Trauma of Forced Displacement in Children as a Result of Russian-Ukrainian War

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, 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.

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.

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 Control 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 questionnaire meets the diagnostic criteria indicated in the Diagnostic and Statistical Manual of Mental Disorders, 5^th 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).

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).

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

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).

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.

Figure. 2.

Severity of PTSD symptoms in children of the experimental group according to the data of the CPSS-V SR scale.

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).

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 %.

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 (Cluster B). Avoidance symptoms were observed in almost half of them, namely in 18 (45%) individuals (Cluster 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 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.

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, 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.

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 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.

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 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)

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 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.

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:

• 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.

• 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.

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 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 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.

• 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.

• 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.

• 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.

• 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.

• According to the analysis of the PCL-5scale, 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 (Cluster 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.

• 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.

• 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:

    • ◦

      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.

• 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.