0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letter to the Editor   |    
Posttraumatic Stress Disorder in Children of Holocaust Survivors
JOHN SIGAL, PH.D.
Am J Psychiatry 1999;156:1295-1295.

To the Editor: In the introduction to their article, Rachel Yehuda, Ph.D., and colleagues (1) wrongly concluded from Solomon et al.’s study (2) of Israeli soldiers who developed posttraumatic stress disorder (PTSD) as a result of combat-related stress that "that study provided…empirical demonstration of a greater vulnerability of offspring of Holocaust survivors to…stressful events." This conclusion is not supported by Solomon et al.’s data. Solomon et al. may only have demonstrated that some of them were more vulnerable to PTSD. They did find statistically significant differences between their index and control groups in the number of symptoms reported. Inspection of their findings, however, suggests that there was considerable overlap between the groups. Furthermore, the mean frequency of any of the five symptoms for which data are reported is less than one per participant, raising some question about the clinical significance of the findings. Finally, because the study was based on questionnaire self-reports, the results may represent nothing more than differences in proneness of the respective groups to report symptoms and not a difference in vulnerability to PTSD.

By contrast, two community-based studies that used probability sampling techniques and widely differing measures of functioning failed to find differences between adult children of survivors and appropriate comparison groups (3, 4).

Dr. Yehuda et al.’s studies (1; R. Yehuda et al., unpublished data, 1998) help us understand the significance of Solomon et al.’s finding. Dr. Yehuda et al. (1) selected a group of Holocaust survivors with PTSD and assessed their adult children. In limiting their study to this population, they reduced the risk of biased findings that might result from their nonrandom sampling method. They found that the children of these survivors were at greater risk than their comparison group for developing PTSD.

What can we conclude from the studies already mentioned about the intergenerational effects of prolonged, potentially traumatic stress? The community studies cited found no evidence for it under normal circumstances in the adult children of people exposed to such stress. (They did not show that there is no difference; one cannot prove the null hypothesis.) Solomon et al.’s study may have shown that some of these children are vulnerable in severe, life-threatening circumstances. Dr. Yehuda and colleagues’ studies demonstrated that having a parent with PTSD may be one of the factors predisposing children to this vulnerability.

That troubled families have vulnerable children is not a new discovery. It is not unique to families of survivors of the Holocaust or of ex-prisoners of war from the various wars in the Far East who have been shown to suffer long-term morbidity and mortality rates similar to those of Jewish and non-Jewish survivors of the Nazi extermination camps. What may be unique, but is yet to be established, is whether this occurs with greater frequency or in different ways in the families of survivors of these atrocities or in other conditions of prolonged, severe adversity. Neither Solomon et al.’s study nor Dr. Yehuda et al.’s studies can answer this question, nor have they claimed to do so.

Yehuda R, Schmeidler J, Giller EL Jr, Siever LJ, Binder-Brynes K: Relationship between posttraumatic stress disorder characteristics of Holocaust survivors and their adult offspring. Am J Psychiatry  1998; 155:841–843
[PubMed]
 
Solomon Z, Kotler M, Mikulincer M: Combat-related posttraumatic stress disorder among second-generation Holocaust survivors: preliminary findings. Am J Psychiatry  1988; 145:865–868
[PubMed]
 
Schwartz S, Dohrenwend BP, Levav I: Nongenetic familial transmission of psychiatric disorders? Evidence from children of Holocaust survivors. J Health Soc Behav  1994; 35:385–402
[PubMed]
[CrossRef]
 
Sigal JJ, Weinfeld M: Trauma and Rebirth: Intergenerational Effects of the Holocaust. New York, Praeger, 1989
 
+

References

Yehuda R, Schmeidler J, Giller EL Jr, Siever LJ, Binder-Brynes K: Relationship between posttraumatic stress disorder characteristics of Holocaust survivors and their adult offspring. Am J Psychiatry  1998; 155:841–843
[PubMed]
 
Solomon Z, Kotler M, Mikulincer M: Combat-related posttraumatic stress disorder among second-generation Holocaust survivors: preliminary findings. Am J Psychiatry  1988; 145:865–868
[PubMed]
 
Schwartz S, Dohrenwend BP, Levav I: Nongenetic familial transmission of psychiatric disorders? Evidence from children of Holocaust survivors. J Health Soc Behav  1994; 35:385–402
[PubMed]
[CrossRef]
 
Sigal JJ, Weinfeld M: Trauma and Rebirth: Intergenerational Effects of the Holocaust. New York, Praeger, 1989
 
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Web of Science® Times Cited: 3

Related Content
Books
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 7.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 7.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 7.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 32.  >
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 12.  >
Topic Collections
Psychiatric News
APA Guidelines
PubMed Articles