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The British Psychological Society Annual
Conference 2013
9-11 April, Harrogate International Centre
Childhood trauma and PTSD in prison
populations: Using an attachment lens
Vittoria Ardino*
*
S
London School of Economics and Political Science, PSSRU Unit, London, UK; [email protected]
“Although not all disturbed
children grow up into antisocial 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
Complex
intersection
of criminal
behaviour
and
traumatic
attachments
Histories of
complex trauma
Trauma at hands
of attachment
figures
Complex PTSD
and attachment:
Dysregulation of emotions
Impulse dyscontrol
Shame and Guilt
•
Implications for re-offending
risk and rehabilitation of
offenders
What does attachment theory in conjunction with
psychotraumatology help us understand about
antisocial-individuals?
S Abuse, neglect or rejection raise anxiety and
intensify a child’s defensive strategies.
S There is a risk that children will recreate their
previous experiences of caregiving re-enacting the
trauma (Ardino, 2009)
S “trauma dependency”(Van der Kolk, 1984)
Dimensions of parenting interact secure base
star
Being
available
Promoting
family
membership
Co-operative
caregiving
SECURE
BASE
Responding
sensitively
Accepting the
child
Being available
Child’s needs/
behaviour
Child
thinking/feeling
I matter, I am
safe
I can explore
and return for
help
Other people
can be trusted
Parenting
behaviour
Helping
children to trust
Alert to child’s
needs/signals
Verbal and nonverbal messages of
availability
Carer thinking/
feeling
What does this
child expect
from adults?
How can I show
this child that I
will not let him
down?
Children who lack trust
S Offenders have often lacked consistent care and
protection from reliable caregivers
S Caregivers unavailable through drugs, mental
health, learning disabilities, own childhoods
S Caregivers may have
S rejected the child's emotional demands
S responded unpredictably
S been frightening or frightened
S Children will have developed defensive strategies to
cope with this lack of trust
Responding sensitively
Child thinking
/feeling
My feelings
make sense -and
can be managed
Other people
have feelings
and thoughts
Parenting
behaviour
Child’s needs/
behaviour
Helping
children to
manage
feelings and
behaviour
Tuning in to the child.
Helping child to
understand /express
feelings appropriately
Carer
thinking/feeling
What might this
child be thinking
and feeling?
How does this
child make me
feel?
Children who find it difficult to manage
their feelings and behaviour
S Feelings have often not been acknowledged or understood in their
birth families
S From infancy, overwhelmed by feelings that can’t be managed
S Feelings often mislabelled/distorted –what is the truth?
S Cannot appropriately express feelings – so excessively expressed or
denied and repressed or dysregulated and chaotic or dissociated.
S Feelings expressed through their bodies in confused ways
Children who do not feel effective- can't
compromise/co-operate
S Lack confidence in getting their needs met
S Have rarely experienced co-operative parenting –
parents were often either too controlling and
intrusive or too passive and ineffective
S Children have often felt powerless or too powerful
NB Feelings like this can be made worse in poor
communities and in the care system
The study….
A focus on neglect as a predictor of PTSD in
offenders
S
Pathway: “traumatic attachments
to criminal behaviour”
Extremely insensitive parenting
Childhood trauma (neglect)
Attachment risk factors
Disconnected parenting
Criminal
behaviour
Reoffending
risk
Pathway: “traumatic attachments to criminal
behaviour”
S The role of traumatic attachments in predicting PTSD?
S Inconsistent care
S Emotional and physical abuse from primary
attachment figures
S The mediating role of cognitive strategies (crucial in
the maintainance of PTSD?
S Re-offending risk?
Trauma & PTSD in offenders: what do we know?
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)
Variables & Measures
Trauma &
PTSD
• 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
• C-PTSD: DAPS (Detailed Assessment of Post-Traumatic Stress; Briere, 2006), is a 104•
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.
item self-report questionnaire assessing traumatic exposure, associated features of
PTSD
Dysfunctional
• 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.
cognitive
• processes
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.,
Criminal
2006), a 130-item self report questionnaire which assesses static, dynamic risk
factors and protective factors.
behaviour
•
METHODS: Participants
• 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)
Total
MARITAL STATUS
N
%
Married
70
41.7
Single
77
45.8
Divorced
15
11.9
Widow
1
0.9
Missing data
6
8.0
Elementary school
34
20.2
Secondary school
110
65.5
High school
20
16.0
Degree
2
1.2
168
100
EDUCATION
Total
DAPS
Trauma exposure
Type of trauma
% (N)
N
Accidents
64.4
76
Natural disasters
34.7
41
Domestic or work accidents
26.3
31)
Physical assault
20.3
24
Threat of violence or sexual
abuse
13.5
16
Shooting
39.0
46
War
13.6
16)
Armed robbery or assault
19.5
23
Sexual abuse
0.8
1
Sexual abuse prior to age 16
3.3
4
Other injuries
36.6
43
Witnessing someone else
being killed or injured
77.1
91
Being beaten by an adult prior
to age 16
34.7
41
Study Results: 1) early trauma
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
14.0
Antipathy (father)
13
17.3
7
28.0
6
12.0
Care (mother)
18
24.0
7
28.0
11
22.0
Care (father)
27
36.0
6
24.0
21
42.0
Neglect (mother)
16
21.3
6
24.0
10
20.0
Neglect (father)
30
40.0
5
20.0
25
50.0
Mother
21
28.0
9
36.0
12
24.0
Father
20
26.7
5
20.0
15
30.0
Sexual abuse
11
14.7
9
36.0
2
4.0
Physical abuse
Regression analyses (1)
CECA as a predictor of PTSD as measured by LASC
PATERNAL
Care total
ß=.391**
R2=.152; F=8.63; p<.01
PTSD measured
by
LASC
Regression analyses (2) CECA as a
predictor of re-offending risk
MATERNAL
PHYSICAL ABUSE
ß=.412**
IORNS
Overall risk index
R2=.170; F=11.67; p<.01
Regression analyses (3) CECA as a
predictor of re-offending risk
MATERNAL CARE
ß=.381**
R2=.145; F=9.69; p<.01
STATIC RISK
FACTORS
Regression analyses CECA as a predictor
of re-offending risk
MATERNAL CARE
ß=.290*
R2=.084; F=5.21; p<.05
DYNAMIC RISK
FACTORS
Regression analyses CECA as a predictor of
negative cognition
NEGATIVE SOCIAL
SUPPORT
ß=.311*
MATERNAL
PHYSICAL ABUSE
R2=.262; F=9.93; p<.01
Mediation analyses
Worry
a)
b)
c)
R2=.314; F=32.90; p<.01
R2=.160; F=13.40; p<.01
R2=.304; F=31.38; p<.01
ß=.158*
Regret
B)
ß=.350**
ß=.265**
C)
ß=.286**
ß=.233**
PATERNAL
TOTAL
CARE
A)
ß=.303**
ß=.370**
PTSD
(as measured by
LASC)
General conclusions
S CECA predicts PTSD as measured by LASC
S CECA predicts re-offending risk
S CECA does not predict PTSD as measured by DAPS
S Attachment does matter!
 Poor family attachment/bonding
 Child victimization and maltreatment
 Pattern of high family conflict
 Family violence