Trauma and bereavement : symptomatology, aetiology and interventions : a case of young survivors of the 1994 genocide in Rwanda
Exposure to traumatic events has deleterious effect resulting in considerable psychological (cognitive and affective/emotional), physical and social impairments. In contrast to natural disasters, victims of man-made disasters have been reported to be vulnerable to severe psychological and psychiatric disorders affecting a large number of abilities and lasting for many years. Among the most common psychiatric diagnosis associated with violence exposure is the Posttraumatic Stress Disorder (PTSD). Like adults, children and adolescents are not exempt from this situation.
In 1994, Rwanda experienced an unprecedented genocide in which about 800.000 Tutsi, for their majority, were atrociously murdered (UN). This genocide generated multiple and massive stressors that may lead to severe and long-lasting PTSD among its survivors, including children and adolescents. Report on traumas exposure and psychological reactions to genocide among young survivors in Rwanda (Dyregrov et al., 2000) unanimously indicate a precarious situation. At the social level, children and adolescents heading household (CHH) are presumably the most vulnerable given their social deprivation. Moreover, the increased number of significant losses (parents, siblings, relatives, family and community cohesion) and the traumatic nature of the death predict traumatic grief among the young orphans of the genocide in Rwanda. The embedment of traumas and bereavement in this population is postulated to increase the likelihood of severe and persistent posttraumatic distress.
With regard to the genocide in Rwanda, especially the extent of its damages; it is hypothesized that psychological consequences from such disaster are crucial. Considering social categories of young survivors, CHH are hypothesized to be vulnerable to several psychological sequels given their social and economic living conditions. The trauma exposure history, traumatic bereavement of key caretakers and attachment figures (parents and other relatives), lack of adult guardianship, insecure family structures and precarious social support are risk factors predicting poor outcomes.
About the structure, this thesis consists of seven chapters, the general introduction and conclusion excluded. The two first chapters are theoretical and overview the literature related to PTSD (Chapter 1) and the association of trauma and bereavement (Chapter 2) resulting in a conjunction of PTSD and grief. They clarify issues related to symptoms and semiotic concepts, diagnostic and assessment protocols, and demonstrate how PTSD and grief can be embedded on certain aspects but not on others.
At the empirical level, findings from PTSD prevalence (chapter 3) and the association of PTSD and grief (chapter 4) among young people survivors of the 1994 genocide in Rwanda are presented. Furthermore, continuous exposure to post-genocide trauma reminders, deleterious socio-economic life conditions, coping strategies and PTSD comorbidity are presented as major risk factors to persistent and complex post-traumatic distress (Chapter 5). Finally, given our findings, a rumination focused cognitive and behavioural therapeutic (RFCBT) protocol is tested in a pilot sample (Chapters 6) and in a Randomized Controlled Trial (RCT) (chapter 7).
Advisor:Prof. Pierre PHILIPPOT
School:Université catholique de Louvain
Source Type:Doctoral Dissertation
Keywords:grief children and adolescent rwanda ptsd genocide
Date of Publication:09/17/2008