiss S, Jennings PJ, Aryee GV, Brown GH, Jappah-Samukai RM, Kamara MS,
Schaack RD, Turay-Kanneh RS (1998) Violence against women during the
Liberian civil conflict. JAMA. 279:625–659.
The Times (2006) Two US Soldiers Guilty of Separate Murders in Iraq. London:
Unicef (2009) Available at: http://www.unicef.org.
Wartime Rape as Assessed by the Modified PDSa
Traumatic Events of Women Who Experienced
Seeing dead and mutilated bodies
Sexual assault with age ?18
Threat to be murdered
Severe accident or explosion
Witnessing mass rapes
Witnessing sexual abuse of others
Witnessing killing or serious wounding of others
Other traumatic event
Witnessing injury or death of family member
Violent assault of family member
Fighting in a war zone
Witnessing Nazi war crimes
aPercentage refers to the total number of participants, n ? 27.
The Journal of Nervous and Mental Disease • Volume 198, Number 6, June 2010 Trauma and Current Posttraumatic Stress Symptoms
© 2010 Lippincott Williams & Wilkins
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