the complexity of trauma response: a 4-year follow-up of adolescent cambodian refugees

Child Abuse & Neglect 27 (2003) 1277–1290

The complexity of trauma response: a 4-yearfollow-up of adolescent Cambodian refugees�

Cécile Rousseaua,b,∗, Aline Drapeaua, Sadeq Rahimia

aDepartment of Psychiatry, Montreal Children’s Hospital, 4018 Ste. Catherine Street West,Westmount, Que., Canada H3Z 1P2

bDepartment of Transcultural Psychiatry, McGill University, Montreal, Que., Canada

Received 5 November 2002; received in revised form 14 June 2003; accepted 2 July 2003

Abstract

Objective: The objective of this study was to document the psychosocial adjustment of young refugeesduring their adolescence and its association with the war-related trauma experienced by their familybefore migration.Method: Data were collected on 57 young Khmer resettled in Montreal and followed from early to lateadolescence. The associations between premigratory exposure to political violence and postmigratorymental health and social adjustment were estimated for early, mid-, and late adolescence.Results: The associations between premigratory exposure to political violence and postmigratory psy-chosocial adjustment fluctuated over the adolescence period. Overall, the adolescents whose familieswere more highly exposed to political violence tended to report a more positive social adjustment andless mental health symptoms than those less exposed.Conclusion: The high expectations of Cambodian parents towards their children and the preservationof traditional values despite the Khmer rouge attempts to eradicate them might contribute to explainthe paradoxical association between the families’ exposure to political violence and the adolescents’psychosocial adjustment in the host country. Although children and adult refugees seen in clinical settingare reminders of the negative effects of adversity, resilience should be more systematically explored incommunity samples to further our understanding of the long-term effects of trauma.© 2003 Elsevier Ltd. All rights reserved.

Keywords:Trauma; Adolescents; Refugees; Resilience; Mental health

� This research was supported by grants from the Conseil Quebecois de la Recherche en Sante and the NationalHealth Research and Development Program of Canada (now known as the Canadian Institutes for Health Research).

∗ Corresponding author.

0145-2134/$ – see front matter © 2003 Elsevier Ltd. All rights reserved.doi:10.1016/j.chiabu.2003.07.001

1278 C. Rousseau et al. / Child Abuse & Neglect 27 (2003) 1277–1290

Introduction

A number of studies have been conducted to understand better the long-term effect of pastexposure to political violence on the mental health of children and adolescents who were forcedto migrate as refugees to various host countries, with or without their parents. Posttraumaticstress disorder has been found to be very prevalent in Khmer children and adolescents whohave survived the Pol Pot regime (Hubbard, Realmuto, Northwood, & Masten, 1995; Kinzie,Sack, Angell, Manson, & Ben, 1986; Kinzie, Sack, Angell, Clarke, & Ben, 1989; Mollica,Poole, Son, Murray, & Tor, 1997; Sack, 1999; Sack, Clarke, & Seeley, 1996; Sack et al., 1994;Savin, Sack, Clarke, Meas, & Richart, 1996) and in their parents (Mollica et al., 1993).

A positive association was observed between children of war’s perception of their ownefficacy and their self-confidence and self-esteem (Garbarino & Kostelny, 1996). Macksoud,Dyregrov, and Raundalen (1993)also noted that traumatized children tend to isolate themselvesfrom their peers. Other studies have reported that children’s personal and social identity andmoral development are affected when their world is disrupted by war (Macksoud et al., 1993;Martin-Baro, 1994; Richman, 1993).

In parallel to the vast literature on the negative impact of political violence on mental health,some studies show that in spite of all their psychological symptoms, the majority of severelytraumatized children manage to become well-adjusted adults (Dalianis-Karambatzakis, 1994;Lyons, 1991; Sigal, 1998). Macksoud and Aber (1996)observed that different experiencesof trauma and loss led to a wide range of emotional and behavioral responses in Lebanesechildren, including such positive effects as an increase in prosocial and planful behavior. Trau-matized children also have been reported to maintain or improve their academic performancein spite of their trauma (Terr, 1983). Finally, in a study of Bosnian adolescents,Ferren (1999)demonstrated that the self-efficacy of traumatized boys was higher than that of their nontrau-matized peers. He hypothesizes that in the Bosnian context, surviving traumatic experiencesmay have a steeling effect that helps maintain high self-efficacy levels.

In war, suffering occurs and is resolved in a social context, shaped by the meaning collec-tively and individually constructed around events (Summerfield, 1999). Exposure to politicalviolence may lead to a wide array of trauma responses, going from building up a resiliencythat may foster psychosocial adjustment to disrupting psycho-emotional balance for a numberof years.

Between 1975 and 1995, 16,818 Cambodian refugees resettled in Canada (United NationsHigh Commissioner for Refugees, 2000). They were either selected by Canadian immigra-tion officers in refugee camps or were sponsored by their families or religious organizations.In either case, they landed in Canada as permanent residents, a status that entitled them tobasic financial support, health and social services, and training in the mainstream language(i.e., French in Quebec, English in other Canadian provinces). Nearly all refugees who haveresettled in Quebec are living in or close to Montreal where migrants make up 20% of thepopulation. Cambodian refugees appear to be ill-equipped to face the challenges of living inan industrialized setting. Most had been peasants or small underground business people withlittle or no education and had no knowledge of either French or English on arrival. A consid-erable number landed in Canada with some or all of their children, most of whom were bornin refugee camps or in Cambodia shortly before the family fled the country.

C. Rousseau et al. / Child Abuse & Neglect 27 (2003) 1277–1290 1279

The study reported here was designed to investigate the evolution of the effects of thefamily’s premigration exposure to political violence on the psychosocial adjustment of youngCambodian refugees from early to late adolescence. Analyses carried out at baseline and 2years later suggest that premigration trauma experienced by a family prior to a child’s birthplays a steeling role at various times in the child’s adolescence. For boys, this translatesin externalizing symptoms and risk behavior, and for girls, in social adjustment (Rousseau,Drapeau, & Platt, 1999). These reactions were interpreted as overcompensation on the partof the children of Pol Pot survivors, to whom the implicit duty of succeeding has beenpassed on.

In this paper, we report on analyses that were carried out, first, to verify whether the steelingeffect of exposure to political violence on some dimensions of the psychosocial adjustment ofyoung Cambodian showed up in early, mid-, and late adolescence of those who took part inthe three phases of the study and, second, to explore the associations between exposure andhow adolescents view themselves and others as they enter adulthood.

Method

Study sample

The study population consisted of Cambodian teenagers born outside of Canada and livingin Montreal. A sample of 57 young Cambodians were followed from early to late adolescenceand were interviewed three times during that period (in 1994, 1996, 1998). Data reported herecover the three phases of the study and pertain to these 57 adolescents.

At baseline, in 1994, the sample numbered 76 Grade 7 and Grade 8 students registeredat six multiethnic high schools. By 1998 (Time 3), the loss to follow-up was 25%. Thebaseline sociodemographic profile was similar for Time 3 participants (n = 57) and non-participants (n = 19), but the pattern of family premigration exposure to political violencediffered. The parents of those lost to follow-up were more likely than the parents of thosewho remained in the study to report more than one premigration trauma experienced afterthe birth of the adolescents under study (74% vs. 44%), and the mean number of traumasexperienced before the children’s birth was lower in nonparticipants than participants (3.1vs. 5.2). However, both the initial sample (n = 76) and the final sample (n = 57) showeda higher level of emotional problems in young Cambodians born into families with a higherversus a lower level of exposure to political violence. So, although the loss to follow-up wasselective, it was probably not a major source of bias, as it did not alter the conclusion drawnat baseline.

The Ethical Review Board of the Montreal Children’s Hospital approved the study andboth parents and adolescents signed consent forms describing their participation and the ob-jectives of the study and ensuring confidentiality. Parents were interviewed in Khmer, whereasteenagers were interviewed in French. The mainstream language in Quebec is French and,in order to preserve this cultural heritage, all immigrant and refugee children are required bylaw to attend French schools. Thus the young Cambodians who participated in the studyhad been studying in French since their first year of schooling in Quebec and were flu-


ent in that language. All interviews were conducted in the parents’ homes by Cambodianinterviewers.

Measures

Premigratory exposure to political violence

At baseline, a series of questions presented in a checklist format were used to ask parentsabout the family’s traumatic experiences. This checklist enumerated 19 types of trauma that,according to Cambodian key informants, may have been experienced by the family or by thechild during the political repression in Cambodia (e.g., threats, harassment, torture, execution,forced labor, disappearance, imprisonment). Parents were asked whether they or a member oftheir family had experienced each type of trauma and, if so, the age of the child under studyat that time.

Two indices of premigratory exposure to political violence were investigated: the numberof traumatic experiences suffered by the family before the child’s birth was used as a proxy forthe child’s indirect exposure, whereas the number experienced after the child’s birth was usedas a proxy for more direct exposure. The number of traumatic experiences suffered before thechild’s birth was normally distributed so this first index was analyzed as a continuous variable.The distribution of the number of traumatic experiences sustained after the child’s birth washighly skewed: 32 of the 57 parents reported only one trauma, most commonly a stay in arefugee camp, whereas other parents reported more than one traumatic experience. Thus, thissecond index was dichotomized: one trauma reported versus more than one.

Because premigration trauma may affect various dimensions of the psychosocial adjustmentof young refugees, three categories of outcome variables were considered: (1) emotional andbehavioral problems, such as internalization, externalization, and risk behavior; (2) socialadjustment, such as the feeling of competence and peer relationships; (3) perception of selfand others, such as self-esteem, collective self-esteem, and experience of racism.

Emotional and behavioral problems

The Youth Self-Report (YSR) developed byAchenbach and his team (1991)is one of themost widely used scales in studies of adolescents. The YSR assesses behavioral and emotionalsymptoms rather than psychiatric diagnosis, and it has shown a high level of crossculturalgeneralizability (Bird, 1996; Crijnen, Achenbach, & Verhulst, 1997, 1999; De Groot, Koot,& Verhulst, 1996; Verhulst & Achenbach, 1995). We used the French version of the YSR,provided by Achenbach’s team, to assess levels of internalizing symptoms (29 items) andexternalizing symptoms (30 items). Reliability of the Internalizing and Externalizing indicesfor the sample of young Cambodians was high, with Cronbach’s alpha ranging from .77 to .87for the whole study.

A questionnaire developed bySylvestre et al. (1992)to measure common risk behaviorsin North American teenagers was used to derive a dichotomous variable indicating whetheror not the adolescent had engaged in risk behavior—such as using drugs or alcohol regularly,


stealing, engaging in physical violence, or belonging to a street gang—in the year precedingthe interview. The questionnaire was well received by teenagers in earlier studies conductedin multiethnic high schools (Rousseau, Drapeau, & Platt, 2000; Sylvestre et al., 1992).

Social adjustment

The YSR was used to assess feelings of social competence (15 items). Reliability was good,with Cronbach’s alpha ranging from .71 to .79 over the three phases of the study.

As is often the case in longitudinal studies, some scales were added over the course of thestudy to investigate specific topics that became meaningful to adolescents as they grew up. TheAdolescent Friendship Inventory (AFI) developed byRubenstein, Heeren, Housman, Rubin,and Stechler (1989)was administered at Time 2 and Time 3 to gather additional informationon peer relationships and on the support that they may provide. This scale is made up of30 statements regarding social comfort and satisfaction (e.g., I find it hard to make friends),emotional support (e.g.,“ I feel better when I talk things over with my friends”), family supportfor peer relationships (e.g., “My friends like being at my house”), loyalty and trust (e.g., “I feelI can trust my friends”) and ambivalence and conflict (e.g., “My friends and I argue a lot”).The choice of answers for each statement is a five point Likert scale (i.e., false, somewhatfalse, not sure, somewhat true or true). The maximum score is 150 and the higher this score,the higher the feeling of satisfaction with peer relationships. The AFI’s reliability was high inthis study, with a Cronbach’s alpha of .80 at Time 2 and .88 at Time 3.

Perception of self and others

At Time 3, the last phase of the study, three scales were added to assess the teenagers’ per-ception of themselves and of the Cambodian community.Rosenberg’s 10-item Self-EsteemScale (SES) (1965)was used to assess personal self-esteem. The SES has been used in a tran-scultural setting byLuhtanen and Crocker (1992)and Cronbach’s alpha for the SES reached.83 in our sample.

Luthanen and Crocker introduced a scale measuring collective self-esteem (CSES) basedon 16 items. The term “collective self-esteem” was proposed as an indicator of an individual’spositive evaluation of his or her sense of identity to his reference group. In the present study,the group of reference was defined as the Cambodian community. The CSES measures fourdimensions of collective self-esteem: personal worth as a member of a group, worth of thegroup in one’s own eyes, how worthy one perceives one’s group to be in other people’s eyes,and how important group membership is to one’s self-identity. Cronbach’s alpha for the CSESwas .81 in our sample.

Beiser, Dion, Gotowiec, Hyman, and Vu (1995)argue that forging an identity in exileis a particular challenge for adolescents, especially when larger social forces like racismcomplicate the struggle. The racism experience scale (Noh, Beiser, Hou, & Kaspar, 1999;Noh, Beiser, Kaspar, Hou, & Rummens, 1999) was used to assess the racism perceived byyoung Cambodians. This scale describes eight types of racist acts and asks whether the teen hadbeen a victim of such acts never, once, sometimes, often, or constantly. The racism experiencescale exhibited a Cronbach’s alpha of. 77 in our sample.


Analysis

To test the evolution of continuous measures of psychosocial adjustment, generalized lin-ear model analyses for repeated measures were carried out separately for each gender. Tostudy the relationships between war-related trauma experienced by their families before orafter the teenagers were born and the outcome variables, and to investigate the evolution ofthese relationships from Time 1 to Time 3, we performed three types of statistical analysis,depending on the scale used to measure the variables. For trauma sustained before the birthof the child and continuous outcome variables, Spearman correlation coefficients were used.For the dichotomous variable opposing one trauma sustained after the child’s birth to morethan one trauma, the mean level of continuous outcome variables was compared for these twocategories. Mean comparisons were also used to study the distribution of trauma experiencedbefore the child’s birth across categories of dichotomous outcome variables. Finally, odds ra-tios served to estimate the association between trauma sustained after the birth of the teenagersand risk behavior, a dichotomous outcome. Confidence intervals at the .95 level were used todetermine the precision and statistical significance of all measures of association or meandifferences, which were calculated separately for girls and boys, and for the whole sample.

Results

At baseline, the mean age of the teenagers was 13.6 years, and they had been living in Canadafor a mean of 9.9 years. The teenagers’ households changed little over the study period. AtTime 3, 63.2% of respondents were living with both parents with the mean number of peopleper household equaling 5. The majority of parents (77.2%) felt that their annual income waslow and 66.7% of all households were headed by unemployed parents. Indeed, the parents,most of whom peasants or fishermen in Cambodia, would often have been ill-equipped to workin an industrialized setting like Montreal as 47.4% had only a primary education or had neverbeen to school.

Premigratory exposure to political violence

The mean number of traumas experienced by the familybeforethe birth of the child was5.2, and 43.9% of parents reported experiencing more than one traumaafter (Table 1). Thetypes of trauma sustainedbeforethe child’s birth were different from those which occurredafter (Table 2). Those most frequently experienced by the familybeforethe birth of the childwere forced labor, execution and threats, whereas those sustainedafter consisted mainly ofstaying in a refugee camp and of traumas sustained while fleeing from Cambodia.

Emotional and behavioral problems

The evolution of emotional symptoms during adolescence varied across mental health mea-sures and sometimes across gender (Table 3). Internalizing scores changed significantly duringthe adolescence. The lowest mean level was found at mid-adolescence for both boys and girls.


Table 1Mean number of war traumas experienced by family before child’s birth and percentage of parents reporting morethan one trauma experienced after child’s birth

Gender of child Before child’s birth After child’s birth

Mean CIa % CI

Total (N = 57) 5.2 4.3 to 6.0 43.9 30.7 to 57.6Girls (n = 24) 5.6 4.2 to 7.0 29.2 12.6 to 51.1Boys (n = 33) 4.9 3.8 to 6.0 54.5 36.4 to 71.9

aConfidence level is .95.

Table 2Type and timing of main war traumas reported by parents (N = 57)

Type of trauma Before child’s birth (%) After child’s birth (%)

Harassment 10.5 3.5Threats 36.8 5.3Imprisonment 3.5 –Execution 38.6 3.5Torture 5.3 –Disappearance 19.3 3.5Forced labor 78.9 8.8Refugee camp – 100.0Youth eyewitness – 8.8Migration trauma – 33.3

Table 3Mean level of psychosocial adjustment measures by gender

Time 1a Time 2b Time 3c Fd p value

InternalizingGirlse 18.2 15.3 17.1 3.98 .034Boysf 17.0 16.0 18.8 3.63 .038

ExternalizingGirls 14.8 12.1 13.3 3.18 .061Boys 15.7 15.8 15.9 .008 .992

CompetenceGirls 22.3 22.4 23.3 .699 .508Boys 23.8 24.3 24.3 .344 .711

Peer relationshipGirls n/a 118.9 119.4 .041 .841Boys n/a 115.7 115.6 .006 .938

aIn 1994.b In 1996.c In 1998.d F statistic for the multivariate test of generalized linear model for repeated measures.e24 girls.f 33 boys.


However, the highest mean level of internalizing symptoms was observed in early adolescencefor the girls and in late adolescence for the boys. Externalizing scores remained constant duringthe adolescence period for the boys whereas it followed a pattern similar to that of internalizingscores for the girls, nearly reaching statistical significance (p = .061).

Risk behavior decreased from 25 (43%) adolescents providing positive reports at baselineto 16 (28%) at both Time 2 and Time 3, and a higher percentage of boys than girls reportedone or more types of risk behavior at each phase of the study.

Social adjustment

The mean feeling of competence slightly increased during the adolescence for both boysand girls but it was far from statistical significance in both genders (Table 3). The mean levelof satisfaction with peer relationships appeared to be similar across time and gender (Table 3).

Table 4Spearman correlations between adolescent psychosocial profile and exposure to political violence before child’sbirth

Psychosocial profile Girls (n = 24) Boys (n = 33) Total sample (N = 57)

ra Cib r CI r CI

InternalizingTime 1c −.25 −.59 to .17 −.01 −.35 to .33 −.11 −.36 to .16Time 2d −.17 −.54 to .25 −.35 −.62 to−.01 −.22 −.45 to .04Time 3e −.11 −.49 to .31 −.10 −.43 to .25 −.13 −.38 to .14

ExternalizingTime 1 −.22 −.57 to .20 −.01 −.35 to .33 −.12 −.37 to .15Time 2 −.003 −.41 to .40 −.38 −.64 to−.04 −.21 −.45 to .05Time 3 .03 −.38 to .43 .05 −.30 to .39 .02 −.24 to .28

CompetenceTime 1 .51 .13 to .76 .02 −.33 to .36 .19 −.07 to .43Time 2 .39 −.02 to .69 −.43 −.67 to−.10 −.07 −.32 to .19Time 3 .30 −.12 to .63 .1 X7 −.18 to .49 .21 −.05 to .45

Peer relationsTime 2 .60 .26 to .81 .11 −.24 to .44 .34 .09 to .55Time 3 .34 −.07 to .65 .04 −.31 to .38 .22 −.04 to .45

Self-esteem (T3)f .28 −.14 to .61 .40 .07 to .65 .34 .09 to .55

Collective self−esteem (T3)f .38 −.03 to .68 .24 −.11 to .54 .28 .02 to .50

Racism (T3)f −.15 −.52 to .27 −.35 −.62 to−.01 −.25 −.48 to .01

aSpearman correlation coefficient.bConfidence level is .95.c In 1994.d In 1996.eIn 1998.f Assessed at Time 3 only.

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Table 5Mean number of exposure to political violence before child’s birth, by presence or absence of risk behavior

Girls (n = 24) Boys (n = 33) Total (N = 57)

Presencea Absenceb CIc Presence Absence CI Presence Absence CI

Risk behaviorTime 1d 4.8 6.0 −1.8 to 4.3 4.5 5.3 −1.4 to 3.1 4.6 5.7 −.6 to 2.8Time 2e 5.0 5.8 −1.5 to 3.0 3.5 5.5 −.4 to 4.3 4.1 5.6 −.08 to 3.2Time 3f 4.0 5.8 −2.6 to 6.2 3.6 5.6 −.3 to 4.3 3.6 5.8 .09 to 4.0

aMean number of traumas for subjects with a positive report of risk behavior.bMean number of traumas for subjects with no report of risk behavior.cConfidence level for mean difference is .95.d In 1994.eIn 1996.f In 1998.


Association between family trauma and adolescents’ psychosocial adjustment

No significant pattern of association was detected between trauma experiencedafter thebirth of the adolescents and their psychosocial adjustment. Thus, we will focus our report onthe associations of the latter with family trauma sufferedbeforethe birth of the teenagers.In short, these associations tended to differ slightly across time and gender (Tables 4 and 5).Overall, for the girls, the relationship between trauma experienced by their familybeforetheirbirth and their personal psychosocial adjustment seemed stronger at baseline than at Time2 or Time 3, although this pattern was not significant (Table 4). Correlations with exposurewere particularly high for feelings of competence, relationship with peers, and collective andpersonal self-esteem (Table 4).

For the boys, the associations between the trauma experienced by their familiesbeforetheirbirth and their psychosocial adjustment were stronger at mid-adolescence than at baselineor Time 3 (Table 4). They were also apparently contradictory. On the one hand, trauma wasnegatively associated at Time 2 with internalizing and externalizing symptoms, which suggeststhat greater family exposure to trauma before the child’s birth gave rise to fewer symptoms inmid-adolescence. On the other hand, a negative association between trauma and psychosocialadjustment was observed at Time 2 for the boys’ feeling of competence, suggesting thatgreater exposure may engender a lower feeling of competence, contrary to the girls, for whomthis association was positive and rather strong throughout adolescence, especially at baseline(Table 4). Trauma experienced by the familybefore the birth of the child was positivelyassociated with the boys’ self-esteem and negatively associated with their experience of racism.

Discussion

Traumatic family experiences linked to the Pol Pot regime may still influence the lives ofyoung Khmer refugees as they enter into adulthood. The results of this longitudinal studysuggest that family trauma experiencedbeforethe birth of a child may have a steeling effect,which can be observed in early and mid-adolescence and persists over time, although in alteredform. The associations between trauma and emotional and behavioral symptoms fade, whereasadolescents reporting involvement in risk behavior tend to be from a less exposed family thanthose reporting no such behavior. Positive social adjustment thus persists, and may reflect akind of overcompensation linked in the adolescents’ minds to the debt they feel towards theirparents (Rousseau et al., 1999).

Family exposure to political violence after the teen’s birth does not appear to show asignificantly persistent association with Cambodian adolescents psychosocial adjustment inthe host country. The very young age of most of our subjects during the Pol Pot era or theirbirth in refugee camps might explain why they have fewer symptoms in the long run than theirolder counterparts interviewed in other studies (Mollica et al., 1990; Sack, Seidler, & Thomas,1976). The fact that the trauma experienced by the family before and after the adolescent birthare not of the same type might also be a reason for the observed difference. Nonetheless, evenstudies reporting long-term persistence (up to 12 years) of PTSD have found rather good socialadjustment in spite of symptoms observed (Sack, Seeley, & Clarke, 1997).


The addition at Time 3 of variables assessing perception of the self and of others throwssome light on the seemingly paradoxical positive association between trauma and psychosocialadjustment. Our data indicate that the intensity of family trauma sustained before the birth ofthe teen, which represents the trauma indirectly experienced by the teen, is positively associatedwith self-esteem in Cambodian adolescents. In focus groups that we conducted sometime ago,Khmer teens did report feeling that their parents would give anything for them and that theyowe them a great deal (Rousseau et al., 1999). Perhaps the parents’ high investment in themendows the teenagers with a feeling of purpose, which, although it can be a burden, alsoenhances their resilience.Dalianis-Karambatzakis (1994), in a unique longitudinal follow-upof young Greek adults who were jailed with their mothers as toddlers, observed that theincarcerated children developed a protective attitude towards their mothers that enhanced theirself-esteem. Although in Dalianis-Karambtzakis study the trauma happened after the birth ofthe child, her results also highlight how certain aspects of the traumatic experience can beappropriated by the children and improve their perception of themselves.

Our finding that mean collective self-esteem is higher in teenagers whose families weremore traumatizedbeforetheir birth is noteworthy.Luhtanen and Crocker (1992), as well asRobins and Foster (1994)have shown that collective self-esteem correlates closely with specificstyles of confrontation selected in response to threats to collective identity, similar to the wayspersonal self-esteem scores have been found repeatedly to predict responses to perceptions ofthreat to personal identity.Verkuyten and Masson (1995)further observed that minority groupmembers who scored higher on the collective self-esteem scale also displayed lower rates ofperception of ethnic prejudice.Martin-Baro (1994)asserts that children are faced with difficultidentity choices during armed conflict. They either internalize an identity that dehumanizeshuman relations but provides them with the relative safety of power or they adopt a sociallystigmatized identity, with the need to resort often to social lies in order to survive. The PolPot regime organized a special assault against the Khmer and Buddhist identity and culture bykilling educated people, including Buddhist monks, and by forbidding traditional rituals. Afterthe war, these events determined the aspects of their collective identity that Cambodians valuedeven more highly than they had before. The relationship between collective self-esteem andtrauma that we have observed may reflect some of the resistance and reconstruction strategiesused by families who had been particularly affected by the war. Perhaps by placing high valueon the collective identity that the Khmer Rouge wanted to destroy, the survivors of the Pol-Potregime may ultimately defeat them.

Finally, the association observed between boys’ decreased perception of racism with traumasustainedbeforetheir birth is also of interest. Here again, the earlier literature would support thereverse relationship: distrust is one of the very well recognized consequences of war. However,given the effect of family trauma on personal and collective self-esteem in our sample, thisfinding may reflect the beneficial influence of a positive group identity that is a source of pride,thus decreasing the perception of the threat that can come from outside of the community.

As mentioned earlier, original studies done in the Netherlands byVerkuyten and Masson(1995)have demonstrated that immigrant adolescents with higher collective self-esteem tendto exhibit less ethnic prejudice than those with lower collective self-esteem. According to theauthors, low collective self-esteem can result in a negative view of the outsiders in an effort toenhance one’s own self-esteem.Rahimi (2000)has also demonstrated a negative relationship


between collective self-esteem and perception of racism. He reported that subjects with highercollective self-esteem tend to perceive lower degrees of racism in an ambiguous situation thando those with lower collective self-esteem. The inverse relationship between trauma beforebirth and lower perception of racism may thus be explained as the outcome of a higher collectiveself-esteem developed by the Khmer population in reaction to the Pol Pot and Khmer Rougeatrocities that targeted their collective identity.

Some caution must be exercised in interpreting the results of this study, which should beviewed as exploratory for a number of reasons. First, the relatively small sample size produceswide confidence intervals and thus imprecise results, especially in some gender-specific anal-yses. Second, though the loss to follow-up was rather small considering that this study wascarried out on teenagers from early to late adolescence, it was somewhat selective, as thosewho completed the study had, on average, been less exposed to premigration political violence.Finally, the scales used in this study were selected, in part, for their demonstrated transculturalvalidity. Nevertheless, some of the social adjustment and self-perception measures used here,such as self-esteem and feelings of competence, may be more in keeping with North Americanvalues rather than with the Khmer conception of adjustment.

The data presented here should not be understood as minimizing the individual and collectivesuffering provoked by organized violence. Children seen in clinical setting are reminders ofthe multiple consequences of adversity (Howard & Hodes, 2000). However, the results dounderline whatSack (1999)calls “the mystery of resiliency” and provide some insight into thecomplex articulation between individual and collective responses to trauma. As one reviewerof this paper pointed out, it also raises important questions such as: How will these teenagersdo over the long haul? What role will the earlier experiences continue to play? And, aboveall, what price does the person pay for her/his resilience? Political violence appropriatesthe private sphere and through this appropriation hurts the community (Vinar, 1993). In thesame way, reconstruction processes borrow from collective representations to structure theindividual experience. The appraisal of the central but very delicate interrelationships betweenthe subject in a community and culture, genealogy and history may become the key to a morecomprehensive understanding of the phenomenon of resiliency.

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French- and Spanish-language abstracts not available at time of publication.

the complexity of trauma response: a 4-year follow-up of adolescent cambodian refugees

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