International Handbook of

Traumatic Stress Syndromes

the Plenum Series on Stress and Coping Series Editor: Donald Meichenbaum, University of Waterloo, Waterloo, Ontario, Canada

Editorial Board: Bruce P. Dohrenwend, Columbia University Marianne Frankenhaeuser, University of Stockholm Norman Garmezy, University of Minnesota Mardi J. Horowitz, University of California Medical Schoo~

San Francisco Richard S. Lazarus, University of California, Berkeley Michael Rutter, University of London Dennis C. Thrk, University of Pittsburgb John P. Wilson, Cleveland State University Camille Wortman, University of Mlcblgan

Current Volumes in tbe Series:

A CUNICAL GUIDE TO THE TREATMENT OF THE HUMAN STRESS RESPONSE George S. Everly, Jr.

COMBAT STRESS REACTION The Enduring Toll of War Zahava Solomon

COPING WITH NEGATIVE UFE EVENTS Clinical and Social Psychological Perspectives Edited by C. R. Snyder and Carol E. Ford

DYNAMICS OF STRESS Physiological, Psychological, and Social Perspectives Edited by Mortimer H. Appley and Richard Trumbull

HUMAN ADAPTATION TO EXTREME STRESS From the Holocaust to Vietnam Edited by John P. Wilson, Zev Harel, and Boaz Kahana

INFERTIU1Y Perspectives from Stress and Coping Research Edited by Annette L. Stanton and Christine Dunkel-Schetter

INTERNATIONAL HANDBOOK OF TRAUMATIC STRESS SYNDROMES Edited by John P. Wilson and Beverley Raphael

POST-TRAUMATIC STRESS DISORDER A Clinician's Guide Kirtland C. Peterson, Maurice F. Prout, and Robert A. Schwarz

THE SOCIAL CONTEXT OF COPING Edited by John Eckenrode

STRESS BETWEEN WORK AND FAMILY Edited by John Eckenrode and Susan Gore

THE UNNOTICED MAJORI1Y IN INPATIENT PSYCHIATRIC CARE Charles A. Kiesler and Celeste G. Simpkins

WOMEN, WORK, AND HEALTH Stress and Opportunities Edited by Marianne Frankenhaeuser, Ulf Lundberg, and Margaret Chesney

A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon actual shipment. For further information please contact the pUblisher.

International Handbook of Traumatic Stress

Syndromes

Edited by

John P. Wilson Cleveland State University

Cleveland, Ohio

and

Beverley Raphael University of Queensland

Herston, Australia

Springer Science+Business Media, LLC

Internat,onal handbook of trau_attc stress syndro.es ' edtted by John P. Htlson and Beverley Raphael.

p. c •. -- (The Plenu. ser'es on stress and coptng) Includes btbltographtcal references Ind ,ndex. ISBN 978-1-4613-6219-7 ISBN 978-1-4615-2820-3 (eBook) DOI 10.1007/978-1-4615-2820-3 1. Post-trau.attc stress d,sorder. 1. Wtlson. John P. (John

Preston) II. Raphael, Beverley. III. Ser,es. [ONLM, 1. Stress Otsorders, Post-Trlu_at;c. HM 172 16053J

RC552.P67158 1993 616.85·21--dc20 DNLM/DLC for Ltbrary of Congress 92-49117

CIP

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ISBN 978-14613-6219-7

C 1993 Springer Sciem:e+BusinelIII Media New YOlk 0rigiDa11y publiabrd by Plcnurn Pn:ss, New York in 1993

Softcover reprint ofthe hardcover lst edition 1993

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To our families

Cassie Rickarby

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And to the children of the future

Contributors

Inger Agger Department of Social Studies and

Organization Aalborg University DK-9220 Aalborg, Denmark

David Alan Alexander Department of Mental Health University of Aberdeen Medical School,

Foresterhill Aberdeen AB 2ZD, Scotland

Ofra Ayalon School of Education University of Haifa Haifa 31999, Israel

Jorge Barros-Beck Centre Hospitalier Specialise Rouffach 68250, France

Andrew Baum Department of Psychology Uniformed Services University of the Health

Sciences Bethesda, Maryland 20814

P. Bell Mater Infirmorum Hospital Crumlin Road Belfast BT 14 6 AB, Northern Ireland

Leonard Bickman Department of Psychology and Human

Development George Peabody College of Vanderbilt

University Nashville, Tennessee 37203

Dora Black Department of Child and Adolescent

Psychiatry Royal Free Hospital Pond Street London NW3, England

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Richard Douglas Blackwell Medical Foundation for the Care of Victims

of Torture 96-98 Grafton Road London NW5 3EJ, England

Edward Blanchard Department of Psychology State University of New York at Albany Albany, New York 12222

Arthur S. Blank, Jr. Readjustment Counseling Service (10B/RC) Department of Veterans Affairs Washington, DC 20420

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Bennett G. Braun Center on Psychiatric Trauma and

Dissociation Rush Institute of Mental Well-Being Rush-Presbyterian-St. Luke's Medical

Center Chicago, lllinois 60612

Joel Osler Brende Martin Army Community Hospital Fort Benning, Georgia 31905; Adult Outpatient Services The Bradley Center, Inc. Columbus, Georgia 31907; and Department of Psychiatry Mercer School of Medicine Macon, Georgia 31206

Elizabeth A. Brett Department of Psychiatry Yale University New Haven, Connecticut 06511

William Buckingham Office of Psychiatric Services Health Department Melbourne, Victoria 3000, Australia

Renate Gronvold Bugge Vest-Agder Sentralsykehus 4600 Kristiansand South, Norway

Ann W. Burgess Department of Psychiatric Mental Health

Nursing University of Pennsylvania School of

Nursing Philadelphia, Pennsylvania 19104

Philip Burgess Psychiatric Epidemiology and Services

Evaluation Unit Health Department Victoria Parkville, Victoria 3052, Australia

Ed Cairns Department of Psychology and Centre for

the Study of Conflict University of Ulster Coleraine, Londonderry BT52 1SA,

Northern Ireland

Stephen R. Couch Department of Sociology Pennsylvania State University

CONTRIBUTORS

Schuylkill Haven, Pennsylvania 17972-2208

Mark Creamer Health Department Victoria, and

Department of Psychology University of Melbourne Parkville, Victoria 3052, Australia

Marc-Antoine Crocq Centre Hospitalier Specialise Rouffach 68250, France

Margaret Cunningham Service for the Treatment and Rehabilitation

of Torture and Trauma Survivors 28 Nelson Street Fairfield, New South Wales 2165, Australia

Peter S. Curran Mater Infirmorum Hospital Crumlin Road Belfast BT 14 6 AB, Northern Ireland

Yael Danieli Group Project for Holocaust Survivors and

Their Children 345 East 80th Street, Apt. 31-J New York, New York 10021

Giovanni de Girolamo Division of Mental Health World Health Organization 1211 Geneva 27, Switzerland

Jan H. M. de Groen Department of Clinical Neurophysiology University of Limburg School of Medicine 6200 MD Maastricht, Netherlands

Owen Dent Department of Sociology Australian National University Acton 2601, Australia

Fabrice Duval Centre Hospitalier Specialise Rouffach 68250, France

CONTRIBUTORS

Atle Dyregrov Center for Crisis Psychology Fabrikkgt 5 5037 Solheimsvik, Norway

Leo Eitinger b Ullern Terr. 67 0380 Oslo 3, Norway

Liisa Eranen Department of Social Psychology University of Helsinki SF-0010a Helsinki, Finland

George S. Everly, Jr. Health Psychology Laboratory, Loyola

College Baltimore, Maryland, and Psychological Services and Behavioral

Medicine Homewood Hospital Center, The Johns

Hopkins Health System 204 Glenmore Avenue Catonsville, Maryland 21228

Paul R. J. Falger Department of Medical Psychology University of Limburg School of Medicine 6200 MD Maastricht, Netherlands

Anthony Feinstein Institute of Neurology and National

Hospital for Nervous Diseases Queen Square London WC1N 3BG, England

Matthew J. Friedman National Center for PTSD Veterans Administration Medical and

Regional Office Center White River Junction, Vermont 05009, and Department of Psychiatry and

Pharmacology Dartmouth Medical School Hanover, New Hampshire 03755

Rob Gordon Department of Psychology Royal Children's Hospital Melbourne, Parkville, Victoria 3052,

Australia

Caroline Gorst-Unsworth The Medical Foundation for the Care of

Victims of Torture 96-98 Grafton Road London NW5 3EJ, England

Kerry Goulston Repatriation Hospital Concord 2139, Australia

Mary C. Grace Traumatic Stress Study Center Department of Psychiatry University of Cincinnati College of Medicine Cincinnati, Ohio 45267-0539

Arthur Green Department of Psychiatry Columbia-Presbyterian Hospital New York, New York 10032

Bonnie 1. Green Department of Psychiatry Georgetown University Hospital Washington, DC 20007

Zev Harel Department of Social Work and Center on

Applied Gerontological Research Cleveland State University Cleveland, Ohio 44115

Laurie Leydic Harkness Yale University Community Support Program and

Psychiatric Rehabilitation Program Veterans Administration Medical Center West Haven, Connecticut 06516

Carol R. Hartman Department of Psychiatric Mental Health

Nursing Boston College School of Nursing Chestnut Hill, Massachusetts 02167

Jean Harris Hendriks Department of Child and Adolescent

Psychiatry Royal Free Hospital Pond Street London NW3, England

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Judith Lewis Herman 61 Roseland Street Somerville, Massachusetts 02143

Are Holen Department of Psychiatry University of Oslo P.O. Box 85 Vinderen N-0319, Oslo 3, Norway

David J de L Home Department of Psychiatry, Clinical Sciences

Block University of Melbourne Victoria 3050, Australia

Mardi J. Horowitz Department of Psychiatry University of California San Francisco, California 94143

Alexandra Hough St. Thomas' Hospital, London, and The Medical Foundation for the Care of

Victims of Torture 96-98 Grafton Road London NW5 3EJ, England

Johan E. Hovens Department of Psychiatry Saint Lucas Hospital 1061 AE Amsterdam, Netherlands

Cao Hua Department of Psychiatry Flinders University of South Australia Bedford Park South Australia 5042, Australia

Edna J. Hunter 3280 Trumbull Street San Diego, California 92106

Arthur Hyatt-Williams Scientific Research and Development

Branch, Home Office, Research and Planning Unit

Queen Anne's Gate London SW1H 9AT, England

Toshiharu Iwadate Department of Psychiatry

CONTRIBUTORS

School of Medicine, Tohoku University Aoba-ku, Sendai 980, Japan

Tony Jaffa The Medical Foundation for the Care of

Victims of Torture, London, and The Adolescent Community Team 32b York Road Battersea, London SW11, England

Soren Buus Jensen Center for Psychosocial and Traumatic

Stress Aalborg Psychiatric Hospital Melleparkvej 10, Aalborg, Denmark

S. Janet Johnston Dover Counselling Centre 9 Cambridge Terrace Dover CT16 1YZ, England

Marianne Juhler Rehabilitation and Research Center for

Torture Victims Juliane Mariesvej 34 2100 Copenhagen 0, Denmark

Boaz Kahana Department of Psychology and Center on

Applied Gerontological Research Cleveland State University Cleveland, Ohio 44115

Eva Kahana Department of Sociology and Elderly Care

Research Center Case Western Reserve University Cleveland, Ohio 44106

Tony Kaplan Department of Child and Adolescent

Psychiatry Royal Free Hospital Pond Street London NW3, England

CONTRIBUTORS

Terence M. Keane Department of Veterans Affairs Medical

Center Boston, Massachusetts 02130

Brian Kelly Department of Psychiatry Royal Brisbane Hospital University of Queensland Herston 4029, Australia

J. David Kinzie Department of Psychiatry Oregon Health Sciences University Portland, Oregon 97201-3098

J. Stephen Kroll-Smith Department of Sociology University of New Orleans New Orleans, Louisiana 70148

Henry Krystal Michigan Psychoanalytic Institute 26011 Evergreen Road, Suite 206 Southfield, Michigan 48076

Richard A. Kulka National Opinion Research Center 1155 East 60th Street Chicago, Illinois 60637

Rima E. Laibow TREAT 13 Summit Terrace Dobbs Ferry, New York 10522

Louise J. Lasschuit Department of Psychiatry Saint Lucas Hospital 1061 AE Amsterdam, Netherlands

C. Shaffia Laue 346 Maine Lawrence, Kansas 66044

Robert Laufer Late Professor of Sociology Brooklyn College of the City University of

New York Brooklyn, New York 11210

Anthony C. Leonard Traumatic Stress Study Center Department of Psychiatry University of Cincinnati College of Medicine Cincinnati, Ohio 45267-0539

Patti Levin Trauma Clinic Massachusetts General Hospital, and Harvard Medical School Boston, Massachusetts 02114

Karmela Liebkind Department of Social Psychology University of Helsinki SF-00100 Helsinki, Finland

Robert Jay Lifton Center on Violence John Jay College of Criminal Justice City University of New York New York, New York 10019

Jacob D. Lindy Department of Psychiatry and Traumatic

Stress Study Center University of Cincinnati Medical School Cincinnati, Ohio 45267-0539

G. C. Loughrey Mater Infirmorum Hospital Crumlin Road Belfast BT 146 AB, Northern Ireland

Tom Lundin Department of Psychiatry University Hospital 5-58185 Linkoping, Sweden

Jean-Paul Macher Centre Hospitalier Specialise Rouffach 68250, France

Mona S. Macksoud Project on Children and War Center for the Study of Human Rights Columbia University New York, New York 10027

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Mary Bernadette Manolias Scientific Research and Development

Branch, Home Office, Research and Planning Unit

Queen Anne's Gate London SW1H 9AT, England

Bertil Mardberg Department of Psychiatry University Hospital 5-58185 Linkoping, Sweden

Alexander Cowell McFarlane Department of Psychiatry University of Adelaide Gilles Plains, South Australia 5086,

Australia

Noach Milgram Department of Psychology Tel-Aviv University Ramat-Aviv 69978, Israel

Jeffrey T. Mitchell Emergency Health Services Department University of Maryland, Baltimore County

Campus Catonsville, Maryland 21228

Kathi Nader Program in Trauma, Violence, and Sudden

Bereavement University of California, Los Angeles, and Neuropsychiatric Institute and Hospital Center for the Health Sciences Los Angeles, California 90024

Bahman Najarian Department of Psychology University of Shahid Chamran Ahwaz, Iran

Fran Norris Department of Psychology Georgia State University Atlanta, Georgia 30303

Carol S. North Department of Psychiatry

CONTRIBUTORS

Washington University School of Medicine St. Louis, Missouri 63110

Frank M. Ochberg Department of Psychiatry Michigan State University East Lansing, Michigan 48824

Tsunemoto Odaira Department of Psychiatry School of Medicine, Tohoku University Aoba-ku, Sendai 980, Japan

Wybrand Op den Velde Department of Psychiatry Saint Lucas Hospital 1061 AE Amsterdam, Netherlands

Roderick Jan emer North Lincolnshire Health Authority Baverstock House, County Hospital St. Anne's Road Lincoln LN4 2HN, England

Ulf Otto Department of Psychiatry University Hospital 5-58185 Linkoping, Sweden

Erwin Randolph Parson P.O. Box 62 Perry Point, Maryland 21902-0062

Philippa Pattison Department of Psychology University of Melbourne Parkville, Victoria 3052, Australia

Robert S. Pynoos Program in Trauma, Violence, and Sudden

Bereavement University of California, Los Angeles, and Neuropsychiatric Institute and Hospital Center for the Health Sciences Los Angeles, California 90024

CONTIUBUIDRS

Beverley Raphael Department of Psychiatry Royal Brisbane Hospital University of Queensland Herston 4029, Australia

Magne Raundalen Asligrenda 8 5095 Ulset, Norway

John Reid Oregon Social Learning Center 207 East 5th Avenue Eugene, Oregon 97401

Robert F. Rich Institute of Government and Public Affairs University of Illinois Urbana, Illinois 61801

Derek Roger Department of Psychology University of York, Heslington York 500, England

Stewart J. Rosenberg Centre Hospitalier Specialise Rouffach 68250, France

Rachel M. Rosser Department of Psychiatry University College and Middlesex School of

Medicine Wolfson Building, Middlesex Hospital London WIN 8AA, England

Susan E. Salasin Center for Mental Health Services Department of Health and Human Services 5600 Fishers Lane Rockville, Maryland 20857

Jose Saporta Trauma Clinic, Massachusetts Mental

Health Center, and Harvard Medical School Boston, Massachusetts 02115

William E. Schlenger Mental and Behavioral Health Research

Program Research Triangle Institute P.O. Box 12194 Research Triangle Park, North Carolina

27709

Erik G. W. Schouten Department of Medical Psychology University of Limburg School of Medicine 6200 MD Maastricht, Netherlands

Robert Schweitzer Department of Psychology University of Queensland St. Lucia, Brisbane, Queensland 4067,

Australia

Raymond Monsour Scurfield Pacific Center for PTSD and Other War-

Related Disorders U.S. Department of Veterans Affairs P.O. Box 50188 Honolulu, Hawaii 96850

Derrick SUove Academic Mental Health Unit University of New South Wales Liverpool Hospital New South Wales 2170, Australia

Michael A. Simpson Intermedica P.O. Box 51 Pretoria, South Africa

Elizabeth M. Smith Department of Psychiatry Washington University School of Medicine St. Louis, Missouri 63110

Susan D. Solomon Disaster Research Program National Institute of Mental Health Rockville, Maryland 20857

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Zahava Solomon Research Branch Department of Mental Health Medical Corps Israel Defence Forces Military P.O. Box 02149, Israel

Daya J. Somasundaram Department of Psychiatry University of Jaffna Jaffna, Sri Lanka

Peter SteingIass Department of Psychiatry George Washington University Washington, DC 20052

Linda Ann Stevenson 104 Moore Road Mapperley, Nottingham NG3 6EJ, England

Christopher Charles Tennant Department of Psychiatry University of Sydney Sydney, Australia, and Royal North Shore Hospital Saint Leonards 2065, Australia

James Thompson Department of Psychiatry University College and Middlesex School of

Medicine, Wolfson Building Middlesex Hospital London WIN 8AA, England

Stuart W. Turner Department of Psychiatry University College and Middlesex School of

Medicine, Wolfson Building Middlesex Hospital London WIN 8AA, England

Robert J. Ursano Department of Psychiatry F. Edward Hebert School of Medicine Uniformed Services University of the Health

Sciences Bethesda, Maryland 20814

CONTRIBUTORS

Bessel A. van der Kolk Trauma Clinic, Massachusetts Mental

Health Center, and Harvard Medical School Boston, Massachusetts 02115

Guus van der Veer Social Psychiatric Centre for Refugees Cornelis Schuystraat 17 1071 JD Amsterdam, Netherlands

Hans Van Duijn Department of Neurophysiology Saint Lucas Hospital 1061 AE Amsterdam, Netherlands

Abdul WaH H. Wardak Department of Psychology University of Hull Cottingham Road Hull HU6 7RX, England

Lars Weisceth Division of Disaster Psychiatry Department of Psychiatry University of Oslo Oslo 3, Norway

Daniel S. Weiss Department of Psychiatry University of California San Francisco, California 94143

Tom Williams Post Trauma Treatment Center 31933 Miwok Trail Evergreen, Colorado 80439

John P. Wilson Department of Psychology Cleveland State University Cleveland, Ohio 44115

Ronnie Wilson Department of Psychology and Centre for

the Study of Conflict University of Ulster Coleraine, Londonderry BT52 ISA,

Northern Ireland

CONTRIBUTORS

Jessica Wolfe Department of Veterans Affairs

Medical Center Boston, Massachusetts 02130

Ruth Wraith Department of Child Psychotherapy Royal Children's Hospital Melbourne, Parkville, Victoria 3052,

Australia

Akbar Zargar Department of Architecture University of Shahid Beheshti Tehran, Iran

xv

Foreword

The history of the field of traumatic stress, or what is now called "traumatology," begins with the ancient Egyptian physician's reports of hysterical reactions. These reports, which were published in 1900 B.C. in Kunyus Papyrus, became one of the first medical textbooks (Veith, 1965). Thus, this Handbook, a remarkable single-volume collection of 84 chapters, represents one of the latest achievements in this long history.

Traumatology is the investigation and application of knowledge about the immediate and long-term psychosocial consequences of highly stressful events and the factors which affect those consequences. This discipline emerged only within the last decade, partly because of the coalescence of numerous divergent fields of scholarly investigation and therapeutic treatment. These areas included, but were not limited to, such fields of study and treatment as the Holocaust, family abuse (e.g., family violence, incest), rape and sexual abuse, crime victimization studies and victimology, war trauma, and, in general, stress and coping.

These areas are built upon the cumulative scholarly and clinical literature that began to emerge extensively in the nineteenth century. A number of historians have traced the various major developments in this field (Absem, 1984; Ellenberger, 1970; Trimble, 1981, 1985; Veith, 1965). To appreciate fully this massive work, it is important to consider this nearly 4,OOO-year history. I will briefly review only the highlights and mention some important references.

In an analysis of the history of hysteria, Veith (1965) suggested that emotional reactions to highly stressful events are found in every century that has records of human behavior. Theories and explanations of these behaviors have varied. The symptoms of flashbacks, dissociation, and startle response were variously viewed as works of God, the gods, the devil, and various types of spirits (Ellenberger, 1970). Thanks to Franz Anton Mesmer, an eighteenth-century physician and inventor of hypnotism, scientific concepts began to replace religious ones, and this led eventually to the analysis of psychological possession and multiple personality (Azam, 1887; Flournoy, 1900; Hodgson, 1891; Veith, 1965).

Hurst (1940) and others (see Trimble, 1981) noted the important contributions of the innovative work being done at La Salpetriere Hospital in Paris (Briquet, 1959). Jean­Martin Charcot, its most distinguished physician, was the first to demonstrate that hysteria had psychic origins (Charcot, 1889). His work subsequently had considerable influence on such traumatologists as Pierre Janet, Sigmund Freud, John Eric Erichsen, and Helmut Oppenheim.

Pierre Janet is credited as the first psychologist to study and treat traumatic stress, including hysterical and dissociative symptoms (van der Hart, Brown, & van der Kolk,

xvii

xviii FOREWORD

1989). His work began in the early 1880s (Janet, 1886). Through his numerous publica­tions, spanning over 50 years, Janet made some of the most important contributions to traumatology. Among his contributions are (1) the recognition of the inability to integrate traumatic memories as the core issue in posttraumatic syndromes (van der Hart et al., 1989), (2) the discovery of the importance of the fundamental biphasic nature of traumat­ic stress (van der Kolk, Brown, & van der Hart, 1989), (3) the articulation of all the symptoms of PTSD that are cited in contemporary diagnostic criteria in the DSM-III (van der Kolk et al., 1989), and other vital research.

Building on Janet and abandoning hypnosis because of its unreliability, Sigmund Freud experimented with direct suggestion, transference, and became involved in the emergence of persuasive therapy (Absem, 1984). Freud's contribution to traumatology (1895, 1914, 1920) is well documented. Less known, however, is the fact that Oppenheim (1911) is credited with coining the term "traumatic neurosis," although Joseph Breuer and Freud (1895/1955) were viewed as the primary contributors. The concept of post­traumatic neurosis emerged with the growing recognition of the emotional impact of highly stressful events.

At that time, there were many examples of human reactions to highly stressful events that resulted in the symptoms of posttraumatic neurosis, or posttraumatic stress disorder (PTSD) in today's parlance. Homer's epic poem, "The Odyssey," describes the psychological travails of Odysseus-a recent veteran of the Trojan Wars who was return­ing home to Ithaca-that include flashbacks and survivor's guilt. Trimble (1985) illus­trated many examples of trauma in literature: for example, Shakespeare's King Henry IV, "Why does thou bend thine eyes upon the earth .... Why hast thou lost the fresh blood in thy cheeks ... [have] thick-eyed musing and cursed melancholy?" Charles Dickens's nonfictional account of surviving a major train accident and his "two or three hours work ... amongst the dead and dying surrounded by terrific sights." His traumatizing experience led to his statement: "I am curiously weak-weak as if I were recovering from a long illness" (Foster, 1969).

Train wrecks were the principal means for the writing of another important chapter in the history of traumatology. Trimble (1981) carefully documented the development of what was called "railway spine" and later "Erichsen's disease," named for its inventor. In 1882, John Eric Erichsen had written a book containing his thesis that the "concussion of the spine" due to "violent shock of railway collision" could account for what would later be described as the symptoms of PTSD. His thesis was confirmed and extended by Clevenger (1889). Both books were used by litigant survivors of various railway accidents to secure a settlement for their ailments that could not be detected physically.

However, Herbert Page (1885), a surgeon working for the London and North West Railway, refuted the spine concussion thesis with his own book. Among other things, Page suggested that survivors of railway accidents who complain of various symptoms, such as sleep disturbances, startle responses, and numbing of various body parts with­out any organic explanation, are suffering from "nervous shock." He was one of the first writers to suggest a psychosocial origin for this heretofore mysterious disease.

War-related traumatic stress became the context for a continuing tradition of impor­tant research and conceptualization. Beginning with the clinical observations in early wars (Hammond, 1883) was the notion of melancholia, which was seen in combat vet­erans of the American Civil War. Shell shock emerged during World War I (Glass, 1954) to account for the PTSD-like symptoms observed in many returning war veterans. It was believed to be caused by the air blasts of explosives that left soldiers dazed and confused. Although this term was replaced with "war neurosis" or "traumatic neurosis" (Grinker & Spiegel, 1945), there was still a reluctance to ascribe its cause to exposure to and coping with frightening stressors. The consensus was that a predisposing character or person­ality defect accounted for why some individuals developed combat-related PTSD and others did not when exposed to the same type of stressor (Figley, 1978). This position

FOREWORD

generally prevailed until the Vietnam War but did not officially change until 1980 with the publication of the DSM-III (American Psychiatric Association, 1980), which now incorporated the term PTSD.

However, the areas of stress and coping seemed to evolve separately from that of traumatic stress with the focus by Claude Bernard (see Selye, 1956) on the milieu inUrieur (internal environment) of a living organism, the importance of which remains fairly constant irrespective of its external environment. Cannon (1929) built on this concept of "homeostasis," the ability of the body to remain in a constant state, thus providing staying power, which is roughly equivalent to a building'S heating system regulated partly by a thermostat.

Hans Selye is widely credited with developing the study of stress. He defined stress as "the state manifested by a specific syndrome which consists of all the non-specifically­induced changes within a biologic system" (Selye, 1956, p. 64). Much later, he defined stress more simply: "The nonspecific response of the body to any demand made upon it" (Selye, 1974, p. 14). Equally important, he was the first researcher to suggest that stress is not simply nervous tension or even exclusively distressing, that stress is some­thing to be avoided, but that complete freedom from stress is death. Even more helpful was Selye's discovery of the biological stress syndrome, which was known more widely as the general adaptation syndrome (Selye, 1974), that describes the body's general method of coping with any type of stressor (Figley, 1989).

Although traumatology has long historical roots, it was in the 1980s that it achieved accelerated growth with important and useful innovations coming to fruition. Among them was the publication of the DSM-III in 1980, the birth of the Society for Traumatic Stress Studies in 1985, and the Journal of Traumatic Stress. Today, traumatology is recog­nized as a separate field of study (Figley, 1988) with thousands of professionals specializ­ing in it worldwide.

The publication of this Handbook is one more important development in this growing field of study. The editors, who are internationally recognized scholars, have done a remarkable job of soliciting, organizing, and editing these chapters into a cohesive collection. When a definitive history of traumatology emerges, I am certain that this work will be a prominent feature.

References

CHARLES R. FIGLEY

Florida State University Tallahassee, Florida

Absem, D. W. (1984). Brief historical overview of the concept of war neurosis and of associated treatment methods. In H. J. Schwartz (Ed.), Psychotherapy of the combat veterans (pp. 1-22). New York: Spectrum.

American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washing­ton, DC: Author.

Azam, E. E. (1887). Hypnotisme, double conscience et alteration de la personalitt!. Paris: BalIiere. Breuer, J., & Freud, S. (1955). Studies of hysteria. In J. Strachey (Ed. and Trans.), The standard edition of the complete

psychological works of Sigmund Freud (Vo!. 2). London: Hogarth Press. (Original work published in 1895) Briquet, P. (1959). Traitt! dinique et therapeutique de l'hysterie. Paris: BalIiere. Cannon, W. B. (1929). Bodily changes in pain, hunger, fear, and rage. New York: Appleton. Charcot, J. (1889). Clinical lectures of the disease of the nervous system. London: New Syndenham Society. Clevenger, S. V. (1889). Spinal concussion. London: F. A. Davies. ElIenberger, H. F. (1970). The discovery of the unconscious: The history and evolution of dynamic psychiatry. New York:

Basic Books. Erichsen, J. E. (1882). On concussion of the spine: Nervous shock and other obscure injuries of the nervous system in their

clinical and medico-legal aspects. London: Longman, Green. Figley, C. R. (1978). Introduction. In Stress disorders among Vietnam veterans: Theory, research, and treatment. New

York: Brunner/Maze!' Figley, C. R. (1988). Toward a field of traumatic stress. Journal of Traumatic Stress, 1(1), 3-16.

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Figley, C. R (1989). Helping traumatized families. San Francisco: Jossey-Bass. Flournoy, T. (1900). A study of a case of glossolalia. New York: Harper. Foster, J. (1969). The life of Charles Dickens (Vol. 2). London: J. M. Dent. Freud, S. (1914). Psychopathology of everyday life (A. A. Brill, Trans.). London: T. Fisher Unwin. Freud, S. (1920). Selected papers on hysteria: Nervous and mental diseases monograph series, No.4. Glass, A. J. (1954). Psychotherapy in the combat zone. American Journal of Psychiatry, 110, 725-73l. Grinker, R, & Spiegel, J. P. (1945). Men under stress. Philadelphia: Blakiston. Hammond, W. A. (1883). A treatise on insanity in its medical relations. London: H. K. Lewis.

FOREWORD

Hodgson, R (1891). A cs [case] of double consciousness. In Proceedings of the Society of Psychical Research. London: Edward Arnold.

Hurst, A. (1940). Medical diseases of war. London: Edward Arnold. Janet, P. (1886). Les actes inconscients et Ie dedoublement de la personalite. Revues Philosophiques, 22(2), 212-

223. Oppenheim, H. (1911). Textbook of nervous diseases for physicians and students (A. T. Bruce, Trans.). London:

Foulis. Page, H. (1885). Injuries of the spine and spinal cord without apparent mechanical lesion. London: J. and A. Churchill. Selye, H. (1956). The stress of life. New York: McGraw-Hill. Selye, H. (1974). Stress without distress. Philadelphia: Lippincott. Trimble, M. R (1981). Post-traumatic neurosis. Chichester, England: Wiley. Trimble, M. R (1985). Post-traumatic stress disorder: History of a concept. In C. R Figley (Ed.), Trauma and its

wake: The study and treatment of post-traumatic stress disorder (Vol. 1, pp. 5-14). New York: Brunner/Mazel. van der Hart, 0., Brown, P., & van der Kolk, B. A. (1989). Pierre Janet's treatment of post-traumatic stress.

Journal of Traumatic Stress, 2(4), 379-396. van der Kolk, B. A., Brown, P., & van der Hart, O. (1989). Pierre Janet's post-traumatic stress. Journal of

Traumatic Stress, 2(4), 365-378. Veith, I. (1965). Hysteria: The history of a disease. Chicago: University of Chicago Press.

Preface

The field of traumatic stress studies has seen remarkable growth during the last decade since the advent of posttraumatic stress disorder (PTSD) as a diagnostic category in the third edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association in 1980. The exponential expansion of the field has moved the study and treatment into the mainstream of modem psychiatry, psychology, the neurosciences, as well as the social and behavioral sciences. To establish some perspective on the rate of growth of the field, one only has to recognize that a decade ago there were no reference books on traumatic stress syndromes, few standardized psychological measures of the disorder, little knowledge about the biological basis of behaviors associated with PTSD, and a limited understanding of effective therapeutic approaches. Today, in contrast, there are over 40 books on trauma and victimization, a Journal of Traumatic Stress, and hundreds of scientific articles in the major professional journals. Furthermore, in the United States, there is now the National Center for Post­Traumatic Stress Disorder, which has five specialized divisions at different Veterans Administration hospital locations. It is clear from these and other indicators that the field has come a long way in a short amount of time and will continue to grow rapidly across national boundaries.

The development of the International Handbook of Traumatic Stress Syndromes grew out of the recognition that a standard reference volume .was needed to organize the subareas of study in the field. The editors undertook an intensive effort to locate important research by some of the leading investigators throughout the world and integrate it within a structured organizational framework. The result of this process of international collaboration is an eight-part Handbook containing 84 chapters. These contributions span the breadth and depth of the field at this time concerning theory, research methodology, and treatment considerations across a number of survivor and victim populations. While every effort was made to be as inclusive as possible, some readers will no doubt find omissions or imbalances in areas that they regard as important to the field. In some cases, too, political pressure and the suppression of scientific data by governments prevented the opportunity for some investigators to have their research published, especially in Middle Eastern countries which have been affected by war and civil vio­lence in the last 20 years. Most of this scholarly material pertained to the effects of war trauma and the use of torture in these countries. Despite whatever limitations may exist, it is our hope that this Handbook will stimulate additional research, encourage the discov­ery of new techniques of treatment, and ultimately help to alleviate the pain and suffer­ing of traumatized persons, their families, and their loved ones.

In the broader social sense, the development of the field of traumatic stress studies

xxi

xxii

must symbolize the evolution of a humane concern for the consequences of violence and destruction, and, as such, must surely speak hopefully for the human race. If, at last, compassion for those who are inevitably wounded and hurt can override the aggressive and destructive themes so congruent in many of our cultures, then we may become ready for peaceful, nonviolent, just, and considerate human relationships amongst those who inhabit this small planet. In many respects, this book speaks dearly to the resiliency of human behavior and to the importance of hope in overcoming adversity, pain, suffering, and various forms of evil, cruelty, and unfairness that intrude into the lives of ordinary people throughout the world.

PREFACE

Acknowledgments

The completion of the massive project which became this Handbook could not have been accomplished without the assistance and support of many organizations and individu­als. First, the College of Arts and Sciences at Cleveland State University in the United States made it possible in 1989 for me (JPW) to have a six-month hiatus from my university teaching schedule in order to work in Australia with Dr. Beverley Raphael at the Royal Brisbane Hospital of the University of Queensland. Appreciation is extended to Dr. Steve Slane, Chairperson of the Department of Psychology, and to Dr. Georgia Lesh-Laurie, former Dean of the College at Cleveland State University, for their efforts on my behalf. I also offer special thanks to Dr. Harry Andrist, Dean of the College of Graduate Studies at Cleveland State University, whose financial support was appreci­ated.

A special thank-you is extended to the University of Queensland, Herston, Aus­tralia, which generously provided a travel grant in order for me to fly from the United States to Australia in June, 1989. Further, the faculty and staff in the Department of Psychiatry at Royal Brisbane Hospital were not only accommodating but also stimulating to work with during the colloquium and other special events. A special debt of gratitude is extended to Jan Parker, administrative assistant to Professor Raphael, who typed and retyped the original manuscripts received in Australia as well as overseeing the entire editing process on a daily basis. On numerous occasions, Ms. Parker worked well beyond her normal responsibilities to insure the proper preparation of the chapters. Thanks are also extended to all of the other secretarial staff who worked with her to complete this task.

During my stay in Australia, the Department of Veterans' Affairs and the Vietnam Veterans' Counselling Service (VVCS) arranged for me to visit every repatriation general hospital (RGH) and VVCS center. This opportunity not only allowed me to travel throughout Australia and Tasmania, but also enabled me to get to know the staff of the service as well. My appreciation and thanks are extended to Trevor Fear, my host on the tour and a good friend, and to Ric Marshall, who was then director of the vves.

At Cleveland State University, many individuals labored to see that this Handbook was completed in a thorough fashion. First and foremost, we wish to thank Lynn Viola, Secretary in the Department of Psychology, who assumed the responsibility of oversee­ing the production of 84 chapters on a daily basis. This enormous task was always carried out with a positive attitude and a recognition of the need to produce a reference volume to aid persons suffering the adverse emotional effects of trauma and victimiza­tion. Ms. Viola's sincerity and dedication were transmitted to students in the depart­ment who likewise worked beyond the call of duty to see that all of the work was correct

xxiii

xxiv ACKNOWLEDGMENTS

and properly organized. Expressing our appreciation here does not serve justice to their input and effort, but it is important to single out Sue Roberts, my graduate assistant, without whose dedication to the field of traumatic stress and expertise with computers the Handbook would not have become a reality. Thanks are also extended to Steve Mind­lin, Brenda Kozie, Adrienne Fitzpatrick, Karen Groth, Dan Ileana, Lisa Weston, Dawn Miller, Nicole Zirzow, Rachel Boyd, Jim Mullin, and David Fleck for their many hours of dedicated work.

We would also like to acknowledge the efforts of the contributors who shared in our vision of creating a state-of-the-art international reference volume on trauma and post­traumatic stress disorder (PTSD) which could be used by practitioners, researchers, scholars, educators, social policymakers, and others concerned with understanding and healing the painful and prolonged effects of traumatization.

Finally, a special thank-you to Dad and Mom, Bernard and Louise Armstrong of Oakey, Queensland, Australia, who graciously provided a wonderful place for the senior editor to live and write with his wife and children. The bucolic splendor of Brookvale Farm made the tasks of editing and writing a labor of love.

JOHN P. WILSON

BEVERLEY RAPHAEL

Contents

I. THEORETICAL AND CONCEPTUAL FOUNDATIONS OF TRAUMATIC STRESS SYNDROMES ............................... 1

1. From Hiroshima to the Nazi Doctors: The Evolution of Psychoformative Approaches to Understanding Traumatic Stress Syndromes ............. 11

Robert Jay Lifton

2. Biological Response to Psychic Trauma

Bessel A. van der Kolk and Jose Saporta

3. Multiple Personality Disorder and Posttraumatic Stress Disorder:

25

Similarities and Differences .......................................... 35

Bennett C. Braun

4. Stress-Response Syndromes: A Review of Posttraumatic Stress and Adjustment Disorders ............................................ 49

Mardi J. Horowitz

5. Psychoanalytic Contributions to a Theory of Traumatic Stress

Elizabeth A. Brett

6. Posttraumatic Stress Phenomena: Common Themes across Wars,

61

Disasters, and Traumatic Events ...................................... 69

Lars Weis~th and Leo Eitinger

7. Technological Hazards: Social Responses as Traumatic Stressors

J. Stephen Kroll-Smith and Stephen R. Couch

xxv

79

xxvi CONTENTS

8. Posttraumatic Stress Disorder in Experienced Anomalous Trauma ....... . 93

Rima E. Laibow and C. Shaffia Laue

9. Theoretical and Intervention Considerations in Working with Victims of Disaster .......................................................... 105

Beverley Raphael and John P. Wilson

II. ASSESSMENT, METHODOLOGY, AND RESEARCH STRATEGIES ..... 119

10. Emergency/Disaster Studies: Practical, Conceptual, and Methodological Issues ............................................................... 125

11.

Andrew Baum, Susan D. Solomon, and Robert J. Ursa no with (alphabetically) Leonard Bickman, Edward Blanchard, Bonnie L. Green, Terence M. Keane, Robert Laufer, Fran Norris, John Reid, Elizabeth M. Smith, and Peter Steinglass

Identifying Survivors at Risk: Trauma and Stressors across Events

Bonnie L. Green

12. Survey Research and Field Designs for the Study of Posttraumatic

135

Stress Disorder ...................................................... 145

Richard A. Kulka and William E. Schlenger

13. A Prospective Study of Victims of Physical Trauma

Anthony Feinstein

14. New Perspectives in the Assessment and Diagnosis of Combat-Related

157

Posttraumatic Stress Disorder ......................................... 165

15.

Jessica Wolfe and Terence M. Keane

Structured Clinical Interview Techniques

Daniel S. Weiss

16. Assessing Posttraumatic Stress Disorder with the Rorschach Projective

179

Technique ........................................................... 189

Patti Levin

17. Posttrauma Reactions Following a Multiple Shooting: A Retrospective Study and Methodological Inquiry .................................... 201

Mark Creamer, Philip Burgess, William Buckingham, and Philippa Pattison

CONTENTS

III. WAR TRAUMA AND CIVIL VIOLENCE

Section A. Trauma and the Aging Process: Studies Related to World War II ..... 213

18. Posttraumatic Stress Disorder in Dutch Resistance Veterans from World War II ........................................................ 219

Wybrand Op den Velde, Paul R. J. Falger, Johan E. Hovens, Jan H. M. de Groen, Louise J. Lasschuit, Hans Van Duijn, and Erik G. W. Schouten

19. Medical and Psychiatric Consequences of Being a Prisoner of War of the Japanese: An Australian Follow-Up Study ....................... 231

Christopher Charles Tennant, Kerry Goulston, and Owen Dent

20. Social Resources and the Mental Health of Aging Nazi Holocaust Survivors and Inunigrants ............................................ 241

Zev Harel, Boaz Kahana, and Eva Kahana

21. Posttraumatic Stress Disorder in World War II Prisoners of War from Alsace-Lorraine Who Survived Captivity in the USSR ............. 253

Marc-Antoine Crocq, Jean-Paul Macher, Jorge Barros-Beck, Stewart J. Rosenberg, and Fabrice Duval

22. War and Remembrance: The Legacy of Pearl Harbor

Zev Harel, Boaz Kahana, and John P. Wilson

Section B. Research from World War II to the Present

23. Posttraumatic Stress Disorder in Vietnam Veterans

Raymond Monsour Scurfield

24. The Vietnam Prisoner of War Experience

Edna J. Hunter

25. Posttraumatic Stress Syndromes among British Veterans

263

275

285

297

of the Falklands War ................................................. 305

Roderick Jan 0rner

26. Posttraumatic Effects and Their Treatment among Southeast Asian Refugees ............................................................ 311

J. David Kinzie

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xxviii CONTENTS

27. Immediate and Long-Term Effects of Traumatic Combat Stress among Israeli Veterans of the Lebanon War ............................ 321

Zahava Solomon

28. Psychiatric Morbidity Due to War in Northern Sri Lanka

Daya J. Somasundaram

29. The Psychiatric Effects of War Stress on Afghanistan Society

Abdul Wali H. Wardak

30. Stress, Coping, and Political Violence in Northern Ireland

Ed Cairns and Ronnie Wilson

333

349

365

31. Posttraumatic Stress Disorder and Civil Violence in Northern Ireland 377

G. C. Loughrey, Peter S. Curran, and P. Bell

32. Effects of Postshooting Experiences on Police-Authorized Firearms Officers in the United Kingdom ........................... . . . . . . . . . . . 385

Mary Bernadette Manolias and Arthur Hyatt-Williams

IV. TRAUMA RELATED TO DISASTERS OF NATURAL AND HUMAN ORIGIN .............................................. 395

33. Posttraumatic Stress Disorder in Natural Disasters and Technological Accidents ........................................................... 405

Elizabeth M. Smith and Carol S. North

34. PTSD: Synthesis of Research and Clinical Studies: The Australia Bushfire Disaster .................................................... 421

Alexander Cowell McFarlane

35. Chernobyl: Nuclear Threat as Disaster ................................. 431

Tom Lundin, Bertil Mdrdberg, and Wf Otto

36. The Buffalo Creek Disaster: A 14-Year Follow-Up 441

Mary C. Grace, Bonnie L. Green, Jacob D. Lindy, and Anthony C. Leonard

37. The Kings Cross Fire: Early Psychological Reactions and Implications for Organizing a "Phase-Two" Response ............................... 451

Stuart W. Turner, James Thompson, and Rachel M. Rosser

CONTENTS

38. The Piper Alpha Oil Rig Disaster

David Alan Alexander

39. The North Sea Oil Rig Disaster

Are Holen

40. Traumatic Stress Reactions in the Crew of the

461

471

Herald of Free Enterprise .............................................. 479

S. Janet Johnston

41. Earthquakes and Traumatic Stress: Early Human Reactions in Japanese Society .............................................................. 487

Tsunemoto Odaira, Toshiharu Iwadate, and Beverley Raphael

42. Study of a Major Disaster in the People's Republic of China: The Yunnan Earthquake .............................................. 493

Alexander Cowell McFarlane and Cao Hua

43. Traumatic Stress Reactions to Motor Vehicle Accidents

David J de L Horne

44. Treatment of Victims of Rape Trauma

Carol R. Hartman and Ann W. Burgess

45. AIDS: Coping with Ongoing Terminal Illness

Brian Kelly and Beverley Raphael

499

507

517

V. THE IMPACT OF TRAUMA ON CHILDREN AND ADOLESCENTS 527

46. Issues in the Treatment of Posttraumatic Stress in Children and Adolescents ..................................................... 535

Robert S. Pynoos and Kathi Nader

47. Father Kills Mother: Effects on the Children in the United Kingdom..... 551

Dora Black, Tony Kaplan, and Jean Harris Hendriks

48. Responses of Children and Adolescents to Disaster

Rob Gordon and Ruth Wraith

561

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xxx

49. Childhood Sexual and Physical Abuse

Arthur Green

50. Father-Daughter Incest

Judith Lewis Herman

51. Bitter Waters: Effects on Children of the Stresses of Unrest

CONTENTS

577

593

and Oppression ...................................................... 601

Michael A. Simpson

52. Traumatic War Experiences and Their Effects on Children

Mona S. Macksoud, Atle Dyregrov, and Magne Raundalen

53. Transgenerational Transmission of War-Related Trauma

Laurie Leydic Harkness

54. Apartheid: Disastrous Effects of a Community in Conflict

Derrick Silove and Robert Schweitzer

55. Psychotherapy with Young Adult Political Refugees: A Developmental

625

635

645

Approach ........................................................... 651

Guus van der Veer

VI. TRAUMA RELATED TO TORTURE, DETENTION, AND INTERNMENT ................................................ 659

56. Traumatic Stress and the Bruising of the Soul: The Effects of Torture and Coercive Interrogation ........................................... 667

Michael A. Simpson

57. The Psychosexual Trauma of Torture

Inger Agger and Seren Buus Jensen

58. Psychological Sequelae of Torture

Stuart W. Turner and Caroline Gorst-Unsworth

59. Therapy with Families Who Have Experienced Torture

Tony Jaffa

685

703

715

CONTENTS

60. Hyperventilation as a Reaction to Torture

Stuart W. Turner and Alexandra Hough

61. Disruption and Reconstitution of Family, Network, and Community

725

Systems Following Torture, Organized Violence, and Exile.............. 733

Richard Douglas Blackwell

62. Torture of a Norwegian Ship's Crew: Stress Reactions, Coping, and Psychiatric Aftereffects ............................................... 743

Lars WeisiEth

63. Principles of Treatment and Service Development for Torture and Trauma Survivors .................................................... 751

Margaret Cunningham and Derrick Silove

64. Medical Diagnosis and Treatment of Torture Survivors

Marianne Juhler

VII. INTERVENTION, CLINICAL TREATMENT, AND PSYCHOTHERAPY:

763

APPROACHES TO RECOVERY AND TREATMENT ................... 767

65. Posttraumatic Therapy

Frank M. Ochberg

66. Psychobiological and Pharmacological Approaches to Treatment

Matthew J. Friedman

67. Neurophysiological Considerations in the Treatment of Posttraumatic

773

785

Stress Disorder: A Neurocognitive Perspective ......................... 795

George S. Everly, Jr.

68. Focal Psychoanalytic Psychotherapy of Posttraumatic Stress Disorder 803

Jacob D. Lindy

69. War-Related Trauma and Victimization: Principles of Traumatic Stress Prevention in Israel .................................................. 811

Noach Milgram

70. Posttraumatic Narcissism: Healing Traumatic Alterations in the Self through Curvilinear Group Psychotherapy ............................. 821

Erwin Randolph Parson

xxxi

xxxii CONTENTS

71. Beyond the DSM-III-R: Therapeutic Considerations in Posttraumatic Stress Disorder ...................................................... 841

Henry Krystal

72. Posttraumatic Stress Recovery of Terrorist Survivors

Ofra Ayalon

73. A 12-Step Recovery Program for Victims of Traumatic Events

Joel Osler Brende

855

867

74. Treatment of Posttraumatic Stress Disorder among Vietnam Veterans 879

Raymond Monsour Scurfield

75. Diagnostic and Therapeutic Use of the Multigenerational Family Tree in Working with Survivors and Children of Survivors of the Nazi Holocaust ........................................................... 889

Yael Danieli

VIII. ORGANIZATION, SOCIAL POLICY ISSUES, AND CRITICAL STRESS INCIDENT DEBRIEFING IN RESPONSE TO VICTIMS OF TRAUMA ...................................................... 899

76. Traumatic Stress in Disaster Workers and Emergency Personnel: Prevention and Intervention .......................................... 905

Jeffrey T. Mitchell and Atle Dyregrov

77. Vet Centers: A New Paradigm in Delivery of Services for Victims and Survivors of Traumatic Stress ..................................... 915

Arthur S. Blank, Jr.

78. Trauma in the Workplace

Tom Williams

79. International Perspectives on the Treatment and Prevention

925

of Posttraumatic Stress Disorder ......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 935

Giovanni de Girolamo

80. Mental Health Policy for Victims of Violence: The Case against Women ...................................................... 947

Susan E. Salas in and Robert F. Rich

CONTENTS xxxiii

81. Coping with Disaster: The Helping Behavior of Communities and Individuals ...................................................... 957

Liisa Eriinen and Karmela Liebkind

82. Temporary Organization for Crisis Intervention: When Disaster-A Hotel Fire-Strikes a Community ........................................... 965

Renate Gnmvold Bugge

83. Role of Voluntary Organizations in the United Kingdom for Disabled Veterans Suffering from War Trauma and Posttraumatic Stress Disorder 975

Linda Ann Stevenson

84. Settlement Reconstruction and Psychological Recovery in Iran

Akbar Zargar, Bahman Najarian, and Derek Roger

979

Index.................................................................... 989