Psychology
2012. Vol.3, No.1, 90-99
Published Online January 2012 in SciRes (http://www.SciRP.org/journal/psych) http://dx.doi.org/10.4236/psych.2012.31015
90
Collective and Personal Annihilation Anxiety: Measuring
Annihilation Anxiety AA
Ibrahim A. Kira1, Thomas Templin2, Linda Lewandowski2, Vidya Ramaswamy2,
Bulent Ozkan2, Jamal Mohanesh3, Abdulkhaleq Hussam3
1Center for Cumulative Trauma Studies, Stone Mountain, USA
2Wayne State University, Detroit, USA
3ACCESS Community Mental Health and Research Center, Dearborn, USA
Received October 21st, 2011; revised November 24th, 2011; accepted December 26th, 2011
AA is defined in the psychoanalytic literature as fear of impending psychic or physical destruction that is
triggered by personal survival threats. Little or no attention in the psychoanalytic literature was given to
collective or group survival threats. We developed a short measure for AA that includes both kinds of
survival threats. We used a clinical sample of 399 mental health clients and measures for cumulative
trauma, PTSD, cumulative trauma related disorders, depression and anxiety. We conducted confirmatory
factor analysis, multiple regressions, and path analysis. The developed short measure has good reliability,
strong divergent and predictive validity and generally fit the theoretical assumptions that underlie the
construct. The measure can be useful in clinical screening, and in psychological and political research,
especially with the multiply traumatized. Subsequent research that utilized the measure replicated the
findings.
Keywords: Collective Identity; Annihilation Anxiety; Identity Threats; Collective Annihilation Anxiety;
Identity Salience; Mortality Salience
Introduction
Definitions and Theory
Annihilation Anxiety AA was introduced in psychoanalytic,
ego, self-psychology, and object relations psychology literature
(e.g., Hurvich, 1989, 2003). However, the construct goes back
to existential philosophies of Sartre and Heidegger (e.g., Petot,
1976). According to Hurvich, 2003, Annihilation anxieties are
defined as an individual subjective fear of impending psychic
or physical destruction that are triggered by personal survival
threats (Hurvich, 2003). AA is found to be associated with dis-
rupted ego functioning and poor ego development, panic, de-
pression, inability to function, avoidant behavior, self-destruc-
tion or self-injurious behavior (e.g., Hurvich, 2003; Borg, 2003;
Cassidy-Charren, 2003). Many authors early identified AA
through the clinical presentation of schizophrenia, borderline
and psychotic disorders (e.g., Rosenfeld, 1950; Teixiera, 1948).
AA is considered to be a key component of post-trauma re-
sponse (Miller, 2001). AA as defined in psychoanalytic litera-
ture, has individualistic bias, as it is focused on the individual’s
concerns for his/her personal survival and put less or no em-
phasis on such feeling resulted from Individual’s concern for
threats to her/his own collective or group survival.
AA is defined by authors is a chronic terror of losing per-
sonal or social self or selves as a result of identity, personal or/
and collective/ group’s survival threats. AA emerges from fears
that one or more of the self salient identities will be subsumed,
devoured, dissolved or fused, penetrated, fragmented, destroyed,
disappeared or subjugated, due to real or perceived threats to
such salient identities’ survival. Identity salience, personal and
collective, is a strong explanatory paradigm for AA (Kira, 2002,
2006; Smith, 1999). Individual’s Identity that has developed
through the individuation process shapes the individual’s feel-
ings of existential belonging to self, family and groups. Differ-
ent kinds of existential identity survival threats can cause dif-
ferent types of AA.
Primary appraisals involve judgments about whether the in-
dividual or his affected group is in jeopardy, whereas secondary
appraisals involve judgments about the group or individual
potential self-efficacy in responding to the event. (e.g., Lazarus
& Folkman, 1984). The individual’s appraisal of his/her self is
related to perception of self-efficacy and adequacy (secondary
appraisal). AA is related to the secondary appraisal process of
trauma, i.e., appraisal of self-efficacy. Such appraisal, when
positive, produces feelings of agency and self-efficacy (c.f.,
Bandura, 1997), when it is negative may produce distress and
AA. Trauma theories distinguish between two types of identity
trauma with relevant identity threats and related levels of AA:
1) AA that results from personal identity trauma. Personal
identity traumas violate personal autonomy, self-control and
self-efficacy, for example rape or sexual abuse. It may include
some debilitating illness and serious disabilities that result loss
of functioning and dependence on others.
2) AA that result from collective identity trauma. According
to self-categorization theory (e.g., Turner, 1985), and to inter-
group emotions theory (Smith, 1999), when social identity is
salient, group members perceive themselves as exemplars of
the group and events that harm or favor the group harm or favor
the self. When social identity is salient, appraisal of events
relevant and important to the group focuses on social rather
than personal concerns. Group-based appraisals elicit specific
emotions and action tendencies (Smith, 1999). Group members

I. A. KIRA ET AL.
feel happy, sad, or traumatized depending on the successes or
failures of the in-group with which they identify, even if they
do not personally contribute to that outcome (Cialdini, et al.,
1976).
In the case of collective identity traumas, the effects of per-
ceived in-group strength or efficacy on offensive and revenge
action tendencies (secondary appraisal) are mediated by anger
(Mackie, Devos & Smith, 2000). Conversely, in the event of
negative appraisal of the group strength or vulnerability (group
efficacy) in severely traumatized and minority groups, fear of
annihilation, feelings of humiliation, subjugation, distress, and
other negative emotions can erupt (e.g., Kira, 2002; Kira, et al.,
2008). Minority groups and oppressed are likely to have less
perceived efficacy compared to dominant groups, which are
associated with increased AA feelings when confronted with
such events. Extreme examples of such threats are nuclear an-
nihilation threats that are posed directly or indirectly to a nation
or to species (e.g., Olsen, 1984). Holocaust for Jewish people
(e.g., Garwood, 1996, and the collective threats to the Jews and
Palestinians (Kira, 2006; Kira, et al., 2007) are other examples.
Such threats to the existence of such groups can activate group
identity salience and deactivate personal identity and mortality
salience causing terror and fear of group annihilation (Kira,
2002, 2006).
While the concept of general anxiety measured in clinical
psychology represents general psychological and physical
symptoms that may be triggered by different general concerns,
AA belongs to different category of anxieties that are specific
and triggered by specific identity survival threats. AA is as-
sumed to predict general anxiety, and to have more severe con-
sequences than general anxiety. Focusing on AA as specific
anxiety resulted from identity survival’s threats, can enrich
empirical and clinical research by focusing on the etiology of
symptoms. Identifying the underlying annihilation anxieties,
that may be key contributors to the emergence and maintenance
of post-identity trauma symptoms, may help better address
them.
It may be useful to tie psychoanalytic and cognitive appraisal
perspectives on evaluating the clinical utility and measuring the
AA concept. AA is almost ignored in the mainstream clinical
and cognitive psychology as well as in traumatology. It may be
worthwhile to develop this initially psychoanalytic construct
and integrate it in the mainstream clinical, political, cognitive
and trauma psychology disciplines. In the next sections we will
briefly discuss the issues relating to AA and trauma measure-
ment.
Measuring AA
The psychoanalytic literature focused more on defining and
measuring AA that result from threats to dependency and or
threats to personal identity. They used a projective Rorschach
sub-test to measure the construct (e.g., Benveniste, Papouchis,
Allen & Hurvich, 1998). Rorschach and projective measures,
while attractive, is hard to use in research with large samples. A
self-report measure for AA, Hurvich experience inventory HEI
has been constructed by Hurvich (1998). HEI was found to
have weak association with Rorchach AA sub-scale (Ben-
veniste, Papouchis, Allen, & Hurvich, 1998). HEI may have
some problems with its face and construct validities. Some of
its items represent potential outcome for AA, rather than AA
per se. For example it includes items about nightmares which
are part of PTSD concept. Other items of HEI ask about panic,
dissociation, fear of death, anxiety for being alone. Such items
made it contaminated and difficult to use to measure its asso-
ciation with such constructs such as PTSD, depression, disso-
ciation, panic attacks, fear of death and general anxiety. Fur-
thermore, the measure does not include items that represent the
other types of threat that may activate AA such as collective
threats. On the other hand, measuring AA in severely trauma-
tized population, for example refugees and torture survivors,
are challenging. Some of the most severe threats to their iden-
tity are collective identity threats. A brief screening measure for
AA that include collective or group identity threats can be more
useful in clinical settings as well as in research with severely
traumatized populations and in political psychology.
Method
Research Questions
Is the concept of AA useful and can be measured and used to
predict negative mental and physical health outcomes to differ-
ent traumas and their appraisal in clinical and research settings.
Is the AA related to collective identity important component of
AA construct?
Research Hypotheses
Hypothesis 1: The multi-component construct of AA as
measured by the brief three items scale, developed in this study,
is valid and reliable.
Hypothesis 2: AA is unique but significantly correlated to
general anxiety.
Hypothesis 3: Different traumas that threaten personal and
collective identities predict AA.
Hypothesis 4: Negative appraisal is stronger predictor of AA
than the sheer occurrence of the traumatic event.
Hypothesis 5: AA predicts poor mental and physical health.
Hypothesis 6: AA mediates the effects of different traumas
on mental and physical health and on suicidality.
Participants
Participants were 420 adult mental health clients in a clinic in
Dearborn Michigan that constitute all active clients that came
for a psychiatrist, therapist, or case manager visit during the 6
month from August 2004, to February 2005, and who accepted
and consented to participate (90%). Twenty one of the ques-
tionnaires, when screened, found to be questionable and ex-
cluded and 399 remained as participants. The sample included
82.7% mental health patients from Arab American and Iraqi
refugees (highly traumatized from collective cultures), and
17.3% from non-Arabic origins. Age ranged from 18 - 76, with
mean of 39.66 and SD of 11.45. It included 53.5% males and
46.5% females. Nineteen percent of the participants (76 par-
ticipants) reported the experience of torture in their own coun-
try of origin. For the length of stay in US, the average was 3.24
years of stay with SD of 2.13. Table 1 details the distribution
of employment, marital status, length of stay in US, citizenship,
education, and religious affiliations.
Procedure
Informed consents were obtained from adult participants. No

I. A. KIRA ET AL.
92
Table 1.
The distribution of employment, marital status, length of stay in us, citizenship, education, and religious affiliations.
Demographic Variable % Demographic Variable %
Employment status: unemployed or on disabilities 51% Citizenship or immigration status: residents 32.2%
Employment status: Employee for organizations 5.5% Citizenship or immigration status: citizen by naturalization 23.4%
Employment status: homemakers or house wives 19.5% Citizenship or immigration status: citizen by birth, 9.6%
Employment status: professionals 3.4% Citizenship or immigration status: others. 3.6%
Employment status: retired 5.7% Education: Illiterate 14.2%
Employment status: other kinds of employment 14,9% Education: Elementary School 27.5%
Marital status: Married 70% Education: Intermediate to Junior high 36.9%
Marital status: Single 17.3% Education: High School 16.5%
Marital status: Separated 2.5% Education: University Graduates 4.9%
Marital status: Divorced 7.6% Income: less than 5,000$ a year, 47%
Marital status: Other 2.5% Income: less that 25,000$ a year 95%
Length of Stay in US: 2 years or less 26.9% Religious affiliation: Muslims 84%
Length of Stay in US: three years 38.3% Religious affiliation: Christians 12.5 %
Length of Stay in US: four years 25.1% Religious affiliation: Jewish 1%
Length of Stay in US: 5 years or more 9.8% Religious affiliation: others. 2.5%
Citizenship or immigration status: refuges from Iraq 31.2%
identifying information, linking subject to the data, was re-
corded and the disclosure of the data could not reasonably place
the subjects at any risk for any liability. Interviews were con-
ducted face to face by clinicians. Participants gave the choice
between being interviewed in Arabic or English. The data col-
lected was part of approved study of the effects of mental
health stigma and stigma consciousness to evaluate an anti-
stigma intervention. The data collection continued from No-
vember 2004 to February 2005.
Measures
Process and Criteria for Developing and Using Measures
In this study, close attention was paid to developing and us-
ing measures that would be reliable, valid, and culturally-ap-
propriate for this refugee and clinical populations.
Several of the tools used in this study as identified in the fol-
lowing section, have previously been shown to have adequate
reliability and validity on Iraqi and Arab populations and in
Arabic and English languages (e.g., Kira, et al, 2001, 2006,
2008). One of the rules we adopted in designing the current
scale is the law of parsimony, which required that we choose
the least number of questions without compromising reliability
or validity. This rule needs to be adopted especially in the case
of refugees and highly traumatized populations as their atten-
tion span and tolerance for long questioning may be limited and
can cause high rates of missing or unreliable data. Chochinov,
Wilson, Enuus, & Lander (1997), in a landmark study on ter-
minally ill subjects, found that a single item measure of depres-
sion had more predictive power for a diagnosis of depression in
this population than other longer clinical tools including the
Beck Depression Inventory. That may mean that single item
and short measures that reduce subject burden, can be reliable
and have high predictive power.
The new measures for this study were first constructed in
English and subsequently translated into Arabic by three bilin-
gual mental health professionals who each individually trans-
lated the measures and then met together to establish a consen-
sus on the final version based on the criteria of adequate cul-
tural sensitivity and appropriateness in measuring the construct
of the instrument.. A fourth mental health professional did the
reverse translation. These measures were pilot tested in focus
groups.
The measures used in the current study include:
Independent Variable Measures
Cumulative Trauma Scale and Its Sub-Scales
The measure includes 61 items. Each item describes ex-
tremely stressful event. The participant was asked to report if
he/she experienced it or not, how many times he have experi-
enced the event, at what age first time, and how much it af-
fected him positively or negatively on a scale from 0 to 7. The
measure provides us with general scales for two of cumulative
Trauma doses: Occurrence and frequency of happenings, two
appraisal sub-scales: negative and positive appraisal. It includes,
at this level, four sub-scales for each trauma types. Trauma
types include according to Kira’s taxonomy of trauma (Kira,
2001, 2004; Kira, et al., 2008a; Kira, et al., 2011a): Collective
identity, personal identity, attachment, interdependence, physi-
cal survival, and self-actualization. For the purpose of this
study we focused on cumulative trauma occurrence and its
cumulative tertiary negative appraisal (CTNA) for the general
scale and for the 6 trauma types (14 sub-scales). The measure

I. A. KIRA ET AL.
and it subscales proved in previous and subsequent studies to
have good alpha reliability coefficients that ranged between .89
and .98, construct and predictive validity (Kira, et al., 2008a,
2008b). Alpha coefficients in the current data are .92 for cumu-
lative occurrence, .98 for cumulative positive appraisal (CTPA),
and .88 for cumulative negative appraisal (CTNA). Its sub-
scales alpha reliability coefficients ranged from .70 - .92.
Dependent Variable Measures
Annihilation Anxiety Scale (AA) (3 items)
The measure is based on the assumption that there are at least
three main sources of the emergence of annihilation anxiety,
personal identity, collective identity survival threats (traumas)
as well as threats from societal structural inequalities, for ex-
ample extreme poverty (Kira, 2004; Cassiman, 2005). These
three sources represent the different sources of AA we dis-
cussed earlier. An item that represents each area of annihilation
concerns was chosen from 10 suggested items for each area by
a group of five clinicians. A three items that represents the three
components were chosen to include the following 5 point-
Likert-type questions:
1) Because of what has happened to me personally or is hap-
pening to me personally, I sometimes worry that I just lose my
sense of self (I worry that I will cease to exist as an individual
person).
5. Strongly Agree 4. Agree 3. Not sure 2. Disagree
1. Strongly Disagree
2) Sometimes I feel the threat of extermination/annihilation
(that is, the threat of termination or “getting rid of” or ultimate
subjugation) of my group because of discrimination or stereo-
typing or acts committed against me, my race, religion, culture,
or ethnic group.
5. Strongly Agree 4. Agree 3. Not sure 2. Disagree
1. Strongly Disagree
3) I feel threatened by extreme inequalities in this society.
5. Strongly Agree 4. Agree 3. Not sure 2. Disagree
1. Strongly Disagree
PTSD Measure (CAPS-2) (18 items): This measure was de-
veloped by Blacke et al. (1990) and is widely used to assess
PTSD. It is a structured clinical interview that assesses 17
symptoms rated on frequency and severity on a 5-point scale.
CAPS demonstrated high reliability with a range from 0.92 -
0.99 and showed good convergent and discriminant validity
(Weathers, Keane & Davidson, 2001). In this study, we used
the frequency sub-scale of CAPS-2 that is currently widely
used in psychiatric literature. The scale used in this study has
high reliability with an alpha of 0.97. The scale has four sub-
scales: re-experiencing, avoidance, arousal and dissociation.
Reliability of the four sub-scales in current sample are adequate
to high (alphas are .96, .92, .89 and .85 respectively).
Cumulative Trauma Disorders Measure CTD (15 items). The
measure has been developed on several community and clinic
samples on adults and adolescents Iraqi refugees and Arab
Americans. It is an index measure that covers 13 different
symptoms: depression, anxiety, somatization, dissociation,
auditory and visual hallucinations, avoidance of being with
people, paranoid ideations, concentration and memory deficits,
loss of self control, feeling too harsh with family, and with
people in general, feeling suicidal, and feeling like hurting self.
Exploratory factor analysis found four factors (sub-scales):
Executive function deficits, suicidality, dissociation/ psycho-
tism, and depression/ anxiety interface. Reliability of the four
sub-scales found to be high (.95, .97, .98, and .96 respectively).
Confirmatory factor analysis confirmed this structure in a dif-
ferent sample. The measure has good reliability (ranged
from .85 and .98), construct, and convergent, divergent and
predictive validity. Test-retest reliability in a 6 week-interval
is .76. Different kinds of traumas, and cumulative trauma in
general accounted for significant variance as predictors of CTD
symptoms (Kira, 2004; Kira, Clifford, Wiencek, & Al-haider,
2001; Kira, Clifford, & Al-Haider, 2002, 2003). It has alpha
reliability coefficient of .91 in the present study.
CES-D Depression Measure: Center for Epidemiologic stud-
ies-Depression mood scale is a 20 item scale (Radloff, 1977).
Each item is assessed on a 4-point scale and reflects the fre-
quency that each symptom is experienced (0 = none of the time,
3 = all of the time). Adequate reliability and validity have been
reported for the CES-D. A cutoff score of ≥16 is commonly
used for the CES-D to indicate a need for further assessment of
the presence of MDD (Radloff, 1977). High internal consis-
tency reliability results (ranging from .85 to .92) have been
found for the CES-D among various age, sex, geographic, and
racial-ethnic subgroups. Validation studies have found that the
CES-D has good convergent validity, discriminant validity
(Himmelfarb & Murrell, 1983), and sensitivity and specificity
(Mulrow, et al., 1995). It has alpha reliability coefficient of .91
in the present study.
Depression, Anxiety Stress Scales. Anxiety (DASS-A) Anxi-
ety Measure (14 items): DASS is a 42-item scale developed by
Lovibond & Lovibond, 1995, and includes three sub-scales that
measure depression, anxiety, and stress. DASS- A sub-scale
measures anxiety, which is increasingly used in different clini-
cal and research settings. Different studies suggest that DASS-
A possess adequate convergent validity, with reliability of .84
in non-clinical samples and .89, and 91 in clinical samples (e.g.,
Lovibond & Lovibond, 1995). Its alpha reliability in the present
study is .95.
Self-rated health SRH is measured by a single item question
about general health. The question asks to rate your general
health according to five Point Likert-type scales (excellent,
good, fair, poor, very poor). Following Wanous and Hudy’s
(2001) method of estimating single-item reliability using factor
analysis, the reliability of the SRH scale was .77 (communality
of the item). Factor analysis was conducted between the item
and other health problems in a previous study on the same
population (Kira, et al., 2006). Using the correction of attenua-
tion formula, reliability is estimated to be between .78 (Con-
servative) and .87 (liberal). The item correlation using the full
12 items health scale (that includes a list of health conditions)
in a previous study was .91.
Analysis
We calculated Alpha reliability for the three item scale, and
for all scales that we utilized. We conducted test-re-test reli-
ability of AA’S on a small sample (n = 30) after 4 weeks. We
conducted exploratory and confirmatory factor analysis using
general anxiety scale (DASS-A) and AA together to test the
independence of AA construct compared to general anxiety and
to explore its construct and divergent validity. We tested AA
predictive validity through using multiple regression analysis
with AA as independent variable and depression, poor health,
PTSD, and general anxiety as dependent variables, controlling
for demographics. To test the hypothesis that specific trauma
types, and high trauma dose predicts AA, we conducted a series

I. A. KIRA ET AL.
94
of multiple regression with trauma dose, trauma types and
negative appraisal of different traumas as independent variables
and AA as dependent variable controlling for demographics.
We used SOBEL test (using SPSS macro with bootstrap, num-
ber of repetitions = 10.000) to examine the potential significant
indirect effects of AA on suicidality through the mediation of
depression, Anxiety, PTSD and other CTD sub-scales.
The proposed path models were evaluated using structural
equation modeling (SEM) with AMOS 7.0 (Arbuckle, 2006).
We constructed hybrid models that used latent and observed
variables. A satisfactory model fit is indicated by a no signifi-
cant Chi Square (although significant values are acceptable
when the sample size is large, which is the case in the current
sample) (see Hu & Bentler, 1999). Accordingly, we tested the
path models of AA as mediator of the effects of specific trauma
type’s occurrence and their CPTA and CNTA on different
mental health conditions as well as on general health. To ex-
amine the mediation hypothesis we used bootstrap (N = 200)
with bias-corrected confidence intervals to tests the significance
of the direct and indirect effects of each predictive variable (e.g.,
Erceg-Hurn & Mirosevich, 2008).
Results
General: Using ANOVA to test the differences between
refugees, permanent residents, naturalized citizens and citizens
by birth in AA, refugees have significantly higher scores of AA
compared to the other groups with no significant differences
between the other three groups (refugees: N = 114, M = 11.33,
SD = 3.12; Permanent residents: N = 108, mean = 8.69, SD =
3.84; naturalized citizens N = 82, M = 8.51, SD = 3.47; Citizens
by birth = 35, M = 8.11, SD = 3.43; Total mean score for the
sample M = 9.50, SD = 3.62; p < .000). The scores are high for
all groups in this sample of mental health clients’ considering
the maximum score is 15. No significant differences found
between age groups, education, marital status or gender catego-
ries in AA. The mean number of life-time trauma types the
participant endured is 10.34 with SD of 7.70. The refugees has
the highest cumulative trauma dose with mean of M = 11.46
and SD of 6.68, compare to all others (M = 9.77, SD = 8.12),
and naturalized citizens (M = 8.48. SD = 8.51) and the differ-
ences are statistically significant.
Hypothesis 1: Alpha reliability of the three item AA scale is
good (.93). It proved to have good concurrent and predictive
validity. Test-re-test after four weeks (N = 30) reliability is .73.
Principal component factor analysis, using Kaiser Criteria of
Eigen value of 1 for factor extraction, found a single factor
accounted for 86.50% of the variance. The loading of each item
on the factor was above .90. The communality of each item was
above .80.
AA scale has good convergent validity as it is highly posi-
tively correlated with PTSD (.50), CTD (r = .45, p < .000),
depression (r = .49, p < .000) and general anxiety (r = .341, p
< .000), and stigma of mental illness (r = .48, p < .000). It cor-
related highly with dissociation psychosis sub-scale of CTD (r
= .51, p < .000). These correlations confirmed the theoretical
assumptions about the prediction of AA (e.g., Hurvich, 2003)
as it is associated with dissociation and psychosis.
Hypothesis 2: Because we assumed that AA and general
anxiety (A), though correlated empirically is unique conceptu-
ally, we conducted factor analysis for the A and AA items to-
gether (17 items) using principal component with Kaiser Nor-
malization and Varimax orthogonal rotation. We found two
unique factors accounted for 64.870% of the variance. The first
loaded on all general anxiety items and second loaded only on
all the AA three items. AA items loaded the highest and have
the highest communality. Table 2 presents each item statistics
factor loadings and communalities.
Hypothesis 3 and 4: Multiple regression analyses conducted
with AA as dependent variable and other types of trauma dose
and negative appraisal as independent variables. We added
demographics to the independent variables list to control for
their effects. All types of trauma and cumulative trauma dose
and their negative appraisal highly predicted AA. The most
predictive trauma was collective identity trauma (β =.74). Fur-
ther, the results confirmed that negative appraisal of different
survival and identity traumas were stronger predictor of AA
than the occurrence of the traumas. These findings give cre-
dence to the differential cognitive appraisal hypothesis among
this adult population. Table 3 describes these results.
Hypothesis 5: Multiple regression analysis with AA as inde-
pendent variable and PTSD, CTD, CES-D, DASS-A, their sub-
scales and self-rated poor health as dependent variables, con-
trolling for demographics, found that AA is a significant pre-
dictor of PTSD (β = 46), CTD (β = 43), general anxiety (β
= .40), depression (β = .38), and poor self-rated health (β = .14).
AA was found to be a significant predictor of all PTSD,
DASS-A, and CTD. The results generally confirm hypothesis
four. Table 3 describes these results.
Hypothesis 6: Using SEM hybrid Path analysis model, we
tested different mediation models that have good fit. Each
model we tested has personal identity, collective identity, sur-
vival, secondary trauma, or cumulative negative appraisal, as
predictive variables. Each predictive variable in these models
has direct positive assenting effects on AA, and on mental
health syndrome (a latent variable which is predicted by PTSD,
depression, and general anxiety), and indirect effects on mental
and physical health as observed outcome variables. The effects
were mediated by AA. All models tested have good fit with
significant direct effects of the independent variables on AA
and mental health syndrome and indirect effects on the other
outcome variables as mediated by AA. We will present in detail
the models, in which the predictive variables: Cumulative nega-
tive appraisal and collective identity negative appraisals, has
the strongest effect on AA and on the other physical and mental
health variables.
In the first mediation model, cumulative negative appraisal
was the predictive variable in the model. AA mediated the ef-
fects of cumulative negative appraisal on mental health syn-
drome (a latent variable in the model) and on physical health.
PTSD accounted for the highest variance in the model (squared
R = .691) followed by CTD (squared R = .574). The model has
good fit (Chi Square = 37.540, d.f. = 12, p = .000, CFI = .972,
RMSEA = .073). Table 4 presents the direct, indirect and total
effects of each variable of the model. All effects are statistically
significant.
The second mediation model has the best fit (Chi Square =
38.547, d.f.= 12, p = .000, CFI = .980, RMSEA = .075). In this
model, we used collective identity trauma CIT as the only in-
dependent variable in the model. CIT has direct effects on AA,
and Mental health syndrome MHS (a latent variable in the
model). AA mediated CIT effects on mental health syndrome
and physical health. AA explained the highest variance in this
model (R squared = .754). Figure 1 presents the path model

I. A. KIRA ET AL.
Table 2.
Rotated Component Matrix for the general anxiety (GA) and AA items: Extraction Method: Principal Component Analysis. Rotation method: varimax
with kaiser normalization.
Factor Loading Item Statistics
1 (GA)2 (AA)Mean SD Communalities
I felt terrified .855 −.023 1.53 1.11 .732
I was worried about situations in which I might panic and make a fool out of myself .835 −.066 1.41 1.07 .702
I experienced trembling .834 .001 1.37 1.04 .695
I felt like I was close to panic .826 .010 1.33 1.05 .683
I feared that I would be thrown by some trivial but unfamiliar task .820 .011 1.32 1.03 .673
I experienced breathing difficulty .799 .085 1.35 1.10 .646
I had a feeling of shakiness .784 .106 1.28 1.07 .626
I was aware of the action of my heart in the absence of physical exertion .764 −.005 1.28 .99 .584
I had a feeling of faintness .761 .027 1.22 1.06 .560
I felt scared without any good reason .749 .101 1.56 1.10 .571
I found myself in situations that made me so anxious .734 .145 1.45 1.04 .560
I perspired noticeably .687 .135 1.29 1.03 .490
I had difficulty in swallowing .682 .065 1.04 .98 .469
I was aware of my dryness in my mouth .633 .116 1.42 1.13 .414
Sometimes I feel the threat of extermination/ annihilation to my group… .045 .944 3.11 1.31 .893
I feel threatened by extreme inequalities in this society. .056 .942 3.15 1.26 .891
Because of what has happened to me personally or is happening, I sometimes worry
that I will just lose my sense of self or cease to exist. .075 .901 3.17 1.31 .818
Factor Eigen value 8.422 2.605 Total Variance
Factor variance 49.544 15.326 64.870
and Table 6 presents the direct, indirect and total effects of
each variable of the model. All effects are statistically signifi-
cant.
Alternative models: Care must be taken when making causal
inferences from cross-sectional data. The theoretical argument
for the proposed models is strong and the model fitted the data
well; however, there are always alternative models (MacCallum
& Austin, 2000). We considered several alternative models in
which we changed the order of the predictors, mediators, and
outcome variables. In the first alternative model (AM), we
considered general health (GH) a mediator and AA and MHS
the outcome variables. In the second AM, we considered MHS a
mediator and GH the outcome variable; in the third AM, we
considered MHS a mediator and AA and AA and GH the out-
come variables. In the fourth AM, we considered general anxi-
ety (GA) a mediator and MHS-GA, AA, and GH the outcome
variables; in the fifth AM, we considered PTSD a mediator and
MHS-PTSD, GH and AA the outcome variables; in the sixth
AM we considered CTD a mediator and MHS-CTD, AA, and
GH the outcome variables. In the seventh AM, we considered
depression (D) a mediator and MHS-D, GH and AA the out-
come variables. All the seven AM have poor fit indexes and are
not viable models.
Conclusions and Discussion
This short measure of Annihilation Anxiety (AA) has good
reliability and adequate divergent and predictive validity and
generally fit the theoretical assumptions that underlie the con-
struct we presented in the introduction and in the psychoana-
lytic literature. The results provide another aspect in the con-
cept that was not adequately addressed in the psychoanalytic
literature, which is the annihilation anxiety related to collective
identity threats, rather than only threats to personal identity.
The measure seems to address both terrors come with threats to
collective and personal identity. However, in the population we
conducted our study, the AA that emanated from the collective
threats seems stronger than those of personal identity treats or
other traumas.
Results confirmed our first and second hypothesis as the
short measure developed in the current study is reliable Alpha
= .93, test re-test, R = .76) and has good construct and divergent
validity. Confirmatory factor analyses have indicated that AA
constitutes a separate factor different from general anxiety. The
results confirmed hypothesis 3 and 4 as different traumas that
threaten identity especially collective identity predicted AA.
While the occurrence of such traumas predicted AA, their

I. A. KIRA ET AL.
96
Table 3.
The effects of cumulative trauma and trauma types’ dose and negative appraisal on AA.
Self-annihilation Anxiety
B SE Beta P
TD a .20 .03 .40 .00001
NACTD a .15 .01 .59 .00001
CITD a .58 .032 .74 .00001
NACIT .58 .03 .74 .00001
ATD a −.06 .34 .01 .86
NAAT a −.02 .23
−.004 .944
PITD a .74 .11 .40 .00001
NAPIT a .42 .04 .55 .00001
STD a .49 .09 .33 .00001
NAST a .31 .03 .47 .00001
ITD a 1.10 .11 .53 .00001
NAIT a .45 .03 .63 .00001
TD = Cumulative Trauma Dose, NACTD = Negative appraisal of cumulative trauma, CITD = Collective Identity trauma dose, NACIT = Negative Appraisal of collective
Identity Trauma, ATD = Attachment Trauma dose, NAAT= Negative appraisal of Attachment trauma, PITD = Personal identity Trauma Dose, NAPIT= Negative Ap-
praisal of personal Identity Trauma, STD = Survival Trauma Dose, NAST = Negative Appraisal of survival trauma, ITD = Interdependence Trauma Dose. NAIT = Nega-
tive Appraisal of interdependence Trauma; (a) Findings are obtained after the effects of gender, age, marital status; education and income were controlled statistically. *p
< .05. **p < .01. ***p < .001. a) n = 399.
Table 4.
The effects of AA on self-rated health and mental health variables (a).
Dependent variables B SE Beta P
Poor Health .03 .01 .14** .002
DASS-A: General Anxiety 1.18 .14 .40**** .000
DASS-A-Physical .47 .07 .33**** .000
DASS-A-Psychological .88 .09 .45 .000
Depression 1.21 .15 .38**** .000
PTSD 3.22 .31 .46**** .000
PTSD-Re-experiencing sub-scale 1.21 .11 .48**** .000
PTSD-Avoidance sub-scale .55 .06 .42**** .000
PTSD-Arousal sub-scale .91 .10 .42**** .000
PTSD-Dissociation sub-scale .81 .09 .42**** .000
CTD 1.50 .16 .43**** .000
CTD-Depression/Anxiety Interface Sub-scale .29 .04 .31**** .000
CTD-Suicidality sub-scale .05 .04 .07 .180
CTD-Executive Function Deficits Sub-scale .28 .03 .39**** .000
CTD-Dissociation/Psychosis Sub-scale .46 .05 .43**** .000
(a) Findings are obtained after the effects of gender, age, marital status; education and income were controlled statistically; *p < .05. **p < .01. ***p < .001, n = 399.

I. A. KIRA ET AL.
Table 5.
The direct and indirect effects of cumulative Negative Appraisal of Trauma on AA, MHS and Poor health.
Endogenous Variables
Causal Variables
AA Health MHS CTD PTSD depression Anxiety
Cumulative Negative appraisal
Direct Effects .474* .000 .303** .000 .000 .000 .000
Indirect Effects .000 .057** .179** .365** .400** .346** .339***
Total Effects .474* .057** .482** .365** .400** .346** .339***
Annihilation Anxiety
Direct Effects .000 .119** .338** .000 .000 .000 .000
Indirect Effects .000 .000 .039** .286** .313** .271** .265**
Total Effects .000 .119** .377** .286** .313** .271** .265**
General Health
Direct Effects .000 .000 .330* .000 .000 .000 .000
Indirect Effects .000 .000 .000 .250* .274* .237* .232*
Total Effects .000 .000 .330* .250* .274* .237* .232*
Mental Health Syndrome
Direct Effects .000 .000 .000 .758** .831** .718** .703**
Indirect Effects .000 .000 .000 .000 .000 .000 .000
Total Effects .000 .000 .000 .758** .831** .718** .703**
Squared Multiple Correlations .225 .014 .450 .574 .691 .516 .494
AA = Annihilation Anxiety, MHS = Mental Health Syndrome, CTD = Cumulative Trauma Disorders; + p < .10 (close to significant) *p < .05, **p < .01, ***p < .001, ****p
< .0001.
Figure 1.
Path diagram for annihilation anxiety as a mediator of the effects of cumulative identity trauma on poor physical and
mental health.

I. A. KIRA ET AL.
98
Table 6.
The direct and indirect effects of collective Identity Trauma on AA and MHS.
Endogenous Variables
Causal Variables
AA Health MHS CTD PTSD depression Anxiety
Collective Identity Negative appraisal
Direct Effects .869** .000 .363** .000 .000 .000 .000
Indirect Effects .000 .104** .180* .411** .454** .386** .379**
Total Effects .869** .104** .543** .411** .454** .386** .379**
Annihilation Anxiety
Direct Effects .000 .119** .169+ .000 .000 .000 .000
Indirect Effects .000 .000 .038** .157* .173* .147* .145*
Total Effects .000 .119** .207** .157* .173* .147* .145*
General Health
Direct Effects .000 .000 .322* .000 .000 .000 .000
Indirect Effects .000 .000 .000 .244* .270* .229* .225*
Total Effects .000 .000 .322* .244* .270* .229* .225*
Mental Health Syndrome
Direct Effects .000 .000 .000 .757** .837** .710** .698**
Indirect Effects .000 .000 .000 .000 .000 .000 .000
Total Effects .000 .000 .000 .757** .837** .710** .698**
Squared Multiple Correlations .754 .014 .408 .574 .700 .504 .488
AA = Annihilation Anxiety, MHS = Mental Health Syndrome, CTD = Cumulative Trauma Disorders; + p < .10 (close to significant) *p < .05, **p < .01, ***p < .001, ****p
< .0001.
negative appraisal has more predictive power in this adult
population. AA in its turn predicted poor physical and mental
health in this population. Further, AA was found to have sig-
nificant indirect effects on suicidality. Dissociation, anxiety and
depression comorbidity, PTSD-emotional numbness/ dissocia-
tion were the most significant mediators of the indirect effects
of AA on suicidality. The findings emphasize the strong direct
effects of AA on re-experiencing, general anxiety and dissocia-
tion/psychosis respectively. Re-experiencing or the re-emer-
gence of catastrophic memories had been long seen in the psy-
choanalytic literature as the source of the emergence of delu-
sional system and dissociation as defense mechanisms that
protect against such re-emergence (e.g., Segal, 1977). Results
of path analysis generally confirmed that AA and general anxi-
ety mediated the effects of cumulative traumas and specific
trauma types, especially collective identity, attachment and
secondary trauma, on mental health. Further, the findings high-
light the importance of assessing for the presence of AA in
therapy as one of the potential keys of healing and of stopping
its catastrophic effects on emotional and physical suffering, as
well as suicidality of the patient.
While the findings demonstrated the benefits of integrating
the psychoanalytic and cognitive appraisal theories in evaluat-
ing the clinical utility of the AA, they introduced this short
measure that can be a useful short clinical assessment tool as
well as a valid, reliable measure in research with traumatized
populations.
The measure was subsequently utilized in research on Pales-
tinian adolescents and proved to have good psychometric prop-
erties in this population. It has alpha = .87, and significantly
predicted collective identity commitment, depression, suicide,
militancy and fear of death (Kira, et al., 2011b).
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