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

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

2. “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

3. Implications for re-offending risk and rehabilitation of offenders

4. 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)

5. Dimensions of parenting interact secure base star

6. Being available Child’s needs/ behaviour Carer thinking/ feeling Child thinking/feeling What does this child expect from adults? How can I show this child that I will not let him down? I matter, I am safe I can explore and return for help Other people can be trusted Helping children to trust Alert to child’s needs/signals Verbal and non-verbal messages of availability Parenting behaviour

7. 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

8. Responding sensitively Child’s needs/ behaviour Child thinking /feeling Carer thinking/feeling My feelings make sense -and can be managed Other people have feelings and thoughts What might this child be thinking and feeling? How does this child make me feel? Helping children to manage feelings and behaviour Tuning in to the child. Helping child to understand /express feelings appropriately Parenting behaviour

9. 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

10. 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

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

12. Disconnected parenting Pathway: “traumatic attachments to criminal behaviour” Criminal behaviour Attachment risk factors Childhood trauma (neglect) Extremely insensitive parenting Re-offending risk

13. 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?

14. Trauma & PTSD in offenders: what do we know?

15. 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)

16. Variables & Measures Trauma & PTSD C-PTSD Dysfunctional cognitive processes Criminal behaviour • 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.

17. METHODS: Participants • 168 prisonermales (mean of age = 37.27; range= 20-74). Nationality: 92.3% (N=155) Italian; 6.0% (N=10) othernationalities. • Violent crime = 22.6% (N=38)

18. DAPSTrauma exposure

19. Study Results: 1) early trauma

20. Regression analyses (1) CECA as a predictor of PTSD as measured by LASC ß=.391** PATERNAL Care total PTSD measured by LASC R2=.152; F=8.63; p<.01

21. Regressionanalyses (2) CECA as a predictor of re-offendingrisk IORNS Overallriskindex MATERNAL PHYSICAL ABUSE ß=.412** R2=.170; F=11.67; p<.01

22. Regressionanalyses (3) CECA as a predictor of re-offendingrisk ß=.381** MATERNAL CARE STATIC RISK FACTORS R2=.145; F=9.69; p<.01

23. Regressionanalyses CECA as a predictor of re-offendingrisk ß=.290* MATERNAL CARE DYNAMIC RISK FACTORS R2=.084; F=5.21; p<.05

24. Regressionanalyses CECA as a predictor of negative cognition NEGATIVE SOCIAL SUPPORT ß=.311* MATERNAL PHYSICAL ABUSE R2=.262; F=9.93; p<.01

25. Mediation analyses R2=.314; F=32.90; p<.01 R2=.160; F=13.40; p<.01 R2=.304; F=31.38; p<.01 Worry ß=.158* Regret A) ß=.303** B) ß=.350** ß=.265** ß=.233** C) ß=.286** PATERNAL TOTAL CARE PTSD (asmeasured by LASC) ß=.370**

26. General conclusions • CECA predicts PTSD asmeasured by LASC • CECA predicts re-offendingrisk • CECA doesnotpredict PTSD asmeasured by DAPS • Attachment doesmatter! • Poor family attachment/bonding • Child victimization and maltreatment • Pattern of high family conflict • Family violence