Profiles of adult survivors of severe sexual, physical and emotional institutional abuse in Ireland

Adult survivors of institutional abuse were interviewed with a comprehensive assessment protocol which included the Childhood Trauma Questionnaire, the Institutional Child Abuse Processes and Coping Inventory, the Structured Clinical Interviews for DSM IV axis I disorders and personality disorders, the Trauma Symptoms Inventory, a Life Problems Checklist, the Experiences in Close Relationships Inventory and the Kansas Marital Satisfaction Scale. Profiles were identified for subgroups who described severe sexual (N=60), physical (N=102), or emotional (N=85) abuse as their worst forms of maltreatment. Survivors of severe sexual abuse had the most abnormal profile, which was characterized by higher rates of all forms of child maltreatment and higher rates of posttraumatic stress disorder, alcohol and substance abuse, antisocial personality disorder, trauma symptoms, and life problems. Survivors of severe emotional abuse were better adjusted than the other two groups. The profile of survivors of severe physical abuse occupied an intermediate position between the other two groups. A thorough assessment of abuse history and current functioning should be conducted when providing services to adult survivors of institutional abuse, since this may have important implications for the intensity of services required. Survivors of severe sexual abuse may require more intensive services. Institutional Abuse 4 INTRODUCTION Recently there have been frequent allegations of child abuse perpetrated within religiouslyaffiliated residential institutions in Ireland. The Irish Government set up the Commission to Inquire into Child Abuse (CICA, 2009) in response to such allegations. The research reported in this paper was commissioned by CICA to throw light on the adjustment of adults who suffered institutional abuse in childhood in Irish religiously-affiliated residential reformatories and industrial schools. These institutions were originally established by religious nuns, brothers and priests for children whose families could not financially support them or provide them with a morally appropriate upbringing. They had the aims of reforming deviant children and providing them with skills to support themselves through manual labour. The Report of the Commission to Inquire into Child Abuse (also known as the Ryan Report) has shown that physical and sexual abuse and neglect within these institutions was widespread (Ryan, 2009). The literature on the effects of child abuse, institutional rearing, and institutional abuse informed the present study, and so is briefly reviewed below. The long-term adverse effects of child abuse and neglect have been well documented (Arnow, 2004; Springer et al., 2003; Widom et al., 2007). For example, Springer et al. (2003) and Arnow (2004) conducted extensive reviews of empirical studies in this area and concluded that child abuse and neglect lead to physical and mental health problems and psychosocial adjustment difficulties in adulthood, with the most severely maltreated being the worst affected. Child abuse and neglect has been shown to lead to frequent illness and risky health behaviour (Kendall-Tackett, 2002), mental health problems notably depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol and substance abuse (McMillan, Fleming, & Streiner, 2001), personality disorders (Battle et al., 2004; Bierer et al., 2003), self-harm (Brodsky et al., 2001; Soloff, Lynch, & Kelly, 2002), difficulty with adult romantic attachments (Colman & Widom, 2004; Davis & Petretic-Jackson, 2000), and educational and occupational problems (Perez & Wodom, 1994) in adulthood. Although the mechanisms by which these adverse outcomes occur are not fully understood, it is clear that the experience of child abuse leads to derailment from normal developmental pathways (Widom et al., 2007). Institutional Abuse 5 Institutional upbringing has been shown to have negative effects on development in childhood and across the lifespan into adulthood (Rutter et al., 2001; Rutter, Quinton, & Hill, 1990; Vorria, Sarafidou & Papaligoura, 2004). In a study of children who suffered severe deprivation from birth until 2 years in Romanian institutions prior to adoption by UK families, Rutter et al. (2001) found that at 4 and 6 years these children showed impaired cognitive development, attachment problems, inattention, overactivity, and autistic-like features. Vorria et al. (2004) found that children reared in Greek institutions had disorganized attachment styles. Those who showed the most problematic adjustment in adulthood had entered institutions before they were two and a half years, and came from families with multignerational histories of disadvantage and deprivation. Rutter et al. (1990) found that adults reared in care in the UK showed high rates of personality disorder and romantic relationship problems. Men reared in care had high rates of criminality, while women reared in institutions had high rates of teenage pregnancy and having their children taken in to care. There is limited evidence on the effects of child abuse perpetrated within religiously affiliated institutions on adult adjustment. The only empirical study published in English on this issue was conducted by Wolfe, Francis and Straatman (2006) in Canada. They found that 88% of a group of 76 adult survivors of institutional abuse, at some point in their lives, suffered from a psychological disorder and 59% presented with a current disorder. The most common conditions were PTSD, alcohol, and mood disorders. Participants also showed significant trauma symptomatology on the Trauma Symptom Inventory (TSI, Briere, 1996) with elevations on TSI scales that assessed trauma, dysphoria, depression, intrusive experiences, defensive avoidance, and dissociation. More than two thirds of the sample had experienced significant sexual problems in adulthood, and over half had a history of criminality. In a previous paper we described a study of 247 Irish adult survivors of institutional abuse in which similar rates of psychiatric disorders were found (Carr et al., In Press). Participants had spent an average of 10 years living in institutions before the age of 16. Almost all said they had been physically abused and about half reported being sexually abused while living in institutions. Over four fifths of participants at some point in their life Institutional Abuse 6 had met the diagnostic criteria for an anxiety, mood, substance use, or personality disorder (American Psychiatric Association, 1994). On the Experiences in Close Relationships Inventory using Brennan, Clark and Shaver’s (1998) algorithm, only 16.59% of cases were classified as having a secure adult attachment style. From this brief summary, it is clear that there was considerable variability within this group, in terms of the types of institutional abuse to which participants had been subjected and their overall adjustment in adulthood. The aim of the present paper was to investigate this heterogeneity by establishing the profiles of survivors who identified severe sexual, physical or emotional abuse as the worst form of child abuse to which they had been subjected in institutions. We set out to profile these subgroups in terms of their histories of maltreatment in childhood and functioning in adulthood on indices of psychological adjustment. Subgroup profiles might have implications for understanding the impact of different patterns of abuse. METHOD Participants Participants were 247 adult survivors of institutional abuse recruited through CICA (Carr et al., In Press). All people who attended CICA before December 2005 and who reported institutional abuse were invited to participate in the study unless their whereabouts were unknown; they were resident outside Ireland and UK; they previously stated they did not want to participate in a research project; they previously stated they did not want to be contacted by CICA; they were known to be deceased; or they were known to be in poor health or to have a significant disability. The overall exclusion rate was 26% (326 of 1267). The response rate for the study was 26% (246 of 941). Approximately 20% of CICA attenders participated in this study. The sample included almost equal numbers of males (54.7%) and females (45.3%), with a mean age of 60 years (SD = 8.33; Range = 40 – 83 years). Participants had spent an average of 5.4 years (SD = 4.55) living with their families before entering an institution and on average spent 10 years (SD = 5.21) living in an institution. It had been 22-65 years since they had suffered institutional abuse. Thirty four Institutional Abuse 7 percent of participants were retired; 24% were unemployed; 27% were unskilled or semiskilled; and the remaining 15% had skilled or professional jobs. Forty nine percent had never passed any state, college or university examination. Fifty five percent were married or in a long term cohabiting relationship, and the mean duration of such relationships was 31.10 years (SD = 10.73 years). In terms of mental health, educational and socio-economic factors, as a group, participants in this study were poorly adjusted compared with the general population, but were probably better adjusted than other CICA attenders, and other survivors of institutional abuse, since older cases in poor health or with significant disabilities and who were homeless were excluded.