Long‐lasting effects of World War II trauma on PTSD symptoms and embodiment levelsin a national sample of Poles

The main aim of this study was to investigate the long‐lasting influences of World War II (WWII) trauma in a national sample of Poles, based on Danieli’s (1998) survivors’ post‐trauma adaptational styles (fighter, numb, victim) and their link with current post‐traumatic stress disorder (PTSD) symptoms and embodiment level among participants. We also sought to investigate whether the level of knowledge about WWII trauma among ancestors could moderate that association. The study was conducted among a representative sample of 1598 adult Poles obtained from an external company. Participants filled out the Danieli Inventory of Multigenerational Legacies of Trauma, the knowledge about traumatic World War II experiences in the family questionnaire, the Posttraumatic Diagnostic Scale‐5, and the Experience of Embodiment Scale. We observed a positive relationship between all survivors’ post‐trauma adaptational styles and current levels of PTSD symptoms among participants. In addition, PTSD level mediated the relationships between those adaptational styles and embodiment intensity; that mediation was additionally moderated by a lack of knowledge about WWII trauma among ancestors in our participants. Our study adds to the literature on intergenerational trauma by highlighting the importance of evaluating embodiment in understanding the mechanisms of trauma transmission. Furthermore, it highlights the moderating effect of knowledge of family history in this mechanism and the need to share family histories with subsequent generations.

It has been more than half a century since Rakoff et al.1 observed the problem of intergenerational trauma among descendants of Holocaust survivors who did not experience the Holocaust directly but were secondarily trau- matized by parental traumatic history and the related negative emotional atmosphere in their family of origin2. More specifically, numerous subsequent studies have found that Holocaust offspring were at increased risk of mental health problems, predominantly posttraumatic stress disorder (PTSD), depression, and anxiety2–6, as well as heightened prevalence of health problems like cancer, heart disease, and chronic pain7–10. These studies on second-generation Holocaust survivors started a new, interdisciplinary line of research focused on whether and how the consequences of surviving trauma may be transmitted from one generation to another (for a review, see11).The term transmission of trauma has been defined in various ways11 but was originally understood as the process of passing specific, trauma-related thoughts, feelings, and behaviors from trauma survivors to their offspring5,12. This process has been observed not only in the case of Holocaust trauma but also among children of war veterans13, families of refugees14, and even families in which one parent was exposed to childhood maltreat- ment and abuse15. Various mechanisms for such trauma transmission processes have been suggested, including psychodynamic explanations16, vicarious trauma models17, learning and modeling13, parenting and family envi- ronment influences18,19, and even biological hypotheses10,20. Although the literature on intergenerational trauma is massive and still expanding (for reviews and meta-analyses, see11,21,22, the topic remains rife with controversies and unanswered but important research questions. First, there is little knowledge of how trauma is transmitted1Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183 Warsaw, Poland. 2Faculty of Psychology, SWPS University of Social Sciences and Humanities, Chodakowska Street 19/31, 03-815 Warsaw, Poland.*email: marcin.rzeszutek@psych.uw.edu.pl(2023) 13:17222 | https://doi.org/10.1038/s41598-023-44300-6 1 Vol.:(0123456789)OPENwww.nature.com/scientificreports page1image1796365888

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Scientific Reports | Vol:.(1234567890)from generation to generation11, and several authors have found no evidence that trauma transmission occurs23. Second, most studies on the subject employ small convenience samples of trauma survivors and draw exaggerated conclusions, often devoid of any theoretical rationale11. Finally, in Europe especially, research on intergenerational trauma is unevenly distributed geographically, with few studies focused on Central and Eastern Europe24. In our project, we aimed to fill some of these research gaps by investigating the long-lasting influences of World War II (WWII) trauma in a national sample of Poles based on the theoretical model of multigenerational legacies of massive trauma: Trauma and the Continuity of Self: A Multidimensional, Multidisciplinary, Integrative Framework (TCMI) by Danieli2.Extensive empirical research and clinical experience working with prolonged and complex traumatic events (predominantly Holocaust survivors) led to the TCMI framework, illustrating the multidimensional and inter- generational nature of surviving massive trauma and adapting to life’s circumstances in its aftermath2,25,26. TCMI operationalizes the trauma survivor’s identity at multiple levels: intrapsychic, family, community, national, and cross-cultural2,25,26. Traumatic experiences cause serious ruptures on all levels. Often, this process is further exacerbated by a conspiracy of silence surrounding such trauma within an individual’s immediate social cir- cle. As a result, the trauma survivor is forced to adopt specific survival strategies, called survivors’ posttrauma adaptational styles, which are classified into three groups: victim (being stuck in the trauma rupture, emotional volatility, and overprotectiveness), numb (characterized by emotional detachment, conspiracy of silence within the family, and intolerance of weakness), and fighter (illustrated by valuing and maintaining national identity and cherishing mastery and justice). These adaptational styles are essentially ways to cope with massive traumatic events and are adopted by those who directly experience them. However, they also impact trauma survivors’ family members by structuring their identity, emotions, and beliefs about themselves, society, and the world in general2,26. Some empirical studies suggest that parents’ intergenerational influences on these adaptational styles affect their offspring’s psychosocial development, increasing susceptibility to PTSD symptoms following exposure to a traumatic event19,27. In our study, we investigate the role of Danieli’s survivors’ posttrauma adaptational styles to understand the long-lasting impacts of WWII trauma in Poland. The psychosocial effects of WWII remain an unspoken topic of scientific discourse and public debate in Poland28,29. However, a few studies have revealed a significant discrepancy between the prevalence of WWII-related PTSD among survivors of the war in Poland compared to other European countries. For example, the prevalence of PTSD among civilian survivors of WWII ranged from 1.9% in Austria30 to 10.9% in Germany31, while PTSD among Polish survivors of that war has been reported to range from 29.4%32 to 38.3%29.Apart from the fact that the observed differences can be related to differences in the measurement methods, this discrepancy is explained by historical factors associated with the vast human and material losses experi- enced by Poles during WWII, along with repression and insecurity during the Communist regime33,34. In other words, Polish survivors of WWII could face powerful obstacles in revealing their traumatic memories in their communities. Thus, they received inadequate support and social acknowledgment of their traumatic WWII experiences29. They might transfer this atmosphere of anxiety and taboo to their offspring35. Some authors have shown that the transmission of intergenerational trauma in families happens through specific structures of attachment and communication36–38. This aligns with developmental theories, highlighting that sharing a fam- ily history with children significantly predicts their self-identity and psychological well-being39. Nevertheless, there is still scant research on the issue of knowledge about traumatic family stories, particularly related to the experiences of ancestors40,41.Finally, we focus on the role of body image as operationalized by the level of embodiment highlighting a variety of experiences of living in one’s own body; that is, referring to an integrated set of connections in which a person experiences their body as comfortable, trustworthy, and deserving of respect and care42–44. Traditionally, psychotherapy underscores the role of appropriate orientation toward body signals as an integral part of the self, which helps individuals sustain their mental and physical health, particularly in the face of stress and trauma45. A large body of empirical research has since shown how the experience of one’s own body can be significantly hampered by experiences of traumatic events46,47 and how body-oriented therapy can help trauma survivors in dealing with PTSD (for a metanalysis, see48). Theoretical explanations of this process have usually focused on a deterioration in the orientation toward body signals in the aftermath of PTSD symptoms that can result in applying a catastrophic or alien orientation toward the body and experiencing one’s body as detached from one’s self49–51. Importantly, similar negative bodily experiences have been observed among offspring of Holocaust survivors8 and children of refugee families14, showing that the intergenerational effects of trauma emerge in multidimensional rather than singular psychosocial outcomes11.The present studyTaking the above considerations into account, the primary objective of this study was to explore the long-term effects of WWII trauma on a national sample of Polish people. We analyzed survivors’ posttrauma adaptational styles (victim, numb, fighter) based on Danieli’s2 framework. We also examined the potential correlation between their adaptational styles and present-day PTSD symptoms and embodiment. Additionally, we investigated how the participants’ upbringing in the shadow of WWII trauma, family atmosphere, and reflections on their parents or grandparents who experienced WWII trauma influenced their posttrauma adaptational styles. Finally, we aimed to investigate whether a lack of knowledge about WWII trauma among their ancestors could moderate these relationships. Although our study is exploratory to a large extent regarding the study sample, study context, and the configuration of study variables, we decided to formulate research hypotheses that direct our analyses:Hypothesis1 Thereisasignificantpositiverelationshipbetweenposttraumaadaptationalstyles(victim,numb, fighter) and the current PTSD symptom levels among participants while controlling for sociodemographic(2023) 13:17222 | https://doi.org/10.1038/s41598-023-44300-6 2

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factors. More specifically, we assume that those posttrauma adaptational styles can also be seen in succeeding generations and have the associations noted above with current PTSD symptoms.Hypothesis2 ThereisasignificantnegativeassociationbetweencurrentlevelsofPTSDsymptomsandlevelsof embodiment among participants while controlling for sociodemographic factors.Hypothesis 3 Current levels of PTSD symptoms are a significant mediator between survivors’ posttrauma adap- tational styles (fighter, numb, victim) and embodiment levels among participants while controlling for sociode- mographic factors.Hypothesis4 AlackofknowledgeaboutWWIItraumaamongancestorssignificantlymoderatesthemediation process noted in Hypothesis 3 while controlling for sociodemographic factors among participants.Method
Participants and procedure
A survey was conducted in September and October 2022 by an external company specializing in nationwide Polish research panels among a representative sample of 1598 adult Poles aged 18–97 (M = 48.78; SD = 20.50). Participants represented different generations of Poles born before, during, and after WWII (see Table 1). The external company used its survey platform to distribute an online version of the measures. Participation in this study was entirely anonymous and voluntary. Each participant provided informed consent, and the survey company provided remuneration by granting specific tokens. This research project was accepted by the ethics committee of the Faculty of Psychology at the University of Warsaw in Poland.Table 1 presents the sociodemographic characteristics of the study sample.The numbers of females (50.7%) and males (49.3%) were similar, and most participants were aged 18–46. The most commonly identified place of residence was a village. Most participants had higher education (44.2%) and were married (49.7%).MeasuresSurvivors’ posttrauma adaptational styles. To assess the multigenerational effect of WWII trauma among our par- ticipants, we used the Polish version of the Danieli Inventory of Multigenerational Legacies of Trauma: Survivors’ Posttrauma Adaptational Styles18. This tool is considered the gold standard for examining the multigenerational effects of massive traumas (e.g., Holocaust, war, genocide). It consists of 60 items describing specific emotions, beliefs, or behaviors evaluating people’s perceptions of their parents and grandparents and upbringing as a reac- tion to such traumas in a family’s history. The three adaptational styles described above—victim, numb, and fighter—are measured via this tool. Participants used a five-point Likert scale to rate their level of agreement with statements about the atmosphere and communication styles in their family of origin. We instructed participants