A question of who, not if: Psychological disorders in holocaust survivors' children

Objective: Because findings on the mental health status of Holocaust survivors' offspring have been inconsistent, we aimed to identify factors that place some offspring at greater risk for developing mood or anxiety disorders. Method: Using a web-based survey and structured clinical interviews with adult children of survivors, we attempted to predict disorders from offspring's circumstances, perceptions of parents' posttrauma adaptational styles, and self-reported reparative adaptational impacts. Posttrauma adaptational styles encompass intrafamilial and interpersonal psychological, social and behavioral coping, mastery, and defense mechanisms used by each parent. Reparative adaptational impacts reflect the offspring's self-reported insecurity about their own competence, reparative protectiveness, need for control, obsession with the Holocaust, defensive psychosocial constriction, and immature dependency. Results: Of the disorders studied, generalized anxiety disorder was most frequent, followed by major depressive episode and posttraumatic stress disorder (PTSD). Only 2 variables independently predicted these disorders: participants' age and reparative adaptational impacts. Parents' styles were correlated with the presence of disorder, but had no effect when the child's reparative impacts were controlled. The age effect was consistent with epidemiologic research showing lower prevalence of psychological disorder in older cohorts. The severity of participants' reparative impacts was unequivocally the most important (OR 5.3) or at least the most proximal precursor to the development of psychological disorders. When reparative impacts were low, frequency of disorder was low (8%); when reparative impacts were high, frequency of disorder was high (46%). Conclusion: Reparative adaptational impacts could guide clinicians in treating children of survivors.