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Identification With the Aggressor and Inward and Outward Aggression in Abuse Survivors
Abstract
Childhood abuse survivors may display both inward and outward aggression manifested in self-injurious behavior (SIB) and violent acts toward others. Scrutinizing the literature reveals that the relational dynamics between victims and their perpetrators might be involved in these phenomena. Yet, research on this subject matter has been sparse. Filling this gap, this study investigated the contribution of the singular bonds between victims and their perpetrators, known as identification with the aggressor, in explaining survivors’ aggression. The study was conducted among 306 Israeli college/university students who reported a history of childhood abuse. Results revealed that levels of adopting the perpetrator’s experience, identifying with the perpetrator’s aggression, and replacing one’s agency with that of the perpetrator were significantly associated with survivors’ inward and outward aggression. Moreover, profile type—that is, having high versus low levels of identification with the aggressor—was implicated in participants’ SIBs, urge to harm others, and violent acts toward others, above and beyond the effects of gender and posttraumatic stress disorder (PTSD) symptoms. The present findings suggest that identification with the aggressor might make survivors prone to the re-enactment of past abusive dynamics, which, in turn, could eventuate in aggression toward themselves and others.
... Although identification with the aggressor may be an important survival mechanism during the abuse itself, it often continues after the abuse ends, at which point it becomes highly maladaptive (Frankel, 2002;Lahav, 2021). Identification with the aggressor has been found to be related to dissociation, guilt, and PTSD symptoms , as well as self-harm and inward aggression (Lahav et al., 2020) among adult childhood abuse survivors. Eating disorders, which may be viewed as a means of engaging in self-harm (Zubery et al., 2016), may also be part of these detrimental outcomes of survivors' post-abuse identification with their aggressor. ...
... By starving the body, bingeing large amounts of food, or torturing the body with purging behaviors, eating disorders may be a way to punish the self (Gur, 2019). These symptoms may be an expression of the adult self, punishing the child self that feels guilty for the abuse (Ross, 2009), or an expression of identifying with the perpetrator's aggression, where that aggression is inflicted upon one's own self (Lahav et al., 2020). At the same time, eating disorder symptoms may be an attempt to cleanse the self from the guilt, shame, and disgust that has been clinging to it. ...
... As identification with the aggressor may take the form of concordant identification, wherein the victims' selfperception is entirely based on that of the perpetrator (Frankel, 2002), victims may not only believe they are deserving of the abuse, but also take pleasure in hurting themselves, as the perpetrator did during the abuse (Lahav et al., 2019). Previous findings revealed associations between identification with the aggressor and non-suicidal self-injury (Lahav et al., 2020), potentially supporting this notion. ...
Background
Childhood abuse has been increasingly recognized as a risk factor for eating disorder symptoms. Additionally, it has been demonstrated that childhood abuse may lead to identification with the aggressor, an automatic defensive process, to survive the abuse. Although it has been clinically implied, the role of identification with the aggressor as a potential mechanism underlying the relation between childhood abuse and eating disorder symptoms has not yet been empirically explored.
Objective
This study examines the role of identification with the aggressor as mediator in the association between history of childhood abuse and eating disorder symptoms among adults.
Participants and methods
A convenience sample of 198 participants completed self-report questionnaires assessing history of childhood abuse, eating disorder symptoms, and the various facets of identification with the aggressor.
Results
Severity of childhood abuse was significantly associated with shape and weight overevaluation, body dissatisfaction, and binge eating, as well as with all components of identification with the aggressor. In addition, almost all components of identification with the aggressor were significantly associated with eating disorder symptoms. Finally, identifying with the perpetrator's aggression mediated the association between childhood abuse and eating disorder symptoms.
Conclusions
The findings may contribute to future clinical interventions by illuminating identification with the aggressor as an important aspect in treating eating disorders. Understanding the pervasive effects of identification with the aggressor on survivors' self and their interactions with others may point to the significance of the therapeutic relationship, through which survivors can reprocess and weaken its detrimental effects.
... Third, as part of IWA, victims may internalize the perpetrator's aggression and may direct this aggression both inward and outward (Frankel, 2002;. Finally, victims who identify with their abusers may adopt their perpetrator's experience concerning the abuse; they may come to mold themselves to their perpetrators, and to view the abuse from their abuser's perspective-namely, to rationalize or deny the abuse while at the same time experiencing selfblame and self-hatred Lahav et al., 2020). ...
... According to IWA theory, although IWA aims to promote survival during the abuse, it often continues to exist even after the abuse ends and has negative repercussions on survivors' well-being (Frankel, 2002;. Evidence from studies among childhood abuse survivors have landed support for this claim, indicating IWA to be related to elevated PTSD, dissociation, selfinjurious behavior, suicidality, and revictimization (Lahav, 2021b;Lahav et al., 2020;Lahav, Talmon, Ginzburg, & Spiegel, 2019). Additionally, a recent study among women reported being subjected to IPV at present or in the past indicated IWA to have unique contribution in explaining trauma-related distress and depressive symptoms above and beyond background characteristics and IPV features (Lahav, 2021a). ...
... Losing their sense of agency and becoming highly attuned to their abusive partners may give rise to feelings of helplessness among survivors as well as doubt concerning their ability to evaluate the abuse correctly (Lahav, 2021a;. Additionally, identifying with their partners' aggression as part of IWA may prone survivors to direct aggression inward (Lahav et al., 2020). These processes, in turn, could result in harsh and punitive self-accusation. ...
This study explored the relation between guilt and identification with the aggressor (IWA) and the moderating role of IWA in the relation between intimate partner violence (IPV) and guilt. An online survey was conducted among a convenience sample of 700 women. IPV survivors demonstrated elevated guilt, and IWA was related to guilt. Furthermore, IWA moderated the relation between IPV and guilt: Among participants with low IWA levels, IPV was unrelated to guilt, but among participants with high IWA levels, IPV was related to guilt. These findings suggest that IWA may be a key element in explaining guilt among IPV survivors.
... In this way, abused children often adopt their perpetrators' emotional experience and beliefs concerning the abuse, while minimizing, rationalizing, or even denying the mistreatment to which they are subjected (Frankel, 2002;Herman, 1992). This form of mental fusion might also consist of victims' identifying with their perpetrators' aggression, which could give rise to enacting aggressive behaviors towards themselves and/or others (Davis and Frawley, 1994;Lahav, Allende, Talmon, Ginzburg, and Spiegel, 2020). ...
... Furthermore, a recent study indicated that identification with the aggressor was related to both inward and outward aggression. Findings of this study revealed that adult survivors of childhood abuse who had high levels of identification with the aggressor reported a higher frequency of non-suicidal self-injury, a greater urge to harm others, and a higher extent of violent acts towards others, compared to survivors who had lower levels of identification with the aggressor (Lahav et al., 2020). ...
... This affirmative attachment has been claimed to last long after the abuse has come to an end, and to not only intensify survivors' distress and psychopathology, but also to increase their susceptibility to self-destructive behaviors (Davis and Frawley, 1994;Frankel, 2002;Van der Kolk, 1989). Nevertheless, it was only recently that these claims were tested empirically with studies documenting the relations between identification with the aggressor and various negative outcomes, such as PTSD symptoms, dissociation, and self-injurious behaviors among adult survivors of childhood abuse (Lahav et al., 2020;. ...
Objective
Childhood abuse survivors are at risk for suicidal ideation and suicide attempts. Research has indicated that posttraumatic stress disorder (PTSD) symptoms and dissociation are related to elevated suicidal ideation and behavior (SIB) among this population. At the same time, although the theoretical and clinical literature in the trauma field have suggested that survivors’ pathological attachment to their perpetrators, known as identification with the aggressor, might explain SIB, this supposition has not been investigated to date.
Method
Filling this gap, this study explored the associations between identification with the aggressor, PTSD symptoms, dissociation, and SIB among 589 adult survivors of childhood abuse.
Results
Identification with the aggressor, PTSD symptoms, and dissociation were related to elevated levels in suicidal ideation and behavior. Furthermore, profile type (namely, having high versus medium or low levels of identification with the aggressor, PTSD symptoms, and dissociation) was implicated in participants’ SIB: Participants who adhered to a profile characterized by high levels of identification with the aggressor, PTSD symptoms, and dissociation had higher levels of suicide risk and suicidal ideation, as well as higher odds of reporting a history of suicide attempts, compared to participants who adhered to the other two profiles (i.e., characterized by medium or low levels of identification with the aggressor, PTSD symptoms, and dissociation).
Limitations
This study relied on convenience sampling and a cross-sectional design.
Conclusions
Identification with the aggressor might serve, alongside PTSD symptoms and dissociation, as a risk factor for suicidal ideation and behavior among childhood abuse survivors.
... The person's (dissociated) self-states that identify with the aggressor lose their own agency and connection to their own wants and needs, become submissive, and undergo mental fusion with the perpetrators via an adoption of the perpetrators' point of view concerning the abuse (Amir, 2016;Coates & Moore, 1997;Lahav, Allende, et al., 2020;. Although this type of identification is assumed to be an automatic reaction that has advantageous effects in terms of promoting survival during the abuse (Frankel, 2002), it often becomes entrenched in victims' mentality and continues to exist long after the abuse has ended (Lahav, 2021b;. ...
Childhood abuse puts individuals at risk for psychopathology and psychiatric symptoms such as posttraumatic stress disorder (PTSD) and anxiety symptoms. At the same time, research has indicated that some survivors report positive transformations in the aftermath of their trauma, known as posttraumatic growth (PTG). Yet the essence of PTG reports is questionable, and some scholars claim that it may reflect maladaptive illusory qualities. Furthermore, according to a recent theoretical model, PTG might be dissociation-based and related to survivors' bonds with their perpetrators. This study aimed to explore these claims by assessing PTG, dissociation, and identification with the aggressor (IWA), as well as PTSD and anxiety symptoms. An online survey was conducted among 597 adult childhood abuse survivors. Study variables were assessed via self-report measures. Analyses indicated positive associations between PTG, dissociation, and IWA. Three distinct profiles were found, reflecting high, medium, and low scores on PTG, dissociation, and IWA. Profile type explained PTSD and anxiety symptoms above and beyond gender, age, and abuse severity. These findings suggest that whereas some childhood abuse survivors might experience a positive transformation subsequent to their trauma, others' PTG reports might reflect dissociative mechanisms and pathological attachments to their perpetrators , and thus might be maladaptive. ARTICLE HISTORY
... This violation threatens the child's sense of security, safety, and trust in the body and undermines these children's capability to defend themselves physically and mentally. By being imprisoned within a betrayed body and forced to continue relying on it for survival, the self has several options: identifying with the aggressor by taking on the victim's (Messman-Moore & Long, 2003;Walker et al., 2019) or the perpetrator's roles by demonstrating outward (Lahav et al., 2022) or inner aggression which involves either harming others or retaliating and punishing the body for its betrayal through self-harm (Lev-Wiesel & Zohar, 2014;Rabinovitch et al., 2015), eating disorders, and a disregard of hygiene (Lev-Wiesel, 2015) and splitting the body and the mind through dissociation (Nijenhuis & van der Hart, 2011). From a therapeutic point of view, the split between mind and body occurs because the child can no longer perceive the body as a safe shelter. ...
Dissociation in child sexual abuse (CSA) survivors remains under-recognized and diagnosed, partly because of the difficulties involved in identifying dissociative symptoms. Qualitative research can contribute to a better understanding of the lived experiences of dissociation. This study focused on the experiences of dissociation in the context of CSA. In all, 22 female incest survivors, all diagnosed with different dissociative disorders, provided narratives about their experiences of dissociation. The narratives were analyzed using interpretative phenomenological analysis. The narrative analysis revealed four central themes. The first theme deals with reliving the experience of the abuse. The second theme refers to the experience of disconnection from the body, the self, and the surroundings. The third theme covers the lack of coherence in the narrative, and the fourth theme describes the bridge between voluntary controlled and nonvoluntary uncontrolled use of dissociation. The data are discussed in light of several traumagenic constructs, including a lack of self-sense, being entrapped in a victim-aggressor relationship, and distorted time perception. It is suggested that the extent to which participants can control their dissociation and the coherency of their narratives reflects the severity of their dissociation. Clinicians can consider helping clients use dissociation as an adaptive defense mechanism.
... In the hope that they would be permitted to survive, they used their strong capacity for empathy and identification to reshape their beliefs and behaviors to fit the ideal image of themselves in the mind of their parents (i.e., the attacker). Thus, their risk-taking, self-harming, and punitive behaviors can be seen as manifestations of identifying with the perpetrator in abuse situations (Lahav et al., 2022) and internalization of the "malignant self-object" (Kohut, 1971) in order to survive. Nevertheless, at the same time, they introjected aspects of external reality and created fantasies that helped them live in the external reality (Frankel, 2002). ...
This purpose of this article is to contribute to the literature on the lived experiences of parentification, its long‐term consequences to the self, and coping strategies related to parentification. A considerable number of quantitative studies have reported on the adverse consequences of destructive or pathological parentification. Nineteen Israeli women aged 30–68 years who believed that they had experienced parentification during childhood and adolescence took part. The women participated in in‐depth semistructured interviews. The data analysis employed the constructivist grounded theory approach. The participants described their childhood and adolescence as a horrifying, threatening, invasive, and neglectful experience that demanded constant adaptation to cope with the anxiety and fear of breakdown. A developmental relational trauma model is proposed to account for the relationships described in their responses. Drawing on convergent findings from psychoanalytic and developmental approaches, the model suggests that the participants developed a split self‐structure to cope with these adverse experiences. It is argued that creating a split disconnecting the topographic structure of the self is key to understanding the sources of role reversal. By aiming to overcome the overwhelming experience of abuse and neglect, this split structure paradoxically protects the traumatized participants from the fragmentation of the self through multiple disconnections. Parentification can be considered a form of emotional abuse and neglect. Clinicians need to recognize the destructive effects of this relationship on self‐structuring.
... Victims may mold their own experience upon the perpetrator's experience, taking on the perpetrator's perspective concerning the abuse and internalizing the perpetrator's aggression. They may therefore view themselves, others, and the abuse from the perpetrator's perspective, feel for and understand their perpetrator, deny or rationalize the abuse, and inflict aggression both inward and outward (Lahav et al., 2019b(Lahav et al., , 2020 . In this way, IWA consists of both concordant and complementary identification (Frankel, 2002): Molding their experience of themselves upon the perpetrators' experience of themselves, victims view IPV from their perpetrators' perspective and adopt their perpetrators' aggression toward others (i.e., concordant identification). ...
Intimate partner violence (IPV) is a global health problem that often results in a variety of mental health detriments,
including trauma-related distress and depressive symptoms. According to the trauma literature, IPV victims
may develop strong bonds with their perpetrators – a phenomenon known as identification with the aggressor
(IWA) – in order to survive the abuse. Yet, this defensive reaction may endure after the abuse has ended, and
may adversely affect victims' mental health. Nevertheless, research exploring these suppositions is lacking. Filling
this void, this study investigated IWA in light of current versus past IPV as well as the relations between IWA,
trauma-related distress, and depressive symptoms among a convenience sample of 297 women. Of them, 68 and
229 participants reported being subjected to IPV at present or in the past, respectively. Results indicated that
whereas participants who reported current IPV had elevated trauma-related distress and depressive symptoms
compared to participants who reported past IPV, no differences were found in IWA levels between the groups.
Identification with the aggressor was related to trauma-related distress and depressive symptoms. Furthermore,
IWA had a unique contribution in explaining trauma-related distress and depressive symptoms above and beyond
background characteristics and IPV features. The findings of the current study suggest that IWA may mirror
the unique relational dynamics that characterize IPV, which continue to exist even after the abuse ends, and may
be implicated in IPV survivors’ psychological distress.
The present cross-sectional study explored whether childhood maltreatment might lead to moral disengagement through emotion regulation strategies, i.e. expressive suppression and cognitive reappraisal. We examined these links in a convenience sample of 178 adults aged 18 to 56 (M = 22.50, SD = 4.89) who completed an online survey. Results suggested that expressive suppression was positively linked to emotioal and sexual abuse and moral disengagement. At the same time, cognitive reappraisal was negatively correlated with emotional abuse. Also, moral disengagement was significantly associated with physical and sexual abuse. Finally, mediation analysis results suggested a significant indirect effect of expressive suppression on the link between emotional and sexual abuse and moral disengagement (but not physical abuse) and moral disengagement. We discuss these findings through the lenses of moral psychology, focusing on moral disengagement as a potential reaction to childhood trauma through expressive suppression.
Study questions:
Although most women who are subjected to intimate partner violence attempt to leave their abusive partners, many return, and resultantly are at risk for even greater violence. Research to date has documented relations between several factors (income and economic dependence, frequency of intimate partner violence (IPV), fear of violence escalations, history of childhood abuse, and post-traumatic stress disorder symptoms) and women's returning to their abusive partners. Nevertheless, the contribution of women's emotional bonds with their violent partners, known as identification with the aggressor (IWA), in explaining their perceived likelihood of going back to the relationship, has remained unclear.
Subjects:
The current study, conducted among 258 Israeli women who had left their violent partners, aimed to fill this void.
Methods:
An online survey was conducted. Demographic variables, history of childhood abuse, frequency of IPV, economic dependence on former partner, fear of future violence escalation, post-traumatic stress disorder symptoms, IWA, and perceived likelihood of returning to the relationship, were assessed via self-report questionnaire.
Findings:
Results indicated that two aspects of IWA-becoming hyper-sensitive to the perpetrator and adopting the perpetrator's experience-were related to women's perceived likelihood of returning to the relationship. Furthermore, a logistic regression analysis indicated that only two factors-income and becoming hyper-sensitive to the perpetrator-uniquely contributed to explaining the likelihood of returning to abusive partners. Major implications: The current findings suggest that women's tendency to be highly attuned to their partners' feelings and needs, as a part of IWA, may impede their ability to permanently leave abusive relationships.
Child maltreatment is negatively associated with subjective well-being in emerging adulthood, but the understanding of the mechanisms of this relationship is incomplete. Guided by the stress process model incorporated with a life-course perspective, the present study examined the protective roles of self-related resources (self-esteem and self-compassion) in this association, while considering various maltreatment types (physical abuse, physical neglect, emotional abuse, emotional neglect, and sexual abuse). The Childhood Trauma Questionnaire-Short Form, Rosenberg Self-esteem Scale, Self-compassion Scale, and Satisfaction with Life Scale were used to measure the key variables through an online survey of 358 Chinese college students (226 females, mean age = 19.18) Direct effect of one type of maltreatment on life satisfaction and the three indirect effects through (a) self-esteem; (b) self-compassion; and (c) self-esteem and self-compassion in sequence were examined while controlling for age, gender, and the other four maltreatment types. The results showed that psychological maltreatment was negatively associated with life satisfaction through self-esteem and through the pathway from self-esteem to self-compassion. Indirect effects of the other three types of maltreatment were not significant. This suggests that self-processes are more vulnerable to psychological maltreatment than to other maltreatment types. The type of maltreatment experienced in childhood is worth considering when investigating the extending effect of child maltreatment on individual developmental outcomes. Our findings broaden the understanding of the mechanisms of the stress process model integrated with a life-course perspective. Self-related resources appear to play substantial roles in the long-term association between early stressors of psychological maltreatment in childhood and subjective well-being in emerging adulthood. Highlighting the need to work on improved self-related resources, including self-compassion and self-esteem, might help practitioners to provide treatment for survivors of adverse childhood experiences..
Background:
Non-suicidal self-injury is being increasingly recognised as a prominent public health concern. Identification of early and modifiable risk factors is necessary to advance the screening and intervention efforts, particularly early detection of at-risk individuals. We aimed to examine childhood maltreatment, including its specific subtypes, in relation to non-suicidal self-injury.
Methods:
We did a comprehensive meta-analysis of childhood maltreatment (overall, sexual abuse, physical abuse and neglect, and emotional abuse and neglect) in association with non-suicidal self-injury. We also provided a qualitative review of mediators and moderators of this association. We identified relevant articles published from inception to Sept 25, 2017, through a systematic search of Embase, MEDLINE, and PsycINFO. We extracted continuous and categorical data and assessed for potential moderators using ten study characteristics. We generated random-effects models for analysis and evaluated for publication bias.
Findings:
We identified 71 publications that met eligibility criteria. Overall childhood maltreatment was associated with non-suicidal self-injury (odds ratio 3·42, 95% CI 2·74-4·26), and effect sizes for maltreatment subtypes ranged from 1·84 (1·45-2·34) for childhood emotional neglect to 3·03 (2·56-3·54) for childhood emotional abuse. Publication bias was not evident, except in the case of childhood emotional neglect. Across multiple maltreatment subtypes, we found stronger associations with non-suicidal self-injury in non-clinical samples.
Interpretation:
With the exception of childhood emotional neglect, childhood maltreatment and its subtypes are associated with non-suicidal self-injury. Screening of childhood maltreatment history in non-suicidal self-injury risk assessments might hold particular value in community settings, and increased attention to childhood emotional abuse is warranted.
Funding:
National Institute of Mental Health.
Many of the revolutionary principles introduced by Ferenczi in his clinical practice have now been widely accepted especially in the field of trauma and trauma therapy. Examples of these innovative views include his emphasis on empathy as opposed to technical neutrality and his stress on the real conditions of child caring and family environmental deficits and on the consequences of interpersonal violence and abuse that lead to “identification with the aggressor” by the victim thereby resulting in the internalization of both aggressiveness and guilt (the split guilt of the abuser). The resulting “fragmentation” of the personality, which is now considered dissociation (instead of Freud’s “repression”), is at the root of several severe disorders, characterized by distortion of reality, loss of touch with one’s body and loss of trust in the other. Therefore “abreaction is not enough”. A new, positive relational experience must be re-inscribed at the level of implicit memory.
The present study examined how social status and gender determine anger expression and behavioral reactions toward experienced anger. In two experiments, anger was induced in a staged social interaction. Behavioral anger reactions were judged by observers. In Experiment 1 (equal status condition; N = 110) participants were provoked by a confederate, in Experiment 2 (low status condition; N = 116) participants were provoked by the experimenter. We found that participants expressed their anger to a lesser extent, were less resistant, and engaged in submissive behaviors if they had a lower status than the anger-target. As expected, gender had a moderating effect: While women's anger reactions were affected by having a lower status than the anger-target, men's anger reactions were affected by low status only when interacting with a female anger-target. Our findings provide new evidence regarding behavioral reactions to anger.
This paper focuses on a unique variant of the mechanism of identification with the aggressor. The term "hermetic narrative" refers to a condition in which the trauma victim creates a hermetically sealed narrative of witnessing, which becomes an addictive and subjugating object in itself, while obstructing natural processes of thinking. This paper examines the ways in which the hermetic narrative reconstructs victim-aggressor relations both within the individual and in the analytic relationship. It further discusses the risk of creating a "false analysis" that is based on a malignant cooperation of the analyst and patient with the internalized traumatic object.
Understanding whether a history of psychological trauma is associated with perpetrating aggressive and violent behavior is of critical importance to public health. This relationship is especially important to study within urban areas where violence is prevalent. In this paper we examined whether a history of trauma or Post Traumatic Stress Disorder (PTSD) in inner city civilians was associated with violent behavior. Data were collected from over 1900 primary care patients at Grady Memorial Hospital in Atlanta, Georgia. Childhood trauma history was assessed with the Childhood Trauma Questionnaire (CTQ) and adult trauma history with the Traumatic Events Inventory (TEI). PTSD symptoms were measured with the PTSD Symptom Scale (PSS) and violent behaviors were measured with the Behavior Questionnaire (BQ). Using these measures we studied violent behavior in the inner city and its association with childhood or adult trauma history or PTSD. Trauma, PTSD and violence were all prevalent in this at-risk urban cohort. Perpetrating interpersonal violence was associated with a history childhood and adult trauma history, and with PTSD symptoms and diagnosis. An association between violent behavior and PTSD diagnosis was maintained after controlling for other pertinent variables such as demographics and presence of depression. Our findings point to a dysregulation of aggressive and violent behavior that may be a consequence of trauma and PTSD. These data indicate that more effective PTSD screening and treatment may help to reduce urban violence.
We review research on the relationship of exposure to psychological trauma, with non-suicidal self-injury (NSSI) and suicidality (suicidal ideation [SI], and suicide attempts [SA]) in individuals with dissociative disorders and posttraumatic stress disorder (PTSD). The review provides a context for the Special Issue of the Journal of Trauma and Dissociation on these topics. Exposure to childhood sexual abuse was the most consistent traumatic antecedent of self-harm, although traumatic violence in childhood (particularly physical abuse) and adulthood (particularly domestic violence) and exposure to multiple types of traumatic stressors also were associated with NSSI and SI/SA. Dissociative disorders and PTSD are consistently associated with increased NSSI and SA/SI. There is preliminary cross-sectional evidence that dissociation and posttraumatic stress disorders may mediate the relationship between psychological trauma and NSSI and SI/SA. Research on emotion dysregulation as a potential cross-cutting mechanism linking dissociation, PTSD, and self-harm is also reviewed. We conclude with discussion of implications for clinical practice and future directions for scientific research.
We conducted a latent class analysis (LCA) on 249 recent motor vehicle accident (MVA) victims to examine subgroups that differed in posttraumatic stress disorder (PTSD) symptom severity, current major depressive disorder and alcohol/other drug use disorders (MDD/AoDs), gender, and interpersonal trauma history 6-weeks post-MVA. A 4-class model best fit the data with a resilient class displaying asymptomatic PTSD symptom levels/low levels of comorbid disorders; a mild psychopathology class displaying mild PTSD symptom severity and current MDD; a moderate psychopathology class displaying severe PTSD symptom severity and current MDD/AoDs; and a severe psychopathology class displaying extreme PTSD symptom severity and current MDD. Classes also differed with respect to gender composition and history of interpersonal trauma experience. These findings may aid in the development of targeted interventions for recent MVA victims through the identification of subgroups distinguished by different patterns of psychiatric problems experienced 6-weeks post-MVA.
No one has described more passionately than Ferenczi the traumatic induction of dissociative trance with its resulting fragmentation of the personality. Ferenczi introduced the concept and term, identification with the aggressor in his seminal "Confusion of Tongues" paper, in which he described how the abused child becomes transfixed and robbed of his senses. Having been traumatically overwhelmed, the child becomes hypnotically transfixed by the aggressor's wishes and behavior, automatically identifying by mimicry rather than by a purposeful identification with the aggressor's role. To expand upon Ferenczi's observations, identification with the aggressor can be understood as a two-stage process. The first stage is automatic and initiated by trauma, but the second stage is defensive and purposeful. While identification with the aggressor begins as an automatic organismic process, with repeated activation and use, gradually it becomes a defensive process. Broadly, as a dissociative defense, it has two enacted relational parts, the part of the victim and the part of the aggressor. This paper describes the intrapersonal aspects (how aggressor and victim self-states interrelate in the internal world), as well as the interpersonal aspects (how these become enacted in the external). This formulation has relevance to understanding the broad spectrum of the dissociative structure of mind, borderline personality disorder, and dissociative identity disorder.
To assess (1) the lifetime prevalence of exposure both to trauma and post-traumatic stress disorder (PTSD); (2) the risk of PTSD by type of trauma; and (3) the determinants of the development of PTSD in the community.
The Diagnostic Interview for Genetic Studies was administered to a random sample of an urban area (N = 3,691).
(1) The lifetime prevalence estimates of exposure to trauma and PTSD were 21.0 and 5.0 %; respectively, with a twice as high prevalence of PTSD in women compared to men despite a similar likelihood of exposure in the two sexes; (2) Sexual abuse was the trauma involving the highest risk of PTSD; (3) The risk of PTSD was most strongly associated with sexual abuse followed by preexisting bipolar disorder, alcohol dependence, antisocial personality, childhood separation anxiety disorder, being victim of crime, witnessing violence, Neuroticism and Problem-focused coping strategies. After adjustment for these characteristics, female sex was no longer found to be significantly associated with the risk of PTSD.
The risk for the development of PTSD after exposure to traumatic events is associated with several factors including the type of exposure, preexisting psychopathology, personality features and coping strategies which independently contribute to the vulnerability to PTSD.
Objective:
Childhood maltreatment increases risk for psychopathology. For some highly prevalent disorders (major depression, substance abuse, anxiety disorders, and posttraumatic stress disorder) a substantial subset of individuals have a history of maltreatment and a substantial subset do not. The authors examined the evidence to assess whether those with a history of maltreatment represent a clinically and biologically distinct subtype.
Method:
The authors reviewed the literature on maltreatment as a risk factor for these disorders and on the clinical differences between individuals with and without a history of maltreatment who share the same diagnoses. Neurobiological findings in maltreated individuals were reviewed and compared with findings reported for these disorders.
Results:
Maltreated individuals with depressive, anxiety, and substance use disorders have an earlier age at onset, greater symptom severity, more comorbidity, a greater risk for suicide, and poorer treatment response than nonmaltreated individuals with the same diagnoses. Imaging findings associated with these disorders, such as reduced hippocampal volume and amygdala hyperreactivity, are more consistently observed in maltreated individuals and may represent a maltreatment-related risk factor. Maltreated individuals also differ from others as a result of epigenetic modifications and genetic polymorphisms that interact with experience to increase risk for psychopathology.
Conclusions:
Phenotypic expression of psychopathology may be strongly influenced by exposure to maltreatment, leading to a constellation of ecophenotypes. While these ecophenotypes fit within conventional diagnostic boundaries, they likely represent distinct subtypes. Recognition of this distinction may be essential in determining the biological bases of these disorders. Treatment guidelines and algorithms may be enhanced if maltreated and nonmaltreated individuals with the same diagnostic labels are differentiated.
An important interest in mixture modeling is the investigation of what types of individuals belong to each latent class by relating classes to covariates, concurrent outcomes and distal outcomes, also known as auxiliary variables. This article presents results from real data examples and simulations to show how various factors, such as the degree to which people are classified correctly into latent classes and sample size, can impact the estimates and standard errors of auxiliary variable effects and testing mean equality across classes. Based on the results of the examples and simulations, suggestions are made about how to select auxiliary variables for a latent class analysis.
Research comparing adolescents engaging in suicidal and non-suicidal self-injury (NSSI), both separately and in combination, is still at an early stage. The purpose of the present study was to examine overlapping and distinguishable features in groups with different types of self-injurious behaviors, using a large community sample of 2,964 (50.6 % female) Swedish adolescents aged 15-17 years. Adolescents were grouped into six categories based on self-reported lifetime prevalence of self-injurious behaviors. Of the total sample, 1,651 (55.7 %) adolescents reported no self-injurious behavior, 630 (21.2 %) reported NSSI 1-4 times, 177 (6.0 %) reported NSSI 5-10 times, 311 (10.5 %) reported NSSI ≥ 11 times, 26 (0.9 %) reported lifetime prevalence of suicide attempt and 169 (5.7 %) adolescents reported both NSSI and suicide attempt. After controlling for gender, parental occupation and living conditions, there were significant differences between groups. Pairwise comparisons showed that adolescents with both NSSI and suicide attempt reported significantly more adverse life events and trauma symptoms than adolescents with only NSSI, regardless of NSSI frequency. The largest differences (effect sizes) were found for interpersonal negative events and for symptoms of depression and posttraumatic stress. Adolescents with frequent NSSI reported more adversities and trauma symptoms than those with less frequent NSSI. There were also significant differences between all the NSSI groups and adolescents without any self-injurious behavior. These findings draw attention to the importance of considering the cumulative exposure of different types of adversities and trauma symptoms when describing self-injurious behaviors, with and without suicidal intent.
This review considers the impact of deliberate emotion regulation on aggression, by integrating findings from recent emotion regulation research with a contemporary model of aggressive behavior, the General Aggression Model. First, it considers how individuals who under-regulate anger and other emotions may be more likely to behave aggressively in an attempt to repair, terminate, or avoid uncomfortable emotional states. Second, it explores how over-regulation of emotion may lead to aggressive behavior by increasing negative affect, reducing inhibitions against aggression, compromising decision making processes, dimin-ishing social networks, increasing physiological arousal and hindering the resolution of difficult situations. Finally, it reviews three skills thought to underlie deliberate emotion regulation: emotional awareness, emotional acceptance and proficiency in a variety of emotion regulation strategies. Treatment encompass-ing all of these skills may improve an individual's ability to regulate difficult emotion states more adaptively and thereby lessen aggressive behavior.
Research indicates an interlink between traumatic experiences and criminal behaviour (Ardino, 2011; Foy, Furrow & McManus, 2011; Weeks & Widom, 1998, 1989) revealing that offenders present a higher prevalence of Post-traumatic Stress Disorder (PTSD; APA, 1994) and associated symptoms when compared with the general population (Wright, Borrill, Teers & Cassidy, 2006). Available studies, however, rarely present data about specific trajectories that connect trauma and PTSD to criminal behaviour. This thematic cluster of articles ‘‘Offending behaviour: the role of trauma and PTSD’’ aims to explore such trajectories and post-traumatic mechanisms in offenders. (Published: 20 July 2012) Citation: European Journal of Psychotraumatology 2012, 3 : 18968 - http://dx.doi.org/10.3402/ejpt.v3i0.18968
Achievement goal research has grown increasingly complex with the number of proposed goal orientations that motivate students. As the number of proposed goal constructs proliferates, a variety of data analytic challenges have emerged, such as profiling students on different types of goal pursuit as well as evaluating the relationships of multiple goal pursuit with different educational outcomes. The purpose of the current article is to showcase the advantages of using latent profile analysis (LPA) over other traditional techniques (such as multiple regression and cluster analysis) when analyzing multidimensional data like achievement goals. Specifically, we review the advantages of LPA over traditional person- and variable-centered analyses and then provide a critical look at three different conceptualizations of goal orientation (2-, 3-, and 4-factor) using LPA.
This study examined lifetime trauma and life event stressors among young and older prisoners. A stratified random sample of young (age 18 to 24 years) and older (age 55 and above) male prisoners was drawn from the New Jersey Department of Corrections. Fifty-eight participants completed a modified version of the Trauma and Stressful Life Experiences Screening Inventory during face-to-face interviews. Approximately 40% of young and older adult prisoners reported exposure to violent victimization. Young prisoners were significantly more likely to report witnessing physical assault, whereas older prisoners were significantly more likely to report experiencing a natural disaster, life-threatening illness, or the death of a loved one. Information about the frequency of lifetime trauma and life event stressors can be used to develop or improve trauma-informed services that target age-specific needs, especially for young and older prisoners.
Meta-analytic reviews of sex differences in aggression from real-world settings are described. They cover self-reports, observations, peer reports, and teacher reports of overall direct, physical, verbal, and indirect forms of aggression, as well as (for self-reports) trait anger. Findings are related to sexual selection theory and social role theory. Direct, especially physical, aggression was more common in males and females at all ages sampled, was consistent across cultures, and occurred from early childhood on, showing a peak between 20 and 30 years. Anger showed no sex differences. Higher female indirect aggression was limited to later childhood and adolescence and varied with method of measurement. The overall pattern indicated males' greater use of costly methods of aggression rather than a threshold difference in anger. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
Identifying with the aggressor is a process wherein victims of abuse, particularly during childhood, take on their perpetrator’s experience. The victim defers to the perpetrator and adopts the perpetrator’s experience, learns the perpetrator’s desires and needs, and gratifies them. Although the clinical and theoretical literature suggests that identification with the aggressor occurs in the aftermath of abuse and has negative long-term implications, to date this concept has not been empirically investigated. To facilitate an exploration of this subject, the current study evaluated the psychometric properties of a new measure: the Identification With the Aggressor Scale (IAS). The study was conducted among convenience samples of students using online surveys. In Study 1, the IAS was administered to 318 students. In Study 2, the IAS, and a battery of questionnaires assessing features of abuse, dissociation, posttraumatic stress disorder (PTSD) symptoms, and posttraumatic guilt were administered to a convenience sample of 368 students. Four reliable IAS factors emerged from Study 1: Adopting the perpetrator’s experience concerning the abuse, identifying with the perpetrator’s aggression, replacing one’s agency with that of the perpetrator, and becoming hypersensitive to the perpetrator. In Study 2, a confirmatory factor analysis confirmed the scale’s underlying factor structure. A history of childhood abuse, recurrence and severity of abuse, and the perpetrator being a parental figure were all associated with higher IAS scores. In addition, IAS scores were correlated with dissociation, PTSD symptoms, and posttraumatic guilt. The present findings indicate that the IAS has good psychometric properties, making it useful as an assessment tool in future research.
This study of college undergraduates (N = 873) examined three hypotheses regarding associations between childhood sexual abuse and lifetime aggression: 1) childhood sexual abuse was expected to account for unshared variance in the lifetime aggression indicators after controlling for the potential effects of parental physical abuse, sibling physical abuse, exposure to intimate partner violence, peer bullying, and respondent age; 2) childhood sexual abuse associations were expected to be relatively stronger among the women than the men; 3) childhood sexual abuse links to lifetime aggression were expected to vary as a function of age of victimization (adolescent < childhood < dual-age victims). Aggression histories varied widely with over 20% reporting prior injuries inflicted on others (3.2% > five injuries). Sexual abuse links to aggression tended to be stronger (p < .001) for the women than the men, and rates of aggression were higher when sexual abuse recurred across both childhood and adolescence. Partial support was found for all three hypotheses.
Background:
Over the past several years there has been considerable interest in the relation between emotion dysregulation and non-suicidal self-injury (NSSI), particularly given that rates of NSSI have been increasing and NSSI is a critical risk factor for suicidal behavior. To date, however, no synthesis of empirical findings exists.
Methods:
The present study presents a comprehensive meta-analytic review of the literature on the association between NSSI and emotion dysregulation. A total of 48 publications, including 49 independent samples, were included in this analysis.
Results:
Overall, a significant association was found between emotion dysregulation and NSSI (pooled OR = 3.03 [95% CI = 2.56-3.59]). This association was reduced but remained significant (OR = 2.40 [95% CI = 2.01-2.86]) after adjustment for publication bias. Emotion dysregulation subscales most strongly associated with NSSI included limited access to regulation strategies, non-acceptance of emotional responses, impulse control difficulties, and difficulties engaging goal-directed behavior. Lack of emotional awareness/clarity and cognitive aspects of dysregulation yielded weaker, yet significant, positive associations with NSSI.
Conclusions:
Findings support the notion that greater emotion dysregulation is associated with higher risk for NSSI among individuals across settings, regardless of age or sex. Furthermore, findings reveal facets of dysregulation that may have unique implications for NSSI. This meta-analysis highlights the importance of better understanding emotion dysregulation as a treatment target for preventing NSSI.
Several studies have demonstrated a vicious cycle of violence, in which experiences of childhood maltreatment (CM) transition into later perpetration of aggressive acts. But evidence for the presence of this cycle in adult women is mixed. The aim of this meta-analysis is to investigate the strength of associations and the mechanisms underlying a cycle of violence in women. Databases were searched for terms related to female aggression, violence, delinquency, antisocial behavior, or offending in addition to exposure to traumatic experiences, abuse, or maltreatment during childhood. Only peer-reviewed studies were included that investigated associations between any type of CM and different acts of aggression. Multi-level meta-analyses were applied, as well as meta-regressions, all based on Cohen's d . K = 34 studies were identified. The overall association between exposure to CM was in the positive but small range (Cohen's d = 0.30). There was no significant difference between specific types of abuse and/or neglect. However, associations were smaller for the perpetration of sexual aggression and violent crime compared with other acts of aggression. These findings underline the long-lasting and devastating impact of CM, including types of maltreatment that were long assumed to be less severe. Due to the limited number of available studies, interactions between types of CM and aggression could not be modeled, thus compromising their probable interacting contribution to the cycle of violence. Early interventions targeting families and women at risk are critical in order to prevent ongoing cycles of violence.
Utilizing a sample of 400 homeless street youth, the study draws on the social schematic theory of crime to examine if childhood trauma (physical abuse, physical neglect, emotional neglect, and sexual abuse) is linked to the development of a criminogenic knowledge structure (CKS) that mediates its relationship with violence. Results indicate childhood trauma is directly associated with the CKS. They also show that it is indirectly related through violent peers. The CKS in turn is directly linked to violence as are childhood trauma and violent peers. The CKS also mediates the relationship childhood trauma and violent peers have with violence. Violent peers likewise mediate the association between childhood trauma and violence. The link between childhood trauma and violence is also serially mediated through violent peers and the CKS. Findings suggest the social schematic theory offers a valuable explanation for the link between childhood trauma and violence.
Childhood sexual abuse (CSA) poses a risk for sexual revictimization.
Additionally, according to theory CSA may lead to
identification with the aggressor, expressed by adopting the
perpetrator’s experience concerning the abuse; identifying
with the perpetrator’s aggression; replacing one’s agency
with that of the perpetrator; and becoming hyper-sensitive to
the perpetrator. Although clinical impressions suggest that
identification with the aggressor underlies reenactment of
trauma, this linkage between identification with the aggressor
and sexual revictimization remains largely uninvestigated. This
study assessed (a) the relationship between identification with
the aggressor (total score and four subscales) and sexual revictimization;
(b) the unique associations between identification
with the aggressor (total score and four subscales) and sexual
revictimization, above and beyond chronicity of abuse and
PTSD symptoms. Participants were Israeli women students
who reported a history of CSA (n = 174). Analyses indicated
significant correlations between two subscales of identification
with the aggressor – replacing one’s agency with that of the
perpetrator and becoming hyper-sensitive to the perpetrator –
and sexual revictimization. These subscales of identification
with the aggressor were associated with sexual revictimization,
above and beyond the effects of chronicity of the abuse and
PTSD symptoms. Nevertheless, these associations were in
opposite directions – while replacing one’s agency with that
of the perpetrator was related with higher occurrence of sexual
revictimization, becoming hyper-sensitive to the perpetrator
was related with lower levels of revictimization. These results
imply that identification with the aggressor may serve as
a multifaceted phenomenon in the context of sexual revictimization,
comprised of both adaptive and maladaptive aspects.
This study sought to enhance knowledge of the link between child sexual abuse (CSA) and long-term criminality by investigating gender-specific effects and the role of index sexual abuse characteristics, revictimization, and serious mental health problems. An Australian sample of 2,759 documented cases of sexual abuse and 2,677 community controls were linked to statewide police records and public mental health service databases, with a follow-up period of 13–44 years. Four key findings emerged from the analysis: (1) CSA victims were more likely than controls to engage in all types of criminal behaviors including violent, sexual, and other offending; (2) gender moderated the relationship between CSA and criminal offending, with stronger associations found among females for general and violent offending, and among males for sexual offending; (3) certain features of the index sexual abuse (i.e., developmental period, number of perpetrators, relation to perpetrator), further victimization experiences, and the development of serious mental health problems were all associated with an increased likelihood of criminal behavior among CSA victims; (4) CSA victims who engaged in criminal offending were more likely to present with cumulative risks than victims not engaging in criminal offending. Implications for future research and clinical practice are discussed.
This review examines posttraumatic stress disorder (PTSD) related to child maltreatment in adults, PTSD comorbidities, and complex PTSD, with a focus on emotion dysregulation. Adults maltreated as children report high rates of PTSD. Although all forms of child maltreatment are associated with increased PTSD risk, effects are stronger for child sexual and emotional abuse, abuse in the context of other adverse childhood experiences, and cumulative abuse. PTSD comorbidities that involve emotion dysregulation are examined, including substance use disorders, eating disorders, and borderline personality disorder. Emotion dysregulation appears to be a coalescent factor in the nexus of child maltreatment, PTSD, and other comorbidities. Treatment recommendations are made for adults with child maltreatment–related PTSD and comorbidities.
Trauma and posttraumatic stress disorder have massive negative consequences; associated anger and aggression are particularly damaging. This overview focuses on these relationships and their potential mechanisms, and offers treatment considerations. Research and theory suggests that trauma impacts anger and aggression through social information processing mechanisms, and an aggression model incorporating impelling, instigating, and disinhibiting factors helps us understand who is at risk under specific circumstances. The association between PTSD and anger and aggression appears stronger for men than women, perhaps reflecting differences in internalizing versus externalizing responses to trauma. Some research indicates that intervention for those with PTSD and anger/aggression problems is effective, and recent studies indicate the benefits of trauma-informed violence prevention for trauma-exposed populations more broadly.
Early developmental trauma is imprinted in the psyche by survival fragmentation and dissociation. Traumatized patients need the analyst to be actively involved and allow for regression to dependence in order to strengthen, create and construct their psychic functioning and structure so that environmental failures will be contained and not rupture continuity of being. I suggest that Ferenczi's and Winnicott's ideas about regression to dependence in analysis are fundamental contributions to these quests, and that Ferenczi set the foundation, which Winnicott further explored and developed. I would like to focus on their clinical theory of treating early developmental trauma of the psyche, describing it in the less known language of Ferenczi, reviving his concept of Orpha and its functions. The complementarities of the two approaches can enrich and broaden our understanding of the clinical complications that arise in the analysis of such states.
Purpose This paper aims to refine our understanding of life course offending patterns across gender and race/ethnicity and to advance work in this area by examining how gender and race/ethnicity interact to influence life course offending patterns. Methods We use criminal justice system data to construct a longitudinal offending cohort that includes all individuals born in 1983/1984 with at least one court finalization for a criminal offense in the state of Queensland between the ages of 10 and 25 years. The data include 41,280 offenders (25.6 % female; 8.9 % Indigenous Australian) responsible for 209,872 offenses (M = 5.08, SD = 12.31). Coupling these data with state-level census data for those born in 1983/1984 (N = 129,782), we estimate cohort offending rates overall and disaggregated by gender and race/ethnicity both independently and jointly. Focusing on the offenders, we use semiparametric group-based modeling to identify the number and longitudinal distributions of offending trajectories within the cohort and compare how subgroups defined by gender, Indigenous status, and their combination sort into these trajectories. Results Most of the birth cohort has little to no contact with the criminal justice system through age 25. However, patterns are not uniform across gender or race/ethnicity, with males and Indigenous Australians most likely to fit the serious and chronic offending trajectories. Gender and race/ethnicity also interact to influence offending patterns with non-Indigenous females significantly more likely than any other group to avoid system contact, while Indigenous males have comparatively exaggerated rates of contact. Moreover, Indigenous females offend in ways more similar to non-Indigenous males than females and, in some instances, evidence even more serious offending. Conclusions Developmental and life course models should highlight not just the operant developmental dynamics across key life stages or the relevant age-graded risk and protective factors at play, but also how gender and race/ethnicity condition these processes both independently and jointly.
Deliberate self-harm (DSH) is associated with diverse psychiatric diagnoses and broad psychopathology but less is known about its association with other forms of interpersonal violence and crime. Using the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), the current study examined linkages between not only DSH and mental health and substance abuse comorbidity, but also childhood abuse, lifetime victimization, and a variety of violent behaviors. We identified a prevalence of 2.91% for DSH and found that DSH is associated with generalized and severe psychopathology, wide-ranging substance abuse, and adverse childhood experiences. Contrary to other studies, we found significant racial and ethnic differences in DSH. African-American, Latinos, and Asians, were substantially less likely than Whites to report DSH. Our hypothesis that DSH would be associated with a variety of violent behaviors including robbery, intimate partner violence, forced sex, cruelty to animals, and use of a weapon was supported even after adjusting for an array of covariates. We extend previous research on DSH by examining its prevalence in one the largest comorbidity surveys ever conducted and show that DSH is associated with multiple forms of violent behavior toward others, including animals.
When we feel overwhelmed by an inescapable threat, we "identify with the aggressor" (Ferenczi, 1933). Hoping to survive, we sense and "become" precisely what the attacker expects of us--in our behavior, perceptions, emotions, and thoughts. Identification with the aggressor is closely coordinated with other responses to trauma, including dissociation. Over the long run, it can become habitual and can lead to masochism, chronic hypervigilance, and other personality distortions. But habitual identification with the aggressor also frequently occurs in people who have not suffered severe trauma, which raises the possibility that certain events not generally considered to constitute trauma are often experienced as traumatic. Following Ferenczi, I suggest that emotional abandonment or isolation, and being subject to a greater power, are such events. In addition, identification with the aggressor is a tactic typical of people in a weak position; as such, it plays an important role in social interaction in general.
The aim of this study is to examine associations among childhood physical, emotional, or sexual abuse and violence toward self (suicide attempts [SA]) and others (interpersonal aggression [IA]). Data were obtained from the National Epidemiologic Survey on Alcohol and Related Conditions Waves 1 and 2 (n = 34,653). Multinomial logistic regression examined associations between type of childhood abuse and violence categories, adjusting for demographic variables, other childhood adversity, and DSM-IV psychiatric disorders. The prevalence of reported childhood abuse was 4.60% for physical abuse, 7.83% for emotional abuse, and 10.20% for sexual abuse. Approximately 18% of adults reported some form of violent behavior, distributed as follows: IA, 13.37%; SA, 2.64%; and SA with IA, 1.85%. After adjusting for demographic variables, other childhood adversity, and psychiatric disorders, each type of childhood abuse was significantly related to increased risk for each violence category as compared with the no violence category. Furthermore, the odds ratio of childhood physical abuse was significantly higher for SA with IA when compared with IA, and the odds ratio of childhood sexual abuse was significantly higher for SA and SA with IA when compared with IA. Childhood physical, emotional, and sexual abuse is directly related to the risk for violent behaviors to self and others. Both internalizing and externalizing psychiatric disorders impact the association between childhood abuse and violence. The inclusion of suicidal behaviors and interpersonal aggression and internalizing/externalizing psychiatric disorders within an integrated conceptual framework will facilitate more effective interventions for long-lasting effects of child abuse.
Research consistently shows that incarcerated juveniles and adults experience high levels of prior traumatic experiences and stressful life events. Yet there is a gap in the literature addressing incarcerated older adults’ life-course experiences of traumatic and stressful life events and their initial and current subjective interpretations of these events. Given that untreated trauma has been linked to decreased health and mental well-being, and recidivism, the current study attempts to address this gap. A secondary data analysis was conducted of the Risk and Resilience Study on older adults in prison. It used a cross-sectional correlation design from an anonymous self-report, self-administered survey of a sample of 667 incarcerated older adults with a mean age of 56.5 years. Cumulative trauma (objective and subjective) was measured using the Life Stressors Checklist-Revised (LSC-R). Up to 70% of participants reported at least one of 31 types of lifetime traumatic or stressful events occurring in childhood and/or adulthood. On average, they also reported higher degrees of current subjective distress about being a victim as opposed to a witness of violence or other stressful experiences. This study helps to break the cycle of silence of trauma and stress among older adults in prison. The complex trauma histories and resulting needs of older adults in prison are a significant public health challenge that must be addressed. Specialized trauma-informed assessment and intervention strategies that may work more effectively with this sensitive population, especially in the challenging prison environment, are discussed.
The research examined whether youth (6-17 years old) who were referred for treatment due to sexual, physical, or both types of abuse presented with distinct profiles of PTSD DSM-IV-TR symptom clusters. When examining data for the 749 youth participants, five PTSD symptom cluster profiles were identified with each profile representing approximately 20% of the youth. The five profiles were also differentiated with respect to being referred for physical or sexual abuse, age, parental ratings of internalizing symptoms, and self-reported depression. The youth referred for treatment in the aftermath of child sexual, physical, or both sexual and physical abuse presented with different profiles of PTSD symptom clusters thereby suggesting a need for individualized tailoring of evidenced-based treatments. Two cognitive behavioral approaches, designed for traumatized children and either their nonoffending or offending parents, were described for treating youth with the distinct PTSD profiles.
Identification of the causes of child maltreatment perpetration is prerequisite for developing efficacious prevention initiatives to reduce its occurrence. Earlier maltreatment victimization is often suggested as an important cause of subsequent maltreatment perpetration. This study investigates a) whether maltreatment victimization causes subsequent perpetration and b) whether the timing of maltreatment victimization-childhood versus adolescence-alters this relationship. We use data from the Rochester Youth Development Study, a longitudinal study begun in Rochester, New York in 1988, based on a stratified random sample of 1000 seventh and eighth graders. At the most recent followup, 80 % were reinterviewed. Child Protective Services data were collected on substantiated incidents of maltreatment victimization from birth to age 17 and on maltreatment perpetration through average age 33, n = 816. Using propensity score models to control selection effects, we find that a history of maltreatment victimization significantly increases the odds of becoming a perpetrator of maltreatment. Although childhood-limited maltreatment does not significantly increase the odds of maltreatment perpetration, maltreatment that occurs in adolescence or that begins in childhood and persists into adolescence does. Adolescent maltreatment was found to be more serious in terms of type, chronicity, and severity than childhood-limited maltreatment, offering a possible explanation for this finding. Therefore, maltreatment victimization, especially during adolescence, is a likely cause of subsequent perpetration. Clinical services to interrupt the cycle of maltreatment are needed to protect subsequent generations from experiencing maltreatment and from experiencing the health-risking behaviors that often flow from maltreatment.
Presents a unified conceptual system for understanding both individual and collective violence. The learning of aggression, the processes which trigger violence, and the rewards and punishments of aggression are discussed. Guidelines for reducing societal levels of aggression are presented. (42 p. ref.) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This study aimed to identify aggression patterns among students, compare teachers' and students' reports on aggressiveness, and examine whether emotional and behavioral problems and self-control intercorrelate with aggression and can explain it among students. The study investigated 363 students aged 8 to 11 years and their 12 homeroom teachers in two elementary schools in central Israel. As expected, students reported higher verbal aggression than physical without gender differences in the general tendency. Also, students reported a higher rate of others' aggression toward them than their own aggression toward others. Similarities emerged between students' and teachers' reports. Four types of students were classified: the aggressive initiator (proactive), the aggressive responder (reactive), the passive victim, and a neutral type. An important outcome was the significant negative association of aggressiveness with self-control. Students with higher rates of self-control skills presented lower rates of aggressive behavior. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In recent years, there has been a growing interest among researchers in the use of latent class and growth mixture modeling techniques for applications in the social and psychological sciences, in part due to advances in and availability of computer software designed for this purpose (e.g., Mplus and SAS Proc Traj). Latent growth modeling approaches, such as latent class growth analysis (LCGA) and growth mixture modeling (GMM), have been increasingly recognized for their usefulness for identifying homogeneous subpopulations within the larger heterogeneous population and for the identification of meaningful groups or classes of individuals. The purpose of this paper is to provide an overview of LCGA and GMM, compare the different techniques of latent growth modeling, discuss current debates and issues, and provide readers with a practical guide for conducting LCGA and GMM using the Mplus software.
The current study examined models of risk for deliberate self-harm (DSH) and suicide attempts (SA) in
a sample of 180 inner-city substance users. The factors of childhood physical, sexual, and emotional abuse, posttraumatic stress (PTS) symptoms, and difficulties controlling impulsive behaviors when
distressed were examined, with path modeling used to explore the interrelationships between variables.
Analyses examined the utility of a model wherein childhood abuse is associated with DSH and SA as a
result of its relationship with PTS symptoms. Further, we examined whether difficulties controlling
impulsive behaviors when distressed accounted for the relationship between PTS symptoms and DSH
and SA. DSH and SA were both related to physical abuse and sexual abuse, PTS symptoms, and
difficulties controlling impulsive behavior when distressed; only SA was associated with emotional
abuse. Further, results demonstrated that the effect of childhood sexual abuse on DSH and SA was
partially explained by PTS symptoms; however, difficulties controlling impulsive behaviors when
distressed contributed little to either model. Findings suggest the importance of developing targeted
interventions for PTS symptoms in order to reduce risk for SA and DSH.
Deliberate self-harm has recently begun to receive more systematic attention from clinical researchers.
However, there remains a general lack of consensus as to how to define and measure this important
clinical construct. There is still no standardized, empirically validated measure of deliberate selfharm,
making it more difficult for research in this area to advance. The present paper provides an
integrative, conceptual definition of deliberate self-harm as well as preliminary psychometric data on a
newly developed measure of self-harm, the Deliberate Self-Harm Inventory (DSHI). One hundred and
fifty participants from undergraduate psychology courses completed research packets consisting of the
DSHI and other measures, and 93 of these participants completed the DSHI again after an interval of
2–4 weeks (M D3:3 weeks). Preliminary findings indicate that the DSHI has high internal consistency;
adequate construct, convergent, and discriminant validity; and adequate test-retest reliability.
The following article reviews literature pertaining to the association between child maltreatment and self-injury and the ways it varies according to maltreatment type. Research supporting various mediators of the relations between different maltreatment types and self-injury is summarized. Informing mediator models, dominant theories of functionality, particularly affect regulation theories, are summarized and granted empirical support. Following from explanations of its functionality, three developmental pathways (regulatory, representational/interpersonal, and reactive/neurobiological) leading from child maltreatment to self-injury are presented within an organizational model of psychopathology. Understanding the deviations in these pathways that perpetuate self-injury helps to inform intervention approaches that forge pathways perpetuating resilience instead. Three psychosocial treatments (i.e., Dialectical Behavior Therapy [DBT], Trauma-Focused Cognitive-Behavioral Therapy [TF-CBT], and Acceptance and Commitment Therapy [ACT]) were chosen for review, based upon their accumulating evidence bases, as well as upon the relevance of their core components in correcting or compensating for trauma-related developmental deviations.
Although significant associations of childhood adversities (CAs) with adult mental disorders have been documented consistently in epidemiological surveys, these studies generally have examined only 1 CA per study. Because CAs are highly clustered, this approach results in overestimating the importance of individual CAs. Multivariate CA studies have been based on insufficiently complex models.
To examine the joint associations of 12 retrospectively reported CAs with the first onset of DSM-IV disorders in the National Comorbidity Survey Replication using substantively complex multivariate models.
Cross-sectional community survey with retrospective reports of CAs and lifetime DSM-IV disorders.
Household population in the United States.
Nationally representative sample of 9282 adults.
Lifetime prevalences of 20 DSM-IV anxiety, mood, disruptive behavior, and substance use disorders assessed using the Composite International Diagnostic Interview.
The CAs studied were highly prevalent and intercorrelated. The CAs in a maladaptive family functioning (MFF) cluster (parental mental illness, substance abuse disorder, and criminality; family violence; physical abuse; sexual abuse; and neglect) were the strongest correlates of disorder onset. The best-fitting model included terms for each type of CA, number of MFF CAs, and number of other CAs. Multiple MFF CAs had significant subadditive associations with disorder onset. Little specificity was found for particular CAs with particular disorders. Associations declined in magnitude with life course stage and number of previous lifetime disorders but increased with length of recall. Simulations suggest that CAs are associated with 44.6% of all childhood-onset disorders and with 25.9% to 32.0% of later-onset disorders.
The fact that associations increased with length of recall raises the possibility of recall bias inflating estimates. Even considering this, the results suggest that CAs have powerful and often subadditive associations with the onset of many types of largely primary mental disorders throughout the life course.