Crombach, Anselm

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Predicting domestic and community violence by soldiers living in a conflict region

2017-11, Nandi, Corina, Elbert, Thomas, Bambonye, Manassé, Weierstall, Roland, Reichert, Manfred, Rukundo-Zeller, Anja C., Crombach, Anselm

Past research revealed war trauma and posttraumatic stress disorder (PTSD) symptoms as potential predictors for domestic and community violence in crisis regions and among soldiers in different armed conflicts. The impact of family violence and other adversities experienced in childhood as well as of a combat-enhanced appeal for aggressive behavior (appetitive aggression) remains to be specified.
In the present study, the authors separately predicted violence against children, intimate partner violence and community violence in 381 Burundian soldiers returning from foreign deployment and living in a post- conflict region. Using path analysis, they aimed to disentangle the independent contributions and pathways of the following variables: Exposure to war trauma and childhood familial violence, PTSD and depression symptom severity, and appetitive aggression.
Childhood familial violence had an independent effect on all contexts of violence and was the only significant predictor for violence against the soldiers’ own children. Intimate partner violence was additionally predicted by depression symptom severity, while community violence was additionally predicted by PTSD symptom severity and appetitive aggression.
Besides war-related mental ill-health and appetitive aggression, violent experiences during childhood development must not be overlooked as a factor fueling the cycle of violence in conflict regions.

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Feasibility and Effectiveness of Narrative Exposure Therapy and Cognitive Behavioral Therapy in a Context of Ongoing Violence in South Africa

2017, Hinsberger, Martina, Holtzhausen, Leon, Sommer, Jessica, Kaminer, Debra, Elbert, Thomas, Seedat, Soraya, Wilker, Sarah, Crombach, Anselm, Weierstall, Roland

Objective: In an observer-blinded intervention trial, we tested the reduction of posttraumatic stress symptoms, aggressive attitude, and behavior in young males living in a context of ongoing community and gang violence by means of (a) forensic offender rehabilitation narrative exposure therapy (FORNET), and (b) the cognitive-behavioral intervention "Thinking for a Change" (TFAC). A waiting list served as the control condition. Method: A total of 39 young men were included in the data analysis: 15 completed FORNET, 11 underwent cognitive-behavioral therapy (CBT), and 13 were on a waiting list for later treatment. The primary efficacy endpoints were the PTSD Symptom Scale-Interview (PSS-I) severity score, the Appetitive Aggression Scale (AAS) score, and the number of perpetrated violent event types 8 months (on average) after treatment. Results: Only in the sample receiving FORNET were posttraumatic stress disorder (PTSD) scores significantly reduced at the first follow-up (Cohen's d = -0.97) and significantly different from those of the control group (Cohen's d = -1.03). The changes in scores for appetitive aggression and perpetrated events were not significant for any of the treatment conditions. Conclusions: The study shows that trauma-focused treatment can reduce the psychological symptoms of posttraumatic stress even for individuals living under unsafe conditions in low-income urban communities. However, achieving changes in violent behavior within a context of ongoing violence may require more than the treatment of trauma-related suffering, confrontation with one's offenses, or cognitive-behavioral interventions.


Predictors of posttraumatic stress and appetitive aggression in active soldiers and former combatants

2015, Nandi, Corina, Crombach, Anselm, Bambonye, Manassé, Elbert, Thomas, Weierstall, Roland

Background: During the period between 1993 and 2005, the people of Burundi were trapped within a violent civil war. In post-conflict regions, symptoms of posttraumatic stress disorder (PTSD) were found to be widespread. At the same time, combatants often reported having perceived committing violence as exciting and appealing, an experience referred to as appetitive aggression. Both of these phenomena hamper the building of a functional and peaceful society.

Objective: This study aims to investigate the factors that are associated with the level of PTSD and appetitive aggression in former and still active combatants.

Methods: Semi-structured interviews were conducted with 948 male Burundians: 556 active soldiers and 392 ex-combatants. PTSD symptom severity was assessed using the PTSD Symptom Scale Interview, while appetitive aggression was assessed using the Appetitive Aggression Scale.

Results: Linear regression analyses revealed that the number of traumatic events, childhood maltreatment, and their interaction predicted PTSD symptom severity, whereas self-committed violence did not. The number of traumatic events and self-committed violence were associated with appetitive aggression. Childhood maltreatment alone was not associated with appetitive aggression; however, its interaction with self-committed violence did predict appetitive aggression. When controlling for predictors, ex-combatants reported a higher degree of PTSD symptomatology, whereas active soldiers reported a higher degree of appetitive aggression.

Conclusion: We conclude that childhood maltreatment is an additional, significant risk factor that exacerbates the psychological consequences of violent conflicts. Self-committed violence may not necessarily engender trauma-related disorders, but is highly related to appetitive aggression.


The individual contribution of DSM 5 symptom clusters of PTSD, life events, and childhood adversity to frontal oscillatory brain asymmetry in a large sample of active combatants

2017-10, Moran, James, Crombach, Anselm, Elbert, Thomas, Nandi, Corina, Bambonyé, Manassé, Wienbruch, Christian, Lommen, Ursula, Weierstall, Roland

Post-Traumatic Stress Disorder (PTSD) has been linked to deviations in lateralized frontal functional oscillatory activity. This is possibly because left and right DLPFC have differential roles in regulating both memory and stress response, which are both dysfunctional in PTSD. However, previous results are heterogeneous, and could be attributable to individual symptom clusters, traumatic or aggressive life events, early life stress, or the interaction of these factors. In a large sample of active combatants (N=401), we regressed these factors on frontal electroencephalography (EEG) asymmetry across 5 frequency bands (delta: 2-4Hz; theta: 4-8Hz; alpha: 8-12Hz; beta: 12-24Hz; gamma: 24-48Hz). Negative cognition and mood was associated with stronger relative left delta and theta band power. Traumatic life events showed stronger right alpha and beta band power. Traumatic life events in interaction with hyperarousal predicted stronger relative right left-right imbalance (theta, alpha, and beta bands), whereas childhood adversity, in interaction with negative cognition and mood, predicted stronger relative left left-right imbalance (delta, theta, alpha and beta bands). The contribution of lateralized DLPFC dysfunction to PTSD is thus dependent on the individual complexities of subsymptom clusters and life history, and future studies need to take these factors into account.


Appetitive Aggression in Women : Comparing Male and Female War Combatants

2016, Meyer-Parlapanis, Danie, Weierstall, Roland, Nandi, Corina, Bambonyé, Manassé, Elbert, Thomas, Crombach, Anselm

Appetitive aggression refers to positive feelings being associated with the perpetration of violent behavior and has been shown to provide resilience against the development of PTSD in combatants returning from the battlefield. Until this point, appetitive aggression has been primarily researched in males. This study investigates appetitive aggression in females. Female and male combatants and civilians from Burundi were assessed for levels of appetitive aggression. In contrast to non-combatants, no sex difference in appetitive aggression could be detected for combatants. Furthermore, each of the female and male combatant groups displayed substantially higher levels of appetitive aggression than each of the male and female civilian control groups. This study demonstrates that in violent contexts, such as armed conflict, in which individuals perpetrate numerous aggressive acts against others, the likelihood for an experience of appetitive aggression increases- regardless of whether the individuals are male or female.


Social Status and the Desire to Resort to Violence : Using the Example of Uganda's Former Child Soldiers

2013, Crombach, Anselm, Weierstall, Roland, Hecker, Tobias, Schalinski, Inga, Elbert, Thomas

Committing violent acts can be appealing, fascinating, exciting, and addictive (i.e., appetitive). Cultural settings that accept vio- lence as a means to power and success promote this appetitive form of aggression. Former child soldiers of Uganda with military rank reported committing a greater variety of violent acts compared to those without rank. They experienced aggressive behavior as more positive than both those without rank and controls who had never been involved in armed groups. The relation between the number of individually committed offense types and appetitive aggression is weaker in former child soldiers without rank compared to those with rank. This indicates that the potential for rapid development of appetitive aggression is rewarded with higher social status in war-afflicted communities.

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Is the Implicit Association Test for Aggressive Attitudes a Measure for Attraction to Violence or Traumatization?

2017-07, Bluemke, Matthias, Crombach, Anselm, Hecker, Tobias, Schalinski, Inga, Elbert, Thomas, Weierstall, Roland

Traumatic exposure is particularly devastating for those who, at a young age, have become combatants or experienced massive adversity after abduction by armed movements. We investigated the impact of traumatic stressors on psychopathology among war-affected young men of Northern Uganda, including former child soldiers. Adaptation to violent environments and coping with trauma-related symptoms often result in an increasing appetite for violence. We analyze implicit attitudes toward violence, assessed by an Implicit Association Test (IAT), among 64 male participants. Implicit attitudes varied as a function of the number of experienced traumatic event types and committed offense types. As the number of traumatic experiences and violence exposure increased, more appetitive aggression was reported, whereas the IAT indicated increasingly negative implicit attitudes toward aggression. The IAT was also the strongest predictor of cortisol levels. Diffusion-model analysis was the best way to demonstrate IAT validity. Implicit measures revealed the trauma-related changes of cognitive structures.

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Appetitive aggression and its relation to posttraumatic stress in Burundian ex-combatants

2016, Nandi, Corina, Crombach, Anselm, Bambonye, Manassé, Elbert, Thomas, Weierstall, Roland

Former combatants have experienced many traumatic events and violence in their past. Symptoms of posttraumatic stress disorder (PTSD) are prevalent among them, but at the same time, many combatants do not suffer from PTSD. Appetitive aggression—the perception of violent acts as appealing and exciting—was found to reduce the risk of developing PTSD symptoms in several studies with combatants of different countries. However, this protective influence waned when traumatization of combatants got too severe. The aim of the present study was to replicate previous findings in a sample of Burundian ex-combatants. The relationship between appetitive aggression and PTSD symptom severity was investigated, and a negative correlation between these variables was expected. On the basis of previous studies, we expected to find this relationship only after excluding the most traumatized participants. Semistructured interviews were conducted with 392 Burundian ex-combatants to assess traumatic event types, self-committed violent acts, PTSD symptom severity (PTSD Symptom Scale Interview) and appetitive aggression (Appetitive Aggression Scale). Appetitive aggression was not correlated with PTSD symptoms severity in the total sample. After the most severely traumatized participants were excluded, appetitive aggression was negatively related to PTSD symptom severity. The findings of the present study confirmed previous findings on the relationship between appetitive aggression and PTSD. Appetitive aggression was shown to lower PTSD symptom severity but is no ultimate protection against PTSD.


When combat prevents PTSD symptoms - results from a survey with former child soldiers in Northern Uganda

2012, Weierstall, Roland, Schalinski, Inga, Crombach, Anselm, Hecker, Tobias, Elbert, Thomas


Human beings from time immemorial have eradicated neighbouring tribes, languages, religions, and cultures. In war and crisis, the cumulative exposure to traumatic stress constitutes a predictor of the development of post traumatic stress disorder (PTSD). However, homicide has evolved as a profitable strategy in man, leading to greater reproductive success. Thus, an evolutionary advantage of perpetrating violence would be eliminated if the exposure to aggressive acts would traumatize the perpetrator. We argue that perpetrating violence could actually ‘immunize’ a person against adverse effects of traumatic stressors, significantly reducing the risk of developing PTSD.


We surveyed 42 former child soldiers in Northern Uganda that have all been abducted by the Lord Resistance Army (LRA) as well as 41 non-abducted controls.


Linear regression analyses revealed a dose–response effect between the exposure to traumatic events and the Posttraumatic Diagnostic Scale (PDS) sum score. However, the vulnerability to develop trauma related symptoms was reduced in those with higher scores on the Appetitive Aggression Scale (AAS). This effect was more pronounced in the formerly abducted group.


We conclude that attraction to aggression when being exposed to the victim’s struggling can lead to a substantial risk-reduction for developing PTSD.