Perpetrator trauma
Trauma from perpetrating violence, distinct from victim-based PTSD.
Perpetrator trauma, sometimes called perpetration- or participation-induced traumatic stress (PITS), describes a form of posttraumatic stress disorder (PTSD) triggered by killing or other violent acts. It differs from moral injury, which centers on the psychological, cultural, and spiritual effects of a perceived moral violation that leads to deep shame.
As a psychiatric condition, the DSM-5 acknowledges active participation as a possible cause of trauma in its discussion of PTSD, adding to the list of causal factors: for military personnel, being a perpetrator, witnessing atrocities, or killing the enemy. Research has been conducted with combat veterans, people who carry out executions or torture, police who shoot in the line of duty, and individuals who commit criminal homicide.
Studies examining severity consistently find that symptoms tend to be more intense for those who have killed than for other causes of trauma. One study using a U.S. government database of Vietnam veterans suggested that the symptom pattern in combat veterans may differ between those who reported killing and those who did not. Those who killed experienced more intrusive imagery, dreams, flashbacks, and unwanted thoughts, while explosive anger, concentration problems, and memory issues were less prominent. Hypervigilance, a sense of alienation, and the non-PTSD symptom of a sense of disintegration were greater among those who acknowledged killing. Alcohol and cocaine use disorders also appeared more severe.
Dream motifs differ from those seen in victim trauma. While eidetic dreams—vivid replays of the event—can occur, other motifs are more common. These include dreams where the tables are turned and the person is killed or vulnerable in the same situation, dreams where victims accuse or demand explanations, and dreams where the self is split in two, with the killer part seen as a separate person.
Therapies that have shown some effectiveness include group therapy, eye movement desensitization and reprocessing, Time Perspective Therapy, and helping sufferers understand how common the problem is. Many who participated in violence due to social expectations benefit from knowing their reaction is normal, not a sign of cowardice or insanity. Traditional remedies like atonement, forgiveness, and bearing witness have also proven helpful over time. More rigorous studies are needed for the
- field
- Psychiatry, trauma studies
- known_for
- Trauma induced by perpetrating violence, distinct from victim-based PTSD
- key_symptom
- Intrusive imagery, dreams, flashbacks, anger outbursts, sense of disintegration
- affected_groups
- Combat veterans, executioners, police, criminal homicide perpetrators, slaughterhouse workers
- therapy_note
- Group therapy, EMDR, Time Perspective Therapy; prolonged exposure counter-indicated
Lore & Background
The DSM-5 addresses active participation as a cause of trauma, adding to causal factors: 'for military personnel, being a perpetrator, witnessing atrocities, or killing the enemy.' Studies have been conducted with combat veterans, people who carry out executions or torture, police who shoot in the line of duty, people who commit criminal homicide, and others. All studies on severity indicate that symptoms tend to be more severe for those who have killed than for other causes of traumatization. One study using the U.S. government database of American veterans of Vietnam suggested that the pattern of symptoms in combat veterans may differ between those who said they had killed and those who said they had not, with intrusive imagery, dreams, flashbacks, and unwanted thoughts more prominent, and explosive anger, concentration, and memory problems less prominent. Hypervigilance, alienation, and a sense of disintegration were greater for those who answered yes on killing, and alcohol and cocaine use disorder appeared more severe.
Reader's Guide
Perpetrator trauma is significant because it expands the understanding of PTSD beyond victimization, acknowledging that those who inflict harm can also suffer severe psychological consequences. The condition has been documented among perpetrators of the Holocaust, the Indonesian Communist Purges, the Cambodian genocide, South African apartheid, and among slaughterhouse workers. Therapies showing some effectiveness include group therapy, eye movement desensitization and reprocessing, Time Perspective Therapy, and traditional remedies of atonement, forgiveness, and bearing witness. However, the 'flooding' technique (Prolonged Exposure) appears counter-indicated when trauma involved active infliction of harm. Expressive writing may increase anger in soldiers. The condition's symptoms—anger outbursts, emotional numbing, detachment, and substance use—can contribute to cycles of violence, including domestic violence and street crime. More vigorous studies are needed for all suggested therapies, with the distinction of perpetration versus victimization in mind.
Did You Know?
- All studies on severity indicate that symptoms tend to be more severe for those who have killed than for other causes of traumatization.
- Dream motifs in perpetrator trauma include the dreamer being killed, victims accusing the dreamer, or the self being split into two parts.
- The 'flooding' technique (Prolonged Exposure) is counter-indicated when trauma involved being active in inflicting harm.
- In the 11th century, soldiers involved in the Norman conquest of England took part in the Ermenfrid Penitential to atone for violence.
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