Childhood reactions to trauma in a Muslim context

Abstract

Empirical evidence demonstrating the deleterious effects of natural disasters and conflict on children has been a burgeoning field in the last two decades. As knowledge about child posttraumatic stress has developed, many researchers have espoused that cognitive models of posttraumatic stress disorder (PTSD) are relevant to persistent posttraumatic stress reactions in children. However, few studies have explored the applicability of these models outside western culture and in the context of Islam. This research aimed to explore the applicability of western-derived concepts of posttraumatic stress reactions in the Indonesian context while appreciating the cultural and religious factors that may influence adjustment in a sample of Acehnese school-aged children exposed to the 2004 Southeast Asian tsunami and years of civil conflict. An initial ethnographic phase of research highlighted psychological problems that are common to previous evidence-based studies in western settings, as well as identifying culturally-specific symptoms and forms of coping. Based on these findings, a survey was conducted with tsunami-affected children (N = 110), which found elevated rates of PTSD (48%), prolonged grief (24%), and depression (35%). Elevated rates of anger and aggression were revealed in boys and girls exposed to the tsunami and conflict. Girls reported significantly higher levels of anger and aggression than boys after the tsunami. Several studies further delineated the mechanisms involved in the experience and expression of anger following a traumatic event, highlighting that anxious attachment, conflict exposure in boys, and acceptance of negative life events in girls impact on anger sensitivity. The applicability of cognitive models regarding the role of autobiographical memories was also addressed. These studies revealed boys’ adoption of an observer vantage point when recalling the tsunami was associated with less PTSD in boys. In addition, a longitudinal study found that the negativity of memories reported by boys was predictive of depression six months later. In attempting to explore the applicability of western-derived nosological categories and cognitive models of trauma in Acehnese children, this thesis highlights the culturally and religiously specific factors that may impinge on the direct application of these models to a cross-cultural population. These findings and the restrictions that were faced throughout the project have significant implications for future cross-cultural research and the implementation of trauma-focused treatment.