Posttraumatic Resilience in Former Ugandan Child Soldiers: Klasen et al, 2010

Question 1

Overview

Answer 1

Study shows that posttraumatic resilience was associated with
Lower exposure to domestic violence
Lower guilt cognitions
Less motivation to seek revenge
Better socioeconomic situation the family
More perceived spiritual support

Question 2

4 characteristics related to childhood trauma that appear to last for long periods of time, regardless of the diagnosis

Answer 2

o repeatedly intrusive memories of the traumatic event
o repetitive behaviors
o trauma-specific fears
o altered attitudes toward people, life and the future

Question 3

Developmental Trauma Disorder (DTD)

Answer 3

PTSD might not be developmentally sensitive.
o To adjust for these discrepancies the concept of developmental trauma disorder (DTD) has been proposed.
o This has been described as a complex PTSD, or disorders of extreme stress not otherwise specified.
o Key features of DTD are
emotional dysregulation
disturbed attachment patterns
behavioral reenactment (e.g. aggressive behavior)
persistently altered attributions and expectancies

Question 4

3 core symptoms of PTSD

Answer 4

Repeated and unwanted reexperience of the event

Hyperarousal

Avoidance of stimuli that could remind of the event

The diagnosis of PTSD might not integrate the full range of psychopatholiges following prolonged and repeated complex traumatic exposure.

Question 5

Traditional dispositional factors of risk/resilience: “hardiness”

Answer 5

Internal locus of control
a sense of meaning
social problem-solving skills
Strong self-esteem

Hardiness integrates many of these characteristics and is associated with posttraumatic adjustment as well as a positive orientation toward the future comprising optimism and goal orientation

Question 6

Traditional social protective factors

Answer 6

Parents and other supportive relationships have a strong protective influence in children and youth. In the context of exposure to severe adversity, children in close proximity to effective caregivers fare better in young people who lose their parents are more vulnerable to psychopathology.

Question 7

Hypotheses

Answer 7

1. A considerable proportion of the child soldiers would be resilient, by not meeting criteria for PTSD, and not meeting criteria for depression, or scoring below the multicultural cutoff for behavioral and emotional problems
2. Trauma severity during induction would be significant risk factor for posttraumatic outcome
3. Loss of parents and domestic and community violence mistakenly would predict posttraumatic outcome
4. Dispositional variables such as responses to trauma and perceived external support would predict posttraumatic outcome over and above what can be predicted from trauma severity

Question 8

Results: significant risk & resilience factors

Answer 8

• 28% of the children showed resilient mental health outcome
• 33% met criteria for PTSD
• 37% met criteria for major depression

• 6 variables proved to be significant predictors of posttraumatic resilience:

Risk factors – 
o	higher age
o	domestic and community violence
o	strong guilt cognitions 
o	revenge motivation

***Protective factors –
o high family SES
o perceived spiritual support

• Despite severe trauma children displayed high average scores of future positive orientation
o This is noteworthy, as a negative future orientation has been described as an indicator of psychological trauma response

Question 9

Factors NOT found to be significant

Answer 9

Gender did not relate to resilience

Trauma Severity
o This contrasts earlier literature and the hypothesis that trauma severity during abduction serves as a crucial predictor of posttraumatic outcome

Loss of parents also was not a significant risk factor for resilience
o Perhaps African extended family systems compensate for the loss of parents

Dispositions (i.e. hardiness and positive future orientation) did not assist in explaining the variance in posttraumatic outcome

Question 10

revenge, rumination, guilt

Answer 10

Revenge motivation was a risk factor for worse posttraumatic outcome, consistent with other research on child soldiers
o Rumination tends to make individuals more aggressive which may translate into violent behavior
• Children indicated that they frequently suffered from guilt, expressing the time spent with the arm grouped cause them pain and suffering and reported current thoughts of their own acts being unjustified and unforgivable
• Guilt was related both to being a victim of violence as well as to being a perpetrator

Question 11

Factors that enable children to become perpetrators

Answer 11

The will to survive
Obedience to orders
Normalization of violence
Ideology