Complex Trauma and Growth in Men Who Have Been Abused as Children and Perpetrated Domestic Violence as Adults

Hurt and complex trauma resulting from childhood maltreatment has serious consequences for the lifespan development of the survivor (Kezelman, Hossack, Stavropoulos, & Burley, 2015; van der Kolk, 2014). Child abuse and neglect involves a betrayal of trust, care and protection within the very relationships upon which the child relies upon for care (Courtois & Ford, 2013). Psychological trauma arising from child abuse and neglect is referred to as complex, or developmental, trauma (Ford et al., 2013). This accounts for the impact of the trauma on the ongoing development of the child into adulthood. Intergenerational continuity research suggests parents’ childhood experiences and current psychosocial functioning are expressed in their parenting behaviour (K. Kim, Trickett, & Putnam, 2010). Further to this is the idea that unresolved childhood experiences of loss and trauma are repeated in the next generation (Bowlby, 2005; Egeland & Susman-Stillman, 1996). Childhood maltreatment research into intergenerational functioning and relationship outcomes in adults, however, is lacking. This thesis comprised a pilot and three studies investigating retrospective reports of childhood experiences and self-reports of current adult functioning outcomes. Participants’ categorical responses to four items on childhood sexual and physical abuse, and physical and emotional neglect, were used to identify any-abused and not-abused groups. Study 1, Experiences of Individuals investigated the relationship and functioning experiences of individuals between groups with, and without, a history of childhood abuse or neglect. Compared to participants without a history of childhood abuse and neglect, any-abused participants had poorer adult functioning outcomes including higher separation-individuation disturbances, lower perceived current social support, higher psychopathology and higher current trauma symptoms. An effect of cumulative harm was demonstrated in participants who reported more than one category of abuse or neglect. There was a link between accessing psychotherapy and poorer adult functioning outcomes. Multiple predictor variables, including adult functioning outcomes and childhood experiences of psychological abuse, physical neglect and sexual abuse were associated with current trauma symptoms. The findings of Study 1 add to the body of research in which poorer adult functioning and relationship outcomes are found in participants reporting a history of childhood abuse and neglect. Study 2, Intergenerational Continuity, examined intergenerational continuity and discontinuity in the relating and functioning of parent–child participant-dyads, with and without a history of child abuse. An intergenerational impact of the effects of childhood abuse and neglect was supported. Regardless of the participant’s own child maltreatment history, participants with a maltreated parent had, on average, poorer adult functioning outcomes, compared to participants whose parent was not maltreated. Participants who reported a history of child abuse or neglect in both generations had poorer adult functioning outcomes, compared to those in which neither generation reported a history of childhood abuse or neglect. In this research, children with an abused or neglected parent had more trauma symptoms themselves, than children with a not-abused parent. A qualitative third study, Survivors’ Experiences of their Parent, focussed on survivors’ lived experiences of their parent. Survivors’ experiences of their caregiving relationship were explored with a focus on the terms trust, hurt and healing. Interpretative Phenomenological Analysis (IPA) (Smith, Flowers & Larkin, 2009) provided a forum for survivors to give voice to their experience and explore their understanding of it. Themes included: a) permanent and generalised distrust and disconnection, b) continued expectation of hurt and anticipation of punishment, c) impact of abuse and neglect on memory, relationships, mental health, adult functioning and self-concept, d) self-protective or protective behaviour, e) slow and difficult healing, f) significant relationships with the other parent and siblings, and g) resilience. Several child abuse survivors wrote that they valued being heard. Being heard and having trauma acknowledged, they felt, may support the healing of other survivors. The lived experience of survivors informs us that, even as adults, their relationship experiences with their parent continue to impact on their relationships with themselves and with others. The current research shows that intergenerational functioning outcomes hold similar implications to outcomes for individuals, and yet has been absent from inclusion in the way we respond, treat and consider complex trauma. The global significance of this research is to shift the focus from the individual effects of childhood maltreatment to a broader understanding of the potential intergenerational effects.

BackgroundThis study assessed whether several adult life experiences, including loss of support, loss of food security, loss of housing, and substance use cessation, are associated with change in domestic violence (DV) perpetration from early to later adulthood. Using 2015 to 2016 cross-sectional, self-report survey data from Medicaid enrollees in Oregon (N = 1620), we assessed change in DV perpetration from early adulthood (19–30 years) to later adulthood (≥ 31 years of age), cut points determined by existing survey questions. Multinomial logistic regression models were constructed to estimate the association between life experiences and physical DV perpetration using odds ratios (OR), adjusting for sociodemographic characteristics, DV victimization, and childhood abuse, bullying, and social support.FindingsOf the 20% of participants who perpetrated DV, 36% perpetrated DV in both early and later adulthood (persisters), 42% discontinued (desisters) and 22% began (late-onsetters) perpetration in later adulthood. Loss of support and loss of food security were both associated with change in DV perpetration (i.e., desistance or late onset of perpetration or both). Loss of support was associated with 9.5 times higher odds of being a desister (OR = 9.5, 95% CI = 1.1, 84.1) and 54.2 times higher odds of being a late-onsetter (OR = 54.2, 95% CI = 6.5, 450.8) of DV perpetration compared to persisters. Loss of food security was associated with 10.3 times higher odds of being a late-onsetter (OR = 10.3, 95% CI = 1.9, 55.4) of DV perpetration compared to persisters. In addition, substance use cessation was associated with 10.3 times higher odds of being a desister (OR = 10.3, 95% CI = 1.9, 56.2) compared to persisters.ConclusionsFindings suggest that specific life experiences in adulthood, including loss of support, loss of food security, and substance use cessation, are associated with changes in DV perpetration.

Objective To explore characteristics of traumatic events and posttraumatic stress disorder (PTSO)symptom among perpetrators of domestic violence(DV).Methods A structured psychiatric interview,self-report Traumatic Life Events Questionnaire(TLEQ)and Impact of Event Scale-revised(IES-R)were administered to 50 male perpetrators of DV and 80 controls matched by age,education and family structure,who were selected from certain community in Mianyang city,Sichuan province,China.Results (1)80%of perpetrators of DV(n=40)had experienced more than three traumatic events,significantly higher than that in the controls (46.2%)(x2=21.70,P=0.000),and the mean number of traumatic events in perpetrators of DV was significantly higher than that in the controls(5.5:3;Z=3.94,P=0.000).(2)The perpetrators of DV had experienced more types oftraumatic events than the controls,such as sudden death of a close friend or aloved one(x2=3.74),witness to domestic violence(x2=6.24),intimate partner abuse(x2=10.06)and childhood sexual abuse(x2=4.53～8.45),with all significant differences(P＜0.05).(3)The total score of IES-R and its'three subscale sores among perpetrators of DV were all significantly higher than those among the controls(P＜0.05).Conclusion In the perpetrators of DV,exposure to traumatic events were very conunon.The importance of screening and early intervention and prevention programmes for psychological traumas among perpetrators of DV was highly emphasized. Key words: Domestic violence; Cross-section survey; Psychological trauma; Childhood abuse

Children Witnessing Domestic and Family Violence: A Widespread Occurrence during the Coronavirus Disease 2019 (COVID-19) Pandemic

Over the past few decades, there has been an increased awareness of the co-occurrence of domestic violence (DV) with child maltreatment and criminal offending. This growing awareness of the complexity of violence occurring within families has brought attention to the fragmented nature of the systems that respond to these forms of violence. Specifically, the civil justice system, the criminal justice system, and the welfare system have traditionally operated independently with opposing procedural, professional, and philosophical frameworks. Additionally, the lack of longitudinal population-based research has impeded the understanding of the intricate relationship between DV, child maltreatment, and criminal offending. Guided by multiple theoretical frameworks including developmental systems theory, developmental and life-course criminology, and cumulative disadvantage, the aim of this thesis was to examine the contact DV victims and DV perpetrators have with the systems that respond to child maltreatment and criminal offending. This aim was addressed through four unique but interrelated studies, each focusing on a specific form of co-occurrence of violence with DV. Each study addressed a primary research question: Study One: What experience do individuals involved with domestic violence (as either a victim or perpetrator) have with child maltreatment victimisation? Study Two: What experience do individuals involved with domestic violence (as either a victim or perpetrator) have with criminal offending? Study Three: What experience do individuals involved with domestic violence (as either a victim or perpetrator) have with perpetrating child maltreatment? Study Four: What are the overlaps of being involved in domestic violence (as a victim and perpetrator), child maltreatment (as a victim and perpetrator), and criminal offending? The overarching aim and research questions of this thesis were addressed through the use of population-based linked administrative data from the Queensland Cross-sector Research Collaboration (QCRC). These data originate from the Queensland government departments that respond to DV, child maltreatment, and criminal offending, and includes all individuals born in Queensland in 1983 and 1984 who were aged 30 years at the time of data extraction. Study One focused on the intergenerational transmission of violence in the family through the examination of the overlap of being a victim of child maltreatment and having later involvement with DV (as either a perpetrator or victim). This study identified a significant overlap between individuals who experienced child maltreatment victimisation and DV. Additionally, the frequency, type, and timing of violence differed between individuals who experienced either DV or child maltreatment when compared to those who experienced both forms of violence. Study Two aimed to determine the specificity or generality of offending by DV perpetrators. Furthermore, the co-occurrence between DV victimisation and criminal offending was explored. A significant overlap was identified between being a perpetrator of DV and a criminal offender, highlighting that DV perpetrators are more general in their violence and deviance. Further, a significant overlap was identified between being a victim of DV and a criminal offender. Again, differences were found for the frequency, type, and timing of violence and deviance between individuals who experienced either DV or criminal offending and those who experienced both. In Study Three, there was an examination of the overlap between individuals involved with DV (as either a perpetrator or victim) and the perpetration of child maltreatment. A significant overlap was found between the two types of violence, with a difference being found for the frequency, type, and timing of the violence between those who were involved with either DV or child maltreatment perpetration and those involved with both. Lastly, Study Four combined the previous studies and aimed to identify the involvement of individuals across the multiple forms of DV (as a perpetrator and a victim), child maltreatment (as a perpetrator and a victim), and criminal offending. Findings showed that not only did a substantial number of individuals have contact with the service systems but that there was a considerable number of individuals that had multiple types of involvement with these systems. For all four studies, the co-occurrence of system contacts was significantly impacted by both race (Indigenous Australian versus non-Indigenous Australian) and gender. The studies of this thesis highlight the significant co-occurrence and complexity of experiencing multiple types of violence. These findings demonstrate the need for holistic and collaborative responses by service systems for individuals experiencing DV, child maltreatment, and criminal offending. Further implications of the results of this research for policy, practice, theory, and future research are discussed at the conclusion of this thesis.

The childhood experience of physical abuse is believed to be associated with parental child abuse. However, not all parents with a childhood history of abuse are abusive, indicating that factors such as social support may buffer the effects of childhood abuse. To examine the role of social support in the discrimination of physical child abusers and nonabusers, the Childhood Social Network Questionnaire (CSNQ) and the Child Abuse Potential (CAP) Inventory were given to matched groups of physical child abusers with a childhood history of physical abuse, nonabusers with a childhood history of physical abuse, and nonabusers without a childhood history of physical abuse. Overall, CSNQ factors and the CAP abuse scale each distinguished between physical child abusers and nonabusers. The CAP abuse scale, however, provided the highest classification rates, and the rates were not improved by the addition of social support factors. In contrast to expectations, none of the social support factors distinguished between physical child abusers with a childhood history of physical abuse and the group of nonabusers with a childhood history of physical abuse.

Psychiatrists Urged to Ask About Domestic Violence

For bariatric surgery candidates, history of child abuse and PTSD may be under-recognized or under-reported at pre-surgical evaluation. On a range of clinically relevant factors, we studied 3045 candidates for bariatric surgery: (1) those with a history of childhood abuse compared to those without such history; and (2) among candidates with a history of abuse, those with a lifetime diagnosis of PTSD compared to those without that diagnosis. We compared them on current and lifetime eating disorders, physical health problems, health behaviors, physical functioning, psychosocial functioning, psychiatric disorders, emotional wellness, body satisfaction, and self-esteem. We hypothesized that patients with a history of childhood abuse, and within that group, those with a lifetime PTSD diagnosis, would display greater overall impairment. Patients were interviewed with semi-structured interviews and completed self-report questionnaires. Results showed that (1) patients with a history of childhood abuse exhibited significantly greater impairment than those without abuse; and (2) among candidates with a history of abuse, those with a lifetime history of PTSD displayed significantly greater impairment than those without a PTSD diagnosis. The findings suggest that a history of both childhood abuse and lifetime PTSD should be thoroughly assessed for at pre-surgical evaluation, and that greater attention be paid to the experience of PTSD symptoms in abuse survivors presenting for bariatric surgery.

The impact of childhood abuse history and domestic violence on the mental health of women in Japan

A Prospective Examination of Service Use by Abused and Neglected Children Followed Up Into Adulthood

Testing a cascade model of linkage between child abuse and negative mental health among battered women in Japan

Domestic violence (DV) is reported by 40% of married women in India and associated with substantial morbidity. An operational research definition is therefore needed to enhance understanding of DV epidemiology in India and inform DV interventions and measures. To arrive at a culturally-tailored definition, we aimed to better understand how definitions provided by the World Health Organization and the 2005 India Protection of Women from Domestic Violence Act match the perceptions of behaviors constituting DV among the Indian community. Between September 2012 and January 2013, 16 key informant interviews with experts in DV and family counseling and 2 gender-concordant focus groups of lay community members were conducted in Pune, India to understand community perceptions of the definition of DV, perpetrators of DV, and examples of DV encountered by married women in Pune, India. Several key themes emerged regarding behaviors and acts constituting DV including 1) the exertion of control over a woman’s reproductive decision-making, mobility, socializing with family and friends, finances, and access to food and nutrition, 2) the widespread acceptance of sexual abuse and the influences of affluence on sexual DV manifestations, 3) the shaping of physical abuse experiences by readily-available tools and the presence of witnesses, 4) psychological abuse for infertility, dowry, and girl-children, and 5) the perpetration of DV by the husband and other members of his family. Findings support the need for a culturally-tailored operational definition that expands on the WHO surveillance definition to inform the development of more effective DV intervention strategies and measures.

The purpose of this study was to examine pathways through which childhood abuse increases the risk of cervical cancer, including smoking, stress, risky sexual behavior, and not having a Papanicolaou (Pap) test. This is a descriptive, correlational study. The sample included 410 women, recruited from a large, multisite women's health center that serves low-income communities in New Jersey. Data were analyzed using path models and conditional regression analysis. Overall, 15% and 12% of the women in the study reported history of physical and sexual childhood abuse, respectively. There was a significant association between child abuse history and failure to receive a Pap test (χ2 = 5.34, p = 0.021). History of childhood abuse was associated with 44% lower odds of having a Pap test. The findings indicate a significant association between child abuse history and cervical cancer risk (χ2 = 7.65, p = 0.006, Cramer's V = 0.138). History of childhood abuse was associated with 96% higher odds of being at risk of cervical cancer. Both physical and sexual abuses were associated with higher levels of smoking, risky sexual behavior, perceived stress, and cervical cancer risk. In the conditional regression analysis, the effect of risky sexual behavior on the likelihood of cervical cancer risk showed an increased risk with higher risky sexual behavior scores only for those with a history of childhood abuse. Childhood abuse increases the risk of cervical cancer in adulthood, through failure to receive a Pap test and higher levels of smoking, perceived stress, and most importantly, risky sexual behavior. More importantly, the combination of childhood abuse and risky sexual behavior plays a greater role in increasing cervical cancer risk.

Previous research on the association between maternal daily stress and cortisol in pregnancy has yielded inconsistent findings. However, past studies have not considered whether stressful experiences in childhood impact maternal cortisol regulation in pregnancy. In this pilot study, we aimed to examine whether the association between maternal daily stress and cortisol differed according to maternal history of child abuse. Forty-one women provided salivary cortisol samples at wake-up, 30 min after wake-up, and bedtime for 3 days at three times over second and third trimesters of pregnancy. On each day of cortisol collection women reported their daily stress. Women reported child abuse experiences prior to age 18 years by completing 15 items from the Adverse Childhood Experiences Scale. Twenty-one percent (N = 9) of women reported a history of child sexual abuse (CSA), 44% (N = 18) reported a history of non-sexual child abuse and 34% (N = 14) reported no history of child abuse. Hierarchical Linear Modeling (HLM) analyses revealed that stress in the day prior was associated with increases in morning cortisol in women with CSA histories compared to women with non-sexual abuse histories or no history of child abuse. Increases in evening cortisol were associated with increases in daily stress in women with CSA histories compared to women with non-sexual abuse histories or no history of child abuse. Results reveal a dynamic association between daily stress and cortisol in pregnancy and suggest that patterns differ according to maternal child abuse history.

Objective To investigate domestic child abuse within one year before the survey being conducted in Grades 4-6 preliminary school students and explore the relationship between domestic child abuse and mental health problems including prevalence of mental disorders, anxiety, depression as well as children's self-awareness in this sample. Methods Screen Questionnaire of Child Abuse was used to screen all the students participated in the survey. For those students whose screen results were positive, further face to face interview was needed to verify the abuse history. Once a child was identified as abused one, a student without abuse history would be matched by sex and the same age. Both groups with abused history and without abuse history over past year were evaluated by the two child psychiatrists with diagnostic an statistical manual of mental disorder(DSM-Ⅳ) and mental health scales. Results 1500 10-13 year-old children received child abuse screening.23.73% students surveyed over the past year suffered child abuse in the family. The proportion of boys who were victims of domestic child abuse was 30.44% while 17.44% to girls (χ2=5.95, P<0.01). The proportion of male students who were victims of domestic abuse was two times that of female students. For all participants, 14.6% had been suffered one-way abuse, 5% for two-way abuse, and 3% for three-way abuse. Prevalence of anxiety disorder in abused students was higher than in non-abused ones (9.26% vs 3.45%, χ2=3.19, P=0.0015). Similarly, the rate of disruptive behavior disorder in abused students was higher than in non-abused ones(18.53% vs 9.22% χ2=3.61, P=0.0001). The total scores of The Screen for Child Anxiety Related Emotional Disorder was higher in abused students group than in non-abused students group while the total scores of Piers-Harris Children's self-concept Scale was lower in abused student group than in non-abused student group. Conclusion Domestic child abuse in 10-13 old-age students is a widespread phenomenon and abuse history over last year is associated with current mental health level. Key words: Domestic child abuse; Mental disorder; Anxiety; Depression; Self-concept