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Clinical experience over a number of years in the diagnosis and treatment of concentration camp survivors and victims of similar forms of persecution appears to indicate that we are dealing with a type of traumatization of such magnitude, severity, and duration as to produce a recognizable clinical entity which—for brevity and want of a better term—I have named the "survivor syndrome". I have used this term to sharpen our understanding of the multifold clinical manifestations encountered in survivors of persecution and to differentiate the clinical picture from other forms of psychopathology.
The syndrome appears to be characterized by the persistence of multiple symptoms among which chronic depressive and anxiety reactions, insomnia, nightmares, personality changes, and far-reaching somatization prevail. More specifically, clinical observation of about 800 survivors of Nazi persecution revealed that the survivor syndrome is composed of the following manifestations:
i.Anxiety—the most predominant complaint. It is associated with fear of renewed persecution, sleep disturbances, multiple phobias, anxiety dreams, and characteristic "re-run" nightmares. With regard to the latter, one of my observations has been that many patients suffer from chronic insomnia partly as an attempt at limiting their hours of sleep because their dreams and nightmares reflecting the concentration experience in concretu et situ, are unendurable for them.
ii.Disturbances of cognition and memory, such as: amnesias, hyperamnesias, and especially upon awakening from nightmares, confusion, with disorientation between the present and the period of persecutions. Also, "lost and bewildered" states as well as dissociative phenomena.
iii.Chronic depressive states, covering the whole spectrum from masochistic character changes to psychotic depression. The incidence and severity correlate closely with "survivor guilt" and certain specific traumata, such as loss of children, parents, siblings, history