Table of Contents

Section I: The Emerging Link Between Sleep and Trauma – Origins and Interventions
Camille Gledhill, Isabel Gross, Lauren Hong, Hyelim Jeong, Enaya Khurram, Emma Steremberg
– 1. Introduction
– 2. Consolidation of Emotional Memories in REM Sleep
– 3. Sleep as a Therapeutic Target in PTSD
– 4. Discussion and Conclusion

Section II: How Family Trauma Shapes Parent-Child Bonds Within and Beyond Generations
Isha Chinta, Saya Gooden, Ethan Howell, Rami Ibrahim, Defne Iscan, Madison McLellan, Valeria Pang
– 1. Introduction
– 2. The Influence of Parental Response to Trauma on Children in War Settings
– 3. How Is War-Related Trauma Passed Intergenerationally?
– – 3.1. Psychological Factors
– – 3.2 Biological Factors
– – 3.3 Psychological vs Biological Transmission
– – 3.4 Epigenetics
– – 3.5 Stress System Biology in Future Generations
– – 3.6 Amygdala and Brain Response to Trauma
– – 3.7 PTSD in African American and Latino Adults
4. Discussion and Conclusion

Section I: The Emerging Link Between Sleep and Trauma – Origins and Interventions

Camille Gledhill, Isabel Gross, Lauren Hong, Hyelim Jeong, Enaya Khurram, Emma Steremberg

1. Introduction

Post-traumatic stress disorder (PTSD) is a psychiatric illness that can develop after directly experiencing or witnessing a traumatic event (Kessler et al., 1995). It is often diagnosed by four key symptoms: intrusion, avoidance, negative changes in thoughts/mood and hyperarousal.

• Intrusion, flashbacks, nightmares and distressing memories are often experienced by patients and classified together with the process of re-experiencing traumatic memories (Law et al., 2019).
• Avoidance is characterised by behavioural compensations to avoid intrusions triggered by places, people and conversations related to the original trauma.
• Intrusions can provoke negative changes in thoughts and mood, triggering feelings such as guilt, shame, emotional numbness and loss of interest in activities (Purnell et al., 2024). 
• Hyperarousal can be categorised as irritability, hypervigilance, difficulty sleeping and being easily startled.

PTSD not only affects behaviour and emotions, but it also influences how memories are processed in the brain. For example, research has consistently shown that individuals with PTSD often have a smaller hippocampus, the region responsible for contextual and episodic memory (Laugharne et al., 2016; Morey et al., 2012; Zhang et al., 2021). At the same time, the amygdala becomes hyperactive, which reinforces intense, emotional and fear-based memories. This imbalance results in highly vivid, yet fragmented, memories that intrude unexpectedly, which, in turn, makes recovery more challenging (Fitzgerald, DiGangi & Phan, 2018). 

Sleep issues are another key feature of PTSD (Richards, Kanady & Neylan, 2019). Many PTSD patients experience frequent nightmares, difficulty falling or staying asleep and fragmented REM sleep. Fragmented REM sleep means that the brain keeps getting interrupted during the dreaming stage, causing short and broken periods of REM sleep instead of long continuous cycles. Sleep plays a critical role in stabilising and integrating memories (Klinzing, Niethard & Born, 2019), and such sleep disruptions can worsen PTSD by interfering with how the brain processes traumatic memories (Nardo et al., 2015; Pace-Schott, Germain & Milad, 2015). Slow-wave sleep supports the transfer of memories into long-term storage, while REM sleep helps regulate emotions and process emotional learning. When sleep is disrupted, these processes fail and traumatic memories persist. Given these linked findings, researchers are exploring sleep as a potential tool for trauma recovery (van der Heijden et al., 2022). Therapies like cognitive behavioural therapy for insomnia (CBT-I) or imagery rehearsal therapy have shown promising results in reducing nightmares and improving healing. Innovative techniques such as targeted memory reactivation (TMR), where sensory cues are played during sleep, are being tested to alter how traumatic memories are stored in the brain (Denis & Payne, 2024; Hu et al., 2020; van der Heijden et al., 2022b). Together, these techniques suggest that improving sleep could help PTSD recovery by restoring normal memory processing, which is negatively affected by disturbed sleep.

This review explores how sleep is not only disrupted in PTSD but may also play a key role in recovery. Exploring how the quality and duration of sleep affect memory consolidation could provide important insights into how trauma recovery occurs.

2. Consolidation of Emotional Memories in REM Sleep

Sleep is broadly categorised into two sections: rapid eye movement (REM) sleep and non-rapid eye movement (NREM) sleep. The stages of REM and NREM alternate in a cycle of approximately 90 minutes each, multiple times (Patel et al., 2024); this phenomenon is known as the ultradian cycle (Kishi et al., 2011). Both phases contribute to memory consolidation more effectively than wakefulness (Gvozdanovic et al., 2023); yet, each fill different roles in memory. NREM sleep stabilises memories, specifically declarative memories involving facts and events that require conscious recall. In contrast, REM sleep consolidates non-declarative memories consisting of skills, habits, perceptual learning and simple classical conditioning (Kumar, Yanagisawa & Funato, 2024). REM sleep includes high activity in the amygdala, an emotion centre in the brain, where emotional responses from simple classical conditioning take place. Thus, REM sleep is primarily responsible for the consolidation of emotional memories (Lancel et al., 2021). Among emotional memories, the radical ones may be memories associated with PTSD.

REM sleep can contribute greatly to the mitigation of traumatic memories through its involvement in the consolidation of emotional memories. Larson, Schapiro and Gehrman (2023) state: “in particular, rapid eye-movement (REM) sleep is thought to be important for the successful processing of emotional memories, including habituation to emotional stimuli, retention of emotionally salient stories and images, and reduction of next-day negative affect associated with a distressing memory”. Habituation to emotional stimuli signifies that individuals gradually get used to the radical emotions from memories, and retention of emotionally salient memories connotes that REM sleep stabilises the emotionally charged memories. They eventually result in the elimination of the long-term effects of traumatic emotions. This indicates that REM sleep builds a protective shield between individuals’ emotional sufferings and traumatic memories and therefore can decrease emotions from traumatic experiences, improving PTSD symptoms.

Similarly, according to the “Sleep to Remember, Sleep to Forget” hypothesis, “REM sleep enhances the episodic components of emotional memories while stripping away their emotional tone” (Larson, Schapiro & Gehrman, 2023). Zhang et al.’s (2024) study found that dreams often cause individuals to forget certain details about memories and therefore reduces emotional intensity. By erasing emotional intensity through selective forgetting of details, REM sleep, where dreams occur, emerges as a mechanism of treatment for PTSD. Moreover, as dreams often include emotionally relevant experiences, Nielsen and Levin suggest that the dream is a cognitive-emotional processing tool. Previously, nightmares in PTSD patients were seen as purely detrimental; this new perspective suggests that they could be from incomplete or maladaptive processing attempts rather than failures of the REM system (Levin & Nielsen, 2009).

REM sleep provides a unique neurochemical environment that is characterised by high acetylcholine levels and low norepinephrine activity. The balance of these chemicals creates the optimal state for memory reactivation without the stress-driven hyperarousal seen while awake (Walker & Van Der Helm, 2009). Low norepinephrine suppresses stress signalling, allowing for emotionally charged experiences to be processed in a calmer state. This neurochemical shift is thought to promote emotional resilience because it enables the brain to separate emotions from the factual content of the memory (Goldstein & Walker, 2014). Neuroimaging studies consistently show heightened activation of the amygdala, hippocampus and medial prefrontal cortex (mPFC) during REM sleep. The amygdala tags emotional importance, while the hippocampus contextualises the event and the mPFC regulates emotional reactivity. These interactions support consolidation of selective memories and emotional recalibration (Hutchison & Rathore, 2015). For instance, research shows that after a night rich in REM sleep, emotionally charged experiences are recalled better than neutral ones, showing REM’s prioritisation of consolidating emotionally significant content (Payne & Kensinger, 2018). These findings have direct implications for mental health. Fragmented or disrupted REM sleep is often associated with PTSD, and patients tend to exhibit increased REM density yet reduced REM stability, which can contribute the persistence of intrusive memories and nightmares (Mellman et al., 2007). Behavioural interventions, like cognitive behavioural therapy for insomnia (CBT-I) or targeted pharmacological treatments, enhance REM sleep quality and have shown promising results in helping trauma survivors improve their emotional regulation (Rash & Born, 2013).

In summary, REM sleep transforms emotionally intense experiences into less distressing memories, acting as an emotional homeostasis. This function protects against affective dysregulation and offers a potentially therapeutic target for disorders that are rooted in maladaptive memory consolidation. Future research aims to leverage REM-enhancing strategies to treat trauma-related disorders, which can help create new ways to treat these disorders.

3. Sleep as a Therapeutic Target in PTSD

Recent research shows that targeting specific sleep stages and patterns could potentially improve memory processing, reduce intrusive memories and support trauma recovery (Kleim et al., 2016). The following section will explore key aspects of sleep biology, such as REM fragmentation, as well as therapeutic solutions to target sleep disturbances, such as wearable sleep monitoring technologies and cognitive behavioural treatments (Neylan, Poe & Risbrough, 2024; Saguin et al., 2023; Saguin et al., 2025).

PTSD patients often experience fragmented REM sleep, meaning that there are frequent interruptions that break up dreaming cycles. These disruptions seem to be linked to memory difficulties (Grafe et al., 2023; Alkalame et al., 2024; Mellman et al., 2002). Evidence from a study demonstrated that in individuals suffering from PTSD, it was REM fragmentation rather than slow-wave sleep disturbances that predicted impaired consolidation of neutral information (Messman et al., 2023). This finding highlights the unique role of REM integrity in memory consolidation since fragmented REM sleep disrupts the brain’s ability to properly stabilise and store even non-emotional memories that would otherwise be retained. This contributes to the broader memory impairments often observed in individuals with PTSD (Lipinska & Thomas, 2019).

Several strategies have been developed to address REM fragmentation in PTSD; these interventions range from established clinical approaches to emerging experimental methods (Germain, 2013). Pharmacological interventions such as prazosin have been shown to reduce nightmares and nocturnal awakenings by dampening noradrenergic hyperarousal, thereby supporting more continuous REM sleep (Raskind et al., 2003). At the same time, experimental approaches are beginning to provide innovative pathways for addressing REM fragmentation. For example, targeted memory reactivation (TMR) involves re-exposing individuals to neutral cues associated with learning while they are in specific sleep stages, particularly REM. These neutral cues, such as sounds or odours which were paired with learning tasks before sleep, are subtly re-exposed during REM. This reactivates associated memory traces and strengthens these memories’ consolidation while directing processing away from trauma-related material (Abdellahi et al., 2023a; Abdellahi et al., 2023b; Beijamini et al., 2021; Carbone & Diekelmann, 2024). Similarly, the development of wearable sleep technologies capable of detecting REM phases and delivering subtle acoustic stimulation has opened up several possibilities of stabilising REM oscillations in real-time. The goal of this stimulation is not to wake the sleeper, but to subtly reinforce the natural brain rhythms of REM sleep, including theta and gamma oscillations. By stabilising these rhythms, wearable devices can reduce micro-arousals and fragmentation, which allows dreaming cycles to unfold with fewer interruptions (Paruthi et al., 2024; Golrou et al., 2018). This enhancement of REM continuity strengthens the brain’s capacity to consolidate both emotional and neutral memories, which is a significant function in PTSD, where REM disruption is a core symptom. By preserving the importance of memory processing during sleep, these technologies hold promise as adjunctive tools in the development of future PTSD treatments (Recher et al., 2024). 

Imagery rehearsal therapy (IRT) and CBT for insomnia (CBT-I) are two examples of cognitive behavioural treatments which are the most commonly identified and reliable approaches to targeting sleep disturbances directly.

IRT specifically targets nightmares induced by trauma. This therapy works on the basis that nightmares are a “learnt” sleep disorder, and to progressively repress the original nightmare, it must be replaced by positive elements which would no longer produce the negative emotions and cognitions associated with the previous content (Albanese et al., 2022; Horowitz, 1983). At the beginning of this process, the patient is offered psychoeducation on sleep and the relationship between their nightmares and their traumatic experiences. Next, the patient learns to cope with the nightmares using techniques that aim to develop pleasant mental images. Some techniques proposed by Krakow include the use of basic colours and shapes to create positive images and a self-talk method in which the patient associates a word with a pleasant image or story (Albanese et al., 2022). The patient would then make any necessary adjustments to their nightmare using these skills, which may involve changing the plot, theme or ending. A study by Harb et al. revealed that most individuals (58%) constructed an alternative ending, 23% inserted positive images without changing the ending, 13% swapped out threatening elements of the nightmare and 10% added reminders or objects that helped them become aware that they were dreaming (Harb et al., 2012). The rescripted nightmare would be rehearsed during the day until a significant reduction in the frequency of the original nightmare is obtained. According to this technique, the constant repetition of the new nightmare script would lead to a modification of the contents of the original nightmare, and as a result, it would no longer be recalled (Krakow, 2002).

CBT-I is recognised as the front-line treatment for chronic insomnia disorder (Manber, Simpson & Gumport, 2023). It is widely favoured as a treatment due to its effectiveness and lack of side effects which are typically present in pharmacological treatment (Okajima & Inoue, 2017; Wilson et al., 2019). It functions by reducing thoughts and behaviour that interfere with sleep, such as naps, inconsistent sleep and dysfunctional thoughts that affect sleep patterns, by utilising psychoeducation about sleep hygiene and behavioural interventions (Morin et al., 1994; Murtagh & Greenwood, 1995; Okajima et al., 2011). CBT-I has been adapted to condense the delivery of the same interventions across fewer sessions and omit cognitive therapy in brief behavioural interventions (Perlis et al., 2006; Currie et al., 2004; Troxel, Germain & Buysse, 2012).

A few studies have examined the efficacy of nonpharmacological interventions for insomnia in individuals suffering from PTSD. In one case, DeViva et al. examined the effectiveness of a five-session CBT-I trial in five patients with PTSD after they had completed a trial of PTSD-specific CBT (DeViva et al., 2005). This treatment led to significant improvements in sleep onset latency, wake after sleep onset and total sleep time. Many studies have examined the combined effect of CBT-I and IRT. A recent study examined the combined therapy in a sample of veterans with PTSD, in which the first three sessions focused on CBT-I. The CBT/IR group displayed large improvements in sleep quality and self-reported PTSD symptoms compared to the control group, but there were no observed improvement in PTSD-specific disruptive nocturnal behaviours (Schoenfeld, 2025; Ulmer, Edinger & Calhoun, 2011). Moreover, Talbot et al. assessed the efficacy of unaltered CBT-I in PTSD. 45 adults, with PTSD meeting research diagnostic criteria for insomnia, engaged in eight weekly sessions of individual CBT-I and were compared to a monitor-only waitlist control group. The participants’ sleep was continuously monitored using diaries and actigraphy, as well as self-report questionnaires and a follow-up six months later. The results demonstrated that CBT-I was superior to the control condition in all sleep diary outcomes, as well as in polysomnography-measured sleep time. More CBT-I participants also reported improved subjective sleep and fewer disruptive nocturnal behaviours, all of which were maintained at the six-month follow-up (Talbot et al., 2014).

4. Discussion and Conclusion

REM sleep plays an important role in the consolidation and mitigation of emotional memories. While NREM sleep stabilises declarative memories, REM sleep manages emotionally charged experiences by reducing the intensity of emotions of the memories. This quality is also suggested in the “Sleep to Remember, Sleep to Forget” hypothesis, where REM sleep works as a protection from traumatic experiences. These findings indicate important implications for mental health, particularly in PTSD. PTSD is connected to intrusive memories and nightmares that are affected by low-quality REM sleep. Although nightmares have been considered to strengthen intrusive memories, research shows that nightmares may actually represent maladaptive attempts at emotional processing, highlighting the complex nature of the REM role in trauma recovery. However, the consistency of these findings remains questionable. Not all individuals experience emotional relief through dreams. In fact, in some cases, REM disturbances may exacerbate pain. Research suggests that improving the quality of REM sleep through behavioural interventions like CBT-I may stabilise individuals’ traumatic emotions more effectively.

Furthermore, clarifications are required for the neurobiological mechanisms for the role of REM sleep in separating memories from traumatic emotions. Future research should study whether enhancing REM sleep can improve recovery from trauma and whether dreams can be considered as a possible way of therapy. Longitudinal studies may explore REM sleep quality and its role in PTSD as a protector. Ultimately, REM sleep has its potential in curing PTSD as a therapeutic target. Moreover, evidence strongly suggests that sleep does not just simply reflect the after-effects of trauma, but it actively shapes how traumatic memories persist. REM fragmentation appears to be a critical mechanism. Repeated arousals during the REM stage prevent the brain from consolidating neutral and emotional memories. This is particularly significant because it means that PTSD symptoms, such as intrusive memories, may be both a cause and a consequence of sleep disruption, which creates a vicious cycle. Studies show that REM predicts memory impairments, reinforcing the unique importance of this stage for cognitive and emotional memory rather than slow-wave sleep. 

IRT and CBT-I, treatment techniques which target nightmares and insomnia respectively, aid in PTSD recovery by breaking the vicious cycle of sleep disruption and PTSD symptoms. However, these techniques do possess several limitations when treating PTSD. While IRT can reduce nightmares and distress in most individuals, it can be inconsistent when dealing with severe or combat-related PTSD. This was evident in a study in Vietnam, in which veterans who had undergone group-based IRT did not significantly improve their sleep or PTSD compared to control groups (Forbes et al., 2003; Harb et al., 2012). Some issues with CBT-I are the physiological and safety concerns of the procedures within the technique. Sleep restriction may trigger flashbacks or dissociation in the patient, while relaxation training may evoke anxiety or discomfort. Another difficulty with CBT-I is treatment engagement. Due to many PTSD patients displaying avoidance behaviours, adhering to strict sleep protocols can prove more challenging, and therefore, dropout rates are higher than those with primary insomnia. Both IRT and CBT-I are techniques which primarily target sleep disturbances as the root of trauma recovery, so the effects often do not extend to other core PTSD symptoms such as hyperarousal or avoidance, and therefore may not be the most effective techniques in treating PTSD as a whole.

In conclusion, these findings provide evidence that a greater quality and duration of sleep allows effective memory consolidation to take place during REM sleep, therefore improving trauma recovery. NREM sleep preserves factual memories, whereas REM sleep decreases the emotional intensity of traumatic experiences and allows individuals to handle the memories without overwhelming distress. The function is crucial for individuals with PTSD, as high-quality REM sleep may mitigate intrustive memories, while low-quality REM sleep may contribute to them. Clinically, these findings suggest the potential of REM sleep to be used as part of therapy in trauma treatment. Approaches, such as CBT-I, IRT and emerging sleep-enhancing technologies, may improve REM stability and therefore alleviate the emotional charges and intrusive memories. Patients with PTSD can experience better overall quality of life by using sleep as an effective technique in trauma recovery. Future research should precisely investigate how REM sleep takes away the emotional charges from traumatic memories. Longitudinal studies should explore how improving REM sleep can prevent the further development of PTSD. Additionally, research for experimental approaches will be needed in order to commercialise the techniques. Therefore, due to growing evidence linking REM sleep with the processing of emotional memories, sleep should be recognised as a foundation of trauma recovery and sleep disturbances, no longer as mere secondary symptoms of trauma. Instead, sleep therapy should be actively integrated into treatment plans for trauma, such as CBT-I or non-invasive sleep technologies that enhance slow-wave sleep. In the future, researchers should consider prioritising investigations on sleep and recovery, not only to improve overall patient health, but also as a strategy to target the fundamental neurocognitive mechanisms in trauma recovery.

Section II: How Family Trauma Shapes Parent-Child Bonds Within and Beyond Generations

Isha Chinta, Saya Gooden, Ethan Howell, Rami Ibrahim, Defne Iscan, Madison McLellan, Valeria Pang

1. Introduction

War is one of humanity’s most destructive forces. At present, the world is experiencing the highest number of armed conflicts since the Second World War, and public discourse often centres on political leaders, military strategists and combatants. However, children bear the most severe consequences; over 473 million children are currently affected by conflict, representing more than one in six globally (UNICEF, 2023). Large-scale wars such as WWI and WWII are not the only instances with significant repercussions for children. Ongoing conflicts, including civil wars and drug-related violence, throughout the world have diminished children’s chances of living a healthy life (Vesco et al., 2024).

In conflict-affected regions, children face barriers to accessing basic needs, such as adequate nutrition, clean water and shelter. These deprivations, compounded with exposure to violence, increase the risk of developing behavioural and emotional dysregulation, such as irritability or recurring outbursts, which manifest both internally and externally (Center, 2025). These difficulties often impair academic performance, household responsibilities and social skills (Catani, 2018). Consequently, parents under stress may struggle to provide adequate care and may resort to violent or coercive disciplinary practices (Catani, 2018). Parental responses play a significant role in moulding a child’s ability to cope with and adapt to trauma. For example, a parent who provides emotional support, boosts the self-esteem of the child and answers the child’s questions may minimise the effects of the trauma. In contrast, punitive parenting styles exacerbate children’s vulnerability to the psychological impact of traumatic experiences (Liu, 2017). 

Children exposed to war are at an elevated risk for long-term psychopathology, including depression, anxiety, PTSD and substance use disorders. Moreover, traumatic impacts do not end with the directly affected generation. Evidence indicates that descendants of war survivors may inherit heightened susceptibility to PTSD, anxiety and depressive disorders, even without exposure to the original trauma (Catani, 2018). For instance, studies of descendants of Holocaust survivors report intergenerational transmission of trauma-related psychopathology (Mbarki, 2024). Recent research suggests that changes resulting from trauma may alter stress regulation mechanisms in future generations, increasing the prevalence of emotional dysregulation and anxiety (McLean Hospital, 2023). These findings highlight that war-related childhood trauma not only impacts the immediate psychological and physiological functioning of the affected children but also has enduring effects across generations.

In addition to health outcomes, trauma substantially affects educational attainment and workforce participation. Individuals who experience war during childhood often face persistent psychological impairments that interfere with employability and long-term career stability (Barriga, 2022). Interrupted schooling and failure to complete formal education further reduce the acquisition of essential skills for stable employment. In this way, war strips children of both immediate safety and long-term opportunity, shaping not only their personal futures but also those of subsequent generations (Barriga, 2022). The cumulative effects underscore the profound impact of conflict-related trauma on human development and societal stability. Childhood trauma caused by war produces measurable psychological, educational and economic deficits that persist into adulthood and across generations. Recognising this burden is essential for designing interventions that not only address the needs of children in conflict zones but also mitigate the lasting biological and social consequences of war. 

2. The Influence of Parental Response to Trauma on Children in War Settings

Parenting is widely recognised as a challenging responsibility, but during times of war, it becomes an extraordinarily courageous act. Parents or caregivers caught in the turmoil of conflict experience heightened fear and grief even as they try to protect and nurture their children. They must strive to create a sense of normalcy, hope and comfort while war disrupts the foundation of family life (Eltanamly et al., 2019). Survival-oriented sacrifices become embedded in daily routines to shield children from harsh realities. Research shows that parents more heavily exposed to war tend to use harsher discipline and display less warmth towards their children. Multiple mechanisms likely drive this pattern, especially parental mental health symptoms, which can make everyday caregiving feel overwhelming and erode supportive, responsive parenting.

Unprocessed trauma can impair a parent’s ability to be a caregiver and increase the likelihood of transmitting psychological wounds from the war to their child; this is where the concept of intergenerational trauma is relevant. Emotional numbing, hypervigilance or intrusive memories are hallmark PTSS symptoms (Torrico & Mikes, 2024). Parents who are experiencing these symptoms may inadvertently create a home environment lacking the emotional security and consistent responsiveness a developing brain requires. As a result, the child’s source of safety, their home, becomes a source of unpredictability, amplified by the devastation of the war happening outside their homes. Such disrupted attachment fosters the intergenerational transmission of trauma, creating a cycle that is difficult to break.

A mixed-methods meta-analysis (38 quantitative studies; N≈54,000) found that greater parental war exposure is reliably linked to less warmth and more harshness, and these shifts partly mediate the relationship between war exposure and children’s PTSD, depression/anxiety, externalising behaviour, social problems and lower quality of life. Notably, war exposure was not consistently associated with changes in behavioural control, and qualitative synthesis showed a context effect: in conditions of immediate danger, parents tended to be harsher and more inconsistent, whereas merely living under threat often produced overprotection and heightened warmth (anxious vigilance) (Eltanamly et al., 2019).

A study of 145 Israeli adolescents exposed to periods of chronic political violence found that the severity of exposure was positively associated with psychological distress and both internalising and externalising symptoms. The study shos that maternal authoritativeness and warmth buffer distress, while maternal authoritarianism exacerbates externalising symptoms. Notably, in the same study, paternal style and warmth were not significant predictors – an asymmetry that warrants further study but does suggest lever points for guidance in acute settings (Slone & Shoshani, 2017).

War’s broader ecology – displacement, disrupted schooling, family separation and the emotional unavailability of traumatised carers – amplifies risks across a child’s development, underscoring the need for both secondary prevention (protecting children’s routines, education and family unity) and tertiary care (rehabilitation after harm) (Santa Barbara, 2006). Newer findings on intergenerational transmission refine what helps: in a 2024 study, positive parenting reduced child PTSS only when parents themselves did not have PTSS; when parents had PTSS, positive parenting alone did not buffer children’s symptoms, pointing to the necessity of dual-track interventions that treat parental trauma and support responsive, predictable caregiving (Allbaugh et al., 2024). Consistent with this, maintaining family cohesion and familiar routines, while actively bolstering warmth and responsiveness, are repeatedly identified as protective scaffolds for children navigating war-related adversity, as it is not enough to focus solely on the child when the carer’s psychological wellbeing is the foundation upon which a child’s resilience is built.

Together, these findings show that the pathways that link war to children’s lives run through both their direct trauma and the rhythms of parenting. By applying a dual focus, from addressing psychological wounds carried by parents and maintaining a safe environment for children to the preservation of family routines, interventions can help parents create a safe and stable environment for their children to start the healing process for themselves and future generations.

3. How Is War-Related Trauma Passed Intergenerationally?

War-related trauma can be passed down intergenerationally, leading to biological and psychological effects on the descendants of survivors (Mulligan et al., 2025; Yehuda & Lehrner, 2018). Research on first-generation war veterans has found that exposure to war trauma causes long-term psychological effects, including higher rates of PTSD and anxiety, which can negatively impact their children, increasing psychological distress and trauma-related symptoms in future generations (Castro-Vale et al., 2019).

Researchers have examined the relationship between veterans’ combat experience and lifelong PTSD, as well as the psychological characteristics of their children 40 years after the war-related trauma (Castro-Vale et al., 2019). Researchers and clinicians are also examining the long-term effects of traumatic events on war victims, as well as their children and their grandchildren. Studies suggest that intergenerational influences are not only psychological but also family-related, social, cultural, neurobiological and possibly even genetic. Psychologists and other social scientists are also investigating how these intergenerational effects may be transmitted across generations (De Angelis, 2023).

3.1 PSYCHOLOGICAL FACTORS

Dr Lidewyde H. Berckmoes, a social and cultural anthropologist at the Netherlands Institute for Crime and Law Enforcement Research in Amsterdam, and her colleagues spent five months observing and interviewing 41 mothers and their adolescent children who had experienced the 1994 Rwandan genocide. They documented the direct effects of the genocide and the ways the mothers communicated with their children about the trauma. The team found direct effects of the genocide, including varied ways that mothers communicated with their children about the trauma, such as maintaining silence about the event or expressing their hope that the event would not occur again. The investigators also observed indirect effects, like how the genocide affected the second generation through changes including heightened poverty, as well as greater family work burden and compromised parenting (De Angelis, 2023).

3.2 BIOLOGICAL FACTORS

Trauma can also be biologically inherited, particularly through epigenetics, which is driven by environmental influences. According to theory and research on the subject, while these processes cannot alter DNA sequences on their own, they can influence heritable traits or diseases. Psychologist Rachel Yehuda, PhD, director of the traumatic stress studies division at the Mount Sinai School of Medicine, has been studying this possible mode of transmission among children of Holocaust survivors (De Angelis, 2023). In a well-known study comparing methylation rates in 32 Holocaust survivors and 22 of their children with those of matched controls, they found that survivors and their children showed changes in the same location of the same gene – the FKBP5, a stress-related gene linked to PTSD and depression – while controls did not (De Angelis, 2023).

3.3 PSYCHOLOGICAL VS BIOLOGICAL TRANSMISSION

Two broad categories of epigenetically mediated effects are highlighted in research. The first involves developmentally programmed effects that may arise from the influence of offspring’s early environmental exposures, postnatal maternal care and intrauterine exposures reflecting maternal stress during pregnancy. The second involves epigenetic changes associated with preconceptional trauma in parents that may affect the germline and influence foetoplacental interactions (Yehuda & Lehrner, 2018).

3.4 EPIGENETICS

Epigenetic mechanisms refer to how certain behaviours can influence changes in how genes work. Traumatic events can significantly impact an adult’s future health, which in turn affects future generations through epigenetic changes. Also known as generational trauma, the lasting psychological or physiological effects are passed down through generations. This is where the “suffering experienced by previous generations continues to badly affect members of the same family, society, etc, who are born later” (Cambridge Advanced Learner’s Dictionary & Thesaurus, n.d.). There is growing evidence that exposure to trauma before conception can affect offspring. In research with adult offspring of Holocaust survivors, FKBP5 site 6 methylation was significantly lower in Holocaust offspring compared to control subjects (Yehuda et al., 2015). These epigenetic factors may contribute to increased sensitivity to stress-related disorders such as depression, substance abuse and anxiety (Howie, Rijal & Ressler, 2019).

3.5 STRESS SYSTEM BIOLOGY IN FUTURE GENERATIONS

One study examined the relationship between cortisol and putative risk factors for PTSD. Twenty-four-hour urinary cortisol excretion was measured in 35 adult offspring of Holocaust survivors and 15 healthy comparison subjects who were not offspring of Holocaust survivors. Key findings included:

• Children with both PTSD in parents and lifetime PTSD had the lowest cortisol levels of all study groups.
• Parental PTSD appeared to be associated with lower cortisol levels in children, even in the absence of lifetime PTSD.
• Children of Holocaust survivors represented a high-risk group for PTSD, as lifetime PTSD was found to be more prevalent in demographically similar individuals who experienced an equivalent number and type of events meeting the DSM-IV definition of trauma.
• PTSD in children of Holocaust survivors appeared to be strongly associated with parental PTSD (Yehuda et al., 2000).

The idea that familial contributions may increase the likelihood of developing PTSD is supported not only by this sample but also by studies showing a relationship between psychological reactions in trauma victims and a family history of psychopathology. As early as 1918, Wolfsohn demonstrated that 74% of 100 patients with war neuroses reported a family history of psychoneurosis compared to none of 100 matched comparison subjects. These observations were replicated by other investigators, who found similar associations in WWI and WWII veterans and their families, and by a later study of traumatised civilians exposed to disaster. The findings of these studies all described a significantly higher rate of familial mental illness in symptomatic trauma survivors with PTSD compared to either nonexposed subjects or similarly exposed survivors who did not develop post traumatic syndromes (Yehuda et al., 2000).

3.6 AMYGDALA AND BRAIN RESPONSE TO TRAUMA

At its core, PTSD is a pathological manifestation of enhanced fear and avoidance responses to traumatic stimuli. Decades of research have demonstrated that the amygdala is a crucial component of PTSD, primarily due to its role in the acquisition and encoding of fear memories (Haris et al., 2023). Children raised in high-risk family contexts can learn hypervigilant threat processing (psychosocial), and adults with intergenerational risk can manifest stress-system calibration that intersects with this circuitry (biological) (Lumey, Stein & Susser, 2011). While the amygdala is often implicated in the neurobiology of post traumatic stress disorder (PTSD), the pattern of results remains mixed. One reason for this may be the heterogeneity of amygdala subnuclei and their functional connections. 

3.7 PTSD IN AFRICAN AMERICAN AND LATINO ADULTS

Research has suggested that African American and Latino adults may develop PTSD at higher rates than white adults, and that the clinical course of PTSD in these minority groups is poor. One factor that may contribute to higher prevalence and poorer outcomes in these groups is sociocultural factors and racial stressors, such as experiences with discrimination. To date, however, no research has explored the relationship between experiences with discrimination and risk for PTSD, and very little research has examined the course of illness for PTSD in African American and Latino samples. Current literature examines these variables with a sample of 139 Latino and 152 African American adults with anxiety disorders. Findings demonstrate the chronic course of PTSD in African American and Latino adults, and highlight the important role that racial and ethnic discrimination may play in the development of PTSD among these populations. Implications for an increased focus on these sociocultural stressors in the assessment and treatment of PTSD in African American and Latino individuals are discussed (Sibrava et al., 2019).

4. Discussion and Conclusion

Based on our research, we found that parenting has a profound impact on how children live during and after experiencing the trauma of war. While much research exists on the psychology of veterans of war, far less has been devoted to children or other civilian victims. This distinction is critical: the effects of war on someone trained to fight and survive differ greatly from those on a child suddenly forced from their home and confronted with constant danger.  Evidence shows that children cannot simply forget war or other traumatic events. Addressing this gap in research is essential because a deeper study could lead to better strategies for supporting and treating children suffering from war-related psychological damage. 

Much research has also examined young children’s physical development, such as studies on nicotine exposure and its effects on serotonin levels. The same logic that children’s brains are malleable and adapt to their environments applies here. Constant fear and stress from war are likely to alter neurological development. Studies of adults with PTSD, for example, reveal hyperactivity in the amygdala, proving that trauma can reshape the brain. If adults’ brains can change under such strain, it is reasonable to assume that children, whose brains are even more neurologically flexible, may experience even greater alterations after prolonged exposure to violence. Neuroscientists have also described the phenomenon of “toxic stress”, in which repeated activation of stress-response systems during childhood reshapes the brain’s architecture and can impair memory, learning and emotional regulation. 

Parenting plays a critical role in how these neurological and psychological effects unfold. Attachment theory suggests that children rely on caregivers to regulate fear and distress; when caregivers are themselves traumatised or unable to provide stable support, children are left vulnerable to intensified symptoms of anxiety and post-traumatic stress. Conversely, studies show that consistent, nurturing caregiving, even in unstable environments, can buffer against the worst outcomes of trauma. This demonstrates that the parent-child relationship is not only a site where trauma can be transmitted but also where resilience can be fostered. 

Childhood trauma from war is life-altering, shaping psychological, biological and social domains not only for survivors themselves but also for future generations. Trauma can be transmitted psychologically (through communication patterns, parenting styles and family dynamics) and biologically (through epigenetic modifications and changes to stress-response systems). Psychological mechanisms include family communication patterns, parenting behaviours and the environmental hardships that shape the experiences of subsequent generations. Its effects extend beyond immediate dangers like displacement and violence, as children’s rapidly developing brains make them uniquely vulnerable to long-lasting disorders such as PTSD and anxiety. Research on Holocaust survivors, Rwandan genocide survivors and disaster-affected communities shows how trauma can rewire stress responses, alter brain structures and increase susceptibility to psychiatric conditions. Biologically, trauma exposure can induce epigenetic modifications that influence offspring’s neurobiology, particularly in stress-related genes such as FKBP5. These changes can alter the structure and functioning of the amygdala and hippocampus, regions critical for emotional regulation and fear processing. Alongside disrupted stress-hormone regulation, such as dysregulated cortisol levels, these biological mechanisms increase descendants’ vulnerability to PTSD and other mental health disorders. 

Another critical dimension of childhood war trauma is its effect on cognitive development and long-term societal participation. Traumatic stress can interfere with attention, working memory and executive functioning, particularly during adolescence when the prefrontal cortex is still developing. Sleep disruptions, already well-documented as a hallmark of PTSD, further impair these functions by interrupting memory consolidation and emotional regulation. When these impairments persist, they contribute not only to academic underachievement but also to reduced employability and civic engagement later in life. At the societal level, the cumulative presence of war-affected youth who struggle with concentration, impulse control or emotional regulation can undermine economic productivity and weaken post-conflict recovery. These outcomes highlight the interconnectedness of neurobiological changes, psychological distress and social instability, reinforcing why interventions must address not only immediate symptoms of PTSD but also the broader cognitive and educational consequences of trauma. By integrating trauma-informed education, mental health services and family-based support, societies can help restore both individual potential and community resilience. 

The study of intergenerational trauma reveals that war’s effects do not end with direct survivors. Trauma is carried across generations through attachment patterns, epigenetic changes and sociocultural factors. Importantly, these pathways are not limited to family or genetics: experiences of racial discrimination, inequality and poverty can compound vulnerabilities, magnifying distress in marginalised communities. This underscores the need for a multidimensional framework that integrates biological, psychological, cultural and social perspectives. Understanding how trauma is transmitted across generations is crucial for effective clinical practice, policymaking and community support. Interventions must move beyond treating individual PTSD symptoms to address broader familial patterns, cultural narratives and systemic inequalities. Recent approaches emphasise community-based healing initiatives, such as culturally grounded mental health programmes, family therapy and resilience-building interventions in schools. Only through such holistic approaches can cycles of inherited trauma be disrupted and pathways toward resilience and healing be realised. 

In summary, our findings underscore the significant role that parenting plays in shaping children’s wellbeing during and after wartime trauma. By addressing both immediate psychological needs and intergenerational effects, we can better support children in healing from the invisible wounds of war. Through all our findings, our research has concluded on the extent to which parenting affects a child’s overall wellbeing, both during and after experiencing the traumas of wartime. Overall, we found that childhood trauma from wartime leads to the appearance of PTSD and has an impact on their careers later in life.

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