title: Anger, PTSD, and the nuclear family: a study of Cambodian refugees.
abstract: This study profiles the family-directed anger of traumatized Cambodian refugees, all survivors of the Pol Pot genocide (1975-1979), who were patients at a psychiatric clinic in Lowell, MA, USA. We focus on the nuclear family (NF) unit, the NF unit defined as the patient's "significant other" (i.e. spouse or boyfriend/girlfriend) and children. Survey data were collected from a convenience sample of 143 Cambodian refugee patients from October 2006 to August 2007. The study revealed that 48% (68/143) of the patients had anger directed toward a NF member in the last month, with anger directed toward children being particularly common (64 of the 143 patients, or 49% [64/131] of the patients with children). NF-type anger was severe, for example, almost always resulting in somatic arousal (e.g., causing palpitations in 91% [62/68] of the anger episodes) and often in trauma recall and fears of bodily dysfunction. Responses to open-ended questions revealed the causes of anger toward a significant other and children, the content of anger-associated trauma recall, and what patients did to gain relief from anger. A type of cultural gap, namely, a linguistic gap (i.e., the parent's lack of English language skills and the child's lack of Khmer language skills), seemingly played a role in generating conflict and anger. NF-type anger was associated with PTSD presence. The effect of anger on PTSD severity resulted in part from anger-associated trauma recall and fears of bodily dysfunction, with 54% of the variance in PTSD severity explained by that regression model. The study: 1) suggests that among traumatized refugees, family-related anger is a major clinical concern; 2) illustrates how family-related anger may be profiled and investigated in trauma-exposed populations; and 3) gives insights into how family-related anger is generated in such populations.
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Department of Psychiatry, Boston, USA. devon_hinton@hms.harvard.edu
authors.forename: Devon E
authors.initials: DE
authors.lastname: Hinton
authors.forename: Andrew
authors.initials: A
authors.lastname: Rasmussen
authors.forename: Leakhena
authors.initials: L
authors.lastname: Nou
authors.forename: Mark H
authors.initials: MH
authors.lastname: Pollack
authors.forename: Mary-Jo
authors.initials: MJ
authors.lastname: Good
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000786:Anger; D002160:Cambodia / Q000208:ethnology; D005195:Family Relations / Q000208:ethnology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007802:Language; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D009679:Nuclear Family / Q000523:psychology*; D010287:Parent-Child Relations; D011569:Psychiatric Status Rating Scales; D012036:Refugees / Q000523:psychology*; D012044:Regression Analysis; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000208:ethnology* / Q000523:psychology; D013315:Stress, Psychological; D014481:United States