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Child Maltreatment and the Development of Posttraumatic Stress Disorder

Child Maltreatment and the Development of Posttraumatic Stress Disorder Abstract • Objective. —The purpose of this study was to compare the relative effects of various forms of maltreatment on the development of posttraumatic stress disorder (PTSD) in children. Design —Children were randomly selected from a population of court-involved maltreated children. The childen were then assigned to a PTSD group and a non-PTSD group on the basis of their responses to a structured interview. Setting. —A juvenile/family court in a large urban area. Participants. —This study examined 101 children who were before a juvenile/family court because of severe child maltreatment. All children had been removed from parental custody as a result of the maltreatment. Interventions. —None. Measurements and Results. —Structured clinical psychiatric interviews were administered to each child and each parent, and all court records were reviewed. The major analyses assessed the extent to which the presence and duration of the most common types of severe maltreatment were associated with a diagnosis of PTSD. Thirty-nine children met criteria for PTSD. Those who were sexually maltreated and those who witnessed family violence had a much greater likelihood of developing PTSD than did those whose histories of maltreatment did not include these types of events. The duration of emotional abuse (psychological terror) also proved to be a significant factor in discriminating children diagnosed as having PTSD from other severely maltreated children. Conclusions. —These findings delineate factors implicated in the cause of PTSD. Moreover, they provide information that will enable the protective service community to screen more effectively for PTSD among maltreated children.(AJDC. 1993;147:755-760) References 1. Burt C. War neurosis of British children . Nerv Child . 1943;2:324-337. 2. Grinker RR, Speigel JJ. Men Under Stress . New York, NY: McGraw Hill International Book Co; 1945. 3. Kardiner A, Speigel H. War Stress and Neurotic Illness . New York, NY: Paul B Hoeber; 1947. 4. Krystal H. Massive Psychic Trauma . New York, NY: International Universities Press; 1968. 5. Wolf S, Ripley HS. Reactions among allied prisoners of war subjected to three years of imprisonment and torture by the Japanese . Am J Psychiatry . 1947;104:108-193. 6. American Psychiatric Association, Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders, Third Edition . Washington, DC: American Psychiatric Association; 1980. 7. American Psychiatric Association, Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition . Washington, DC: American Psychiatric Association; 1987. 8. Eberly RE, Engdahl BE. Prevalence of somatic and psychiatric disorders among former prisoners of war . Hosp Community Psychiatry . 1991;42:807-813. 9. Bownes IT, O'Gorman EC, Sayers A. Assault characteristics and posttraumatic stress disorder in rape victims . Acta Psychiatr Scand . 1991;83:27-30.Crossref 10. Foa EB, Rothbaum BO, Riggs DS, Murdock TB. Treatment of posttraumatic stress disorder in rape victims: a comparison between cognitive-behavioral procedures and counseling . J Consult Clin Psychol . 1991;59: 715-723.Crossref 11. Curran PS, Bell P, Murray A, Loughrey G, Roddy R, Rocke LG. Psychological consequences of the Enniskillen bombing . Br J Psychiatry . 1990; 156:479-482.Crossref 12. Kutz I, Garb R, David D. Post-traumatic stress disorder following myocardial infarction . Gen Hosp Psychiatry . 1988;10:169-176.Crossref 13. Patterson DR, Carrigan L, Questad KA, Robinson R. Post-traumatic stress disorder in hospitalized patients with burn injuries . J Burn Care Rehabil . 1990;11:181-184.Crossref 14. Buydens-Branchey L, Noumair D, Branchey M. Duration and intensity of combat exposure and posttraumatic stress disorder in Vietnam veterans . J Nerv Ment Dis . 1990;178:582-587.Crossref 15. Green BL, Grace MC, Lindy JD, Gleser GC, Leonard A. Risk factors for PTSD and other diagnoses in a general sample of Vietnam veterans . Am J Psychiatry . 1990;147:729-733. 16. McFall ME, Smith DE, Roszell DK, Tarver DJ, Malas KL. Convergent validity of measures of PTSD in Vietnam combat veterans . Am J Psychiatry . 1990;147:645-648. 17. Orr SP, Claiborn JM, Altman B, et al. Psychometric profile of posttraumatic stress disorder, anxious, and healthy Vietnam veterans: correlations with psychophysiologic responses . J Consult Clin Psychol . 1990;58:329-335.Crossref 18. Paige SR, Reid GM, Allen MG, Newton JE. Psychophysiological correlates of posttraumatic stress disorder in Vietnam veterans . Biol Psychiatry . 1990;27:419-430.Crossref 19. Resnick HS, Foy DW, Donahoe CP, Miller EN. Antisocial behavior and post-traumatic stress disorder in Vietnam veterans . J Clin Psychol . 1989;45: 860-866.Crossref 20. Famularo R, Kinscherff R, Fenton T. Symptom differences in acute and chronic presentation of childhood post-traumatic stress disorder . Child Abuse Neglect . 1990;14:439-444.Crossref 21. Heins T, Gray A, Tennant M. Persisting hallucinations following childhood sexual abuse . Aust N Z J Psychiatry . 1990;24:561-565.Crossref 22. Breslau N, Davis GC, Andreski P, Peterson E. Traumatic events and posttraumatic stress disorder in an urban population of young adults . Arch Gen Psychiatry . 1991;48:216-222.Crossref 23. Famularo R, Kinscherff R, Fenton T. Post-traumatic stress disorder among maltreated children presenting to a juvenile court . Am J Forens Psychiatry . 1989;10:33-39. 24. Kinzie JD, Sack W, Angell R, Clarke G, Ben R. A three-year follow-up of Cambodian young people traumatized as children . J Am Acad Child Adolesc Psychiatry . 1989;28:501-504.Crossref 25. Lindberg FH, Distad LJ. Post-traumatic stress disorders in women who experienced childhood incest . Child Abuse Negl . 1985;9:329-334.Crossref 26. Craine L, Henson C, Colliver J, MacLean D. Prevalence of a history of sexual abuse among female psychiatric patients in a state hospital system . Hosp Community Psychiatry . 1988;39:300-304. 27. Deblinger E, McLeer SV, Atkins MS, Ralphe D, Foa E. Post-traumatic stress in sexually abused, physically abused, and nonabused children . Child Abuse Negl . 1989;13:403-408.Crossref 28. Kiser LJ, Heston J, Millsap PA, Pruitt DB. Physical and sexual abuse in childhood: relationship with post-traumatic stress disorder . J Am Acad Child Adolesc Psychiatry . 1991;30:776-783. 29. Silvern L, Kaersvang L. The traumatized children of violent marriages . Child Welfare . 1989;68:421-436. 30. Carlson BE. Children's observations of interparental violence . In: Roberts A, ed. Battered Women and Their Families: Intervention Strategies and Treatment Programs . New York, NY: Springer-Verlag NY Inc; 1984:147-167. 31. Nader K, Pynoos R, Fairbanks L, Frederick C. Children's PTSD reactions one year after a sniper attack at their school . Am J Psychiatry . 1990;147:1526-1530. 32. Pynoss R, Nader K. Children who witness the sexual assaults of their mothers . J Am Acad Child Adolesc Psychiatry . 1988;27:567-572.Crossref 33. Davis LV, Carlson BE. Observation of spouse abuse: what happens to the children? Interpers Violence . 1987;2:278-291.Crossref 34. Hughes HM. Psychological and behavioral correlates of family violence in child witnesses and victims . Am J Orthopsychiatry . 1988;58:77-90.Crossref 35. Spitzer RL, Williams JBW, Gibbon M, First MB. Structured Clinical Interview for DSM-III . New York, NY: Biometrics Research Division, New York State Psychiatric Institute; 1989. 36. Reich W, Welner Z. DICA-R-C (DSM-IIIR Version), Revised Version 5-R . St Louis, Mo: Washington University; 1990. 37. Famularo RA, Kinscherff RT, Fenton T. Psychiatric diagnoses of maltreated children: preliminary findings . J Am Acad Child Adolesc Psychiatry . 1992;31:863-867.Crossref 38. Famularo RA, Fenton T, Kinscherff RT. Medical and developmental histories of maltreated children . Clin Pediatr . 1992;31:536-541.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Child Maltreatment and the Development of Posttraumatic Stress Disorder

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Publisher
American Medical Association
Copyright
Copyright © 1993 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1993.02160310057018
Publisher site
See Article on Publisher Site

Abstract

Abstract • Objective. —The purpose of this study was to compare the relative effects of various forms of maltreatment on the development of posttraumatic stress disorder (PTSD) in children. Design —Children were randomly selected from a population of court-involved maltreated children. The childen were then assigned to a PTSD group and a non-PTSD group on the basis of their responses to a structured interview. Setting. —A juvenile/family court in a large urban area. Participants. —This study examined 101 children who were before a juvenile/family court because of severe child maltreatment. All children had been removed from parental custody as a result of the maltreatment. Interventions. —None. Measurements and Results. —Structured clinical psychiatric interviews were administered to each child and each parent, and all court records were reviewed. The major analyses assessed the extent to which the presence and duration of the most common types of severe maltreatment were associated with a diagnosis of PTSD. Thirty-nine children met criteria for PTSD. Those who were sexually maltreated and those who witnessed family violence had a much greater likelihood of developing PTSD than did those whose histories of maltreatment did not include these types of events. The duration of emotional abuse (psychological terror) also proved to be a significant factor in discriminating children diagnosed as having PTSD from other severely maltreated children. Conclusions. —These findings delineate factors implicated in the cause of PTSD. Moreover, they provide information that will enable the protective service community to screen more effectively for PTSD among maltreated children.(AJDC. 1993;147:755-760) References 1. Burt C. War neurosis of British children . Nerv Child . 1943;2:324-337. 2. Grinker RR, Speigel JJ. Men Under Stress . New York, NY: McGraw Hill International Book Co; 1945. 3. Kardiner A, Speigel H. War Stress and Neurotic Illness . New York, NY: Paul B Hoeber; 1947. 4. Krystal H. Massive Psychic Trauma . New York, NY: International Universities Press; 1968. 5. Wolf S, Ripley HS. Reactions among allied prisoners of war subjected to three years of imprisonment and torture by the Japanese . Am J Psychiatry . 1947;104:108-193. 6. American Psychiatric Association, Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders, Third Edition . Washington, DC: American Psychiatric Association; 1980. 7. American Psychiatric Association, Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition . Washington, DC: American Psychiatric Association; 1987. 8. Eberly RE, Engdahl BE. Prevalence of somatic and psychiatric disorders among former prisoners of war . Hosp Community Psychiatry . 1991;42:807-813. 9. Bownes IT, O'Gorman EC, Sayers A. Assault characteristics and posttraumatic stress disorder in rape victims . Acta Psychiatr Scand . 1991;83:27-30.Crossref 10. Foa EB, Rothbaum BO, Riggs DS, Murdock TB. Treatment of posttraumatic stress disorder in rape victims: a comparison between cognitive-behavioral procedures and counseling . J Consult Clin Psychol . 1991;59: 715-723.Crossref 11. Curran PS, Bell P, Murray A, Loughrey G, Roddy R, Rocke LG. Psychological consequences of the Enniskillen bombing . Br J Psychiatry . 1990; 156:479-482.Crossref 12. Kutz I, Garb R, David D. Post-traumatic stress disorder following myocardial infarction . Gen Hosp Psychiatry . 1988;10:169-176.Crossref 13. Patterson DR, Carrigan L, Questad KA, Robinson R. Post-traumatic stress disorder in hospitalized patients with burn injuries . J Burn Care Rehabil . 1990;11:181-184.Crossref 14. Buydens-Branchey L, Noumair D, Branchey M. Duration and intensity of combat exposure and posttraumatic stress disorder in Vietnam veterans . J Nerv Ment Dis . 1990;178:582-587.Crossref 15. Green BL, Grace MC, Lindy JD, Gleser GC, Leonard A. Risk factors for PTSD and other diagnoses in a general sample of Vietnam veterans . Am J Psychiatry . 1990;147:729-733. 16. McFall ME, Smith DE, Roszell DK, Tarver DJ, Malas KL. Convergent validity of measures of PTSD in Vietnam combat veterans . Am J Psychiatry . 1990;147:645-648. 17. Orr SP, Claiborn JM, Altman B, et al. Psychometric profile of posttraumatic stress disorder, anxious, and healthy Vietnam veterans: correlations with psychophysiologic responses . J Consult Clin Psychol . 1990;58:329-335.Crossref 18. Paige SR, Reid GM, Allen MG, Newton JE. Psychophysiological correlates of posttraumatic stress disorder in Vietnam veterans . Biol Psychiatry . 1990;27:419-430.Crossref 19. Resnick HS, Foy DW, Donahoe CP, Miller EN. Antisocial behavior and post-traumatic stress disorder in Vietnam veterans . J Clin Psychol . 1989;45: 860-866.Crossref 20. Famularo R, Kinscherff R, Fenton T. Symptom differences in acute and chronic presentation of childhood post-traumatic stress disorder . Child Abuse Neglect . 1990;14:439-444.Crossref 21. Heins T, Gray A, Tennant M. Persisting hallucinations following childhood sexual abuse . Aust N Z J Psychiatry . 1990;24:561-565.Crossref 22. Breslau N, Davis GC, Andreski P, Peterson E. Traumatic events and posttraumatic stress disorder in an urban population of young adults . Arch Gen Psychiatry . 1991;48:216-222.Crossref 23. Famularo R, Kinscherff R, Fenton T. Post-traumatic stress disorder among maltreated children presenting to a juvenile court . Am J Forens Psychiatry . 1989;10:33-39. 24. Kinzie JD, Sack W, Angell R, Clarke G, Ben R. A three-year follow-up of Cambodian young people traumatized as children . J Am Acad Child Adolesc Psychiatry . 1989;28:501-504.Crossref 25. Lindberg FH, Distad LJ. Post-traumatic stress disorders in women who experienced childhood incest . Child Abuse Negl . 1985;9:329-334.Crossref 26. Craine L, Henson C, Colliver J, MacLean D. Prevalence of a history of sexual abuse among female psychiatric patients in a state hospital system . Hosp Community Psychiatry . 1988;39:300-304. 27. Deblinger E, McLeer SV, Atkins MS, Ralphe D, Foa E. Post-traumatic stress in sexually abused, physically abused, and nonabused children . Child Abuse Negl . 1989;13:403-408.Crossref 28. Kiser LJ, Heston J, Millsap PA, Pruitt DB. Physical and sexual abuse in childhood: relationship with post-traumatic stress disorder . J Am Acad Child Adolesc Psychiatry . 1991;30:776-783. 29. Silvern L, Kaersvang L. The traumatized children of violent marriages . Child Welfare . 1989;68:421-436. 30. Carlson BE. Children's observations of interparental violence . In: Roberts A, ed. Battered Women and Their Families: Intervention Strategies and Treatment Programs . New York, NY: Springer-Verlag NY Inc; 1984:147-167. 31. Nader K, Pynoos R, Fairbanks L, Frederick C. Children's PTSD reactions one year after a sniper attack at their school . Am J Psychiatry . 1990;147:1526-1530. 32. Pynoss R, Nader K. Children who witness the sexual assaults of their mothers . J Am Acad Child Adolesc Psychiatry . 1988;27:567-572.Crossref 33. Davis LV, Carlson BE. Observation of spouse abuse: what happens to the children? Interpers Violence . 1987;2:278-291.Crossref 34. Hughes HM. Psychological and behavioral correlates of family violence in child witnesses and victims . Am J Orthopsychiatry . 1988;58:77-90.Crossref 35. Spitzer RL, Williams JBW, Gibbon M, First MB. Structured Clinical Interview for DSM-III . New York, NY: Biometrics Research Division, New York State Psychiatric Institute; 1989. 36. Reich W, Welner Z. DICA-R-C (DSM-IIIR Version), Revised Version 5-R . St Louis, Mo: Washington University; 1990. 37. Famularo RA, Kinscherff RT, Fenton T. Psychiatric diagnoses of maltreated children: preliminary findings . J Am Acad Child Adolesc Psychiatry . 1992;31:863-867.Crossref 38. Famularo RA, Fenton T, Kinscherff RT. Medical and developmental histories of maltreated children . Clin Pediatr . 1992;31:536-541.Crossref

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Jul 1, 1993

References