Tag Archives: PTSD

March 17, 2008 · 1:02 pm

Science Monday: Perpetrators have PTSD? New connections between attachment and PTSD


Unfortunately, many people experience violent or near death experiences. Some of those folks go on to have symptoms fitting the diagnosis of Posttraumatic Stress Disorder (PTSD): intrusive memories/flashbacks cause them to reexperience the event coupled with attempts to numb themselves in some way and yet still finding themselves in a heightened state of vigilance all of the time.

Since the Vietnam War, we’ve learned a lot about this set of problems. The primary forms of treatment touted now are controlled and imaginal exposure to the traumatic event(s) coupled with relaxation, distraction, and cognitive reframes. And we continue to learn about the presence of PTSD in violent family dynamics as mentioned last Monday (3/10/08).

But here are two articles pointing to somethings I hadn’t thought much about:

1. Perpetrators of violent crimes sometimes experience PTSD from their crimes. A group of English researchers did a study of 105 prisoners who had committed intentional violent crimes. 46% experienced distressing intrusive memories (one aspect of PTSD) and 6% met criteria for PTSD. The more antisocial the criminal before the crime, the less likely they would actually experience distressing intrusive memories. So, those who are most uncaring don’t really struggle with these problems. Here’s a question: should you try to help perpetrators with their distressing, intrusive memories? Does having them lead them to be less likely to re-victimize? Or do they make them more distressed, more hypervigilant and therefore more likely to attack?

Biblio: Evans et al. (2007). Intrusive memories in perpetrators of violent crimes: Emotions and cognitions. Journal of Consulting and Clinical Psychology, 75, 134-144.  

2.  Why is it that attachment literature and adult PTSD from child abuse literatures have been separate? Stovall-McClough & Cloitre of NYU ask this very question and review the literatures from each area. Attachment literatures come out of developmental theories while PTSD research tends to be CBT based. But the two are quite connected. Consider the authors points:

  • “As many as 48-85% of survivors of childhood abuse show a lifetime prevalence of PTSD…”
  • “As many as 80% of maltreated children [are] classified as [having a disorganized attachment pattern]…”
  • “…the theoretical mechanisms underlying the expression of both PTSD and [attachment problems], although developed separately, are notably similar.” How so? Both see powerful events stored in the mind that shape one’s sense of self and the world. Powerful and negative events are avoided in an “effort to contain the intensity of emotions triggered by attachment injuries or traumatic events
  • “When traumatic events are kept locked away or otherwise chronically avoided, the result is often long-term struggles with PTSD symptoms and ongoing fragmentation of memory and fear-related belief systems.” 
  • Both unresolved attachment problems and PTSD lead to dissociative and intrusive self-focused thought patterns
  • Unresolved childhood attachment problems (as opposed to secure or dismissing attachment styles) may predict PTSD in adults
  • Avoidance strategies which help the individual manage distress from the abuse may, in fact, increase emotional distress and cognitive disorganization. This is sad in that those best able to divorce themselves from those early experiences (which may protect them as a child) may set themselves up for the most pervasive PTSD. I suspect that avoidance strategies hinder the person from being able to carefully evaluate themselves in a clear and helpful manner. Thus at a later point when they can no longer avoid, they have little sense of self to use to understand their place in the world.

Biblio: Stovall-McClough & Cloitre (2006). Unresolved attachment, PTSD, and dissociation in women with childhood abuse histories. Journal of Consulting Psychology, 74, 219-228.

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March 10, 2008 · 10:06 am

Science Monday: Child PTSD


Today’s psychopathology class focuses on child related problems. Given the societal focus on ADHD and Asperger’s, our class will hang out there. However, I want to bring to your attention some work in the area of family violence and childhood trauma reactions. Gayla Margolin and Katrina Vickerman (of USC) published 2 articles in a 2007 (38:6) issue of Professional Psychology: Research and Practiceon the topic of PTSD in children exposed to family violence.

Article one (pp 613-619) provides an overview. First, they recognize that some kids have PTSD without a single discrete precipitating and/or life-threatening event. It appears that prolonged exposure to violence (e.g., domestic violence, physical abuse, sexual abuse, community violence) likely has a deleterious impact on children. Some 30% of kids living with both parents experience domestic violence. Some 5-10% of kids experience severe physical abuse. One article summarizing a number of studies suggested that somewhere between 13 and 50% of kids exposed to family violence qualify for a PTSD diagnosis. In foster home and clinic studies, the number with PTSD seems higher, especially in girls. Not every child who experiences violence shows signs of PTSD. Severity and frequency of exposure to violence probably matters most. What makes family violence so troubling is that the child is faced with the constant threat of additional episodes.

What are the common domains of impairment related to complex trauma exposure? Affect regulation (inability to modulate anger, chronic flooding of negative affect), information processing (concentration, learning difficulties, missing subtle environmental nuances, overestimation of danger, preoccupied with worry about safety), self-concept (shame, guilt), behavioral control (aggression, proactive defenses, and substance abuse), interpersonal relationships (trust), and biological processes(delayed sensorimotor development (p. 615).

The authors repeat a previous suggestion of a new diagnosis: Developmental Trauma Disorder(DTD) to adequately capture the picture of youth trauma reactions to family violence. Criteria include: repeated exposure to adverse interpersonal trauma, triggered pattern of repeated dysregulation of affect, persistently altered attributions and expectancies about self and other, and evidence of functional impairment.

In their second article (pp. 620-628), the authors summarize typical treatments for children: reexposure interventions(to help the child understand and gain mastery over their past experiences that intrude. This is done primarily by a trauma interview where therapists work directively to bring fragments of the story together into a coherent whole and meaning and safety are explored), cognitive restructuring and education about violence exposure (goal to undo lessons learned, practice thought stopping, and to normalize reactions), emotional recognition and expression (to attend to and understand connections between emotions, thoughts, and behaviors), social problems solving, safety planning for those not able to be out of potentially violent environments, and parenting interventions.

Do any of these treatments work? It appears several do. I’ll mention just one here:Trauma-focused CBT for child abuse victims (by Cohen, Mannarino, and Deblinger. That intervention is published in their 2006 Guilford Press book, Treating trauma and traumatic grief in child and adolescents.   

We should not underestimate the impact of family and community violence on children. There are many kids labeled bi-polar, ADHD, personality disordered, oppositional (and worse) who carry within their body the impact of violence. They might look like a gang-banger or a thug who’d kill you because you scuffed his shoes, but they likely are hypervigilant and only read part of the environmental cues to determine if they are in danger.

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October 3, 2007 · 9:28 am

You can leave The War, but it won’t leave you


Caught the last 15 minutes of the last installment of Ken Burns’ The War on PBS.  At some point I’m going to have to watch all 15 hours of it. A couple of men were talking about the unspoken PTSD they experienced after the war but couldn’t really talk about (back then). One man, from Minnesota, had described several traumatic experiences in other installments. He concluded the show with a comment that I don’t have in quotes but is as close as I can remember it. He said something to the effect of, I’ve had a great life; I’ve enjoyed myself; I have a great family…but sometimes the war sucks you back in.

Another gentleman described coming home from being a POW in Japan and being filled with hate for anything Japanese. At some point in his life he realized he had to let it go. As he said, the Japanese weren’t being hurt by his anger, he was. He met with a preacher who helped him find relief and to let it go. But the most interesting part of this little story is that the man telling his story then paused and said something like, but its taken me another 30 years to deal with it.

Isn’t that the truth. We find relief and healing; but that doesn’t mean no ongoing consequences and no ongoing fighting to hang on to truth, hope, sanity, and peace. Healing rarely is immediate and complete. But don’t mistake slowness and ongoing battles as the absence of healing. No, we are being healed–just day by day as we hang on to God and the folks he has placed in our lives.  

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