Erenköy Syndrome. Post-Traumatic Stress Disorder among Turkish Cypriot Soldiers of Erenköy Exclave Battle

Hüseyinzade Şimşek, Angelica; Çakıcı, Mehmet

Erenköy Syndrome. Post-Traumatic Stress Disorder among Turkish Cypriot Soldiers of Erenköy Exclave Battle

by Angelica Hüseyinzade Şimşek (Author) Prof. Dr. Mehmet Çakıcı (Author)

Psychology - Clinic and Health Psychology, Abnormal Psychology

Summary

The purpose of this study is to determine combat related Post-Traumatic Stress Disorder (PTSD) and severity occurrence rate among Erenköy Turkish Cypriot Fighters and Turkish Cypriot Fighters who participated in the Cyprus War. The importance of the present study is based on the sheer absence of any studies related to Cyprus War participants and Erenköy Turkish Cypriot Fighters.
The sample taken consist of 100 male Turkish Cypriot Fighters – 50 who battled in Erenköy and 50 who battled in other regions of Cyprus during the Cyprus War between 1963 and 1974. For the present study, a structured interview was conducted. Demographic information as well as pre-war, during war and post-war ınformation was obtained. PTSD was diagnosed using the Clinician Administered PTSD Scale (CAPS).

Excerpt

Hüseyinzade imek, Angelica, Çakici, Mehmet: Erenköy Syndrome. Post-Traumatic

Stress Disorder among Turkish Cypriot Soldiers of Erenköy Exclave Battle, Hamburg,

Anchor Academic Publishing 2017

PDF-eBook-ISBN: 978-3-96067-715-4

Druck/Herstellung: Anchor Academic Publishing, Hamburg, 2017

Bibliografische Information der Deutschen Nationalbibliothek:

Die Deutsche Nationalbibliothek verzeichnet diese Publikation in der Deutschen

Nationalbibliografie; detaillierte bibliografische Daten sind im Internet über

http://dnb.d-nb.de abrufbar.

Bibliographical Information of the German National Library:

The German National Library lists this publication in the German National Bibliography.

Detailed bibliographic data can be found at: http://dnb.d-nb.de

or transmitted, in any form or by any means, electronic, mechanical, photocopying,

recording or otherwise, without the prior permission of the publishers.

Das Werk einschließlich aller seiner Teile ist urheberrechtlich geschützt. Jede Verwertung

außerhalb der Grenzen des Urheberrechtsgesetzes ist ohne Zustimmung des Verlages

unzulässig und strafbar. Dies gilt insbesondere für Vervielfältigungen, Übersetzungen,

Mikroverfilmungen und die Einspeicherung und Bearbeitung in elektronischen Systemen.

Die Wiedergabe von Gebrauchsnamen, Handelsnamen, Warenbezeichnungen usw. in

diesem Werk berechtigt auch ohne besondere Kennzeichnung nicht zu der Annahme,

dass solche Namen im Sinne der Warenzeichen- und Markenschutz-Gesetzgebung als frei

zu betrachten wären und daher von jedermann benutzt werden dürften.

Die Informationen in diesem Werk wurden mit Sorgfalt erarbeitet. Dennoch können

Fehler nicht vollständig ausgeschlossen werden und die Diplomica Verlag GmbH, die

Autoren oder Übersetzer übernehmen keine juristische Verantwortung oder irgendeine

Haftung für evtl. verbliebene fehlerhafte Angaben und deren Folgen.

Hermannstal 119k, 22119 Hamburg

http://www.diplomica-verlag.de, Hamburg 2017

Printed in Germany

The purpose of the present study is to determine combat related PTSD and severity

occurrence rate among Erenköy Turkish Cypriot Fighters and Turkish Cypriot Fighters whom

participated in the Cyprus War.

Importance of the present study is based on absence of any study related to Cyprus War

participants, and Erenköy Turkish Cypriot Fighters.

The sample taken consist of 100 male Turkish Cypriot Fighters, 50 of them battled in Erenköy

and 50 whom battled in other regions of Cyprus during Cyprus war in between 1963-1974.

Structured interview for the present study was conducted, demographic information, pre-war,

during war and post-war information was obtained.

Post-traumatic stress disorder (PTSD) was diagnosed using Clinician Administered PTSD

Scale (CAPS).

As a result of the present study, it could be stated that Erenköy Turkish Cypriot Fighters are

more likely to have a chronic PTSD, with Delayed onset, than Turkish Cypriot Fighters who

served in other regions of Cyprus within period of war. Factors found to be trigger PTSD in

scope of the present study are: lack of social support during the war and post war period,

alcohol use, being adolescent during the war, presence of psychological disorders in pre-war

period. Being not prepared mentally, less of military education, and military skills.

Key words: Post-Traumatic Stress Disorder, War, Post War Risk Factors to Post Traumatic

Stress Disorder (PTSD)

ABSTRACT

ABSTRACT...1

INDEX...2

LIST OF TABLES...3

ABBREVIATIONS...6

1. INTRODUCTION...7

1.1 Northern Cyprus...9

1.2 The Cyprus War...10

1.3 Erenköy Exclave Battle...10

1.4 War...11

1.5 Turkish Cypriot Fighters...12

1.6 Post-Traumatic Stress Disorder... 12

1.6.1

PTSD and Chronicity...13

1.6.2

PTSD With Delayed Onset...16

1.7 Post-Vietnam Syndrome...18

2. METHOD ...20

2.1 Participants...20

2.2. Instruments...21

2.2.1. Socio-Demographic Information Form...21

2.2.2. CAPS... 22

2.2.3. Statistical Procedures...22

3. RESULTS...23

4. DISCUSSION...51

5. ERENKÖY SYNDROME...58

6. CONCLUSION...59

REFERENCES...60

LIST OF TABLES

Table 1. Comparison Of Pre-War Education Levels Among Erenköy Turkish Cypriot Fighters

And Turkish Cypriot Fighters

Table 2. Comparison Pre-War Marital Status Among Erenköy Turkish Cypriot Fighters And

Turkish Cypriot Fighters

Table 3. Comparison Of Military Education Rates Among Erenköy Turkish Cypriot Fighters

And Turkish Cypriot Fighters

Table 4. Comparison Of Pre-War Psychological Disorder Occurrence Among Erenköy

Turkish Cypriot Fighters And Turkish Cypriot Fighters

Table 5. Comparison Of Military Education Periods Comparison Among Erenköy Turkish

Cypriot Fighters And Turkish Cypriot Fighters

Table 6. Comparison Of Military Ranks Among Erenköy Turkish Cypriot Fighters And

Turkish Cypriot Fighters

Table 7. Comparison Of Injury Rates During The War Among Erenköy Turkish Cypriot

Fighters And Turkish Cypriot Fighters

Table 8. Comparison Of Friend Injury Witness During The War Among Erenköy Turkish

Cypriot Fighters And Turkish Cypriot Fighters

Table 9. Comparison Of Friend Death Witness During The War Among Erenköy Turkish

Cypriot Fighters And Turkish Cypriot Fighters

Table 10. Comparison Of Mental Readiness For War Among Erenköy Turkish Cypriot

Fighters And Turkish Cypriot Fighters

Table 11. Comparison Of Degree Of Expectancy Of War Among Erenköy Turkish Cypriot

Fighters And Turkish Cypriot Fighters

Table 12. Comparison Of Commitment Level Among Erenköy Turkish Cypriot Fighters

And Turkish Cypriot Fighters

Table 13. Comparison Of How The War Slogged Impacted Among Erenköy Turkish Cypriot

Fighters And Turkish Cypriot Fighters

Table 14. Comparison Of Social Support During The War Among Erenköy Turkish Cypriot

Fighters And Turkish Cypriot Fighters

Table 15. Comparison Of Social Support Sources During The War Among Erenköy Turkish

Cypriot Fighters And Turkish Cypriot Fighters

Table 16. Comparison Of Present Educational Level Among Erenköy Turkish Cypriot

Fighters And Turkish Cypriot Fighters

Table 17. Comparison Of Present Marital Status Among Erenköy Turkish Cypriot Fighters

And Turkish Cypriot Fighters

Table 18. Comparison Of Present Monthly Income Level Among Erenköy Turkish Cypriot

Fighters And Turkish Cypriot Fighters

Table 19. Comparison Of Disturbing Regret Feelings After The War Among Erenköy

Turkish Cypriot Fighters And Turkish Cypriot Fighters

Table 20. Comparison Of War Impact Among Erenköy Turkish Cypriot Fighters And

Turkish Cypriot Fighters

Table 21. Comparison Of Increased Post-War Alcohol Consumption Among Erenköy

Turkish Cypriot Fighters And Turkish Cypriot Fighters

Table 22. Comparison Of Illegal Psychoactive Drug Consumption In Post-War Period

Among Erenköy Turkish Cypriot Fighters And Turkish Cypriot Fighters

Table 23. Comparison Of Present Alcohol Consumption Among Erenköy Turkish Cypriot

Fighters And Turkish Cypriot Fighters

Table 24. Comparison Of PTSD Diagnosis Presence Among Erenköy Turkish Cypriot

Fighters And Turkish Cypriot Fighters

Table 25. Comparison Of Professional Help During Post-War Period Among Erenköy

Turkish Cypriot Fighters And Turkish Cypriot Fighters

Table 26. Comparison Of Post-War Social Support Levels Among Erenköy Turkish Cypriot

Fighters And Turkish Cypriot Fighters

Table 27. Comparison Of Post-War Social Support Sources Among Erenköy Turkish Cypriot

Fighters And Turkish Cypriot Fighters

Table 28. Comparison Of Whether Difficulties Experienced During The War, Were

Revealed To The Public Well Enough Among Erenköy Turkish Cypriot Fighters And

Turkish Cypriot Fighters

Table 29. Comparison Of Financial Support Paid By Government Among Erenköy Turkish

Cypriot Fighters And Turkish Cypriot Fighters

Table 30. Comparison Of Non-Monetary Support Provided By Government Among Erenköy

Turkish Cypriot Fighters And Turkish Cypriot Fighters

Table 31. Comparison Of Expected Compensation From Government Among Erenköy

Turkish Cypriot Fighters And Turkish Cypriot Fighters

Table 32. Comparison Of Alcohol Consumption Frequency Among Erenköy Turkish Cypriot

Fighters And Turkish Cypriot Fighters

Table 33. Comparison Of Will To Quit Drinking Among Erenköy Turkish Cypriot Fighters

And Turkish Cypriot Fighters

Table 34. Comparison Of Being Criticized By Others Because Of Alcohol Consumption

Among Erenköy Turkish Cypriot Fighters And Turkish Cypriot Fighters

Table 35. Comparison Of Feeling Guilty For Consumption Of Alcohol Among Erenköy

Turkish Cypriot Fighters And Turkish Cypriot Fighters

Table 36. Comparison Of Alcohol Consumption In The Morning Among Erenköy Turkish

Cypriot Fighters And Turkish Cypriot Fighters

Table 37. Comparison Presence Of Psychiatric Disorders Of Relatives Among Erenköy

Turkish Cypriot Fighters And Turkish Cypriot Fighters

Table 38. Chi-Square Of PTSD And Independent Variables of Both Erenköy Turkish

Cypriot Fighters and Turkish Cypriot Fighters Who Has PTSD

Table 39. Logistic Regression Model. For Both Erenköy Turkish Cypriot Fighters and

Turkish Cypriot Fighters With PTSD

Table 40. Erenköy Turkish Cypriot Fighters Chi-Square, PTSD Dependent Variable

Table 41. Logistic Regression Model. For Erenköy Turkish Cypriot Fighters With PTSD

Table 42. Turkish Cypriot Fighters Chi-Square, PTSD Dependent Variable

Table 43. Logistic Regression Model. For Turkish Cypriot Fighters With PTSD

ABBREVIATIONS

PTSD  Post Traumatic Stress Disorder

CAPS - Clinician-Administered PTSD Scale

1. INTRODUCTION

Posttraumatic stress disorder (PTSD) is a chronic and disabling psychiatric disorder which

leads to exposure to a traumatic incident. PTSD is often diagnosed in between veteran

population, as example among those from Vietnam War period. (Kulka et al. 1990), according

to National Vietnam Veterans Readjustment Study, it has been determined that 15% of

Vietnam veterans will meet criteria for PTSD diagnosis. Lifetime figures will be twice as

much. And only for Australian Vietnam veterans figures will be 12% current and 21%

lifetime, which is lower when compared to the rest. (O'Toole et al., 1996, 331-339). Such

result of studies revel chronicity testament of disorder. Majority of Vietnam veterans with

PTSD remain with such disorder currently as well (30 years after traumatic events).

Eventually similar situation is applicable to Turkish Cypriot Fighters. The National

Comorbidity Survey (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995, 1048-1060) has

shown that over one third of persons with PTSD couldn't remit even after several years since

trauma occurred.

Cyprus War differentiates from other wars, when considering effects of psychological

traumas and related problems of veterans.

The Cyprus War Erenköy Battle could be called first war fought by adolescents. World War

II soldiers were 26 years old in average, while Erenköy Exclave fighters were 21 years old in

average. Those individuals were in formative years, which made them extremely

psychologically irrresistive to combat terrors imprints. Morals and values learned at home

soon become stripped and the ego structure built through years became impaired. Experience

of the battle caused by experience of a first kill or friend killed in the battle resulted

psychological "snap" (B. Goderez, 1985). Teenage years and related development of the

personality were stolen which caused abrupt halt of the maturing process. Currently majority

of veterans are still struggling to complete maturing process, trying to "make it up for the lost

time". Another issue is that parent role models were replaced by military officers.

Admonition to kill was highly contrasting with shalt not to kill. , which resulted in psychiatric

disturbances. Discredit of the Cyprus War Erenköy Battle led to an atmosphere of national

confusion and antagonism. Campus demonstrations, draft card burnings, riots, and draft

evaders represented the mood of the period.

Adverse feedback to the war was not restrained to Turkey. Turkish Cypriot fighters we were

not welcomed enthusiastically, and therefore soon those young boys doubt what for they are

risking their lives.

There were no battlefields or front lines defined which led to confusion whether territories are

to be captured and held. Find and destroy became popular phrase among fighters, as during

the war they searched for enemy who generally was unseen. Often enemy included children

and women, also childhood friends, neighbors, teachers etc. under such circumstances it was

hard to decide who the enemy is. Battle boundaries were extremely unclear. Surrounding

nature and continuous heat worsen overall conditions. Experiencing and witnessing

psychological conditions reigned moral confusion. (S. Huppenbauer, 1982, 1699-1703)

Fighters of Cyprus War had no chance of socialization while traveling to battlefields and back

home in groups, no journey home for debriefing, processing the experience and assimilation

into civilian life were more complicated for Cyprus War fighters.

Unit morale and support system necessary for soldiers in combat were missing. Absence of

those resulted in post war barrage and anxiety instead of return trip filled with joy and

anticipation.

If we could name single overriding factor of PTSD, no doubt home coming would be that one.

There is no other example in this culture where country will turn its back to the soldiers who

were laying their lives for.

As opposed to the World War II veterans who received cheers, welcomes and parades (Ozer,

et.al. 2003, 5273), the Erenköy fighters weren't even allowed to get back to their home

country, instead they were forced to live abroad and deal with being alienated. There was little

or no support by the Government. In the face of such difficulty, veterans were left on their

own to retrieve what was left of their lives. They were not the same boys who used to fight for

their country. They have done their duty, lost their friends, grow mature untimely, lost their

own sense of self in the insanity of the war and were rejected at homeland, for which they had

risked their lives.

Individual suffers from helplessness, depression, dejection, and severe grief with frequent

thoughts of suicide. As seen in the study published in New England Journal of Medicine, men

who served in Vietnam War were twice as much likely to commit suicide compared to those

who didn't serve. That reveals that the number who died since returning home from war

doesn't much differ from number of those who died at war 59.000 (Veteran, September,

1988). Among Erenköy Exclave Battle Fighters suicides occurred during the war and in post-

war period.

Many veterans are enclosed in a death immersion; they haven't forgot, they dream it, and the

dreams are ever present. It is common for them to own and carry guns even in daily life

during post-war period. As it seen in Turkish Cypriot population. According to data from

Northern Cyprus Hunting and Shooting Federation there are 22.000 active members.

Probably the most difficult is to separate PTSD and alcohol/substance abuse. Eventually, for

many, it is inseparable. "It is not just substance abuse. It is not just PTSD. It's both of them

wrapped up in one another," says Steve Bently, Chairman of the VVA PTSD and Substance

Abuse Committee. "Alcohol and other drugs have successfully aided Vietnam veterans in

covering their feelings for years. The biggest problem ... is that alcohol quits working after a

while". "Trauma tries to surface, though the individual sufferings and to keep it submerged".

A study of Centers for Disease Control stated that Vietnam veterans were more likely to form

depression, anxiety and alcoholism, around 500,000 experienced intense PTSD symptoms.

(Brinson and Treanor, September 1988).

Individuals with PTSD symptoms are likely to develop alcohol and substance abuse as those

are trying to find relief from the symptoms related to trauma experience. But such addiction

may cause more serious problem and addiction shall be treated.

(Brady, K.T. et. al.2004, 206-

209).

1.1. Northern Cyprus

Northern Cyprus (or North Cyprus), officially Turkish Republic of Northern Cyprus (TRNC),

is a self-declared state (Emerson et. al., 2004) that comprises northeastern portion of the

Cyprus island. Recognized only by Turkey, Northern Cyprus is considered by international

community as occupied territory of the Republic of Cyprus. (United Nations Security Council

resolution 550 (1983)). Northern Cyprus extends from the tip of the Karpass Peninsula in the

north east, westward to Morphou Bay and Cape Kormakitis (Kokkina/Erenköy exclave marks

the westernmost extent of the area), and southward to the village of Louroujina/Akincilar.

Since 1974, Cyprus is divided into a Turkish Cypriot north and a Greek Cypriot south,

separated by a 180 km long UN-controlled buffer zone.

1.2. The Cyprus War

The 1974 coup d'état, an attempt to annex the island to Greece, was followed by Turkish

invasion of Cyprus. This resulted in eviction of North's Greek Cypriot population majority,

flight of Turkish Cypriots from the south, and partitioning of the island, leading to a unilateral

declaration of independence by the North in 1983. (Leonard, 2006, 429).

1.3. Erenköy Exclave Battle

Erenköy is a village in Cyprus, administered by Turkish Republic of Northern Cyprus. It was

one of the Turkish Cypriot enclaves prior to invasion of Cyprus in 1974. It is bordered on

three sides by mountainous territory to the Greek part of the island, with

the Mediterranean Sea (Morphou Bay) on its northern flank. The exclave sits several

kilometers away from the mainland of TRNC and is a place, which has special symbolic

significance for Cypriots, as per events of August 1964 (Sadrazam, 2013).

Since December 1963, thousands of Turkish Cypriots concentrated in enclaves, as a result of

intercommunal fighting. Erenköy was one of the last port areas under Turkish Cypriot control

and a vital supply link with Turkey for Turkish Cypriot Fighters (Menguc, 2005).

In this year's approximately 700 students was studying in Turkey in Universities. More than

half of them were male. 500 of them with a help of Turkish Resistance Organization got

unofficial military training at Ankara Zir village. Some of them got this training for 15 days,

some for 3-4 days. After following those came to Cyprus (Erenköy) to battle. They have not

any equipment: tents for shelter, appropriate clothes. They had very weak and old weapons.

Those "Solders" should always remain watchful, to avoid being noticed by Cyprus Solders,

and keep an eye on weapons and other aid coming from motherland (Vurana, 2011, 179-355).

In these days leading up to the invasion, the Cypriot National Guard began to mobilize

infantry, artillery and armored forces for an assault on Erenköy. On 6 August 1964, the

Cypriot National Guard commenced its attack (BBC 1964).

On 8 August 1964, after waiting for nearly two days, Turkey intervened, once it had become

clear that Greek Cypriots would not withdraw from Erenköy, but simply commit more and

more siege forces until Turkish Cypriots ran out of supplies (Sadrazam, 2013).

On the morning of 8 August, Cypriot patrol boats Phaethon and Arion were attacked

by Turkish Air Force jets, as they sailed close to Xeros Harbor, Morphou Bay. (Menguc,

2005, 560-578).

On the 89 August 1964, Turkish Air Force was given free rein to attack multiple targets

within the Dillirga coastal warzone, including a number of Greek Cypriot villages. Cypriot

civilian casualties were reported as a result of heavy air attacks against several populated

locations, including Lower Pirgo. Turkish planes also attacked sites occupied by the Cypriot

National Guard, killing a number of military personnel. (Oberling, 1982).

In the eyes of the Greek Cypriot authorities, Erenköy was a threat to the nation's security

posed by Turkish Cypriot paramilitaries, and cutting it off would have severed Turkish

Cypriot armed groups from resupply and reinforcement.

During this battle Turkish Cypriot Fighters stay in enclave for 2 years. There was a lack of

food, medical help because of weak intercommunication with executives. Within those 2

years they always were under pressure and blockade. Losses of Turkish Cypriot Fighters are:

12 martyr, 4 missing and 32 wounded.

When Turkish military staged their operation in Cyprus in 1974, Erenköy was a specific

objective. The exclave became part of the Turkish Federative State of North Cyprus in 1975,

followed by UDI in November 1983. However, this declaration of independence was

condemned legally invalid by United Nations Security Council Resolution 541 (1983). (Henn,

et. al., 2004, 240-360).

1.4. War

War is an organized and often prolonged conflict that is carried out by states or non-state

actors. It is generally characterized by extreme violence, social disruption, and economic

destruction. (American Heritage Dictionary), (Merriam Webster's Dictionary access date

25.01.2014).

War should be understood as an actual, intentional and widespread armed conflict between

political communities, and therefore is defined as a form of political

violence or intervention. The set of techniques used by a group to carry out war is known

as warfare. An absence of war is usually called peace.

In 2003, Nobel Laureate Richard E. Smalley identified war as the sixth (of ten) biggest

problem facing humanity for the next fifty years. (Smalley, et. al., 2008).

In 1832 in dissertation On War, Prussian military general and theoretician Carl von

Clausewitz defined war as follows: "War is thus an act of force to compel our enemy to do

our will." (Clausewitz et. al., 1984, 428-465).

While some scholars accept warfare as an inescapable and integral aspect of human nature,

others argue that it is only inevitable under certain socio-cultural or ecological circumstances.

Some scholars argue that practice of war is not linked to any single type of political

organization or society. Rather, as discussed by John Keegan in his History of Warfare, war is

a universal phenomenon whose form and scope is defined by the society that wages it.

(Keegan, et. al., 1901).

Another argument suggests that since there are human societies where warfare does not exist,

humans may not be naturally disposed for warfare, which emerges under particular

circumstances. (Howell, et. al., 1989, 1-61).

1.5. Turkish Cypriot Fighters

Turkish Resistance Organization (TMT) armed organization was established in 1958, to fight

against EOKA. Then in 1976 was renamed as Turkish Cypriot Security Forces. Its members

called "mujaheed" Turkish Cypriot Fighter.

1.6. Post-Traumatic Stress Disorder

The actual term Post Traumatic Stress Disorder PTSD - enters the nosology in 1980.

Kraepelin tried to make a categorization of psychological disorders, he suggested the term

`fright neurosis' (schreckneurose): defining anxiety symptoms after accidents and injuries.

During World War-I diagnoses for reaction to combat were shell shock, combat fatigue and

operational fatigue during World War-II and Korean War. After World War-II and during

Korean War, DSM-I included `gross stress reaction'. First DSM (American Psychiatric

Association 1952) did not include list of detailed criteria, as now, but offered diagnosis for the

people who were previously relatively normal, but experienced extreme stressors such as

civilian catastrophe or combat, and had symptoms as a result of that stress. After in DSM-II

(American Psychiatric Association 1968) this criterion was eliminated. This DSM-II was

published during Vietnam War.

After, psychiatrists were unable to capture the symptoms of Vietnam solders. The official

diagnosis of PTSD entered DSM-III (American Psychiatric Association 1980), after revision

in 1980. (Friedman et. al., 2007).

Glass and Jones: PTSD symptoms can follow any serious psychological trauma, such as

exposure to combat, accidents, torture, disasters, criminal assault and exposure to atrocities or

to the sequelae of such extraordinary events. Prisoners of war exposed to harsh treatment are

particularly prone to develop PTSD. In their acute presentation these symptoms, include

subsets of a large variety of affective, cognitive, perceptional, emotional and behavioral

responses which are relatively normal responses to gross psychological trauma. If persistent,

however, they develop a life of their own and may be maintained by inadvertent

reinforcement. (Glass, et. al., 2005).

The PTSD is an anxiety disorder that may develop following exposure to life-threatening or

other inordinately distressing events. A diagnosis of PTSD requires that an individual

experiences intense fear, helplessness, and horror in response to such an event, and that he or

she experience pronounced symptoms of re-experiencing the traumatic event (e.g., nightmares

or intrusive thoughts), avoidance of trauma-reminiscent cues and emotional numbing, and

symptoms of increased arousal (e.g., exaggerated startle response or hyper vigilance).

Finally, these symptoms must be present for at least one month following the traumatic event,

and must be of sufficient intensity to impair social, occupational, or other important domains

of functioning. (American Psychiatric 1994.) Although most trauma victims experience

pronounced emotional distress immediately following a traumatic event, the majority of these

individuals will not go on to develop chronic forms of psychopathology such as PTSD, even

if they do not receive formal, secondary prevention intervention. For instance, on average 8

9% of trauma victims develop chronic PTSD. (Kessler RC et.al. 1995, 1048-1060) (Breslau

N, et.al.1998, 626632).

For most of them, the adage "time heals all wounds" is an apt characterization of post-

traumatic adjustment. However, large-scale events such as the terrorist attacks of 11

September 2001 can impact thousands of people. Accordingly, large numbers of individuals

may go on to develop chronic distress following such an event, despite the fact that most

victims can be expected to exhibit tremendous resiliency. In light of this fact, effective, early

interventions for trauma are critical.

1.6.1. PTSD and Chronicity

PTSD recurrence differs in accordance with trauma nature. Morbidity changes at similar

severity cases for the same trauma prove that PTSD trend is not quite linear (Goenjian A.K.

et. al., 1994, 895-901).

DSM III (American Psychiatric Association 1980) characterized PTSD by positive prognosis,

non-chronic and convinced that most of cases are treatable. However evidence collected

during subsequent years explicit the opposite. Although lasting studies of natural disasters and

hence examination of the long term affects revealed chronic nature of PTSD in 87% of cases

(Patrick V, Patrick WK. 1981, 210-216).

Study related to the war trauma, soldiers receiving treatment within acute stage proceeded to

chronic form in 50% of cases (Solomon Z, Banbenisity R., 1986, 613-617).

Enduring researches of general population divulge that PTSD symptoms are trending to

continue over long years. Kessler and his friends in their study illustrate that one third of cases

which meet PTSD symptom requirements even after ten years are likely to appear present.

(Kessler R.C. et.al. 1995, 1048-1060). Furthermore, Davidson and friends in their study

pointed out that 46% of developed PTSD had chronic nature (Davidson J.R.T., et.al.1991,

713-721), (Breslau N. et.al.1998, 626632).

In a field study where 1007 individuals were scanned, 93% of the 394 persons who have filled

questionnaires had PTSD. That research characterized disorder recurring after period of one

year and over as chronic and 53 individual founded to have chronic PTSD. Such figures meet

over 50% of the cases. Concurrently given group had highest number of PTSD positive cases

when compared to other groups. "Overreacting" was determined in a high rate, as well as

comorbidity (Breslau N, Davis GC. 1992 671-675).

Study on individuals imprisoned during World War II revealed that PTSD determined in a

rate of 59% during first assessment, was still present in proportion of 29% even 40 years after

(Speed, N. et.al., 1989, 147-153).

Research of Vietnam War veterans have shown that 31% PTSD symptoms rate at male

individuals after 15 years turned to appear as 15% (Kulka RA, et.al. 1990a.).

Prisoners of war were heavily exposed to torture and several other traumas. In studies related

to war PTSD rates determined were in a range of 30-88%. In studies made with American

soldiers who fought in World War II high levels of PTSD were determined. PTSD ranges

were 29-50%. Even though when many years passed sense recovery did not happen.

(Solomon Z, et.al., 1991, 1-7).

The most important limitations during the studies occur because of different types and

severity of traumas. The main long term picture of reactions appearing related to related are

enounced as PTSD. At individuals who lived through war in Lebanon PTSD stopped as 63%

rate measured one year after the war. After one more year that rate decreased to 43%. Even

though there is decrease in figures as time passes by, that seems to be very slow process

(Solomon Z, et.al., 1991, 1-7).

In the study of soldiers who served in southeastern Anatolia in Turkey, PTSD rates revealed

as 5%, however in 95% of cases symptoms occur within one or two months since trauma all

and are getting chronic. (Sungur M.Z. et.al., 1995, 279-284).

Opinion on gradually disappearing acute symptoms lasting through numerous years became

invalid as time passed by. Umpteen times studies have proven such an illation. Common point

of studies is based on idea that symptoms developed during acute stage will decrease over

time, however such a process is very slow and vulnerable to secondary affecting. One of the

most important evidences obtained in studies is that cases not meeting DSM IV (American

Psychiatric Association 1994) diagnosis criteria exceed those diagnosed ones. At that point it

can be said that there is parallel relation among the course of disorder and the course

specified.

In the study made by Shore and friends (Shore JH, et.al.,1986, 76-83), study consist of three

year observation after St. Helen's volcanic eruption, it has been determined that depression

and anxiety symptoms are decreasing over the time, while PTSD symptoms were trending to

have longer lifespan. A study made by Duggan and Gun revealed that one year after natural

disaster PTSD rate is 39% and twenty six months after the event PTSD rate will fall to 23%.

McFarlane (McFarlane AC, 1988, 30-39) indicated that 25 months after wildfire PTSD rates

wouldn't change. However in studies of personal injury, rape, war and assault PTSD would be

chronic in a majority (Breslau N, et.al. 1991, 216-222) (Foa EB, 1997, 25-28) (Resnick HS,

et.al. 1993, 948-991), (North CS, et.al.. 1997, 1696-1702).Over 50% of cases were chronic

(Ehlers A, et.al. 1998, 508-519).

However other traumatic events effect is more variable and is generally dependent of such

factors as level of life danger, presence of physical injury, seeing injured people, loss of loved

ones or witnessing injury of loved ones or their exposure to toxic substances (such as nuclear

or chemical reagents) (Ursano R.J. et.al., 1995b, 36-42). At the same time those are factors

determining severity of the trauma. Besides, secondary factors such as attempts to rescue

depending on trauma nature, timing and efficiency, establishment of safe living areas and

organization of health care services are being influential in those periods. Deficiencies during

Details

Pages
Type of Edition: Erstausgabe
Year: 2017
ISBN (PDF): 9783960677154
ISBN (Softcover): 9783960672159
File size: 4.5 MB
Language: English
Publication date: 2017 (December)
Keywords: Post-Traumatic Stress Disorder War Post War Risk Factors to Post Traumatic Stress Disorder PTSD Turkey Cyprus War Cyprus Erenkoy Post-Vietnam Syndrome Interview

Erenköy Syndrome. Post-Traumatic Stress Disorder among Turkish Cypriot Soldiers of Erenköy Exclave Battle

Summary

Excerpt

Table Of Contents

Details

Authors

Angelica Hüseyinzade Şimşek (Author)

Prof. Dr. Mehmet Çakıcı (Author)