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Attachment & Human Development

Vol. 10, No. 2, June 2008, 105121

Does intergenerational transmission of trauma skip a generation?

No meta-analytic evidence for tertiary traumatization with third
generation of Holocaust survivors
Abraham Sagi-Schwartza*, Marinus H. van IJzendoornb and
Marian J. Bakermans-Kranenburgb

Center for the Study of Child Development, University of Haifa, Israel;

Centre for Child and Family Studies, Leiden University, the Netherlands

In a series of meta-analyses with the second generation of Holocaust survivors, no

evidence for secondary traumatization was found (Van IJzendoorn, BakermansKranenburg, & Sagi-Schwartz, 2003). With regard to third generation traumatization,
various reports suggest the presence of intergenerational transmission of trauma. Some
scholars argue that intergenerational transmission of trauma might skip a generation.
Therefore, we focus in this study on the transmission of trauma to the third generation
ospring (the grandchildren) of the rst generations traumatic Holocaust experiences
(referred to as tertiary traumatization), and we present a narrative review of the
pertinent studies. Meta-analytic results of 13 non-clinical samples involving 1012
participants showed no evidence for tertiary traumatization in Holocaust survivor
families. Our previous meta-analytic study on secondary traumatization and the present
one on third generations psychological consequences of the Holocaust indicate a
remarkable resilience of profoundly traumatized survivors in their (grand-)parental roles.
Keywords: Holocaust; tertiary traumatization; meta-analysis

Whereas clinically based reports on ospring of Holocaust survivors point to
intergenerational transmission of traumatic experiences, more controlled studies have
not found much psychopathology (Van IJzendoorn et al., 2003), except when secondgeneration subjects were confronted with life-threatening situations (Baider, Peretz,
Hadani, Perry, Avramov, & De Nour, 2000; Solomon, Kotler, & Mikulincer, 1988; see
Van IJzendoorn et al., 2003). Thus, a germane question is whether the trauma has been
passed on to the ospring in the third generation (Bar-On et al., 1998). The question is
of critical importance because of the large scale of the Holocaust. The existence of longterm psychological eects of the Holocaust on the survivors and their ospring still keeps
the scientic and clinical literature divided (Bar-On et al., 1998).
This issue is not only important for the study of the Holocaust. Unfortunately, during
the past century, genocide has not been restricted to World War II. In the International
handbook of multigenerational legacies of trauma (Danieli, 1998), genocides in Armenia,
*Corresponding author. Email: sagi@psy.haifa.ac.il or VANIJZEN@FSW.leidenuniv.nl or
ISSN 1461-6734 print/ISSN 1469-2988 online
2008 Taylor & Francis
DOI: 10.1080/14616730802113661


A. Sagi-Schwartz et al.

Cambodia, former Yugoslavia, Rwanda, and Nigeria are mentioned, and these constitute
only a selection. The Holocaust was a unique genocide because of its scale, its almost
industrial design, and its uselessness in political, economic, or military respects (Lacqueur,
2001). Nevertheless, we may learn from the Holocaust survivors and their (grand-)children
about the long-term and intergenerational eects of traumatic experiences, and develop
insights into the fate of survivors and ospring of more recent and future genocidal
In order to resolve the divergence of the clinical and non-clinical ndings on
intergenerational transmission of trauma, between qualitative and quantitative approaches, and between methodologically more robust versus less robust studies, we
developed a programmatic series of studies to address the issue. We began with our rst
published study (Sagi-Schwartz et al., 2003) in which careful matching of Holocaust
survivors and comparisons was employed to form a research design with three generations,
including 98 families with grandmother, mother, and their infant, who were engaged in
attachment- and trauma-related interviews, questionnaires, and observational procedures.
Holocaust child survivors (now grandmothers) showed severe signs of traumatic stress and
more often lack of resolution of trauma than comparisons, but they were not impaired in
their general adaptation. Also, the traumatic eects did not transmit across second
generation (mothers) and third generation (infants). We concluded that Holocaust child
survivors may have been able to protect their ospring from their war experiences,
although they themselves still suered from the Holocaust.
Because the ndings of our rst study ran against the wide spread belief that Holocaust
survivors do transmit the trauma even across more than one generation, we felt that the eld
might be reluctant to accept our conclusions despite the fact that very robust sampling and
methodology had been employed in our study (for more details, see Sagi-Schwartz et al.,
2003). Therefore our next step was to carry out a series of meta-analyses on 32 samples
involving 4418 second generation participants; the hypothesis was tested that secondary
traumatization in Holocaust survivor families exist. We found that, largely, there is no
evidence for secondary traumatization (Van IJzendoorn et al., 2003). More specically,
secondary traumatization emerged only in studies that consisted of participants who were
recruited through clinical practices or Holocaust survivor support groups and similar
organizations (select samples). In a set of adequately designed studies, with what was
referred to as non-select samples, no evidence for the inuence of the parents traumatic
Holocaust experiences on their children was found. A stress-diathesis model was used to
interpret the remarkable resilience in Holocaust survivors and their ospring (Paris, 2000).
Given the fact that there does not seem to be solid empirical evidence for a higher
prevalence of psychological problems in the second-generation ospring, it may be argued
that no transmission to the third generation should be expected either, especially with nonselect samples. At the same time, studies such as Multigenerational occurrence of
survivor syndrome symptoms in families of Holocaust survivors (Rubenstein, Cutter, &
Templer, 19891990) and The intergenerational transmission of increased anxiety traits
in third-generation Holocaust survivors (Wetter, 1998), characterize many of the existing
reports about the intergenerational eects of the Holocaust. Such far reaching statements
have become ingrained to a large extent in the belief system within the professional as well
as the wider community (not necessarily with sound conceptual or theoretical basis for
such a transmission) and therefore there is a need to set the record straight on the issue of
tertiary traumatization by an integrative review and analysis of all available studies.
Also, because some scholars still argue that intergenerational transmission of profound
traumas might skip a generation, using metaphorically the case of some biologically

Attachment & Human Development


inherited diseases (Bulmer, 1998), the eld still seems to beg for further systematic
examination of third generation eects, even in light of the absence of evidence-based
second generation eects. A psychological model for transmission to the third generation
might be the idea of more intensive learning and communication of the third generation
about the Holocaust compared to the second generation. The era of the conspiracy of
silence approached an end in the 1980s, and survivors gradually began to be considered
heroes more than lambs led to the slaughter (Bar-On, 1999). Grandchildren were urged
to learn about their grandparents past through interviews for school roots projects. For
the aging grandparents, time was ripe to return to their past and to create a sense of
coherence of their Holocaust experiences (Van der Hal-van Raalte, Van IJzendoorn, &
Bakermans-Kranenburg, in press). Since the last decade of the past century, thousands of
students have participated in Holocaust-centered excursions to Poland, and it is still
unclear what meaning this confrontation with the Holocaust might have (Chaitin, 2000),
but traumatizing eects on at least some of the participants cannot be excluded.
Lastly, as will be discussed, one may also raise the possibility of domain-specic eects,
namely that third generation eects may emerge in one area of functioning (e.g.,
internalizing or externalizing symptoms) but not in other areas such as attachment.
Therefore, in this review and meta-analysis we wish to shed further light on the
transmission of the Holocaust traumatic experiences, this time to the third generation

Narrative review of third generation Holocaust studies

Qualitative case studies in non-clinical groups
In her rst qualitative study, Chaitin (2000) examined the meaning of the Holocaust for
Israeli families of survivors in which there are three generations, and participants were
asked to tell their life story. The second and the third generations tended to value both
family teamwork and more non-conforming behavior. The second study (Chaitin, 2002)
looked at how three generations in Israeli families of Holocaust survivors work through
the past. The interviews were analyzed for central themes and values. For all generations,
family relationships and the emotional diculty of dealing with the Holocaust were
important. The grandchildren stressed both close family ties and conict, but also
emphasized the importance of teaching younger generations about the Holocaust. It was
concluded that the working through process poses dierent problems for each generation.
The case study by Bar-On and Gilad (1994) exhibits a diverse picture of optimism,
coping, and diculties, in a narrative that portrays various aspects in the life of the
In an American study (Hogman, 1998) that adopted a qualitative methodology with a
few cases, the author described both second and third generations as a group of purposeful
people who believe in the preciousness of life. They were also described as thoughtful,
empathic, and as being aware of social and political inequities. Moreover, the thirdgeneration members of the family seemed to feel somewhat burdened by the legacy of the
Holocaust and at the same time they felt obligated to stand up for Jewish identity and be
successful in their own lives. The author suggested that as the third generations identity
becomes intimately intertwined with its origins, a feeling of continuity is developed which
provides a sense of armation of the group and of the self. It also includes an awareness of
the suering of the Holocaust group and the suering of other groups subjected to
violence throughout the world.


A. Sagi-Schwartz et al.

Clinical correlational and case studies

Five papers pertain to clinical samples. The three reports by Berger-Reiss (1997),
Rosenthal and Rosenthal (1980), and Winship and Knowles (1996) are case studies that
provide clinical impressions and interpretations. The rst report was on the eects of
anxiety on third generation ospring in a therapy context. The second case report aimed to
make psychiatrists aware of what is being referred to as a psycho-historical approach to
the diagnosis and treatment of patients who are the third generation of the Holocaust, and
the need to identify the nature of the multigenerational processes within such families. The
last report attempted to characterize what is referred to as the transgenerational impact
of cultural trauma and its links to treatment of third generation survivors of the
Two more publications that concern clinical samples are quantitative in their design.
The work of Bienstock (1989) compared third generation ospring of Holocaust survivors
and non-Holocaust survivors regarding their relationship to their maternal grandmothers.
The study reported by Sigal, DiNicola, and Buonvino (1988) allowed for a comparison
between third-generation ospring with Holocaust versus non-Holocaust background.
The study examined the reported complaints of patients in a child psychiatry clinic and it
found a large dierence between the two groups, with an eect size of d 1.76 (95% CI
1.29 * 2.23; p 5 .001, our re-computation), indicating that third generation survivors
did function much less well, according to the parents reports, than ospring of nonHolocaust survivors. The study consisted of clinical participants only. In a non-clinical
sample without a comparison group, Jurkowitz (1996) found that openness of
communication between the second and third generation was related to a decrease in
depression, shame, and guilt in the third generation. However, there was no eect of
problem communication between the second and third generation on these three variables.
Quasi-experimental studies
We identied 13 third-generation Holocaust studies that aimed at comparing the
adjustment of third generation children of Holocaust survivors with that of a comparison
group. These so-called quasi-experimental investigations with more or less careful
comparisons between third generation ospring of Holocaust survivors and their peers
with grandparents who were not Holocaust survivors were also quantitatively combined in
a series of meta-analyses (see below). Six studies consisted of non-select samples and seven
studies of select samples (corresponding to the terms used in our study with secondgeneration traumatization).
Non-select samples
Five out of the six studies with non-select samples were carried out in Israel, covering a
wide spectrum of outcome measures including aggression, communication, self-esteem,
attachment, coping, and adjustment. In one study, Bachar, Cale, Eisenberg, and Dasberg
(1994) examined aggression of early adolescents who were recruited from the main sectors
of the East European community of immigrants who came to Israel after the end of the
World War II. They lived in urban areas and rural kibbutzim. Grandchildren of Holocaust
survivors did not dier from controls on the level of reported aggressiveness. In three
studies, attachment security of the third generation was assessed. In one study (Sagi,
Grossmann, Joels, Grossmann, Scharf, & Van IJzendoorn, 1999; Sagi-Schwartz et al.,

Attachment & Human Development


2003; Van IJzendoorn, Grossmann, Grossmann, Joels, Sagi, & Scharf, 1999) infant
attachment security/insecurity (third generation) with the mother (second generation) was
assessed using the Strange Situation procedure (Ainsworth, Blehar, Waters, & Wall, 1978);
no signicant dierences were found between the infantmother attachment status of
children with and without Holocaust background of their grandmothers. In the other two
studies (Goldberg & Wiseman, 2006; Wiseman, 2005), two non-clinical high school-based
samples consisted of late adolescents of Israeli-born parents and from intact families, half
having grandparents who suered the Holocaust and half with no Holocaust background.
In both studies, the Experiences in Close Relationships scale (Brennan, Clark, & Shaver,
1998) was used to assess the adolescents appraisal of their attachment status, with scales
for attachment anxiety and avoidance. In one study, no signicant dierences were
reported on the attachment anxiety scale (Wiseman, 2005), whereas in another study
(Goldberg & Wiseman, 2006) grandchildren of Holocaust survivors reported a higher level
of attachment anxiety than did their non-Holocaust counterparts, but similarly to the rstmentioned study (Wiseman, 2005) no dierences were found on the attachment avoidance
scale. In these two studies also no signicant dierences were found between grandchildren
of Holocaust survivors and comparisons on measures of communication and self-esteem.
Given that the study was carried out during the period of terror bombing attacks in cities
in Israel, the higher attachment anxiety may be interpreted as indicating greater
vulnerability to life-threatening and extremely stressful situations (comparable to Baider
et al., 2000; Solomon et al., 1988). However, this explanation needs to be further explored
in future studies on the third generation of the Holocaust (H. Wiseman, personal
communication, February 2008).
In one more study in Israel with third generation of adolescent grandchildren of
Holocaust survivors and their comparisons, Scharf (2007) dierentiated between families
in which both parents, one parent, or no parent were ospring of Holocaust survivors.
They found that families with both parents being ospring of Holocaust survivors showed
most distress symptoms. The grandchildren in these families reported lower self-esteem,
and their peers rated them as functioning poorer in Israeli military service (Scharf, 2007).
Adolescents with one parent being Holocaust survivor ospring functioned similarly to
the comparisons without any Holocaust background.
Lastly, a large community study with a non-select sample of grandchildren was carried
out in Canada (Sigal & Weinfeld, 1989). In this study, parents rated their children (who
were the third generation children of Holocaust survivors or of a comparison group) using
a 50-item behavior problem checklist. The combined scores did not show a signicant
dierence between the two groups, but on three of the six factors that were extracted from
the questionnaire the grandchildren of Holocaust survivors were functioning better than
the comparisons. In sum, in the six studies with non-select samples the dierences between
ospring of survivors and comparisons were found to be for the most part non-signicant.
Select samples
In the seven studies with select samples also a wide range of measures were used, albeit
more of a clinical nature. The measures were: therapy use, SCL-90, fear, psychopathology,
anxiety, depression, eating problems, partner and parent relationship, and adjustment. All
seven studies were conducted in the USA. Two studies found signicant eects, i.e., the
studies by Huttman (2003) and Wetter (1998) reporting respectively more diculties in
relations with parents and higher rates of anxiety and despression among third generation
ospring with Holocaust background. In another study (Gopen, 2001) assessing


A. Sagi-Schwartz et al.

normative functioning, participants who were recruited during a memorial day for the
Holocaust were asked to describe their intimate relationships and family climate; no
signicant dierences emerged between those participants whose grandparents were
survivors of the Holocaust and those who were not.
In a study by Liebenau (1992), focusing on various adjustment measures, the
participants were referred from an organization known as Second Generation of Los
Angeles, and from friends and family members of the investigator. Additionally, the
investigator recruited subjects during the American Gathering of Holocaust Survivors in
Los Angeles. Outcomes in this study were not compared to a control group but were
contrasted to existing norms on self-esteem, locus of control, behavior problems, and
social problems to determine whether they were manifesting signicantly higher or lower
levels of adjustment, testing the hypothesis that individuals of third generation
descendants of Holocaust survivors would demonstrate signicantly less strength and
more problems than the norm. All the hypotheses remained without support.
The remaining three select samples focused on psychological symptoms, psychopathology, and clinical outcomes. In a study carried out by Ganz (2002), young adults
who were grandchildren of Holocaust survivors and comparisons with no Holocaust
background were recruited on the basis of the authors personal network and by
circulating yers in Jewish synagogues in New York City asking to volunteer to the study.
No dierences between the groups were found on psychological symptoms checklist and
on the use of therapy. In another study testing for multigenerational occurrence of
psychopathological symptoms in families of Holocaust survivors, third generation adult
participants with Holocaust background were recruited through Jewish organizations and
the comparisons were friends and acquaintances referred by the participants who belonged
to the Holocaust group (Rubenstein et al., 19891990). The authors inferred a
transmission eect on the basis of various reported indicators of psychopathology. Our
own re-computations showed a signicant third generation eect for aggression, but a
non-signicant overall eect based on the combined psychopathology measures used in
the study.
The last select study (Zelman, 1997) examined eating problems among third generation
female participants ranging from age 14 to age 25. These grandchildren of Holocaust
survivors were recruited from the records of the United States Holocaust Memorial
Museum in Washington, DC, and their comparisons without Holocaust background were
recruited from an undergraduate pool of students at the University of Hartford. The two
groups were not found to dier on eating problems.
In all, the set of select samples suggests a mixed picture of ndings with both signicant
and non-signicant dierences between grandchildren of Holocaust survivors and
comparisons without Holocaust background. Moreover, a rather wide range of measures
and assessments were used in these studies, ranging from aggression to eating problems,
anxiety, and attachment. Such a variety of measures may represent three global domains
of internalizing symptoms, externalizing symptoms, and attachment patterns. In the metaanalysis, we will dierentiate between these dimensions.
A meta-analytic approach
In a research domain with conicting results, the method of narrative review may be
insucient to create a coherent picture (Cooper & Hedges, 1994). Counting studies with
supporting versus falsifying evidence might be an inadequate approach to reconciling
diverging study outcomes, as it does not take into account the highly heterogeneous

Attachment & Human Development


quality and size of the studies (Kellermann, 2001). A quantitative analysis and synthesis of
the tertiary traumatization literature is needed to come to a more denite conclusion.
Through meta-analysis, it is possible to compute the average eect size across studies, and
to explain dierences in outcome between studies on the basis of study characteristics
(Mullen, 1989; Rosenthal, 1991, 1995). Thus, in order to overcome the clinical-science
gap, which leads to inconsistent conclusions, we present meta-analytic ndings that are
based on all existing studies with third generation which meet the basic criteria for
inclusion in a meta-analysis. Given the lack of a clear and adequate conceptual model that
may endorse the existence of tertiary traumatization and given the mixture of ndings in
prior research, we left the question of transmission to the third generation open without
assuming a specic hypothesis in comparing third generation ospring of Holocaust
survivors with those of non-Holocaust survivors. We also explored whether any
dierences emerged in the areas of externalizing, internalizing, and attachment issues.
Data collection
Pertinent studies were collected systematically, using three dierent search strategies
(Mullen, 1989; Rosenthal, 1991). First, PsychInfo, Medline, and PILOTS (a comprehensive database on posttraumatic stress) were searched with keywords Holocaust, third
generation, grandchildren, and survivors. Second, the references of the collected
papers, books, and book chapters were searched for relevant Holocaust studies. Third,
some recent narrative reviews were used as a source for relevant papers, in particular the
exhaustive review of Kellermann (2001).
Holocaust survivors spent the war in Nazi-occupied Europe, either in concentration/
labor camps, or in various hideaway shelters, being adopted by gentile families, or using
a combination of escape and survival strategies. More often than not, they lost parents and
other family members. Second and third generation Holocaust survivors have become
accepted terms to refer to ospring of Holocaust survivors (Solomon, 1998). For obvious
reasons, the number of studies with third generation ospring is much smaller than that on
rst and second generation. Thus, our selection criteria were rather broad, in order to
include as many Holocaust studies as possible, regardless of research design and platform
of publication. We included any formal platform such as journals, books, PhD
dissertations, conference presentations, and nal reports to grant foundations.
The most important criterion was that the study should contain at least one
comparison group, and that it presented data to derive the pertinent meta-analytic
statistics from. As with our meta-analytic study on secondary traumatization (Van
IJzendoorn et al., 2003), the idea was to test empirically also with third generation the
inuence of design features, and therefore not to exclude any quantitative study on a priori
grounds (Rosenthal, 1995). Case studies and qualitative publications were excluded
because they do not t into a meta-analysis paradigm. In Tables 1 and 2 we listed all
existing publications, including case studies and qualitative studies, so as to inform the
reader about all available work in the eld. As a result of our search, 23 papers were
identied, of which 13 met the set of criteria for inclusion in the meta-analysis. For an
overview, see Table 1 for studies not included in the meta-analysis and Tables 2 and 3 for
studies included in the meta-analysis. All but one of the studies suitable for a meta-analytic
analysis were non-clinical, so that it was impossible to test the moderating role of clinical
status in our meta-analyses. We therefore decided that ndings would be more robust if we
kept the meta-analysis more homogenous by including only non-clinical samples.

Table 1.

A. Sagi-Schwartz et al.
Studies on third generation Holocaust survivors not included in the meta-analysis.

Non-clinical samples
Bar-On and Gilad
Chaitin (2002)
Chaitin (2000)
Hogman (1998)
Jurkowitz (1996)1
Clinical samples
Sigal et al. (1988)2
Bienstock (1989)3
Berger-Reiss (1997)
Rosenthal and
Rosenthal (1980)
Winship and
Knowles (1996)


of residence





Themes and values/Qualitative



Themes and values/Qualitative

Themes and values/Qualitative
Themes and values/Qualitative
Communication openness/Quantitative



Clinical referrals/Quantitative
Parents behavior (PBI)/Quantitative
Clinical impressions
Clinical impressions



Clinical impressions


Quantitative data available but correlational study: no control.

Quantitative data available for meta-analysis but clinical study (d 1.76; 95% CI (1.29 * 2.23); p 5 .001).
Outcome measure is based on third generations report about parents behavior.

Coding system
A coding system was used to rate every Holocaust study on design, sample, and
measurement characteristics (see Table 2). We coded sample size (grandchildren of
Holocaust survivors and comparison group in the study) and recruitment as design
characteristics. Studies were coded as non-select when participants were randomly
sampled, e.g., from several neighborhoods or a population registry, or when the entire
Jewish population of a certain country was involved. They were coded as select when
samples were recruited through, e.g., Holocaust survivor meetings, personal contacts, or
advertisements. We also coded gender of the samples (male, female, or mixed). Eleven
studies were represented by both males and females, whereas one sample consisted of allmales only and one sample of all-female only. Moreover, we coded whether the sample
was clinical or non-clinical, and we registered the current country of residence of the
sample (Israel, Canada, and USA).
We coded an overall type of outcome, namely adjustment, which was dened broadly,
and involved positive indicators such as general adjustment, attachment security, self
esteem, partner relationship and family climate, close relationship, coping, and negative
indicators like anxiety/depression, aggression, eating problems, clinical referrals,
psychopathology. All these constructs were measured with standard and valid
instruments, commonly used for the assessment of mental health, posttraumatic stress,
coping, adaptation, and maladaptation. Furthermore, we distinguished three categories of
functioning, relating to externalizing, internalizing, and attachment issues. When
outcomes in more than one domain of functioning were reported within a study, we
selected the outcome that most unambiguously reected one of the three domains of
functioning, and at the same time led to the largest numbers of eect sizes in the various
domains (resulting in k 3 studies for externalizing, k 5 studies for internalizing, and
k 5 studies for attachment, see Table 3). As an example, Rubenstein et al. s (19891990)
study provided a combined outcome for psychopathology that was used in the




Huttman (2003)
Liebenau (1992)1
Rubinstein et al. (19891990)
Wetter (1998)
Zelman (1997)
Total select samples



Wiseman (2005)
Total non-select samples
Select samples
Ganz (2002)
Gopen (2001)




Therapy use/SCL-90/Fear
Partner relationship and attachment
to parent
Close relationship
Eating problems

Distress coping/problem coping/

peer-reported distress and functioning
Conduct problems/strangeness/

Outcomes are not compared to a control group but contrasted to existing norms.
Homogeneous set of outcomes.




Sigal and Weinfeld (1989)












(70.19 * 0.41)
(70.63 * 0.31)

(70.51 * 0.47)
(70.11 * 0.17)

(70.73 * 0.02)

(70.23 * 0.29)

(70.15 * 0.65)
(70.15 * 0.47)
(70.33 * 0.47)


Attachment security




(70.14 * 0.23)




of residence

Total samples
Non-select samples
Bachar et al. (1994)
Goldberg and Wiseman (2006)
Sagi-Schwartz et al. (2003)
Van IJzendoorn et al. (1999)
Scharf (2007)


95% CI

General adaptation of third generation Holocaust ospring in non-clinical studies suitable for meta-analysis.


Table 2.








Attachment & Human Development



A. Sagi-Schwartz et al.

Table 3. Externalizing, internalizing and attachment dierences in non-clinical third generation

Holocaust ospring.
Bachar et al.
Sigal and
Rubinstein et al.
Scharf (2007)

Gender of residence Outcome

97 Mixed
118 Mixed
51 Mixed


70.15 * 0.65





70.67 * 0.07





0.02 * 1.34



7 0.32 * 0.61


Peer-reported 70.06
distress and
Self esteem

70.51 * 0.39


70.58 * 0.46
72.63 * 0.23
0.27 * 1.19


70.54 * 1.01


70.29 * 0.53


Ganz (2002)
Liebenau (1992)1
Wetter (1998)

60 Mixed
36 Mixed
74 Mixed


Zelman (1997)

29 Female





Huttman (2003)

95% CI


79 Male

Goldberg and
et al. (2003)
Van IJzendoorn
et al. (1999)
Wiseman (2005)
Gopen (2001)

160 Mixed




70.06 * 0.57


95 Mixed




70.33 * 0.47


67 Mixed
72 Mixed


70.65 * 0.33
70.70 * 0.25


74 Mixed


to parent
to parent

71.16 *70.10 .02

70.22 * 0.15


Contrast for eect sizes of the various domains: Qbetween 1.03, p .60.
Outcomes are not compared to a control group but contrasted to existing norms.
Homogeneous set of outcomes.

meta-analysis on general adjustment, and an outcome for aggression (as part of the
psychopathology outcome) that was included in the externalizing category of the metaanalysis exploring the dierences in functioning in the three domains.
Data analysis
Because the studies included in this series of meta-analyses reported various statistics, the
outcomes of all studies were re-computed with Mullens (1989) Advanced BASIC Metaanalysis program, and transformed into Cohens d (the standardized dierence in means

Attachment & Human Development


between the third generation of Holocaust survivors and comparisons). In several cases,
we had to compute the eect sizes on the basis of means and standard deviations provided
in the study report. When more than one outcome was reported (e.g., Wiseman, 2005),
they were meta-analytically combined into one eect size for adjustment, that is Cohens d.
Moreover, an overall eect size for general adjustment based on available positive and
negative indicators for adjustment was computed for each study in order to avoid counting
a study or participant more than once.
The resulting set of eect sizes were inserted into Borenstein, Rothstein, and Cohens
(2000) Comprehensive Meta-Analysis (CMA) program that computed xed as well as
random eect model parameters. CMA also computed condence intervals around the
point estimate of an eect size. Because the leading hypothesis in this area of research is
that the grandchildren of Holocaust survivors would be less well-adapted, we used this
directed hypothesis and present here the 95% condence boundaries of the point estimates
for the eect sizes (with alpha set at .05; see Tables 2 and 3). Thus, for meta-analytic
purposes, we assigned positive signs to those eects that indicated the presence of a third
generation eect (i.e., negative outcomes for the third generation compared to
comparisons without Holocaust background), and negative signs to eects that indicated
better outcomes for the Holocaust third generation ospring.
Signicance tests and moderator analyses in xed eects models are based on the
assumption that dierences between studies leading to dierences in eects are not
random, and that in principle the set of study eect sizes is homogeneous at the population
level. Signicance testing is based on the total number of subjects, but generalization is
restricted to other participants that might have been included in the same studies of the
meta-analysis (Rosenthal, 1995). Statistical inferences may be regarded as applying only to
the specic set of studies at hand (Hedges, 1994). In random eects models this
assumption is not made (Hedges & Olkin, 1985), and they allow for the possibility that
each separate study has its own population parameter. In random eects models
signicance testing is based only on the total number of studies and generalization is to the
population of studies from which the current set of studies was drawn (Rosenthal, 1995). It
has been argued that random eects models more adequately mirror the heterogeneity in
behavioral studies, and use non-inated alpha levels when the requirement of homogeneity
has not been met (Hunter & Schmidt, 2000). In our meta-analyses, some data sets were
heterogeneous. In those cases, the random eects model parameters (signicance,
condence intervals) were presented (see Tables 2 and 3).
The current analyses included 13 studies, including 1012 participants (grandchildren of
Holocaust survivors and comparisons). The sample sizes ranged from 29 (Zelman, 1997)
to 160 (Goldberg & Wiseman, 2006). For each of the 13 samples, the standardized
dierence between the Holocaust and comparison group was computed (Cohens d;
Mullen, 1989). For each sample, Fisher Z was computed as an equivalent to the
correlation coecient r (see Mullen, 1989). No outlying eect sizes were identied in the
set of Holocaust studies on the basis of standardized z-values larger than 3.29 or smaller
than 73.29 (p 5 .001; Tabachnick & Fidell, 2001).
Does tertiary traumatization exist?
In the total set of 13 samples on 1012 families, we did not nd a signicant dierence in
psychological well-being and adaptation between the third generation Holocaust survivors
and their comparisons. The size of the combined eect was a Cohens d of 0.04 (p .66),


A. Sagi-Schwartz et al.

condence interval 70.14 * 0.23 (see Table 2). Based on the overall eect size for general
adjustment in each sample, the third-generation Holocaust survivors did not dier
signicantly from the comparisons.
Are study results associated with the type of recruitment of participants?
When the set of studies was divided in sub-sets with select and non-select samples, we
found basically similar outcomes. The seven select samples, including 616 subjects, showed
a small but non-signicant combined eect size of d 0.07 (p .65) for general
adjustment. The six non-select studies with a more adequate recruitment of participants
also showed a non-signicant eect size of d 0.03 (p .69) in a homogeneous set of
outcomes. Thus, both studies with non-select and with select samples failed to show a
tertiary traumatization eect, that is, third generation Holocaust survivors did not show
less well-being or adaptation than did the comparisons.
Does tertiary traumatization exist in specic domains of functioning?
Because convenience and non-convenience samples did not dier in combined eect sizes,
we examined dierences between studies addressing externalizing, internalizing, and
attachment problems across the total set of studies. Table 3 presents the outcomes and the
combined eect sizes for the three categories of functioning (k 3 studies for
externalizing, k 5 studies for internalizing, and k 5 studies for attachment). Although
the number of study outcomes in the externalizing category was small, we decided to
explore the dierences in combined eect sizes between these three domains. For
externalizing, internalizing, and attachment the combined eect sizes were d 0.15,
d 0.12, and d 70.03, respectively (see Table 3). These combined eect sizes for the
three domains were non-signicant, and the contrast between the three sets was not
signicant either (Q(2) 1.03, p .60), see Table 3. Tertiary traumatization could not be
detected in the three domains of functioning separately or combined into the overarching
category of adaptation. It should be noted that our test of dierences between domains
was only exploratory because of the small number of study outcomes in the externalizing
Discussion and conclusions
Our narrative review of studies on the transmission of trauma to the third generation
ospring of Holocaust survivors showed a mixed picture of signicant and non-signicant
dierences between grandchildren of Holocaust survivors and comparisons without
Holocaust background. In a meta-analysis of 13 studies, involving over 1000 participants,
no evidence for tertiary traumatization was found, whether or not participants were
recruited in a select or non-select manner, and whether or not we divided the study
outcomes into three possible domains of traumatization, that is externalizing, internalizing, or attachment issues.
We should not overlook the limited evidence that is presented for specic
traumatization eects in clinical (Sigal et al., 1988) or particularly vulnerable populations,
evidence that might be lost or discounted in the meta-analysis. For example, in order to
increase statistical power, we had to merge the subgroups as reported by Scharf (2007).
Although in that study grandchildren with both parents raised by Holocaust survivors
showed more adaptation problems, the combined groups (with one and two parents raised

Attachment & Human Development


by survivors) did not dier signicantly from the comparisons in other-reported

adjustment to military service. A potentially additive traumatization eect of having
two parents who were the ospring of Holocaust survivors might have been uncovered if a
larger set of studies would have dierentiated between these groups. Thus, as might be the
case with any meta- analytic approach, especially when the available number of studies is
not very large, some specic moderating eects may remain hidden. It should also be
noted that some of the studies included in the meta-analysis were not published in peerreviewed journals (e.g., doctoral dissertations, conference presentations). At the same
time, meta-analytic methodology requires the inclusion of unpublished material in order
to prevent publication biases to inate the outcome of meta-analyses (Lipsey & Wilson,
2001; Rosenthal, 1995).
Overall, however, we are inclined to take the absence of dierences between ospring
of Holocaust survivors and comparisons as a replicated fact. This meta-analytic nding
may be interpreted as a sign of resilience on the part of the survivors that facilitated the
well functioning of their second and third generation ospring. Already at the level of
relationships between the rst generation and the second generation, we noted an
impressive resilience of Holocaust survivors who, as parents, seem to have managed to
protect their children from being aected by the Holocaust (Van IJzendoorn et al., 2003).
Moreover, the idea that the trauma might skip a generation (i.e., the second) and that it
may emerge only in the next one (i.e., third), as might be the case with the transmission
of some biologically inherited diseases (Bulmer, 1998), did not receive support from
our meta-analytic investigation. Given an absence of a well-substantiated conceptual
model for transmission of psychological eects to the third generation, a Mendelian
model that might be appropriate for genetic inheritance might not be so for social
For the lack of transmission of trauma from the rst to the second generation and for
the remarkable resilience of rst generation Holocaust survivors (Van IJzendoorn et al.,
2003), we proposed a bio-psychological stress-diathesis model of PTSD (Paris, 2000)
focusing on three important protective or risk factors which determine the intensity and
duration of posttraumatic stress: repeated or lack of repeated exposure to traumatic
events, the presence or absence of a genetic predisposition for PTSD, and the availability
or lack of availability of social support in coping with the traumatic experiences.
The remarkable resilience in Holocaust survivors from this stress-diathesis perspective
was explained by noting that the traumatic experiences of the survivors were not inicted
by their own parents or other attachment gures (Sagi-Schwartz et al., 2003; Van
IJzendoorn et al., 2003). These experiences, instead, emerged from an almost anonymous,
destructive process with bureaucratic characteristics (Bauman, 1989). The Holocaust
therefore may not have undermined the feelings of basic trust in their attachment gures,
enabling them to adequately fulll their own role as trusted parents for their children.
Moreover, most survivors had experienced several pre-war years of normal family life, and
were thus able to establish secure attachment relationships with their parents or other
attachment gures. The survivors might have had adequate models of parenting available
when they became parents themselves.
With regard to genetic factors, as part of a stress-diathesis model we have already
speculated that Holocaust survivors were not genetically biased to develop intense
posttraumatic stress reactions (Van IJzendoorn et al., 2003), as these responses would have
left them vulnerable in their struggle for survival (Schwartz, Dohrenwend, & Levav, 1994).
Suerers from PTSD may have had a smaller chance of surviving the extremely stressful
circumstances of hiding or being in camps. Survivors may have been protected against


A. Sagi-Schwartz et al.

PTSD through their genes (Goldberg, True, Eisen, & Henderson, 1990) as well as through
myriads of other personality, social, and chance factors. This genetic protection against
PTSD might have been transmitted to the next generations. Children of Holocaust
survivors, therefore, may not have been especially sensitive to potentially traumatic events
or reports arising from their parents eorts to deal with the Holocaust atrocities. We are
currently exploring the genetic component more directly by collecting DNA in our Israeli
study, in a search for vulnerability genes (Sagi-Schwartz et al., 2003).
The last factor in a stress-diathesis model concerns the presence or absence of social
support to cope with trauma afterwards. We proposed that after World War II the
survivors were forced to nd meaning in helping to build up a new society, everywhere
they could, in Europe and Northern America, but also, and maybe especially, in Israel
(Frankl, 1984). The newly founded State of Israel, to which many survivors emigrated
after the war, and also the success of many Jews throughout the Western world served as
symbols of the ultimate failure of the Final Solution (Solomon, 1998). Ever since the
establishment of Israel, various memorials in Israel and subsequently also outside Israel
have been erected to commemorate the victims of the Holocaust and to support survivors
and their families in working through the traumatic memories of the past, all of which
might have served as important social support for Holocaust survivors.
Unfortunately, due to the relatively small number of pertinent studies it was not
possible to test country dierences meta-analytically (but see Van IJzendoorn et al., 2003).
Similarly, no separate results were available in the various studies for males versus females
and the variability in this set of studies was insucient to test whether gender was a
moderator. The search for moderators and mediators would have been very important,
though, if the database in the dierent studies included in the meta-analyses would have
allowed for such analyses.
In sum, our series of meta-analyses show that second generation as well as third
generation ospring of Holocaust survivors are, in general, well adapted. The provocative
idea that the intergenerational transmission of the trauma might skip a generation and
thus may emerge in the third generation was not substantiated in our meta-analyses. Such
a potential sleeper eect does not appear to be the case, the youngest generation seems
also to develop in a normal way. Protective factors in the ospring or in their environment
may have lessened the impact of the rst generations trauma. More plausibly, studies on
the second-generation and third-generations psychological consequences of the Holocaust
indicate a remarkable resilience of traumatized survivors in their parental roles, even when
they personally may be traumatized profoundly.
Clinically, every case is a unique constellation of etiological factors responsible for
current suering, and the Holocaust experiences of the earlier generation might be one of
those factors even though on the level of the population secondary and tertiary
traumatization are not the rule. The absence of tertiary traumatization, however, should
sensitize clinicians working with (second or) third generation ospring of Holocaust
survivors to the possibility that their clients may be stimulated to search for the roots of
their problems in other directions besides the Holocaust experience of their grandparents.
Abraham Sagi-Schwartz was supported by the Mary Main Visiting Professional Chair at the Centre
for Child and family studies, Leiden University, the Netherlands. Marinus van IJzendoorn and
Marian Bakermans-Kranenburg were supported by research awards from the Netherlands
Organization for Scientic Research (NWO SPINOZA prize and VIDI grant no. 452-04-306,

Attachment & Human Development


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