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


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

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

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

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

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

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

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

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

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2 Comments

Filed under Abuse, Anxiety, Post-Traumatic Stress Disorder

2 responses to “Science Monday: Perpetrators have PTSD? New connections between attachment and PTSD

  1. Scott Knapp, MS

    PTSD in perpetrators is an intriguing idea…and from the standpoint of a law-abiding citizen, why not let the perp remain mired in the natural consequences of his/her crimes? As a therapist of biblical bent, whether to treat a perpetrator for PTSD doesn’t strike me as the piquing question, so much as WHY to treat (and I don’t mean that in a vindictive sense whatsoever). If my purpose for hanging out a shingle is to help people to overthrow the curse of Genesis by figuring out how to think and feel differently about their worlds so as to reduce the groaning of daily living in a fallen world, then of course I would welcome the “perp” into my “morally-bias-free” office and consider him as entitled to emotional relief as much as anyone else with a less-sullied past. My goal as a biblically-guided helper is somewhat different, so my “why” for treating PTSD in a violent perpetrator would be surprisingly different. Ultimately, my objective in working with this kind of client would be to offer him the opportunity to examine and address anything that stands in the way of his becoming a fully devoted worshipper of Jesus…and my avenue to doing so is the presentation of pathology. A passage that immediately springs to mind is 2 Timothy 2:24-26, in which Paul instructs Timothy on how to talk to (counsel?) those who are in opposition to the truth of Timothy’s message. He states that we must counsel in such a way so that “…they may come to their senses and escape from the snare of the devil, having been held captive by him to do his will.” “Come to their senses” implies thinking aright, having an accurate and proper perspective on whatever things are being considered. Would it not make sense that in order for a perpetrator of violent crimes to be able to effectively repent of his sin, he would need to “come to his senses” and have an accurate memory and frame of reference on his crimes? Would he not need to be willing to fully enter once again into the depths of those memories, re-experience their horror and tragedy, in order to have an honest and transparent heart before God concerning them? In my helping efforts, I am fostering this perpetrator’s courage and willingness to honestly examine and evaluate his behaviors, and subsequent reactions to their memory as a fallen, sinful and self-protective being, and aiding him in acquiring a rational, responsible and healthy (as biblically defined) frame of reference upon them. In helping him come to his senses about his actions and their memories, I’m simultaneously treating his PTSD. If in this process he is relieved of some of the presenting emotional problems associated with PTSD, all the better…fewer excuses for resisting in therapy…however, that simply is not the end goal I have in mind as the therapist.

  2. “Attachment literatures come out of developmental theories while PTSD research tends to be CBT based. But the two are quite connected.”

    To me, this is the academic holy grail. I am interested in PTSD in our adopted children and now I understand why the adoption/pediatric/psychology community doesn’t know, or recognize that infants can be traumatized by their adoption, or multiple transfer of caretakers.

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