Case 1. A woman in her late 30s was referred for treatment of obsessive-compulsive disorder, depression, past substance abuse and general chaos. Her most striking symptoms were extreme anxiety, apprehension and confusion in the face of interpersonal tasks that seemed within the scope of someone so intelligent and articulate. She had not responded to therapy with several different psychiatrists in the past. In the initial history-taking, it emerged that she had been raped in her late teens but denied that it produced any lasting effects. After several months of therapy, she revealed that--before she was born--her mother and maternal grandfather had witnessed the murder of her grandmother. The mother and grandfather had both been chronically depressed, anxious, fearful and preoccupied with reliving experiences since the murder. It became clear that the patient's OCD was partially an attempt to create some sense of predictability and safety. Significant improvement in functioning was achieved through a combination of antidepressants, lamotrigine(Drug information on lamotrigine) (Lamictal), some family therapy, and individual therapy and psychoeducation regarding traumatic effects in each generation.
Case 2. A male professional in his late 20s presented for treatment of bulimia, depression and several anxiety disorders. In initial history-taking, he denied a history of trauma. As therapy progressed, he mentioned that his paternal grandparents were Holocaust survivors who were very involved in his upbringing. They were loving and overprotective but also very anxious and highly critical. Therapy clarified that the criticism was in the service of trying to make everything perfect to avoid some new, unspecified catastrophe. The patient's bulimia was an attempt to have a perfect body and, therefore, avoid bad things. When seen in family therapy, the patient's father clearly had second-generation problems and accepted a referral for therapy. The father's treatment greatly aided the patient, as his father could now model for him how to navigate through life's shoals in a calm, reasonable manner. Individual therapy, antidepressant treatment and the father's improvement resulted in almost complete recovery.Further Directions
Intergenerational transmission of trauma seems to have a particular significance in offspring of parents with a history of major trauma and subsequent PTSD. The phenomenon is not just limited to Holocaust survivors. Children of parents who suffer from PTSD are most likely to develop a specific lifetime vulnerability to traumatic stress and are possibly more likely to develop comorbidity.
Future studies will have to shed more light on the different types of transmission. For instance, it is not known whether the transmission of trauma in Holocaust families is similar to the cycle of violence seen in families with other types of trauma. Similarly, the relationship between such factors of vulnerability and the social resiliency seen in some offspring of trauma survivors has to be further explored. In addition, there needs to be more research and better understanding of the genetic traits that make certain traumatized individuals most likely to develop PTSD. This would lead to better theories about what has been potentially genetically transmitted to the second (and third) generation that might influence their response, among other things, to their parent's psychopathology.