449659
TMTXXX10.1177/1534765612
449659Perlstein and MottaTraumatology
Article
An Investigation of Potential HolocaustRelated Secondary Trauma in the Third
Generation
Traumatology
19(2) 95­–106
© The Author(s) 2012
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DOI: 10.1177/1534765612449659
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Perella Perlstein1 and Robert W. Motta2
Abstract
The study assessed for the presence of Holocaust-related trauma characteristics in ultra-Orthodox grandchildren of
Holocaust survivors. Measures included the Secondary Trauma Scale (STS; Motta, Hafeez, Sciancalepore, & Diaz, 2001),
the Impact of Events Scale-Revised (EIS-R; Weiss & Marmar, 1997), the A-Trait Scale of the State-Trait Anxiety Inventory
(STAI; Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983), and the Modified Stroop procedure. Participants included ultraOrthodox grandchildren of two or more Holocaust survivors (n = 58), ultra-Orthodox grandchildren of non-Holocaust
survivors (n = 51), and non-Jewish grandchildren of non-Holocaust survivors (n = 41). Results indicated that ultra-Orthodox
participants, regardless of their grandparents’ Holocaust survivorship status, showed response latencies for color-naming
Holocaust-related stimuli on the Modified Stroop procedure. The findings suggest that the transfer of Holocaust trauma is
not generated by the experience of being a grandchild of Holocaust survivors, but rather from the experience of being a
member of the ultra-Orthodox community.
Keywords
assessment and diagnosis, consequences of trauma, culture, race, ethnicity, human-caused
Estimates of exposure to traumatic events range from 37 to
92% of respondents reporting exposure to one or more events
that meet the Diagnostic and Statistical Manuel of Mental
Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association [APA], 2000) “objective” criteria (AI) for
trauma (Cahill & Foa, 2007). Though significant, these statistics say nothing about the scores of individuals who are
exposed to traumatized individuals and meet diagnostic criteria for secondary trauma. The Holocaust may be considered the most dramatic and systematic victimization against
a specific group (Sigal & Weinfeld, 1989). Thus, one may
assume that if the transmission of transgenerational trauma
was to be observed in the second and third generation, it
would be observed in children and grandchildren of Holocaust
survivors.
References to posttraumatic stress disorder (PTSD) have
characterized the literature on war and catastrophe for centuries (van der Kolk, 2007). however, the actual diagnosis of
PTSD did not enter the compendium of psychological diagnoses until 1980, when it was added to the third edition of the
DSM (DSM-III; APA, 1980) as an anxiety disorder. PTSD
may develop as a result of directly experiencing, or exposure
to, a traumatic event that involves actual or threatened death
or serious injury. PTSD criteria include intrusive thoughts,
attempts to physically or psychologically avoid all reminders
of the trauma, cognitive or memory disturbances, and heightened physiological arousal (APA, 2000).
Following World War II, trauma research expanded to
accommodate the long-term effects of trauma in concentration camp survivors. In the absence of a formal diagnosis,
clinicians developed terms such as Buchenwald syndrome
(Friedman, 1948), survivor syndrome (Chodoff, 1975;
Niederland, 1968), and concentration camp syndrome
(Hocking, 1970) to explain the consistent trauma reactions
and maladaptive behavior patterns exhibited by Holocaust
survivors.
PTSD and Survivors of the Holocaust
Between the years of 1939 and 1945, six million Jews, one
third of world Jewry, were killed as part of the Nazis’
methodical plan to obliterate all traces of Jewish life and
culture (Weber, 2000). Virtually no Jewish family remained
1
Touro College, Graduate School of Psychology, New York, NY, USA
Hofstra University, Hempstead, NY, USA
2
Corresponding Author:
Perella Perlstein, Touro College-Graduate School of Psychology, 50 West
23rd St., New York, NY 10010, USA.
Email: [email protected]
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96
intact. Numerous survivors, many of whom remained the
sole survivor of their pre-Holocaust families, attempted to
rebuild their lives and reestablish families. The determination of Holocaust survivors to recreate families and communities in the aftermath of the largest genocide against
modern-day Jewry may explain why the world, including
the mental health community, initially took little notice of
this generation. With the exception of Friedman (1948,
1949) who, under the instruction of the American Joint
Distribution Committee, assessed the psychological health
of Jewish displaced persons, there was little recognition of,
or attention given to, the psychological needs of Holocaust
survivors.
At first, the literature on the Holocaust and its psychological effects was largely limited to testimonials of survivors
and historical accounts of life and death in ghettos or concentration camps (e.g., Bettelheim, 1943; Frankl, 1963; Wiesel,
1972) and clinical observations of Holocaust survivors
(Chodoff, 1970, 1975; de Graaf, 1975; Etinger, 1961, 1962;
Krystal, 1968; Krystal & Niederland, 1968; Niederland,
1964, 1968). Many Holocaust survivors were diagnosed
with and treated for depression. However, the severe display
of increased levels of social withdrawal and suspiciousness
(Krystal, 1968), chronic anxiety (Chodoff, 1970; de Graaf,
1975; Levav & Abramson, 1984), and intense feelings of
guilt (Chodoff, 1975) prompted clinicians to question the
accuracy of the diagnosis of depression (Niederland, 1988).
The display of symptoms is now generally recognized as
meeting DSM-IV-TR (APA, 2000) diagnostic criteria for
PTSD.
Clinical observations of post-Holocaust effects were
followed by a growing body of progressively empirical
Holocaust-related research (e.g., Kuch & Cox, 1992; Landau
& Litwin, 2000; Levav & Abramson, 1984; Nadler & BenShushan, 1989; Sigal & Weinfeld, 1989; Yehuda et al. 1995).
Holocaust survivors, particularly male survivors (Landau &
Litwin, 2000) were found to exhibit elevated symptoms of
DSM diagnostic criteria for PTSD, with the most common
symptoms being those of sleep disturbances, recurrent nightmares, and extreme distress over reminders of the Holocaust
(Kuch & Cox, 1992).
Secondary Trauma and
Children of Holocaust Survivors
Secondary trauma refers to the experience of negative emotions and consequent behaviors that result from close or
extended contact with a traumatized individual (Figley,
1995; Motta, 2008). The symptoms of secondary trauma
nearly parallel those of PTSD; however, secondary trauma
symptoms differ in that they are generated from the knowledge of a traumatic event that occurred to a significant other,
rather than from the direct experience of the traumatic event
(Figley, 1995). Secondary trauma symptoms are also similar
to, but not as severe as, those experienced in PTSD (Motta,
Traumatology 19(2)
Kefer, Hertz, & Hafeez, 1999; Suozzi & Motta, 2004).
Secondary trauma symptoms include anger, anxiety, depression, emotional exhaustion, difficulty concentrating, intrusive and unwanted thoughts, low self-esteem, body aches, sleep
disturbances, changes in eating patterns, increased addictive
behavior, and social withdrawal (Motta, 2008; Motta,
Chirachella, Maus, & Lombardo, 2004).
A history of exposure to psychological stress has been
shown to affect the development and severity of PTSD
(Bremner, Southwick, & Charney, 1995; Yehuda et al.,
1995) and secondary trauma (Figley, 1995; Kassam-Adams,
1995). Solomon, Kotler, and Mikulincer (1988) assessed the
impact of the Holocaust on the development of PTSD among
second-generation Holocaust survivor Israeli combat soldiers who sustained combat stress reactions following the
1982 Lebanon War. Solomon et al. (1988) compared 96 soldiers whose parents were Holocaust survivors to soldiers
with no Holocaust family history. Results revealed that,
compared with their counterparts who had no Holocaust
background, second-generation Holocaust survivor soldiers
and reported a larger average number of PTSD symptoms.
The study is particularly significant as all participants were
reported to be physically and psychologically healthy prior
to their combat participation. Thus, the severity of secondgeneration Holocaust survivors’ PTSD may be a reactivation
of a latent trauma that was suffered as a result of parental
Holocaust experiences.
Since the publication of the first article (Rakoff, Sigal, &
Epstein, 1966) which suggested a transmission of Holocaust
trauma to children of Holocaust survivors (COS), the field
has produced a rich body of psychological research with
almost 400 publications (Felson, 1998; Kellerman, 2001). In
his review of transgenerational transmission of Holocaust
trauma research, Kellerman (2001) delineated four overlapping and somewhat arbitrary stages that characterized four
decades of COS research. The 1960s’ COS literature was
primarily limited to observational and descriptive clinical
data (e.g., Rakoff et al., 1966). The 1970s’ COS research
saw a gradual shift toward initial empirical research, which
was later criticized for its various methodological flaws
(Solkoff, 1981). The 1980s produced the largest body of
empirically based COS studies which, through the use of
improved sampling methods, yielded a more valid representation of the overall COS population and consequentially
produced some generalizable results (Solkoff, 1992). Finally,
the 1990s’ COS literature gave way to a series of comprehensive reviews that attempted to identify and synthesize
well-constructed COS literature in order to draw scientific
conclusions from the cumulative research (Felson, 1998).
Recently, researchers examined the effects of intrafamilial patterns of Holocaust communication on COS psychological well-being (Solkoff, 1992; Sorscher & Cohen, 1997;
Wiseman et al., 2002). Sorscher and Coehn (1997) compared
40 COS to 38 children of American Jews to ascertain
maladaptive Holocaust effects (e.g., elevated Holocaust
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Perlstein and Motta
ideation), along with potentially adaptive responses (e.g.,
ethnic identification). Measures included the Brenner Scale
of Jewish Identification (Brenner, 1961); the Communication
Questionnaire (Lichtman, 1983), a measure of parental communication of war time experiences; and, the Scale of
Holocaust-Related Imagery (Sorscher, 1991), a measure of
the rate of Holocaust-related thoughts, associations, fantasies, dreams, and symptoms. When compared to children of
American Jews, COS demonstrated significantly greater
Holocaust-related imagery, with increased prevalence of
Holocaust related dreams, Holocaust-related thoughts, and
Holocaust-associated places. Furthermore, adaptive communication styles were significantly correlated with overall ethnic identification, but not with Holocaust ideation, suggesting
affective parental communications about the Holocaust may
facilitate the development of adaptive coping mechanisms.
Finally, no difference in overall Jewish identity between the
two groups was found; thus, past persecution had not weakened present religious identification.
Rose and Garske (1987) investigated COS levels of
adjustment in relation to family environmental factors. COS
(n = 20) were compared to three control groups who were
matched for age and education. In addition to two control
groups of children of Jewish native-born Americans (n = 20)
and children of non-Jewish, native-born Americans (n = 16),
Rose and Ganske included a third control group of children
of non-Jewish immigrants (n = 17) in order to control for an
immigration effect. Maladjustment measures included the
State-Trait Anxiety Inventory (STAI; Spielberger et al.,
1983) and the Beck Depression Inventory (BDI; Beck, Ward,
Mendelson, Mock, & Erbaugh, 1961). Family environment
was evaluated via the Moos Family Environment Scale
(FES; Moos & Moos, 1981). Though no differences among
the groups were found across the maladjustment measures,
COS FES scores indicated that they exhibited significantly
lower feelings of independence and self-sufficiency when
compared to the other groups. Rose and Garske suggest that
the survivors’ disrupted opportunities to differentiate fully,
and separate naturally, from their own parents renders them
unable to separate easily from their children.
Aligned with Rose and Ganske (1987), Weiss, O’Connell,
and Siiter (1986) conducted a comparative study to determine whether COS symptomology was, at least in part, due
to the immigration effect. COS (n = 25) were compared to
second generation European immigrants (4% Jewish, 96%
Non-Jewish) who immigrated to the United States during or
after World War II, and descendants of American-born parents (4% Jewish, 96% Non-Jewish). Participants completed
a modified Nettler Alienation Scale (NAS; Nettler, 1957),
the Guilt Inventory (GI) of the Buss and Durkee (1957)
Hostility-Guilt Inventory, and the Brief Mental Health Index
(BMHI; Gunderson & Arthur, 1969). Demographic information on parental Holocaust experiences, immigration status,
and background information was also obtained. No significant
differences were found between COS and second generation
97
immigrants across the measures of alienation, feelings of
guilt, and mental health. Weiss et al. (1986) conclude that
COS, having had experiences similar to those of other immigrant groups, may present reactionary symptoms to their
parents’ immigration status rather than to their parents’
Holocaust experience.
Sigel and Weinfeld (1989) overcame major methodological flaws that characterized much of the previous COS literature through the use of random sampling methods, control
groups, and an unusually large sample size. Siegel and
Weinfled compared 242 COS to 209 children of Canadianborn Jewish parents and 76 children of non-Holocaust survivor Jewish immigrants. Unlike previous findings (e.g., Sigal,
Silver, Rakoff, & Ellin, 1973), no difference between COS
and control groups were found across the scales on the
Psychological Epidemiological Research Instrument (PERI;
Dohrenwend, Shrout, Egri, & Mendelsohn, 1980), a measure
of personality and affective dysfunction, and demographic
questions that probed for the experience of anxiety or depression within the previous 12 months. Sigal and Weinfeld’s
study suggests that if a latent form of transgenerational transmission of Holocaust trauma exists among the second generation, it does not appear to significantly encroach on COS’s
daily functioning.
In an effort to further expand the boundaries of intergenerational transmission of trauma, Rubenstein, Cutter, and
Templer (1990) examined Holocaust-related trauma effects
in children and grandchildren of Holocaust survivors (GOS).
The study consisted of three groups that included one group
in which both spouses were COS (15 families), one group in
which only one spouse was a child of a survivor (25 families), and a control group of non-COS participants (12 families). Participants completed Templer’s Death Anxiety Scale
(Templer, 1970) and the Kincannon’s Mini-Mult (Kincannon,
1968), a shortened version of the MMPI which consists of
three scales: Depression, Psychasthenia, and Hypochondriasis.
The Kincannon’s Mini-Mult (Kincannon, 1968) was selected
for its assessment of the three most frequently reported
Holocaust survivor symptoms, that is, depression, anxiety,
and excessive somatic concern. Third generation emotional,
behavioral, and interpersonal psychopathology was assessed
via the parent rating form of the Louisville Behavior
Checklist (Miller, 1967). When compared with controls,
COS demonstrated greater psychopathology on the
Kincannon’s Mini-Mult (Kincannon, 1968), signaling some
level of intergenerational transmission of Holocaust trauma.
COS displayed above-average levels of death anxiety,
though their scores did not differ significantly from the nonCOS group. Parental ratings for grandchildren of Holocaust
survivors indicated that the children were more fearful, displayed neurotic behaviors, aggressive tendencies, social
withdrawal, inhibition, and depressed affect. These ratings,
consistent with clinical impression-based observations that
COS (Zilberfein, 1996) and their children (Scharf, 2007)
tend to exhibit social withdrawal, depression, anxiety, and
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98
reduced self-esteem, suggest a level of transmission of
Holocaust trauma to the third generation.
To date, few attempts have been made to clarify the presence of Holocaust-related trauma characteristics in the third
generation. The objectives of the study were to bolster the
current knowledge concerning the long-term effects of intergenerational trauma and to overcome the methodological
limitations of COS and GOS literature through the use of
improved sampling procedures, increased sample size, a
well-matched control group, and psychometrically reliable
and valid measures of secondary trauma.
First, the study utilized the Modified Stroop procedure, a
strong measure of intrusive symptoms (McNally, 1995),
which has demonstrated acute sensitivity in detecting trauma
symptoms that other, more subjective measures were unable
to detect (Motta, Joseph, Rose, Suozzi, & Leiderman, 1997).
Only one study (Kassai & Motta, 2006) has utilized the
Modified Stroop procedure in the study of transgenerational
transmission of Holocaust trauma. The Modified Stroop procedure has been shown to discriminate between adults with
PTSD and those without PTSD (McNally, English, & Lipke,
1993; McNally, Kaspi, Riemann, & Zeitlin, 1990) and to characterize child survivors of sexual abuse (Dubner & Motta,
1999) and adult survivors of rape (Cassidy, McNally, &
Zeitlin, 1992; Foa, Feske, Murdock, Kozac, & McCarty 1991).
Second, the study utilized the Secondary Trauma Scale
(STS; Motta et al., 2001) which, unlike other paper-and-pencil
measures of secondary trauma, presents cutoff scores (Motta
et al., 2004). The study further utilized the Impact of Events
Scale-Revised (IES-R; Weiss & Marmar, 1997), a measure of
PTSD symptoms, and the Trait Scale of the State-Trait
Anxiety Inventory (STAI; Spielberger et al., 1983), a measure
of overall anxiety, which has been shown to characterize
Holocaust survivors (Niederland, 1981) and their children
(Lichtman, 1984; Rubenstein et al., 1990; Zilberfein,1996).
Finally, the study examined the relationship between ultraOrthodox affiliation and transmission of Holocaust trauma
characteristics. The variety of reactions to the Holocaust,
such as viewing the Holocaust as God’s punishment (Marcus
& Rosenberg, 1988), may itself be a source of trauma among
ultra-Orthodox GOS. The study explored whether the ultraOrthodox community’s strong emphasis on the past (Heilman,
1992, 2006) perpetuates Holocaust exposure and transmission of Holocaust trauma characteristics to the third generation. Moreover, ultra-Orthodox sects restrict exposure to
secular influences and media outlets, a factor that may clarify
whether elevations in secondary trauma characteristics result
from the intergenerational transmission of trauma, rather than
from exposure to media reports of the Holocaust.
Method
Participants
Participants included 150 grandchildren who were selected
based on their grandparents’ status during the Second World
Traumatology 19(2)
War. The first group consisted of ultra-Orthodox grandchildren of two or more Holocaust survivors (n = 58). UltraOrthodox membership was assessed through a self-affiliation
question on a demographic questionnaire. Holocaust survivorship status was determined via the latest eligibility criteria set by the Conference of Jewish Material Claims Against
Germany, Inc. (Claims Conference, 2009) for allocation of
Holocaust compensation and restitution payments. The second group, and the first comparison group, consisted of
ultra-Orthodox grandchildren of non-Holocaust survivors
(n = 51). The third group, and the second comparison group,
consisted of non-Jewish grandchildren of non-Holocaust
survivors (n = 41). The number of participants was recruited
based on Cohen’s (1992) recommendations for a medium
effect size (0.5). The age range of the sample was between
18 and 41 years of age. The gender distribution of the sample was unevenly divided between males (40%, n = 63) and
females (60%, n = 87). The participants were overwhelmingly White (86%) with the remaining sample of African
American (5%), Asian American (2%), and Hispanic (3%)
extraction. Predictably, the sample was overwhelmingly
Jewish (70%).
Procedure and Measures
The participants were recruited from synagogues and college campuses throughout the New York and New Jersey
area. Participants were told that the study would involve an
investigation of Holocaust-effects and that their responses
would be confidential. Individuals who were color-blind
were asked not to participate in the study, as it involved a
color naming task. Upon volunteering, participants were
asked to read and sign an informed consent form that
assured their right to withdraw from the study at any time.
After signing the informed consent form, participants completed the following measures:
Demographic Questionnaire. Participants were asked to
complete a questionnaire which provided information on
age, gender, religion, relationship of the grandparent involved
in the Holocaust (i.e., maternal vs. paternal), grandparent
residential statues during the Holocaust, year of grandparent
immigration to the United States, grandparent countries of
origin, and amount of past/current contact with the participants’ grandparents. For Jewish participants, the questionnaire included a religious-affiliation questionnaire that
assessed for membership of ultra-Orthodox communities.
Modified Stroop procedure. The Modified Stroop procedure is an objective measure of attentional bias and intrusive
cognitions, which are characteristics of PTSD (Dubner &
Motta, 1999; McNally et al., 1990). In line with the traditional Stroop paradigm (Stroop, 1935), participants are
shown words of varying affective significance and asked to
name the colors in which the words are printed while ignoring the meaning of the words (Mathews & MacLeod, 1985).
Delays in color-naming (i.e., Stroop interference) occur
when the meaning of the word automatically activates the
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Perlstein and Motta
participant’s attention despite the effort to attend to the color
of the word.
The Modified Stroop procedure is a reliable and valid
index of intrusive cognitions (McNally et al., 1993). Testretest reliability for color naming latencies for PTSD words
was reported to be r (22) = .80, p < .001 (McNally et al.,
1993). Furthermore, Cassiday, McNally, and Zeitlin (1992)
found a significant correlation (r = .41) between the
Modified Stroop procedure and the intrusive subscale of
the IES-R (Weiss & Marmar, 1997). The Modified Stroop
procedure is superior to structured interviews (McNally
et al., 1993) and self-report measures (Lubliner, 2008;
Motta et al., 1997), which are vulnerable to demand characteristics and social desirability influences (Motta, 2008).
The Modified Stroop procedure has been shown to successfully distinguish between genuine and fictitious depression
(Lubliner, 2008).
Participants were shown control stimuli, which consisted
of colored zeroes, and two target-word categories, that is,
neutral stimuli and PTSD-related stimuli. Neutral stimuli
(i.e., mix, pen, input, paper, and, planet) were obtained from
a previous study (Kassai & Motta, 2006) of transgenerational transmission of Holocaust trauma. PTSD-related stimuli were selected via a pilot study that included 20
ultra-Orthodox grandchildren of non-Holocaust survivors.
Participants were given ten words, thought to be relevant to
the trauma of the Holocaust, and asked to rate each word on:
(a) the estimate of word frequency in conjunction with the
Holocaust, and (b) the degree of thereat the word represented. The participants responded on a scale of 0 (not very
frequent or threatening) to 5 (very frequent or threatening).
The following words were rated highest for frequency and
threat, and comprised the PTSD word category of the study’s
Modified Stroop paradigm: Auschwitz, Hitler, Nazi, concentration camp, and six million.
Participants in the study were presented with three Stroop
cards, which were constructed from white sheets of paper,
with words in varying colors (i.e., red, yellow, blue, black,
and green). The three stimulus cards were presented in the
same order (i.e., control, neutral, and PTSD-related stimuli)
to each participant. Participants were instructed to name the
colors of the stimuli from left to right, top to bottom of the
given stimulus card. Participants were told to ignore the
words themselves and to name the colors of the stimuli
instead. Participants were cautioned to make as few errors as
possible, and to work quickly and accurately. A stopwatch
was used to record the time taken to complete the color naming on each card to the tenth of a second. Timing began with
the first color named aloud and ended with the last color
named on the card. To control for differences in color-naming
speed, Stroop scores were computed by subtracting the time
to complete the control card from the time to complete each
of the remaining cards. The dependent variables were the
differences between the mean response latency for colornaming the control stimuli and the mean response latency for
color-naming the PTSD-related stimuli.
99
Prior to testing the hypotheses, the variable of single- and
compound word status of the Holocaust-related stimuli and
control stimuli were statistically compared in order to evaluate the necessity of including it as a possible confounding
variable in the final analyses. Participants (n = 20) who had
not previously participated in the study were presented with
two Stroop stimulus cards. Consistent with the amount of
single- and compound words displayed on the Holocaustrelated Stroop stimulus card, the first Stroop stimulus card
consisted of three neutral single words and two neutral compound words (i.e., input, planet, paper, gas ember, and helicopter pad). The second Stroop stimulus card contained the
original neutral stimuli utilized in this study (i.e., mix, pen,
input, paper, and planet). Overall, no differences were found
in response times across the two stimulus cards.
Secondary Trauma Scale. The Secondary Trauma Scale
(STS; Motta, Hafeez, Sciancalepore, & Diaz, 2001) is an
18-item self-report measure that assesses for secondary
trauma related distress. The STS is completed on a one
(rarely/never) to five (very often) scale. The STS is derived
from the six criteria for PTSD cited in the DSM-IV (APA,
1994) and from the Compassion Fatigue Self-Test for Psychotherapists (Figley, 1995). Examples of items include the
following: “I experience troubling dreams similar to his/her
problems;” “I have felt on edge and distressed and this may
be related to thoughts about his/her problem,” and so forth.
The possible range of scores is 18 to 90. The STS has strong
psychometric properties, such as strong internal consistency
with a coefficient alpha of .82 and good concurrent, content,
and discriminant validity (Motta et al., 1999; Motta et al.,
2001), as indicated by its significant correlation with the
Beck Anxiety Inventory (BAI; Beck, Epstein, Brown, &
Steer, 1988), the Modified PTSD Symptoms Scale-Self
Report (Resnick, Falsetti, Resnick, & Kilpatric, 1991), and
the Impact of Events Scale (IES; Horowitz, Wilner, &
Alvarez, 1979; rs ranged from .33 to .56, p < .01). The STS
has been validated with samples involving members of the
community, practicing therapists, and students. Reliability
estimates of the STS have been reported to range from .8 to
.9 for college students and mental health workers (Motta et
al., 1999, 2001). The STS (Motta et al., 2001) remains the
only scale measuring secondary trauma that has cutoff scores
associated with clinically significant levels of distress
(Motta, 2008). STS scores at or above 38 suggest mild to
moderate anxiety and depression, while scores at or above 45
suggest moderate to severe anxiety. Similarly, scores of 49
or higher are associated with moderate to severe depression
(Motta et al., 2004).
Impact of Events Scale-Revised. The Impact of Events
Scale-Revised (IES-R; Weiss & Marnar, 1997) is a 22-item
self-report measure that assesses for the impact of a traumatic event. Since the original IES (Horowitz et al., 1979)
was created prior to the addition of PTSD into the DSM-III
(APA, 1980), it originally assessed for only intrusion and
avoidance, two of the three DSM-IV-TR (APA, 2000) diagnostic criteria for PTSD. The IES-R expanded to include a
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100
hyperarousal subscale, and thus offers a more valid assessment tool for PTSD. Intrusion (Mean of Items 1, 2, 3, 6, 9,
14, 16, and 20), Hyperarousal (Mean of Items 4, 10, 15, 18,
19, and 21), and Avoidance (Mean of Items 5, 7, 8, 11, 12,
13, 17, and 22) are accessed via a Likert-type scale. Respondents rate each item on a scale of 0 (not at all), 1 (a little bit),
2 (moderately), 3 (quite a bit) and 4 (extremely) according to
the past seven days. Participants are asked to report a stressful event they experienced in the past two to three weeks and
respond to the 22 items based on how they felt in the past
seven days. The mean item response is calculated for each
subscale, and the three clinical subscale scores sum to form
the IES-R total score. The IES-R has strong internal consistency with intrusion, avoidance, and hyperarousal subscale
alphas ranging from .79 to .90 (Weiss & Marnar, 1997).
Test-retest reliability for the three subscales was reported to
be .94, .89 and .92 respectively.
State-Trait Anxiety Inventory (Form Y2/A-Trait Scale). The
State-Trait Anxiety Inventory (STAI; Form Y; Spielberger
et al., 1983) is a two 20-item self report scale that assesses
for A-State and A-Trait. State anxiety (A-State) is defined as
a transitory emotional state that varies in intensity and fluctuates over time. Conversely, trait anxiety (A-Trait) denotes
relatively stable individual differences in anxiety proneness
and refers to a general tendency to respond with anxiety to
perceived threats in the environment (Spielberger et al.,
1983). The A-State scale requires participants to indicate the
intensity of their feelings of anxiety at a particular moment
in time; the A-Trait scale requires participants to describe
how they generally feel in terms of the frequency with which
they typically experience specific symptoms of anxiety.
Given the purpose of this study, only aspects of A-Trait anxiety were explored; therefore, only the A-Trait scale was
administered (i.e., STAI; Form Y2; Spielberger et al., 1983).
The STAI Form Y features high rates of content and construct validity (Spielberger & Vagg, 1984). The A-State
scale has coefficients ranging from .86 to .94, while the
A-Trait scale has coefficients ranging from .86 to .92
(Spielberger, Vagg, Barker, Donham, & Westberry, 1980).
Predictably, only the A-Trait scale has high test-retest reliability (.73-.86), as the A-State is expected to vary across
different stress situations. The T-Anxiety (Spielberger et al.,
1983) has strong construct validity, as demonstrated by the
significantly higher scores exhibited by neuropsychiatric
patient groups, when compared to typical participants. The
STAI has been shown to demonstrate an ability to discriminate between typical and psychiatric patients for whom anxiety is a major symptom (Spielberger et al., 1983).
Results
The current study assessed for potential transgenerational
transmission of Holocaust trauma to grandchildren of
Holocaust survivors. Prior to the main data analysis, a
Levene’s test
Traumatology 19(2)
(Levene, 1960) was conducted to assess for homogeneity
of the variance with respect to gender among the three experimental groups. The percentage of genders represented
across the three subgroups was unequal, F(2, 147) = 4.44,
p < .05. As a result, an independent samples t test was conducted in order to assess the effect of gender on the participants’ mean latency response (in seconds) for color-naming
Holocaust-related stimuli on the Modified Stroop procedure.
Overall, there was no significant difference between the
response latencies exhibited by males (M = 4.60, SD =.83)
and females (M = 6.41, SD = .62, t(123) = –1.75, p > .05).
Moreover, a one-way analysis of variance (ANOVA) was
conducted in order to analyze the impact of age on the participants’ response latency in color-naming the Holocaustrelated Stroop stimulus card. The ANOVAs yielded no
statistically significant differences among the three age
groups, F(2, 147) = 3.25, p > .05. Finally, the potential
impact of ethnicity on the participants’ response latency in
color-naming the Holocaust-related stimuli was analyzed.
The ANOVA revealed no significant differences among the
ethnic groups, F(2, 147) = 1.45, p > .05. The lack of significant intergroup differences among the remaining measures
rendered it unnecessary to further analyze any potential
impact age, gender, or ethnicity may have had on the overall
scores.
It was predicted that ultra-Orthodox participants, regardless of grandparent Holocaust survivorship status, would
exhibit significantly longer response latencies (in seconds)
for PTSD words consisting of Holocaust-related stimuli on
the Modified Stroop procedure, as compared to response
latencies for neutral stimuli. The hypothesis predicted no
such difference among non-Jewish participants. The hypothesis was confirmed. A one-way analysis of variance confirmed the significant difference between response latencies
in color-naming Holocaust-related stimuli, compared with
the response latencies for color-naming neutral stimuli in
ultra-Orthodox participants, F(2, 147) = 7.29, p < .05. In
fact, ultra-Orthodox grandchildren of Holocaust survivors
displayed significantly longer response latencies for colornaming Holocaust-related stimuli (M = 7.14, SD = 6.63),
when compared to neutral stimuli (M = 2.57, SD = 3.76,
p < .05). Similarly, ultra-Orthodox grandchildren of nonHolocaust survivors exhibited significantly increased
response latencies when color-naming Holocaust-related
stimuli (M = 6.35, SD = 4.93) as compared to neutral stimuli
(M = 2.45, SD = 2.89, p < .05). Conversely, non-Jewish participants exhibited no significant difference in response latencies for color-naming Holocaust-related stimuli (M = 2.68,
SD = 6.05) and neutral stimuli (M = 1.61, SD = 3.36, p > .05).
Table 1 presents the analyses of participant mean differences
in Stroop reaction times.
It was further predicted that compared to ultra-Orthodox
grandchildren of non-Holocaust survivors, ultra-Orthodox
grandchildren of Holocaust survivors would exhibit significantly longer response latencies (in seconds) for color-naming
101
Perlstein and Motta
Table 1. Mean Differences in Stroop Reaction Times (in Seconds) by Third Generation Group.
Ultra-Orthodox Holocaust Grandchildren
Diff a
SD
DF
2-tailed p value
Holocaust stimulus card vs. Neutral stimulus card
4.57
5.73
57
<.001
Ultra-Orthodox, Nonholocaust Grandchildren
Diff
SD
DF
2-tailed p value
Holocaust stimulus card vs. Neutral stimulus card
3.90
4.43
50
<.001
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Non-Jewish Grandchildren
Diff
SD
DF
2-tailed p value
Holocaust stimulus card vs. Neutral stimulus card
1.07
4.45
40
.13
Note: Mean response times are calculated by subtracting response time to a given card from the control card.
a
Diff refers to the difference in the mean response times on the two stimulus cards being compared.
Holocaust-related stimuli on the Modified Stroop procedure.
The hypothesis was not confirmed. An independent samples
t test revealed no statistical difference in overall response
latencies between ultra-Orthodox grandchildren of Holocaust
survivors and ultra-Orthodox grandchildren of non-Holocaust
survivors, t(107) = .71, p > .05.
Moreover, it was predicted that ultra-Orthodox grandchildren of Holocaust survivors would score significantly higher
on the Secondary Trauma Scale (Motta et al., 2001), the
Impact of Events Scale-Revised (Weiss & Marnar, 1997),
and the Trait Scale of the State-Trait Anxiety Inventory
(Spielberger et al., 1983), as compared to the comparison
groups. The hypothesis was not supported.
The overall F test indicated no significant differences in
mean STS (Motta et al, 2001) scores among the three groups
of participants, F(2, 147) = .45, p > .05. The mean secondary
trauma score for grandchildren of Holocaust survivors
(M = 28.84, SD = 8.99) did not differ significantly from that
of ultra-Orthodox grandchildren of non-Holocaust survivors
(M = 28.65, SD = 7.79, p > .05) or that of non-Jewish participants (M = 27.10, SD = 12.04, p > .05).
Moreover, comparisons between mean avoidance, hyperarousal, and, intrusive sores on the IES-R (Weiss & Marmar,
1997) were analyzed via three, one-way analyses of variance. The overall F tests conducted were statistically nonsignificant for avoidance, F(2, 147) = .22, p > .05, hyperarousal,
F(2, 147) = 1.96, p > .05, and intrusion, F(2, 147) = .93,
p > .05. The mean avoidance score for grandchildren of
Holocaust survivors (M = 0.63, SD = 0.76) did not differ
significantly from that of ultra-Orthodox grandchildren of
non-Holocaust survivors (M = 0.54, SD = 0.63, p > .05) or
non-Jewish participants (M = 0.65, SD = 1.14, p > .05).
Similarly, grandchildren of Holocaust survivors did not differ in their hyperarousal subscale scores (M = .32, SD =.53),
when compared to ultra-Orthodox grandchildren of nonHolocaust survivors (M = 0.26, SD = 0.43, p > .05), or nonJewish participants (M = .53, SD = 1.04, p > .05). With
respect to intrusion, there were no significant mean differences between grandchildren of Holocaust survivors
(M = 0.47, SD = 0.47) and ultra-Orthodox grandchildren of
non-Holocaust survivors (M = 0.57, SD = 0.61, p > .05) or
non-Jewish participants (M = 0.67, SD = 0.70, p > .05).
Finally, analysis of the standardized trait anxiety (A-Trait)
scores on the State Trait Anxiety Inventory (Spielberger
et al., 1983) revealed no overall differences in mean trait
anxiety scores across the three groups, F(2, 147) = 2.80, p > .05).
Specifically, mean A-Trait scores of grandchildren of
Holocaust survivors (M = 38.28, SD = 8.40) did not differ
significantly from those of ultra-Orthodox grandchildren of
non-Holocaust survivors (M = 39.51, SD = 8.26, p > .05), nor
from those of non-Jewish participants (M = 35.27, SD = 9.63,
p > .05). Though the means reported for the trait anxiety
scales are based on raw scores, the analysis was repeated
using the standardized trait anxiety (A-Trait) scores. The
results were the same.
An additional analysis was conducted to further assess for
symptoms of secondary trauma in grandchildren of Holocaust
survivors. A one-way analysis of variance was conducted
across the three groups in order to analyze the scores of those
participants exhibiting high STS scores, i.e. above 37. The
overall F test indicated a significant difference in high STS
scores across the three groups, F (2, 14) = 6.15, p < .05.
Interestingly, a greater number of grandchildren of Holocaust
survivors (17.2%, n = 10) exhibited levels of STS scores that
exceeded its cutoff score (M = 44.30, SD = 7.30) when compared to ultra-Orthodox grandchildren of non-Holocaust survivors (7.8%, n = 4; M = 49.75, SD = 9.57) and non-Jewish
participants (7.3%, n = 3; M = 63.00, SD = 9.17). Pearson’s
chi-square test was conducted to assess whether the number
of participants who exhibited high STS scores represented a
significant portion of any of the three subgroups that comprised the study’s sample. There was a nonsignificant association between group membership status and high STS
scores, χ2(26) = 30.03, p > .05.
102
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Discussion
The study examined the presence of Holocaust-related
trauma characteristics in ultra-Orthodox grandchildren of
Holocaust survivors. It is well documented that the variables
of ultra-Orthodoxy and religiosity have had a compelling
effect on some Holocaust survivors (Frankl, 1963) and an
adverse effect on others (Wiesel, 1972). The obvious impact
of ultra-Orthodoxy on the survivors’ phenomenological
experiences solidified the inclusion of the variable of ultraOrthodoxy in the investigation of transgenerational transmission of Holocaust trauma.
A latent form of transgenerational Holocaust trauma was
confirmed in the study. Ultra-Orthodox grandchildren of
Holocaust survivors and ultra-Orthodox grandchildren of
non-Holocaust survivors were found to exhibit response
latencies for color-naming Holocaust-related stimuli on the
Modified Stroop procedure. The finding that residual trauma
affects members of ultra-Orthodox participants, regardless
of their grandparents’ Holocaust survivorship status, suggests that the residual psychological effects of the Holocaust
has succeeded in effectively altering the collective psyche of
the ultra-Orthodox community. The fact that ultra-Orthodox
grandchildren, independent of their grandparents’ war experiences, exhibited increased levels of Holocaust trauma is
not unreasonable given the collective conscious of ultraOrthodox communities and the sensitive nature of the
Holocaust. Moreover, ultra-Orthodox communities seek to
preserve and restore the past in the present (Heilman, 1992,
2006), and in so doing, may inadvertently perpetuate the
memories of the Holocaust in an effort to preserve its
victims.
Interestingly, past findings (Kassai & Motta, 2006)
indicate an equal level of latent Holocaust trauma in
modern-Orthodox grandchildren of Holocaust survivors,
modern-Orthodox American-born grandparents, and nonJewish grandchildren of immigrants. When assessed with
the modified Stroop procedure, the three groups exhibited
increased response latency for color-naming Holocaustrelated stimuli. Kassai and Motta (2006) speculated that
the delay in response times were due to the increased level
of Holocaust exposure n the post-Holocaust era, i.e., the
influence of the Holocaust in the movie industry and other
media outlets. The implication of the media’s role in perpetuating Holocaust exposure further clarifies the role of
Jewish identity, specifically ultra-Orthodox identity, in
transmitting Holocaust-trauma in ultra-Orthodox communities. Ultra-Orthodox communities attempt to stem the
flow of outside influences, particularly those of media outlets (Heilman, 1992, 2006). Thus, ultra-Orthodox participants’ response latency for color-naming Holocaust-related
stimuli appears to result from the trauma of the Holocaust
itself, rather than that of the media’s perpetuation of
Holocaust-material exposure.
Traumatology 19(2)
Overall, ultra-Orthodox grandchildren of Holocaust survivors did not exhibit significantly higher levels of secondary trauma symptoms on STS (Motta et al., 2001), the IES-R
(Weiss & Marmar, 1997), and the A-Trait scale of the STAI
(Spielberger et al., 1983). The finding is not surprising given
the subtle nature of secondary trauma assessment. Secondary
trauma symptoms are similar to, but not as severe as, those
experienced in PTSD (Motta et al., 1999; Suozzi & Motta,
2004). Thus, it would stand to reason that a more precise
form of secondary trauma assessment, e.g., the Modified
Stroop procedure, would detect the presence of such symptoms, while less precise measures, e.g., the STS (Motta et al.,
2001), the IES-R (Weiss & Marmaar, 1997), and the STAI
(Spielberger et al., 1983), would not.
Moreover, it must be noted that a substantially high percentage of ultra-Orthodox grandchildren of Holocaust survivors (17%, n = 10) exhibited STS scores that exceeded its
cut-off score. Though the sample does not represent a
significant percentage of ultra-Orthodox grandchildren of
Holocaust survivors, the increased level of high STS scores
presents further evidence of their propensity to develop
symptoms of secondary trauma.
It appears that the transfer of Holocaust trauma is not generated by the experience of being a grandchild of Holocaust
survivors, but rather from the experience of being a member
of the ultra-Orthodox community. Ultra-Orthodox communities’ cognitive internalization of the Holocaust resembles
the trauma victim’s tendency to keep the trauma in the forefront of consciousness, and in doing so, reinforce and guard
against future danger. The Holocaust has assimilated itself
into the cognitive schema of the ultra-Orthodox community,
a factor that must be considered in the treatment of anxietyrelated disorders in the population.
Methodological Strengths and Limitations
The study has advanced the reserve of Holocaust-related
empirical data through its use of improved sampling procedures, an increased sample size, a well-matched control
group, and, most importantly, the utilization of psychometrically reliable and valid measures of secondary trauma, i.e.,
the Modified Stroop procedure, a strong measure of current
levels of intrusive symptoms (McNally, 1995) and the STS
(Motta et al., 2001). However, several weaknesses in the
study cannot be ignored. Participants were volunteers; thus,
it is possible that many of their item responses on the selfreport measures, most of which were in the normal range,
were understated due to volunteer bias and social desirability
effects. Moreover, the study did not address the plausible link
between participant educational background and the transfer
of trauma to the third generation. Educational background
has been shown to mediate the severity of stress levels and
impact coping styles in victimized populations (Ford, 2012),
a relationship that could not be explored in the study.
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Perlstein and Motta
Furthermore, since it was not possible to locate a sample
of ultra-Orthodox grandchildre whose four grandparents
experienced the Holocaust, the study adopted the criterion
used by a previous study (Kassai & Motta, 2006), and
required that a participant have two or more grandparent
Holocaust survivors. The lack of significant differences in
secondary trauma symptoms exhibited by ultra-Orthodox
grandchildren of Holocaust survivors and ultra-Orthodox
grandchildren of non-Holocaust survivors may be, at least in
part, due to the diluted PTSD impact which may have
resulted from having one or more grandparents who did not
suffer the trauma of the Holocaust.
Finally, the fact that so many Holocaust survivors have
passed away in the 65 years since the Holocaust may have
further diluted the impact their Holocaust survival experiences may have had on their grandchildren. Though the
demographic questionnaire probed for the amount of time
spent with all four grandparents, the question did not specify
past or current time spent with the grandparents. Thus, it was
not possible to obtain an estimate of current time spent with
the grandparents. Therefore, it is possible that, despite having spent time with their Holocaust survivor grandparents,
ultra-Orthodox grandchildren of Holocaust survivors’ levels
of transgenerational transmission of Holocaust trauma may
have lessened due to their grandparents’ death and their lack
of contact with their grandparents.
Authors’ Note
This study is based on the doctoral dissertation of the first author
under supervision of the second author.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
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