Mairead Tagg PhD
[email protected]
Impact and Consequences
 Compared to non-abused women, survivors of domestic
 Show significantly higher rates of depression, anxiety
and PTSD. (Campbell 2002, Romito et al 2005 and Golding 1999),
 Suffer chronic pain and inhibition from injuries (Anderson
and Aviles 2006,Whittaker et al 2006)
 15 x more likely to abuse alcohol
 9 x more likely to abuse drugs
 3 x more likely to be diagnosed depressed or psychotic
 5 x more likely to attempt suicide at least once (Stark and
Flitcraft 1997)
 Many women will show signs of acute emotional collapse
similar to disaster victims
....And Not Forgetting the
• .
“it must be recognised that children are
witness to and subjected to much of this abuse
and there is a significant correlation between
domestic abuse and the mental, physical and
sexual abuse of children
• The National Strategy also recognises that
children who witness, or are used in the abuse
of their mothers can experience stress and fear
and may suffer a range of adverse effects,
including physical injury, poor health and an
array of psychological difficulties
Domestic Abuse Delivery Plan for Children and Young People
IPV and Children
 Can include threats to harm the children as part of
the man’s control strategy (Dobash and Dobash, 1984, Saunders
 Children are typically in the same or next room when
their mother is being attacked (Childline 2004, Hughes 1992)
 Nearly half of children interviewed stated that they
had witnessed their fathers choking their mothers
(McCloskey et al, 1995)
 Significantly more likely to directly experience other
forms of child abuse, including child sexual abuse,
(Graham-Bermann et al, 2010, Finkelhor et al 2009, Herrenkohl et al 2008)
 Being exposed to IPV places children at significant
risk of experiencing an enduring cycle of financial
hardship, homelessness and social isolation
Houghton, 2008b
Child Protection Issues
 Child protection is seen as a thing apart from the
mother’s experience of domestic abuse
 Women are expected to protect children – usually
by leaving the abusive situation BUT
 Are expected to facilitate child contact
 Contact assessments are often inappropriate and
 Psychological trauma can be defined as ”intense
fear, helplessness, loss of control and fear of
Comprehensive Textbook of Psychiatry
 Occurs when:
 Action is of no avail -
 Resistance is futile  Escape is impossible –
Types of Trauma
 Type 1 trauma: Single unanticipated traumatic event
e.g. car accident, single assault, natural disaster
 Results in typical PTSD with intrusion, hyperarousal
and avoidance
 Type 2 trauma: Repeated exposure to extreme external
events; domestic abuse, child sexual abuse, neglect
 NOT post traumatic - trauma is never-ending
 Victims protect themselves psychologically
 Denial, repression, dissociation, traumatic bonding,
aggression against self and/or others
What Happens in Trauma?
 Amygdala is the alarm centre of the brain
 Lays down templates of trauma
 No sense of context or history
 Anything close to trauma template triggers full alarm
 Language centres in the cerebral cortex close down
 Full stress response activates flight, fight, freeze
 Neurochemicals adrenaline and noradrenaline affect the
 Leads to time distortions, memory distortions and a lack
of cohesive narrative of the trauma
Domestic Abuse and Pregnancy
 Women who experience domestic abuse are more
than twice as likely to experience miscarriage and
stillbirth. (Humphreys et al 2008, BMA Board of Science 2007,
Kovacs et al. 2006)
IPV, Pregnancy and Perinatal Issues
 30% of domestic abuse begins during pregnancy
 Physical attacks during pregnancy are often directed at
a woman’s abdomen and breasts (BMA, 2007)
 Higher rates of health problems during pregnancy in
 Babies adversely affected, with higher rates of pre-term
births (BMA 2007)
 Higher rates of infection and emotional dysregulation,
typically manifested in excessive crying and difficulties
with feeding and sleeping (Coker Sanderson and Dong
Risks to The
Developing Brain
 The foetus begins to respond to the external
environment from around 2 months gestation
 The brain continues to undergo periods of
substantial development until adulthood.
 The first years are critically important in order to
develop a healthy brain
 Relationship with care-givers vital for brain
organisation and development
Trauma Affects the Developing Brain
 The brain organises according to experience
 Living with constant fear, stress and distress means
child is likely to develop a “warrior brain” in order
to maximise survival
 Where the harm is in the home, vitally important
attachment to the child’s primary caregiver is
fundamentally compromised
 Children who do not have healthy attachments to
their primary carer may well develop such
attachments to peer-group
Developing a Different Brain
 Babies with unresponsive, traumatised
and/or traumatising carers have brains that
present a very different picture.
 Some of the interconnections never get
made and there is a pruning of those already
made that are not being used.
 Failure to modulate stress arousal leads to
those connections that are being made
being made in different locations and of a
different nature.
Foetal Alcohol Syndrome
 Wide set eyes
 flattened central region
 thin upper lip
 Born smaller and lighter
May suffer from
 seizures
 hearing difficulties
 learning difficulties
May have problems with
 attention
 memory
 language development
 motor development
Risks to Brain Development
Damage to Prefrontal Cortex
 Can’t relate to others sensitively
 Oblivious to social cues
 Prone to dissociation
 Unable to empathise and or experience social
 Unable to regulate stress or impulse
 These children are thinking and feeling with a
very different brain.
 Problem gets worse as the child gets older
Vulnerable Teenagers Brains
Reorganisation facilitates faster and more efficient
information processing
 Serves 3 social transitions
1. Moving away from family of origin
2. Establishing identity /connection with peer group
3. Creation of a new family
 Can lead to confusion, disorientation and depression
 Increased vulnerability to risky behaviours, and
 Poor judgement and inadequate impulse control
The Consequences of Trauma
May be
 Permanently hyper-aroused
 Unaware of physical state
 Clumsy/ uncoordinated
 Unable to regulate emotions and impulses
 Unable to experience empathy for others
 Unable to trust
 Chronically angry and controlling
Can also
 Dissociate as a routine response to stress
 Lose preference for the human voice
 Experience difficulties reading and writing
 Experience of continuous terror and
distress is psychologically overwhelming
 Use a variety of coping strategies to avoid
feeling the feelings
 These behaviours are the child/young
person’s solution to the problem
 Agencies mistakenly focus on alarming
 Intervention goal = behaviour change
 Cannot change behaviour until healthy
alternatives are in place
What is Attachment?
 Set of behaviours that serve the function of
creating and maintaining physical and
psychological safety for the individual
 Term originally used by John Bowlby
 Regulates security and independence
 Applies across the lifespan
 Can be used to explain loss reactions at any age
IPA and Attachment
 Pregnant mother’s inner representation of her baby
cabbe negatively affected
 Critically important bonding between mothers and
children is negatively affected by IPA (Huth-Bocks et al 2004,
Levendosky and Graham-Bermann 2001, Zeanah et al 1999, Holden and
Ritchie 1991).
 IPA during pregnancy resulted in significant evidence
of impaired mother-infant attachment even a year
after the baby’s birth. (Quinlivan and Evans 2005 )
Attachment Trauma in Infancy
 Unlike the more identifiable traumatic experiences
of later childhood
 Babies effectively need two brains in order to
develop normally
 Hidden trauma of early dysregulation occurs
within the “split-second world of mother and
infant” (Stern 1977)
 Occurs through varieties of caregiver
unavailability and interactive dysregulation
 Mother must be psychobiologically
attuned to reflect infant’s internal state
Pervasive Harm
 IPA reduces the ability of mothers to provide
comfort and protection in the home
 IPA in the home is associated with infants having
insecure attachments, but more particularly
disorganised attachments. Zanah et al 1999
 Generates tensions and misattunement in the
attachment relationship. (Huth-Bocks et al 2004)
 Women more likely to make negative attributions
about their children, “seeing” similarities between
the child/young person and the abusive partner
Traumatic Bonding
Sometimes called
Stockholm Syndrome.
 When captives and captors develop a close
emotional bond
 This bond is pathological and extremely
 Arises from disturbances in attachment
 It is a survival mechanism
 It affects adults and children alike
 Often missed by professionals during
How Does This Develop?
Occurs in situations where:
Victim experiences the perpetrator as wielding
the power of life and death
Helplessness/terror instilled by the abuse forces
victim to reach out to the only available hope for
relief: the perpetrator.
Perpetrator WILL “rescue”/stop the abuse, or
take victim out of the confines of their pain - at a
price: absolute obedience and silence.
This is the traumatic underpinning of abuse - a
combination of cruelty and kindness; terror and
rescue; degradation and praise.
Attachment Trauma and IPA
Traumatic bonding mistaken for healthy
Child/young person’s acting out attributed to
mother’s poor parenting
No recognition of attachment trauma
No support for non-abusing parent
Children medicalised and medicated
Assessing the Risk to Children from Batterers
Bancroft and Silverman 2002
Conditions for Recovery
 A sense of physical and emotional safety in their
current surroundings.
 Structure, limits and predictability.
 A strong bond to the non-abusive parent.
 Not to feel responsible to take care of adults
 A strong bond to their siblings
 Contact with the abusive parent if strong
protection for their physical and emotional safety
can be guaranteed.
The Necessary Steps
 The need for agencies to work across service
boundaries; to place a child's safety and wellbeing
at the heart of their response to domestic abuse
and, in parallel, to ensure any action they take
empowers and protects adult victims of domestic
abuse, and holds perpetrators accountable for
their abusive behaviour
Domestic Abuse Delivery Plan for Children and Young People