The Legacy of Combat Trauma

Clinical Implications of Intergenerational Transmission
  • Michelle R. Ancharoff
  • James F. Munroe
  • Lisa M. Fisher
Part of the The Plenum Series on Stress and Coping book series (SSSO)


Posttrauma symptoms can have a profound effect on the manner in which a trauma survivor relates to others, including, perhaps most significantly, family members. Survivors are markedly changed by their experiences. The psychological impact of trauma is well established in a variety of survivor populations (e.g., Burgess & Holmstrom, 1974; Davis & Friedman, 1985; Figley, 1978; Foa, Rothbaum, Riggs, & Murdock, 1992; Kilpatrick, Veronen, & Best, 1985; Koopman, Classen, &Spiegel, 1994; Laufer, Frey-Wouters, & Gallops, 1985; Titchner, Kapp, & Winget, 1976). These posttrauma symptoms include (1) experiencing the trauma through flashbacks, nightmares, and persistent thoughts; (2) cognitive and phobic avoidance of trauma-related stimuli; (3) hyperarousal symptoms of irritability, startle response, and sleep disturbance (American Psychiatric Association, 1994). It is easy to understand how survivors’ numbing of responsiveness, social withdrawal, and irritability, with episodic outbursts of rage, can make it difficult for them to maintain interpersonal relationships. In turn, children of traumatized patients may be affected directly or indirectly by their parents’ posttrauma symptoms. For example, Rosenheck and Nathan (1985) described a child of a combat veteran with post-traumatic stress disorder (PTSD) as having insomnia; headaches; tearfulness; feelings of helplessness; fears of being kidnapped, shot, or killed; attention problems at school; and fantasies similar to his father’s flashbacks. These authors coined the term secondary traumatization to describe this phenomenon. Others have referred to this as transgenerational transmission of trauma (Harkness, 1993). Although the terminologies differ, common to these descriptions is the notion that children are affected by their parents’ posttrauma sequelae. Despite a plethora of descriptive information, intergenerational transmission of trauma is a poorly defined empirical construct, and one that is not well understood within the professional community. We do not know the extent to which parental trauma affects the next generation or how many generations may be influenced. One of the best predictors for PTSD is the intensity and duration of exposure to traumatic events (Gleser, Green, & Winget, 1981; van der Kolk, 1988). We can speculate that one of the best predictors for secondary trauma in children may be the intensity and duration of trauma exposure of their parents. Combat veterans are a group that has been exposed to extensive trauma and, therefore, represent a population in which intergenerational transmission is likely. The objectives of this chapter are to describe the legacy of combat trauma on the children of Vietnam veterans and identify the mechanisms through which these cognitive, affective, and behavioral patterns are handed down. In addition, this chapter explores issues of how to determine if, when, and how to intervene.


Traumatic Stress Intergenerational Transmission Compassion Fatigue Vietnam Veteran Trauma Survivor 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd edition, rev). Washington, DC: Author.Google Scholar
  2. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders ( 4th edition ). Washington, DC: Author.Google Scholar
  3. Ancharoff, M. R. (1994). Intergenerational transmission of trauma: Mechanisms and messages. Unpublished doctoral thesis, Graduate School of Professional Psychology, University of Denver.Google Scholar
  4. Baron, L., Reznikoff, M., & Glenwick, D. S. (1993). Narcissism, interpersonal adjustment, and coping in children of Holocaust survivors. Journal of Psychology, 127(3), 257–269.Google Scholar
  5. Ben-David, A., & Lavee, Y. (1992). Families in the sealed room: Interaction patterns of Israeli families during SCUD missile attacks. Family Process, 31, 35–44.PubMedCrossRefGoogle Scholar
  6. Bloom, S. (1995). The germ theory of trauma: The impossibility of ethical neutrality. In B. Stamm (Ed.), Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators (pp. 257–276 ). Lutherville, MD: Sidran.Google Scholar
  7. Burgess, A. W, & Holmstrom, L. L. (1974). Rape trauma syndrome. American Journal of Psychiatry, 131, 981–986. Catherall, D. R. (I 992a). Back from the brink: A family guide to overcoming traumatic stress. New York, Bantam. Catherall, D. R. (1992b). Working with projective identification in couples. Family Process, 31, 355–367.Google Scholar
  8. Chrestman, K. R. (1994). Secondary traumatization in therapists working with survivors of trauma. Unpublished doctoral dissertation, Nova University, Fort Lauderdale, Florida.Google Scholar
  9. Danieli, Y. (1981). Therapists’ difficulties in treating survivors of the Nazi Holocaust and their children. Dissertation Abstracts International, 42, 4947-B.Google Scholar
  10. Danieli, Y. (1984). Psychotherapists’ participation in the conspiracy of silence about the Holocaust. Psychoanalytic Psychology, 1(1), 23–42.Google Scholar
  11. Danieli, Y. (1985). The treatment and prevention of long-term effects and intergenerational transmission of victimization: A lesson from Holocaust survivors and their children. In C. R. Figley (Ed.), Trauma and its wake: The study and treatment of post-traumatic stress disorder (pp. 295–313 ). New York: Brunner/Mazel.Google Scholar
  12. Danieli, Y. (1988a). Confronting the unimaginable: Psychotherapists’ reactions to victims of the Nazi Holocaust. In J. P. Wilson, Z. Harel, & B. Kahana (Eds.), Human adaptation to extreme stress: From the Holocaust to Vietnam (pp. 219–238 ). New York: Plenum Press.Google Scholar
  13. Danieli, Y. (1988b). Treating survivors and children of survivors of the Nazi Holocaust. In E Ochberg (Ed.), Post-traumatic therapy and victims of violence (pp. 278–294 ). New York: Brunner/Mazel.Google Scholar
  14. Danieli, Y. (1993). Diagnostic and therapeutic use of the multigenerational family tree in working with survivors and children of survivors of the Nazi Holocaust. In J. P. Wilson & B. Raphael (Eds.), International handbook of traumatic stress syndromes (pp. 889–898 ). New York: Plenum Press.CrossRefGoogle Scholar
  15. Davidson, J., Smith, R., & Kudler, H. (1989). Familial psychiatric illness in chronic post-traumatic stress disorder. Comprehensive Psychiatry, 30 (4), 339–345.PubMedCrossRefGoogle Scholar
  16. Davis, R. C., & Friedman, L. N. (1985). The emotional aftermath of crime and violence. In C. R. Figley (Ed.), Trauma and its wake: The study and treatment of post-traumatic stress disorder (pp. 90–112 ). New York: Brunner/Mazel.Google Scholar
  17. DeFazio, V. J., & Pascucci, N. J. (1984). Return to Ithaca: A perspective on marriage and love in posttraumatic stress disorder. Journal of Contemporary Psychotherapy, 14(1), 76–89.Google Scholar
  18. Doreleijers, T. A. H., and Donovan, D. (1990). Transgenerational traumatization in children of parents interned in Japanese civil internment camps in the Dutch East Indies during World War II. Journal of Psychohistory, 17 (4), 435–447.Google Scholar
  19. Epstein, H. (1979). Children of the Holocaust: Conversations with sons and daughters of survivors. New York: Pengu in Books.Google Scholar
  20. Eth, S., & Pynoos, R. S. (Eds.). (1985). Post-traumatic stress disorder in children. Washington, DC: American Psychiatric Association Press.Google Scholar
  21. Figley, C. R. (Ed.) (1978). Stress disorders among Vietnam veterans: Theory, research, and treatment. New York: Brunner/Mazel.Google Scholar
  22. Figley, C. R. (1985). From victim to survivor: Social responsibility in the wake of catastrophe. In C. R. Figley (Ed.), Trauma and it’s wake: the study and treatment of post-traumatic stress disorder (pp. 398–415 ). New York: Brunner/Mazel.Google Scholar
  23. Figley, C. R. (1988). A five-phase treatment of post-traumatic stress disorder in families. Journal of Traumatic Stress, 1 (1), 127–141.CrossRefGoogle Scholar
  24. Figley, C. R. (1989). Helping traumatized families. San Francisco: Jossey-Bass.Google Scholar
  25. Foa, E. B., Rothbaum, B. O., Riggs, D. S., & Murdock, T. (1992). A prospective examination of post-traumatic stress disorder in rape victims. Journal of Traumatic Stress, 5(3), 455–475.Google Scholar
  26. Freyberg, J. T. (1980). Difficulties in separation-individuation as experienced by offspring of Nazi Holocaust survivors. American Journal of Orthopsychiatry, 50 (1), 87–95.PubMedCrossRefGoogle Scholar
  27. Gallagher, R. E., Flye, B. L., Hurt, S. W, Stone, M. H., & Hull, J. W. (1992). Retrospective assessment of traumatic experiences (RATE). Journal of Personality Disorders, 6, 99–108.CrossRefGoogle Scholar
  28. Gizynski, M. N. (1983). The effects of maternal depression on children. Clinical Social Work, 11, 339–350.CrossRefGoogle Scholar
  29. Gleser, G. C., Green, B. L., & Winget, C. (1981). Prolonged psychological effects of disaster: A study of Buffalo Creek. New York: Academic Press.Google Scholar
  30. Goodwin, J. (1988). Post-traumatic symptoms in abused children. Journal of Traumatic Stress, 1 (4), 475–488.CrossRefGoogle Scholar
  31. Green, B. L. (1993). Identifying survivors at risk: Trauma and stressors across events. In J. P. Wilson & B. Raphael (Eds.), International handbook of traumatic stress syndromes (pp. 135–144 ). New York: Plenum Press.CrossRefGoogle Scholar
  32. Greenfield, S. F., Swartz, M. S., Landerman, L. R., & George, L. K. (1993). Long-term psychosocial effects of childhood exposure to parental problem drinking. American Journal of Psychiatry, 150(4), 608–613.Google Scholar
  33. Halik, V., Rosenthal, D. A., & Pattison, P. E. (1990). Intergenerational effects of the Holocaust: Patterns of engagement in the mother-daughter relationship. Family Process, 29, 325–339.PubMedCrossRefGoogle Scholar
  34. Harkness, L. (1991). The effect of combat-related PTSD on children. National Center, for Post-Traumatic Stress Disorder Clinical Newsletter, 2 (1), 12–13.Google Scholar
  35. Harkness, L. (1993). Transgenerational transmission of war-related trauma. In J. P. Wilson & B. Raphael (Eds.), International handbook of traumatic stress syndromes (pp. 635–643 ). New York: Plenum Press.CrossRefGoogle Scholar
  36. Holaday, M., Armsworth, M. W, Swank, P. R., & Vincent, K. R. (1992). Rorschach responding in traumatized children and adolescents. Journal of Traumatic Stress, 5(1), 119–129.Google Scholar
  37. Jacobsen, L. K., Sweeney, C. G., & Racusin, G. R. (1993). Group psychotherapy for children of fathers with PTSD: Evidence of psychopathology emerging in the group process. Journal of Child and Adolescent Group Therapy, 3 (2), 103–120.CrossRefGoogle Scholar
  38. Janoff-Bulman, R. (1992). Shattered assumptions: Towards a new psychology. New York: Macmillan.Google Scholar
  39. Jordan, B. K., Maarmar, C. R., Fairbank, J. A., & Schlenger, W. E. (1992). Problems in families of male Vietnam vet-erans with postraumatic stress disorder. Journal of Consulting and Clinical Psychology, 60(6), 916–926.Google Scholar
  40. Jurich, A. P. (1983). The Saigon of the family’s mind: Family therapy with families of Vietnam veterans. Journal of Marital and Family Therapy, 9 (4), 355–363.CrossRefGoogle Scholar
  41. Keinan, G., Mikulincer, M., & Rybricki, A. (1988). Perception of self and parents by second generation Holocaust survivors. Behavioral Medicine, 14, 6–12.PubMedCrossRefGoogle Scholar
  42. Kestenberg, J. S. (1983). Psychoanalyses of children of survivors from the Holocaust: Case presentation and assessment. Journal of the American Psychoanalytic Association, 28, 775–804.CrossRefGoogle Scholar
  43. Kilpatrick, D. G., Veronen, L. J., & Best, C. L. (1985). Factors predicting psychological distress among rape victims. In C. R. Figley (Ed.), Trauma and its wake: The study and treatment of post-traumatic stress disorder (pp. 113–141 ). New York: Brunner/Mazel.Google Scholar
  44. Klein, H. (1971). Families of Holocaust survivors in the kibbutz: Psychological studies. International Psychiatry Clinics, 8, 67–92.PubMedGoogle Scholar
  45. Koopman, C., Classen, C., & Spiegel, D. (1994). Predictors of post-traumatic stress symptoms among survivors of the Oakland/Berkeley, California, firestorm. American Journal of Psychiatry, 151 (6), 888–894.PubMedGoogle Scholar
  46. Krell, R. (1982). Family therapy with children of concentration camp survivors. American Journal of Psychotherapy, 36(4), 513–522.Google Scholar
  47. Krinsley, K. E., & Weathers, F. W. (1995). The assessment of trauma in adults. PTSD Research Quarterly, 6, 1–6. Krystal, H., & Niederland, W. G. (1968). Clinical observations on the survivor syndrome. In H. Krystal (Ed.), Massive psychic trauma (pp. 327–348 ). New York: International Universities Press.Google Scholar
  48. Krystal, H., & Niederland, W. G. (Eds.). (1971). Psychic traumatization: Aftereffects in individuals and communities. New York: Little, Brown.Google Scholar
  49. Kulka, R. A., Schlenger, W. E., Fairbank, J. A., Hough, R. L., Jordan, B. K., Marmar, C. R., & Weiss, D. S. (1990). The National Vietnam Veterans Readjustment Study: Tables of findings and technical appendices. New York: Brunner/Mazel.Google Scholar
  50. Laufer, R., Frey-Wouters, E., & Gallops, M. S. (1985). Traumatic stressors in the Vietnam war and post-traumatic stress disorder. In C. R. Figley (Ed.), Trauma and it’s wake: The study and treatment of post-traumatic stress disorder (pp. 73–89 ). New York: Brunner/Mazel.Google Scholar
  51. Leon, G., Butcher, J., Kleinman, M., Goldburg, A., & Almagor, M. (1981). Survivors of the Holocaust and their children: Current status and adjustment. Journal of Personality and Social Psychology, 4, 503–516.CrossRefGoogle Scholar
  52. Lichtman, J. (1984). Parental communication of Holocaust experiences and personality characteristics among second-generation survivors. Journal of Clinical Psychology, 40, 914–924.PubMedCrossRefGoogle Scholar
  53. Link, N., Victor, B., & Binder, R. L. (1985). Psychosis in children of Holocaust survivors: Influence of the Holocaust in the choice of themes in their psychoses. Journal of Nervous and Mental Disease, 173 (2), 115–117.PubMedCrossRefGoogle Scholar
  54. Maloney, L. J. (1988). Posttraumatic stresses on women partners of Vietnam veterans. Smith College Studies School of Social Work, 58 (2), 122–143.CrossRefGoogle Scholar
  55. Mason, P. (1990). Recovering from the war. New York: Viking Penguin.Google Scholar
  56. Matsakis, A. (1988). Vietnam wives. Kensington, MD: Woodbine House.Google Scholar
  57. McCann, I. L., & Pearlman, L. A. (1990a). Psychological trauma and the adult survivor: Theory, therapy, and transformation. New York: Brunner/Mazel.Google Scholar
  58. McCann, I. L., & Pearlman, L. A. (1990b). Vicarious traumatization: A framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress, 3 (1), 131–149.CrossRefGoogle Scholar
  59. McLeer, S. V, Deblinger, E., Atkins, M. S., Foa, E. B., & Ralphe, D. L. (1988). Post-traumatic stress disorder in sexually abused children. Journal of the American Academy of Child and Adolescent Psychiatry, 27(5), 650–654.Google Scholar
  60. McNally, R. S. (1996). Assessment of post-traumatic stress disorder in children and adolescents. Journal of School Psychology, 0, 000–000.Google Scholar
  61. Moos, R. H., & Moos, B. S. (1986). Family environment manual scale. Palo Alto, CA: Consulting Psychologists Press. Munroe, J. E (1991). Therapist traumatization from exposure to clients with combat related post-traumatic stress disorder: Implications for administration and supervision. Dissertation Abstracts International, 52–03B, 1731.Google Scholar
  62. Munroe J., Shay, J., Fisher, L., Makary, C., Rapperport, K., & Zimering, R. (1995). Preventing compassion fatigue: A team treatment model. In C. R. Figley (Ed.), Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized (pp. 209–231 ). New York: Brunner/Mazel.Google Scholar
  63. Munroe, J., Shay, J., Fisher, L., Zimering, R., & Ancharoff, M. (1993). Preventing traumatized therapists: Coping with survivor engagement patterns. Workshop conducted at the 9th Annual Meeting of the International Society for Traumatic Stress Studies, San Antonio, TX.Google Scholar
  64. Nadler, A., Kav-Vanaki, S., & Gleaitman, B. (1985). Transgenerational effects of the Holocaust: Externalization of aggression in second generation of Holocaust survivors. Journal of Consulting and Clinical Psychology, 53 (3), 365–369.PubMedCrossRefGoogle Scholar
  65. Nagata, D. K. (1991). Transgenerational impact of the Japanese-American internment: Clinical issues in working with children of former internees. Psychotherapy, 28(1), 121–128.Google Scholar
  66. Ogata, S. N., Silk, K. R., Goodrich, S., Lohr, N. E., Westen, D., & Hill, E. M. (1990). Childhood sexual and physical abuse in adult patients with borderline personality disorder. American Journal of Psychiatry, 147, 1008–1013.PubMedGoogle Scholar
  67. Parsons, J., Kehle, T. J., & Owen, S. V. (1990). Incidence of behavior problems among children of Vietnam war veterans. School Psychology International, 11(4), 253–259.Google Scholar
  68. Prince, R. M. (1985). Second generation effects of historical trauma. Psychoanalytic Review, 72 (1), 9–29.PubMedGoogle Scholar
  69. Pynoos, R. S., & Eth, S. (1988). Witness to violence: The child interview. In S. Chess, A. Thomas, & M. Hertzig (Eds.). Annual progress in child psychiatry and child development, 1987 (pp. 299–326 ). New York: Brunner/Mazel.Google Scholar
  70. Pynoos, R. S., Nader, K., Black, D., Kaplan, T., Hendriks, J. H., Gordon, R., Wraith, R., Green, A., & Herman, J. L. (1993). The impact of trauma on children and adolescents. In J. P. Wilson & B. Raphael (Eds.), International handbook of traumatic stress syndromes (pp. 535–657 ). New York: Plenum Press.Google Scholar
  71. Pynoos, R. S., Steinberg, A. M., & Wriath, R. (1995). A developmental model of childhood traumatic stress. In D. Cicchetti & D. J. Cohen (Eds.), Developmental psychopathology: Vol 2. Risk, disorder, and adaptation (pp. 72–95 ). New York: Wiley.Google Scholar
  72. Rakoff, V. (1966). A long-term effect of the concentration camp experience. Viewpoints, 1, 17–22.Google Scholar
  73. Rakoff, V, Sigal, J., & Epstein, N. (1966). Children and families of concentration camp survivors. Canada’s Mental Health, 14, 24–26.Google Scholar
  74. Rodin, R. G., & Rodin, M. M. (1982). Children of Holocaust survivors. Adolescent Psychiatry, 10, 66–72.Google Scholar
  75. Rose, S., & Garske, J. (1987). Family environment, adjustment, and coping among children of Holocaust survivors: A comparative investigation. American Journal of Orthopsychiatry, 57, 332–344.PubMedCrossRefGoogle Scholar
  76. Rosenheck, R., & Nathan, P. (1985). Secondary traumatization in children of Vietnam veterans. Hospital and Community Psychiatry, 36 (5), 538–539.PubMedGoogle Scholar
  77. Schauben, L. J., & Frazier, P. A. (1995). Vicarious trauma: The effects on female counselors of working with sexual violence survivors. Psychology of Women Quarterly, 19, 49–54.CrossRefGoogle Scholar
  78. Sigal, J., & Rakoff, V. (1971). Concentration camp survival: A pilot study of effects on the second generation. Canadian Psychiatric Association Journal, 16, 393–397.PubMedGoogle Scholar
  79. Solomon, Z. (1988). The effect of combat-related posttraumatic stress disorder on the family. Psychiatry, 51 (3), 323–329.PubMedGoogle Scholar
  80. Solomon, Z. (1990). From front line to home front: Wives of PTSD veterans. Paper presented at the 6th Annual Meeting of the Society for Traumatic Stress Studies, New Orleans, LA.Google Scholar
  81. Solomon, Z., Kotler, M., & Mikulincer, M. (1988). Combat-related post-traumatic stress disorder among second-generation Holocaust survivors: Preliminary findings. American Journal of Psychiatry, 145(7), 865–868.Google Scholar
  82. Solomon, Z., Waysman, M., Avitzur, E., & Enoch, D. (1991). Psychiatric symptomatology among wives of soldiers following combat stress reaction: The role of the social network and marital relations. Anxiety Research, 4 (3), 213–223.CrossRefGoogle Scholar
  83. Terr, L. C. (1979). Children of Chowchilla: A study of psychs trauma. Psychoanalytic Study of the Child, 34, 552–623.Google Scholar
  84. Terr, L. C. (1983). Chowchilla revisited: The effects of psychic trauma four years after a school-bus kidnapping. American Journal of Psychiatry, 140, 1543–1550.PubMedGoogle Scholar
  85. Terr, L. C. (1985). Children traumatized in small groups. In S. Eth & R. S. Pynoos (Eds.), Post-traumatic stress disorder in children (pp. 45–70 ). Washington, DC: American Psychiatric Association Press.Google Scholar
  86. Terr, L. C. (1990). Too scared to cry: Psychic trauma in childhood. Grand Rapids, MI: Harper & Row.Google Scholar
  87. Terr, L. C. (1991). Childhood traumas: An outline and overview. American Journal of Psychiatry, 148(1), 10–20.Google Scholar
  88. Titchener, J. L., Kapp, F. T., & Winget, C. (1976). The Buffalo Creek syndrome: Symptoms and character change after a major disaster. In H. J. Parad, H. L. P. Resnick, & L. G. Parad (Eds.), Emergency and disaster management (pp. 283–294 ). Bowie, MD: Charles Press.Google Scholar
  89. Trossman, B. (1968). Adolescent children of concentration camp survivors. Journal of the Canadian Psychiatric Association, 13, 121–123.Google Scholar
  90. Verbosky, S. J., & Ryan, D. A. (1988). Female partner of Vietnam veterans: Stress by proximity. Issues in Mental Health Nursing, 9 (1), 95–104.PubMedCrossRefGoogle Scholar
  91. Wardi, D. (1992). Memorial candles: Children of the Holocaust. London: Tavistock/Routledge.Google Scholar
  92. van der Kolk, B. A. (1988). The trauma spectrum: The interaction of biological and social events in the genesis of the trauma response. Journal of Traumatic Stress, 1(3), 273–290.Google Scholar
  93. Weiss, E., O’Connell, A. N., & Siites, R. (1986). Comparisons of second generation Holocaust survivors, immigrants, and non-immigrants on measures of mental health. Journal of Personality and Social Psychology, 50, 828–831.PubMedCrossRefGoogle Scholar
  94. Williams, C. (1980). The veteran system with a focus on women partners: Theoretical considerations, problems and treatment strategies. In T. Williams (Ed.), Post-traumatic stress disorders of the Vietnam veteran (pp. 169–192 ). Cincinnati, OH: Disabled American Veterans.Google Scholar
  95. Wilson, J. R, & Lindy, J. D. (Eds.). (1994). Countertransference in the treatment of PTSD. New York: Guilford.Google Scholar
  96. Zerling, I., Podietz, K., Belmont, H., Shapiro, M., Ficher, I., Eisenstein, T., & Levick, M. (1984). Engagement in families of Holocaust survivors. Journal of Marital and Family Therapy, 10(1), 43–51.Google Scholar

Copyright information

© Springer Science+Business Media New York 1998

Authors and Affiliations

  • Michelle R. Ancharoff
    • 1
  • James F. Munroe
    • 1
  • Lisa M. Fisher
    • 1
  1. 1.Department of Veterans Affairs Outpatient ClinicNational Center for Posttraumatic Stress DisorderBostonUSA

Personalised recommendations