Diagnosis and assessment if Intergenerational Trauma

There is extensive literature on the effects of the Holocaust on adult and children survivors and their offspring. The Holocaust model intergenerational trauma originated in the 1960’s through a primarily psychoanalytic framework and has been highly influential in defining the parameters of studies researching other populations such as American Indians (Whitbeck et al. 2014). The majority of psychoanalytic investigations have consisted of single case studies (e.g., Fonagy 1999). Larger scale empirical studies have mainly employed standardised questionnaires to investigate relationships between variables such as parental symptomatology, parenting styles, and their effects on children.

There are numerous problems with establishing the prevalence of historical trauma and clearly linking historical losses to symptoms of emotional distress and severity in day to day functioning between different populations. One such reason is differentiating between distal and proximal causes to trauma, especially when the current context of a population (e.g., reservation living and boarding schools in Native Americans) can be the source of current trauma (Whitbeck et al. 2014). Below are some examples of diagnostic instruments designed to capture the presence of intergenerational trauma in an individual.

Native Americans: Les B. Whitbeck and his colleagues (Whitbeck et al. 2004) devised the Historical Loss Scale and The Historical Loss Associated Symptoms Scale (Appendix 1).

Holocaust Survivors: Melissa C. Kahane-Nissenbaum (2011) developed a questionnaire to assess historical trauma in third generation Holocaust survivors (Appendix 2).

Afro-Caribbean communities: The African American Historical Trauma Questionnaire (AAHTQ) was designed as part of a Dr Myra Miller’s dissertation on schizophrenia in African Americans. As we do not have any more information on this work, please contact Dr Miller at sustainablelifedesign.wordpress.com.

Familiar trauma

The Multi-Tiered Trans-Generational Genogram (MTTG) and the EMDR-Accelerated Information Resourcing (EMDR-AIR) protocols (Tel-Oren 2011, Yoeli & Prattos 2012) have been developed in order to explain both dysfunctional behaviours and adaptive strategies developed by the traumatised individual. These instruments are designed to be used in conjunction with EMDR. The EMDR-Air focuses on behavioural patterns within the client’s personal history in order to contextualise the client’s current response to a traumatic event. The MTTG is used to elicit behavioural patterns within the client’s family history.

The McMaster Family assessment device (Epstein et al. 1983) is given to all family members from the age of 12 and above and consists of 60 statements that family members are asked to indicate their agreement with. It assesses 6 dimensions: affective involvement, affective responsiveness, behavioral control, communication, problem solving, and roles. There is also a 7th scale measuring general family functioning. The protocol can be found here.

The Family Adaptability and Cohesion Scale (FACES-IV) (Olson et al. 2006) comprises of six subscales. Two assess the “mid-range” variables of adaptability and cohesion, and four assess the “extreme” variables of rigidity, chaos, disengagement, and enmeshment. It can be purchased from www.facesiv.com.

Guidance on assessing familial trauma and a number of other free resources can also be found on the National Child Traumatic Stress Network (NCTSN) “Families and Trauma” guide.

Intergenerational attachment trauma

A helpful list of tools to assess trauma in children and adolescents, entitled Standardized Measures to Assess Complex Trauma, has been complied by the National Child Traumatic Stress Network (NCTSN).

Intergenerational trauma in the form of disorganised attachment can be diagnosed using the Adult Attachment Interview (Main et al. 1985). Although using the AAI requires training to administer, the diagnostic process can take up to an hour and a half and the transcribing process well over ten hours, it includes questions that the therapist can ask to generate opportunities to detect the presence of unresolved states of mind and dissociation (George et al. 1985). The interview questions can be found here.

The mentalization concept is an evolution of the attachment paradigm. It postulates that the drive for proximity to the caregiver does not simply arise from the need for physical safety but also from the need to maximise opportunities for the development of the capacity to see oneself and others as having minds. This is achieved through the development of a second order representation of affective states, as a result of “marked” and “contingent” mirroring by the primary caregiver. A recent publication (Bateman & Fonagy 2011) details a framework for the assessment of the individual’s capacity for mentalization and the effects of disorganised attachment on thinking about feeling and feeling about thinking.

A psychoanalytic framework, and particularly its relational and attachment based variants, provides the tools for diagnosing intergenerational trauma though the deployment of many standard analytic techniques. The exploration of enactment and dissociation can be used to capture intergenerationally transmitted “not-me” states linked to dissociated familial history and manifesting in the client’s unconscious relational patterns (Coles 2011, Bromberg 20112006, Brothers 2008, Stern 2010).


Appendix 1: Historical Trauma Protocols

Historical Losses Scale

A   The loss of our land
B   The loss of our language
C   Losing our traditional spiritual ways
D   The loss of our family ties because of boarding schools
E   The loss of families from the reservation to government relocation
F   The loss of self-respect from poor treatment by government officials
G   The loss of trust in whites from broken treaties
H   Losing our culture
I    The losses from the effects of alcoholism on our people
J   Loss of respect by our children and grandchildren for elders
K   Loss of our people through early death
L   Loss of respect by our children for traditional ways

Historical Losses Associated Symptoms Scale

A   Feeling sadness or depression
B   Anger
C   Anxiety or nervousness
D   Uncomfortable around white people when you think of these losses
E   Shame when you think of these losses
F   A loss of concentration
G   Feel isolated or distant from other people when you think of these losses
H   A loss of sleep
I    Rage
J   Fearful or distrust the intention of white people
K   Feel like it is happening again
L   Feel like avoiding places or people that remind you of these losses

Appendix 2: The Third Generation Questionnaire

  1. Which of your grandparent/s was a survivor?
  2. How did you find out about your grandmother’s/grandfather’s/grandparent’s history? How old were you at the time?
  3. What were you told about your grandparents’ experiences? How did you feel at the time and how have those feelings followed you through your life if at all?
  4. When you think about the Holocaust and what your grandparents went through, what kind of thoughts come to mind?
  5. How do you think having a parent who is a second generation survivor has impacted your life? Do you think it has affected your family dynamics, consciousness of being Jewish, or possibly your outlook on life?
  6. In what ways if any do you believe the Holocaust has impacted your life?
  7. Do you talk about you and your family’s story? If so, what do you say? What is your story? If not, why not?
  8. Is there anything else that we haven’t talked about that is relevant to you as a third generation survivor?

Appendix 3: Questions for the Therapist

Does my client/patient come from a social group which has been historically traumatised by war, persecution or discrimination?

What do I know about his/her parents’ and grandparents’ experiences of trauma?

What was the quality and type of attachment relationship that my patient/client experienced in infancy and early childhood?


Bateman, A & Fonagy, P 2011, Handbook of mentalizing in mental health practice, American Psychiatric Publishing, Washington, DC.

Bromberg, P 2006, Awakening the dreamer, Routledge, New York, NY.

Bromberg, P 2011, The shadow of the Tsunami and the growth of the relational mind, Routledge, New York, NY.

Brothers, D 2008, Toward a Psychology of Uncertainty, Analytic Press, New York, NY.

Coles, P. 2011, The Uninvited Guest from the Unremembered Past, Karnac Books, London, England.

DeMaria, R, Hof L & Weeks GR, 1999, Focused genograms: intergenerational assessment of individuals, couples, and families, Routledge, New York, NY.

Epstein, N, Baldwin, L, & Bishop, D 1983, ‘The McMaster family assessment device’, Journal of Marital and Family Therapy, vol. 9, pp. 19-31.

Fonagy, P 1999, ‘The transgenerational transmission of holocaust trauma’, Attachment & Human Development, [online] vol. 1, no. 1, pp. 92-114, available at: http://dx.doi.org/10.1080/14616739900134041[Accessed 17 Oct. 2014].

George, C, Kaplan, N, & Main, M 1985, ‘The Adult Attachment Interview‘, Unpublished manuscript, University of California at Berkeley.

Kahane-Nissenbaum, MC (2011), ‘Exploring intergenerational transmission of trauma in third generation Holocaust survivors’, Doctorate in social work (DSW) dissertations. [Accessed 17 Oct. 2014].

Main, M & Hesse, E. 1990, ‘Parents’ unresolved traumatic experiences are related to infant disorganized attachment status: is frightened and/or frightening parental behaviour the linking mechanism?’, in M Greenberg, D Cicchetti & EM Cummings (eds), Attachment in the preschool years: theory, research, and intervention, University of Chicago Press, Chicago, IL, pp. 161-184.

McGoldrick, M, 2011, Genograms: assessment and intervention (3rd edn), W.W. Norton & Company, Inc, New York, NY.

McGoldrick, Monica, 2008, The genogram journey: reconnecting with your family, W.W. Norton & Company, Inc, New York, NY.

Mucci, C 2013, Beyond individual and collective trauma: intergenerational transmission, psychoanalytic treatment, and the dynamics of forgiveness, Karnac Books, London, England.

Olson DH, Gorall DM, Tiesel JW 2006, FACES-IV package: administration, Life Innovations, Inc, Minneapolis, MN.

Ruppert, F 2008, Trauma, bonding and family constellations: healing Injuries of the soul, Green Balloon Publishing, West Sussex, England.

Ruppert, F, 2011, Splits in the soul: integrating traumatic experience, Green Balloon Publishing, West Sussex, England.

Ruppert, F, 2012, Symbiosis and autonomy: symbiotic trauma and love beyond entanglements, Green Balloon Publishing, West Sussex, England.

Stern, Donnel, B 2010, Partners in thought, Routledge, New York, NY.

Tel-Oren, A (2011), ‘Multi-Tiered Transgenerational-Trauma Genogram (MTTG): an exciting new approach to resolving deep, elusive, and resistant physio-emotional challenges’, available at: http://www.ecopolitan.com/images/ecopolitan/media/2011_04_12_mttg_final.pdf [Accessed 17 Oct. 2014].

Whitbeck, LB, Adams, GW, Hoyt, DR & Chen, X 2004, ‘Conceptualizing and measuring historical trauma among American Indian people’, American Journal of Community Psychology, vol. 33, no. 3-4, pp. 119-30.

Yoeli, FR & Prattos, T (2012), ‘The EMDR-Accelerated Information Resourcing (EMDR-AIR) protocol’, in M Luber (ed), Eye movement desensitization and reprocessing (EMDR) scripted protocols, Springer Publishing Co., New York NY, pp. 31-48.