Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ

ISSN 2612-2138

Trauma of Forced Displacement in Children as a

Result of Russian-Ukrainian War

Kateryna Dzivak, Ivan Romash, Iryna Romash, Karina Pimenova, Volodymyr Paliichuk, Valeriia

Slobodian, Vasyl Obidniak, Mykhaylo Pustovoyt .

Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine

Abstract

Introduction: In the modern world, forced displacement is considered as one of the most

serious threats to mental health, especially for vulnerable groups, and at the same time

as a decisive humanitarian problem. Children who are still in the process of identity and

psycho-

emotional stability formation are an extremely vulnerable category, since their

ability to adapt significantly depends on adults and relationships with the environment.

Purpose: To

study the impact of traumatic experience associated with forced

displacement due to Russian-Ukrainian war, on the development of post-traumatic stress

disorder (PTSD) and behavioral disorders in children.

Methodology: The study included 40 children, 11±2.3 years old

. The control group,

representative by age and sex, consisted of 20 children. Using PCL-5, CPS-V-SR, SSS-8, and

Vanderbilt Attention-

Deficit/Hyperactivity Disorder Parenting Scale (VADPRS), the authors

have conducted a quantitative and qualitative study of post-traumatic symptoms.

Results:

The results indicated the high prevalence of PTSD, with dominance of intrusive

symptoms, hyperactivation, negative cognitive schemes, and somatic complaints. The

factor analysis confirmed the binary structure of post-

traumatic response:

“psychophysiological matrix of uncontrolled trauma” and “pattern of affective depletion.

VADPRS scale revealed a persistent tendency to mild distraction as a leading cognitive

symptom, as well as less common but structured manifestations of impulsiveness,

opposition, anxiety, and affective turbulence. Factor analysis provided an opportunity to

define four patterns of psycho-emotional disorganization: socio-cognitive disorientation,

impulse dysregulation, antisocial processing of trauma, and affective protest behavior.

Conclusion:

The authors emphasize the importance of not only clinical recognition of

these patterns, but also the public recognition of the fact of traumatization due to forced

displacement, which is often depreciated in public discourse.

Keywords

Mental health, forced displacement, involuntary dislocation, children, adolescents, war, post-

traumatic stress disorder.

Address for correspondence:

Ivan Romash, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine

E-mail: iromashr@gmail.com

This work is licensed under a Creative Commons Attribution- 4.0 International

License (CC BY 4.0).

©Copyright: Dzivak et al., 2025

Publisher: Sciendo (De Gruyter)

DOI: https://doi.org/10.56508/mhgcj.v8i1.298

Submitted for publication: 29

April 2025

Revised: 27 July 2025

Accepted for publication: 13

August 2025

140

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ

ISSN 2612-2138

Introduction

Now my home is memories

I return there after a walk through the war….

Pavlo Matiusha

“Free poetry”

https://warpoetry.mkip.gov.ua/8651

We left our home, but our hearts remained in

the homes we left behind...

Yulia Musalovska

"We have no more old things": poems and

illustrations. Tictor Media.

https://tyktor.media/polytsia/virshi-ta-iliustratsii-

pro-dim/

The term “involuntary dislocation” carries a rich

phenomenological significance and has been

extensively conceptualized in the works of Renos

Papadopoulos. According to his framework, this

condition arises from catastrophic events—such

as war, persecution, natural disasters, or other

profound crises—that radically alter an individual's

subjective perception of home. A person no

longer experiences their home as a safe and

livable space and, irrespective of personal volition,

is compelled to leave their familiar environment in

search of refuge. Thus, involuntary dislocation

encompasses not only the physical act of fleeing

but also a deeply personal experience: the

psychological and emotional loss of home as a

sanctuary.

This term is conceptually distinct and lacks a

precise synonym, as it integrates two fundamental

dimensions: the erosion of safety within one’s

familiar surroundings and the spatial separation

from them (Papadopoulos, 2021).

In contemporary discourse, involuntary

dislocation—often referred to as forced

displacement—is recognized as one of the most

pressing threats to mental health, particularly

among vulnerable populations. It is also regarded

as a critical humanitarian concern (Rayan et al.,

2021a; Rayan et al., 2021b; Matiashova et al.,

2022; Mohamed et al., 2024). Although

displacement may offer prospects of protection,

shelter, and new opportunities, it is almost

invariably accompanied by profound losses. The

most severe consequences include the disruption

of social networks, loss of educational continuity,

disturbance of daily routines, and—most

significantly—the destruction of a sense of

personal safety. Children, whose identities and

psycho-emotional stability are still in formation,

constitute an especially vulnerable group, as their

capacity to adapt is heavily dependent on adult

caregivers and environmental relationships (Vus et

al., 2024).

The issue of forced displacement has become

particularly acute in Ukraine following the full-scale

invasion by the Russian Federation in 2022. Since

then, millions of children have been compelled to

abandon their homes, losing not only physical

shelter but also access to schools, friendships,

familiar environments, and, in many cases, one or

both parents.

According to Dangmann and colleagues,

forced displacement exerts a multidimensional

impact on children's lives, coinciding with critical

phases of physical, emotional, cognitive, and

social development (Dangmann et al., 2022).

During this formative period, foundational beliefs

about the self, others, and the external world are

established. Disruptions in environmental stability

and emotional support can therefore exert

profound and enduring effects on mental

development.

A systematic review of contemporary literature

reveals several common psychosocial challenges

faced by displaced children, regardless of the

specific nature of their displacement. These

include: the breakdown of familiar social

structures; loss of routine and safe spaces;

integration difficulties stemming from linguistic,

cultural, or bureaucratic barriers; increased

prevalence of anxiety, depression, and behavioral

disorders; and experiences of isolation or

stigmatization within educational settings. Notably,

Kapel Lev-Ari and colleagues report that over 50%

of Ukrainian children exhibit clinically significant

levels of psychological distress (Kapel Lev-Ari et al.,

2024).

Psychological trauma becomes particularly

complex and multilayered in children affected by

war (Romash et al., 2023a). It encompasses not

only direct or indirect exposure to violence,

destruction, and bereavement, but also severe

disruptions in basic safety, disorientation,

hyperarousal, persistent fear, and diminished trust

in the adult world. According to Martsenkovskyi

and co-authors, the loss of one or both parents is

among the most potent independent factors

exacerbating the severity and progression of post-

traumatic symptoms in children. Such cases are

often characterized by emotional numbness,

depressive states, ambivalent responses to the

deceased parent, and manifestations of

antisocial or self-destructive behavior

(Martsenkovskyi et al., 2024).

Nevertheless, several protective factors can

foster resilience. These include stable, emotionally

nurturing relationships with at least one

dependable adult; successful integration into a

new social environment; preservation of cultural

identity; and access to targeted psychosocial

interventions, such as psychotherapy, body-

oriented therapy, or art therapy. Accordingly,

141

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ

ISSN 2612-2138

forced displacement should ideally culminate in

the establishment of a new safe space and

gradual adaptation to altered circumstances,

rather than leaving behind a solely destructive

legacy.

In this process, the presence of a reliable adult

who can provide emotional companionship,

guidance, and support is crucial. In the absence

of parents or when they are emotionally

unavailable, this role may be assumed by

teachers, psychologists, mentors, or foster families

(Kang H et al., 2024). Institutional support from

schools and communities can partially

compensate for the loss of parental care.

Participation in creative, group-based, or

therapeutic initiatives can serve as a powerful

resource for restoring children's capacity to trust,

form relationships, and continue their

development.

Purpose

The objective of the research was to study the

impact of traumatic experience associated with

the forced displacement due to the armed

aggression of the Russian Federation against

Ukraine on the development of post-traumatic

stress disorder (PTSD) and behavioral disorders in

children. The research attention was focused on

the analysis of mental mechanisms by which

children worked through the experienced stress, as

well as the identification of a characteristic

symptomatic profile of post-traumatic disorders.

Methodology

The scientific research engaged children who

had direct experience of military conflict in the

territory of Ukraine. At the time of inclusion in the

study, the average exposure to the stress factor

was from 6 to 10 months. Some of them lost their

homes and relatives, witnessed shelling, cities

occupation as well as killing civilians. At the time of

inclusion in the study, these children were in the

territory of Western Ukraine, in various sanatoriums

of the Carpathian region.

The study involved 40 children (62% - girls; 38%

-boys). The average age of the children was 11 ±

2.3 years. The Сontrol group, representative by age

and sex, consisted of 20 children. The research

design provided several steps of the examination.

All participants of the study underwent a

general clinical examination, after which they filled

out the “Somatic Symptom Scale-8” (SSS-8). It is a

short self-questionnaire of depression somatic

manifestations. It consists of eight questions, each

of which is estimated from 0 to 4 points, where 0

= “does not worry” and 4 = “worries very much”.

Somatic symptoms were evaluated by calculating

a total assessment, which varied from 0 to 32

points. The degree of intensity of manifestation was

evaluated as follows: from 0 to 3 - minimum; 4-7-

low; 8-11-medium; 12-15-high; 16-32-very high

(Gieerk et al., 2014).

All the children underwent scaling according to

the “Primary Screening of the PTSD” questionnaire.

The next step was to fill in the Child PTSD Symptom

Scale Self-Report for DSM-5, authored by Edna B.

Foa and Sandy Capaldi (CPSS-V SR). This scale

takes about 10 minutes to fill. CPSS-V-SR contains

a trauma screening to evaluate the history of

traumatic experiences, as well as a semi-

structured interview of 27 points, which includes 20

points evaluating PTSD symptoms according to the

DSM-5 criteria, and seven points evaluating the

worsening of symptoms in everyday functioning.

20 PTSD symptoms are rated according to a 5-

point frequency and severity scale from 0

(absolutely not) to 4 (6 or more times a

week/almost always). 7 functional points are

evaluated by choosing yes/no (Foa et al., 2018)

The PCL-5 was also used to evaluate PTSD

symptoms. The PCL-5 (Posttraumatic Stress

Disorder Checklist for DSM-5) consists of 20

questions, each of which is rated from 0 to 4

points, depending on the severity of the symptom

(Weathers et al., 2013).

Since this questionnaire is commonly used for

PTSD screening, its questions are evaluated by the

appropriate clusters of PTSD symptoms according

to the DSM-5 classification: Cluster A – a

description of a traumatic event; Cluster B –

intrusion symptoms – encompass questions from 1

to 5; Cluster C – avoidance symptoms – questions

6 and 7; Cluster D – negative thoughts and

emotions - from questions 8 to 14; Cluster E –

symptoms of excessive reactivity – from questions

15 to 20. The minimum score is 0, the maximum

possible one is 80. The presence of an exposure to

a traumatic event is mandatory for PTSD diagnosis.

There are 2 approaches to interpret the results:

calculation of the total number of points and

calculation by the clusters of symptoms. The

symptoms are considered clinically significant if,

respectively, at least one question from each of

the clusters B and C, and two questions from the

clusters D and E are ≥ 2 points, or the total

indicator is ≥ 33 points (Bezsheiko et al., 2016).

According to the scientific data, PCL-5 is a

psychometrically reasonable, valid, and reliable

tool, useful for quantitative assessment of the

severity of PTSD symptoms and sensitive to

changes in time (Bovin et al., 2016).

A questionnaire of the National Institute for

Children’s Health Quality (NICHQ), namely

Vanderbilt Attention-Deficit/Hyperactivity Disorder

Parenting Scale (VADPRS) was used to study the

symptoms of behavioral disorders in children and

adolescents. It should be noted that this

142

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ

ISSN 2612-2138

questionnaire meets the diagnostic criteria

indicated in the Diagnostic and Statistical Manual

of Mental Disorders, 5th edition (DSM-5). Although

this scale was originally developed for children at

the age of 6-12, it is now widely used for children

at the age of 4-17 (Wolraich, et al., 2003;

Anderson, et al., 2022).

This questionnaire includes 55 questions, each

of which is estimated from 0 to 3, where 0 is

“never”, 1 is “sometimes”, 2 is “often”, and 3 is “very

often”, and contains 7 diagnostic subscales, six in

the first part and one in the second one. The

answers (points) to the questions in each subscale

are added and reflect the severity of the cluster

according to each individual subscale.

The scale consists of two parts. The initial

screening of symptoms is conducted in the first

part which consists of six segments. The

productivity, namely its deterioration, is evaluated

in the second part. Among the questions of the

initial scale, “positive” is considered to be an

indicator of 2 or 3, indicating frequent or very

frequent cases of symptoms listed in the scale.

The evaluation in the second part is made from

1 to 5, and the indicators 4 or 5 display problems

in the implementation. The first part consists of the

following six subscales: inattention (questions 1-9);

hyperactivity (10-18); combined version of the two

previous conditions (1-18); oppositional defiant

disorder (19-26); behavioral disorders (27-40);

anxiety and depression (41-47).

The second part of the scale contains a set of

performance indicators, productivity of the

examined person, evaluating his or her functioning

in various spheres of life, such as: relationships with

parents, brothers/sisters, relationships with peers,

success in learning, participation in different group

activities.

The evaluation technique involves specifying

the total number of “positive” answers in each of

the seven clusters presented (subscales).

According to the diagnostic criteria, if the surveyed

person has positive answers for at least 6 out of 9

items (2 or 3 points) in questions 1-9 and 4 points

for at least two questions or 5 points for one

question of the second part (questions 48–54),

then he or she is classified as a predominantly

inattentive subtype. Similarly, if the patient scores 2

or 3 points for 6 out of 9 items in questions 10-18

and 4 points for at least two questions or 5 points

for one question of the second part, he or she

should be referred to as a predominantly

hyperactive/impulsive subtype. Combined

inattention / hyperactivity requires the presence of

both of the above-mentioned criteria.

By the same principle, we search for

oppositional defiant disorder. The patient should

give positive answers to 4 out of 8 items in

questions 19-26 and get 4 points for at least two

questions or 5 points for one question of the

second part. In case of behavior disorders, the

patient should give positive answers to 3 out of 14

items, which is an example of behavioral actions

(questions 27-40), and 4 points for at least two

questions or 5 points for one question of the

second part. In the presence of

anxiety/depression, the patient should give

positive answers to 3 out of 7 behavioral actions

(questions 41-47). The VADPRS scale was filled out

exclusively by the parents of the child. In the

absence of parents (children who are deprived of

parental care), the questionnaire was filled out by

the guardians.

In order to understand the internal logic of the

indicators of different scales and measurements

of the PCL-5 and VADPRS questionnaires, a factor

analysis was applied to the quantitative data of

the research sample. It is a statistical method that

explores correlation links between the selected

features, encoded in the survey scales/

Statistical processing of the obtained results

was conducted using the statistical functions

package of the Microsoft Excel, 2016 and Jamovi,

2024 (computer software: version 2.6.26).

Results

All participants of the study underwent the

survey according to the “Primary Screening of

PTSD” scale and only 18 (45%) subjects gave a

positive answer to more than 3 questions.

According to the PCL-5 scale, the indicators

exceeded the maximum permissible limits of the

total score (≥ 33 points) only in 16 (40%) surveyed

individuals. The presentation of this data is shown

in Figure 1a).

Calculation on the clusters of the symptoms

showed that the scales indicators corresponded to

the previous PTSD diagnosis in 34 (85%) patients,

which is shown in Figure 1b).

As presented in Figure 2, according to CPS-5-

SR scale data, the minimal level of PTSD symptoms

severity was determined in 9 (22.5%) children of

the experimental group, the mild one was found

in12 (30%) patients, the moderate one – in 11

children (27.5%), severe one was observed in

7(17.5%) patients. Very severe PTSD symptoms

were not identified in this sample.

143

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ

ISSN 2612-2138

Figure.1 a) indicators of the PCL-5 scale in the surveyed patients of the research group.

Note: - patients whose scaling scores are consistent with a previous PTSD diagnosis and require further

examination

Figure. 1 b) Indicators of the PCL-5 scale in the surveyed patients of the experimental group.

Note: * - Patients whose scaling indicators correspond to the previous PTSD diagnosis and require further

examination.

As presented in Figure 2, according to CPS-5-

SR scale data, the minimal level of PTSD symptoms

severity was determined in 9 (22.5%) children of

the experimental group, the mild one was found

in12 (30%) patients, the moderate one – in 11

children (27.5%), severe one was observed in

7(17.5%) patients. Very severe PTSD symptoms

were not identified in this sample.

The results of measuring the somatic symptoms

levels according to the SSS-8 scale showed that

their minimal manifestation was in 7 (17.5%)

participants of the experimental group, low – in 16

(40%) patients, medium – in 6 (15%) patients, high

–in 4 (10%) cases, and very high – in 7 (17.5%)

cases, respectively. These data are schematically

presented in Figure 3. The average value for the

study group was 8.625 ± 0.99 points, while for the

control group - 5.5 ± 0.57 points (t = 0.66;

p≤0.01).

144

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ

ISSN 2612-2138

Figure. 2. Severity of PTSD symptoms in children of the experimental group according to the data of the

CPSS-V SR scale.

Figure. 3. Comparison of the quality values according to the SSS-8 scale in the surveyed children.

Note: * – (р<0.05) the data are reliable between the Control and Experimental groups

The results of the correlation analysis (Fig. 4)

showed that there was a strong correlation

between the SSS-8 and CPSS-V-SR scales (R

=+0.690; P <0.05), and the determination

coefficient (R²) showed that the variation of the first

indicator was determined by the variation of the

second by 47.6 %.

145

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ

ISSN 2612-2138

Figure. 4. The link between SSS-8 and CPSS-V-SR scales in the research group. Correlation field and

regression line (with the equation that describes it (r =+0.690; p <0.05); R² is the determination

coefficient.

The results of correlation analysis (Fig. 5) showed

that there was a strong correlation ((r =+0.831; p

<0.05) between PCL-5 and CPS-V-SR scales, and

the determination coefficient (R²) showed that the

variation of the first indicator was determined by

the variation of the second by 69.07.

Figure. 5 The link between PCL-5 scales and CPSS-V-SR in the research group. Correlation field and

regression line (with the equation describing it (r =+0.831; p <0.05); R² - the coefficient of determination.

According to the results obtained after the

evaluation of the data on the PCL-5 scale, only 2

of the 40 surveyed patients of the research group

did not have the intrusion phenomena (Сluster B).

Avoidance symptoms were observed in almost

half of them, namely in 18 (45%) individuals (Сluster

C). 21 children (52.5%) had negative thoughts and

emotions (Cluster D). The symptoms of excessive

reactivity were observed in 27 (67.5%) patients

(Cluster E).

A detailed analysis of the results according to

the PCL-5 scale showed an uneven distribution of

symptoms of post-traumatic stress disorder (PTSD)

by the main DSM-5 diagnostic clusters (Table 1).

Intrusion symptoms (Cluster B) were the most

common clinical vector of PTSD in children

dislocated due to war and was observed in 38 of

40 children (95%). The coefficient of internal

consistency of this cluster was quite high

(Cronbach’s α = 0.729), which confirmed the

homogeneity of the phenomenological structure

of this cluster, as well as the reliability of the

measurement. The most pronounced symptom

was 4b item – “feeling upset when something

146

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ

ISSN 2612-2138

reminds of a traumatic experience” (M ± m: 2.08

± 0.207; SD = 1.31), which indicated a high

frequency of affective flashbacks and recurrent

activation of affective horror. This provides an

opportunity to interpret the first factor as a

syndrome of “overloaded memory”, where

unprocessed experience breaks into

consciousness and bodily reactions are beyond

the control of the “I”.

Symptoms of avoidance (Cluster C) are less

prevalent, but have a pronounced clinical

structure. They were present in 18 children (45%),

and the internal consistency indicator constituted

Cronbach’s α = 0.755 indicating the relative

stability of displacement mechanisms and mental

isolation. 6C symptom was the most common, i.e.

“Avoidance of memories, thoughts or feelings

associated with traumatic experiences” (M ± m:

1.40 ± 0.189; SD = 1.19), which was interpreted

as a regressive form of instinctive self-defense

aimed at localizing mental pain.

Negative cognitive schemes (Cluster D)

indicate deep transformations of the image of

yourself and the object world. The internal

consistency of the cluster (α = 0.785) was the

highest of all, which may indicate the

consolidation of internal persuasion of the world

threat. Symptoms of Cluster D were detected in 21

children (52.5%). The most significant symptom

was 9D, i.e. “Strong negative beliefs about yourself,

other people and the world” (m ± m: 1,60; SD =

1,41), which provided an opportunity to interpret

this cluster as a result of the destruction of basic

trust in the world, “Basic Trust” by Erikson.

Cluster E (hyperactivation) indicates a chronic

violation of autonomic self-regulation. It was

observed in 27 children (67.5%). The internal

consistency of this cluster was slightly lower

(Cronbach’s α = 0.522), which may indicate the

heterogeneity of the ways of hyperactivity

somatization. The most common symptom - 20E

“Trouble falling asleep or waking up at night” (M =

1.70, SD = 1.18) – demonstrated sleep disorders

as a somatic form of intrusive repetition and an

acute expectation of danger.

Table 1

The heat card of the average values on the PСL-5 scale

Symptoms

Cluster

Cluster D

Cluster

Unwanted memories

1.6

Worrying dreams

1.4

Flashbacks

1.4

Sadness

2.1

Physical reactions

1.4

Avoiding thoughts/feelings

1.4

Avoiding incentives

1.2

Amnesia

1.4

Negative beliefs

1.6

Self-blame

1.1

Negative emotions

1.4

Loss of interest

1.1

Alienation

1.2

Anhedonia

0.97

Irritation/aggression

1.1

Risky behavior

0.8

Hypervigilance

1.2

Feeling constant tension

1.3

Difficulty with focus

1.5

Sleep disorders

1.7

Cronbach's α

0.729

0.755

0.785

0.522

According to the results of the factor analysis of the

PCL-5 scale (Table 2) data which was conducted

by the principal component analysis with Oblimin

rotation, two main components were identified,

147

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ

ISSN 2612-2138

which were consistent with the key diagnostic

clusters of PTSD in accordance with DSM-5 (APA,

2013). The analysis included symptoms with a load

> 0.3. According to scientific recommendations,

the used threshold is acceptable for preliminary

interpretation, the so-called exploratory data

(Field, 2013; Pituch & Stevens, 2015). This provides

an opportunity to identify weak but potentially

significant connections that we plan to check in

the future on a larger sample.

Thus, on the basis of the conducted factor

analysis, it can be concluded that the first factor

indicates how a child’s psyche responds to

traumatic war events through the intrusion

symptoms, which are accompanied by both

psycho-emotional and physiological

hyperactivation. It also represents the reactions to

the traumatic experience and its somatic

manifestations. This includes obsessive memories,

dreams, and the feeling that traumatic events

happen again. All this leads to physiological

reactions such as shortness of breath, heartbeat,

and emotional arousal, as well as avoiding

everything that reminds of the experience. The first

factor also covers the hyper-sense of the threat,

constant tension, and the need “to be alert”

(feelings as if a stressful experience happens

again; strong physical reactions and severe

negative emotions when something resembles a

traumatic event) and behavioral reactions of

protection (staying “wound up” or “on a guard”;

incentives to do things that can do harm; etc.).

The second factor covers the manifestations of

internal emotional disorganization and cognitive

vulnerability. The factor demonstrates the

depressed affective sphere, depressive traits, and

self-isolation. It includes self-blame, loss of interest

in activities that earned pleasure, sleep disorders,

awakening, or night waking. This factor also covers

problems related to concentration, a sense of

emotional distance from others, which indicates

reduced regulation of emotions and cognitive

fatigue.

Table 2

The heat card of factor loads of the PCL-5 scale indicators according to the results of the Oblimin

rotation. (Visualization includes all the symptoms with load ≥ 0.3 by at least one component)

The initial screening of symptoms based on the

analysis of data of the VADPRS scale showed (Fig.

6) that children with combined type disorders,

such as inattention and hyperactivity, prevailed

among the surveyed research group. The average

data amounted to 1.55 ± 0.592 points in the

experimental group, which was 42.6% higher than

in the control group, where this figure constituted

Clusters

Symptoms

Factor 1

Factor 2

Cluster

Unwanted memories

0.525

Exciting dreams

0.41

0.348

Flashbacks

0.625

0.39

Sadness

0.55

Physical reactions

0.79

Cluster

Avoiding thoughts/feelings

0.846

Avoiding incentives

0.64

Cluster D

Amnesia

0.527

0.344

Negative beliefs

0.444

Self -blame

0.729

Negative emotions

0.849

Loss of interest

0.318

0.303

Alienation

0.551

0.438

Anhedonia

0.447

Cluster E

Irritation/aggression

0.419

Risky behavior

0.558

Hypervigilance

0.776

-0.382

Feeling constant tension

0.682

Difficulty with focus

0.691

Sleep disorders

0.654

148

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ

ISSN 2612-2138

0.89 ± 0.179 (p≤0.05). The second place was

occupied by attention disorders. The average rate

was 1.375 ± 0.445 points in the experimental

group, while it amounted 0.8 ± 0.231 points

(p≤0.05) in the control group. It is important to

note that the children of the experimental group

had opposititonal defiant disorder symptoms

(0.525 ± 0.229 points), while this phenomenon

was not observed in the control group.

Figure. 6 Averaged VADPRS scale indicators in the examined patients.

Note: * – (р<0.05) the data are reliable between the Control and Experimental groups.

Table 3

The heat card of the average values according to the VADPRS scale

Inattentive

Hyperactivity/

Impulsivity

Oppositional

Defiant Disorder

Behavioral

Disorders

Anxiety/

Depression

Efficiency/

performance

indicators

1.18 0.65 0.65 0.1 0.55 1.55

1.05

0.33

0.6

0.15

0.7

1.5

0.8

0.33

0.65

0.45

0.75

1.6

0.7

0.55

0.5

0.2

0.6

1.52

0.78

0.57

0.33

0.17

0.5

1.3

0.93

0.88

0.65

0.03

0.4

1.52

0.68

0.95

0.42

0.1

0.88

1.55

1.27

0.7

0.28

0.03

1.68

0.95

0.78

0.03

0.05

The screen of behavioral disorders noted that

the indicators of this subscale were within the

normal range both in the control group and in the

experimental one. However, anxiety and

depression screen indicated the presence of

anxiety-depressive symptoms in both groups of the

149

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ

ISSN 2612-2138

surveyed patients: 0.7 ± 0.251 in the Experimental

group and 0.2 ± 0.121 in the Control group

(p≤0.05).

The second part of the VADPRS scale is devoted

to the assessment of the features of the individual

functioning in various fields, such as: training (in

particular, success); communication with parents,

peers; participation in various group activities. It is

important to evaluate the efficiency of its actions

and productivity by identifying problems in its

performance. The averaged data/performance

data constituted 0.5±0.202 in the research group

and 0.3±0.09 in the control one (p≤0.05).

The detailed analysis of the results according to

the VADPRS scale revealed the characteristic

profiles of emotional and behavioral disorders

among children who had undergone

psychotraumatic experiences as a result of war

and forced displacement (Table 4)

Table 4

Detailed analysis of emotional-behavioral symptoms according to the VADPRS scale

Subscale

Cronbach’s

Leading Item

Original

Item nº

M ± SE; SD

Inattention

0.936

Is easily distracted by

noises or other things

1.27 ± 0.172; SD 1.09

Hyperactivity/

Impulsivity

0.890

Blurts out answers

before questions have

been completed

0.95 ± 0.143; SD 0.904

Oppositional Defiant

disorder

0.898

Actively refuses to follow

an adult’s requests or rules

0.65 ± 0.116; SD 0.736

Behavioral Problems

0.809

Lies to get out of trouble

or to avoid jobs

0.45 ± 0.087; SD 0.552

Anxiety/Depression

0.889

Feels unconfident and

too shy

0.875 ± 0.161; SD 1.02

Efficiency/

performance

indicators

0.954

Overall impairment in

academic and behavioral

performance

49-55

1.68 ± 0.233; SD 1.47

Clinically significant number of symptoms of

inattentive subtype was recorded in 8 out of 40

participants. The coefficient of internal consistency

of this subscale was high (Cronbach’s α = 936),

which confirmed the reliability of the

measurement. The most pronounced symptom

was item 8 – “Gets distracted by noises or other

things easily” (M ± m: 1.27 ± 0.172; SD = 1,09).

Symptoms of hyperreactive/impulsive behavior

were found in 2 children. The internal consistency

of the subscales was Cronbach's α = 0.890. The

most common symptom was represented by item

16 – “Blurts out answers before questions have

been completed” (M ± m: 0.950 ± 0.143; SD =

1.09).

Symptoms of oppositional defiant disorder

were also detected in 2 children; the internal

consistency of this subscale was Cronbach's α =

0.898. The most common symptom of this

subscale was presented in item 21 – “Actively

refuses to follow an adult’s requests or rules” (M ±

m: 0.65 ± 0.11; SD = 0.73).

The results of the evaluation of behavioral

disorders did not show clinically significant values

(Cronbach's α = 0.809). The symptom represented

by item 29 – “Lies to get out of trouble or to avoid

jobs” was the most common among the data (M

± m: 0.450 ± 0.08; SD = 0.552).

The symptoms of anxiety and depressive

experiences were detected in 8 children (%), with

a consistency of this subscale constituting 0.889.

The most common symptom of this subscale was

represented by item 47 – “Feels unconfident and

too shy” (M ± m: 0.875 ± 0.16; SD = 1.02).

Particular attention is drawn to the results of the

Functional Performance Subscale, which reflects

the impact of behavioral difficulties on a child’s

social and educational effectiveness. The internal

consistency of this subscale was the highest of all

–Cronbach’s α = 0.954, which indicated its

extraordinary reliability as a diagnostic tool. In

150

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ

ISSN 2612-2138

general, most children had an average level of

functioning disorders. The highest average score

was obtained for item 55 – “General success at

school” (M = 1.68; se = 0.233; SD = 1.47), which

indicated potential learning difficulties due to post-

traumatic influence.

The results of the VADPRS survey confirmed the

multifactorial structure of behavioral and

emotional disorders in children who were in

chronic stress or had experienced traumatic

events.

Factor analysis with the use of inverse rotation

(Oblimin Rotation) and at the load level ˃0.3

allowed to distinguish four latent components,

each of which demonstrated an internally agreed

and clinically meaningful pattern.

Table 5

The heat card of factor analysis according to the VADPRS scale

Subscale

№

Symptoms

Factors

Inattention

Does not pay attention to details or makes careless

mistakes, for example homework

0.302

0.548

Has difficulty in completing tasks that require sustained

concentration 0.379 0.543

Does not seem to listen when spoken to directly

0.592

Does not follow through when given directions and

fails to finish things

0.75

Has difficulty organizing tasks and activities

0.744

Avoids, dislikes, or does not want to start tasks that

require ongoing mental effort

0.687

Loses things needed for tasks or activities

(assignments, pencils, books)

0.425

0.459

Is easily distracted by noises or other things

0.507

0.519

Is forgetful in daily activities

0.633

Hyperactiv

ity/

Impulsivity

Moves arms or legs restlessly, fidgets in place

0.578

Gets up from a chair during class or in another place

where they are supposed to stay in their seat

0.784

Runs about or climbs too much when they are

supposed to stay seated

0.811

Has difficulty playing or starting quiet games

0.703

0.389

Acts as if he/she is “wound up” like a toy with its internal

motor turned on.

0.58

Talks too much

0.379

0.345

Blurts out answers before questions have been

completed

0.607

Has difficulty waiting their turn

0.878

Interrupts or bothers others when they are talking or

playing games

0.328

0.549

Oppositio

nal Defiant

disorder

Argues with adults

0.425

0.322

0.463

Loses temper

0.442

0.506

Actively disobeys or refuses to follow an adults’

requests or rules

0.374

0.457

Bothers people on purpose

0.551

0.506

Blames others for his or her mistakes or misbehaviors

0.301

0.329

0.521

151

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ

ISSN 2612-2138

Sensitive, irritable, easily “loses his temper”

0.4

0.425

Angry and offensive

0.408

0.56

Is hateful and wants to get even

0.683

Behavioral

Problems

Bullies, threatens, or scares others

0.703

Starts physical fights

0.381

0.613

Lies to get out of trouble or to avoid jobs (i.e., “fools”

others)

0.385

Skips school without permission

0.31

0.624

Is physically unkind to people

0.888

Has stolen things that have value

0.335

Destroys others’ property on purpose

0.52

Has used a weapon that can cause serious harm

(bat, knife, brick, gun)

0.497

Is physically mean to animals

0.908

Has set fires on purpose to cause damage

0.755

Has broken into someone else’s home, business, or

car

0.755

Has stayed out at night without permission

0.755

Has run away from home overnight

0.908

Has forced someone into sexual activity

0.908

Anxiety/

Depressio

Is scared, nervous, or worried

0.51

0.356

Is afraid to try new things for fear of making mistakes

0.656

Undervalues him/herself (feels inferior or worse than others)

0.797

Blames oneself for problems, feels guilty

0.726

Feels lonely, unwanted, or unloved; complains that “no

one loves him/her”

0.58

Is sad or unhappy

0.521

0.453

0.393

Feels unconfident and too shy

0.731

Efficiency/

performan

indicators

Overall school performance assessment

0.801

0.381

How is your child doing in reading?

0.742

How is your child doing in writing?

0.749

How is your child doing in math?

0.828

How does your child get along with you?

0.813

How does your child get along with brothers and sisters?

0.743

How does your child get along with their peers?

0.832

Participation in joint/team games and other group

activities.

0.694

152

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ

ISSN 2612-2138

Factor 1: Social-Cognitive Disorientation. This

factor covers symptoms of inattention,

anxiety/depression, as well as reducing academic

productivity and social functioning. It consists of

manifestations such as forgetfulness in daily

activities, being easily distracted, reluctance to

engage in tasks requiring sustained mental effort,

feelings of inferiority, guilt, loneliness, difficulties in

reading, writing, math, in relations with parents,

peers, brothers/sisters, and reduced participation

in joint games and group activities. This cluster of

symptoms can be interpreted as a pattern of

social-cognitive disorientation that combines

disorders in Cold, Hot, and Social Cognition. It

probably reflects the impaired ability of the child

to process information, emotional regulation, and

interpersonal interaction. In the context of

traumatic experience, this pattern may indicate

deep adaptive disorganization.

Factor 2: Impulse Dysregulation and Behavioral

Disorganization. The second factor includes

symptoms of hyperactivity/impulsiveness as well as

elements of opposition behavior: fidgeting,

blurting out answers, interrupting others, inability to

wait turn, task incompletion, excessive talking,

noncompliant behavior, and emotion reactivity.

This pattern reflects the violation of behavioral self-

regulation and deficiency of impulse control,

which can be a secondary response to the loss of

a sense of security and stability caused by the

experience of war, movement, or family

destabilization.

Factor 3: Antisocial Trauma Processing Pattern.

The third factor includes markers of severe

behavioral disorders, including: physical

aggression, bullying, lying to avoid punishment,

deliberate property destruction, cruelty to animals,

fire-setting, staying out overnight without

permission, coercive sexual behavior, and

vengeful attitude. This pattern is characteristic of

the antisocial form of response to chronic trauma,

loss of trust in adults, and deep disorganization of

the inner world. Despite its destructive orientation,

such behavior performs a compensatory function,

turning the experience of impotence and fear into

a sense of control or dominance. It is noteworthy

that such pattern is not associated with a

significant decrease in cognitive abilities or

academic efficiency, which can indicate

cognitive intact against the background of deep

emotional dysfunction.

Factor 4: Affective Turbulence and Protest

Behavior. The fourth factor combines symptoms of

emotional instability and opposition-protest

behavior, in particular: loss of temper, deliberately

annoying others, blaming others, school truancy,

running away from home, fire-setting, breaking

into others’ property. Despite its external

resemblance to the previous factor, this pattern

has a different psychodynamic nature: it does not

indicate the loss of social ties, but rather indicates

the distorted form of appeal to the adult

environment, an attempt to attract attention

through destructive behavior. It is a behavioral

denial of loss, accompanied by high internal

tension and an unconscious desire to restore

security. Unlike antisocial patterns, this factor

demonstrates the preservation of hope, despite

the existing maladaptation.

Summarizing the results of the study, it can be

argued that the factor structure of disorders found

according to the VADPRS scale in our sample

reflects two key vectors of disregulation:

1. Violation of socio-cognitive processing – that

is, difficulty in understanding social

communication, processing of input information,

as well as in cognitive, emotional, and

interpersonal regulation.

2. Disorders of affective self-regulation – a

decrease in the ability to control your own

emotional reactions and impulses, which can be

manifested through various behavioral patterns

that differ in their depth, direction, and

psychodynamic content.

The identified four clinically significant patterns

(factors) can be considered as different forms of

adaptation to psycho-traumatic events, including

the experience of war, forced displacement, loss

of stability, and violation of the basic sense of

security.

Each of these patterns represents not only a set

of symptoms, but also a special way of mental

processing of traumatic experience, which is

formed depending on the individual

neuropsychological characteristics of the child.

Thus, the results of the study not only clarify the

structure of behavioral disorders in children, but

also offer clinicians relevant directions for

understanding the child’s subjective experience,

his or her inner world, and the specifics of response

to trauma.

These data can be used as a basis for targeted

psychotherapeutic intervention, which takes into

account not only the diagnostic category, but also

the psychodynamic content of behavior and the

level of disorganization due to stressful events.

Discussion

Trauma due to displacement is not just an

event or a number of circumstances, but a deep,

multi-level destruction of the basics of trust in the

world, which violates the ontological matrix of

childhood experience. It is a trauma that affects

153

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ

ISSN 2612-2138

those layers of the psyche that are still being

formed, a trauma that changes the architectonic

of subjectivity itself.

The economic dimension of traumatic

anxiety becomes of crucial significance when we

talk about a child as a subject in the process of

structural formation. As Henry Krystal rightly points

out, it is the excessive, unprocessed intensity of

affect that distinguishes a traumatic event from

usually pathogenic influences (Krystal, 1996).

In this context, the concept of “automatic

anxiety” of Sigmund Freud is especially relevant.

Unlike a signal anxiety that performs a protective

function through a warning representation of

threat, an automatic anxiety breaks into the

psyche as a non-indexed, raw affect, lacking

symbolization. For a child who has no experience

of integrating anxiety within I, this archaic anxiety

acquires the status of a nameless, total threat that

can neither be aware of nor placed in a linguistic

or figurative form (Freud, 1919; Bohleber, 2024a,

2024b).

It is an affective excess that breaks the

stimulus barrier of the psyche, causing the

disorganization of the Ego and regressive splitting

of the holistic experience of the I. This condition is

correctly defined as “pure trauma”, i.e. a condition

in which the mental structure itself is fragmented.

According to the deep observations of the

German psychoanalyst Werner Boleber, trauma is

not only a mental event, but a bodily inscription

that passes through the thinking and symbolic shell

of the subject, leaving traces in bodily memory.

This concept of somatic traumatogram, or

bodily record of the experience, is a key to

understanding why a child’s psyche, being

deprived of an adequate container for affect,

displaces traumatic experience into the body as

the last resistance line (Bion, 1962; McWilliams,

2011; Kechle, 2020).

In this light, the empirical data on the high

frequency of somatic complaints among children

who have experienced forced displacement are

not accidentally obtained. They testify not only to

bodily responsiveness, but also to somatic

representation of the trauma, i.e. the bodily carrier

of unlearned experience. The body becomes a

material resonator of an unspoken, silent cry of a

child who has not been able to find an

environment capable of retaining and symbolizing

his/her suffering.

The protective mechanisms of the child’s

psyche, which are usually formed on the basis of

intersubjective interaction with primary care

providers, are overloaded, insufficient, or

fragmentary in case of displacement trauma.

Therefore, the body appears as a ultimate

repository of an unnoticed experience, as an

“archive without an interpreter”.

Displacement trauma is not only a loss of

home, school or habitual environment. First of all,

it is a symbolic catastrophe of losing contact with

internal good objects such as the image of a

warm, stable home, with the fantasy of parents as

all-powerful defenders capable of holding back

the catastrophe. When this image is destroyed, the

ability of the psyche to maintain a basic sense of

safety disappears.

In the structure of traumatic experience, an

empathy internal object is silent. It is an internal

mediator that usually interprets external stimuli,

contains anxiety and forms a bridge between the

I and the world. The loss of communication with

this object makes it impossible for mental

processing of experience. It is the loss of the ability

to symbolize experiences that deprives the subject

of belonging to the group, to the linguistic field, to

the human space of understanding (Bion, 1962;

Bohleber, 2024a); Bohleber, 2024b).

According to modern psychoanalysts,

trauma that is not processed through narrative

cannot be integrated into the psyche. It remains a

clot of an inarticular affect that cannot “grow

together” into a story, namely the story that has

received recognition and validation. In this

context, audio and video interviews with victims,

recorded in the presence of an empathic listener,

have not only a documentary but also a

therapeutic function. One of these fragments is

presented in our article as a clinical case (see

below).

The difficulty of displacement trauma is that a

person cannot fit his or her experience in a public

narrative. He or she experiences the depreciation

of pain in a place where he/she has been offered

“benefits” such as salvation, safe place, because

his/her experience is not recognized as traumatic.

There is no place for subjective suffering in social

discourse, especially when it comes to the so-

called “tolerated” traumatic events, which forced

displacement is often considered to be.

This conflict is especially acute in case of

children. They have witnessed a unique but still

unnamed history. It is unnamed, neither by

politicians, lawyers, nor by historians, i.e. by

“competent adult”. And even when traumatized

children begin to form their own understanding of

what has happened, they doubt whether they

have the right to express that understanding,

whether someone is able to accept it at all. Where

society denies the trauma of displacement,

protecting their own collective refusal to know, the

child continues to remain alone with the

154

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ

ISSN 2612-2138

experience that undermines his/her basic trust in

the world.

Such situation deprives him/her of language,

not because they cannot speak, but because

they do not feel that someone will hear them. Thir

symbolic apparatus remains paralyzed due to the

absence of an addressee.

A child tries to “tame” the experience in the

absence of a language field where the injury

could be identified. He or she directs an

“undifferentiated trauma” into symptoms that

serve as substitute forms of expression: into

attention deficiency as a form of attacks on their

own susceptibility; into opposition behavior - as a

staging of hope to be heard through a conflict;

into deviant actions – as an internalization of the

aggressor and an attempt to restore the lost

subjectivity by imposing control.

This behavior is not arbitrary. It is an inversion

form of symbolization when aggression and

disorder act as a language in which the child

reports to the world of his/her pain and

abandonment.

The tragedy is that as long as the trauma

remains nameless, unreasonable, it can be either

integrated or mourned. It will continue to be

repeated unconsciously, emerge in new

situations, causing retraumatization and

enhancing the internal confusion. It is only through

a recognition that injury can be transformed from

a foreign core into a part of a biography, like the

pain that ceases to be a stranger when being

mourned.

In this context, it would probably not be an

exaggeration to say that the war, as a

catastrophic event in every sense, creates such a

dense amalgam of psychic fragments of human

pain that humanity has not yet invented an

adequate technology for “distilling” this substance

–no psychosocial or therapeutic process capable

of exhaustively defining, dividing, and mourning

the full scale of this dark side of human existence.

Perhaps, as in case of other collective traumas of

the twentieth century, such ability of a mankind

may be formed through a certain

intergenerational distance, namely a space

where it will be possible to understand the war not

only as a fact, but as an experience that is

subjected to language, narrative, symbolization.

The following clinical case illustrates the

above-mentioned information.

Clinical case The text is adapted in

compliance with ethical principles and stylistically

edited in order to preserve the semantic depth

and ensure the connection of the story.

Past medical history (Anamnesis vitae)

(reconstruction): Patient A., 16 years old, is under

the care of the Center for Psychological Protection

of Children. She was brought up in a maladaptive

family environment with multiple attachment

disorders. According to the girl, her parents did not

participate in her life. The girl does not remember

her father, but characterizes her mother as

emotionally detached, impulsive, and aggressive,

with a background of alcohol abuse and

psychoactive substances.

In childhood, the patient lived most of the

time with her grandmother, whom she remembers

as a tough, emotionally insensitive person. The girl

has a stepfather who is a drug-dependent man

with high levels of aggressiveness, thus creating a

chronically traumogenic environment in the

family. The girl remembers violent conflicts

between her mother and stepfather, with the use

of dangerous items (knives, axes), to which she was

either directly involved or became a witness.

With the beginning of the full-scale invasion of

the Russian Federation into Ukraine in 2022, the

patient, her mother and stepfather were in a city

that was occupied by Russian troops for one

month. This period was accompanied by a

chronic threat to life: restriction of freedom of

movement, forced stay in the basement,

witnessing public executions of civilians, threats

from the invaders, robbery, and the experience of

finding dead bodies of familiar inhabitants. After

the liberation of the city by the Ukrainian army, the

girl was evacuated, and her mother was deprived

of parental rights. Patient A. was directed to the

Center for Psychological Protection of Children,

where she continues to stay. Despite her external

adaptation to the new environment, the girl

demonstrates symptoms of emotional exhaustion,

alienation and anxious alertness. She complains of

nightmares, meaningfully related to war, episodes

of sensory intrusion, accompanied by somatic

manifestations, as well as the return of traumatic

experiences under the influence of reminders.

Mental status (Status mentalis)

Appearance and behavior. The patient is

neat, her clothing is appropriate for her age. She

demonstrates the tendency to mask the face

(always wears a long bang that covers the eyes).

She avoids eye contact, sits tensely, and her

movements are tight. The behavior is mostly

restrained, with signs of emotional closure.

Contact is reluctant, communication is measured

and fragmented.

Orientation and thinking. The statements are

logical, but the content is concentrated around

the topics of danger, loneliness, distrust, fear of loss

155

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ

ISSN 2612-2138

of control. She often uses metaphors such as “the

world is no longer joyful”, “I seem to disappear”,

“my life has lost colors”. There is a deep need for

self-identification: “After occupation, my ideas

about life have been radical”. “I often don’t know

who I am”. “Sometimes it seems that I would like to

be a boy, because it means power, because it is

control”.

Affective sphere. The mood is depressed,

emotionally unstable. The girl complaints about

the return of frightening experiences under the

influence of random reminders of the war. She

expresses a sense of hopelessness, loss of future,

existential loneliness: “I am scared that I will be 18

soon. And I don’t know where to go”. Ambivalence

is noted in the statements: the simultaneous desire

for loneliness and the search for somebody who

would accept her. Signs of emotional numbness

are noted – “Joy no longer brings satisfaction”.

There are also episodes of anxiety and fear

associated with future and repeated loss of shelter.

Sleep. The sleep is interrupted. There are

nightmares of traumatic content: repeated

dreams about murder, shelling, and scenes from

the occupation. There is a fear of falling asleep.

Memory and attention. The patient complains

of difficulties with concentration, attention,

especially during studying. A decrease in cognitive

endurance is observed.

Identity and perception of oneself. The girl

shows signs of a crisis of identity, especially

gender: she is not sure of her own sexual self-

identification. The girl notes that the image of a

man for her is associated with the force that she

wants in order to “control her life”. The patient notes

difficulties in determining her sexual orientation.

The girl seeks for self-isolation, but at the same time

emphasizes her “power” over other girls in the

institution, which can be interpreted as a

compensatory form of control, where she appears

not as a victim, but as an influential, effective

person.

The level of criticality. It is generally preserved,

but mechanisms of dissociation, avoidance, and

behavioral response are observed in the field of

interpersonal relationships.

Psychometric examination results:

1. “Primary PTSD screening”- 17 points.

2. “Posttraumatic Stress Disorder Checklist for DSM

-5” – 64 points.

3. “Somatic Symptom Scale-8” (SSS-8) – 17 points

4. Child PTSD Symptom Scale Self-Report for DSM-

5 (CPSS-5-SR) – 66 points.

5. VADPRS: the scale of oppositional defiant

disorder and anxiety-depressive disorder is

performed.

Diagnostic assumptions (Provisional

Diagnostic Formulation): based on the case

history, mental status and reconstruction of the

patient’s experience, the following diagnostic

hypotheses can be formulated:

1.Post-traumatic stress disorder (F43.1, by ICD-

10).

The clinical picture meets the PTSD criteria:

obsessive memories, flashbacks, nightmares,

hyperexcitability reactions (sleep disorders,

increased alertness), avoidance of trigger

memories, impaired affective regulation are

observed. Traumatic events (occupation,

evidence of violence and murder, long

experience of abuse by mother and stepfather)

are difficult enough to form a disorder.

2. Complex PTSD / C-PTSD syndrome.

The symptoms go beyond the classic PTSD.

There are persistent difficulties in the interpersonal

sphere, destabilization of self-esteem, emotional

dysregulation, dissociative processes, and

disorders of self-determination, which are typical

for C-PTSD, especially in children who have

experienced chronic and cumulative trauma, in

particular in case of domestic violence, loss of

patients’ care and military action.

3. Disorders of identity and social behavior as a

result of trauma.

The patient demonstrates a disorganized

structure of self-awareness, unstable gender

identity, difficulty in understanding her own role, a

tendency to exhibit behavioral patterns that

violate social boundaries, as well as impulsiveness

and a lack of a stable image of “I”. This provides

an opportunity to consider phenomena close to

identity disorders due to severe traumatization.

4. The risk of Borderline Personality Disorder

(BPD) and dissociative disorders development.

Significant affective instability, tendency to self-

destructive behavior or destructive interactions in a

peer group, identity problems, dissociative

symptoms (fragmentation of memories,

emotional detachment) indicate the risk of BPD

development or structurally close personality

disorders in the future. The development of partial

dissociative phenomena as a secondary response

to uncontrolled traumatic tension is not excluded.

Conclusions

1. Post-traumatic symptoms in children

displaced due to war are a common and

multidimensional phenomenon. According to

PCL-5, CPS-V-SR, and primary PTSD screening data,

many children demonstrate pronounced

symptoms of PTSD of varying severity.

156

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ

ISSN 2612-2138

2. Intrusions, hyperexcitability, and negative

cognitive schemes are the most common PTSD

symptoms in the studied sample. Such symptoms

as the recurrence of trauma, irritability, sleep

disorders, and severe negative beliefs about

themselves and the world were particularly

common. This indicates a chronic activation of

memory mechanisms and the need for

psychotherapeutic work with the reconsolidation

of traumatic narratives.

3. There is a strong statistical link between

somatic complaints and PTSD symptoms. The

correlation analysis revealed a significant

association between the results of SSS-8 and CPSS-

V-SR (r = 0.690; p <0.05), confirming the

psychosomatic component of post-traumatic

symptoms in children, which is often

underestimated in clinical practice.

4. PCL-5 and CPSS-V-SR scales show a high

degree of conformity in PTSD assessment. The

correlation between them was R = 0.831 (p

<0.05), which allows them to be recommended

for comprehensive use in screening and

monitoring of changes in symptoms.

5. According to the analysis of the PCL-5

scale, post-traumatic symptoms in children who

have been displaced due to war have a

pronounced and structured character, which

indicates a deep mental trace of traumatic

experience:

A) Intrusive symptoms (Сluster B) are the

dominant vector of PTSD. It is observed in 95% of

children and is accompanied by affective

flashbacks, physiological hyperactivation and

repeated experience of traumatic events. This

provides an opportunity to interpret intrusions as

the nucleus of an uncontrolled traumatic

experience that breaks into the body and psyche

without the participation of the “I” function;

B) The symptoms of avoidance (Cluster C)

represent the protective isolation of the psyche

from excessive affect and do not interfere with the

general pattern of repeated traumatic response.

Their prevalence constituted 45 %;

C) Negative cognitive schemes (Cluster D)

reflect the deformation of the basic ideas about

oneself, others and the world caused by the loss of

a safe objective environment. This cluster has the

highest internal consistency, which indicates the

stabilization of a negative worldview;

D) Symptoms of hyperactivation (Cluster E)

are found in 67.5% of children and indicate a

violation of neurovegetative regulation, which is

manifested in sleep disorders, increased vigilance,

and irritability. This pattern is a somatic

continuation of the intrusive PTSD nucleus.

6. Factor analysis of the PCL-5 scale confirms

the binary structure of post-traumatic response in

children displaced due to war:

Factor 1: Unassimilated mental trauma and

somatic hyperactivation. This factor combines the

following symptoms: intrusions (flashbacks,

emotional reactions to triggers); hyperactivation

(irritability, sleep disorders, physiological arousal);

behavioral avoidance. In general, this factor

reflects the syndrome of uncontrolled obsessive

repeated experience of the trauma, where

unintegrated experience breaks into the psyche

and body without mediation by the Ego. It can be

interpreted as a “psychophysiological matrix of

uncontrolled trauma, which supports the

retraumatization cycle”.

Factor 2: Affective exhaustion and internal

alienation. This component covers the following

symptoms: depressive spectrum (self-accusation,

loss of interest, cognitive fatigue); affective

alienation (emotional separation, difficulty in

resonance with others). In our opinion, it reflects a

violation of affective integration, the loss of an

internal idea of a “good object” and the

dissociation of “I” from internal and external

sources of support. This condition can be

described as “a pattern of affective depletion”,

which leads to a reduction in affective self-

regulation and the capacity to mentalize

emotional states.

7. The results of statistical processing of the

VADPRS scale show the following:

A) Inattention was the most common type of

disorder in the sampling (20%) with high internal

consistency of the subscale (α = 0.936). This

indicates a persistent tendency to mild distraction

as a typical sign of cognitive difficulties in children

after trauma.

B) Symptoms of hyperactivity/impulsiveness

and oppositional behavior were found less

frequently (5%), but both subscales demonstrated

good structural consistency (α=0.890; α=0.898).

Therefore, such disorders are less common but

clinically significant markers of mental

dysregulation.

C) Anxiety and depressive symptoms were

found in 20% of children. Excessive anxiety in

interpersonal relationships was the most common

symptom indicating a lack of basic safety and

difficulties in emotional attachment.

D) Functional difficulties in studying were the

most stable clinical phenomenon (α = 0.954). This

provides an opportunity to interpret the decline in

academic performance as a sensitive indicator of

post-traumatic maladaptation.

E) Factor analysis allowed to distinguish four

dysregulation patterns:

157

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ

ISSN 2612-2138

◦Socio-cognitive disorientation – combines

inattention, emotional vulnerability and reduction

of functioning.

◦Impulse dysregulation – reflects self-control

and behavioral instability.

◦Antisocial pattern treatment – manifests as

external aggression on the background of deep

internal helplessness.

◦Affective-protest behavior is a destructive

reaction to a loss that masks emotional burning.

F) Totally, the symptomatology, revealed

according to the VADPRS scale, was organized

around two axes, namely cognitive-social

disorganization and affective-impulsive instability.

Both axes represented various forms of adaptation

to child psycho-trauma caused by war and forced

displacement.

8. The fact of displacement should be

recognized as a potentially traumatic event in

order to provide effective psychosocial support for

children who have experienced the forced

displacement. The social narrative should include

space for subjective pain, even in cases where the

event is presented as “salvation” or “good”.

Otherwise, the depreciation of the child’s

experience only enhances alienation, blocks the

verbalization of suffering and complicates his or

her integration into the psyche.

Ethical Considerations

The study was conducted in accordance with

the “Rules of Ethical Principles of Human

Research”, which were approved by the Helsinki

Declaration (1964-2013). The study was approved

by the bioethics committee at the Ivano-Frankivsk

National Medical University (Expert Opinion No.

139/23 of 16.11.2023). Participation in the survey

was voluntary and all the necessary permits (incl.,

informed consent) from parents or official

guardians were provided.

Funding statement

The study is a fragment of the research project

“Mental and psychosomatic consequences of

mental trauma as a result of hostilities in Ukraine

among the military and civilian population. Issues

of diagnosis, differential diagnosis, and differential

therapy” (№ state registration 0123U100350) on

the Department of Psychiatry, Narcology and

Medical Psychology, Ivano Frankivsk National

Medical University.

Conflict of interest

The authors declare no conflict of interest.

References

Anderson, N.P., Feldman J.A., Kolko D.J., Pilkonis

P.A., Lindhiem O. (2022). National Norms for

the Vanderbilt ADHD Diagnostic Parent

Rating Scale in Children. Journal of

pediatric psychology. 47(6); 652–661.

https://doi.org/10.1093/jpepsy/jsab132

Bezsheiko V. (2016). Adaptation of the Clinician-

Administered PTSD Scale and the PTSD

Checklist for the Ukrainian Population.

Psychosomatic Medicine and General

Practice. 1(1), e010108. https://uk.e-

medjournal.com/index.php/psp/article/vie

w/8

Bion, W. R. (1962) Learning from experience.

London: Heinemann.

Bohleber W. (2024). Remembrance, trauma and

collective memory. The battle for memory in

psychoanalysis. Ukrainian Psychoanalytic

Journal, 2(2), 118–135.

https://doi.org/10.32782/upj/2024-2-2-11 (

in Ukrainian.)

Bohleber, W. (2024). The development of trauma

theory in psychoanalysis. Ukrainian

Psychoanalytic Journal, 2(1), 123–139.

https://doi.org/10.32782/upj/2024-1-15 ( in

Ukrainian.)

Bovin, M. J., Marx, B. P., Weathers, F. W.,

Gallagher, M. W., Rodriguez, P., Schnurr, P.

P., & Keane, T. M. (2016). Psychometric

properties of the PTSD Checklist for

Diagnostic and Statistical Manual of Mental

Disorders-Fifth Edition (PCL-5) in veterans.

Psychological assessment, 28(11), 1379–

1391. https://doi.org/10.1037/pas0000254

Dangmann, C., Dybdahl, R., & Solberg, Ø.

(2022). Mental health in refugee children.

Current Opinion in Psychology, 48, 101460.

https://doi.org/10.1016/j.copsyc.2022.1014

Field, A. (2013). Discovering statistics using IBM

SPSS Statistics (4th ed.). London: SAGE

Publications.

Foa, E. B., Asnaani, A., Zang, Y., Capaldi, S., &

Yeh, R. (2018). Psychometrics of the Child

PTSD Symptom Scale for DSM-5 for Trauma-

Exposed Children and Adolescents. Journal

of clinical child and adolescent

psychology: the official journal for the

Society of Clinical Child and Adolescent

Psychology, American Psychological

158

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ

ISSN 2612-2138

Association, Division 53, 47(1), 38–46.

https://doi.org/10.1080/15374416.2017.135

0962.

Freud, S. (1919). Introduction to Psychoanalysis

and the War Neuroses. S.E.,17: 207–210.

London: Hogarth Press.

Gatt, J. M., Alexander, R., Emond, A., Foster, K.,

Hadfield, K., Mason-Jones, A., Reid, S.,

Theron, L., Ungar, M., Wouldes, T. A., & Wu,

Q. (2020). Trauma, Resilience, and Mental

Health in Migrant and Non-Migrant Youth: An

International Cross-Sectional Study Across Six

Countries. Frontiers in psychiatry, 10, 997.

https://doi.org/10.3389/fpsyt.2019.00997

Gierk, B., Kohlmann, S., Kroenke, K.,

Spangenberg, L., Zenger, M., Brähler, E., &

Löwe, B. (2014). The somatic symptom

scale-8 (SSS-8): a brief measure of somatic

symptom burden. JAMA internal medicine,

174(3), 399–407.

https://doi.org/10.1001/jamainternmed.201

3.12179

Kang, H., Fischer, I. C., Esterlis, I., Kolyshkina, A.,

Ponomarenko, L., Chobanian, A., Vus, V., &

Pietrzak, R. H. (2024). Helping the Helpers:

Mental Health Challenges of Psychosocial

Support Workers During the Russian-Ukrainian

War. Disaster medicine and public health

preparedness, 18, e95.

https://doi.org/10.1017/dmp.2024.68

Kapel Lev-Ari, R., Aloni, R., & Ben-Ari, A. (2024).

Understanding the dyadic mental health of

refugee parents and children after fleeing

the 2022 Ukraine war. Psychological

trauma: theory, research, practice and

policy, 10.1037/tra0001715. Advance

online publication.

https://doi.org/10.1037/tra0001715

Kechle, D. (2020). Containment in

contemporary psychoanalytic practice.

London: Routledge.

Krystal, H. (1995). Trauma and aging: A thirty-year

follow-up. Trauma: Explorations in memory,

76-99.),

Martsenkovskyi, D., Karatzias, T., Hyland, P.,

Shevlin, M., Ben-Ezra, M., McElroy, E.,

Redican, E., Vang, M. L., Cloitre, M., Ho, G.

W. K., Lorberg, B., & Martsenkovsky, I. (2024).

Parent-reported posttraumatic stress

reactions in children and adolescents:

Findings from the mental health of parents

and children in Ukraine study. Psychological

trauma: theory, research, practice and

policy, 16(8), 1269–1275.

https://doi.org/10.1037/tra0001583

Matiashova, L., Tsagkaris, C., Essar, M. Y.,

Romash, I. B., & Vus, V. I. (2022). Achilles in

Ukraine: Concerns and priorities over the

long-term implications of trauma. The

International journal of health planning and

management, 37(6), 3369–3371.

https://doi.org/10.1002/hpm.3562

McWilliams, N. (2011). Psychoanalytic diagnosis:

Understanding personality structure in the

clinical process (2nd ed.). New York:

Guilford Press.

Mohamed, E. H., & Kheir, D. A. (2024).

Prevalence of Post-Traumatic Stress Disorder

and Depression and Associated Factors

Among Internally Displaced Persons in Al-

Galgala, Sudan. Neuropsychiatric disease

and treatment, 20, 1155–1168.

https://doi.org/10.2147/NDT.S462342

Papadopoulos, R.K. (2021). Involuntary

Dislocation: Home, Trauma, Resilience, and

Adversity-Activated Development (1st ed.).

Routledge.

https://doi.org/10.4324/9781003154822

Pituch, K.A., & Stevens, J.P. (2015). Applied

Multivariate Statistics for the Social

Sciences: Analyses with SAS and IBM’s SPSS,

Sixth Edition (6th ed.). Routledge.

https://doi.org/10.4324/9781315814919

Rayan, R. A., Zafar, I., Tsagkaris, C., Romash, I.

(2021). Internet of Things for Mitigating

Climate Change Impacts on Health.

In Artificial Intelligence and Internet of

Things. 2021:317-330. CRC Press

http://dx.doi.org/10.1201/9781003097204-

Rayan, R.A., Zafar, I. and Romash, I.B. (2021).

Healthcare System 4.0 Perspectives on

COVID-19 Pandemic. In Enabling

Healthcare 4.0 for Pandemics (eds A.

Juneja, V. Bali, S. Juneja, V. Jain and P.

Tyagi). https://doi.org/10.1002/9781119769

088.ch2

Romash IR, Romash IB, Dzivak KV, Tymkiv IS,

Neyko VY, Kelly SK, Pustovoyt MM. Traumatic

events and mental diseases: the role of

certain neurotransmitters, metalloenzymes

and hormones. Pol Merkur Lekarski.

2023;51(2):156-160.

https://doi.org/10.36740/merkur202302109

Romash, I. (2023). Assessment of comorbid

profile, quality of life and social functioning

in patients with schizophrenia and

schizotypal disorders. Medicni

Perspektivi, 28(1), 131–141.

Romash, I. R., Romash, I. B., & Pustovoyt, M. M.

(2022). Features of social dysfunction,

assessment of levels of social frustration and

satisfaction with the quality of medical care

in patients with schizophrenia on the

159

Mental Health: Global Challenges Journal

https://www.sciendo.com/journal/MHGCJ

ISSN 2612-2138

background of somatic comorbidity.

Wiadomosci lekarskie (Warsaw, Poland :

1960), 75(8 pt 1), 1876–1881.

https://doi.org/10.36740/WLek202208110

Tsagkaris, C., Papazoglou, A. S., Romash, I. B.,

Moysidis, D. V., Romash, I. R., Gabunia, L., &

Gorbatiuk, T. (2021). The bone-brain axis?

Biopsychosocial aspects of orthopedics

and a mental wellbeing action plan in

musculoskeletal care Wiadomosci lekarskie

(Warsaw, Poland : 1960), 74(11 cz 1), 2829–

2835.

Vus, V. I., Shkoliar, M. V., Proskuriakov, S., &

Fradelos, E. (2024). Maintaining the mental

health of Ukrainians in time of war: searching

for a mechanism to provide a

comprehensive system of psychosocial

support and mental health awareness.

Polski merkuriusz lekarski : organ Polskiego

Towarzystwa Lekarskiego, 52(3), 373–379.

https://doi.org/10.36740/Merkur202403116

Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri,

P. A., Marx, B. P., & Schnurr, P. P. (2013). The

PTSD Checklist for DSM-5 (PCL-5) – Standard

[Measurement instrument]. Available from

https://www.ptsd.va.gov/

Wolraich, M. L., Lambert, W., Doffing, M. A.,

Bickman, L., Simmons, T., & Worley, K.

(2003). Psychometric properties of the

Vanderbilt ADHD diagnostic parent rating

scale in a referred population. Journal of

Pediatric Psychology, 28(8), 559-

567. https://doi.org/10.1093/jpepsy/jsg046

160