ESR Kimberley Anderson Graduates from Leipzig University

For her doctoral work, presented as two parts in her dissertation: Being a Mother, Being a Survivor, since 2015 ESR Kimberley Anderson has explored the psychosocial outcomes of conflict-related sexual violence (CRSV) against women. Despite current COVID-19 restrictions, Kimberley successfully defended her dissertation online on 1 February 2021, within the Department for Medical Psychology and Medical Sociology at Leipzig University’s Universitätsklinikum. Her supervisors, Prof. Heide Glaesmer (Leipzig University), Prof. Ivan Komproe (Utrecht University) and Dr. Elisa van Ee (Psychotraumacentrum Zuid Nederland) were all present.

Based on a cumulative dissertation comprising four peer-reviewed journal publications and a forthcoming book chapter, Kimberley’s dissertation utilised various methodological approaches to explore the psychosocial outcomes associated with CRSV, with a particular focus on children born as a result of sexual violence within a refugee population, and a unique look at posttraumatic growth.

Being a Mother

The first part of her dissertation explored reflective functioning (i.e., parents’ representations of their children, themselves as parents, and their relationship with their children) and adds weight to existing evidence that vulnerable mothers with children born of sexual violence (CBSV) may be unable to articulate the complex interactions of emotions and behaviours between themselves and their child, which ultimately impacts their relationship. This may be as a result of their own emotion dysregulation following the trauma of sexual violence or indeed ambivalence towards their child as a result of his/her conception. These experiences may be compounded by migration or asylum-seeking and acculturation into a refugee host country.[1]

These findings are strengthened with the addition of a Delphi study[2], which makes a strong contribution to the knowledge base on how to care for women and children affected by sexual violence (when children are born as a result), by collating and integrating the expertise of researchers, clinicians and advocates. Experts rated difficulties with relationships as the primary concern for this population (with a husband or spouse, with children or with the wider community) with the most common focus of treatment as fostering mother-child interactions. Experts advocated for a combination of group work (to connect mothers) and individual work (to achieve personal stabilisation). Interestingly, experts highlighted that if mothers/children did not have a formal mental health diagnosis, their ability to treat them was unchanged. This likely reflects the degree to which mental well-being is only one small part of their experience within a wider social context. A lack of financial resources, a limited evidence-base and treatments starting too late were barriers experts identified to providing optimal support.

Being a Survivor

Within the stories of hardship, however, Kimberley recognised glimmers of strength, and the second part of this dissertation introduces the idea that, even for women who experience CRSV, growth is still possible. It looked at survivors of from Bosnia & Herzegovina following the 1990s conflict, and participants were assessed on measures of psychopathology (including posttraumatic stress disorder (PTSD), as well as coping, optimism and posttraumatic growth (PTG)[3].

The first research question explored the extent of PTSD and PTG in this sample and results showed that 92% of participants screened positive for PTSD, while scores of PTG also sat in the mid-high range compared to other samples of survivors of interpersonal violence (including rape). The second question examined the relevance of coping and optimism in this relationship. Results showed that both these factors correlated with PTG, with two coping strategies in particular accounting for the largest proportion of variance: positive reinterpretation (being able to process the event and its psychological sequalae) and behavioural disengagement (withdrawing from sources of the stressor). Importantly, it seems that growth in this sample was possible while simultaneously experiencing distress. This is evidence for PTG and PTSD as separate entities, as opposed to being either end of a single spectrum, and it is this concept that Kimberley explored further in a second paper using the same data[4].

Using structural equation modelling, main findings first showed that lower scores of PTSD did not mean participants showed greater signs of growth, or vice versa, meaning that PTG/PTSD are both possible outcomes after war-related events and that war survivors will respond with both distress and growth. Second, positive reinterpretation predicted PTG in both groups. But among CRSV survivors, behavioural disengagement mediated this relationship, reducing the amount of growth obtained for this group overall. The implications of these results suggest that PTSD and PTG are likely working as a dual mechanism: as separate but related risk and protective factors.

Conclusion

These findings serve to highlight the key message from Kimberley’s dissertation, that: The needs of survivors and their environments are engaged in a full interactional process to be considered at every stage of treatment, advocacy and research, in conflict, post-conflict and other fragile settings. This work has highlighted a transgenerational understanding of CRSV and is one of the first indications that we should focus on this type of parental behaviour, and the capacity to understand the wellbeing of the child in this context. Importantly, findings from the second part of her dissertation also show that healing and growth are possible, and apply not only at an individual level, but each of those seen in the model. Lastly, given that the implications of CRSV are vast and far-reaching, at different levels of society and within the self, these could explain how trauma is managed and processed, which is useful in psychosocial care settings.

Following the reviews of her dissertation and successful defence, Kimberley awaits the final formal steps to completion..