Archives of Sexual Behavior

, Volume 43, Issue 6, pp 1059–1064

Long-Term Effects of Conflict-Related Sexual Violence Compared with Non-Sexual War Trauma in Female World War II Survivors: A Matched Pairs Study

  • Philipp Kuwert
  • Heide Glaesmer
  • Svenja Eichhorn
  • Elena Grundke
  • Robert H. Pietrzak
  • Harald J. Freyberger
  • Thomas Klauer
Original Paper

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.

Keywords

Trauma PTSD Wartime rape War Sexual violence 

References

  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.Google Scholar
  2. Campbell, R., & Wasco, S. M. (2005). Understanding rape and sexual assault: 20 Years of progress and future directions. Journal of Interpersonal Violence, 20, 127–131.CrossRefPubMedGoogle Scholar
  3. Cann, A., Calhoun, L. G., Tedeschi, R. G., Taku, K., Vishnevsky, T., Triplett, K. N., et al. (2010). A short form of the Posttraumatic Growth Inventory. Anxiety, Stress and Coping, 23, 127–137.CrossRefGoogle Scholar
  4. Casanas, G. (2010). UN: Wartime rape no more inevitable, acceptable than mass murder. CNN World News. Retrieved November 23, 2011 from http://edition.cnn.com/WORLD/.
  5. Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum Press.Google Scholar
  6. Derogatis, L. R. (2000). BSI-18: Brief Symptom Inventory 18: Administration, scoring, and procedures manual. Minneapolis, MN: NCS Pearson.Google Scholar
  7. Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavioral Research Methods, 39, 175–191.CrossRefGoogle Scholar
  8. Foa, E. B., Cashman, L., Jaycox, L., & Perry, K. (1997). The validation of a self-report measure of posttraumatic stress disorder: The Posttraumatic Diagnostic Scale. Psychological Assessment, 9, 445–451.CrossRefGoogle Scholar
  9. Forstmeier, S., Kuwert, P., Spitzer, C., Freyberger, H. J., & Maercker, A. (2009). Posttraumatic growth, social acknowledgment as survivors, and sense of coherence in former German child soldiers of World War II. American Journal of Geriatric Psychiatry, 17, 1030–1039.CrossRefPubMedGoogle Scholar
  10. Frazier, P., Conlon, A., & Glaser, T. (2001). Positive and negative life changes following sexual assault. Journal of Consulting and Clinical Psychology, 69, 1048–1055.CrossRefPubMedGoogle Scholar
  11. Glaesmer, H., Kaiser, M., Braehler, E., Freyberger, H. J., & Kuwert, P. (2012). Posttraumatic stress disorder and its comorbidity with depression and somatisation in the elderly: A German community-based study. Aging and Mental Health, 16, 403–412.CrossRefPubMedGoogle Scholar
  12. Gola, H., Engler, H., Schauer, M., Adenauer, H., Riether, C., Kolassa, S., et al. (2011). Victims of rape show increased cortisol responses to trauma reminders: A study in individuals with war- and torture-related PTSD. Psychoneuroendocrinology, 37, 213–220.CrossRefPubMedGoogle Scholar
  13. Gottschall, J. (2004). Explaining wartime rape. Journal of Sex Research, 41, 129–136.CrossRefPubMedGoogle Scholar
  14. Hargreaves, S. (2001). Rape as a war crime: Putting policy into practice. Lancet, 357, 737.CrossRefPubMedGoogle Scholar
  15. Henigsberg, N., Folnegovic-Smalc, V., & Moro, L. (2001). Stressor characteristics and post-traumatic stress disorder symptom dimensions in war victims. Croatian Medical Journal, 42, 543–550.PubMedGoogle Scholar
  16. Johnson, K., Scott, J., Rughita, B., Kisielewski, M., Asher, J., Ong, R., et al. (2010). Association of sexual violence and human rights violations with physical and mental health in territories of the Eastern Democratic Republic of the Congo. Journal of the American Medical Association, 304, 553–562.CrossRefPubMedGoogle Scholar
  17. Kuwert, P., & Freyberger, H. J. (2007). The unspoken secret: Sexual violence in World War II. International Psychogeriatrics, 19, 782–784.CrossRefPubMedGoogle Scholar
  18. Kuwert, P., Klauer, T., Eichhorn, S., Grundke, E., Dudeck, M., Schomerus, G., et al. (2010). Trauma and current posttraumatic stress symptoms in elderly German women who experienced wartime rapes in 1945. Journal of Nervous and Mental Disease, 198, 450–451.CrossRefPubMedGoogle Scholar
  19. Laufer, A., & Solomon, Z. (2006). Posttraumatic symptoms and posttraumatic growth among Israeli youth exposed to terror incidents. Journal of Social and Clinical Psychology, 25, 429–447.CrossRefGoogle Scholar
  20. Leiner, A. S., Kearns, M. C., Jackson, J. L., Astin, M. C., & Rothbaum, B. O. (2012). Avoidant coping and treatment outcome in rape-related posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 80, 317–321.PubMedCentralCrossRefPubMedGoogle Scholar
  21. Lev-Wiesel, R., & Amir, M. (2003). Posttraumatic growth among Holocaust child survivors. Journal of Loss and Trauma, 8, 229–237.CrossRefGoogle Scholar
  22. Linley, P. A., & Joseph, S. (2004). Positive change following trauma and adversity: A review. Journal of Traumatic Stress, 17, 11–21.CrossRefPubMedGoogle Scholar
  23. Loncar, M., Medved, V., Jovanovic, N., & Hotujac, L. (2006). Psychological consequences of rape on women in 1991–1995 war in Croatia and Bosnia and Herzegovina. Croatian Medical Journal, 47, 67–75.PubMedCentralPubMedGoogle Scholar
  24. Maercker, A., & Müller, J. (2004). Social acknowledgement as a victim or survivor: A scale to measure a recovery factor of PTSD. Journal of Traumatic Stress, 17, 345–351.CrossRefPubMedGoogle Scholar
  25. McMillen, J. C., Smith, E. M., & Fisher, R. H. (1997). Perceived benefit and mental health after three types of disaster. Journal of Consulting and Clinical Psychology, 65, 733–739.CrossRefPubMedGoogle Scholar
  26. Mollica, R. F., 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. Journal of Nervous and Mental Disease, 180, 111–116.CrossRefPubMedGoogle Scholar
  27. Newman, E., & Kaloupek, D. G. (2004). The risks and benefits of participating in trauma-focused research studies. Journal of Traumatic Stress, 17, 383–394.CrossRefPubMedGoogle Scholar
  28. Powell, S., Rosner, R., Butollo, W., Tedeschi, R. G., & Calhoun, L. G. (2003). Posttraumatic growth after war: A study with former refugees and displaced people in Sarajevo. Journal of Clinical Psychology, 59, 71–83.CrossRefPubMedGoogle Scholar
  29. Roelofs, K., van Peer, J., Berretty, E., Jong, P., Spinhoven, P., & Elzinga, B. M. (2009). Hypothalamus–pituitary–adrenal axis hyperresponsiveness is associated with increased social avoidance behavior in social phobia. Biological Psychiatry, 65, 336–343.CrossRefPubMedGoogle Scholar
  30. Swiss, S., Jennings, P. J., Aryee, G. V., Brown, G. H., Jappah-Samukai, R. M., Kamara, M. S., et al. (1998). Violence against women during the Liberian civil conflict. Journal of the American Medical Association, 279, 625–629.CrossRefPubMedGoogle Scholar
  31. Tedeschi, R. G., & Calhoun, L. G. (1996). The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9, 455–472.CrossRefPubMedGoogle Scholar
  32. Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic growth: Conceptual foundations and empirical evidence. Psychological Inquiry, 15, 1–18.CrossRefGoogle Scholar
  33. van Berlo, W., & Ensink, B. (2000). Problems with sexuality after sexual assault. Annual Review of Sex Research, 11, 235–257.PubMedGoogle Scholar
  34. Weaver, T. L. (2009). Impact of rape on female sexuality: Review of selected literature. Clinical Obstetrics and Gynecology, 52, 702–711.CrossRefPubMedGoogle Scholar
  35. Witteveen, A. B., Huizink, A. C., Slottje, P., Bramsen, I., Smid, T., & van der Ploeg, H. M. (2010). Associations of cortisol with posttraumatic stress symptoms and negative life events: A study of police officers and firefighters. Psychoneuroendocrinology, 35, 1113–1118.CrossRefPubMedGoogle Scholar
  36. Zawati, H. M. (2007). Impunity or immunity: Wartime male rape and sexual torture as a crime against humanity. Torture, 17, 27–47.PubMedGoogle Scholar
  37. Zoellner, T., & Maercker, A. (2006). Posttraumatic growth in clinical psychology—A critical review and introduction of a two component model. Clinical Psychology Review, 26, 626–653.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Philipp Kuwert
    • 1
  • Heide Glaesmer
    • 2
  • Svenja Eichhorn
    • 2
  • Elena Grundke
    • 1
  • Robert H. Pietrzak
    • 3
    • 4
  • Harald J. Freyberger
    • 1
  • Thomas Klauer
    • 1
  1. 1.Department of Psychiatry and PsychotherapyUniversity Medicine Greifswald at the HELIOS Hansehospital StralsundStralsundGermany
  2. 2.Department of Medical Psychology and Medical SociologyUniversity of LeipzigLeipzigGermany
  3. 3.National Center for Posttraumatic Stress DisorderVA Connecticut Healthcare SystemWest HavenUSA
  4. 4.Department of PsychiatryYale University School of MedicineNew HavenUSA

Personalised recommendations