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Why war’s emotional wounds run deeper for some kids and not others

Author: Bruce Bower / Source: Science News

PRIMED FOR PTSD The horrors of Syria’s war take the biggest emotional toll on refugee children who are highly sensitive to their environment and encountered few adversities before the war, a study finds. Here, young refugees play outside tents at a Lebanese camp.

After her husband’s death in Syria’s civil war, Amouna Sharekh Housh gathered her eight children and headed for safety in the neighboring country of Lebanon. At the Lebanese border, Islamic State (ISIS) militants demanded that Housh hand her children over to them. She refused, even when an ISIS soldier put a gun against the head of her then 9-year-old son, Manar. After passing through that hellish checkpoint, the still-intact family moved into a Lebanese refugee camp. Their house was a tent. Food was scarce, and sanitation was absent.

A year later, the entire family was struggling. Once-calm children were now jittery and emotionally volatile. Manar’s condition had taken a particularly bad turn. He suffered from post-traumatic stress disorder (PTSD), a condition that includes having tormenting thoughts and dreams about distressing events, feeling detached from others, staying in a constant state of high-alert for potential dangers and reacting violently to minor frustrations. Housh shared her family’s trials with workers at a Beirut therapy and vocational training center run by the New York City–based nonprofit Art of Hope, and gave them permission to tell her story on the organization’s website.

Housh’s family represents one drop in a sea of tears pouring out of Syria. Since civil war erupted in early 2011, the U.N. High Commission on Refugees (UNHCR) estimates that more than 5 million Syrians have fled the country; another 6.6 million people displaced from their homes are still living in Syria. UNHCR has registered about 1 million Syrian refugees in Lebanon, more than half of whom are 17 or younger — though the Lebanese government pegs the total number of Syrian refugees there at more than 1.5 million.

Her family also highlights another sad fact of war: Everyone suffers, but some more than others.

Most people who live through violent conflict and other extreme traumas experience emotional turmoil, but don’t develop PTSD. A minority, like Manar, suffer severe psychological wounds that don’t heal without outside help. Even then, there are no guarantees.

A new investigation conducted with Syrian refugee youngsters in Lebanon offers a peek at why some kids emotionally rebound while others wilt in the face of wartime horrors. Children fleeing war zones are especially likely to develop PTSD if, before military conflict turned their worlds upside-down, two factors were in play, say Lebanese psychiatrist Elie Karam and his colleagues. First, PTSD-prone youngsters grew up especially aware of and responsive to good and bad aspects of their families, schools and neighborhoods. Second, those “environmentally sensitive” kids encountered few or no early adversities, such as serious physical illness or constantly fighting parents.

Two-way risks

High environmental sensitivity and low or moderate levels of pre-war adversity (dark blue bars at left and middle) resulted in an especially high likelihood of Syrian refugee youngsters developing PTSD. High levels of pre-war adversity resulted in comparable levels of PTSD, regardless of how high or low refugee children scored on a test of environmental sensitivity (bars at right).

Variations in kids’ PTSD risk based on childhood adversity and environmental sensitivity

E.G. Karam et al/BJPsych 2019

“Highly sensitive children who are sheltered from early adversities end up being least prepared to cope with wartime experiences,” says Karam. He is the president of the Institute for Development, Research, Advocacy and Applied Care (IDRAAC), a nonprofit mental health organization in Beirut.

Karam’s study, slated to appear in the British Journal of Psychiatry, joins a growing effort to examine how environmental sensitivity, a trait that varies from one person to another, affects well-being and mental health. This line of research builds on long-standing observations of two types of youngsters. So-called “orchid children” benefit greatly from nurturing surroundings, and do particularly badly when neglected or treated harshly (SN Online: 4/6/11). “Dandelion children” do pretty well in both good and bad environments, and don’t dramatically profit from enriched surroundings.

A new research review led by psychologist Corina Greven of Radboud University Medical Center in Nijmegen, the Netherlands, concludes that a person’s environmental sensitivity hinges on a genetic tendency to think about personal and social experiences in great depth, develop a heightened sense of empathy and quickly feel overstimulated by various sensations. In the March Neuroscience & Biobehavioral Reviews, the scientists say that this trait is best classified as sensory processing sensitivity.

In one measure of the trait’s prevalence, surveys conducted among…

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