S

Childhood trauma and PTSD in prison populations: Using an attachment lens

Vittoria Ardino*

The British Psychological Society Annual Conference 2013

9-11 April, Harrogate International Centre

* London School of Economics and Political Science, PSSRU Unit, London, UK; V.Ardino@lse.ac.uk

“Although not all disturbed children grow up into anti-social adults, most adults who regally commit crimes or drink excessively or exhibit seriously unacceptable social behaviour have suffered disturbed relationships during childhood.”(Howe,1995)

The lack of secure attachment is lined to a dysfunctional theory of mind (important for the development of morality and to several difficulties in emotion regulation

• Implications for re-offending risk and rehabilitation of offenders

Complex intersectio

n of criminal

behaviour and

traumatic attachmen

ts

Histories of complex traumaTrauma at hands of attachment figures Complex PTSD and attachment:

Dysregulation of emotionsImpulse dyscontrolShame and Guilt

What does attachment theory in conjunction with psychotraumatology help us understand about antisocial-individuals?

Abuse, neglect or rejection raise anxiety and intensify a child’s defensive strategies.

There is a risk that children will recreate their previous experiences of caregiving re-enacting the trauma (Ardino, 2009) “trauma dependency”(Van der Kolk, 1984)

Dimensions of parenting interact secure base star

Being available

Responding sensitively

Accepting the child

Co-operative caregiving

SECURE BASE

Promoting family membership

Being available Child’s needs/

behaviourWhat does this child expect from adults? How can I show this child that I will not let him down?

Alert to child’s needs/signals Verbal and non-verbal messages of availability

I matter, I am safeI can explore and return for helpOther people can be trusted

Helping children to

trust

Carer thinking/ feeling

Parenting behaviour

Child thinking/feeling

Children who lack trust

Offenders have often lacked consistent care and protection from reliable caregivers

Caregivers unavailable through drugs, mental health, learning disabilities, own childhoods

Caregivers may have rejected the child's emotional demands responded unpredictably been frightening or frightened

Children will have developed defensive strategies to cope with this lack of trust

Responding sensitively Child’s needs/

behaviourWhat might this child be thinking and feeling?

How does this child make me feel?Tuning in to the

child.Helping child to understand /express feelings appropriately

My feelings make sense -and can be managedOther people have feelings and thoughts

Helping children to

manage feelings and behaviour

Carer thinking/feeling

Parenting behaviour

Child thinking /feeling

Children who find it difficult to manage their feelings and

behaviour Feelings have often not been acknowledged or

understood in their birth families From infancy, overwhelmed by feelings that can’t be

managed Feelings often mislabelled/distorted –what is the truth? Cannot appropriately express feelings – so excessively

expressed or denied and repressed or dysregulated and chaotic or dissociated.

Feelings expressed through their bodies in confused ways

Children who do not feel effective- can't compromise/co-operate

Lack confidence in getting their needs met Have rarely experienced co-operative

parenting – parents were often either too controlling and intrusive or too passive and ineffective

Children have often felt powerless or too powerful

NB Feelings like this can be made worse in poor communities and in the care system

S

The study….A focus on neglect as a predictor of PTSD

in offenders

Atta

chm

ent r

isk fa

ctor

s

Childhood trauma

(neglect)

Extremely insensitive parenting

Disconnected parenting

Re-offendin

g risk

Pathway: “traumatic attachments to criminal

behaviour”

Criminal behavio

ur

Pathway: “traumatic attachments to criminal behaviour”

The role of traumatic attachments in predicting PTSD? Inconsistent care Emotional and physical abuse from primary

attachment figures The mediating role of cognitive strategies

(crucial in the maintainance of PTSD? Re-offending risk?

Trauma & PTSD in offenders: what do we know?

Studies of posttraumatic stress disorder (PTSD) have predominantly focused on victims of trauma (Foa & Riggs, 1995).

Offenders present histories of trauma, prior to and after becoming a known offender (Farrington, 2004; Gibson et al., 1999; Jordan, et al, 1996).

Trauma and attachment in offender populations

• Longitudinal studies: – Early traumas predispose to antisocial behaviour

(Falshaw, Browne, & Hollin, 1996; Haapasalo & Pokela, 1999)

• Prospective studies:– Early victimisation predicts higher risk of being arrested

(Widom, 1989; 1996)

– PTSD is more prevalent in prison populations than in community sample: from 21.4% (Butler et al., 2003) to 78% (Jordan et al., 1996)

• Past traumas: Ceca-Q (Bifulco, 2003), a semi-structured questionnaire assessing childhood experiences of abuse and neglect . Scales: Antipathy; Neglect; Care; Physical abuse; Sexual abuse.

• PTSD: LASC (Los Angeles Symptoms Checklist; King, King, Leskin, & Foy, 1995 ), a 43-item self-report questionnaire. Seventeen of the items correspond closely with the B, C, D, symptoms of PTSD

• C-PTSD: DAPS (Detailed Assessment of Post-Traumatic Stress; Briere, 2006), is a 104-item self-report questionnaire assessing traumatic exposure, associated features of PTSD

• Worry: PSWQ (Penn state worry questionnaire; Meyer, Miller, Metzger, & Borkovec, 1990), a 16-item self-report questionnaire which assesses an individual’s general tendency to worry excessively.

• Perception of Social Support: assessed by a 7-point Likert scale self-report questionnaire (6-item). Dunmore et al. (1999; 2001).

• Re-offending risk: IORNS (Inventory of offender risk, needs and strengths; Miller et al., 2006), a 130-item self report questionnaire which assesses static, dynamic risk factors and protective factors.

Variables & Measures

Dysfunctional cognitive processes

Trauma & PTSD

C-PTSD

Criminal behaviour

METHODS: Participants

MARITAL STATUSTotal

N %

Married 70 41.7

Single 77 45.8

Divorced 15 11.9

Widow 1 0.9

Missing data 6 8.0EDUCATIONElementary school 34 20.2

Secondary school 110 65.5

High school 20 16.0Degree 2 1.2

Total 168 100

• 168 prisoner males (mean of age = 37.27; range= 20-74). Nationality: 92.3% (N=155) Italian; 6.0% (N=10) other nationalities.

• Violent crime = 22.6% (N=38)

Type of trauma % (N) NAccidents 64.4 76

Natural disasters 34.7 41Domestic or work

accidents 26.3 31)

Physical assault 20.3 24Threat of violence or

sexual abuse 13.5 16

Shooting 39.0 46War 13.6 16)

Armed robbery or assault 19.5 23Sexual abuse 0.8 1

Sexual abuse prior to age 16 3.3 4

Other injuries 36.6 43Witnessing someone else

being killed or injured 77.1 91

Being beaten by an adult prior to age 16 34.7 41

DAPSTrauma exposure

CECA-Q (Childhood Experience of Care and Abuse; Bifulco et al, 2003)

Total Females Males

N % N % N %

Antipathy (mother) 14 18.7 7 28.0 7 14.0Antipathy (father) 13 17.3 7 28.0 6 12.0Care (mother) 18 24.0 7 28.0 11 22.0Care (father) 27 36.0 6 24.0 21 42.0Neglect (mother) 16 21.3 6 24.0 10 20.0Neglect (father) 30 40.0 5 20.0 25 50.0

Physical abuseMother 21 28.0 9 36.0 12 24.0Father 20 26.7 5 20.0 15 30.0

Sexual abuse 11 14.7 9 36.0 2 4.0

Study Results: 1) early trauma

PATERNAL Care total

PTSD measured by

LASC

R2=.152; F=8.63; p<.01

ß=.391**

Regression analyses (1)CECA as a predictor of PTSD as measured by LASC

MATERNAL PHYSICAL ABUSE

IORNS Overall risk index

R2=.170; F=11.67; p<.01

ß=.412**

Regression analyses (2) CECA as a predictor of re-offending risk

MATERNAL CARE STATIC RISK FACTORS

R2=.145; F=9.69; p<.01

ß=.381**

Regression analyses (3) CECA as a predictor of re-offending risk

MATERNAL CARE DYNAMIC RISK FACTORS

R2=.084; F=5.21; p<.05

ß=.290*

Regression analyses CECA as a predictor of re-offending risk

NEGATIVE SOCIAL SUPPORT

R2=.262; F=9.93; p<.01MATERNAL

PHYSICAL ABUSE

ß=.311*

Regression analyses CECA as a predictor of negative cognition

Mediation analyses

PATERNAL TOTAL CARE

Worry

Regret

PTSD (as measured by

LASC)ß=.370**

ß=.158*

ß=.265**

ß=.233** C) ß=.286**

A) ß=.303**

B) ß=.350**

a) R2=.314; F=32.90; p<.01b) R2=.160; F=13.40; p<.01c) R2=.304; F=31.38; p<.01

General conclusions CECA predicts PTSD as measured by LASC

CECA predicts re-offending risk

CECA does not predict PTSD as measured by DAPS Attachment does matter!

Poor family attachment/bonding

Child victimization and maltreatment

Pattern of high family conflict

Family violence