Post-traumatic stress disorder after World War II

Last updated

Traumas during WWII led to the development of PTSD. Sicily Husky WWII Dead Pilot 1943.jpg
Traumas during WWII led to the development of PTSD.

Post-traumatic stress disorder (PTSD) results after experiencing or witnessing a terrifying event which later leads to mental health problems. [1] This disorder has always existed but has only been recognized as a psychological disorder within the past forty years. [2] [3] [4] Before receiving its official diagnosis in 1980, when it was published in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-lll), [2] Post-traumatic stress disorder was more commonly known as soldier's heart, irritable heart, or shell shock . [2] [3] [4] [5] [6] Shell shock and war neuroses were coined during World War I when symptoms began to be more commonly recognized among many of the soldiers that had experienced similar traumas. [2] [3] [5] [6] By World War II, these symptoms were identified as combat stress reaction or battle fatigue. [2] [3] [6] In the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I), post-traumatic stress disorder was called gross stress reaction which was explained as prolonged stress due to a traumatic event. [2] Upon further study of this disorder in World War II veterans, psychologists realized that their symptoms were long-lasting and went beyond an anxiety disorder. [2] [7] Thus, through the effects of World War II, post-traumatic stress disorder was eventually recognized as an official disorder in 1980. [2] [3] [4]

Contents

General overview

Changing terminology

Nostalgia, soldier's heart, and railway spine

A soldier with shell shock. Shellshock2 (cropped).jpg
A soldier with shell shock.

The term nostalgia was first coined in 1761 when soldiers reported feeling homesick, sleep disturbances, and anxiety after being in combat. [2] Later, soldier's heart was used to describe these symptoms but instead blamed cardiac problems as the source of anxiety and overstimulation. [2] [5] Railway spine also explained physical causes for PTSD symptoms. After railroad accidents became more common, the victims of these accidents exhibited emotional distress. [2]

Shell shock and war neuroses

Before the term post-traumatic stress disorder was established, people that exhibited symptoms were said to have shell shock [6] [5] [2] [3] or war neuroses. [8] [3] [9] This terminology came about in WWI when a commonality among combat soldiers was identified during psychiatric evaluations. [3] These soldiers all appeared to be in a catatonic state following battle, or "shocked by shells", [3] hence the term shell shocked.

Battle fatigue and combat stress reaction

During World War II, the diagnosis for shell shock was replaced with combat stress reaction. [6] [2] [3] These diagnoses resulted from soldiers being in combat for long periods of time. [2] There was some skepticism surrounding this diagnosis as some military leadership, including George S. Patton did not believe "battle fatigue" to be real. [2] Yet, due to evolving practices, such as proximity, immediacy, and expectancy (PIE), this new diagnosis was taken seriously and recovery was made the first priority. [2]

Prevalence

Post-traumatic stress disorder has always been prevalent whether it was recognized as a psychological disorder or not. [2] [3] [4] Yet, because PTSD was not recognized as an official disorder, it is difficult to estimate what the prevalence rate during WWII was. [5] A rough estimate, found through hospitalization records, suggests that approximately 43 per 1000 soldiers were hospitalized due to war traumas. [3] Again, however, this estimate is only based upon those who actually sought help, with many at this time not seeking help. Another prevalence rate, found in the 1950s, suggests that about 10% of WWII soldiers had PTSD at some point. [9] While it is difficult to retroactively discern prevalence for PTSD in WWII soldiers, what is clear is that it is prevalent now more than ever due to the long-lasting effects of combat in World War II. For example, half of all male veterans 65 and older have had military experience, which predisposes them to the acquisition of PTSD. [1] Thus, PTSD continues to affect World War II veterans and their families.

In the 1990's a questionnaire was given to a sample of Dutch WWII veterans. Out of 4057 veterans 66 of them fall under the qualifications for a PTSD diagnosis. The higher percentage of these were people, who had been victims of persecution. The next highest was among military veterans. The lowest level was among those who served as civilians. In the 1990's VA treatment centers saw an increase of WWII vets reporting PTSD symptoms. This can be contributed to, them entering retirement age. Their children were now grown. Which left them with more time alone with their thoughts.

Symptoms

Symptoms of post-traumatic stress disorder differ from person to person in that they can begin shortly after a traumatic event or even years after the event. [2] [10] Moreover, symptoms can continue to present long after the traumatic event's occurrence, with some people experiencing symptoms for the rest of their lives. [10] Symptoms of PTSD can be grouped into four main categories: "Intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions". [10]

Treatment

Treatments used during WWII

Sodium Pentothal, or truth serum, was used as a treatment for PTSD during WWII. Pentothal vintage package - truth serum.jpg
Sodium Pentothal, or truth serum, was used as a treatment for PTSD during WWII.

New treatment methods for PTSD emerged during WWII, likely due to the high demand for care, and the subsequent increase in investigation. [8] [7] Interestingly, despite little understanding of the mechanisms whereby PTSD happened, much of the early interventions by psychiatrists in the 1940s remain similar to the methods still used today, such as medications and group therapy. [7] [2]

One early treatment plan, from 1944, suggests a three part treatment to PTSD through use of sedatives to secure rest; use of intravenous barbiturates to promote mental catharsis, thereby assisting in the recall of a suppressed episode and use of drugs acting directly on the autonomic nervous system. [7] In addition to medication plans, another method that was utilized for PTSD during WWII was the principle of proximity, immediacy, and expectancy, or "PIE". [2] In essence, the PIE method emphasized immediate action in the treatment of PTSD. While first treatment plans for PTSD were crude and simplistic, they demonstrated the rapidly changing field of psychiatry that WWII initiated, as will be further discussed below.

Broader impacts

Divorce rates following WWII

Following WWII, the high rates of shell-shocked veterans and prisoners of war (POWs) returning home largely impacted marital relationships. A correlation between war and higher divorce rates is typical, [11] and extends to WWII vets, specifically ex-POWs since the rates of PTSD are much higher for this group. [12] For example, it was found that 30% of POWs with PTSD experienced relationship problems, with only 11% of veterans without PTSD experiencing marital problems. [12] Moreover, a different study found that being in active combat or on the front lines also increased likelihood of marital discord. [11] [13] From this, it can be suggested that those who have been in high stress situations, and have subsequently developed PTSD, have a higher prevalence of marital problems than those without PTSD. Those with PTSD likely have more marital problems due to slow adjustment back home, a lack of valuable communication/expression, intimacy problems, life disruption, economic problems, aggression, and lingering mental health impacts. [15] [12] [11] Thus, the effects of PTSD on WWII vets were not isolated to the vets themselves, as evidenced through high rates of marital discord following the war.

Development of psychiatry

During WWII the field of psychiatry was beginning to evolve, with a specific emphasis on military psychiatry due to the high rates of PTSD in soldiers. [8] [7] This can be seen in the changing technologies and aims of the American Psychological Association (APA) during the years that the United States was fighting in WWII. For example, between the years of 1943 and 1944, APA went from claiming that fear was the mechanism behind PTSD to attempting to understand the real underlying processes of PTSD, [7] which represents a change in understanding of mental illnesses. Additionally, these years in APA history represent a switch from suggesting rest to soldiers to prescribing medications and having specified treatment plans. [7] These changes in understanding were important to evolving psychiatry into what it is today; yet, the ideas about PTSD during WWII were still in their infancy, meaning that psychiatrists during WWII made some unethical choices. [8] For example, two famous military psychiatrists by the names of Roy Grinker and Frederick Hanson implemented mandatory sodium pentothal treatments, which were intended to induce the truth during psychoanalysis for soldiers claiming "exhaustion". [8] These treatments have since been proven harmful rather than helpful. [8] [7] Yet, it was through these initial contributions that the DSM-I was published in 1952, [2] thus proving WWII as a pivotal time for the advancement of psychiatry. [2] [3] [4]

Personal accounts

The impacts of PTSD from wartime trauma vary from person to person, yet the degree of trauma often indicates the severity of the PTSD. [16] [1] Additionally, other pre-existing factors, such as personality or preparedness, [3] [1] [14] also play into the development of PTSD in a veteran. Much like how no two people are alike, no two veterans will have the exact same experiences with PTSD, yet, there can still be commonalities such as negative homecoming experiences or lack of social support. [1] With this being said, one way to gain a better understanding of both the similarities and differences of PTSD among WWII veterans is through reading first-hand accounts that emphasize both the chronicity and longevity of war-time PTSD.

In the 1990s a questionnaire was given to a sample of Dutch WWII veterans. Out of 4057 veterans 66 of them fall under the qualifications for a PTSD diagnosis. The higher percentage of these were people, who had been victims of persecution. The next highest was among military veterans. The lowest level was among those who served as civilians. In the 1990s VA treatment centers saw an increase of WWII vets reporting PTSD symptoms. This can be attributed to, them entering retirement age. Their children were now grown. Which left them with more time alone with their thoughts.

Earl Crumby

An overview map of the battle that Earl Crumby fought in. Battle of the Bulge 6th.jpg
An overview map of the battle that Earl Crumby fought in.

71 years after the Battle of the Bulge, Earl Crumby sat down with Tim Madigan in 2015 to be interviewed about his part in it. At the time of the interview, his wife had just recently died and yet, he is quoted as saying, "as dearly as I loved that woman, her death didn’t affect me near as much as it does to sit down here and talk to you about seeing those young boys butchered during the war. It was nothing but arms and legs, heads and guts". [17] This personal account of Crumby's emphasizes just how intense these experiences were/are as well as underscores the chronicity of PTSD in WWII veterans.

Otis Mackey

When Otis Mackey was interviewed by Tim Madigan in 2015, his traumatic war experiences had not diminished over the years, but rather had increased in severity. Mackey is quoted saying, "I get that empty feeling, just deep down, and I don’t care whether I live or die". [17] In addition to emptiness, Mackey also has strong flashbacks of comrades being blown up and intense nightmares of bombs going off. "I seen it coming at me. I just ducked, and McGhee’s leg went flying right by my head...I never could figure out why it was him and not me". [17] This personal account of Mackey's emphasizes the severity of PTSD, even decades after his WWII service.

Dutch Shultz

Portrayed in the 1962 movie, The Longest Day , Dutch Shultz is remembered as an innocent and happy paratrooper. Yet, this idealized version bears little resemblance to the real Shultz, who is quoted as saying, "people did not want to know what it was like". [18] Based on accounts from Shultz's daughter, Carol, her father was always drinking in order to take the pain of war away. Additionally, according to Carol, her father "would wake up with nightmares every single day", [18] and even tried to take his own life. This account from both Shultz and his daughter emphasize both the chronicity and longevity of the traumas of war as well as shows that PTSD did not just impact those with the disorder. Dutch Shultz never got help for his PTSD, and Carol went her entire life having a half-present, drunk father.

Roy "Eric" Cooper

Roy "Eric" Cooper fought at Burma, and according to his daughter Ceri-Ann, "every second of every day, Burma was with him, even to his last breath". [18] While he was alive, Cooper is quoted as saying troubling things such as, "I don’t feel very well in my mind and I am a bad man". [18] Much like the other accounts, this account emphasizes the longevity of his war traumas as well as the hopelessness in Cooper's life.

Bombings, such as those at Pearl Harbor, can cause the development of PTSD in both veterans and non-veterans. USS SHAW exploding Pearl Harbor Nara 80-G-16871 2.jpg
Bombings, such as those at Pearl Harbor, can cause the development of PTSD in both veterans and non-veterans.

Anonymous Accounts

In 2011, researchers [19] collected quotes from survivors of WWII atomic bombs in order to determine the level of health among survivors. The survivors of these bombings range in age from 75 to 92, with both veterans and non-veterans included. Non-veteran's experiences are often overlooked, however their levels of health were similar to those who had seen combat. [19] This suggests that non-veteran's experiences with PTSD can be just as severe, and therefore important, as that of veteran's experiences. The following anonymous quote is one of many from the 2011 research [19] that suggests that the trauma seen within WWII has a strong relationship to a lifetime of PTSD.

There were too many kids in the water. And it's hard to pass up someone in the water. We saw real early on that . . . the ones that were squished bad . . . you couldn't get em' in the launch. You couldn't do nothing for em' . . . We took loads of em' and we could hold about 60 . . . In the meantime, we went back out and it just kept repeatin' itself. [19]

The above quote is from a veteran who experienced the bombing at Pearl Harbor, which was a traumatic event that influenced both veteran and non-veteran [19] development of PTSD.

See also

Related Research Articles

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples include violence, rape, or a terrorist attack.

<span class="mw-page-title-main">Combat stress reaction</span> Medical condition

Combat stress reaction (CSR) is acute behavioral disorganization as a direct result of the trauma of war. Also known as "combat fatigue", "battle fatigue", or "battle neurosis", it has some overlap with the diagnosis of acute stress reaction used in civilian psychiatry. It is historically linked to shell shock and can sometimes precurse post-traumatic stress disorder.

Acute stress reaction and acute stress disorder (ASD) is a psychological response to a terrifying, traumatic or surprising experience. Combat stress reaction (CSR) is a similar response to the trauma of war. The reactions may include but are not limited to intrusive or dissociative symptoms, and reactivity symptoms such as avoidance or arousal. It may be exhibited for days or weeks after the traumatic event. If the condition is not correctly addressed, it may develop into post-traumatic stress disorder (PTSD).

Complex post-traumatic stress disorder is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

A trauma trigger is a psychological stimulus that prompts involuntary recall of a previous traumatic experience. The stimulus itself need not be frightening or traumatic and may be only indirectly or superficially reminiscent of an earlier traumatic incident, such as a scent or a piece of clothing. Triggers can be subtle, individual, and difficult for others to predict. A trauma trigger may also be called a trauma stimulus, a trauma stressor or a trauma reminder.

Memory and trauma is the deleterious effects that physical or psychological trauma has on memory.

Jonathan Shay is an American doctor and clinical psychiatrist. He holds a B.A. from Harvard (1963), and an M.D. (1971) and a Ph.D. (1972) from the University of Pennsylvania. He is best known for his publications comparing the experiences of Vietnam veterans with the descriptions of war and homecoming in Homer's Iliad and Odyssey.

<span class="mw-page-title-main">Shell shock</span> Term for post-traumatic stress disorder

Shell shock is a term that originated during World War I to describe the type of post-traumatic stress disorder (PTSD) that many soldiers experienced during the war, before PTSD was officially recognized. It is a reaction to the intensity of the bombardment and fighting that produced a helplessness, which could manifest as panic, fear, flight, or an inability to reason, sleep, walk, or talk.

<span class="mw-page-title-main">Yuval Neria</span>

Yuval Neria is a Professor of Medical Psychology at the Departments of Psychiatry and Epidemiology at Columbia University Medical Center (CUMC), and Director of Trauma and PTSD Program, and a Research Scientist at the New York State Psychiatric Institute (NYSPI) and Columbia University Department of Psychiatry. He is a recipient of the Medal of Valor, Israel's highest decoration, for his exploits during the 1973 Yom Kippur War.

Jon Elhai is a professor of clinical psychology at the University of Toledo. Elhai is known for being an expert in the assessment and diagnosis of Posttraumatic stress disorder (PTSD), forensic psychological assessment of PTSD, and detection of fabricated/malingered PTSD; as well as in internet addictions.

Because of the substantial benefits available to individuals with a confirmed PTSD diagnosis, which causes occupational impairment, the distinct possibility of false diagnoses exist, some of which are due to malingering of PTSD. Malingering of PTSD consists of one feigning the disorder. Post-traumatic stress disorder (PTSD) is an anxiety disorder that may develop after an individual experiences a traumatic event. In the United States, the Social Security Administration and the Department of Veterans Affairs each offer disability compensation programs that provide benefits for qualified individuals with mental disorders, including PTSD. Malingering can lead to a decline in research and subsequent treatment for PTSD as it interferes with true studies. Insurance fraud may also come about through malingering, which hurts the economy.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Rachel Yehuda is a professor of psychiatry and neuroscience, the vice chair for veterans affairs in the psychiatry department, and the director of the traumatic stress studies division at the Mount Sinai School of Medicine. She also leads the PTSD clinical research program at the neurochemistry and neuroendocrinology laboratory at the James J. Peters VA Medical Center. In 2020 she became director of the Center for Psychedelic Psychotherapy and Trauma Research at Mount Sinai.

The genetic influences of post-traumatic stress disorder (PTSD) are not understood well due to the limitations of any genetic study of mental illness; in that, it cannot be ethically induced in selected groups. Because of this, all studies must use naturally occurring groups with genetic similarities and differences, thus the amount of data is limited. Still, genetics play some role in the development of PTSD.

<span class="mw-page-title-main">Post-traumatic stress disorder among athletes</span> Prevalence of PTSD among athletes

Posttraumatic stress disorder (PTSD) is a cognitive disorder, which may occur after a traumatic event. It is a psychiatric disorder, which may occur across athletes at all levels of sport participation.

The Child PTSD Symptom Scale (CPSS) is a free checklist designed for children and adolescents to report traumatic events and symptoms that they might feel afterward. The items cover the symptoms of posttraumatic stress disorder (PTSD), specifically, the symptoms and clusters used in the DSM-IV. Although relatively new, there has been a fair amount of research on the CPSS due to the frequency of traumatic events involving children. The CPSS is usually administered to school children within school boundaries, or in an off-site location to assess symptoms of trauma. Some, but not all, people experience symptoms after a traumatic event, and in serious cases, these people may not get better on their own. Early and accurate identification, especially in children, of experiencing distress following a trauma could help with early interventions. The CPSS is one of a handful of promising measures that has accrued good evidence for reliability and validity, along with low cost, giving it good clinical utility as it addresses a public health need for better and larger scale assessment.

Operational stress injury or OSI is a non-clinical, non-medical term referring to a persistent psychological difficulty caused by traumatic experiences or prolonged high stress or fatigue during service as a military member or first responder. The term does not replace any individual diagnoses or disorders, but rather describes a category of mental health concerns linked to the particular challenges that these military members or first responders encounter in their service. There is not yet a single fixed definition. The term was first conceptualized within the Canadian Armed Forces to help foster understanding of the broader mental health challenges faced by military members who have been impacted by traumatic experiences and who face difficulty as a result. OSI encompasses a number of the diagnoses found in the Diagnostic and Statistical Manual of Mental Disorders (DSM) classification system, with the common thread being a linkage to the operational experiences of the afflicted. The term has gained traction outside of the military community as an appropriate way to describe similar challenges suffered by those whose work regularly exposes them to trauma, particularly front line emergency first responders such as but not limited to police, firefighters, paramedics, correctional officers, and emergency dispatchers. The term, at present mostly used within Canada, is increasingly significant in the development of legislation, policy, treatments and benefits in the military and first responder communities.

<span class="mw-page-title-main">Post-traumatic stress disorder and substance use disorders</span> Association of PTSD and substance dependencies

Post-traumatic stress disorder (PTSD) can affect about 3.6% of the U.S. population each year, and 6.8% of the U.S. population over a lifetime. 8.4% of people in the U.S. are diagnosed with substance use disorders (SUD). Of those with a diagnosis of PTSD, a co-occurring, or comorbid diagnosis of a SUD is present in 20–35% of that clinical population.

Psychological trauma in adultswho are older, is the overall prevalence and occurrence of trauma symptoms within the older adult population.. This should not be confused with geriatric trauma. Although there is a 90% likelihood of an older adult experiencing a traumatic event, there is a lack of research on trauma in older adult populations. This makes research trends on the complex interaction between traumatic symptom presentation and considerations specifically related to the older adult population difficult to pinpoint. This article reviews the existing literature and briefly introduces various ways, apart from the occurrence of elder abuse, that psychological trauma impacts the older adult population.

References

  1. 1 2 3 4 5 6 7 Kang, Sungrok; Aldwin, Carolyn M.; Choun, Soyoung; Spiro, Avron (2016-02-01). "A Life-span Perspective on Combat Exposure and PTSD Symptoms in Later Life: Findings From the VA Normative Aging Study". The Gerontologist. 56 (1): 22–32. doi:10.1093/geront/gnv120. ISSN   0016-9013. PMC   4935780 . PMID   26324040.
  2. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Friedman, Matthew. "History of PTSD in Veterans: Civil War to DSM-5 – PTSD: National Center for PTSD". www.ptsd.va.gov. Retrieved 2020-11-04.
  3. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Crocq, M. A.; Crocq, L. (2000). "From shell shock and war neurosis to posttraumatic stress disorder: a history of psychotraumatology". Dialogues in Clinical Neuroscience. 2 (1): 47–55. doi:10.31887/DCNS.2000.2.1/macrocq. ISSN   1294-8322. PMC   3181586 . PMID   22033462.
  4. 1 2 3 4 5 6 Kolk, Bessel van der; Najavits, Lisa M. (2013). "Interview: What is PTSD Really? Surprises, Twists of History, and the Politics of Diagnosis and Treatment". Journal of Clinical Psychology. 69 (5): 516–522. doi:10.1002/jclp.21992. ISSN   1097-4679. PMID   23592047.
  5. 1 2 3 4 5 Langer, Ron. "Combat trauma, memory, and the World War II veteran." War, Literature, and the Arts: An International Journal of the Humanities 23, no. 1 (2011): 50–58. http://www.pitt.edu/~nancyp/uhc-1510/CombatTraumaMemoryWWIIVet.pdf
  6. 1 2 3 4 5 Spiller, Roger (1990). "Shellshock". www.americanheritage.com. Retrieved 2020-11-05.
  7. 1 2 3 4 5 6 7 8 Stein, Murray B.; Rothbaum, Barbara O. (2018-06-01). "175 Years of Progress in PTSD Therapeutics: Learning From the Past". American Journal of Psychiatry. 175 (6): 508–516. doi: 10.1176/appi.ajp.2017.17080955 . ISSN   0002-953X. PMID   29869547.
  8. 1 2 3 4 5 6 Boone, Katherine; Richardson, Frank (2010). "APA PsycNet". Journal of Theoretical and Philosophical Psychology. 30 (2): 109–121. doi:10.1037/a0021569 . Retrieved 2020-11-04.
  9. 1 2 Friedman, Matthew J.; Schnurr, Paula P.; McDonagh-Coyle, Annmarie (1994-06-01). "Post-Traumatic Stress Disorder in the Military Veteran". Psychiatric Clinics of North America. 17 (2): 265–277. doi:10.1016/S0193-953X(18)30113-8. ISSN   0193-953X. PMID   7937358.
  10. 1 2 3 4 5 6 7 8 9 Mayo Clinic Staff. "Post-traumatic stress disorder (PTSD) – Symptoms and causes". Mayo Clinic. Retrieved 2020-11-05.
  11. 1 2 3 4 Gimbel, Cynthia; Booth, Alan (1994). "Why Does Military Combat Experience Adversely Affect Marital Relations?". Journal of Marriage and Family. 56 (3): 691–703. doi:10.2307/352879. ISSN   0022-2445. JSTOR   352879.
  12. 1 2 3 4 Cook, Joan; Riggs, David; Thompson, Richard; Coyne, James; Sheikh, Javaid (2004). "Posttraumatic Stress Disorder and Current Relationship Functioning Among World War II Ex-Prisoners of War". American Psychological Association.
  13. 1 2 Pavalko, Eliza K.; Elder, Glen H. (1990-03-01). "World War II and Divorce: A Life-Course Perspective". American Journal of Sociology. 95 (5): 1213–1234. doi:10.1086/229427. ISSN   0002-9602. S2CID   144986348.
  14. 1 2 3 Malone, Johanna C.; Distel, Laura M. L.; Waldinger, Robert J. (2018). Spiro III, Avron; Settersten Jr., Richard A.; Aldwin, Carolyn M. (eds.). "Midlife Ego Development of World War II Veterans: Contributions of Personality Traits and Combat Exposure in Young Adulthood". American Psychological Association.
  15. ↑ Tamoria, Nicholas A.; Alampay, Miguel M.; Santiago, Patcho N. (2015), Ritchie, Elspeth Cameron (ed.), "Intimate Relationship Distress and Combat-related Posttraumatic Stress Disorder", Posttraumatic Stress Disorder and Related Diseases in Combat Veterans, Cham: Springer International Publishing, pp. 363–370, doi:10.1007/978-3-319-22985-0_25, ISBN   978-3-319-22985-0 , retrieved 2020-11-04
  16. ↑ DiMauro, Jennifer; Carter, Sarah; Folk, Johanna B.; Kashdan, Todd B. (2014-12-01). "A historical review of trauma-related diagnoses to reconsider the heterogeneity of PTSD". Journal of Anxiety Disorders. 28 (8): 774–786. doi:10.1016/j.janxdis.2014.09.002. ISSN   0887-6185. PMID   25261838.
  17. 1 2 3 Madigan, Tim (2015-09-11). "Their war ended 70 years ago. Their trauma didn't". Washington Post. ISSN   0190-8286 . Retrieved 2020-11-04.
  18. 1 2 3 4 Mulvey, Stephen (2019-06-07). "The long echo of WW2 trauma". BBC News. Retrieved 2020-11-04.
  19. 1 2 3 4 5 Liehr, Patricia; Nishimura, Chie; Ito, Mio; Wands, Lisa Marie; Takahashi, Ryutaro (2011). "A Lifelong Journey of Moving Beyond Wartime Trauma for Survivors From Hiroshima and Pearl Harbor". Advances in Nursing Science. 34 (3): 215–228. doi: 10.1097/ANS.0b013e3182272370 . ISSN   0161-9268. PMID   21822070. S2CID   205464668.

References https://nyaspubs-onlinelibrary-wiley-com.uab.idm.oclc.org/toc/17496632/2006/1071/1

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.