Does perpetrating violence damage mental health? Differences between forcibly recruited and voluntary combatants in DR Congo

To Trust is to Survive: Toward a Developmental Model of Moral Injury

Research on trauma- and stressor-related disorders has recently expanded to consider moral injury, or the harmful psychological impact of profound moral transgressions, betrayals, and acts of perpetration. Largely studied among military populations, this construct has rarely been empirically extended to children and adolescents despite its relevance in the early years, as well as youths' potentially heightened susceptibility to moral injury due to ongoing moral development and limited social resources relative to adults. Application of the construct to young persons, however, requires theoretical reconceptualization from a developmental perspective. The present paper brings together theory and research on developmentally-oriented constructs involving morally injurious events, including attachment trauma, betrayal trauma, and perpetration-induced traumatic stress, and describes how they may be integrated and extended to inform a developmentally-informed model of moral injury. Features of such a model include identification of potentially morally injurious events, maladaptive developmental meaning-making processes that underlie moral injury, as well as behavioral and emotional indicators of moral injury among youth. Thus, this review summarizes the currently available developmental literatures, identifies the major implications of each to a developmentally-informed construct of moral injury, and presents a conceptual developmental model of moral injury for children and adolescents to guide future empirical research.

The role of violence perpetration in driving externalizing problems and offending behavior among youth from eastern Democratic Republic of Congo

Youth in conflict-affected regions are exposed to a multitude of traumatic events. These individuals often witness violence; experience it firsthand; and, in some cases, become perpetrators. The interplay of events shapes systematic trauma histories that may have unique implications for youths' mental health. In a cross-sectional study conducted in eastern Democratic Republic of Congo (DRC), we interviewed 295 war-affected youth (63.4% boys, M_age = 16.70 years), including former child soldiers (n = 171), regarding their traumatic experiences and mental health. Using latent class analysis, we identified four common trauma history classes categorized by (a) low exposure, (b) medium exposure, (c) high exposure, and (d) high exposure/perpetration. Across the sample, gradual increases in trauma load corresponded with increased vulnerability to posttraumatic stress disorder (PTSD) symptoms, η_p ² = .36, and internalizing problems, η_p ² = .12; however, only youth from the high exposure/perpetration class differed significantly from other youth in their levels of externalizing problems, η_p ² = .13, and offending behaviors, η_p ² = .17. A longer time in armed groups was related to a higher risk of both experiencing and perpetrating violence. The results indicate that it is not child soldier status, per se, but the perpetration of violence that reinforces a cycle of violence in conflict-affected societies by contributing to increased externalizing problems and offending behaviors. In conflict regions, integrated approaches are needed to address both trauma and externalizing problems of war-affected youth.

Developing mental health services during and in the aftermath of the Ebola virus disease outbreak in armed conflict settings: a scoping review

Background

Mental health is mostly affected by numerous socioeconomic factors that need to be addressed through comprehensive strategies. The aftermath of armed conflict and natural disasters such as Ebola disease virus (EVD) outbreaks is frequently associated with poor access to mental healthcare. To design the basis of improving mental health services via the integration of mental health into primary health care in the Democratic Republic of Congo (DRC), we conducted a scoping review of available literature regarding mental illness in armed conflict and EVD outbreak settings.

Methods

This scoping review of studies conducted in armed conflict and EVD outbreak of DRC settings synthesize the findings and suggestions related to improve the provision of mental health services. We sued the extension of Preferred Reporting Items for Systematic Reviews and Meta-Analyses to scoping studies. A mapping of evidence related to mental disorders in the eastern part of DRC from studies identified through searches of electronic databases (MEDLINE, Scopus, Psych Info, Google Scholar, and CINAHL). Screening and extraction of data were conducted by two reviewers independently.

Results

This review identified seven papers and described the findings in a narrative approach. It reveals that the burden of mental illness is consistent, although mental healthcare is not integrated into primary health care. Access to mental healthcare requires the involvement of affected communities in their problem-solving process. This review highlights the basis of the implementation of a comprehensive mental health care, through the application of mental health Gap Action Program (mhGAP) at community level. Lastly, it calls for further implementation research perspectives on the integration of mental healthcare into the health system of areas affecting by civil instability and natural disasters.

Conclusion

This paper acknowledges poor implementation of community mental health services into primary health care in regions affected by armed conflict and natural disasters. All relevant stakeholders involved in the provision of mental health services should need to rethink to implementation of mhGAP into the emergency response against outbreaks and natural disasters.

Psychological distress and terrorist engagement: Measuring, correlating, and sequencing its onset with negative life events, social factors, and protective factors

This article employs probability-based modelling to unpack the complex and multifaceted individual, social, and psychological processes that may provide psychological protection for individuals engaged with terrorist groups. We outline the predictors of the onset of psychological distress across two phases of terrorist involvement (pre-engagement and engagement). Using a dataset of 96 terrorist autobiographies, we conduct sequence analyses to pinpoint the onset of psychological problems and the experiences that preceded and followed this onset. The results demonstrate a complexity in the relationship between mental disorders and terrorist engagement, as well as the heterogeneity of the lived experience of "being" a terrorist. The experience of psychological distress was mediated by numerous factors and the combination of these factors. The evidence suggests that, in certain cases, individual and group resilience may be a protective factor when an individual faces negative experiences. The presence of protective factors may not be sufficient to explain why group-actor terrorists present with a lower than expected prevalence of mental disorder. Future work should examine whether experiences commonly viewed as risk factors may be more useful in examining the occurrence of psychopathology in terrorists.

The Association Between PTSD Symptoms and IPV Perpetration Across 6 Years

A large literature documents that posttraumatic stress disorder (PTSD) symptoms are associated with intimate partner violence (IPV) perpetration among adults. However, research on this relationship among adolescents and young adults has been plagued by methodological flaws (e.g., cross-sectional designs). Thus, the purpose of the present study was to examine the longitudinal and bidirectional associations between PTSD symptoms and psychological and physical IPV perpetration from adolesence to young adulthood. A sample of racially and ethnically diverse high school students (N = 1,042; 56% female) were assessed annually for 6 years (from 2010 to 2015 in Southeastern Texas). At each assessment, participants completed measures of PTSD symptoms and psychological and physical IPV perpetration. The mean age of the sample at the first assessment was 15.09 (SD = .79). Structural equation modeling demonstrated that PTSD symptoms at Years 2, 3, and 4 predicted increases in psychological IPV perpetration in the subsequent year. In turn, psychological IPV perpetration at Years 1 and 4 predicted increases in PTSD symptoms in the subsequent years. In addition, psychological IPV perpetration mediated the association between PTSD symptoms and physical IPV perpetration over time. Results were consistent across gender and race/ethnicity. Findings provide initial evidence that PTSD symptoms are associated with IPV perpetration across time from adolescence to young adulthood. Prevention and intervention programs for adolescent and young adult IPV perpetration may benefit from screening for, and potentially treating, PTSD symptoms.

Vulnerable children: Protection and social reintegration of child soldiers and youth members of gangs

In the 30 years since the adoption of the United Nation's Convention of the Rights of the Child (CRC), international policy and research has continuously examined the impact of community violence exposure on child development. This article uses the framework of the CRC to review how the world has studied the involvement of child soldiers in armed conflict. We then apply Article 38 of the CRC (which prohibits the use of child soldiers) to parallel the literature regarding youth involvement in gangs. We argue that due to high similarities of these groups, including in regards to risk factors, traumatic experiences, and post-experience sequelae, youth gang members should be included as a protected group under the CRC as are child soldiers. We conclude with a discussion of programs that may be effective at preventing recruitment into armed conflict and gang memberships, and programs that reduce traumatic symptoms of children who experience and perpetrate violence.

The cycle of violence as a function of PTSD and appetitive aggression: A longitudinal study with Burundian soldiers

During deployment, soldiers face situations in which they are not only exposed to violence but also have to perpetrate it themselves. This study investigates the role of soldiers' levels of posttraumatic stress disorder (PTSD) symptoms and appetitive aggression, that is, a lust for violence, for their engaging in violence during deployment. Furthermore, factors during deployment influencing the level of PTSD symptoms and appetitive aggression after deployment were examined for a better comprehension of the maintenance of violence. Semi-structured interviews were conducted with 468 Burundian soldiers before and after a 1-year deployment to Somalia. To predict violent acts during deployment (perideployment) as well as appetitive aggression and PTSD symptom severity after deployment (postdeployment), structural equation modeling was utilized. Results showed that the number of violent acts perideployment was predicted by the level of appetitive aggression and by the severity of PTSD hyperarousal symptoms predeployment. In addition to its association with the predeployment level, appetitive aggression postdeployment was predicted by violent acts and trauma exposure perideployment as well as positively associated with unit support. PTSD symptom severity postdeployment was predicted by the severity of PTSD avoidance symptoms predeployment and trauma exposure perideployment, and negatively associated with unit support. This prospective study reveals the importance of appetitive aggression and PTSD hyperarousal symptoms for the engagement in violent acts during deployment, while simultaneously demonstrating how these phenomena may develop in mutually reinforcing cycles in a war setting.

Disarming Ex-Combatants' Minds: Toward Situated Reintegration Process in Post-conflict Colombia

Collective violence in the context of armed conflict impacts the economy, health systems, and social stability of affected countries. This is considered a complex phenomenon with interwoven biological, psychological, social, cultural, and political factors. However, most of the research on this topic still lacks suitable established integrative approaches to assess multilevel perspectives. Social, cognitive and affective mental processes (SCAMP) are critical factors that should be considered in multilevel approaches. In this article, we critically discuss some of the classically isolated approaches used in violence research, the absence of successful interventions for ex-combatants reintegration, and the specific neglect of SCAMP in these interventions. We present the case of post-conflict Colombia as a unique opportunity to study the different roots of collective violence, and we call for a more robust and situated approach to understanding of and intervention in this multifaceted phenomenon. In addition, we suggest a two-stage approach for addressing ex-combatants’ reintegration programs, which considers the situated nature of post-conflict scenarios and the urgent need for evidence-based interventions. This approach focuses on the comprehensive scientific assessment of specific factors involved in violence exposure and the subsequent design of successful interventions. The implementation of this approach will contribute to the effective reintegration of individuals who have been exposed to extreme violence for more than 50 years.

Psychotherapeutic Intervention in the Demobilization Process: Addressing Combat-related Mental Injuries with Narrative Exposure in a First and Second Dissemination Stage

BACKGROUND

Depending on the exposure to traumatic stressors and combat, 20% to 50% of ex-combatants present with trauma-related disorders, and more than half of the members of armed groups have a proclivity to violence. Therefore, psychotherapeutic assistance should address both, trauma-related suffering and the lowered threshold for aggressive behaviour.

OBJECTIVE

Supporting the demobilization process of ex-combatants in the eastern DR-Congo, we implemented a version of Narrative Exposure Therapy adapted for Forensic Offender Rehabilitation (FORNET).

METHOD

In two successive dissemination stages (DS), local counsellors conducted FORNET. In DS1, they were trained by clinical experts, and in DS2, the by then experienced counsellors trained and supervised a second group of local counsellors (DS2). The training consisted of a 3-week workshop covering theoretical concepts and practical therapeutic skills. In DS1 and DS2, a total of 98 demobilizing combatants received an intervention; treatment-as-usual served as the control condition. Posttraumatic stress disorder, appetitive aggression, depression severity and drug dependence were assessed prior to the intervention and 6 and 12 months later; additionally, we assessed reintegration success.

RESULTS

Six months post-intervention, FORNET significantly reduced Posttraumatic stress disorder symptoms but had less effect on the trait of appetitive aggression; moreover, beneficial effects were found for depression severity and drug dependence as well as for reintegration indices. Treatment gains were retained at 12 months.

CONCLUSIONS

Individuals without previous training in psychotherapy can learn to effectively apply the brief intervention FORNET and support the demobilization process in ongoing conflicts. The study suggests that it is possible to pass down psychotherapeutic techniques over generations of counsellors. © 2015 The Authors. Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd.

KEY PRACTITIONER MESSAGE

Posttraumatic stress symptoms, depression and clinically relevant levels of drug dependence can effectively be reduced with a version of Narrative Exposure Therapy (NET) adapted for Forensic Offender Rehabilitation (FORNET). The intervention is effective in the context of ongoing conflict. Individuals without previous training in psychotherapy can learn to effectively apply the brief intervention FORNET. It is possible to pass down psychotherapeutic techniques like FORNET over generations of counsellors. Psychotherapeutic interventions like FORNET may facilitate the transition to peace in war-torn regions.

The role of intrinsic and extrinsic rewards in committing violence during combat: A cross-sectional study with former combatants in the DR Congo

It has been postulated that the violent behavior that characterizes armed conflict is reinforced by the possibility of receiving rewards. The present study examined the potential influence of two types of rewards in an ongoing setting of conflict: extrinsic and intrinsic rewards. Former combatants active in the Democratic Republic of the Congo (N = 198) were interviewed and questioned about the way they were recruited, the offenses they committed during combat, their level of perceived intrinsic rewards (i.e., appetitive perception of violence), and the number of received extrinsic rewards during their time in the armed group (e.g., money, extra food, alcohol, or drugs). A moderated multiple regression analysis showed that the number of received extrinsic rewards and the level of intrinsic rewards were significantly positively related to the number of different types of offenses committed. In contrast to our expectations and previous findings, the recruitment type (forced conscription vs. voluntary enlistment) did not moderate this relation. Our findings suggest that both types of rewards play a role in committing violence during combat. We suggest, therefore, that reintegration programs should not only consider the influence of extrinsic rewards, but also need to address the influence of intrinsic rewards to counter violent behavior among former combatants. Aggr. Behav. 43:241-250, 2017. © 2016 Wiley Periodicals, Inc.

PTSD symptom severity relates to cognitive and psycho-social dysfunctioning - a study with Congolese refugees in Uganda

Background: In the ongoing conflict in the Democratic Republic of the Congo (DRC), civilians have been heavily exposed to traumatic stressors. Traumatizing experiences cumulatively heighten the risk for trauma-related disorders, and with it affect cognitive and psycho-social functioning. Objectives: We aimed at investigating the association between trauma-related disorders and cognitive and psycho-social functioning and hypothesized that PTSD symptom severity would negatively correlate with executive functioning, working memory and psycho-social functioning in everyday life. Method: In total, 323 Congolese refugees (mean age: 31.3 years) who arrived in the Ugandan Nakivale refugee settlement after January 2012 were assessed regarding their exposure to traumatic events, PTSD symptom severity (posttraumatic symptom scale interview), executive functioning (Tower of London), working memory performance (Corsi block tapping task) and psycho-social dysfunctioning (Luo functioning scale). Results: Hierarchical regression analyses indicated a significant negative association between PTSD symptom severity and working memory (β = -0.32, p < 0.001), as well as executive functions (β = -0.19, p = 0.003). Furthermore, the impairment of psycho-social functioning in everyday life was positively related with PTSD symptom severity (β = 0.70, p < 0.001), and negatively with executive functioning (β = -0.15, p = 0.003). However, working memory performance was not significantly related to psycho-social dysfunctioning (β = 0.09, p > 0.05). Conclusion: Trauma survivors not only suffer from the core PTSD symptoms but also from impaired cognitive functioning. PTSD symptom severity seems furthermore to be related to impaired psycho-social functioning. Our findings suggest that trauma-related mental health problems may heighten the risk for poverty and lack of prospect and further aggravate the consequences of war and conflict.

Abducted children and youth in Lord's Resistance Army in Northeastern Democratic Republic of the Congo (DRC): mechanisms of indoctrination and control

Background

Globally, an estimated 300,000 children under the age of 18 participate in combat situations; those in armed groups in particular suffer prolonged exposure to psychological and physical abuse. The Lord’s Resistance Army (LRA) is a rebel movement known for its widespread conscription of children; yet little is known about this process once the group moved beyond northern Uganda. In this paper, we describe the processes related to abduction and indoctrination of youth by the LRA in northeastern Democratic Republic of the Congo ( DRC).

Methods

In-depth interviews were conducted with formerly abducted children, their family members, community leaders, and service providers (total n = 34) in four communities in LRA-affected areas of northeastern DRC. Inductive coding of transcripts was undertaken to identify salient themes.

Results

Informants articulated a range of practices by the LRA to exert high levels of control over new recruits, including strict social isolation from recent abductees; control of communication; promoting new identity formation; and compelling children to act out strictly defined gendered roles. Witchcraft and secrecy are used to intimidate recruits and to magnify perception of the group’s power. These methods promote de-identification with one’s civilian and family life; and eventually the assimilation of a new language and identity.

Conclusion

Indoctrination of newly abducted children into the LRA occurs via a complex system of control. This study provides one of the first detailed explorations of social and psychological mechanisms through which this is achieved, and focuses particularly on the gendered differences in the indoctrination process. Results support past findings that the LRA is a strategic and well-organized organization in its approach to enlisting child soldiers. Understanding some of the ways in which the LRA controls its recruits and the psychological impact of indoctrination enables reintegration programs to more effectively address these issues and serve the complex needs of formerly abducted children.

Appetitive Aggression in Women: Comparing Male and Female War Combatants

Appetitive aggression refers to positive feelings being associated with the perpetration of violent behavior and has been shown to provide resilience against the development of PTSD in combatants returning from the battlefield. Until this point, appetitive aggression has been primarily researched in males. This study investigates appetitive aggression in females. Female and male combatants and civilians from Burundi were assessed for levels of appetitive aggression. In contrast to non-combatants, no sex difference in appetitive aggression could be detected for combatants. Furthermore, each of the female and male combatant groups displayed substantially higher levels of appetitive aggression than each of the male and female civilian control groups. This study demonstrates that in violent contexts, such as armed conflict, in which individuals perpetrate numerous aggressive acts against others, the likelihood for an experience of appetitive aggression increases- regardless of whether the individuals are male or female.

Sensitive Periods for Developing a Robust Trait of Appetitive Aggression

Violent behavior can be intrinsically rewarding; especially combatants fighting in current civil wars present with elevated traits of appetitive aggression. The majority of these fighters were recruited as children or adolescents. In the present study, we test whether there is a developmental period where combatants are sensitive for developing a robust trait of appetitive aggression. We investigated 95 combatants in their demobilization process that were recruited at different ages in the Kivu regions of the eastern Democratic Republic of Congo. Using random forest with conditional inference trees, we identified recruitment at the ages from 16 and 17 years as being predictive of the level of appetitive aggression; the number of lifetime, perpetrated acts was the most important predictor. We conclude that high levels of appetitive aggression develop in ex-combatants, especially in those recruited during their middle to late teenage, which is a developmental period marked by a natural inclination to exercise physical force. Consequently, ex-combatants may remain vulnerable for aggressive behavior patterns and re-recruitment unless they are provided alternative strategies for dealing with their aggression.

The Cycle of Violence: Associations Between Exposure to Violence, Trauma-Related Symptoms and Aggression--Findings from Congolese Refugees in Uganda

War-related trauma exposure has been linked to aggression and enhanced levels of community and family violence, suggesting a cycle of violence. Reactive aggression--an aggressive reaction to a perceived threat--has been associated with posttraumatic stress disorder (PTSD). In contrast, appetitive aggression--a hedonic, intrinsically motivated form of aggression--seems to be negatively related to PTSD in offender and military populations. This study examined the associations between exposure to violence, trauma-related symptoms and aggression in a civilian population. In semistructured interviews, 290 Congolese refugees were questioned about trauma exposure, PTSD symptoms, and aggression. War-related trauma exposure correlated positively with exposure to family and community violence in the past month (r = .31, p < .001), and appetitive (r = .18, p = .002) and reactive aggression (r = .29, p < .001). The relationship between war-related trauma exposure and reactive aggressive behavior was mediated by PTSD symptoms and appetitive aggression. In a multiple sequential regression analysis, trauma exposure (β = .43, p < .001) and reactive aggression (β = .36, p < .001) were positively associated with PTSD symptoms, whereas appetitive aggression was negatively associated (β = -.13, p = .007) with PTSD symptoms. Our findings were congruent with the cycle of violence hypothesis and indicate a differential relation between distinct subtypes of aggression and PTSD.

Treating Traumatized Offenders and Veterans by Means of Narrative Exposure Therapy

Violent offenders and soldiers are at high risk of developing appetitive aggression and trauma-related disorders, which reduce successful integration into societies. Narrative exposure therapy (NET) for forensic offender rehabilitation (FORNET) aims at reducing symptoms of traumatic stress (e.g., posttraumatic stress disorder) and controlling readiness for aggressive behavior. It follows the logic of the evidence-based trauma-focused NET with special emphasis on violent acts in past and future behavior. In NET, the therapist guides the client by means of exposure through his traumatic experiences in chronological order linking the negative emotions, such as fear, shame, and disgust, to the past context and integrating the traumatic experiences into the autobiographical memory. During FORNET, we also encourage verbalization of any positive emotions and experiences linked to past violent and aggressive behaviors. This recall of positive emotions (linked to the there and then) is contrasted with feelings that emerge during the narration process (here and now). In this way, the therapist helps the client to anchor the whole range of sensory and bodily experiences, cognitions, and emotions to the contextual cues. Over the process of the therapy, we support the client to begin the role change from a violent offender to a citizen, who is capable of living a non-violent and socially adjusted life. Finally, the client develops visions and wishes for the future to support a successful integration into society. Several studies with veterans and violent youths have proven the feasibility of FORNET, found evidence of a positive outcome (recovered mental health, fewer offenses committed, less drug intake, and improved integration into civil society), and highlighted the importance of addressing the whole range of experiences while treating violent offenders or veterans.

Predictors of posttraumatic stress and appetitive aggression in active soldiers and former combatants

BACKGROUND

During the period between 1993 and 2005, the people of Burundi were trapped within a violent civil war. In post-conflict regions, symptoms of posttraumatic stress disorder (PTSD) were found to be widespread. At the same time, combatants often reported having perceived committing violence as exciting and appealing, an experience referred to as appetitive aggression. Both of these phenomena hamper the building of a functional and peaceful society.

OBJECTIVE

This study aims to investigate the factors that are associated with the level of PTSD and appetitive aggression in former and still active combatants.

METHODS

Semi-structured interviews were conducted with 948 male Burundians: 556 active soldiers and 392 ex-combatants. PTSD symptom severity was assessed using the PTSD Symptom Scale Interview, while appetitive aggression was assessed using the Appetitive Aggression Scale.

RESULTS

Linear regression analyses revealed that the number of traumatic events, childhood maltreatment, and their interaction predicted PTSD symptom severity, whereas self-committed violence did not. The number of traumatic events and self-committed violence were associated with appetitive aggression. Childhood maltreatment alone was not associated with appetitive aggression; however, its interaction with self-committed violence did predict appetitive aggression. When controlling for predictors, ex-combatants reported a higher degree of PTSD symptomatology, whereas active soldiers reported a higher degree of appetitive aggression.

CONCLUSION

We conclude that childhood maltreatment is an additional, significant risk factor that exacerbates the psychological consequences of violent conflicts. Self-committed violence may not necessarily engender trauma-related disorders, but is highly related to appetitive aggression.

The challenge of living on: psychopathology and its mediating influence on the readjustment of former child soldiers

Current civil wars are characterized by the increasing involvement of civilian populations and the systematic employment of child soldiers. An example of such wars was the conflict in Northern Uganda, where the war-affected population is still challenged by the reintegration of formerly abducted children and youths. A cross-sectional, population-based survey, using a multistage cluster sampling approach of 1,113 Northern Ugandans aged between 12 and 25 in camps for internally displaced persons and locally validated instruments was conducted to assess symptoms and diagnoses of Posttraumatic Stress Disorder (PTSD) and probable Depression in war-affected, as well as formerly abducted individuals. Further objectives were to determine predictors of psychopathology and to relate indicators of maladjustment (i.e., impairments in daily and community functioning, somatic complaints, suicidality, aggressiveness and discrimination) to abduction, level of exposure to violence and psychopathology. 43% of the sample reported abduction by the rebel army. Exposure to violence among this group was higher than for non-abducted youths (t = 28.05; p<.001). PTSD point prevalence rates were 25% among former child soldiers and 7% among the comparison group. High suicidal ideation was present in 16% and 6% respectively. A higher amount of experienced and witnessed event-types (β = . 32. p<.001), loss of first-degree relatives (β = .13. p<.001) and the number of event-types involving forced perpetration (β = .23. p<.001) were identified as risk factors of PTSD symptoms in former child soldiers. The associations between abductee-status and indicators of maladjustment were fully mediated by level of trauma exposure and psychopathology. Results show that child soldiering and its psychological sequelae affect a substantial proportion of children and youths. After release or flight, their readjustment depends at least partly on their level of mental traumatization.

The benefits of aggressive traits: a study with current and former street children in Burundi

Aggressive behavior in children and youths is commonly associated with exposure to violence and maltreatment. Consequently, aggressive behavior has often been explained as a form of reactive behavior in response to violence-inflicted mental suffering. However, perpetrating violence can become appealing, fascinating and exciting, i.e., may acquire appetitive, self-rewarding aspects. We postulated that this appetitive form of aggression reduces the vulnerability for developing Posttraumatic Stress Disorder (PTSD) in insecure and violent environments. Furthermore we investigated the extent to which reactive aggression and appetitive aggression account for recent violent behavior in children and youths. We conducted semi-structured interviews in a sample of 112 children and youths (Mage=15.9 years) recruited from the streets, families and a residential center for vulnerable children in Burundi. We investigated the cumulative exposure to traumatic events and to domestic and community violence, assessed the recently committed offenses, the severity of PTSD symptoms, and the potential for reactive and appetitive aggression. Reactive aggression was positively related to PTSD, whilst appetitive aggression was negatively related to PTSD. Children higher in appetitive aggression were also more likely to display violent behavior. These results suggest that an appetitive perception of violence may be an useful adaption to insecure and violent living conditions reducing the vulnerability of children for trauma-related mental disorders. However, positive feelings experienced through violent or cruel behavior are also an important risk factor for ongoing aggressive behavior and therefore need to be considered in prevention strategies.

Analyzing the microfoundations of human violence in the DRC - intrinsic and extrinsic rewards and the prediction of appetitive aggression

Background

Civil wars are characterized by intense forms of violence, such as torture, maiming and rape. Political scientists suggest that this form of political violence is fostered through the provision of particular intrinsic and extrinsic rewards to combatants. In the field of psychology, the perpetration of this kind of cruelty is observed to be positively linked to appetitive aggression. Over time, combatants start to enjoy the fights and even the perpetration of atrocities. In this study, we examine how receiving rewards (intrinsic versus extrinsic) influence the level of appetitive aggression exhibited by former combatants.

Method

We surveyed 95 former combatants in the eastern provinces of the Democratic Republic of the Congo.

Results

Linear regression analyses reveal that intrinsic as well as extrinsic rewards are linked to the former combatants’ Appetitive Aggression score. However, this relationship is partly determined by the way in which combatants are recruited: While abducted combatants seem to react more strongly to extrinsic rewards, the score of those that joined voluntarily is primarily determined by intrinsic rewards.

Conclusions

We conclude that receiving rewards influence the level of appetitive aggression. However, which type of rewards (intrinsic versus extrinsic) is of most importance is determined by the way combatants are recruited.

Relations among appetitive aggression, post-traumatic stress and motives for demobilization: a study in former Colombian combatants

BACKGROUND

Former combatants have frequently reported that aggressive behaviour can be appetitive and appealing. This appetitive aggression (AA) may be adaptive for survival in a violent environment, as it is associated with a reduced risk of combat-related psychological traumatization. At the same time, AA might impair motivation for re-integration to civil life after ending active duty. Whereas in Colombia those combatants who volunteered for demobilization were mostly tired of fighting, those who demobilized collectively did so mainly by force of the government. We predicted those who were demobilized collectively would still be attracted to violence, and benefit from the resilience against trauma-related mental suffering, moderated by appetitive aggression, as they would have continued fighting had they not been forced to stop.

METHOD

A sample of 252 former Colombian former combatants from paramilitary and guerrilla forces was investigated. Appetitive aggression was assessed using the Appetitive Aggression Scale (AAS) and post-traumatic stress disorder (PTSD) symptoms with the PTSD Symptom Scale-Interview (PSS-I). We distinguished between individual and group demobilization and assessed reasons for disarmament.

RESULTS

Most of the guerrilla troops who demobilized individually and were tired of fighting reported both an attraction to violence as well as increased trauma symptoms, owing to their former engagement in violent behaviour. In contrast, among those who were demobilized collectively, appetitive aggression was associated with a reduced risk of PTSD. However, this effect was not present in those combatants in the upper quartile of PTSD symptom severity.

CONCLUSION

The influence of combat experience on traumatization, as well as the motivation for demobilization, differs remarkably between those combatants who demobilized individually and those who were members of a group that was forced to demobilize. This has important implications for the implementation of re-integration programmes and therapeutic interventions.

Growing up in armed groups: trauma and aggression among child soldiers in DR Congo

BACKGROUND

Child soldiers are often both victims and perpetrators of horrendous acts of violence. Research with former child soldiers has consistently shown that exposure to violence is linked to trauma-related disorders and that living in a violent environment is correlated with enhanced levels of aggression.

OBJECTIVE

To gain more insight into the experiences and the mental health status of former child soldiers, we conducted a survey with N=200 former child soldiers and adult combatants in the DR Congo.

METHODS

We conducted semi-structured interviews concerning military experiences, experienced and perpetrated violence, and mental health.

RESULTS

Former child soldiers reported more experienced and perpetrated violence, a greater severity of trauma-related suffering, as well as higher appetitive aggression than adult ex-combatants. Appetitive aggression was related to more perpetrated violence, higher military ranks, voluntary recruitment and higher rates of reenlistments in former child soldiers.

CONCLUSIONS

Our results indicate that growing up in an armed group is related to higher levels of trauma-related disorders and aggressive behavior. This may explain the challenge of reintegrating former child soldiers. It is thus important to consider mental health problems, particularly trauma-related disorders and aggressive behavior, of former child soldiers for designing adequate reintegration programs.

Aggression inoculates against PTSD symptom severity-insights from armed groups in the eastern DR Congo

BACKGROUND

In the ongoing conflict in the Democratic Republic of the Congo (DRC), combatants are exposed to massive forms of violence and other traumatic stressors. Nevertheless, many combatants do not suffer from trauma-related disorders, although they have experienced numerous traumatizing events. Perceiving aggressive behavior as fascinating and arousing might be a defense against trauma-related disorders in the violent environment of war and conflict.

OBJECTIVE

Thus, in this study we investigated the relationship between the exposure to traumatic stressors, appetitive aggression, and posttraumatic stress disorder (PTSD) symptom severity. We hypothesized that cumulative traumatic experiences correlated positively and appetitive aggression negatively with PTSD symptom severity.

METHOD

In total, 105 voluntary male combatants from different armed groups in the eastern DRC took part in this study. In a semistructured interview, respondents were questioned about their exposure to traumatic stressors, the extent of appetitive aggression (Appetitive Aggression Scale) and their PTSD symptom severity (PTSD Symptom Scale - Interview).

RESULTS

A multiple sequential regression analysis showed that traumatic events were positively related to PTSD symptom severity. For participants with low to medium PTSD symptom severity, appetitive aggression correlated negatively with PTSD symptom severity.

CONCLUSIONS

The results of this study provide further support for earlier findings that repeated exposure to traumatic stressors cumulatively heightens the risk of PTSD and revealed that appetitive aggression buffers the risk of developing PTSD symptoms under certain circumstances. Thus, the perception of aggressive behavior as fascinating and arousing seem to help combatants to adapt to violent environments but may also be one reason for recurrent failure of reintegration programs for excombatants.