The relationship between childhood trauma and personality traits structure in adulthood
Doctoral thesis at the Medical University of Vienna for obtaining the academic degree
Doctor of Medical Science
Submitted by
MSc. Naim Telaku
Supervisor: Assoc. Prof. Priv.-Doz. Dr. Dietmar Winkler
Universitätsklinik für Psychiatrie und Psychotherapie Währinger Gürtel 18-20 1090 Wien
Vienna August 2018
Childhood trauma and personality … 2
Contents Contents ...... 2
Declaration ...... 5
Contents of tables and figures ...... 6
Abbreviations ...... 7
Acknowledgements ...... 8
Abstract...... 9
Abstract in German ...... 10
1. CHAPTER ONE: INTRODUCTION ...... 11
1.1. General Introduction ...... 11
1.2. What this study is about ...... 12
1.3. Theoretical Background ...... 15
1.3.1. Personality Definition ...... 15
1.3.2. History of Personality Research ...... 16
1.3.3. The Lexical Perspective ...... 19
1.4. The Five Factor Model of Personality (McCrae et al., 1997) ...... 20
1.5. The 1998-99 War in Kosovo and the psychological consequences of it ...... 23
1.6. Psychology of Trauma ...... 23
1.6.1. Psychological and psychiatric disorders as a reaction to trauma ...... 25
1.6.2. PTSD as a reaction to Trauma ...... 26
1.6.3. Studies that link PTSD and Depression with war trauma ...... 28
1.6.4. Personality and Trauma ...... 30
1.7. Early childhood trauma, brain development and the effect of age of traumatization on personality development ...... 32
1.8. The current study ...... 34
1.8.1. Aims of the study ...... 35
1.9. Hypothesis ...... 36 Childhood trauma and personality … 3
2. CHAPTER TWO: RESULTS ...... 37
2.1. Descriptive statistics of the main variables ...... 37
2.1.1. Neuroticism ...... 38
2.1.2. Extraversion ...... 38
2.1.3. Openness to experience ...... 39
2.1.4. Agreeableness ...... 39
2.1.5. Conscientiousness ...... 39
2.2. Depression ...... 40
2.3. Trauma exposure and PTSD ...... 41
2.4. Correlations between variables ...... 42
2.5. Correlations within the variables measuring trauma ...... 44
2.6. Age correlations ...... 45
2.7. Personality correlations ...... 45
2.7.1. Neuroticism facets correlations ...... 45
2.7.2. Correlations of other personality facets ...... 46
2.8. Linear regression analysis ...... 47
2.9. Summary of the results ...... 48
3. CHAPTER THREE: DISCUSSION ...... 49
3.1. Reiteration of hypothesis and General discussion of the findings ...... 49
3.2. General discussion of the results ...... 50
3.2.1. Trauma exposure and Post Traumatic Stress Disorder ...... 50
3.3. Correlation of age with the dependent variables ...... 52
3.4. Trauma exposure and depression ...... 52
3.5. Personality findings ...... 54
3.5.1. Trauma and personality ...... 55
3.6. Theoretical explanations of the findings from a neuroscientific perspective ...... 57 Childhood trauma and personality … 4
3.6.1. The Rothbart (2006) conceptualization of temperament and personality continuity 60
3.7. Experienced Trauma and Personality disorders ...... 61
3.8. General implications of the study ...... 61
3.8.1. Clinical implications of the study ...... 62
3.8.2. Limitations ...... 62
3.8.3. Future prospects ...... 63
3.9. Conclusion ...... 63
4. CHAPTER FOUR: MATERIALS and METHODS ...... 64
4.1. Sample selection and sample size ...... 64
4.2. Inclusion criteria and compensation ...... 64
4.3. Procedure ...... 64
4.4. Instruments ...... 65
4.4.1. NEO PI-R (Costa et al., 1992) ...... 65
4.4.2. Beck Depression Inventory II (BDI II, 1996) ...... 68
4.4.3. Harvard Trauma Questionnaire (HTQ, Mollica et al., 2000) ...... 68
4.5. Data processing ...... 70
REFERENCES ...... 71
CV Naim Telaku ...... 86
Letter of ethical approval ...... 87
Childhood trauma and personality … 5
Declaration
This research project was developed at the Department of Psychiatry and Psychotherapy of the Medical University of Vienna. The data have been collected at the Department of Psychology at the University of Pristina. Hereby, the staff of the aforementioned department has given a considerable contribution in the process of data collection.
The author herby confirms that planning of the study, testing, statistical analysis of results and preparation of the manuscript were exclusively performed by himself under the guidance of his supervisor.
Naim Telaku MSc.
Childhood trauma and personality … 6
Contents of tables and figures
Table 1. Cattell’s 16 factor personality model...... 18 Table 2. Five factor model of personality...... 21 Table 3. Descriptive statistics of the main variables...... 36 Table 4. The average scores of neuroticism facets...... 37 Table 5. The average scores of extraversion facets...... 37 Table 6. Main correlations between variables.....42 Table 7. Correlations between depression and neuroticism facets.....45 Table 8. Five factors of personality description...... 46 Table 9. Linear regression of trauma exposure and dependent variables...... 47
Figure 1. Extraversion average scores...... 39 Figure 2. Severity of depressive symptomatology...... 40 Figure 3. Severity of trauma exposure...... 41 Figure 4. Scatterplot between trauma exposure and extraversion...... 43 Figure 5. Severity of depression BDI…….52
Childhood trauma and personality … 7
Abbreviations
(A) Agreeableness (C) Conscientiousness (E) Extraversion (N) Neuroticism (O) Openness APA American Psychiatric Association BDI Beck Depression Inventory DSM Diagnostic and Statistical Manual of mental disorders FFM Five Factor Model of Personality HTQ Harvard Trauma Questionnaire MDD Major Depressive Disorder NEO PI-R Neuroticism-Extraversion-Openness-Personality Inventory revised PTSD Post-Traumatic Stress Disorder
Childhood trauma and personality … 8
Acknowledgements
I take the chance to thank the staff of the Department of Psychology of the University of Pristina, who have given the first impetus that this research project started off well on its feet. In particular, I am personally thankful to my colleagues Dashamir Bërxulli, Aliriza Arënliu, Laura Berisha, Kaltrina Kelmendi, Zamira Hyseni, Liridona Jemini, Erëblir Kadriu, Natyra Agani, Fitim Uka, and Shpend Voca.
But most of all, I am thankful to my supervisor Prof. Dietmar Winkler, who believed in me and by hisconstant readiness to answer my questions, in the shortest time possible, has enabled me to reach the end of this project.
I also thank my brother Agim, for offering me free accommodation during my studies in Vienna, and my friends Roland and Yvi, who have made life much easier and colorful for me there.
Childhood trauma and personality … 9
Abstract
The aim of this study is to investigates the prolonged effects of childhood trauma on personality and emotionality in adulthood. We looked for personality changes, depression and posttraumatic stress disorder (PTSD) among university students who had experienced the Kosovar war of 1998-
1999 as children.
To measure the exposure to trauma and PTSD, we used the Harvard Trauma Questionnaire, while for personality traits measurements, the NEO personality inventory – revised was applied on 355 respondents. Beck depression inventory was used to measure depression.
Our findings reveal that 13.1% of our participants fulfill the criteria for PTSD. The personality factors of extraversion and agreeableness were negatively correlated with the experience of childhood traumatic events. The other personality factors of neuroticism, openness to experience and conscientiousness did not correlate with trauma. Neither did depression.
The findings of this study reveal that childhood trauma can have long lasting effects on personality.Lowered scores on extraversion and agreeableness might indicate a poorer social participation and performance, and lower satisfaction with social interactions and less positive emotions in general.
Childhood trauma and personality … 10
Abstract in German
Die Folgen von frühen Kindheitstraumata auf Persönlichkeitsstrukturen im späteren Erwachsenenleben sind aus unserer Sicht von der bisherigen Forschung nur unzulänglich behandelt worden. Die etablierte Literatur zum Thema Persönlichkeit behandelt Persönlichkeit als stabile Eigenschaften, die sich während der unterschiedlichen Lebensabschnitte nicht verändert, das heißt, es wird angenommen, dass die Persönlichkeit bis ins hohe Alterstabilbleibt. Dieses Forschungsprojekt ist auf der gegenteiligen Hypothese aufgebaut: Die Persönlichkeit im Erwachsenenalter reflektiert Traumaerfahrungen im Kindersalter. Genauer gesagt haben wir versucht, den Effekt eines Traumas zu messen, und zwar 16 Jahre, nachdem das Trauma stattgefunden hat. Zudem ist unsere Hypothese, dass die Raten für Depression und posttraumatische Belastungsstörung (PTSD) bei im Kindesalter traumatisierten erwachsenen Personen höher ist. Das Fünf-Faktoren-Model der Persönlichkeit bildet die Ausgangsbasis unserer Studie, um die Persönlichkeiten zu messen. Daten von 355 Universitätsstudenten, die vor etwa 16 Jahren, im Alter zwischen 2 und 8 Jahren, ein kriegsbezogenes Trauma erlitten haben, füllten einmalig den NEO PI-R (McCrea, 1992), denHarvard Trauma Fragebogen (Mollica, 2000) und dasBeck Depressionsinventar (Beck, 1961)aus. Unsere Ergebnisse zeigen, dass mindestens zwei der fünf Faktoren der Persönlichkeit, und zwar Extraversion (Extravertiertheit) und Agreeableness(Verträglichkeit) stark mit einem Kindheitstrauma korrelieren. Anders ausgedrückt:Um so stärker/schlimmer das Traumaerlebnis war, desto niedriger war der Wert in diesen beiden Persönlichkeitsfaktoren, wobei bekannt ist, dass sowohl Extraversion als auch Agreeableness einen Einfluss auf unsere sozialen Kompetenzen und Anpassungsfähigkeiten ausüben. Niedrige Werte für Extraversion und Agreeableness deuten auf eine schwache soziale Eingliederung, Leistung und Zufriedenheit hin. Die Regressionsanalysezeigte, dass 3,6% der Schwankung in Extraversion und 1,8% der Schwankung in Agreeableness auf ein kindliches Trauma zurückzuführen ist. Zudem zeigen unsere Ergebnisse eine starke Verbindung zwischen Kindheitstrauma und PTSD, jedoch keine signifikante Beziehung zwischen Kindheitstrauma und Depression Childhood trauma and personality … 11
1. CHAPTER ONE: INTRODUCTION
1.1. General Introduction
The twentieth century as we remember it, has not been strange to wars and other collective adversities caused by humans to other humans. Unfortunately, most of the nations that populate the earth today, in one way or another, have undergone war-like circumstances. Hence, needless to say that wars are catastrophic and to be avoided at any cost. ”War destroys communities and families and often disrupts the development of the social and economic fabric of nations” (Murthy, 2006). Just like any other catastrophe that spares nothing in its course, wars don’t spare children either. A recent report from UNICEF (2016) indicates that one in ten children worldwide, currently live in war impacted zones. Moreover, as we speak, around 250 million children are growing up amidst war traumas and tortures. Around the globe, one in six children is directly or indirectly affected by war (Rieder et al., 2012). In the spring of 1998, a disastrous war started between the local Albanian population of Kosovo (located in south-eastern Europe) and the armed forces of the neighboring country, Serbia. The war ended fifteen months later, leaving behind 13 000 people dead, 11 000 local Albanians, the vast majority of them unarmed civilians, and 2 000 non-Albanians, most of them Serbians (Fanaj et al., 2017). According to Agovino (1999), the Albanian population of Kosovo “were victims of the worst cleansing in Europe since WW II” (p. 1701). Initial post-conflict evaluations revealed that from the 1.9 million population of Kosovo, 200 000 to 400 000 of them were estimated to have been traumatized during the war in Kosovo (Gierlichs, 2008). In total, about one million people were negatively affected by the conflict, and half of them were children (Barath, 1999). Studies that investigate the mental scars of war trauma upon children, reveal that posttraumatic stress disorder is highly present in all the affected and surveyed cases, ranging from 10% in the Iraqi post war (2001) to 70% among the Palestinian children who have been undergoing armed conflicts most of their life (Dimitry, 2012). The participants of the current study, at the time of Kosovo war (1998-99) were preschool children, while at the time of data collection (2015), had reached the age of university, entering adulthood. The impact of war trauma that endured this sixteen year period, and could still influence the personalities and the mental health of our participants, is the main focus of this study. Childhood trauma and personality … 12
1.2. What this study is about
The impact of war trauma can be disastrous for the wellbeing of those affected, regardless their age, gender or ethnicity. Many studies from different countries report various psychological disturbances due to the experience of traumatic events. A national, population-based study conducted in Palestine, involving 799 adults found that among respondents who had experienced trauma in the past 10 years, 67.7% suffered from depression, 72.2% suffered from anxiety, and 42% suffered from PTSD (Cardoso et al., 2004). In Cambodia, studies have found a high level of mental disturbances even 10 years after the war (Bohenlein et al., 2004). Similar results were found by Sholte et al., (2004) in Afganistan. Furthermore, the latter found that the severity of symptoms was related to the number of traumatic events experienced by respondents (Sholte et al., 2004). When similar studies were conducted with the Balkan nations that underwent war, the researchers found similar results as well. A study with Bosnian refugees from the 1992-1995 war with Serbia, found a steady link between psychiatric disorders such as PTSD and depression with the experience of traumatic events (Momartin et al., 2003). Similar results that report psychiatric disorders such as PTSD, anxiety, somatoform disorders and depression among sufferers of trauma were found in other countries such as Chechenya (Human Rights Watch, 2003), Israel (Benyaimini et al., 2005; Bleich et al., 2003), Lebanon (Bryce et al., 1989; Karem et al., 1998; Saab et al., 2003), Uganda (Paardekooper et al., 1999), Somalia (UNICEF, 2004), Sri Lanka (Somasundaramet al., 1994), Rwanda (Gourevitch et al., 1999) and Palestine (Quotaet al., 2003). According to initial reports after the Kosovo war, 64.9% of the population were traumatized (Gierlichs, 2008). Moreover, seven years after the war, studies still found a high prevalence of post-traumatic stress disorder (PTSD) (22%) and depression (43.1%) (Wenzel et al., 2006). The findings demonstrated only a small alleviation of results in the studies conducted in the following years. In 2013, the rates for PTSD among Kosovo population fell at 17.9% (Fanaj et al., 2014). As can be deduced from the above mentioned studies, the two main realms in which the trauma impact is psychologically manifested are the anxiety spectrum disorders, in which the most common type of disorder is PTSD, and affective spectrum disorders, in which case, the most common type of disorder is major depressive disorder (MDD). According to Rutkowski (2016), psychiatric disorders such as PTSD and depression are not the only long lasting consequences of childhood trauma. Personality could be negatively affected by trauma as well. Even though, we didn’t have much luck in finding studies which link childhood war trauma with adult personality, the studies which find correlations between other types of trauma such as neglect and abuse and Childhood trauma and personality … 13
adult personality traits and personality disorders are many (Czapiga, 2009; Rutkowski et al., 2016; Yoyen et al., 2017). In the same line of scientific inquiry, this study looks back at the Kosovar preschoolers who underwent war in the years 1998-99, and examines the way their personalities have been shaped in their adult life, with the aim of finding out if the war trauma has played any role with regard to such developments. The way that personality reacts and manages traumatic events adds more ramifications to the already complex nature of the human personality. In this study, personality refers to a theoretical structure borne out of frequencies within language. The Five Factor Model of Personality by McCrae (1992) (the factors being: neuroticism, extraversion - introversion, agreeableness, openness to experience, and conscientiousness) that is used here, will serve as the theoretical negative against which the data will be extrapolated and analyzed within this study project. This model, also known as the ‘big five’, is a description of personality traits based on how most people described each other in the past and how they codified these descriptions in language. The most popular words, especially adverbs, eventually gained gravity and were to be ever more present in the everyday language. The five factors of the Five Factor Model (FFM) also known as traits, are the most common adverbs that people used to describe one another in the past in different cultures and languages (Widger, 2017).The FFM is proven to comprise the most persistent traits of personality in many cultures and nations (McCrae et al., 2002). Furthermore, it can be said that this model of personality has engrained and incorporated the gist of most alternative models as driven by different personality schools. Many studies have found links between childhood trauma and different personality factors (Kendler et al., 2006; Radlof et al., 1997). Childhood trauma, especially the one caused by humans, can result in the destruction of the linking scheme between the self and the others in a person, and especially in a child (Czapiga, 2009). Interpersonal relationships and competences are deteriorated for long periods of time as well. There are many psychological disorders, syndromes and other psychological influences which have been named and can be linked with severe physical or psychological trauma, but they are not in the scope of this study. This study focuses on the remnants of PTSD, depressive disorders and the structure of personality of a sample which consists of people who experienced 15 months of war-related trauma events in Kosovo 16 years before data collection for this study. The psychological mechanisms and factors that this study investigates are very complex and hard to precisely define and delineate. The concept of trauma itself is hard to define, a difficulty that is worsened by the fact that people tend to react very differently towards traumatic Childhood trauma and personality … 14
experiences. Other than that, personality is a very complex term and hard to operationalize as well. While one could say that personality consists of the most stable patterns of behavior of an individual, usually referred to as trait dispositional level conceptualization of personality, another might argue that everything is a product of circumstances and personality is just the initial feats of reaction, referred to as behavioral-conditioning level conceptualization of personality (Mischen & Shonda, 2008). On another dimension, lives of the subjects of this study should have been filled with many events and experiences during these 16 years after the war. For most of them, freedom that came after the traumatic events of war is defined as their ‘lifetime event’. Meanwhile, distinctive cultural changes have been evident. People changed the way of living, including the way the families were organized, moving from a collectivist way of living towards an individualistic one. Participation in open education, accompanied by opportunities for more freedom and liberties, allows people in Kosovo to opt for various choices that came along. Nevertheless, high hopes and dreams of the perfect world after the war vanished very quickly. For a good portion of the local population of Kosovo, domestic violence is not an unknown experience. Many children grow up in families where different kinds of abuse and neglect are the norm (Qosaj-Mustafa et al., 2009). These factors, combined with the impact of trauma that a war might cause, could result in a complex pattern of interactions, correlations and confounding variables that could affect the results. However, this study does not intend to look at all of these factors. It rather focuses on the basic and general structure of personality traits with regard to each of the five factors of personality and how they could correlate with traumatic experiences. The research method of this study is quantitative, aiming to build correlational relationships between the investigated variables. It is believed that using such a research method would best aid the aim of building a relationship between two variables with a broader sample of subjects. Paper-pencil tests of personality (NEO PI-R, 1978), depression (Beck Depression Inventory II, 1968), traumatic experiences and PTSD (Harvard Trauma Questionnaire, 1991) were applied to a sample of university students studying Psychology at the University of Pristina. These tests offer a distinguished picture and conceptualization of both personality traits and mental functioning anomalies related to PTSD and depression. Students that were subjects of this study had a mean age of 21, and were between the ages of 5and 11 when the war in Kosovo happened. That is a very critical age of development in many respects. Children learn and experience a wider scope of interpersonal relationships, while the development of language, emotional and cognitive skills is at a critical point. Theorists of personality, especially those falling in the waves of Childhood trauma and personality … 15
psychoanalysis, associate this period of life with how one reacts to everything that happens later in life as a grown up.
1.3. Theoretical Background
1.3.1. Personality Definition
Personality refers to an individual’s characteristic patterns of thought, emotion, and behavior, together with the psychological mechanisms hidden behind those patterns (Funder, 2004). According to this conceptualisation, the definition of personality seems rather easy and straightforward. In reality, the definition of personality is one of the hardest definitions that psychologists had to agree upon. This was mostly due to the fact that any trait or any psychological function that could be thought of, could be adopted within the personality definition. For example, Larsen and Buss (2005), tend to incorporate and give precedence to interpersonal relations within the personality conceptualization. Furthermore, according to them, ‘personality is the set of psychological traits and mechanisms within an individual’s mind, which are organized and relatively enduring and which influence the individual’s interactions and adaptations to the others, as well as to the psychic, physical and social environments (Larsen et al., 2005). However, there are other definitions of personality which tend to follow a rather convergent and inclusive approach, mostly based on the end products of personality dynamics such as behavior and action. In this direction, Mayer (2007) defines personality as “the organized, developing system within the individual that represents the collective action of that individual’s major psychological subsystems”. Regardless of the sources used to define personality, there are few factors which are almost always present with most of the definitions. These factors represent the inborn traits of temperament and the individual history of a person (McCrae et al., 1978). Moreover, when speaking of personality, one is supposed to always have in mind a dynamic and interacting mechanism between different parts that make up the human psyche. These diverse parts or factors interact together in a very dynamic mode without ever coming to termination. Yet, the picture is not complete if the explanation of personality is attempted without taking into consideration the behavior and objective output that it generates. In a way or another, the behavioral manifestation of personality traits is the only microscope that grants access to personality structure. Before moving on to the models of personality conceptualization, it is worth mentioning that although most theories and studies on personality aim to identify and bring together the similarities between individuals-- the ‘basic particles’ that make up all humans-- some personality definitions, especially those laying at the periphery of psychological mainstream, put Childhood trauma and personality … 16
the emphasis on individual differences rather than similarities when defining personality (Aronsonet al., 2005). Depending on the school of thought or time of occurrence, there are six basic levels of conceptualizing personality (Mischel & Shoda, 2008): The trait-dispositional level: seeks to identify the types of stable psychological qualities and behavioral dispositions that characterize different individuals and types consistently. The biological level: aims at answering the old question in psychology, nature vs. nurture. Different schools of thought, such as psychoanalysis, give more precedence to the impact that heredity plays in personality structure and functioning, whereas other behavioral and cognitive schools put the emphasis on the effects of upbringing and external circumstances. The psychodynamic motivational level: tends to reduce the explanation of personality to internal psychological dynamics such as unresolved childhood conflicts, while at the same time, the role of biology and instincts is held at a high regard. The behavioral-conditioning level: within this model of explanation, personality is viewed as the sum of the learned experiences throughout conditioning. The phenomenological-humanistic level: unlike the behavioral and psychodynamic levels, this model of personality conceptualisation takes into consideration the subjectivity and freedom of individuals when explaining personality. The social cognitive level: aims at scrutinizing the person’s social knowledge of the world, their sense for other people and for themselves, and their given meaning and goals of their lives (Mischel & Shoda, 2008). The FFM model of personality (McCrea et al., 1978), which is the theoretical background of this study, embraces the trait dispositional conceptualization of personality.
1.3.2. History of Personality Research
Gordon Allport is among the pioneers that advanced research on personality. The aim of Allport with regard to this field of research was to build a model of personality which would make it possible to measure the distinguishable qualitiesof all humans (Allport, 1937). To do this, he utilized the construct of traits as steady feats of personality that express uniqueness and consistency in behavior. As summarized in Liebert and Spiegler (1998), traits as Allport conceptualized them have these characteristics: Childhood trauma and personality … 17
Traits arenot necessarily just descriptive but are integrative parts of personality. Traits are more general modes of behaving than just habits. Traits are dynamic and produce behavior. Traits can be measured empirically. Traits are independent of each other. Traits are not synonymous with moral or social judgments. Traits can be viewed both ideographically and nomothetically1. Behaviors and acts incompatible with traits do not nullify the latter. The trait-dispositional model is not necessarily the same as the Five Factor Model used in this study, as postulated by the Lexical Model (Wiggins, 1996), to which we will get back later. Raymond Catell embraced the trait-dispositional model even though he did not comply totally with the genotypic characteristics of traits. He was more in line with the lexical model of personality, because he believed all feats of the psyche to have eventually evolved into language, or as he put it: “... all aspects of human personality which are or have been of importance, interest or utility, have already become recorded in the substance of language” (Cattell, 1943. p. 483). To enrich the conceptualization of personality, Cattell started his work by building on the first opus of personality language words (17.953 words), which Allport had initially developed. He firstly reduced the list into 160 categories which were initially presented as bipolar mode (Catell, 1943). In his final factor analysis studies, he found 12 primary factors with 35 clusters which later became known as Catell’s 16 personality factor model (Catell, 1943). The primary factors as listed by Berxulli (2009) are:
1Idiographic: Unique, not necessarily universal. Nomothetic: Universally present.
Childhood trauma and personality … 18
Table 1 Primary Factors and Descriptors in Cattell’s 16 personality Factor Model Descriptors of low range Primary Factor Descriptors of high Range
Schizothymia Warmth Affectothymia
Lower scholastic Reasoning Higher scholastic Mental capacity capacity
Lower ego strength Emotional stability Higher ego strength
Submissiveness Dominance Dominance
Desurgency Liveliness Surgency
Low ego strength Rule Consciousness High ego strength
Threctia Social Boldness Parmia
Harria Sensitivity Premsia
Alaxia Vigilance Pretension
Praxernia Abstractedness Autia
Artlessness Privateness Shrewdness
Untroubled Apprehension Guilt proneness
Conservatism Openness to change Radicalism
Group adherence Self-reliance Self-sufficiency
Low integration Perfectionism High self-concept control
Low ergic tension Tension High ergic tension
The work of Cattell was continued by Fiske (1949), but due to a different model of factor analysis that Fiske utilized, he could not reciprocate the Cattell 16 factor model. A similiar Childhood trauma and personality … 19
approach to the FFM, which also uses factorial analysis, was presented by Tupes and Cristal (1992). They identified the following five strong factors emerging from factor analysis: surgency, agreeableness, dependability, emotional stability and culture (Cristal et al., 1992).
1.3.3. The Lexical Perspective
One of the hot topics in the history of personality research has been whether personality models should include and explain the genetic predispositions of psychological attributes, i.e. genotype, or only the phenotypes, i.e. the manifested and observed part of the behavior. The lexical perspective, which stands as the backbone of the Five Factor Model of Personality, supports the view that good personality models, including the FFM, phenotypically derive from language. Hence, they can only describe phenotypes but not genotypes (Wiggins, 1996). In another publication in 1957, Cattell took this assumption one step further by supporting the position that all interpersonal dynamics and interpersonal influences get eventually stamped into language or some other symbolic manner. In his words: “Over the centuries, by the pressure of urgent necessity, every aspect of one human being’s behavior that is likely to affect another, has come to be handled by some verbal symbol—at least in any developed language” (Cattell, 1957. p. 71). We find another prominent figure in personality research, Warren Norman, arguing in the same line of thought. Norman (1967), argues that “any taxonomy of personality attributes must take as its fundamental database the set of all perceptible variations in performance and appearance between persons, or within individuals over time and varying situations that are of sufficient social significance, of sufficiently widespread occurrence, and of sufficient distinctiveness to have been encoded and retained as a subset of descriptive predicates in the natural language during the course of its development, growth, and refinement.” In other words, Cattell, Norman and other theorists of personality, position language and language development at the very foundation of the personality taxonomy. These approaches are best summarized within the lexical model of personality. Wiggnis (1996) identifies the main principles of the lexical model. Personality language refers to phenotypes and not to genotypes according to him. Phenotypic attributes are encoded in the natural language. Here, it is worth mentioning that according to this model, any personality taxonomy must consist of attributes of personality and not necessarily of traits which are thought to include genotypes as well. The degree of representation of an attribute in language has some correspondence to the general importance of the attribute. Golberg (1981; cited in Wiggnis, 1967) Childhood trauma and personality … 20
adds to this that “the more important an individual difference is in human transactions, the more languages will have a term for it.” The lexical perspective provides an unusually strong rationale for the selection of variables in personality research. Person-description and sedimentation of important differences in language both work primarily through the adjective function. Thus, the main proposition here is that the bulk of important individual differences, expected to represent personality attributes, is encoded in adjectives, rather than in nouns or verbs. The structure of person-descriptions in phrases and sentences is closely related to that of single words. The most important dimensions in aggregated personality judgments are the most invariant and universal dimensions (Wiggins, 1996).
1.4. The Five Factor Model of Personality (McCrae et al., 1997)
By means of empirical clustering and factor analysis procedures, Cattell managed to eliminate more than 99% of the 4500 terms to describe personality that Allport (1937) had managed to come up with. Furthermore, the remaining 35 variable list was reduced to 12 personality factors, to further evolve into 16 Personality Factors, also known as the 16PF Questionnaire (Cattell et al., 1970.) The reduction in the number of variables and the simplification of the model made it possible for hundreds of other researchers to develop and test much shorter versions of the questionnaires with different samples. A considerable contribution in this respect was made by Tupes and Christal (1961), who reanalyzed correlation matrices from eight diverse samples of different demographic groups and different classes of populations. In all of their analysis, without any exception, they were subjected to only five stable and recurrent factors (Tupes and Christal, 1961). This five factor model was replicated by many other prominent researchers including Norman (1963), who, from the 35-variables model of Cattell (1970) came up with the five-factors framework, which initially were named as follows: 1. Extraversion or Surgency (talkative, assertive, energetic) 2. Agreeableness (good-natured, cooperative, trustful) 3. Conscientiousness (orderly, responsible, dependable) 4. Emotional Stability versus Neuroticism (calm, not neurotic, not easily upset) 5. Culture (intellectual, polished, independent-minded) (Norman, 1963). Not much time passed and this model became known as the Big Five Model of Personality. One point of clarification with the name big five: Big Five does not mean that there are only five Childhood trauma and personality … 21
factors or variables relevant to personality, but rather that there are hundreds of such variables that can be compiled into five broad categories.
Table 2 Five Factor Model of personality Factor Definition
Neuroticism (emotional Maladjustment, worrying and insecure, depressed stability; adjustment) vs. adjusted and calm.
Extraversion- Sociable and affectionate vs. retiring and reserved. Introversion (surgency) Openness to Imaginative and independent vs. practical and experience (intellect; culture) conforming.
Agreeableness Trusting and helpful, good natured, cooperative vs. (likability; friendliness) suspicious and uncooperative.
Conscientiousness Well organized and careful vs. disorganized and (dependability; conformity) careless.
Neuroticism. People who score high on neuroticism tend to experience negative feelings most of the time. They are prone to depression, anxiety, anger and are very vulnerable to any kind of criticism and negative feedback from the others. Another defining characteristic of people scoring high on neuroticism is their emotional instability. In everyday encounters, high scorers on neuroticism might behave impulsively, as well as with anger and hostility. As a general rule, neurotics are anxious and mostly unhappy (McCrae et al., 1997; 2008). Extraversion. High scorers on extraversion are among the good adjusted individuals. Extraverts resonate more energy, higher social competence, better social adaptability, and in many cases, better adjustment to life altogether. While high scorers on neuroticism suffer considerably from anxiety and poor affection, high scorers on extraversion experience much more positive emotions. They also tend to be more sociable, seek company of others, are more talkative, avoid solitude and are more assertive(McCrae et al., 1997; 2008). When high extraversion is combined with high openness to experience, the result can be a colorful and stimulating life. Childhood trauma and personality … 22
Openness to experience. High scorers on this trait, as stipulated by the name, appreciate new experiences and seek new sensations most of the time. They show curiosity for adventure, novelty, art, etc. They might take unnecessary risks as well (McCrae et al., 1997; 2008). It is not wrong to parallel openness to experience with intellectuality, creativity, curiosity and novelty. Agreeableness. People who score high on the trait of agreeableness tend to be very reliable and cooperative. They trust others and are trustworthy themselves. They do not hesitate to help others, and are there for them when needed. Others can count on them because highly agreeable people will be there to keep their word (McCrae et al., 1997; 2008). Compared to a neurotic or introverted individual, a highly agreeable person would look too cheerful and talkative. Conscientiousness. While the other traits of personality have more to do with interpersonal relationships, conscientiousness reflects on how an individual organizes him/herself and his/her time and energy. High scorers on conscientiousness are characterized by high self-discipline and competence; they are usually thoughtful and can stick to personal goals and ideals. Conscientiousness can also be understood as the effort and energy that a person puts on the process of reflection upon their thoughts and behaviors. Needless to say, high scorers on conscientiousness prefer organization and regularity versus disorganization and chaos (McCrae et al., 1997; 2008).
It is of cardinal importance to reiterate here that, at first glance, these factors seem to structure the division of personality types into two opposite poles, for instance people who are open to experience and those who are not, but the whole theory behind the FFM says that such a division is not to be made. This model and others alike, describe a continuum where one could score high, low or medium on each of the five factors. It cannot be said that someone is 100% neurotic or the other way around, because every score can be positioned somewhere within the scale. Only a comprehensible and inclusive score on all these five factors could offer us an idea about the stable patterns of personality. “By [scalability] we mean that a trait is a certain quality or attribute, and different individuals have different degrees of it. If individuals differ in a trait by having higher or lower degrees of it, we can represent the trait by means of a single straight line. . . . Individual trait positions may be represented by points on the line.” (Guilford, 1959, pp. 64– 65). In conclusion, it is close to impossible to find absolute agreement in each detail with regard to what each of these factors measure. The theory presented above tends to extract the commonalities of three theoreticians, namely Allport (1937), Cattell (1943) and Eysneck (1967) and find the right contours for each personality factor. In other words, the five factor model taxonomy serves an integrative function, given that it can represent various and diverse systems of personality in a single framework. Childhood trauma and personality … 23
1.5. The 1998-99 War in Kosovo and the psychological consequences of it
In Kosovo, during the years 1998-1999, an armed conflict occurred between the local Kosovo Albanians and the armed forces of the neighboring country Serbia. The vast majority of the population of Kosovo experienced severe traumatic events for fifteen months. More specifically, about one million people (out of 1.9 million which was the population of Kosovo at the time of war) were affected by the military operations, possibly, half of them were children. Between 200 000 and 400 000 people have been estimated to have been traumatized (Fanaj et al., 2014). The psychological consequences in the whole population of Kosovo were tremendously high and negative. Many studies conducted right after the war reveal that the prevalence of post-traumatic stress disorder among the population was very high in the immediate post-war phase. For instance, in the year 1999, the prevalence was 17.1% to 25%, (Cardozo et al., 2003; Fanaj et al., 2014; Wenzel et al., 2006). In a study published in 2010 by Wenzel (2010; a pilot project implemented by the University of Vienna and the universities of Pristina and Rijeka) was revealed that PTSD was still highly present in 2010 varying between 24.5% and 30% based on the geographical area. Other than PTSD, depression and emotional distress due to trauma were evidenced to be highly present, at least for the first decade of the new millennium in the post-war Kosovo. In 2006, the measured depression symptomatology was reported to had risen up to 43% (Morina et al., 2010), while another study with war veterans, estimated that up to 7.5% of them were at risk for suicidal behavior (Wenzel et al., 2010).
1.6. Psychology of Trauma Psychological trauma Whenever we are faced unusual circumstances that disturb our internal biological and psychological normal functioning, we tend to denote the experience as trauma. However, when we talk about psychological trauma, we have to keep in mind that the individuals who experience such a state of mind have undergone extreme life events and shows clear psychological reactions to the experienced trauma. According to Pearlman (1995, p.60), we can talk about psychological trauma when the following conditions have been fulfilled: 1. The individual's ability to integrate his/her emotional experience is overwhelmed, or 2. The individual experiences (subjectively) a threat to his/her life, bodily integrity, or sanity. Childhood trauma and personality … 24
In other words, we can say that an individual is suffering from psychological trauma when he/she is overwhelmed after the traumatic event(s), and as a consequence, the abilities of the individual to cope with everyday stressors is severely hindered because the individual finds him/herself in constant state of fear that the trauma might repeat itself. "It is the subjective experience of the objective events that constitutes the trauma...The more you believe you are endangered, the more traumatized you will be...” (Allen et al. 1995, p. 14). Furthermore, according to Saakvitne (2000), the subjective long lasting effects and reactions to trauma may include substance dependence and abuse, personality disorders (especially borderline personality disorder), depression, anxiety (including post traumatic stress disorder), dissociative disorders, and eating disorders. These disorder and maledictions may have at their core deficits of the traumatized individual in self- soothing, seeing the world as a safe place, trusting others, organized thinking for decision-making and avoiding exploitation. The strongest manifestations of such deficits are met in cases when the victims of traumatic events have been in their early childhood and the traumatic event has been caused by other humans, such as in circumstances of war (Allen et al., 1995; Saakvitne et al., 2000). Studies from affected war zones all over the world, found major effects of war on children, mainly in the form of psychopathologies such as PTSD and affective disorders (Ahmad et al., 2000; Ajdukovic, 1998; Nader et al., 1993; Thabet et al.,2004). Thabet (2004) concluded that there is no unique relationship between exposure to trauma and the development of PTSD. What this could mean is that not all the individuals who undergo traumatic life events develop PTSD, especially given the fact that PTSD is just one of the disorders that might develop in the course of the repercussions of trauma (Czapiga, 2009). Consequently, even if PTSD does not develop immediately after the experience of trauma, it does not necessarily mean that no damage has been caused at all. A delayed onset of the condition is common and is termed as incubation of fear (Shreurs et al., 2011). Moreover, there are other anomalies of behavior, of the body, and of the mind that can develop in cases of severe trauma. The Disaster Mental Health Response Handbook, (NSW Health, 2000), offers a rather inclusive typology of reaction to trauma development spreading into three phases. Impact phase After the traumatic event has happened, it is a normal body reaction to try and keep unhindered the homeostasis of the body and of the mind. The organism tries to protect what is left of itself as well as of the others around. However, this is just the normal healthy reaction to trauma. Some people react to it in inadequate ways by failing to organize themselves and their reactions to the event, and end up wondering helplessly. Regardless of the cause of the Childhood trauma and personality … 25
disaster/trauma, according to the same report, there are some certain stressors which usually have recognizable consequences such as threat to life and encounter with death, feelings of helplessness and powerlessness and inescapable horror. Immediate post-disaster period: recoil and rescue. In this phase, the trauma undergone ‘meets’ herself after having had been lost it in the trauma world. Erratic and unexpected fluctuations are not rare in this phase of recovery. Anxiety may hit high levels and may develop drastically and people appear evermore depressed. A few common symptoms characteristic to this phase of facing the trauma are numbness, denial or shock, flashbacks, nightmares, grief reactions to loss, anger, despair, sadness, and hopelessness (NSW Health, 2000). Recovery phase What usually happens in this phase with regard to the trauma is that people return to their places from where they have been displaced. First, they encounter the effects of the disaster and try to make their peace with them. Then things start to get back to normality and an optimistic and altruistic nature becomes sporadically present. People become more understanding and helping at this phase. However, along with the altruistic approach, or right after it, the long lasting psychological effects of the trauma kick in, and as a result, daily routines become difficult to handle. However, in more than half of the cases, the trauma undergoes manage to rely on their recovery abilities and recover from the traumatic experiences without developing any psychiatric or other disorders (NSW, 2000).
1.6.1. Psychological and psychiatric disorders as a reaction to trauma
Short term and long term psychological consequences of traumatic experiences may include many symptoms falling in the spheres of anxiety and mood irregularities, such as restlessness and nervousness, emotional instability, contact anxiety, depression, specific anxiety and stress disorders (especially PTSD). In the social sphere, as pointed out by Qirjako (2007), children manifest a poorly adapted social behavior, stronger aggressiveness, a distorted moral understanding and an inadequate cognitive adaptation to their violent, threatening environment. The initial symptoms as summarized by Qirjako (2007) may also include restlessness, arbitrary movements, being frightened by light and noise, insomnia, tantrums, in case of children, clinging to their parents, regression to past behavioral patterns (such as thumb sucking, wetting etc.). Emotional reactions include panic, sadness / depression, mistrust, aggression / hate. While Childhood trauma and personality … 26
the cognitive reactions include a sense of reality loss and loss of logical patterns, regressive thinking, recourse to mystical world-images (magic) and disorientation in time and space. According to DSM IV TR (APA, 2000) and ICD-10 (WHO, 1992) as summarized by Czapiga (2009), the main psychiatric disorders to develop as a consequence of facing severe trauma experiences are: a. Reaction to severe stress and adjustment disorders, b. Acute stress disorder, manifested through persistent recurrence of trauma which could lead the individual to dissociation and, c. Post-traumatic stress disorder (Czapiga, 2009).
1.6.2. PTSD as a reaction to Trauma
Post-Traumatic stress disorder was not recognized as a specific category of psychopathology, until it was first introduced into DSM-III in 1980. To be diagnosed with PTSD, one must necessarily have undergone traumatic experiences. The traumatic experiences can be of many sorts, including natural disasters and man-made disasters. According to Davey (2008), the main symptoms of PTSD can be categorized into three main categories: 1. Increased arousal: exaggerated startle response, difficulties with sleeping, hypervigilance and difficulties in concentrating; 2. Avoidance and numbing of emotions: manifested as a tendency to avoid any stimuli that might evoke memories of the trauma; 3. Re-experiencing: the individual regularly recalls very vivid memories and experiences flashbacks of the events experienced during the traumatic times (Davey, 2008, p. 154). According to DSM-IV-TR (APA, 2000), traumatic events that might lead to the development of PTSD are: military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attacks, torture, incarceration as a prisoner of war or in a concentration camp, natural or man-made disasters, severe automobile accidents, or being diagnosed with life-threatening illnesses. Witnessed events on the other side, according to DSM-IV-TR (2000) include observing serious injuries or unnatural death of another person due to violent assault, accidents, wars, disasters, or unexpectedly witnessing a dead body or body parts. The stressor may cause more damage when it is man-made. Furthermore, DSM-IV TR (2000) lists three specifiers to be taken into consideration with regard to the symptomatology of post-traumatic stress disorder: 1. Acute: to be used when the duration of symptoms is less than three months. Childhood trauma and personality … 27
2. Chronic: when the symptoms last longer than three months. 3. With delayed onset: a specifier indicating that at least six months have passed between the traumatic event and the onset of symptoms (DSM-IV TR, 2000, p. 465). It is worth mentioning here that the symptomatology of PTSD may occur right after the trauma or it may start with a delayed onset. The factors which mostly influence the development of PTSD according to DSM-IV TR (2000) are the severity and duration of the trauma and the proximity of the individual to the traumatic event. The diagnostic criteria for Post-traumatic Stress Disorder according to DSM-IV TR (2000, p. 467-8) are: A. The person has been exposed to a traumatic event; B. The traumatic event is persistently re-experienced; C. Presence of persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), D. Persistent symptoms of increased arousal, which were not present before the trauma, E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than one month. F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The Prevalence of post-traumatic stress disorder According to Helzeret al., (1987), the lifetime prevalence of PTSD is between 1 and 3%. On the other hand, according to Ozer and Weiss (2004), half of the grown up population of the world, experience at least one traumatic event during their lifetime. Women are twice as likely as men to develop PTSD (Tolin et al., 2006). Risk factors for developing PTSD Not all people who undergo traumatic life events end up developing post-traumatic stress disorder. There are many factors that have an impact on how the body and mind deal with the trauma and whether PTSD develops afterwards or not. According to Davey (2008), there are a few main factors which characterize an individual’s likelihood to develop PTSD: A tendency to take personal responsibility for the traumatic event and the misfortunes of others involved, Developmental factors such as early separation from parents or an unstable family life during childhood, Childhood trauma and personality … 28
A family history of PTSD, High intelligence serves as a protecting factor against developing PTSD in reaction to trauma (Silva et al.,2000) Existing high levels of anxiety or any other pre-existing psychological disorder (Breslauet al., 1997).
1.6.3. Studies that link PTSD and Depression with war trauma
There are innumerable studies which link traumatic experiences with PTSD. Even though experiencing trauma does not necessarily always cause PTSD, it does so in many instances. However, even if someone manages to escape the trap of psychopathology in the case of a singular trauma, there are situations in which trauma is repeated many times over, such as in war circumstances, and with each repetition of trauma, the risk for developing PTSD increases (Breslau et al., 1999). In this line of evidence, the DSM-IV-TR distinguishes between two types of traumatic events, the first type being one single trauma event, and the second type, which is also known as the complex type, includes many cases of traumatization and is more suitable to describe the pattern of traumatization that a war causes (APA, 2000). In two conclusive studies on the traumatic events of the ongoing wars in Afghanistan, data show a very high prevalence of anxiety, depression and PTSD among the tested population. In the first study published by Cardozo (2004), the prevalence of depression was spread among 67.7% of the studied population; PTSD was recorded in 42% of the cases, while symptoms of anxiety in general were found in 72% of the respondents (Cardoso et al., 2004). Cambodia, like many other developing countries, has undergone many civil riots and wars which culminated in the 60’s, with a civil war which was later followed by the “Khmer Rouge” rule and genocide. A study published by Mollica (1993), which examined refugees at the border with Thailand, found that 80% of the respondents felt depressed while over 50% of them had symptoms characteristic of PTSD (Mollica et al., 1993). In a rather rare follow-up study conducted with only 27 Cambodian young war refugees, published by Kinzie (1989), respondents were tested twice within three years, and the findings revealed high symptomatology of depression and PTSD amongst them, 41% and 48%, respectively (Kinzie, 1989). The long spell-over wars in the region of the Middle East, culminating with the Gulf War of 1991 and the Iraqi war with the United States in the early twenty-first century, left many wounds in the minds and souls of the Iraqi people. A study investigating the former war was conducted by Ahmad et al.,and was published in 2000. This study found that PTSD was present in 87% of investigated children of Iraq (Ahmad et al., 2000). Studies also found a very high prevalence of Childhood trauma and personality … 29
PTSD amongst Palestinian children exposed to war-related traumatic events. A study examining the Gaza strip wars of the last decade published by Thabet and his colleagues (2016) found that 59% of their participants were in the clinical range for PTSD. Similar results were found in another study conducted with the same aim of revealing the effects of traumatic war events in Sri Lanka. Meghir and Katon (1995), conducted a study with 38 Afghan war refugees aged between 12 and 24. Five of them (13%) met the DSM III criteria for PTSD, 11 (29%) of them qualified for depression while 13 (34%) had either PTSD or depression (Meghir et al.,1995). Altawil and Harrold (2008) conducted a study in a sample of 1137 respondents, children of 10 to 18 years of age in the Gaza Strip, all of whom were exposed to traumatic events. Post- traumatic stress disorder was present in 41% of the cases. Its emotional subset was prevalent in 22% of the cases (Altawil et al.,2008). Moreover, they found that as a result of trauma, many other cognitive faculties were affected, which produced a lower performance in school and in many other activities. On a more positive note, the study showed that when victims of war trauma have a strong support by family and friends the ability to cope with the worsened reality can be significantly improved. On average, childhood trauma increases the risk for depression three to five times (Edwards et al., 2003). Furthermore, children who undergo traumatic events, remain at higher risk for suicide for the rest of their lives. According to Dubet et al., (2001), abused children are twelve times more likely to attempt suicide compared to non-abused children. Other studies link childhood abuse with alcoholism and drug usage later in life (Dube et al.,2001), and while some other studies found childhood trauma to be strongly correlated with the leading causes of death, including heart disease, cancer, diabetes, liver disease, and emphysema (Felitti et al., 1998). One last thing that needs to be addressed here is related to the system of values that play a protective role against the development of PTSD, depression and other mental disorders, especially when the cause of trauma is war. Two separate studies from Palestine and the Philippines revealed that the residents who previously or currently were actively engaged in the fight against their enemy, suffered less consequences and were more mentally resilient (Dawes and De Villiers, 1987). A further support for this line of argumentation comes from Kostelny and Garbarino (1994). The authors interviewed traumatized mothers and children in Palestine and found a high symptomatology of depression and PTSD, and most interestingly they revealed that it was the adolescents ability to perceive themselves as ‘freedom fighters’ which made the experiences of invasion and detention less traumatic” (Kostelny et al., 1994). Lastly, Qirjako (2007) conducted a study to investigate the effects of war trauma in Kosovo (1998-99) on a population of ages 10 to 25. The study recruited 220 children for testing. In order Childhood trauma and personality … 30
to find out about psychological symptomatology she used SCID (the Structured Clinical Interview, APA, 2000), which represents the diagnostic criteria of DSM-IV. Her study showed that the prevalence of PTSD among children, who had undergone war trauma in Kosovo was 25.5% (Qirjako, 2007), including the emotional subscale, the social withdrawal subscale as well as the cognitive subscale.
1.6.4. Personality and Trauma
According to Austin (2002) intrusive recurrence of early childhood trauma memories, tend to be persistent with the individual into adulthood, and as such, they can disrupt adult life–through increasing the possibility for depression, anxiety, alcoholism, substance abuse and personality disorders (Austin et al., 2002). Furthermore, Allen and Lauterbach (2007) reported that traumatic events experienced in childhood and personality traits in adulthood are correlated with each other, meaning that those kids, who were traumatized as children, are more likely to score high on neuroticism and low on openness to experience in adulthood. Furthermore, their findings describe trauma survivors to be tense, nervous, irritable, insecure, and emotionally down for a good portion of the time. The aforementioned studies and many others delineate the impact of war trauma on mental health of sufferers mainly in the spheres of affective disorders and anxiety spectrum disorders including PTSD. However, not many studies have been conducted to explore the longitudinal relationship between war trauma and personality. The ones that have been conducted speak of a rather vague relationship between war trauma and personality traits. In a study conducted by Bollingeret al., (2004) with 107 Vietnam war veterans, found high rates of personality disturbances among them. 79.4% of the participants were diagnosed with at least one personality disorder, 21.5% were diagnosed with two personality disorders, 15.9% had three and 12.1% suffered from four or even more personality disorders (Bollinger et al., 2004). The most common personality disorders among veterans, were avoidant personality disorder (47.2%), paranoid personality disorder (46.2%), obsessive compulsive personality disorder (28.3%) and antisocial personality disorder (15.1%). Seth et al., (2005), also found a relationship between trauma, PTSD and features of borderline personality disorder. In a later study with combat veterans, Siereles (1986) found that 64% of the study sample met the criteria for antisocial personality disorder. A study conducted later by Southwicket al., (1993), with 18 inpatients and 16 outpatients, found that about one third of them suffered from at least one personality disorder. The most common personality disorder to be diagnosed amongst them was borderline personality disorder (76% of the cases), obsessive compulsive personality disorder was diagnosed in 44% of Childhood trauma and personality … 31
the cases, avoidant personality disorder in 41% and paranoid personality disorder in 38% of the cases (Southwick et al., 1993). Inpatients were generally more often diagnosed than outpatients. Normal life events do not seem to have a high impact on personality (Costa et al., 2000; Vaidyaet al., 2002). The usual negative ones, maybe not either. Studies do not report a high correlation between extreme adverse life events and personality changes per se. However, many studies have found a correlation between post-traumatic stress disorder and one of the five factors of personality. These studies have found that PTSD is correlated with a higher level of neuroticism (Breslau et al.,1991; Berger and Rudd, 2007; Chunget al.,2005; Davidson et al.,1987; Hyer et al., 1994; McFarlane, 1988). On the other hand, these studies have found a negative correlation between PTSD and extraversion (Chung et al., 2005; Davidson et al., 1987; McFarlane, 1988), as well as between PTSD and agreeableness (Chung et al., 2005; Hyer et al., 1994; Talbert et al.,1993).Withdrawal from contact can be characteristic both for high neuroticism as well as low openness to experience (Daud et al., 2008). Eaton and Costa (2009) conducted a study with 458 participants about longitudinal personality changes in response to extremely adverse life events. The big five personality traits were assessed two times, in average every four years. One fourth of the participants had reported an extremely horrifying life event in the past two years. The results revealed that such experiences were correlated with increased scores in neuroticism, lower scores in the compliance facet of agreeableness as well as lower scores in the facet of values, part of the factor of openness to experiences. All these studies demonstrate that personality is not immune to extreme adverse life events. Czpiga (2009) summarized the difficulties in personality development due to trauma in two classes: the first class includes, but is not limited to, withdrawing from contact, which is manifested in inhibitions, passiveness, apathy, and social anxiety. The children, who adapt this way of reacting, are at risk for neurotic disorders and for developing patterns of reactions dominated by anxiety (e.g. avoidant, dependent, and obsessive-compulsive modes of behaviour). The other pattern of reactions manifests itself through hyperactivity, aggressive behavior towards others or towards oneself, expansion, dominance over people and lack of affective control. According to Czapiga (2009) the second group is prone to develop a personality with a tendency to emotional hyperactivity and deliberate instability (Czapiga, 2009). If we look at this categorization of Czapiga, we can see that even though she did not try to fit the symptoms to any of the big five personality factors, it is easy to see that almost all of them represent an impoverished personality with regard to life coping mechanisms and interpersonal skills. Childhood trauma and personality … 32
1.7. Early childhood trauma, brain development and the effect of age of traumatization on personality development
The brain areas most affected by traumatic events are the frontocerebral areas which are responsible for the reward-punishment circuitry, complex emotions and photographic memory; the corpus callosum, which is the connection between the two hemispheres of the brain, the anterior cingulate cortex (ACC) which is responsible for the detection of cognitive conflicts and the limbic structures including amygdale and hippocampus (Baumont, 2008). Sheline (2003) found that when the hippocampus has to function under high stress for long periods of time, the result might be a shrinkage and reduction in its volume, with repercussions for the whole emotional and cognitive functioning of the individual (Sheline et al., 2003). Not only the hippocampus could atrophies under prolonged exposure to stress, but studies have found that the whole brain or parts of it might suffer changes in their architectonics as well (De Bellis et al.,1999). Regarding the cognitive deficits due to trauma, the damage is most noticeable on memories. According to Austin (2002) “The formation of memory is created by patterns, intensity, and frequency of neural activity. The more frequently a certain pattern of neural activation occurs, the more indelible the memory becomes. Traumatic experience thus creates a processing template through which all new input is filtered and rerun constantly” (p. 143). The whole idea of permanent brain atrophies and irreversible damage to the affective world is best summarized by Karr Morse (1997) who argues that while we might like to believe that given sufficient opportunity we can reverse any damage done to the children’s brain, the research tells us that the effects of some early traumatic experiences cannot be undone. Regarding the coping mechanisms that children develop in order to compensate for the hardware damage due to trauma, a comprehensive explanation is given by Shannon and Heckman (2007). They argue that, after the child has been exposed to traumatic events for a certain period of time, both the nervous system and the whole individual start to function and behave in highly aroused states, and after some time, that becomes a normal pattern of reaction. Children’s brains seem to be unable to drop back to normality after experiencing severe traumatic events. This can be due to the fact that the neuronal firings and hemispherical connections of the hippocampus could be significantly weakened by trauma (Shannon and Heckmann, 2007). What is even more staggering, studies from orphanages in Romania have found that ill-treated and neglected children, had a significantly smaller brain size compared to their normally-reared counterparts (Putnam, 1997). Their intelligence coefficient (IQ) scores showed lower averages as well. A study by Dennis (1973) found strong evidence in support of the finding that being exposed Childhood trauma and personality … 33
to trauma and living in an unsupportive environment in early childhood can influence the IQ. Furthermore, the timing when a child is moved from the foster care and is being adopted, has a significant correlation with the average IQ. Statistically speaking, only the children adopted before the age of two are expected to have an average IQ of 100. If a child is adopted between the age of 2 and 6, he could only reach an IQ of 80 (fist level below average). But for the ones with the worst luck, the ones who remain un-adopted at institutions until the age of 16, their IQ circles around 50, which can be classified as a moderate to severe mental retardation (Dennis, 1973). If we move our attention to the micro-organizations of the nervous system, more specifically to how specific neurons are impacted in cases of severe traumas, Beers and DeBellis (2002) have published a paper where they report that in cases where individuals are exposed to prolonged traumatic events, glutamatergic neurotransmitters which are responsible for neuronal firing in cases of stressful events remain hyper-activated for prolonged periods of time, and consequently, they can severely damage the development of the brain, by causing excessive neuronal death, blocked neurogenesis, abnormal pruning etc., a process known as excitotoxicity (Beers et al., 2002). All these dysregulations of brain functioning, including those at a macro level, i.e. general higher arousal of large regions of the brain, brain shrinkage at regional level, loss of hippocampal volume; those at a neuronal level, i.e. neuronal death and abnormal pruning of neurons; those at neurotransmitter and hormonal level, i.e. disturbances with dopamine, norepinephrine and cortisol, could push the child’s psyche to rely for functioning on more primitive organizations of the nervous system, such as the limbic system and basic fight or flight mode of the autonomous nervous system. The rational thinking is hard to be engaged, and as a natural consequence, circumstances seem to worsen off progressively. Furthermore, according to some other studies, there might exist a negative correlation between the age of traumatization and the magnitude of brain shrinkage due to trauma. The younger the age of traumatization, the bigger the damage to the brain (Sheline et al., 2003). Not only the brain damage reflects the age of traumatization, but according to some studies, the whole psychological reaction to trauma as well, is closely related to the age of traumatization. A study conducted by Yöyen et al., (2017) divided the participants (who had undergone trauma in their early childhood) in two categories: older than five and younger than five. They found that the smaller the age when the trauma was experienced, the higher the symptomatology of PTSD, and the poorer the social relationships and the psychological health of the participants in general. A similar study design was applied by Rutkowski et al., (2016) wherein, the traumatized children were divided again between older and younger than five. In contrary to Yöyen, Rutkowski found Childhood trauma and personality … 34
that both groups of children had similar overall profiles as a reaction to trauma, however, the younger children experienced more intense anxiety symptoms than their older counterparts. Finally, according to Daud (2008), the pattern of reaction to trauma doesn’t differ much between children and grownups. Grownups like children, when experiencing prolonged exposure to traumatic events, display avoidant and withdrawal personality traits and high levels of irritability, anger, frustration and inability to tolerate pain.
1.8. The current study
The connection between traumatic life experiences and impaired mental health is intuitive and documented by many researchers. Studies so far have shown a clear link between war trauma and mental disorders, mostly with PTSD and depression. In many cases of severe trauma, the trauma impact lingers along in time by affecting the whole personality, including the way someone organizes themselves, the way they interact with the others, the way they feel, think etc (Kinzie et al.,1989; Mollica et al.,1993, Czapiga, 2009). Sixteen years have passed between the war in Kosovo (1999) and the time when data samples for this study have been collected (2015). Hence, many confounding variables could be at play and pose problems in our data interpretation. Personality on the other hand is not easy to either define or measure. However, there is a reasonable amount of arguments to support a link between war childhood trauma and personality traits in adult life. The current study builds on previous findings that relate trauma to personality traits and aims to test them on a sample of Kosovar students who had undergone childhood traumatic events during the Kosovo war 1998-99. It also investigates the link of PTSD and depression with trauma.
Childhood trauma and personality … 35
1.8.1. Aims of the study
To measure the psychological effects of war trauma of the 1998-1999 war in Kosovo among a population which was in early childhood during this period. To investigate the relationship between childhood trauma and PTSD in adulthood. To investigate the relationship between childhood trauma and depression in adulthood. To investigate the relationship between childhood trauma and personality traits in adulthood. To investigate the possible modulatory effect of age with regard to the above mentioned interactions.
Childhood trauma and personality … 36
1.9. Hypothesis 1. The children’s exposure to traumatic events-- the war in Kosovo 1998-99-- measured by the Harvard Trauma Questionnaire (HTQ, 1992), will correlate with higher feats of DSM-IV (APA, 2000) axis one specifications for PTSD measured by the second part of the Harvard Trauma Questionnaire (1992), and MDD (Major depression disorder) measured by Beck Depression Inventory (1961). 2. A correlation between the severity of trauma exposure and personality traits measured by NEO PI-R (Costa, 2010) is expected. 2.1. We expect a positive correlation between the severity of trauma exposure and the personality factor of Neuroticism (N). 2.2. We expect to find a negative correlation between trauma exposure and Extraversion (E), Openness to experiences (O), Agreeableness (A) and Conscientiousness (C). 3. We expect an intermediary effect of age on traumatization, depression and personality structure.
Childhood trauma and personality … 37
2. CHAPTER TWO: RESULTS
2.1. Descriptive statistics of the main variables2 Initially, we ran an overall analysis of the main variables, namely trauma exposure, PTSD, depression, neuroticism, extraversion, openness, agreeableness and conscientiousness on 355 subjects. As is usually the case with university students, the mean age of our sample was around twenties (specifically 20.6 years) with the sample ranging from 16 to 46 years old and a SD ±3.87. If we subtract the years that have passed between the time of traumatization (war in Kosovo 1998- 1999) and the time of data collection (2015), we can see that 16 to 17 years have passed in between, and this indicates that the mean age of our respondents at the time of war was between 2 and 8 years old, with the oldest respondent being 30 years old and the youngest, one year old. Table 3 Main test scores for 355 subjects
Variables Mean SD Trauma and PTSD, HTQ 3.19 .48 Trauma exposure, HTQ 3.12 .53 Culturally sensitive PTSD, HTQ 3.26 .48 Depression (BDI) 11.36 8.07 Neuroticism 97.25 15.55 Extraversion 105.99 13.48 Openness 104.84 11.70 Agreeableness 112.39 13.41 Conscientiousness 115.33 14.18
As it can be seen from table 4, there is a relatively similar spreading of scores between the five factors of personality, with conscientiousness having the highest score and neuroticism having the lowest.
2 The Results chapter in this study project is presented before the Methods and Discussion sections because such is the recommendation of MUW where the author plans to defend his thesis. Childhood trauma and personality … 38
2.1.1. Neuroticism
Based on the range for scoring offered by the NEO PI-R creators (McCrea et al., 1992) a neuroticism score of 97.2 is considered a high score. A person who scores highly on neuroticism is expected to worry a lot and be apprehensive and anxious most of the time. In social situations, high neurotics are mostly withdrawn and demonstrate many doubts towards the ones they are interacting with (Costa and McCrae, 2000). In general, the high scorers on neuroticism are characterized by negative affective moods, which is why neuroticism can be considered the opposite of extraversion and positive emotions. The facets of neuroticism are anxiety (our sample’s mean score was 23, high), angry hostility (19, high), depression (19, high), self- consciousness (22, high), impulsivity (20, high) and vulnerability (14, high). Table 4 The average scores of Neuroticism (N) Facets
Neuroticism Anxiety Angry Depression Self- Impulsivity Vulnerability N=353 (N) (N1) Hostility (N3) Consciousness (N5) (N6) (N2) (N4) Mean 97.25 22.86 19.01 19.73 22.10 19.91 14.83 SD 16.55 16.55 16.87 19.01 18.11 18.07 14.14 Range High high high high high high high
2.1.2. Extraversion
A mean score of 105 on the factor of extraversion is considered average. The facets of extraversion are warmth (current sample, 24, high), gregariousness (23, high), assertiveness (21, high), activity (20, average), excitement (21, high) and positive emotion (23, high). When a person scores high on the extraversion factor and its facets, it means that the person is usually warm towards the others and rejoices in social interactions. High scorers on extraversion get a lot of satisfaction from social interaction, hence they experience more positive emotions, seem more lively and energjetic (Costa and McCrae, 1992).
Childhood trauma and personality … 39
Table 5 The average scores of Extraversion facets
-
N=353
-
Extraver (E) sion Warmth (E1) Gregariou sness (E2) Assertive ness (E3) Activity (E4) Exciteme nt Seeking (E5) Positie Emoti on(E6) Mean 105.99 24.14 22.71 21.16 20.9 21.23 23.28 SD 13.48 16.75 19.55 20.46 15.84 20.04 17.47 Ran. average high high high aver. high high
2.1.3. Openness to experience
We obtained a mean score for openness of 104, which is considered average. The facets of openness are fantasy (17, average), aesthetics (24, high), feelings (25, high), actions (19, high), ideas (23, high), and values (21, high). When someone scores high on openness and its facets, it generally means that that individual is open, responsive to beauty in music, art, poetry, or nature, and gives importance to feelings and emotional reactions (Costa et al.,2000).
2.1.4. Agreeableness
We obtained a mean raw score of 112 on the factor of agreeableness. In the scoring ranges of NEO PI-R (McCrae et al., 1992), this score is categorized as average. Its facets are trust (21, high), straightforwardness (24, high), altruism (25, high), modesty (19, average) and tender-mindedness (25, high). When someone scores high on the factor of agreeableness and its facets, usually that person trusts the others and assumes the best about the people he meets. Usually, high scorers on agreeableness are sincere, forthright and will not manipulate or lie to the others. Furthermore,they tend to be very reliable and desired for cooperation (Costa et al.,2000).
2.1.5. Conscientiousness
We obtained a mean score of 115 on the factor of conscientiousness and such a score is considered average. The facets of conscientiousness are competence (21, average), order (24, high), dutifulness (27, high), achievement striving (25, high), self-discipline (20, average) and deliberation (24, high). Someone who scores high on conscientiousness is expected to have a very good knowledge of themselves, their emotions, motives and behaviors. As a consequence, these individuals demonstrate an organized and directional lifestyle, which as a consequence, Childhood trauma and personality … 40
makes them appear neat, punctual and reliable. In the figure below, the mean scores of extraversion have been graphically presented (Mean=105.99, SD=13.48, Min.=60, Max.=165).
Figure 1. Extraversion scores N=355
2.2. Depression The Beck depression inventory (Beck, 1961) has 21 items with a four point Liker scale scoring profile from 0 to 3. The mean score of our sample was 11.36 (SD=8.07, Range=44). The results of the BDI could indicate affective functioning that ranges between normal ups and downs to extreme depression. The cutoff point for a mild depression categorization is 11 (Beck, 1961). For illustration, please see Figure 1. Childhood trauma and personality … 41
Figure 2. Severity of depressive symptomatology
In percentages, 53.8% of our respondents scored within the range of normal ups and downs; 25.7% scored in the range of mild mood disturbances; 6.4% scored in the range of borderline clinical depression; 10.7% scored in the range of moderate depression; 2.1% scored in the range of severe depression while the remaining 1.2% scored in the range of extreme depression.
2.3. Trauma exposure and PTSD Our findings revealed that 39.4% of our respondents had been exposed to traumatic events during the war in Kosovo, and 13.1% fit the criteria for trauma exposure and PTSD related to it, as measured by the first part of the HTQ (Mollica et al.,2007), which is adopted to the DSM 5 (APA, 2013) criteria for PTSD. The average score for the culturally sensitive part of HTQ, which also measures the current remnants of traumatization, was 3.26. Figure 3 displays the severity of trauma exposure measured by HTQ (HTQ range score=4).
Childhood trauma and personality … 42
Figure 3 The severity of exposure to trauma HTQ
2.4. Correlations between variables As an initial step, we ran tests of normality distribution with regard to our main independent variable (trauma exposure), and both tests, the Kolgomorov-Smirnov and the Shapiro-Wilk show that our data are normally distributed at a significance level p<.000.
Childhood trauma and personality … 43
Table 6. Bivariate correlations between trauma scores (HTQ) and personality factors (NEO-
PI-r). Given is Pearson’s correlation coefficient. The numbers on the top row represent the variables as numbered in the first column. *** p < 0.001
N=355
1 2 3 4 5 6 7
1 HTQ all -
2 HTQ trauma 0.955 -
exposure ***
3 HTQ culture 0.93 0.778 -
*** ***
4 Neuroticism -0.026 -0.004 -0.045 -
5 Extraversion -0.192 -0.189 -0.17 -0.197 -
*** *** *** ***
6 Openness -0.08 -0.06 -0.097 -0.003 0.364 -
***
7 Agreeableness -0.151 -0.119 -0.171 -.006 0.04 0.811 -
*** *** ***
8 Conscientiousness -0.041 -0.06 -0.017 -0.439 .0118 -0.012 .0206
*** *** ***
As it can be seen from table 3, the overall score from the Harvard trauma questionnaire, which represents both the trauma exposure and PTSD symptomatology, was Childhood trauma and personality … 44
positively correlated with its subparts in the HTQ trauma exposure (r=.955, p<.001), as well as with the other subpart in the HTQ culturally sensitive questions (r=.930, p<.001). On the other hand, trauma exposure and PTSD were negatively correlated with the personality factors of extraversion (r=-192, p<.001) and agreeableness (r=-.151, p<.001).
2.5. Correlations within the variables measuring trauma The trauma exposure subscale of the HTQ has 16 items, and is considered to measure exposure to specific traumatic events such as having faced circumstances of a death, injury, kidnapping of a close person. Our correlational analysis found that trauma exposure was positively correlated with HTQ culture (r.778, p<.001) and negatively correlated with extraversion (r=-.189, p<.001) and agreeableness (r=-.119, p<.001). The HTQ Culture section has 14 items, which have been adapted to specific cultures and circumstances. Our findings reveal a negative correlation between this section of HTQ and personality factors of extraversion (r=-.17, p<.001) and agreeableness (r=-.171, p<.001). Figure 4 illustrates a steady decline in extraversion scores, as the mean scores of trauma exposure slightly go up.
Figure 4 Scatterplot with regression line of Trauma exposure and Extraversion. N=355, B=4.799, r = 0.189, p < 0.001.
Childhood trauma and personality … 45
The first factor of personality, neuroticism (48 items), was positively correlated with depression (BDI) (r=.525, p<.001) and negatively correlated with the other factor, extraversion (48 items) (r=-.197, p<.001) and conscientiousness (r=-.439, p<.001). Extraversion had a significant positive correlation with openness (r=.364, p<.001) and conscientiousness (r=.118, p<.001). Openness showed no significant correlation with any other factor. Agreeableness showed a positive correlation with conscientiousness (r=.206, p<.001).
2.6. Age correlations Age was negatively correlated with all the measures of HTQ: HTQ all (r=-.191, p<.001), trauma exposure (r=.-182, p<.001), HTQ culture (r=-.181, p<.001). The negative correlation between age and trauma measures tells us that the smaller the age of traumatization, the more severe the impact of trauma and PTSD related to it.
2.7. Personality correlations 2.7.1. Neuroticism facets correlations
Neuroticism (N) as a personality factor was significantly correlated only with depression (r=.525, p<.001). When we looked for significant correlations between different facets of neuroticism, namely anxiety, anger, depression, self-consciousness, impulsivity and vulnerability, we found that most of the facets had a significant positive correlation with depression (BDI). Depression (BDI) was positively correlated with anxiety (r=.150, p<.001); anger (r=.127, p<.001); depression (r=.174, p<.001); self-consciousness (r=.151, p<.001) and vulnerability (r=.148, p<.001). The facet of anxiety was positively correlated with anger (r=.541, p<.001), depression (r=.410, p<.001), self-consciousness (r=.341, p<.001), impulsivity (r=.291, p<.001) and vulnerability (r=.511, p<.001). The facet of anger also had a significant positive correlation with all the other facets of the neuroticism. Anger was positively correlated with depression (r=.717, p<.001), self-consciousness (r=.599, p<.001), impulsivity (r=.530, p<.001), and vulnerability (r=.383, p<.001).
Childhood trauma and personality … 46
Table 7 Pearson’s Correlations between 6 facets of Neuroticism (N) and Depression. (The numbers 1 to 6 in the top row correspond to the 6 facets of Neuroticism presented in the first column).
1 2 3 4 5 6
1. Depression - BDI 2. Anxiety (N1) .15 - ** 3. Angry .127 .541 - Hostility (N2) ** ** 4. Depression .174 .41 .717 - (N3) ** ** ** 5. Self- .151 .341 .599 .643 - consciousn. ** ** ** ** (N4) 6. Impulsivity .083 .291 .53 .589 .535 - (N5) ** ** ** ** 7. Vulnera- .148 .511 .408 .383 .355 .468 bility (N6) ** ** ** ** ** **
**. Correlation is significant at 0.01 level (2-tailed). *. Correlation is significant at 0.05 level (2 tailed).
The facet of depression (N3) was positively correlated with all the other facets of neuroticism, depression and self-consciousness (r=.643, p<.001), depression and impulsivity (r=.589, p<.001), depression and vulnerability (r=383, p<.001).The facet of self-consciousness (N4) had a significant positive correlation with impulsivity (N5, r=.535, p<.001) and vulnerability (N6) (r=.355, p<.001). The facet of impulsivity (N5) had a significant positive correlation with vulnerability (N6, r=.468, p<.001).
2.7.2. Correlations of other personality facets
Extraversion was negatively correlated with HTQ total score (r=-.192, p<.001), trauma exposure (r=-.189, p<.001),PTSD (r=-170,p<.001), neuroticism (r=-197,p<.001), and positively correlated with openness (r=.364, p<.001), and self-consciousness (r=.118, p<.001). None of the Childhood trauma and personality … 47
facets of extraversion had any significant correlation with the main variables. The average score for the extraversion factor (E) ranged as average, while its facets, with the exception of activity (E4) which ranged average, ranged as high in the NEO PI-R scales (McCrae et al., 1992). Neither did we find any significant correlation between the facets of openness to experiences and the other main variables. The same goes for the facets of agreeableness and conscientiousness.
2.8. Linear regression analysis We applied linear regression analysis in order to analyze the associations between trauma exposure and neuroticism, extraversion, openness to experience, agreeableness, consciousness, BDI, Depression. We found a significant negative association in the relationship between trauma exposure and extraversion B=-4.799, F (1,348) =12.847, p<.001. Trauma exposure in early childhood explained 3.6% (R=.189) of our independent variable, extraversion. There was also founda significant negative association in the relationship between trauma exposure and agreeableness F (1,348) =5.006, p=.026. Trauma exposure in early childhood explained 1.8% (R=.119) of our independent variable, agreeableness. We found a significant positive association in the relationship between trauma exposure and PTSD F (1,347) =532.646, p<.001. Trauma exposure in early childhood explained 60.5% (R=.778) of our independent variable, PTSD.
Table 8 Linear regression with Trauma exposure HTQ as the predictive variable Variables R F p B Extraversion .189 12.84 .001* -4.799 Agreeablen. .119 5.006 .026* -3.006 PTSD .778 5.326 .001* 2.425 Neuroticism .004 .946 .147 -.106 Openness .060 1.273 .260 -1.333 Depression .048 .789 .372 .726
We also ran a stepwise multiple regression analysis, to see if personality factors could have played a role on trauma impact. The dependent variable was HTQ all, while as the predictive variables served the five personality factors. The findings reveal an association between the personality factor of extraversion and trauma, B=3.914, F (1,346) =13.186, p<.001. 3.7% of the trauma impact could be explained through the personality factor of extraversion. A positive association between the other personality factor of agreeableness and trauma was also found, B=4.466, F (1,347) =10,425 p<.000. 5.7% of the variability of trauma impact could be explained Childhood trauma and personality … 48
by the personality factor of agreeableness. The other personality factors i.e. openness to experience, neuroticism and conscientiousness were excluded by the model. Please see table 10. TABLE 10. Stepwise linear regression with HTQ all as the dependent variable and personality factors as independent variables. The other three personality factors were excluded from the model. Included R F p B variables Extraversion 0.192 13.186 < 3.914 0.001 Agreeablen. 0.239 10.425 < -3.006 0.001
Excluded variables Neuroticism -0.066 -1.228 0.220 Openness -0.012 -0.230 0.818 Conscientiousness -0.017 0.225 0.748
2.9. Summary of the results 1. Trauma exposure in childhood and PTSD in adult life were found to be positively correlated. 2. Trauma exposure in childhood and depression in adult life were not found to be correlated. 3. Trauma exposure in childhood and personality structure in adulthood were found to be partly correlated. 4. Extraversion and agreeableness were found to be negatively correlated with childhood trauma. 5. Age was only correlated with trauma measurements, but not with the any of the dependent variables.
Childhood trauma and personality … 49
3. CHAPTER THREE: DISCUSSION
3.1. Reiteration of hypothesis and General discussion of the findings Literature on the topic of trauma relates unequivocally traumatic experiences of early childhood with general mental health later in adult life (Edwards et al., 2003). In line with the existing literature, but, with the addition of some new research questions and variables, we conducted this study with the goal of explicating the development of the different hypothesis, namely that:
1. Traumatic experiences experienced early in childhood (5 to 11 years of age), would correlate with higher symptomatology of anxiety later in the adult life; a. Traumatic experiences experienced in early childhood would correlate with higher symptomatology of depression later in the adult life; 2. Traumatic experiences experienced in early childhood would correlate with the structure of personality traits later in the adult life, and, 3. The age of traumatization would correlate with the severity of the influence of trauma, with regard to the personality structure, depression and anxiety, measured later in the adulthood. In a nutshell, we tried to establish a link between the experience of early childhood traumatic events with personality traits and mental well-being in adulthood. The findings of this study, mostly in accordance with previous studies of the same area of research, reveal that: H1. The experience of traumatic events in childhood is significantly correlated with PTSD in adulthood, but not with depression. Hypothesis, partly confirmed. o The correlation between trauma exposure and PTSD was strongly positive. Hypothesis confirmed. o There was no statistically significant correlation between trauma exposure and depression. Hypothesis rejected. H2. We found correlations between trauma exposure and the personality factors of extraversion and agreeableness, but we did not find significant interactions between trauma exposure and other personality factors neuroticism, openness, and conscientiousness. o There was no statistically significant correlation between trauma exposure and neuroticism. Childhood trauma and personality … 50
o We found a significant negative correlation between trauma exposure and extraversion, as well as between trauma exposure and agreeableness, but we failed to find any significant correlation between trauma exposure and openness to experiences or conscientiousness. H3. We only found an effect of age with respect to traumatization (both scales of HTQ), but failed to find any significant correlations between age and depression or personality structure. o The correlation between age of traumatization and the severity of trauma impact and PTSD was negative, meaning the smaller the age when trauma takes place, the higher the impact of it. If we were to dissolve the findings of this study into smaller bits, and then get the pieces back together, we might see that within our human psyche structures, and the neuronal basis of it, there is diversity and variation with regard to how external and internal information is processed and the impact it might generate on us.
3.2. General discussion of the results 3.2.1. Trauma exposure and Post Traumatic Stress Disorder The findings of this study reveal that most of our participants had undergone very severe traumatic life events during the 1998-99 war in Kosovo. More specifically, 82% of them were exposed to the death of a close person, 83% were exposed to the kidnapping of a close person and 81% were exposed to severe injury of a close relative. Our findings regarding the severity of traumatization, compare well with other studies from countries that have undergone war. For example, in a study conducted by Altawil and his colleagues (Altawil et al.,2008), in the year 1999 with the children of the Gaza Strip in Palestine, it was revealed that 99% of children there had suffered humiliation, 97% were exposed to bombardment, and 85% had witnessed death during the clashes. A study published by Qirjako in 2007 with the young population of Kosovo, revealed that around 25% of the respondents had been exposed to severe traumatic events (Qirjako, 2007). Regarding the prevalence of PTSD among our respondents, the results of such prevalence were rather high (13.1%). The prevalence of PTSD among our participants was considerably higher compared to the prevalence of PTSD in general populations in peaceful countries. In a study published by Burri et al., (2014), the PTSD prevalence in France was 2.3%, in the Netherlands 3.3%, and in the UK 3.0% (Burri et al., 2014). If we come back to the sample and population of this study, studies reveal a stable decline in PTSD symptomatology after the year 2000. As reported by Wenzel et al., (2010), in 1999 PTSD Childhood trauma and personality … 51
prevalence had been at 17.1%, while in 2000 it rose to 25%. After 2000, a noticeable decline was present, and the PTSD prevalence dropped back to 16% amongst war veterans when measured in 2010. Our study, with data collection taking place in 2015, posits PTSD at 13.1%, 16 years after the war-trauma. The overall trend of these findings tells us that PTSD seems to follow a natural decline with time.
The fluctuations of PTSD prevalence, as shown by Wenzel et al., (2010) and the current study. Year PTSD prevalence 1999 17.1 2000 25% Wenzel et al.,(2010) 2010 16% 2015 13.1% Current study
In conclusion, it can be said that the impact of war experiences among our respondents was high. Our findings demonstrate that war experiences cause severe psychological trauma, and that such trauma can last longer than it is generally expected. Such findings are supported by the literature on trauma and most empirical studies. In a review study conducted by Czapiga (2009), he concluded that the reaction of children to childhood trauma is complex and may take different forms and manifestations. According to this study, the three most common disorders developed as a reaction to trauma are: reaction to severe stress and adjustment disorder; acute stress disorder and PTSD. Nonetheless the fact that the findings of this study are in line with the findings from literature on trauma, there still remains one point we need to address here, namely the high prevalence of exposure to traumatic events among our respondents, but still a rather lower incidence of PTSD. Studies have revealed that even though PTSD is a direct consequence to experiencing traumatic events, not every individual, child or grown up develops PTSD or other psychiatric disorders in reaction after experiencing traumatic events (Czapiga, 2009). Moreover, Breslau et al., (1998) reports that most of the people who experience severe traumatic events never develop PTSD. But for the ones who develop PTSD as a reaction to trauma, there seem to be a few factors involved. According to Yehuda (1998a) the main risk factors for developing PTSD as a reaction to trauma can be environmental, which include prior exposition to traumatic events. One or many prior events of being exposed to trauma increases the likelihood for developing PTSD. Family instability after the incidence of trauma increases the likelihood for developing PTSD as well, while a stable family and social environment has the opposite effect (King et al., Childhood trauma and personality … 52
1996; Solomon et al., 1988). Regarding the demographic risk factors for developing PTSD, gender, age, socioeconomic and educational variables play a crucial role (Brelasu et al., 1999b). Personality profiles also play a role in the development of PTSD in response to trauma. Breslau (1998) and Schnurr (1993) found that avoidant, antisocial and neurotic personalities have a higher propensity for developing PTSD after trauma. Our findings also revealed that the personality factors of extraversion and agreeableness could help to explicate the nature of impact of trauma among our respondents.
3.3. Correlation of age with the dependent variables We failed to find any major effect of age on any of our main dependent variables (depression or personality structure). The only interactions that we found were with HTQ subscales of trauma exposure and PTSD. Furthermore, this interaction was negative, and a negative interaction in this case means that the younger the age of our respondents at the time of traumatization, the higher the severity of impact of the trauma. This effect is in line with our expectations as well as other scientific studies. For example, a similar result was reported by Yöyen and his colleagues (2017). They also found that social relationships and psychological health were impacted by the age of traumatization (Yöyen et al., 2017). In a study published by Rutkowski et al., (2016), two groups of children were compared, the first group being traumatized before the age of five, and the second group after the age of five. Even though, they found similar psychological profiles of both groups, as a general trend they discovered that the younger the age of traumatization, the more disintegrated the self becomes. Furthermore, their findings unveil that childhood trauma can have severe impact even in cases when the traumatized individual does not have any conscious recollections of the traumatic experiences. Other studies found that very early childhood trauma could cause brain shrinkage (Putman et al., 1997), and the younger the age of traumatization, the more noticeable the brain damage (Sheline et al., 2003). With regard to our study, and the lack of interaction between age and personality characteristics, we assume that this non finding could be attributed to the fact that we had a very small variation in our population with regard to age. The standard deviation within our population was 3.78 years from the mean age, and this variation is too small to produce any major impact, especially considering the fact that the data were collected 16 years after the traumatic events took place.
3.4. Trauma exposure and depression As postulated by the author of the BDI himself, Aaron Beck (1961), the BDI does not offer a categorical separation between those who would qualify as depressed and those who would Childhood trauma and personality … 53
not, but it rather offers five ranges of categorization between borderline unhappy moods and extreme depression, i.e. 1-10, normal ups and downs; 11-16, mild mood disturbance; 17-20; borderline clinical depression; 21-30, moderate depression; 31-40, severe depression and over 40, extreme depression (Beck, 1961). 53.8% of our respondents scored within the range of normal ups and downs; 25.7% scored in the range of mild mood disturbances; 6.4% scored in the range of borderline clinical depression; 10.7% scored in the range of moderate depression; 2.1% scored in the range of severe depression while the remaining 1.2% scored in the range of extreme depression (see Figure 5).
Figure 5 Severity of depressive symptoms BDI 60%
50%
40%
30%
20%
10%
0% Not Boderline Mild Moderate Severe Extreme depressed depressed depression depression depression depression
Many other studies conducted earlier to investigate the relationship between trauma and depression reveal a close relationship between the two (Ajdukovic et al.,1998; Ahmad et al.,2000; Thabet et al.,2004; Wenzel et al.,2010; Zivcic et al.,1993). However, our correlational and regression analysis failed to build any significant relationship between early life traumatization and depression later in life, and our regression analysis attributed only 4.8% of the depressive symptomatology to trauma exposure. We believe that the lack of such interactions can be attributed to the following confounding variables: This study was designed as a correlational study, aiming to build correlational relationships between variables at two distinct points in time; hence, it is hard to know for sure the state of mental functioning at the time of trauma impact. Sixteen years have passed between the time of trauma impact and the time of measurement. Many alternations with regard to the mood can happen in such a long period of time, especially when we consider Kosovo as a post-war and developing country, with a very poor socioeconomic well-being and a low standard of living. Childhood trauma and personality … 54
As reported in the results section, depression measured by BDI and neuroticism as a personality factor showed a twofold interaction. First, the overall score of BDI was positively correlated with the overall score of the personality factor of neuroticism, and second, five of the six facets of neuroticism were positively correlated with depression. Such a strong link between depression and neuroticism could be reduced to the definition of both constructs themselves. While depression and its symptomatology mainly represent the prolonged experience of negative feelings, anhedonia and withdrawal from daily activities (Davey, 2008), neuroticism on the other hand represents the tendency to experience negative emotions such as anger, anxiety, and depression (McCrae et al., 1997; 2008). Furthermore, there are studies which have tried to find a common genetic ground between depression and neuroticism (Kendler et al.,2006; Radlof et al., 1997).
3.5. Personality findings The findings of this study demonstrate a balanced distribution of scores among the five personality factors: neuroticism, extraversion, openness to experiences, agreeableness and conscientiousness. The mean score of all the factors differs, at most, for ten points from each other. Furthermore, we found that, with the exception of neuroticism, all other factors scored average. A high score on neuroticism means that the individual is mainly experiencing negative emotions, has lots of worries and doubts, is characterized by negative apprehensions about the future, and is mostly distrustful towards the others, as opposed to extraversion which is associated with positive emotions, warmth, good social relationships, good humor, and in general a pleasant life (Costa et al., 2010). In other words, neuroticism and extraversion reveal two opposite poles of our emotional wellbeing and social functioning. We found a strong significant negative correlation between these two factors. This tells us that the more one is prone to negative feelings and negative experiences, the less likely that person is to have satisfying social interactions with the others, and a good- natured emotional life (Wilson et al., 2006; Rusting et al., 1997). Neuroticism was also negatively correlated with conscientiousness. Given that a person scoring high on conscientiousness is characterized by a well-established direction and organization of life, accompanied by good relations with others, a sense of trust and sharing, as well as a high level of accountability, it is not hard to imagine that neuroticism represents the exact opposite attribute relative to conscientiousness. Hence, a negative correlation between the two is the first result one would expect. We also found a significant positive correlation between extraversion and openness to experiences. Given that openness to experience represents the proneness of an individual for Childhood trauma and personality … 55
seeking sensations, and living an active and participating life, with positive social interactions (McCrae, 1997), one cannot resist but notice the similarities between the two factors. No other factors showed any significant correlations with each other, or any of the other variables. However, we found strong positive correlations between the five facets of neuroticism and depression. In other words, the neuroticism facets anxiety, angry hostility, depression, self- consciousness and vulnerability, strongly correlate with depression measured by BDI, and the correlations were positive. This means that, the more an individual is neurotic, the more he is likely to be depressed as well. To understand this relationship, we need to look back at the main characteristic of each of the correlated facets, namely the states of worry, anxiety and nervousness for anxiety; restlessness, irritability, anxiety and tension for angry hostility; pessimism, worrying and negative emotions for depression and shyness, distrustfulness, inhibition and anxiety for self-consciousness (Costa et al., 2008). The experience of such negative arousal states for prolonged periods of time increases the sensitivity for negative emotions in general (Wilson et al.,2006), and as a final consequence, the individual is highly likely to experience negatively charged emotions such as sadness, anger, anxiety, loneliness, frustration and worry (Rusting et al.,1997). When we add these symptoms together, we get the gist of the symptomatology of depression itself. In a similar line of reasoning, but from a neurobiological perspective, Arborelius (1999) argues that when the subcortical structures of the brain, namely the hypothalamus, the pituitary gland and the adrenal gland are activated continuously for a prolonged duration of time, due to the experience of anxious emotional states, the result is a substantial vulnerability of the limbic structures of the brain responsible for our emotions, which as a final consequence makes it more likely for the individual to experience depressive moods.
3.5.1. Trauma and personality From the five factors of personality (neuroticism, extraversion, agreeableness, openness to experiences and conscientiousness) only two of them, extraversion and agreeableness interacted with the experience of traumatic events in childhood. Our findings reveal that extraversion and agreeableness were negatively correlated with the experience of traumatic events. In other words, this finding tells us that the more traumatic events experienced in childhood, the less likely we are to have a social and adaptable personality as adults, at least in two distinct spheres: our affinity for active participation in social life as well as our ability to lead a smooth and positive interaction with the others. While we were looking for studies to compare our finding to, we came across a study by Yӧyen (2017) stating that there has been no study to build a direct relationship between childhood trauma and personality as in the Five Factor Model of Childhood trauma and personality … 56
Personality (Yoyen et al., 2017), however, there have been studies published which find correlations between the symptomatology of PTSD and different personality factors separately. For example, many studies have found a positive correlation between PTSD and the personality factor of neuroticism (Breslau et al.,1991; Chunget al., 2005; Chunget al.,2007; Davidson et al.,1987; Hyer et al., 1994). On the other hand, other studies have found a negative correlation between PTSD and extraversion (Chung et al., 2005; Davidson et al., 1987; McFarlane, 1988), as well as PTSD and low agreeableness (Chung et al., 2007; Hyer et al., 1994; Talbert et al.,1993). The correlations between PTSD and personality traits found by studies mentioned above and the current study, do not tell us much about the causal relationship between the two in the sense of trauma causing personality changes or personality structure influencing how the trauma impact is generated. Our findings revealed that just like 3.6% of extraversion and 1.4% of agreeableness variability can be explained by the trauma impact, the same goes the other way around too, 3.7% and 5.7% of the variability of trauma impact is related to the personality factors of extraversion and agreeableness. Other studies have found strong basis to establish personality structure as an influencing factor for the development of PTSD after trauma (Fauerbach et al., 2000, Cox et al., 2003). When we bring these findings together, they imply a bidirectional relationship between personality structure and trauma impact. Such a finding is not much surprising given the fact that personality is the underlying structure of our mind and it influences everything that we perceive and react to. With regard to the impact that trauma experiences could generate on personality structure traits, one cannot help but notice a scarcity of studies linking childhood trauma with adult personality. Hence, we were challenged to approach the issue from a different perspective, since our regression analysis revealed that 3.6% of the variability in the extraversion dimension and 1.4% of variability in the agreeableness factor can be explained by being exposed to trauma in childhood. According to Cohen (1998) 1.4-3.6% is a rather weak relationship, so there seem to be a lot of other influencing factors, which is expected given the fact that 16 years have passed in between trauma impact and personality measurements. Nonetheless, the latent influence still seems to be measurable. But before we move into tentative explanations of this relationship, we would like to bring to notice the similarities between these two factors, i.e. extraversion and agreeableness. Both of them mainly have to do with where one finds most pleasure and productivity in life, either in social environments as is the case with extraverts and highly agreeable people, or in isolation and individual activities, as do prefer the introverts and low scorers on agreeableness. Consequently, Childhood trauma and personality … 57
we assume that much of the literature, which is relevant for extraversion, is relevant for agreeableness as well. The studies which could help us build an indirect link between trauma exposure and its negative link with extraversion and agreeableness in adulthood are many, and most of them come from the field of evolutionary neuroscience and developmental theories of personality.
3.6. Theoretical explanations of the findings from a neuroscientific perspective We believe that in order to explain our findings, we have to go as far back as the phylogenetic and ontogenetic history and architecture of the nervous system and human brain itself. From an evolutionary perspective (phylogenetic), the first structure to develop in our brain is the autonomic nervous system which is also called the reptilian part of the brain. Ontologically in a fetus, this is also the part of the nervous system which matures first (MacLean, 1970; 1990). The reptilian nervous system’s crucial role is to ensure our survival by regulating our heart rate, digestion, breathing etc. through the mechanism known as “fight or flight” & “rest and digest”, which enable us to avoid threats and dangers when we face them on a daily basis or in extreme circumstances, such as war. It is worth mentioning that in reptiles, the brainstem and the spinal cord constitute the whole nervous system (MacLean, 1970). According to the triune brain model proposed by MacLean, the reptilian brain or reptilian complex in us, could have first appeared in some fish as far as 550 million years ago (MacLean, 1970). If this structure of the brain is this old, it might be because it proved indispensable for the survival of all the animals, hence it makes sense that, ontologically, it matures sooner in humans as well, with the aim of carrying on the maturation of the organism and to ensure its survival. The neuronal bases of this branch of the nervous system are the spinal cord and the brain stem. Coincidentally, these regions, together with some limbic structures of the brain, are the first structures to respond to anxiety and highly aroused mental states and their prolonged activation could lead to depression (Arborelius et al., 1999). In circumstances of war, the survival of one’s self and their relatives being is likely to be threatened extremely, hence the activation of these brain regions might be extreme in such circumstances, due to the long history they carry with them. Moreover, studies from neuroscience have found inborn structures within the amygdale, responsible for reaction to certain threats and fears (Beaumont, 2008). Interwoven with these structures we have the mesopart section of the brain known as the limbic system, or the mammalian brain (McLean, 1970). This branch of the nervous system represents the mammalian history in us, mainly expressed in emotional states based in brain areas such as amygdala, hippocampus, thalamus, hypothalamus, basal ganglia and cingulate Childhood trauma and personality … 58
gyrus. If the reptilian part of our nervous system enables us basic whole body movements, mainly approach or withdrawal from the threat, the limbic system is associated with more complex global or partial body movements.
If we leave the involvement of the prefrontal cortex aside for a moment, we are safe to say that our emotional states arise, develop and travel further from exactly these above mentioned structures of the brain. According to a few recent studies, but most prominently the ones by Arborelius (1999) and Nestler (2002), there is a downward trident regulation of the hypothalamus, pituitary gland and adrenal gland which are heavily involved in the experience of highly aroused and depressive states. As we stated earlier, the HPA axis stays mainly hyperactive when the biology of the organism is threatened continuously for a certain period of time (Arborelius et al., 1999; Nestler et al., 2002). We believe that this was exactly the typical mental state of our respondents during that one and a half year of war they were stuck in. Many of such extremely aroused states, through the HPA mechanism, in the long run, may result not only in depression (Champman, 2014), but changes in personality as well (Dube, 2001). While Champman et al., (2014) found a clear relationship between the number of experienced adverse events and the level of depression experienced afterwards, Dube and his colleagues found that childhood traumas could increase the risk for suicidal behavior later in life from two to five fold (Dube et al.,2001). A study by Brewinet al., (2002) reveals that the biological underpinnings of prolonged exposure to stressful events, through the prolonged hyperactivation of the HPA axis, might correlate with a reduction of hippocampal tissue in our brain, a similar result was found by Sheline et al., (2003) among individuals with prolonged depression who were not taking antidepressant medications. With regard to personality, Hans Eysenck found that introverts need only a small stimulation in order to be over stimulated physiologically, as compared to extraverts whose physiology cannot be awakened easily (Eyseneck, 1967). In line with the Eysenck’s findings (1967), we could argue that the low scores we found on extraversion and agreeableness represent a lag effect of hyper activation due to trauma, with physiological underpinnings. However, in order to address the neuronal basis of personality we have to mention the crucial role that the frontal lobes of the cerebral cortex play with regard to personality. “The frontal lobes, are home to key components of the neural circuitry of executive functions such as planning, working memory, and impulse control” (Sowell et al., 1999). From an evolutionary perspective, the cerebral cortex is the youngest part of our brain as well (Murphy, 2017). Childhood trauma and personality … 59
The key fact with regard to personality neuronal structures, is that the cerebral cortexes, unlike most other brain regions, do not fully mature until the mid-twenties (Sowell et al., 1999). This is important because many skills, psychological functions, and even body organs, have a sensitive period of development. For example, Hubel and Weisel (1959) found that if kittens are deprived of colors in the first six months of their life, they will not see color ever again. Or likewise, if a child shares the bad luck of growing up in the wilderness, at least until the age of thirteen, he would lose the capacity to speak a language for the rest of his life. Studies like the one from Coronado (2013) demonstrate clearly the existence of a critical age for language acquisition as well. This and many other cases of psychological functions specificities, tell us that each psychological function has a window of time within which it is dynamic, and then it reaches a stable state where from, change is harder to occur. Such is the case with our body organs as well. For example, our eyes have a critical time of development (Purves, 2001), while our brain reaches 90% of its final stage within our first six years of life (Reiss et al.,1996), but roughly completes its development at the age of 25 (Sowell, 1999). If the neuronal bases of personality maintain a higher rate of plasticity for longer in our lifetime, then personality itself could be responsive to change for longer as well. This was the case with the findings of our study, and is the case with the findings from other studies as well.
Data from intimate relationships and attachment styles reveal that up to 15% of people can change their attachment style from insecure to secure later in life (Brehm, 2001). Others can learn emotional intelligence. Even the cognitive intelligence can be improved, up to three IQ points per decade (Miller, 2007). Satisfaction with life and with work has shown to increase the extraversion related scores, while dissatisfaction with life and work contributes to increases in neuroticism scores (Roberts, et al., 2003; Roberts and Chapman, 2000; Scollon and Diener, 2006; Van Aken et al., 2006). According to Neyer and Asendorpf (2001), entering a positive relationship would increase extraversion scores and decrease the neuroticism ones. These results are corroborated by Costa et al., (2000), Robertsand Chapman (2000), Robins et al., (2002), who found that getting married or getting divorced has the power to influence personality traits such as extraversion and neuroticism in a positive way. When we add the findings from the current study to the above mentioned studies, the natural conclusion is that personality is not fluid only in childhood, but keeps a dose of fluidity and plasticity throughout the adult life as well.
Childhood trauma and personality … 60
3.6.1. The Rothbart (2006) conceptualization of temperament and personality continuity
There are many theorists within the field of developmental psychology who support the preposition that temperament, at least to a certain degree, demonstrates a continuity during early years of childhood (Goldsmith et al., 1987; Lemeryet al., 1999; Rothbart and Bates, 2006). In this respect, temperament should be identified with the aspects of our psyche which are with the infant from the very moment of birth, in other words, which are not a result of interactions with grownups (Komsiet al.,2006). These feats of temperament control the responsivity of the nervous system to sensory information as well as the basic behavioral reactions (Rothbart and Derryberry, 1981). Or as Goldsmith puts it (Goldsmith et al., 1987), temperament represents inborn traits which set the stage for sensory and behavioral patterns (Komsi et al., 2006). These inborn traits, according to Rothbart and Goldsmith (1991), include early differences in motor activity, smile-proneness, soothability, attention span, anger-proneness and fearful distress (Komsi et al.,2006). Rothbart (2001) later adds to this list attention focusing, positive anticipation, fear, impulsivity, reaction patterns to stimulus intensity, pleasure as a response to stimulation, inhibitory control, sadness, shyness, smiling, laughter etc. In the Rothbart’s model, changes in temperament later in life are not ruled out altogether. On the contrary, temperament seems to be open to transformation, and upon the completion of age three, these temperamental feats seem to set off the stage for the first modes of inhibition and behavior regulation together with attention mechanisms (Rothbart at al., 1981). Furthermore, according to Rothbart (2001), these feats of temperament could serve as the basis for the development of personality. The fourteen temperamental differences that exist in early childhood set the foundations for emotional and personality development later in life accordingly (Derryberry and Rothbart, 1997). Different researchers such as Rothbart (2001), then Caspi and Roberts (1999), McCrae (2000) etc, support the idea that the previously explained structure of temperament becomes very stable after childhood, and could hardly be affected by life experiences. According to Caspi and Roberts (1999), personality in adulthood represents stable descriptions across time. In other words, these descriptions which can be thought of as traits are homotypically continuous (literally continuous) (Putnam et al.,2008). McCrae and his colleagues (2000), go as far as to rule out any external influences on the basic temperamental tendencies of childhood. The common denominator of the above mentioned studies is that temperament, which sets the stage for personality development is stable over time and cannot be much influenced by external influences. Furthermore, based on the Rothbart conceptualization of personality Childhood trauma and personality … 61
continuity, we could argue that the personality of our respondents, at least partly resisted the influence of the trauma, and was not altogether altered by the experiencing of war circumstances, as our finding partly show. In other words, our findings reveal that childhood trauma can actually change personality, and that change is stable. Luckily, the story does not end here. Many studies have found that even major changes in adulthood, such as entering a stable relationship and getting a good job or building a satisfying life-style, could change, or should we say re-change our personality—mainly the factors of extraversion and neuroticism (Costa, et al, 2000; Roberts and Chapman, 2000; Robins et al., 2002). A first assumption one could draw from this, is that personality is at least as fluid as it is rigid. Not every experience gets to rebuild over the old structures of personality, but some major ones, apparently seem to have a lasting impact.
3.7. Experienced Trauma and Personality disorders Seth and colleagues (Seth et al., 2005) found a relationship between trauma, PTSD and features of borderline personality disorder. Another study conducted in 1993 by Southwick, Yehuda and Giller (1993), with 18 inpatients and 16 outpatients, found that at least one third of them suffered from at least one personality disorder. The most common personality disorder to be diagnosed with was borderline personality disorder in 76% of the cases, obsessive compulsive personality disorder was diagnosed in 44% of the cases, avoidant personality disorder in 41%, and paranoid personality disorder in 38% of the cases (Southwick et al., 1993). Inpatients were generally more often diagnosed than outpatients. The results from the above mentioned studies demonstrate that prolonged exposure to traumatic events, is not only capable of causing variations in personality factors, but their effects could be as severe as to play a major role in the development of certain personality disorders as well. The main symptoms of the borderline personality disorder, paranoid personality disorder and avoidant personality disorder are related to the experience of high anxiety in social interactions (Davey, 2008), and as a result, poorer social interactions, and decrease in their frequency. Our finding that trauma reduces our positioning on extraversion and agreeableness also reflects a poorer quality of interpersonal functioning and performance.
3.8. General implications of the study The prevalence of PTSD amongst the general population of peaceful countries circles around 2 to 5 percent (3.5% according to Negele et al.,2015), while the prevalence of PTSD among our participants was ranged at 13.1%. This noticeable disproportion could be an issue of consideration for the governmental, educational and economical institutions of the country. Childhood trauma and personality … 62
Other than PTSD, around 45% of our participants fit some of the criteria for depression as well. When we consider that the carriers of these mental disturbances are just in their twenties, then the impact can be expected to have long-lasting major consequences which demand serious consideration. Suicidal ideation (any subjects with non-zero scores of the BDI suicidality item) ranged at 7%. The mental costs of the Kosovo war that happened almost two decades ago, could follow a transformation path into other modes of costs such as: o In the personal sphere, more tendencies to use drugs and other modes of self-destructive behaviors in order to manage emotions, less professional and personal stability as well as less interpersonal stability. o There are also costs in the field of mental health by increasing the need for mental health professionals in order to deal with the psychiatric squeal of the trauma. Moreover, the tendency to experience higher levels of stress, as anxious and depressed people tend to do, weakens the physical health considerably, and as a consequence the general medical related costs could increase considerably (Walker, 2003). o Economic costs would include poor job performance, low productivity, more drop outs, and higher unemployment rates (Greenberg et al., 1999; Sayer et al., 2011).
3.8.1. Clinical implications of the study Studies using brain imaging techniques such as magnetic resonance imaging, focusing on the developments in the limbic areas of the brain, immediately after the traumatic experiences, could unveil the early neurobiological changes that set off this chain of negative reactions in the minds of the traumatized individuals. The findings of this study, could serve as a guideline to mental health practitioners to investigate more thoroughly and faster in the sphere of possible childhood traumas, whenever treating socially isolated patients.
3.8.2. Limitations The long time laps between trauma exposure and time of measurements could be regarded as a confounding variable and a limitation in itself. This study investigates depression and personality structure 16 years after our respondents were exposed to traumatic events. As a result, it is impossible for us to know how our respondents would have scored 16 years ago with regard to these constructs. Childhood trauma and personality … 63
The whole number of items that our respondents answered on a sitting was 365. Boredom and tiredness could have impacted the answers of at least some of the respondents as well. Given the fact that we investigated memory-based traumatic events, recall bias could have impacted the answers.
3.8.3. Future prospects We believe that most of the study subjects who took part in this study can be reached again for follow up studies. It would be particularly interesting to see how the structure of their personalities has shaped up, or if the structure of their personalities has changed any further, now after they have reached the age of >25—the critical age for cerebral development completion. Further investigating the causal relationship between extraversion and neuroticism could be of significant importance. It could inform us upon the trajectory of anomalies i.e. does social isolation come first, and as a result people become prone to negative feelings, or are people firstly prone to negative feelings as an impact of trauma, and as a result isolate themselves from the others.
3.9. Conclusion This study was conducted with the aim of bringing together very distant points and bits of our psychological development. The rationale behind the study was that childhood traumas influence personality characteristics in adulthood, and our findings confirmed that. Moreover, our findings reveal that the psychological functions that usually enable us smooth and fulfilling interactions with others are the functions which suffer most after the experience of childhood traumas. It turns out that, just like a happy marriage and a good job could turn people to be more extraverted, childhood trauma can turn children into more introverted and less likely to have enjoyable social interactions with others, as it is the case with low scorers on agreeableness. In contrary to our expectations, adult depression was not linked with childhood trauma.
Childhood trauma and personality … 64
4. CHAPTER FOUR: MATERIALS and METHODS
4.1. Sample selection and sample size Given that the Kosovo war of 1998-1999 could have impacted most of the Kosovar children living at that time in Kosovo, the population of this study is those kids, now as adults, varying between the ages of 18 and 24 at the time of measurement. The data were collected in 2015, 16 years after the war had taken place. The age of the participants of this study falls between 18 and 24. The average age of the sample was 20.6 years (SD=±3.87). We used a random convenient method of sampling, in which case almost the whole student population of the Department of Psychology of the University of Pristina was selected to participate in the study. Our sample consists of 355 respondents, while the department of Psychology of the University of Pristina can be calculated to have had approximately 500 registered students at that time. Hence, we are safe to say that more than 70% of the students of the Department of Psychology of the University of Pristina have participated in this study. Around 70% of our respondents were females, while the other 30% were males. All the participants of the study were Kosovo Albanians, and above 90% of them were declared muslims. With regard to territorial representation, the participants came from all the municipalities of Kosovo, and the rural and urban areas were similarly represented.
4.2. Inclusion criteria and compensation All of the students of the Department of Psychology were instructed by their professors to take part in the study, but still their participation was voluntary. The students, who would participate in the study, would get a few extra points in one of the classes they were taking that semester. The study has been approved by the Ethical Board of the University of Pristina (a scanned copy of the approval documentation will be attached to this report). Full anonymity and non data disclosure has been assured to the participants.
4.3. Procedure The study was conducted in a university setting, during lecture hours. As instructed by the manuals of the questionnaires, the timing for test taking was not limited. The testing took place during regular class hours, with the presence of the lecturers in the class, with the aim of getting as dedicated and sincere responses as possible. In order to collect data from a rather big sample, and in accordance with other studies on personality, we decided to use self-report paper-pencil instruments. After conducting a literature review on the possible instruments with which the data could be collected, the NEO PI-R (McCrea et al., 1992), Beck Depression Inventory II (Beck et al., 1968) Childhood trauma and personality … 65
and Harvard Trauma Questionnaire (Mollica et al., 2000) were selected as the main instruments for data collection, based on the overall frequency of usage on similar studies and their availability in Albanian. The testing would usually start with a set of instructions upon the goal of the study and instructions on how to fill in the questionnaires. Then three separate tests were positioned on the desk of each student, without the instructor ever leaving the room. On average, students took one hour to fill in the questionnaires and the demographic data section. Students answered the questions on an individual basis. It is worth mentioning that different tests had different answering modes. For example, the usual pattern of questions on NEO PI-R is that a declaration such as “I would rather praise the others than praise myself.” is made. And then the respondents have five options to answer on a Likert scale, starting from (1) Strongly disagree, (2) Disagree, (3) Neutral, (4) Agree, to (5) Strongly agree (McCrae et al., 1992). On the BDI section, each item had its specific options, ranged on a four point Likert Scale from (0) Least severe as the lowest score to the (3) Most severe manifestation of the experience (Beck et al., 1961). The items of the Harvard Trauma Questionnaire are scaled on a four point Likert scale, whereas the first option is (1) experienced, (2) witnessed, (3) heard about, (4) no (Mollica et al., 2000).
4.4. Instruments 4.4.1. NEO PI-R (Costa et al., 1992)
The Neuroticism-Extraversion-Openness-Personality-Inventory-Revised (NEO PI-R) is one of the most comprehensive instruments to evaluate personality. NEO PI-R was developed in many stages, but the current version was adopted by Costa and McRea (1992). The first tentative to draft an instrument like NEO PI-R unfolded successfully in the year 1978, when the first version known as NEO-I (Costa and McCrea, 1978) came out. This version of the instrument only measured 3 dimensions and 18 traits. Then, in the year 1985 the second version of the instrument known as the NEO-PI (Costa and McCrae, 1985) came out. This version already contained all the five big factors and most of the facets that NEO PI-R has today. Seven years later, in the year 1992 the instrument was updated again by Costa and McCrea and now it already had 240 questions and two different formats: S (self report), and R (observer report). In the year 2005, the NEO-PI 3 came along and it already had all the 240 questions of it adapted in the five point scale of Likert, going from strongly disagree to strongly agree. In this version, 37 items were revised from before (Costa and McCrae, 2005). Childhood trauma and personality … 66
The theoretical basis of the actual NEO PI-R is the Five Factor Personality model (McCrae et al., 1997; 2008). In other words, NEO PI-R investigates personality with regard to the big five factors: neuroticism, extraversion, agreeableness, openness to experience and conscientiousness. With regards to these five factors and this conceptualization of personality, the NEO PI-r has proven to be a very useful tool. It enables researchers of personality to use a common language in personality papers, a good theoretical framework to organize research and it serves as a guiding instrument for the assessment of individuals. The testing spectrum of NEO PI-R is very broad. The 240 questions that it contains enable researches to collect data on many aspects such as emotional functioning, interpersonal relationships and other interpersonal dynamics, experiential and subjective frame of reference of the individual, conative side of behavior, attitudes etc. NEO PI-R is useful for testing with non- clinical as well as clinical populations, as well as for older adults and for younger adolescents. It can also be used in many fields of application, such as industry, job interviews, in clinical assessment, in psychological research etc. Regarding the guidelines for administering the test, the timing for filling the NEO-Pi is unlimited, however, it usually can be finished in 30 to 40 minutes. There exist paper and computer versions of the test. The test is usually accompanied by a scoring booklet. The takers of the test are advised to answer all the questions if possible. In cases where within a single test, more than 41 items are missing, the tests are regarded as not valid. NEO PI-R is an instrument which has undergone many revisions. The NEO-PI-3, like NEO PI-r, gathers data on the big five personality factors, and it also measures each six facets of each of the five factors. The NEO-PI-3, except from retaining the validity and reliability measures of the NEO PI-R, has also proven to be adaptable for testing young adults and adolescents (Costa, 2010). The reliability and internal consistency of the current used version of the test were satisfactory, with a Crombach alpha of each factor ranging over .80, more specifically, neuroticism α=.91, extraversion α=.91, agreeableness α=.85, openness to experience α=.98 and conscientiousness α=.97. The translation and the initial standardization of the measure into Albanian was conducted by Berxulli, (2009).
Childhood trauma and personality … 67
Table 10 The Five Factors and 30 facets of the NEO PI-R Factor Facets Neuroticism Anxiety 6 facets Hostility 48 items Depression Self-consciousness Impulsiveness Vulnerability Extraversion Warmth 6 facets Gregariousness 48 items Assertiveness Activity Excitement seeking Positive emotions Agreeableness Trust 6 facets Compliance 48 items Altruism Straightforwardness Modesty Tender-mindedness Openness Fantasy 6 facets Aesthetics 48 items Feelings Actions Ideas Values Conscientiousness Competence 6 facets Order 48 items Dutifulness Achievement striving Self-discipline Deliberation
Childhood trauma and personality … 68
4.4.2. Beck Depression Inventory II (BDI II, 1996)
Even though the BDI was initially drafted by the father of cognitive school of Psychology, Aeron Beck, for the purpose of measuring the effects of treatment in dealing with depression in a clinical setting, not much time passed before BDI became the most well-known and used self- rating instrument to measure the symptomatology of depression. The original and most used version of BDI consists of 21 questions covering the vast majority of the affective spectrum symptoms (Beck et al., 1961). BDI utilized a Likert scoring scale, ranged from zero (least severe) to three (most severe manifestation of the symptom). Even though not much changed with the scaling, BDI soon transformed into BDI II (Beck, 1993).The main purpose of this adaptation was to make BDI more compatible with DSM-IV. Together with this update, four new symptoms were tested newly from the new BDI II, i.e. irritability, worthlessness, difficulties with concentration and lack of energy (Beck, 1996). On this occasion, symptoms such as weight loss, body image distortions, job difficulties and other somatoform concerns were eliminated from the new version. Also the assessment time was lengthened from one week to two in accordance with DSM criteria for depression. Furthermore, BDI has proven to be a very good instrument to measure depression symptomatology for a few reasons: it is short and easy to score, it is scored based on a clear scaling system, it doesn’t ask for special qualifications to apply it, it does not ask for special education achievements from the respondents to fill it in and it has been standardized in many languages and cultures (Biggs, 1978). Within the current study, BDI II has been utilized. Beck Depression Inventory has been tested for its validity in many studies. On a meta- analysis study directed by Beck himself (1988) which included all the papers that had used BDI from 1961 to 1986, he found a very high alpha coefficient (0.86) of the instrument (Beck, 1988). Regarding the consistency and reliability of the test, we received satisfactory results with a Cronbach alpha of .82 (21 items). The instrument was translated into Albanian by Arënliu, Kelmendi, Halimi, Bërxulli, and Begolli (2009) and resulted a Cronbach alpha of .87 and correlation r= .65, p=.001 between two measures with same population.
4.4.3. Harvard Trauma Questionnaire (HTQ, Mollica et al., 2000)
The HTQ was developed as an initiative of the Harvard Program for traumas among refugees in the year 1980. The goal of this initiative was to offer an alternative to the western models of existing tests for measuring trauma. The HTQ firstly was developed to clinically study Childhood trauma and personality … 69
the effects of trauma among refugees and other displaced populations (Mollica et al., 2000). The updated versions of the Harvard Trauma Questionnaire have proven very suitable for measuring trauma in different cultures and in diverse populations. A study from Sigvardsdotter (2016), reviewed the existing studies upon instruments used to measure trauma, and the HTQ was by far the most utilized instrument. While different instruments circulate around measuring trauma, the Harvard Trauma Questionnaire, part 1 is by far the most used one (Sigvardsdotter et al., 2006). According to Mollica (2004) who also has been involved in the initial design of the HTQ and in most of the upcoming versions, the goal of the Harvard Trauma Questionnaire is twofold: To obtain information about the actual trauma events and to assess the DSM-IV diagnostic criteria for PTSD (Mollica, 2006). The Harvard Trauma Questionnaire has four parts: (a) Trauma events- this is the bigger part of the test containing 16 questions about traumatic experiences; (b) Personal description of the most traumatic event that the respondent experienced; (c) Brain injury including brain injury due to starvation or suffocation; (d) Post-traumatic symptoms, with questions sensitive to cultural differences (Mollica, 2007).
For each item in the questionnaire, respondents have the chance to choose between four options: (a) experienced, (b) witnessed, (c) heard about, and (d) no. The fourth part of the scale measures PTSD and it is directly derived from the criteria for PTSD of the DSM III. This part has remained mostly unchanged in all the following versions of DSM (APA, 1987; 1994; 2000; 2003). This part of the test is designed to measure symptoms which can be categorized as intrusion/re-experiencing, avoidance/numbing, and hypervigilance/arousal symptom (APA, 2000). The original version of the test contains 30 questions, but in different adaptations, questions have been added or removed. In this study, the HTQ has 31 questions. 30 from the original version, and one additional question, which asked the respondents about a free description of anything that caused them extreme fear. The first 16 ones measure the exposure to trauma and PTSD related to it. The last 15 ones measure the culturally sensitive PTSD. Further in the text, we will be referring to these three measures with the following names: The overall score of HTQ (all 31 questions) will be referred as the HTQ all. The first part of the HTQ (16 Childhood trauma and personality … 70
questions) will be regarded as the HTQ trauma exposure, which is also compatible with the DSM 5 criteria for PTSD; and the last part, which consists of 15 questions (14 closed ones, and an open one) will be referred to as, HTQ culturally sensitive. From this part, we will be able to derive the symptomatology of PTSD. Regarding the parametric properties of the test, its high validity has been confirmed many times and in different studies (Miyazaki et al.,2006), but it also has proven to have a very high reliability and internal consistency ranging from alpha .86 to .94 (Miyazaki et al.,2006).
4.5. Data processing A battery of the above mentioned tests was applied to a sample of 355 respondents. All the applied tests were self-report tests, including the NEO PI-R S version. The tests, excluding the demographic questions, altogether had 365 questions, and it took the respondents approximately one hour to fill them in. The data collected were entered into IBM SPSS version 21 (Armonk, 2012) and were analyzed after initial data filtering, correction and standardization procedures took place. The level of statistical significance (two-sided) was set at p=.05. The data were not corrected for multiple comparisons due to the fact that this was an exploratory study. The main performed analysis included Pearson’s correlations and linear regression.
Childhood trauma and personality … 71
REFERENCES
Adler, A. (1927). Understanding human nature. New York: Greenburg. Ahmad, A., Sofi, M. A., Sundelin-Wahlsten, V., and Knorring, A. V. (2000). Post-traumatic stress disorder in children after the military operation "Anfal" in Iraqi Kurdistan. European Child and Adolescent Psychiatry,9(4), 235-243. doi:10.1007/s007870070026 Ajdukovic, M. (1998). Displaced adolescents in Croatia: Sources of stress and posttraumatic stress reaction. Adolescence, 33, 209– 217.
Allen, B., and Lauterbach, D. (2007). Personality characteristics of adult survivors of childhood trauma. Journal of Traumatic Stress,20(4), 587-595. doi:10.1002/jts.20195. Allen, Jon G. (1995). Coping with Trauma: A Guide to Self-Understanding. Washington, DC: American Psychiatric Press. Allport, G. W., Personality: A psychological interpretation. New York: Holt, 1937. Altawil, M., Nel, P.W., Asker, A., Samara, M., and Harrold, D. (2008). The Effects of Chronic War Trauma among Palestinian Children. In M. Parsons (Ed.) Children: The Invisible Victims of War-An Interdisciplinary Study. Peterborough-England: DSM Technical Publications Ltd. American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, Revised. Washington, DC. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC. American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC. American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). doi:10.1176/appi.books.9780890423349. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC. Arborelius, L., Owens, M.J., Plotsky, P.M., Nemeroff, C.B., 1999. The role of corticotropin-releasing factor in depression and anxiety disorders. J. Endocrinol. 160, 1–12. Arnone D, McIntosh A. M, Ebmeier K. P., Munafò M. R., Anderson IM. Magnetic resonance imaging studies in unipolar depression: systematic review and meta-regression analyses.Eur Neuropsychopharmacol2012;22: 1–16. Aronson, E., Wilson, T. D., and Arket, R. M., (2005). Methods of research in social psychology. University of California. Childhood trauma and personality … 72
Asendorpf, J. B., Borkenau, P., Ostendorf, F., and Van Aken, M. A. G. (2001). Carving personality description at its joints: Confirmation of three replicable personality prototypes for both children and adults. European Journal of Personality, 15, 169-198. Austin, D. M. and Roberts, A. R. (2002).The cost of caring: Secondary traumatic stress and the impact of working with high-risk children and families. Child Trauma Academy. Beaumont, J. G (2008). Introduction to Neuropsychology Second Edition. New York: The Guilford Press. Beck A. T, Steer R. A., Brown G. K. (1996). BDI-II: Beck Depression Inventory Manual. 2nd ed. San Antonio: Psychological Corporation; 1996. Beck A. T, Steer, R. A., Beck, J. S., and Newman, C. F. (1993). Hopelessness, Depression, Suicidal Ideation, and Clinical Diagnosis of Depression. Suicide and Life-Threatening Behavior. Beck AT, Ward CH, Mendelson M, Mock JE, Erbaugh J. K (1961) . An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561-71. Beck, A. T., Steer, R.A., & Garbin, M.G. (1988) Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8(1), 77-100. Beers, S. R., Bellis, M. D. (2002). Neuropsychological Function in Children with Maltreatment- Related Post-traumatic Stress Disorder. American Journal of Psychiatry,159(3), 483-486. Bërxulli, D. (2009). Standardization of NEO PI – R into Albanian Language. Prishtinë. ISBN 978- 9951- 466-64-6. Biggs, J. T., Wylie, L. T. & Ziegler, V. E. (1978). Validity of the Zung self-rating depression scale. British Journal of Psychiatry 132, 381–385. Bleich, A., Solomon, Z. (2003). Exposure to Terrorism, Stress-Related Mental Health Symptoms, and Coping Behaviors Among a Nationally Representative Sample in Israel. JAMA :The journal of the American Medical Association. 290. 612-20. 10.1001/jama.290.5.612. Boehnlein, J. K., Kinzie, J. D., Sekiya, U., Riley, C., Pou, K., &Rosborough, B. (2004). A ten-year treatment outcome study of traumatized Cambodian refugees. Journal of Nervous and Mental Disease, 192(10), 658-663. Bollinger, L., Avouac, J.P., Cattin, R., Pandey, M.R., 2004. Stress buildup in the Himalaya. J. Geophys. Res. 109. doi:10.129/2003JB002911. Brehm, A., Harris, D.J., Hernandez, M., Cabrera, V.M., Larruga, J.M., Pinto, F.M., Gonzalez, A.M. (2001). Structure and evolution of the mitochondrial DNA complete control region in the Drosophila subobscura subgroup. Insect Mol. Biol. 10(6): 573--578. Childhood trauma and personality … 73
Breslau N, Chilcoat HD, Kessler R.C, Davis G.C. (1999). Previous exposure to trauma and PTSD effects of subsequent trauma: results from the Detroit Area Survey of Trauma. American Journal of Psychiatry. 1999;156:902–907. Breslau, N., & Peterson, E. L. (2010). Assaultive violence and the risk of posttraumatic stress disorder following a subsequent trauma. Behaviour Research and Therapy, 48(10), 1063– 1066. http://doi.org/10.1016/j.brat.2010.07.001. Breslau, N., Davis, G., Andreski, P., and Peterson, E. (1991). Traumatic events and post-traumatic stress disorder in an urban population of young adults. Archives of General Psychiatry, 48, 216-222. Breslau, N., Kessler, R. C., Chilcoat, H. D., Schultz, L. R., Davis, G. C., and Andreski, P. (1998). Trauma and post-traumatic stress disorder in the community: The 1996 Detroit Area Survey of Trauma. Archives of General Psychiatry, 55, 626-632. Breslau, N., Kessler, R.C., Lucia,V.C. (1999b). Vulnerability to assaultive violence: Further specification of the sex difference in post-traumatic stress disorder. Psychological Medicine, 29, 813-821. Breslau, N., Kessler, R.C., Davis, G.C., & Anderski, P. (1998). Trauma and posttraumatic stress disorder in the community: The 1996 Detroit Area Survey of Trauma. American Journal of Psychiatry, 55, 626 632 Brewin, C.R.; Rose, S.; Andrews, B.; Green, J.; Tata, P.; McEvedy, C.; Turner, S.; Foa, E.B. (2002). Brief screening instrument for post-traumatic stress disorder. Br. J. Psychiatry 2002, 181, 158–162. Brown, G.W., Moran, P., 1994. Clinical and psychosocial origins of chronic depressive episodes. I: A community survey. Br. J. Psychiatry 165, 447–456. Burri, A, Maercker, A. (2014). Differences in prevalence rates of PTSD in various European countries explained by war exposure, other trauma and cultural value orientation. BMC Research Notes. 2014;7:407. doi:10.1186/1756-0500-7-407.
Cardozo L.B., Agani F., Vergara A. Gotway A.C. (2003). Mental Health, Social Functioning, and Feelings of Hatred and Revenge of Kosovar Albanians One Year after the War in Kosovo. Journal of Traumatic Stress, Vol. 16, No. 4, pg. 351-60.
Cardozo, B. L. (2004). Mental Health, Social Functioning, and Disability in Postwar Afghanistan. Jama,292(5), 575. doi:10.1001/jama.292.5.575 Childhood trauma and personality … 74
Caspi, A., and Roberts, B. W. (1999). Personality continuity and change across the life course. In Pervin, L. A. and John O. P. (Eds.), Handbook of personality: Theory and research (2nd ed., pp. 300–326). New York: Guilford Press. Cattell, R. B. (1943). The description of personality: Basic traits resolved into clusters. The Journal of Abnormal and Social Psychology,38(4), 476-506. doi:10.1037/h0054116 Cattell, R. B. (1957). Personality and motivation theory based on structural measurement. Psychology of Personality: Six Modern Approaches.,63-119. doi:10.1037/11138-003. Cattell, R.B. (1943). The Description of Personality: Basic Traits Resolved into Clusters. Journal of Abnormal and Social Psychology, 38, 476-506.
Champaign, I.L., Norman, W. T. (1963). Toward an adequate taxonomy of personality attributes: Replicated factor structure in peer nomination personality ratings. The Journal of Abnormal and Social Psychology,66(6), 574-583. doi:10.1037/h0040291
Chapman DP, Anda RF, Felitti VJ, Dube SR, Edwards VJ, Whitfield CL (2004) Epidemiology of adverse childhood experiences and depressive disorders in a large health maintenance organization population. Journal of Affect Disorders 82:217–225 Chung, MC, Berger, Z, Rudd, H (2007).Comorbidity and personality traits in patients with different levels of posttraumatic stress disorder following myocardial infarction. Psychiatry Research 152: 243–252. Chung, R., Firth, M. & Kim, J.B. (2005). Earnings management, surplus free cash flow, and external monitoring. Journal of Business Research, 58, 766-776. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum. Coronado, N. (2013). The critical period hypothesis on language acquisition studied through feral children. Retrieved from http://www.newsactivist.com/en/articles/knowledge-media/critical- period-hypothesis-language-acquisition-studied-through-feral. Costa, D. A., Ferreira, G. D. G. ; Araujo, C. V. ; Colodo, J. C. N. ; Moreira, G. R. ; Figueiredo, M. R. P., (2010). Intake and digestibility of diets with levels of palm kernel cake in sheep. Rev. Bras. Saúde Prod. Anim., 11 (3): 783-792. Costa, P. T. Jr., McCrae, R. R. (1997). Stability and change in personality assessment: The Revised NEO Personality Inventory in the Year 2000. Journal of Personality Assessment, 68, 86-94. Costa, P. T., Jr., Herbst, J. H., McCrae, R. R., & Siegler, I. C. (2000). Personality at midlife: Stability, intrinsic maturation, and response to life events. Assessment, 7, 365–378. Childhood trauma and personality … 75
Costa, P.T., and McCrae, R. R. (1992). NEO PI-R: Professional manual. Odessa, FL: Psychological Assessment Resources. Cox B.J, MacPherson P.S, Enns M.W, McWilliams L.A (2004): Neuroticism and self-criticism associated with posttraumatic stress disorder in a nationally representative sample. Behav Res Therap 2004; 4:105–114. Czapiga, A. (2009). Personality development Process of Persons who experienced trauma in their childhood. The Institute of Psychology, University of Wroclaw, Poland.
Daud, A., Klinteberg, B. A., and Rydelius, P. (2008). Trauma, PTSD and personality: The relationship between prolonged traumatization and personality impairments. Scandinavian Journal of Caring Sciences,22(3), 331-340. doi:10.1111/j.1471-6712.2007.00532.
Davey,G.C. (2008). Psychopathology: Research, Assessment and Treatment in Clinical Psychology (BPS Textbooks in Psychology) Paperback. Davidson, J., Mpodozis, C., Godoy, E., Hervé, F., Pankhurst, R. and Brook, M. (1987). In: Late Paleozoic accretionary complexes on the Gondwana margin of southern Chile: Evidence from the Chonos Archipelago. American Geophysical Union, Washington D.C.. 40: 7. doi: 10.1029/GM040p0221. Dawes, A., and De Villiers, C. (1987). Preparing children and their parents for prison: the wynberg seven. In D. Hanson (Ed.), Mental health in transition. Cape Town: OASSSA Second National Conference Proceedings. De Bellis, M. D., Keshavan, M. S., Clark, D. B., Casey, B. J., Giedd, J. N., Boring, A. M., and Ryan, N. D. (1999).Developmental Traumatology Part II: Brain Development De Raad, B., Mlačić, B. (2017). The Lexical Foundation of the Big Five Factor Model. The Oxford Handbook of the Five Factor Model. Dennis, W. (1973). Children of the Crèche. New York: Appleton-Century-Crofts. Disorder and comorbidity. Military Medicine, 166(8), 677-680. Dimitry L (2012). A systematic review on the mental health of children and adolescents in areas of armed conflict in the Middle East. Child Care Health 2012;38:153–61.doi:10.1111/j.1365- 2214.2011.01246.x. Domino, G., Domino, M. L. (1974). The History of Psychological Testing. Psychological Testing,517- 534. doi:10.1017/cbo9780511813757.020. Childhood trauma and personality … 76
Dube, S. R., Anda, R. F., Felitti, V. J., Chapman, D. P., Williamson, D. F., and Giles, W. H. (2001). Childhood Abuse, Household Dysfunction, and the Risk of Attempted Suicide Throughout the Life Span. Jama,286(24), 3089. doi:10.1001/jama.286.24.3089
Edwards, V. J., Holden, G. W., Felitti, V. J., and Anda, R. F. (2003). Relationship between Multiple Forms of Childhood Maltreatment and Adult Mental Health in Community Respondents: Results from the Adverse Childhood Experiences Study. American Journal of Psychiatry, 160(8), 1453-1460. doi:10.1176/appi.ajp.160.8.1453 Elklit, A., Hyland, P., & Shevlin, M. (2014). Evidence of symptom profiles consistent with posttraumatic stress disorder and complex posttraumatic stress disorder in different trauma samples. European Journal of Psychotraumatology,5, 24221. doi./10.3402/ejpt.v5.24221. Eysenck, H. J. (1963). Biological Basis of Personality. Nature,199(4898), 1031-1034. doi:10.1038/1991031a0. Eysenck, H. J. (1967). The Biological Basis of Personality. Springfield, IL: Thomas.
Fanaj, N., Halilaj, G., Melonashi, E., Drevinja, F., Dana, X., Poniku, I., Haxhibeqiri, S. (2014). PTSD, depression and quality of life in post-war Kosovo. European Psychiatry, 29(Supp. 1), 1. doi:10.1016/S0924-9338(14)77859-9. Fauerbach J.A, Lawrence J.W, Schmidt C.W, Munster A.M, Costa P.T., (2000). Personality predictors of injury-related posttraumatic stress disorder. J Nerv Ment Dis 2000; 188:510–517.
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Marks, J. S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. American Journal of Preventive Medicine,14(4), 245-258. doi:10.1016/s0749-3797(98)00017-8
Fiske, D. W. (1949). Consistency of the factorial structures of personality ratings from different sources. The Journal of Abnormal and Social Psychology,44(3), 329-344. doi:10.1037/h0057198 Freud, S., Strachey, J., Freud, A., Rothgeb, C. and Richards, A. (1953). The standard edition of the complete psychological works of Sigmund Freud. London: Hogarth Press. Frodl T, O'Keane V. (2013).How does the brain deal with cumulative stress? A review with focus on developmental stress, HPA axis function and hippocampal structure in humans.Neurobiol Dis 2013; 52: 24–37. Childhood trauma and personality … 77
Funder, D. C., and Ozer, D. J. (2004). Pieces of the personality puzzle: Readings in theory and research. New York: Norton. Goldsmith, H. H., Buss, A. H., Plomin, R., and Rothbart, M. K. (1987). What is temperament? Four approaches. Child Development, 58, 505-529. Greenberg, P.E., Sisitsky, T., Kessler, R.C., Finkelstein, S.N., Berndt, E.R., Davidson, J.R., and Fyer, A.J. (1999). The economic burden of anxiety disorders in the 1990s. J Clin Psychiatry, 60(7), 427–435. Guilford, J. P. (1959). Personality. New York: McGraw-Hill. Hammen, C., Davila, J., Brown, G., Ellicott, A., Gitlin, M., (1992). Psychiatric history and stress: Predictors of severity of unipolar depression. J. Abnorm. Psychol. 100, 555–561. Heyer, W.R., Donnelly, M.A., McDiarmid, R.W., Hayek, L.C. and Foster, M.S., (1994). Measuring and monitoring biological diversity: Standard methods for amphibians. Smithsonian Institution Press, Washington, DC. Hollifield, M., Warner, T. D., Lian, N., Krakow, B., Jenkins, J. H., Kesler, J., Westermeyer, J. (2002). Measuring trauma and health status in refugees: A critical review. Journal of the American Medical Association, 288, 611–621. doi: 10.1001/jama.288.5.611http://dx.doi.org/10.1097/01.nmd.0000142033.79043.9d. Hubel, D. H.; Wiesel, T. N. (1959). "Receptive fields of single neurones in the cat's striate cortex". The Journal of Physiology. 124 (3): 574–591. Human Rights Watch (2003). Abusing the User: Police Misconduct, Harm Reduction and HIV/AIDS in Vancouver, May 2003. Jacobsen, L.K., Southwick, S.M., & Kosten, T.R. (2001). Substance use disorders in patients with posttraumatic stress disorder: A review of the literature. American Journal of Psychiatry, 158, 1184–1190. Johnson SB, Blum RW, Giedd JN. (2008). Adolescent maturity and the brain: the promise and pitfalls of neuroscience research in adolescent health policy. J Adolesc Health. 2009;45(3):216–221. doi: 10.1016/j.jadohealth.2009.05.016. Katon, W., von Korff, M., Lin, E., Walker, E., Simon, G., Bush, T., et al., (1995). Collaborative management to achieve treatment guidelines: Impact on depression in primary care. Journal of the American Medical Association, 273, 1026 –1031.
Katz, C. L., Pellegrino, L, Pandya, A, Ng, A. &DeLisi, L. E. (2002). Research on psychiatric outcomes and interventions subsequent to disasters: A review of the literature. Psychiatric Research, 110, 201-217. Childhood trauma and personality … 78
Kendler, K. S., Gatz, M., Gardner, C. O., and Pedersen, N. L. (2006). Personality and Major Depression. Archives of General Psychiatry,63(10), 1113. doi:10.1001/archpsyc.63.10.1113. Kendler, K.S., Kessler, R.C., Neale, M.C., Heath, A.C., Eaves, L.J., (1993). The prediction of major depression in women: toward an integrated etiologic model. Am. J. Psychiatry 150, 1139– 1148. Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., and Nelson, C. B. (1995). Post-traumatic stress disorder in the national comorbidity survey. Archives of General Psychiatry, 52, 1048-1060. doi: 10.1002/1099-1298(200011/12) Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., and Friedman, M. J. (2013). National estimates of exposure to traumatic events and PTSD prevalence using DSM- IV and DSM-5 criteria. Journal of Traumatic Stress, 26, 537-547. doi: 10.1002/jts.21848 Kim, E. J., Pellman, B., and Kim, J. J. (2015). Stress effects on the hippocampus: A critical review. Learning and Memory,22(9), 411-416. doi:10.1101/lm.037291.114 King, D.W., King, L.A., Foy, D.W., (1996). Prewar factors in combat-related posttraumatic stress disorder: Structural equational modeling with a national sample of female and male Vietnam veterans. Journal of Consulting and Clinical Psychology, 64, 520-531.
Kinzie, J. D., Sack, W., Angell, R., Clarke, G., and Ben, R. (1989). A Three-Year Follow-up of Cambodian Young People Traumatized as Children. Journal of the American Academy of Child and Adolescent Psychiatry,28(4), 501-504. doi:10.1097/00004583-198907000-00006
Koenen, K. C., Ratanatharathorn, A., Ng, L., McLaughlin, K. A., Bromet, E. J., Stein, D. J., Kessler, R. C. (2017). Post-traumatic stress disorder in the World Mental Health Surveys, Psychological Medicine, 1-15. Kolb, B., & Whishaw, I. (2008). Fundamentals of Human Neuropsychology, 5th edition. Worth. Komsi, N, Räikkönen, K., Pesonen, A-K., Heinonen, K., Keskivaara, P., Järvenpää, A-L., & Strandberg, T.E. (2006). Continuity of temperament from infancy to middle childhood. Infant Behavior & Development, 29, 494-508. Kosova Women’s Network (2008). Security Begins at Home. Research to Inform the First National Strategy and Action Plan against Domestic Violence in Kosovo. Kostelny, K., and J. Garbarino (1994). Coping with the consequences of living in danger: The case of Palestinian children and youth. International Journal of Behavioral Development 17 (4): 595-611. Kozaric-Kovacic D, Kocijan Hercigonja D, Grubišiæ-Ilic M. (2001). Posttraumatic stress disorder and depression in soldiers with combat experiences. Croat Med J. 2001;42: 165-70. Childhood trauma and personality … 79
Kronenberg G, Tebartz van Elst L, Regen F, Deuschle M, Heuser I, Colla M. (2009). Reduced amygdala volume in newly admitted psychiatric in-patients with unipolar major depression. J Psychiatr Res 2009; 43: 1112–1117. Larsen, R. J., and Buss, D. M. (2005). Personality psychology: Domains of knowledge about human nature (2ndEd.). New York: McGraw Hill. Lemery, K. S., Goldsmith, H. H., Klinnert, M. D., and Mrazek, D. A. (1999). Developmental models of infant and childhood temperament. Developmental Psychology, 35, 189–204. Liebert, R. M., and Spiegler, M. D. (1998). Personality: Strategies and issues. Pacific Grove, CA: Brooks/Cole. Lisak, D., and Beszterczey, S. (2007). The cycle of violence: The life histories of 43 death row inmates. Psychology of Men and Masculinity,8(2), 118-128. doi:10.1037/1524-9220.8.2.118 MacLean P.D. (1970): The triune brain, emotion, and scientific bias. In: The Neurosciences Second Study Program, Schmitt FO, ed. New York: Rockefeller University Press. MacLean, P.D. (1990) The Triune Brain in Evolution (Role in Paleocerebral Functions). Plenum Press, New York. MacMillan, H.L., Fleming, J.E., Streiner, D.L., Lin, E., Boyle, M.H., Jamieson, E., Duku, E.K., Walsh, C.A., Wong, M.Y., Beardslee, W.R., (2001). Childhood abuse and lifetime psychopathology in a community sample. Am. J. Psychiatry 158, 1878–1883. Mayer, J. D. (2007). Personality: A systems approach. Boston: Allyn and Bacon. McCrae R.R, Costa P.T. (2008). The Five-Factor Theory of Personality In: John OP, Robins RW, Pervin LA, editors. Handbook of Personality: Theory and Research. Third ed. New York: NY: The Guilford Press; 2008. pp. 159–181. Mccrae, R. R., and Costa, P. T. (1997). Personality trait structure as a human universal. American Psychologist,52(5), 509-516. doi:10.1037//0003-066x.52.5.509 McCrae, R. R., Costa, P. T., Jr., Ostendorf, F., Angleitner, A., Hebíþková M., Avia, M. D., Sanz, J., Sánchez-Bernardos, M. L., Kusdil, M. E., Woodfield, R., Saunders, P. R., and Smith, P. B. (2000). Nature over nurture: Temperament, personality, and life span development. Journal of Personality and Social Psychology, 78, 173–186. McKinnon M.C, Yucel K, Nazarov A, MacQueen G.M. (2009).A meta-analysis examining clinical predictors of hippocampal volume in patients with major depressive disorder.J Psychiatry Neurosci 2009;34: 41–54. Miller, Rowland S., Brehm Sh. (2007). Intimate Relationships. Boston: McGraw-Hill Higher Education, 2007. Childhood trauma and personality … 80
Mischel, W., Ayduk, O., and Shoda, Y. (2008). Introduction to personality: Toward an integrative science of the person. Hoboken, NJ: John Wiley and Sons. Miyazaki, T., Dewaraja, R., & Kawamura, N. (2006). Reliability and validity of the scales related to posttraumatic stress disorder of Sri Lankan version. International Congress Series, 1287, 82–85. doi:10.1016/j.ics.2005.12.016. Mollica, R. F. (1993). The Effect of Trauma and Confinement on Functional Health and Mental Health Status of Cambodians Living in Thailand-Cambodia Border Camps. JAMA: The Journal of the American Medical Association,270(5), 581. doi:10.1001/jama.1993.03510050047025 Mollica, R.F., Caspi-Yavin, Y., Bollini, P., Truong, T., Tor, S., & Lavelle, J. (1992). The Harvard Trauma Questionnaire. Validating a cross-cultural instrument for measuring torture, trauma and post-traumatic stress disorder in Indochinese refugees. Journal of Nervous and Mental Disease, 180(2), 111-116. Mollica, R.F., McDonald, L.S., Massagli, M.P., & Silove, D. (2004). Measuring trauma, measuring torture. Cambridge, MA: Harvard Program in Refugee Trauma. Morina, N., Rudari, V., Bleichhardt, G., Prigerson, H. G. (2010). Prolonged grief disorder, depression, and posttraumatic stress disorder among bereaved Kosovar civilian war survivors: A preliminary investigation. International Journal of Social Psychiatry, 56, 288- 297. doi:10.1177/0020764008101638. Morse, R.M, Wiley, M.S. (1997). Ghosts from the Nursery: Tracing the Roots of Violence. Atlantic Monthly Press Revised 2014. Mosquera, D., Gonzales, A., and Hart, O. V. (2011). Borderline personality disorder, childhood trauma and structural dissociation of the personality. 44-73. Murphy, C. M., Christakou, A. , Giampietro, V. , Brammer, M. , Daly, E. M., Ecker, C. Johnston, P. , Spain, D. , Robertson, D. M., , , Murphy, D. G. and Rubia, K. (2017). Abnormal functional activation and maturation of ventromedial prefrontal cortex and cerebellum during temporal discounting in autism spectrum disorder. Hum. Brain Mapp., 38: 5343-5355. doi:10.1002/hbm.23718. Murthy, R. S., & Lakshminarayana, R. (2006). Mental health consequences of war: a brief review of research findings. World Psychiatry, 5(1), 25–30. Nader K. O., Pynoos R. S., Fairbanks L. A., Al- Ajeel, M., & Al- Asfour, A. (1993). A preliminary study of PTSD and grief among the children of Kuwait following the Gulf crisis. British Journal of Clinical Psychology, 32, 407- 416. http://dx.doi. org/10.1111/j.2044- 8260.1993.tb01075.x Childhood trauma and personality … 81
Negele, A., Kaufhold, J., Kallenbach, L., and Leuzinger-Bohleber, M. (2015). Childhood Trauma and Its Relation to Chronic Depression in Adulthood. Depression Research and Treatment,2015, 1-11. doi:10.1155/2015/650804 Nestler, Eric & Barrot, Michel & J DiLeone, Ralph & J Eisch, Amelia & J Gold, Stephen & Monteggia, Lisa. (2002). Neurobiology of Depression. Neuron. 34. 13-25. 10.1016/S0896- 6273(02)00653-0. Newman, William & Buckeridge, John & Pitombo, Fabio. (2016). The Anatomy of a Proposed Name Change Involving Chthamalus southwardorum (Cirripedia, Balanomorpha, Chthamalidae), A Critique. Journal of Marine Science: Research & Development. 6. 10.4172/2155- 9910.1000207. Norman, W. T. (1963). Toward an adequate taxonomy of personality attributes: Replicated factor structure in peer nomination personality ratings. Journal of Abnormal and Social Psychology, 66, 574-583.
Norman, W.T. (1967). 2800 Personality Trait Descriptors: Normative Operative Characteristics for a University Population. Unpublished Manuscript, Department of Psychology, University of Michigan. NSW Health (2000).Disaster Mental Health Response Handbook. Relationship between Childhood Trauma and Personality Typology. Ozer, E. J., and Weiss, D. S. (2004). Who Develops Post-traumatic Stress Disorder? Current Directions in Psychological Science,13(4), 169-172. doi:10.1111/j.0963-7214.2004.00300.
Pearlman, A., Laurie A., and Saakvitne, K.W., (1995). Trauma and the Therapist. New York: Norton. Piaget, J.; Inhelder, B. (1969). The psychology of the child. Basic Books. Protacio-Marcelino, E. (1989). Children of political detainees in the Philippines: Sources of stress and coping patterns.
Purves D, Augustine GJ, Fitzpatrick D, (2001). Critical Periods in Visual System Development; Sunderland (MA): Sinauer Associates; Neuroscience, Second edition.
Putnam, F. W. (1997). Dissociation in children and adolescents: A developmental perspective. New York: Guilford Press. Childhood trauma and personality … 82
Putnam, S. P., Rothbart, M. K., and Gartstein, M. A. (2008). Homotypic and heterotypic continuity of fine-grained temperament during infancy, toddlerhood, and early childhood. Infant and Child Development, 17, 387-405. Qirjako, E. (2007). Traumatisierte Kinder und Jugendliche: EinflussPosttraumatischer Belastungsstörung auf psychische Auffälligkeitenbei Kindern und Jugendlichen. Dissertation, LMU München: Fakultät für Psychologie und Pädagogik. Radloff, L. S. (1977). The CES-D Scale. Applied Psychological Measurement,1(3), 385-401. doi:10.1177/014662167700100306
Reiss A.L, Abrams M.T, (1996). Brain development, gender and IQ in children: a volumetric imaging study. Brain. 1996;119(5):1763–1774. doi: 10.1093/brain/119.5.1763.
Rieder M., Choonara I. (2012). Armed conflict and child health. Archives of Dis Child;97:59– 62.doi:10.1136/adc.2009.178186. Roberts, B.W., and Chapman, C. N. (2000). Change in dispositional well-being and its relation to role quality: A 30-year longitudinal study. Journal of Research in Personality, 34, 26–41 Roberts, B.W., Caspi, A., and Moffitt, T. E. (2003).Work experiences and personality development in young adulthood. Journal of Personality and Social Psychology, 84, 582–593. Robins, R. W., Caspi, A., and Moffitt, T. E. (2002). It’s not just who you’re with, it’s who you are: Personality and relationship experiences across multiple relationships. Journal of Personality, 70, 925–964. Rothbart, M. K., Ahadi, S. A., Hershey, K. L., and Fisher, P. (2001). Investigations of temperament at three to seven years: The Children’s Behavior Questionnaire. Child Development, 72, 1394– 1408. Rothbart, M. K., and Bates, J. (2006). Temperament. In W. Damon (Series Ed), and N. Eisenberg (Vol. Ed), Handbook of child psychology: Social emotional and personality development (Vol. 3, 6th ed., pp. 99–166). New York: Wiley. Rothbart, M. K., and Derryberry, D. (1981). Development of individual differences in temperament. In M. E. Lamb and A. L. Brown (Eds.), Advances in developmental psychology (pp. 37–86). Hillsdale, NJ: Erlbaum. Rusting, C.L.; Larsen, R.J. (1997). Extraversion, neuroticism, and susceptibility to positive and negative affect: A test of two theoretical models. Personal. Individ. Differ. 1997, 22, 607–612. Saakvitne, K. W. et al., (2000). Risking Connection: A Training Curriculum for Working with Survivors of Childhood Abuse. Sidran Press. January, 2000. Childhood trauma and personality … 83
Saleh K, Carballedo A, Lisiecka D, Fagan AJ, Connolly G, Boyle G l.(2012). Impact of family history and depression on amygdala volume.Psychiatry Res 2012; 203: 24–30. Sarraj, E. E., and Qouta, S. (2005). The Palestinian Experience. Disasters and Mental Health,229- 237. doi:10.1002/047002125x.ch16 Sayer, N.A., Carlson, K., and Schnurr, P. (2011). Assessment of functioning and disability in individuals with PTSD. In Clinical manual for the management of post-traumatic stress disorder (pp 255–287). Benedek D, and Wynn GH (Eds.). Arlington, VA: American Psychiatric Association Publishings. Schnurr, P.P., Friedman, M.J., (1993). Premilitary MMPI scores as predictors of combat-related PTSD symptoms. American Journal of Psychiatry, 150, 479 483. Scholte, W. F. (2004). Mental Health Symptoms Following War and Repression in Eastern Afghanistan. Jama, 292(5), 585. doi:10.1001/jama.292.5.585 Schreurs, B. G., Smith-Bell, C. A., & Burhans, L. B. (2011). Incubation of Conditioning-Specific Reflex Modification: Implications for Post Traumatic Stress Disorder. Journal of Psychiatric Research, 45(11), 1535–1541. doi10.1016/j.jpsychires.2011.07.003. Scollon, C. N., and Diener, E. (2006). Love, work, and changes in extraversion and neuroticism over time. Journal of Personality and Social Psychology, 91, 1152–1165. Seth, N., Deshmukh, S. G., & Vrat, P. (2005). Service quality models: a review. International Journal of Quality & Reliability Management, 22(9), 913-949. doi: 10.1108/02656710510625211. Shannon, S.M., Heckman, E. (2007). Please don’t label my child: Break the doctor-diagnosis- drug cycle and discover safe, effective choices for your child’s emotional health. (pp.182-185). New York: Roldale Books. Sheline, Y., Gado, H., Mokhtar C. (2003). Untreated Depression and Hippocampal Volume Loss. The American journal of psychiatry. 160. 1516-8. 10.1176/appi.ajp.160.8.1516. Shoeb, M., Mollica R. (2007) The Harvard Trauma Questionnaire: Adapting a Cross-Cultural Instrument for Measuring Torture, Trauma and Posttraumatic Stress Disorder in Iraqi Refugees. International Journal of Social Psychiatry, vol. 53, 5: pp. 447-463. Sigvardsdotter, E., Malm, A., Tinghög, P., Vaez, M., & Saboonchi, F. (2016). Refugee trauma measurement: a review of existing checklists. Public Health Reviews, 37, 10.http://doi.org/10.1186/s40985-016-0024-5. Silva RR, Alpert M, Munoz DM, Singh S, Matzner F, Dummit S. (2000). Stress and vulnerability to post-traumatic stress disorder in children and adolescents. The American Journal of Psychiatry. 157:1229–1235. doi:10.1176/appi. ajp.157.8.1229. Childhood trauma and personality … 84
Southwick S.M., Krystal J.H., Morgan CA (1993). Abnormal Noradrenergic Function in Posttraumatic Stress Disorder. Arch Gen Psychiatry. 1993;50(4):266–274. doi:10.1001/archpsyc.1993.01820160036003. Sowell, E.R., Thompson, P.M., Holmes, C.J., Batth, R., Jernigan, T.L., Toga, A.W., (1999). Localizing age-related changes in brain structure between childhood and adolescence using statistical parametric mapping. NeuroImage 9, 587 – 597. SPSS: IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. Sutin, A. R., Costa, P. T., Jr., Miech, R., & Eaton, W. W. (2009). Personality and career success: Concurrent and longitudinal relations. European Journal of Personality, 23(2), 71-84. doi: 10.1002/per.704 Thabet A.A, Stretch D, Vostanis P. (2000). Child mental health problems in Arab children: application of the Strengths and Difficulties Questionnaire. Int J Soc Psychiatry 2000; 46: 266-80.
Thabet, A. A., Abed, Y., and Vostanis, P. (2004). Comorbidity of PTSD and depression among refugee children during war conflict. Journal of Child Psychology and Psychiatry,45(3), 533- 542. doi:10.1111/j.1469-7610.2004.00243.x
The five-factor model of personality: Theoretical perspectives. Edited by Jerry S. Wiggins, 163–179. New York: Guilford, 1996. Tolin, D. F., and Foa, E. B. (2008). Sex differences in trauma and post-traumatic stress disorder: A quantitative review of 25 years of research. Psychological Trauma: Theory, Research, Practice, and Policy,S(1), 37-85. doi:10.1037/1942-9681.s.1.37 Tupes, E. C., and Christal, R. E. (1992). Recurrent personality factors based on trait ratings. PsycEXTRA Dataset. doi:10.1037/e531292008-001 UNICEF (2016). Humanitarian Action for Children. The state of the World’s Children in Numbers. August 24, 2015. Retrieved May 4, 2016. Van Aken, M. A. G., Denissen, J. J. A., Branje, S. J. T., Dubas, J. S., and Goossens, L. (2006). Midlife concerns and short-term personality change in middle adulthood. European Journal of Personality, 20, 497–513 Vayida, C. J. and Gabrieli J. D. E. (2002). Immature frontal lobe contributions to cognitive control in children: evidence from fMRI. Neuron, 33. 301-311. Childhood trauma and personality … 85
Walker EA, Katon W, Russo J, Ciechanowski P, Newman E, Wagner AW (2003). Health Care Costs Associated With Post-traumatic Stress Disorder Symptoms in Women. Arch Gen Psychiatry. 2003;60(4):369–374. doi:10.1001/archpsyc.60.4.369.
Wenzel T. Shahini M., Diacanu G., Ahmeti A., Franziskovic T. (2010). War, persistent post-traumatic stress and suicidal ideation in a high risk population in Kosovo. Join research and technology development projects 2007-2010.
Wenzel, T., Agani, F., Rushiti, F., Abdullahu, I., & Maxhuni, B. (2006). Long-term sequels of war, social functioning and mental health in Kosovo. Pristina, Kosovo: Danish Refugee Council. White, J., Pearce, J., Morrison, S., Dunstan, F., Bisson, J. I., and Fone, D. L. (2015). Risk of post- traumatic stress disorder following traumatic events in a community sample. Epidemiology and Psychiatric Sciences, 24, 249-257. Widera-Wysoczańska, A. and Kuczynska, A. (2010). Interpersonal trauma and its consequences in adulthood. Newcastle: Cambridge Scholars. Wilson, E.J.; MacLeod, C.; Mathews, A.; Rutherford, E.M (2006). The causal role of interpretive bias in anxiety reactivity. J. Abnorm. Psychol. 2006, 115, 103–111. Winter, D. A., Brown, R., Goins, S., and Mason, C. (2016). Trauma, survival and resilience in war zones: The psychological impact of war in Sierra Leone and beyond. London: Routledge, Taylor and Francis Group. World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization. YÖYEN ELIF (2017). Relationship Between Childhood Trauma and Personality Typology. Balkan and Near Eastern Journal of Social Sciences, 3(1), 123-129. Yehuda, R., SHalev, A.Y. (1998a). Predicting the development of posttraumatic stress disorder from the acute response to a traumatic event. Biological Psychiatry, 44, 1305-1313.
Childhood trauma and personality … 86
CV Naim Telaku Born: 06.07.1985, Banje Malisheve, Kosovo Education: Plitical sciences, BA. College “Fama”, Pristina, 2004-2007. Psychology, BA. University of Pristina, Prishtina, 2005-2008. Neuro-cognitive Psychology, MSc. LMU, Munich, 2009-20011. Mental health and behavioral medicine, MUW, Vienna, 2011-.
Working experience: Clinical psychologist, Pristina, 2015-. Lecturer, University college “AAB”, Pristina, 2016-. Teaching assistant, University of Pristina, 2012-2016. President of the National Association of Professional psychologists of Kosovo: “APKO”, 2015- 2017. Member of the Chamber of medical professionals of Kosovo, 2015-2017.
Publications: Telaku, N. Placenta, 2017. Olymp, Pristina.
Telaku, N. Ouroboros, 2015. Olymp, Pristina.
Bërxulli, D., Arënliu, A, &Telaku, N. (2014, November). Exploring further the validity of the measures of NEO PI-R and BDI in Albanian population. International Scientific Conference ‘Psychology – Traditions and Perspectives’. SWU ‘NeophitRilski’. Blagoevgrad. Bulgaria. ISSN - 1314 – 9792.
Arënliu, A. Kelmendi, K., Bërxulli, D &Telaku, N. (2014). Human values, depression, and wellbeing: findings from a population-based study in Kosovo. International Conference, Transition and Society, An Interdisciplinary Approach. Albanian University Press. Tirana, Albania. ISBN: 978-9928-127-47-1.
Telaku, N., Uka, F., Maxhera, F., Meholli, F., & Hamiti, A. (2015). Ndikimi i imazhit për trupin në shprehitë e të ushqyerit tek adoleshentët. Paper presented at the International Conference “Week of Science”, Prishtinë, Kosovo.
Childhood trauma and personality … 87
Letter of ethical approval