Mairead Tagg PhD mairead.tagg@gmail

1. Mairead Tagg PhD mairead.tagg@gmail.com

2. Impact and Consequences • Compared to non-abused women, survivors of domestic abuse: • 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

3. ....AndNot Forgetting the Children • . “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

4. IPV, Children and RiskIPV and Children • Can include threats to harm the children as part of the man’s control strategy (Dobash and Dobash, 1984, Saunders 1995) • 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)

5. Being exposed to IPV places children at significant risk of experiencing an enduring cycle of financial hardship, homelessness and social isolation Houghton, 2008b )

6. 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 dangerous

7. Trauma • Psychological trauma can be defined as ”intense fear, helplessness, loss of control and fear of annihilation” Comprehensive Textbook of Psychiatry • Occurs when: • Action is of no avail - • Resistance is futile - • Escape is impossible –

8. 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

9. 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 response • Language centres in the cerebral cortex close down • Full stress response activates flight, fight, freeze • Neurochemicals adrenaline and noradrenaline affect the hippocampus • Leads to time distortions, memory distortions and a lack of cohesive narrative of the trauma

10. 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)

11. 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 women, • 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 2004)

12. 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

13. 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

14. 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.

15. 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

16. Risks to Brain Development

17. Damage to Prefrontal Cortex • Can’t relate to others sensitively • Oblivious to social cues • Prone to dissociation • Unable to empathise and or experience social connectedness. • 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

18. Vulnerable Teenagers Brains • Reorganisation facilitates faster and more efficient information processing • Serves 3 social transitions • Moving away from family of origin • Establishing identity /connection with peer group • Creation of a new family HOWEVER • Can lead to confusion, disorientation and depression • Increased vulnerability to risky behaviours, and addictions • Poor judgement and inadequate impulse control

19. 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

20. Hyper-Avoidance • 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 behaviour • Intervention goal = behaviour change • Cannot change behaviour until healthy alternatives are in place

21. 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

22. 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 )

23. 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

24. 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

25. Traumatic BondingSometimes called Stockholm Syndrome. • When captives and captors develop a close emotional bond • This bond is pathological and extremely powerful • Arises from disturbances in attachment • It is a survival mechanism • It affects adults and children alike • Often missed by professionals during assessments

26. 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.

27. Attachment Trauma and IPA • Traumatic bonding mistaken for healthy attachment • 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

28. 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.

29. 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

30. CHILDREN ARE OUR FUTURE