Issues for the safety and wellbeing of children in families with multiple and complex problems

The co-occurrence of domestic violence, parental substance misuse, and mental health problems
NCPC Issues No. 33 – December 2010

Trauma histories of parents with multiple and complex problems

Frequently, parental substance misuse, domestic violence and mental health problems occur as a precursor to or consequence of previous experiences of trauma and adversity, such as physical or sexual assault or childhood experiences of abuse and neglect. For example, based on data from the Adverse Childhood Experiences Study in the United States  researchers found that adults with four or more adverse experiences in childhood were seven times more likely to consider themselves an alcoholic compared to other adults and five times more likely to have used illicit drugs (Felitti et al., 1998). Based on data from the National Co-Morbidity Survey in the United States, adults who had experienced child abuse were two and half times more likely to have major depression compared to adults who had not experienced abuse, and were six times more likely to have post-traumatic stress disorder (Afifi, Boman, Fleisher, & Sareen, 2009). Victims of child abuse or neglect or adult sexual and physical assault may be prone to revictimisation. Widom, Czaja, and Dutton (2008) found that all types of childhood victimisation (physical abuse, sexual abuse and neglect) were associated with increased risks of lifetime revictimisation. Other adverse outcomes associated with past histories of child abuse and neglect include homelessness, physical health problems, revictimisation, unemployment and eating disorders (Gilbert et al., 2009; Johnson, Cohen, Kasen, & Brook, 2002; Kendall-Tackett, 2002).

Box 1: What is trauma?

Trauma theory provides a useful frame for understanding some of the adverse outcomes experienced by adults with past histories of violence, abuse and neglect. Trauma is the overwhelming and uncontrollable feeling of intense fear, helplessness and loss of control in response to terrifying life events (Herman, 1997). Trauma may be experienced as a single traumatic life event such as rape, a near-death experience or witnessing the torture or abuse of another person. Trauma—particularly that which occurs within a domestic context such as domestic violence or child abuse—can also be prolonged and repeated. Herman (1997) equated the experience of prolonged and repeated domestic violence and child abuse with being held hostage. In this situation, Herman argued, victims can become stuck in a present where their initiative is confined to thinking not how they will escape but how they will survive. This narrowing of initiative becomes habitual and must be unlearned to enable the survivor to participate in planning for the future.

Traumatic events induce a wide range of debilitating symptoms that affect all aspects of life for survivors, which can in itself constitute multiple and complex problems. Acknowledging the difficulties that parents may have coming to terms with their own experiences of trauma and victimisation and empathising with their situation does not mean ignoring or excusing abusive or neglectful behaviour directed towards their children. However, understanding parents' past histories may better enable practitioners to determine the underlying causes of parental problems, therefore helping them to engage parents and to assist them to make positive change.