Commission to Inquire into Child Abuse

Table 4.8. Adult attachment style on the Experiences in Close Relationships Inventory in 4 groups of participants who had spent different amounts of time in institutions and entered under different circumstances.

Adult Attachment Style		Group 1	Group 2	Group 3	Group4	Chi Square	Group Diffs
		N=108	N=67	N=22	N=48
Secure	f	18.00	13.00	4.00	6.00	7.29	NS
	%	16.70	19.40	18.20	12.50

Fearful	f	52.00	27.00	9.00	19.00
	%	48.10	40.30	40.90	39.60

Preoccupied	f	10.00	7.00	3.00	11.00
	%	9.30	10.40	13.60	22.90

Dismissive	f	28.00	20.00	6.00	12.00
	%	25.90	29.90	27.30	25.00

Note: Group 1 spent more than 12 years in an institution and entered before age 5. Group 2 spent 5-11 years in an institution and placement occurred because parents couldn’t cope or died. Group 3 spent 5-11 years in an institution and placement occurred through the courts. Group 4 spent 4 or fewer years in institutions. Cases were classified as falling into the four attachment style categories using the Experiences in Close Relationships Inventory, SPSS algorithm in Brennan, K., Clark, C., & Shaver, P. (1998). Self-report measure of adult attachment: An integrative overview. In J. Simpson & W. Rholes (Eds.), Attachment Theory and Close Relationships (pp. 46-76). New York: Guilford Press. Within each group the percentages sum to approximately 100. Minor deviations from 100 are due to rounding of decimals to two places. Percentages across rows do not sum to 100. NS=Not significant.

Table 4.9. Strengths in 4 groups of participants who had spent different amounts of time in institutions and entered under different circumstances.

Variable			Group 1	Group 2	Group 3	Group4	Chi Square	Group Diffs
			N=110	N=67	N=22	N=48
Where does your strength come from?
	Relationship with current partner	f	8.00	8.00	7.00	17.00	37.72***	4>1,2
		%	7.50	12.10	31.80	35.40

	Relationship with a friend including other survivors	f	15.00	3.00	0.00	1.00		1>2,3,4
		%	14.00	4.50	0.00	2.10

	Relationship with God or spiritual force	f	15.00	11.00	2.00	12.00		NS
		%	14.00	16.70	9.10	25.00

	Self-reliance, my optimism, my work, my skills	f	69.00	44.00	13.00	18.00		1,2,3>4
		%	64.50	66.70	59.10	37.50

What has helped you most in facing life challenges?

	Relationship with current partner	f	22.00	19.00	7.00	15.00	13.84	NS
		%	20.60	28.40	31.80	31.90

	Relationship with a friend including other	f	11.00	1.00	0.00	2.00
	Survivors	%	10.30	1.50	0.00	4.30

	Relationship with God or spiritual force	f	9.00	11.00	1.00	4.00
		%	8.40	16.40	4.50	8.50

	Self-reliance, my optimism, my work, my skills	f	65.00	36.00	14.00	26.00
		%	60.70	53.70	63.60	55.30

What is the thing that means most to
You in your life?
	Relationship with partner	f	12.00	9.00	4.00	8.00	9.57	NS
		%	11.10	13.40	20.00	17.00

	Relationship with a friend including other	f	7.00	4.00	0.00	1.00
	Survivors	%	6.50	6.00	0.00	2.10

	Relationship with God or spiritual force	f	3.00	2.00	1.00	1.00
		%	2.80	3.00	5.00	2.10

	Self-reliance, my optimism, my work, my skills	f	31.00	11.00	3.00	8.00
		%	28.70	16.40	15.00	17.00

	Relationship with Children / Family	f	55.00	41.00	12.00	29.00
		%	50.90	61.20	60.00	61.70

Table 4.10. Profiles of 4 groups of participants who had spent different amounts of time in institutions and entered under different circumstances.

	Group 1 12 years Entered before 5 years	Group 2 5-11 years Entered due to parental problems	Group 3 5-11 years Entered through courts	Group 4 Under 4 years

PAST HISTORY & DEMOGRAPHICS
Few years with family before entry	+	-	-	0
Many years in institution	+	-	-	0
Entry reason
Illegitimate	+	-	-	-
Parents unable to care	+	+	-	-
Parental death	+	+	-	-
Through courts for petty crime	-	-	+	+
Leaving reason
Too old	+	+	+	-
Institution closed	-	-	+	-
Sentence over	-	-	-	+
Family wanted person back	-	-	-	+
Institution management
Nuns	+	+	-	-
Religious brothers & priests	-	-	+	+
Both	+	-	-	-
Mixed feelings leaving	+	-	-	0
Gender
Male	-	-	+	+
Female	+	+	-	-

INSTITUTIONAL ABUSE
Physical institutional abuse	+	-	-	0
Physical abuse began at an early age	+	-	-	0
Physical abuse lasted many years	+	-	-	0
Sexual institutional abuse	-	-	+	+
Sexual abuse began at an early age	+	+	-	-
Worst thing in institution was severe sexual abuse	0	0	+	-
Worst thing in institution was severe emotional abuse	+	+	-	-
Worst thing began at an early age	+	-	-	0
Worst thing lasted a long time	+	-	-	0

FAMILY-BASED CHILD ABUSE
Physical abuse	0	0	+	-

ADULT PSYCHOLOGICAL ADJUSTMENT
Psychological disorders
Alcohol & Substance use disorder, lifetime	-	-	+	+
Antisocial personality disorder	-	-	+	+
Multiple life problems (substance use, crime, unemployment)	-	-	+	+
Strengths
Relationship with partner	0	0	-	+
Relationship with friends	+	-	-	-
Self-reliance, optimism, work, skills	+	+	+	-

Note: +=the feature was a significant feature of the group profile. 0=the feature was not a significant element of the group profile. – a moderate level of the feature characterized the groups profile.

Table 4.11. Historical and demographic characteristics on which four groups who reported suffering differing types of worst abusive experiences in institutions differed significantly

Variable	Categories		Group 1 S&P abuse	Group 2 P abuse	Group 3 S abuse	Group 4 E Abuse	Chi Square or ANOVA F	Group Diffs
			N=23	N=99	N=40	N=85
Gender (N=247)
	Male	f	15.00	55.00	35.00	30.00	31.34***	3>4
		%	65.20	55.60	87.50	35.30

	Female	f	8.00	44.00	5.00	55.00		4>3
		%	34.80	44.40	12.50	64.70

Age in years (N=247)		M	56.74	62.22	57.55	59.60	4.96**	2>3,1
		SD	8.57	8.34	7.36	8.13

Years with family before		M	4.75	5.71	7.78	4.09	6.74***	3>4,1
entering an institution (N=246)		SD	3.82	4.76	4.96	3.78

Years in an institution (N=247)		M	10.96	9.74	7.75	11.21	4.57**	4>3
		SD	4.98	5.34	5.46	4.63
Reason for entering an institution (N=245)
	Illegitimate	f	2.00	18.00	4.00	24.00	32.70***
		%	8.70	18.20	10.00	28.90

	Petty crime	f	5.00	29.00	19.00	5.00		3>4
		%	21.70	29.30	47.50	6.00

	Parents could not provide care	f	12.00	40.00	13.00	39.00
		%	52.20	40.40	32.50	47.00

	Parent died	f	4.00	12.00	4.00	15.00
		%	17.40	12.10	10.00	18.10
Institution management (N=247)
	Nuns	f	9.00	46.00	8.00	58.00	35.64***	4>3
		%	39.10	46.50	20.00	68.20

	Religious brothers and priests	f	7.00	35.00	24.00	11.00		3>4
		%	30.40	35.40	60.00	12.90

	Priests, religious brothers and Nuns	f	7.00	18.00	8.00	16.00
		%	30.40	18.20	20.00	18.80

Were you happy to leave the institution? (N=247)
	Yes	f	12.00	62.00	35.00	43.00	17.75**	3>4
		%	52.20	62.60	87.50	50.60

	Mixed feelings	f	9.00	32.00	5.00	38.00		4>3
		%	39.10	32.30	12.50	44.70

	No	f	2.00	5.00	0.00	4.00
		%	8.70	5.10	0.00	4.70
Education - highest exam (N=244)
	None	f	8.00	64.00	18.00	31.00	33.30**	2>1,4
		%	34.80	66.00	45.00	36.90

	Junior school exam in 5^th or 6^th class	f	12.00	19.00	8.00	23.00		1>2,3
	(e.g. primary cert)	%	52.20	19.60	20.00	27.40

	Inter/Leaving Cert.	f	1.00	8.00	9.00	11.00
		%	4.30	8.20	22.50	13.10

	Certificate, diploma, apprenticeship	f	2.00	6.00	5.00	19.00		4>2
	exam, or primary degree	%	8.70	6.20	12.50	22.60


Children’s living arrangements (N=211)
	Spent some time living with their other	f	5.00	11.00	9.00	3.00	22.63**	1,3>4
	parent	%	25.00	12.60	26.50	4.30

	Spent some time living with their	f	0.00	7.00	1.00	8.00
	relatives or in Care	%	0.00	8.00	2.90	11.40

	Always lived with respondent	f	15.00	64.00	24.00	59.00
		%	75.00	73.60	70.60	84.30

	Children put up for adoption	f	0.00	5.00	0.00	0.00		2>1,3,4
		%	0.00	5.70	0.00	0.00

Note: Group 1 contained 23 cases where the worst thing reported was severe physical and sexual abuse. Group 2 contained 99 cases where it was severe physical abuse. Group 3 contained 40 cases where it was severe sexual abuse. Group 4 contained 85 cases where it was severe emotional abuse. Participants’ statements were classified as severe physical abuse if they reported physical violence, beating, slapping, or being physically injured, but not having medical attention withheld. Statements were classified as severe sexual abuse if the person reported the words sexual abuse or mentioned rape; genital, anal or oral sex; masturbation; or other coercive sexual activities involving either staff or older pupils. Statements were classified as severe physical and sexual abuse if they involved both severe physical abuse and severe sexual abuse as defined earlier. Statements of actions involving humiliation, degradation, severe lack of care, withholding medical treatment, witnessing the traumatization of other pupils and adverse experiences that were not clearly classifiable as severe sexual or physical abuse were classified as severe emotional abuse. Inter-rater agreement greater than 90% was achieved for a sample of 10% of statements. Details of statements are in Table 3.4. For each variable with multiple categories, within each group the percentages sum to approximately 100. Minor deviations from 100 are due to rounding of decimals to two places. Percentages across rows do not sum to 100. For continuous variables F values are from one-way analysis of variance and inter-group differences are based on Scheffe post hoc tests for comparing groups with unequal Ns that were significant at p<.05. For categorical variables, where chi square tests were significant at p<.05, group differences were interpreted as significant if standardised residuals exceeded an absolute value of 2. **p<.01. ***p<.001

Table 4.12. Recollections of child abuse in four groups who reported suffering differing types of worst abusive experiences in institutions

Variable			Group 1 S&P Abuse	Group 2 P abuse	Group 3 S abuse	Group 4 E Abuse	ANOVA F	Group Diffs
			N=23	N=99	N=40	N=85
INSTITUTIONAL ABUSE
IAS >(N=247)	Specific institutional abuse	M	55.56	49.50	52.02	48.12	4.16**	1>3>2,4
		SD	8.94	9.29	9.64	10.66
CTQ-Institution >(N=247)
	Total institutional abuse score	M	58.47	49.22	56.41	45.60	20.65***	1>3>2>4
		SD	7.94	8.23	9.92	9.59

	Physical abuse	M	54.75	51.70	51.55	45.99	8.20***	1>2,3>4
		SD	6.98	8.96	9.29	10.92

	Sexual abuse	M	59.13	47.20	61.66	45.31	55.55***	1,3>2,4
		SD	9.61	8.52	7.51	6.21

	Emotional abuse	M	53.91	50.12	51.00	48.33	2.12	NS
		SD	7.60	9.91	9.37	10.73

	Physical neglect	M	54.99	50.71	49.13	48.18	3.20	NS
		SD	8.63	9.50	10.11	10.47

	Emotional neglect	M	50.46	49.75	50.49	49.95	0.07	NS
		SD	10.81	8.57	10.83	11.07

SPSA-Institution >(N=247)	Total severe institutional abuse	M	55.34	48.40	54.30	48.40	22.70***	1,3>2,4
		SD	4.81	4.79	5.13	5.85

	Severe institutional physical abuse	M	54.07	49.59	49.90	49.37	1.45	NS
		SD	7.54	9.45	9.87	11.08

	Severe institutional sexual abuse	M	58.88	46.73	59.54	46.89	34.57***	1,3>2,4
		SD	7.55	8.64	5.78	9.33

Note: Group 1 contained 23 cases where the worst thing reported was severe physical and sexual abuse. Group 2 contained 99 cases where it was severe physical abuse. Group 3 contained 40 cases where it was severe sexual abuse. Group 4 contained 85 cases where it was severe emotional abuse. Participants’ statements were classified as severe physical abuse if they reported physical violence, beating, slapping, or being physically injured, but not having medical attention withheld. Statements were classified as severe sexual abuse if the person reported the words sexual abuse or mentioned rape; genital, anal or oral sex; masturbation; or other coercive sexual activities involving either staff or older pupils. Statements were classified as severe physical and sexual abuse if they involved both severe physical abuse and severe sexual abuse as defined earlier. Statements of actions involving humiliation, degradation, severe lack of care, withholding medical treatment, witnessing the traumatization of other pupils and adverse experiences that were not clearly classifiable as severe sexual or physical abuse were classified as severe emotional abuse. Inter-rater agreement greater than 90% was achieved for a sample of 10% of statements. Details of statements are in Table 3.4. CTQ=Childhood Trauma Questionnaire (Bernstein, D. & Fink, L. (1998). Childhood Trauma Questionnaire: A retrospective self-report. Manual. San Antonio, TX: The Psychological Cooperation). IAS=Institutional abuse scale. SPSA=Most severe forms of physical and sexual abuse. To aid profiling across variables, all variables were transformed to T-scores with means of 50 and standard deviations of 10 before ANOVAs were conducted . T-score for variable X = ((X-M)/SD)X10)+50), where X is the score of a case on variable X; M is the mean for all cases on variable X and SD is the standard deviation for all cases on variable X. F values are from one-way analysis of variance and inter-group differences are based on Scheffe post hoc tests for comparing groups with unequal Ns that were significant at p<.05. For the MANOVA on all subscales of the institution versions of the CTQ, SPSA & the IAS, F (24, 685) = 7.30, p<.001. For the MANOVA on all subscales of the family versions of the CTQ and SPSA, F (21, 319) = 1.31, p=NS. **p<.01. ***p<.001.

Table 4.13. Timing of severe abuse and worst abuse in four groups who reported suffering differing types of worst abusive experiences in institutions

Variable		Group 1 S&P abuse	Group 2 P abuse	Group 3 S abuse	Group 4 E Abuse	Chi Square	Group Diffs
		N=23	N=99	N=40	N=85
Age when most severe form of	M	8.06	8.91	9.50	7.60	3.00	NS
physical abuse began (N=233)	SD	3.02	3.49	4.24	3.56

Duration of most severe form of	M	6.67	6.49	5.94	7.45	1.18	NS
physical abuse (N=229)	SD	3.66	4.58	4.71	4.26


Age when most severe form of	M	10.28	11.06	11.36	9.79	2.02	NS
sexual abuse began (N=122)	SD	2.63	2.64	2.76	3.27

Duration of most severe form of	M	3.04	2.75	2.09	3.34	1.01	NS
sexual abuse (N=111)	SD	2.46	3.12	2.15	3.99


Age when worst thing began	M	9.20	9.02	11.48	8.24	7.72***	3>1,2>4
(N=237)	SD	2.92	3.65	2.95	3.71


Duration of worst thing (N=225)	M	4.49	5.86	2.63	5.92	5.70***	2,4>3
	SD	3.67	4.49	2.82	5.40

F values are from one-way analysis of variance and inter-group differences are based on Scheffe post hoc tests for comparing groups with unequal Ns that were significant at p<.05. ***p<.001

Table 4.14. Psychological disorders in four groups who reported suffering differing types of worst abusive experiences in institutions

Variable		Group 1 S&P abuse	Group 2 P abuse	Group 3 S abuse	Group 4 E Abuse	Chi Square	Group Diffs
		N=23	N=99	N=40	N=85
Anxiety disorders
Posttraumatic stress disorder, current	f	8.00	10.00	14.00	9.00	20.51***	1,3>2,4
	%	34.80	10.10	35.00	10.60

Alcohol and substance use disorders
Any alcohol and substance use disorder, lifetime	f	12.00	33.00	23.00	20.00	16.74***	3>4
	%	52.20	33.30	57.50	23.50

Alcohol dependence, lifetime	f	7.00	27.00	20.00	12.00	18.14***	3>4
	%	30.40	27.30	50.00	14.10

Personality disorders
Antisocial personality disorder	f	2.00	4.00	9.00	2.00	19.31***	3>4
	%	8.70	4.00	22.50	2.40

Note: Note: Group 1 contained 23 cases where the worst thing reported was severe physical and sexual abuse. Group 2 contained 99 cases where it was severe physical abuse. Group 3 contained 40 cases where it was severe sexual abuse. Group 4 contained 85 cases where it was severe emotional abuse. Participants’ statements were classified as severe physical abuse if they reported physical violence, beating, slapping, or being physically injured, but not having medical attention withheld. Statements were classified as severe sexual abuse if the person reported the words sexual abuse or mentioned rape; genital, anal or oral sex; masturbation; or other coercive sexual activities involving either staff or older pupils. Statements were classified as severe physical and sexual abuse if they involved both severe physical abuse and severe sexual abuse as defined earlier. Statements of actions involving humiliation, degradation, severe lack of care, withholding medical treatment, witnessing the traumatization of other pupils and adverse experiences that were not clearly classifiable as severe sexual or physical abuse were classified as severe emotional abuse. Inter-rater agreement greater than 90% was achieved for a sample of 10% of statements. Details of statements are in Table 3.4. Diagnoses were made using the SCID I (First, M., Spitzer, R., Gibbon, M., and Williams, J. (1996). Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-I). Washington, DC: American Psychiatric Press) and SCID II (First, M., Spitzer, R., Gibbon M., & Williams, J. (1997). Structured Clinical Interview for DSM-IV Personality Disorders, (SCID-II). Washington, DC: American Psychiatric Press). Psychological disorders do not represent mutually exclusive categories and so percentages within and across groups sum to more than 100%. Where chi square tests were significant at p<.01, group differences were interpreted as significant if standardised residuals exceeded an absolute value of 2. ***p<.001.

Table 4.15. Current adjustment of participants in four groups who reported suffering differing types of worst abusive experiences in institutions

		Group 1 S&P abuse	Group 2 P abuse	Group 3 S Abuse	Group 4 E Abuse	ANOVA F	Group Diffs
		N=23	N=99	N=40	N=85
Total trauma symptoms (TSI)	M	54.74	49.14	53.24	48.20	4.46**	1,3>4
(N=247)	SD	8.32	10.76	9.44	9.11

Total No of life problems (LPC)	M	51.06	49.66	57.46	46.59	12.37***	3>2>4
(N=247)	SD	10.79	8.35	11.99	8.66

Total quality of life (WHOQOL)	M	47.44	50.57	49.43	50.30	0.68	NS
(N=247)	SD	9.90	9.92	10.42	9.98

Global functioning (GAF)	M	47.67	50.26	49.22	50.73	0.66	NS
(N=235)	SD	7.99	10.46	10.93	9.57

Marital satisfaction (KMS)	M	24.16	30.38	32.49	25.72	0.89	NS
(N=136)	SD	20.89	21.33	23.57	19.46

Parental satisfaction (KPS)	M	48.35	49.15	48.96	49.85	0.12	NS
(N=212)	SD	11.91	11.20	11.04	11.36

Note: Group 1 contained 23 cases where the worst thing reported was severe physical and sexual abuse. Group 2 contained 99 cases where it was severe physical abuse. Group 3 contained 40 cases where it was severe sexual abuse. Group 4 contained 85 cases where it was severe emotional abuse. Participants’ statements were classified as severe physical abuse if they reported physical violence, beating, slapping, or being physically injured, but not having medical attention withheld. Statements were classified as severe sexual abuse if the person reported the words sexual abuse or mentioned rape; genital, anal or oral sex; masturbation; or other coercive sexual activities involving either staff or older pupils. Statements were classified as severe physical and sexual abuse if they involved both severe physical abuse and severe sexual abuse as defined earlier. Statements of actions involving humiliation, degradation, severe lack of care, withholding medical treatment, witnessing the traumatization of other pupils and adverse experiences that were not clearly classifiable as severe sexual or physical abuse were classified as severe emotional abuse. Inter-rater agreement greater than 90% was achieved for a sample of 10% of statements. Details of statements are in Table 3.4. TSI=Trauma Symptom Inventory (Briere, J. (1996). Trauma Symptom Inventory. Odessa, FL: Psychological Assessment Resources). LPC=Life Problems Checklist. WHOQOL= World Health Organization Quality of Life 100 UK (Skevington, S. (2005). World Health Organization Quality of Life 100 UK Version. Bath, UK: WHO Centre for the Study of Quality of Life, University of Bath). GAF=Global assessment of functioning scale (Luborsky, L. (1962). Clinicians’ Judgements of Mental Health. Archives of General Psychiatry, 7, 407–417). KMS=Kansas Marital Satisfaction Scale (Schumm, W.R., Paff-Bergen, L.A., Hatch, R.C., Obiorah, F.C., Copeland, J.M., Meens, L.D., Bugaighis, M.A. (1986) Concurrent and discriminant validity of the Kansas Marital Satisfaction Scale. Journal of Marriage & the Family, 48, 381-387). KMS means and SDs are based on the number of participants who lived with partners (N=136). KPS=Kansas Parenting Satisfaction Scale (James, D. E., Schumm, W. R., Kennedy, C. E., Grigsby, C. C., Shectman, K. L., Nichols, C. W. (1985). Characteristics of the Kansas Parental Satisfaction Scale among two samples of married parents. Psychological Reports, 57, 163-169). KPS means and SDs are based on the number of participants with children (N=212). To aid profiling across variables, all variables were transformed to T-scores with means of 50 and standard deviations of 10 before ANOVAs were conducted. T-score for variable X = ((X-M)/SD)X10)+50), where X is the score of a case on variable X; M is the mean for all cases on variable X and SD is the standard deviation for all cases on variable X. F values are from one-way analysis of variance and inter-group differences are based on Scheffe post hoc tests for comparing groups with unequal Ns that were significant at p<.05. **p<0.01 ***p<0.001. NS=Not significant.

Table 4.16. Profiles of 4 groups of participants who reported suffering differing types of worst abusive experiences in institutions

	Group 1 Severe Sexual and Physical Abuse	Group 2 Severe Physical Abuse	Group 3 Severe Sexual Abuse	Group 4 Severe Emotional Abuse

PAST HISTORY & DEMOGRAPHICS
Few years with family before entry	+	-	0	+
Many years in institution	-	-	0	+
Entry reason
Through courts for petty crime	-	-	+	0
Institution management
Nuns	-	-	0	+
Religious brothers & priests	-	-	+	0
Mixed feelings leaving	-	-	0	+
Gender
Male	-	-	+	0
Female	-	-	0	+
AGE
Older (60s)	0	+	0	-
Lower educational achievement	0	+	-	0
Parent-child living arrangements
Children spent time living with other parent	+	-	+	0
Children put up for adoption	-	+	-	-

INSTITUTIONAL ABUSE
Physical institutional abuse	+	-	-	0
Sexual institutional abuse	+	-	+	-
Worst thing began at an early age	-	-	0	+
Worst thing lasted a long time	-	+	0	+

ADULT PSYCHOLOGICAL ADJUSTMENT
Psychological disorders
Posttraumatic stress disorder, current	+	-	+	-
Alcohol & Substance use, lifetime	-	-	+	0
Antisocial personality disorder	-	-	+	0
Multiple trauma symptoms	+	-	+	0
Multiple life problems	-	0	+	0

Part 5 Profiles of groups with different patterns of psychological disorders

Summary of Part 5

3.217There was an association between having psychological disorders and reporting both institutional and family-based child abuse and neglect. Certain patterns of psychological disorders were associated with institutional abuse alone, and other patterns were associated with institutional family-based child abuse and neglect. For participants with multiple co-morbid diagnoses, and for those with mood disorders, greater institutional, but not family-based physical, sexual and emotional abuse was reported. Participants with PTSD, alcohol and substance use disorders, avoidant and antisocial personality disorder reported both institutional and family-based abuse or neglect. Participants with multiple diagnoses had the poorest adult psychological adjustment and those with no diagnoses were the best adjusted. Subgroups selected by diagnosis showed an intermediate level of adult psychological adjustment between these extremes. What follows are brief profiles of groups with different patterns or types of psychological disorders.

3.218Multiple comorbid diagnoses. Participants with 4 or more diagnoses reported greater institutional sexual and emotional abuse (but not more family-based abuse) than participants with fewer diagnoses. Participants with 4 or more diagnoses had more trauma symptoms and life problems, and a lower quality of life and global level of functioning, than participants with 1-3 diagnoses, who in turn were less well adjusted than participants with no diagnoses. More participants with 4 or more diagnoses had a fearful adult attachment style, and fewer had secure or dismissive adult attachment styles. On average more participants with 4 or more diagnoses were in their 50s compared with those with no diagnoses who where were in their 60s. Also, more participants with 4 or more diagnoses were unemployed and of lower SES than participants with fewer diagnoses.

3.219Mood disorders. Participants with mood disorders, more than half of whom had co-morbid anxiety disorders, reported greater institutional sexual and emotional abuse and greater institutional severe physical and sexual abuse (but not family-based child abuse) than participants with no diagnoses. Participants with mood disorders had more trauma symptoms and life problems, and a lower quality of life and global level of functioning than participants with no diagnoses. More participants with mood disorders had a fearful adult attachment style, and fewer had a secure adult attachment style. On average participants with mood disorders were in their late 50s while those with no diagnoses were in their 60s. Also, on average, participants with mood disorders had had their first child in their mid-20s, while those with no diagnoses had their first children a couple of years later.

3.220Posttraumatic stress disorder. Participants with PTSD, more than half of whom had other co-morbid anxiety disorders and alcohol or substance use disorders, reported greater institutional physical, sexual and emotional abuse, and greater institutional severe physical and sexual abuse than participants with no diagnoses. They also reported having experienced greater family-based emotional abuse. Participants with PTSD had more trauma symptoms and life problems, and a lower quality of life and global level of functioning, than participants with no diagnoses. Fewer participants with PTSD had a dismissive adult attachment style. On average participants with PTSD were in their 50s while those with no disorders were in their 60s.

3.221Alcohol and substance use disorders. Participants with alcohol and substance use disorders, more than half of whom had a co-morbid anxiety disorder, reported greater institutional sexual and emotional abuse, and greater institutional severe sexual abuse than participants with no diagnoses. They also reported having experienced greater family-based physical and emotional abuse. Participants with alcohol and substance use disorders had more trauma symptoms and life problems, and a lower quality of life and global level of functioning than participants with no diagnoses. Compared with those with no diagnoses, participants with alcohol and substance use disorders were younger (in their 50s not their 60s); had had their first children at a younger age (in early, not their late 20s); were of lower SES; and fewer had entered an institution because their parents had died.

3.222Avoidant personality disorder. Participants with avoidant personality disorders reported greater institutional and family-based emotional abuse than those with no diagnoses. Almost all participants with an avoidant personality disorder had a co-morbid anxiety, mood or substance use disorder. Participants with avoidant personality disorder had more trauma symptoms and life problems, and a lower quality of life and global level of functioning, than participants with no diagnoses. Compared to those with no diagnoses, more participants with an avoidant personality disorder had a fearful adult attachment style and fewer had a secure adult attachment style. Compared to participants with no diagnoses, participants with avoidant personality disorder were younger (in their 50s, not their 60s) and more had been placed in institutions run by nuns because their parents could not care for them.

3.223Antisocial personality disorder. Participants with antisocial personality disorder reported greater institutional sexual abuse than participants with no diagnoses. All participants with antisocial personality disorder had co-morbid anxiety, mood or substance use disorders. Participants with antisocial personality disorder had more trauma symptoms, more life problems, a lower quality of life, a lower global level of functioning, and lower parental satisfaction than participants with no diagnoses. Compared to those with no diagnoses, participants with antisocial personality disorder were younger (in their 50s, not their 60s); had spent fewer years in institutions (5 1/2 not nearly 10 years); more were unemployed; and more were of low SES.

3.224Borderline personality disorder. Participants with borderline personality disorder and those with no diagnoses, did not differ in their reported levels of institutional or family-based child abuse, although both reported a high level of child abuse. All participants with borderline personality disorder had co-morbid anxiety, mood or substance use disorders. Participants with borderline personality disorders had more trauma symptoms, more life problems, a lower quality of life, a lower global level of functioning, and more had a fearful adult attachment style than participants with no diagnoses. Compared to those with no diagnoses, participants with borderline personality disorder were younger (in their 50s, not 60s), more were unemployed, and on average reported being abused from an earlier age.

Introduction

3.225Recollections of both institutional and family-based child abuse by adult survivors of institutional living with varying patterns of psychological disorders are the main focus of this Part. In addition, profiles of subgroups of cases with varying patterns of psychological disorders are presented with respect to their trauma symptoms, life problems, quality of life, global functioning, relationships, adult attachment styles and demographic characteristics. A number of specific questions were addressed:

1.Do adult survivors of institutional living with many co-morbid diagnoses report more institutional and family-based child abuse compared to those with few or no diagnoses and what are the profiles of groups with many, few and no diagnoses?

2.Do adult survivors of institutional living with mood disorders report more institutional and family-based child abuse compared to those with no diagnoses and what is the profile of participants with mood disorders?

3.Do adult survivors of institutional living with posttraumatic stress disorder (PTSD) report more institutional and family-based child abuse compared to those with no diagnoses and what is the profile of participants with PTSD?

4.Do adult survivors of institutional living with alcohol and substance use disorders report more institutional and family-based child abuse compared to those with no diagnoses and what is the profile of participants with alcohol and substance use disorders?

5.Do adult survivors of institutional living with personality disorders report more institutional and family-based child abuse compared to those with no diagnoses and what is the profile of participants with personality disorders?

Statistical analysis strategy

3.226The results of analyses conducted to address these questions will be presented in five sections, corresponding to the five questions. There are sections on multiple disorders, mood disorders, PTSD, substance use disorders and personality disorders. In answering the questions addressed in this Part, the following strategy was used in all statistical analyses. For categorical variables, chi square tests were conducted with p values set conservatively at p<.01 to reduce the probability of type 1 error (misinterpreting spurious group differences as significant). Where chi square tests were significant at p<.01, group differences were interpreted as significant if standardised residuals in table cells exceeded an absolute value of 2. For continuous variables, to control for type 1 error, where possible multivariate analyses of variance (MANOVAs) were conducted on groups of conceptually related variables. Where MANOVAs were significant at p<.05, specific variables on which groups differed at a significance level of p<.01 were identified by conducting one-way analyses or variance (ANOVAs) or t-tests. t-tests were used where only two groups were compared and ANOVAs were used where comparisons involved more than two groups. Scheffe post-hoc comparison tests for designs with unequal cell sizes were conducted to identify significant intergroup differences in those instances where ANOVAs yielded significant F values. Dunnett’s test was used instead of Scheffe’s, where the assumption of homogeneity of variance was violated. In addition to these parametric analyses of continuous variables, in those instances where dependent variables were not normally distributed, non-parametric Kruskall Wallace (for 3 groups) or Mann Whitney (for two groups) tests were conducted as well as ANOVAs. If these non-parametric tests yielded results that differed from those of the ANOVAs, these were reported. For continuous variables where MANOVAs were not conducted, because there were no grounds for conceptually grouping variables, to control for type 1 error, t-tests or ANOVAs were interpreted as statistically significant if p<.01. For the TSI and the WHOQOL, which are multiscale instruments, unless the pattern of subscale scores differed greatly from that of total scores, for brevity, only analyses of total scores are reported. To facilitate interpretation of profiles of tabulated means, all psychological variables on continuous scales were transformed to T-scores (with means of 50 and standard deviations of 10) before analyses were conducted. T-score for variable X = ((X-M)/SD)X10)+50), where X is the score of a case on variable X; M is the mean for all cases on variable X and SD is the standard deviation for all cases on variable X.

Multiple co-morbid psychological diagnoses

3.227In this section results are presented of analyses which address the question: Do adult survivors of institutional living, with many co-morbid diagnoses report more institutional and family-based child abuse compared to those with few or no diagnoses and what are the profiles of groups with many, few and no diagnoses? To address this question cases were classified into three groups. Group 1 contained 83 cases with four or more current or lifetime diagnoses as assessed with the SCID I and SCID II, while none of the 45 cases in group 3 had any current or lifetime diagnoses. 119 participants with 1 to 3 current or lifetime diagnoses were assigned to group 2.

3.228From Table 5.1. it may be seen that compared with groups 2 and 3, group 1 obtained significantly higher mean scores on the IAS; the total, sexual and emotional abuse scales of the institutional version of the CTQ; and on the total and sexual severe abuse scales of the institutional version of the SPSA.

3.229The MANOVA for the scales and subscales of the family versions of the CTQ and SPSA was not significant, so it was concluded that there were no significant differences between scores of the three groups on family versions of the CTQ or SPSA.

3.230From Table 5.2 it may be seen that for the total number of Trauma symptoms on the TSI and the total number of life problems on the LPC, the mean scores for group 1 were significantly higher than those of group 2, which in turn were significantly higher than those of group 3. For the total score on the WHOQOL and the GAF, the mean scores for group 1 were significantly lower than those of group 2, which in turn were significantly lower than those of group 3. These results show that, participants with 4 or more diagnoses had more trauma symptoms and life problems, and a lower quality of life and global level of functioning, than participants with 1-3 diagnoses, who in turn were less well adjusted than participants with no diagnoses.

3.231From Table 5.3 it may be seen that on the ECRI compared with groups 2 and 3, significantly more members of group 1 had a fearful adult attachment style, and significantly fewer had secure or dismissive adult attachment styles.

3.232On demographic variables, significant group differences occurred for age (Group 1: M= 57.64; Group 2: M = 60.37; Group 3: = 63.67; F (2, 244) = 8.26, p<.001; Group 3>Group 1); currently unemployed (Group 1: 36.4%; Group 2: 22.7%; Group 3: 11.10%; Chi Square (8, N=247) = 20.62, p<.01; Group 1>Group 2 & Group 3); achieving a skilled manual SES level (Group 1: 7.79%; Group 2: 12.39%; Group 3: 24.44%; Chi Square (8, N=247) = 20.37, p<.01; Group 3>Group 1 & Group 2); and achieving a lower professional or managerial SES level (Group 1: 6.49%; Group 2: 19.47%; Group 3: 24.44%; Chi Square (8, N=247) = 20.37, p<.01; Group 1< Group 2 & Group 3). These results show that group 1 was younger than group 3; more members of group 1 were unemployed; and their highest achieved SES level was lower than that of the other two groups.

3.233Summary. Participants with 4 or more diagnoses, reported greater institutional sexual and emotional abuse than participants with fewer diagnoses. However, those with 4 or more diagnoses did not report experiencing more family-based child abuse or neglect. Participants with 4 or more diagnoses had more trauma symptoms and life problems, and a lower quality of life and global level of functioning, than participants with 1-3 diagnoses, who in turn were less well adjusted than participants with no diagnoses. More participants with 4 or more diagnoses had a fearful adult attachment style, and fewer had secure or dismissive adult attachment styles. On average more participants with 4 or more diagnoses were in their 50s compared with those with no diagnoses who where were in their 60s. Also, more participants with 4 or more diagnoses were unemployed and of lower SES than participants with fewer diagnoses.

Mood disorders

3.234In this section results are presented of analyses which address the question: Do adult survivors of institutional living with mood disorders report more institutional and family-based child abuse compared to those with no diagnoses and what is the profile of participants with mood disorders? To address this question 142 cases with a diagnosis of lifetime or current major depression or current dysthymia were compared with those with no current or lifetime anxiety, mood, substance use or personality disorders. Among the142 participants with mood disorders, comorbid disorders were common. More than half (57%) had a current anxiety disorder; 44% had a current or lifetime alcohol and substance use disorder; and 38% had a personality disorder.

3.235From Table 5.4 it may be seen that compared with group 2, group 1 obtained significantly higher mean scores on the total, sexual and emotional abuse scales of the institution version of the CTQ, and on the total, physical and sexual severe abuse scales of the institutional version of the SPSA. The MANOVA for the scales and subscales of the family versions of the CTQ and SPSA was not significant, so it was concluded that there were no significant differences between scores of the three groups on family versions of the CTQ or SPSA.

3.236From Table 5.5 it may be seen that for the total number of Trauma symptoms on the TSI and the total number of life problems on the LPC, the mean scores for group 1 were significantly higher than those of group 2. For the total score on the WHOQOL and the GAF, the mean scores for group 1 were significantly lower than those of group 2. These results show that participants with mood disorders had more trauma symptoms and life problems, and a lower quality of life and global level of functioning than participants with no diagnoses.

3.237From Table 5.6 it may be seen that on the ECRI compared with group 2, significantly more members of group 1 had a fearful adult attachment style, and significantly fewer had a secure adult attachment style.

3.238On demographic variables, significant group differences occurred for age (Group 1 M= 59.18, Group 2 M = 63.67, t(245) = 3.19, p<.01), and age when first child was born (Group 1 M= 24.90, Group 2 M = 27.71, t(159) = 2.69, p<.01). These results show that on average participants in group 1 were in their late 50s, while those in group 2 were in their 60s. Also, on average participants in group 1 had their first child in their mid-20s, while those in group 2 had their first children a couple of years later.

3.239Summary. Participants with mood disorders, more than half of whom had co-morbid anxiety disorders, reported greater institutional sexual and emotional abuse; and greater institutional severe physical and sexual abuse than participants with no diagnoses. However, those with mood disorders did not report experiencing more family-based child abuse or neglect. Participants with mood disorders had more trauma symptoms and life problems, and a lower quality of life and global level of functioning than participants with no diagnoses. More participants with mood disorders had a fearful adult attachment style, and fewer had a secure adult attachment style. On average participants with mood disorders were in their late 50s while those with no diagnoses were in their 60s. Also, on average participants with mood disorders had had their first child in their mid-20s, while those with no diagnoses had their first children a couple of years later.

Posttraumatic stress disorder

3.240In this section results are presented of analyses which address the question: Do adult survivors of institutional living with posttraumatic stress disorder (PTSD) report more institutional and family-based child abuse compared to those with no diagnoses and what is the profile of participants with PTSD? To address this question 63 cases with a diagnosis of lifetime or current PTSD were compared with 45 cases with no current or lifetime mood, anxiety, substance use or personality disorders. Among the 63 participants with PTSD comorbid disorders were common. More than three quarters (77%) had another current anxiety disorder; 55% had a lifetime diagnosis of any anxiety disorder; 50% had a lifetime diagnosis of alcohol and substance use disorder; 47% had a lifetime diagnosis of a mood disorder; and 41% had a personality disorder.

3.241From Table 5.7 it may be seen that compared with group 2, group 1 obtained significantly higher mean scores on the IAS; the total, physical, sexual and emotional abuse scales of the institution version of the CTQ; and on the total, physical and sexual severe abuse scales of the institutional version of the SPSA. Compared with group 2, group 1 also obtained significantly higher mean scores on the emotional abuse scale of the family version of the CTQ and the total scale of the family version of the SPSA. However, cautious interpretation of scores from the family version of the SPSA is warranted because of the low reliability of the total and physical severe abuse scores from this instrument, mentioned in Part 3 and documented in Table 3.11.

3.242From Table 5.8 it may be seen that for the total number of Trauma symptoms on the TSI and the total number of life problems on the LPC, the mean scores for group 1 were significantly higher than those of group 2. For the total score on the WHOQOL and the GAF, the mean scores for group 1 were significantly lower than those of group 2. These results show that participants with PTSD disorders had more trauma symptoms and life problems, and a lower quality of life and global level of functioning than participants with no diagnoses.

3.243From Table 5.9 it may be seen that on the ECRI compared with group 2, significantly fewer members of group 1 had a dismissive adult attachment style.

3.244The only demographic variable on which the groups differed significantly was age (Group 1 M = 57.49, Group 2 M = 63.67, t(106) = 3.97, p<.01). On average participants with PTSD were in their 50s, while those with no diagnoses were in their 60s.

3.245Summary. Participants with PTSD, more than half of whom had other co-morbid anxiety disorders and alcohol or substance use disorders, reported greater institutional physical, sexual and emotional abuse; and greater institutional severe physical and sexual abuse than participants with no diagnoses. They also reported having experienced greater family-based emotional abuse. Participants with PTSD had more trauma symptoms and life problems, and a lower quality of life and global level of functioning than participants with no diagnoses. Fewer participants with PTSD had a dismissive adult attachment style. On average participants with PTSD were in their 50s while those with no disorders were in their 60s.

Substance abuse

3.246In this section, results are presented of analyses which address the question: Do adult survivors of institutional living with alcohol and substance use disorders report more institutional and family-based child abuse compared to those with no diagnoses and what is the profile of participants with alcohol and substance use disorders? To address this question 99 cases with a current or lifetime diagnosis of an alcohol or substance use disorder were compared with 45 cases with no diagnosis. Among the 99 participants with alcohol or substance use disorders, comorbid disorders were common. More than half (54%) had a current anxiety disorder, 48% had a lifetime diagnosis of any anxiety disorder, 39% had a current or lifetime diagnosis of a mood disorder, and 39% had a personality disorder.

3.247From Table 5.10 it may be seen that compared with group 2, group 1 obtained significantly higher mean scores on the IAS; the total, sexual and emotional abuse scales of the institution version of the CTQ; and the total and sexual severe abuse scales of the institutional version of the SPSA. Compared with group 2, group 1 obtained significantly higher mean scores on the physical and emotional abuse scales of the family version of the CTQ, and on the total scale of the family version of the SPSA. However, cautious interpretation of scores from the family version of the SPSA is warranted because of the low reliability of the total and physical severe abuse scores from this instrument, mentioned in Part 3 and documented in Table 3.11.

3.248From Table 5.11 it may be seen that for the total number of Trauma symptoms on the TSI and the total number of life problems on the LPC, the mean scores for group 1 were significantly higher than those of group 2. For the total score on the WHOQOL and the GAF, the mean scores for group 1 were significantly lower than those of group 2. These results show that participants with alcohol and substance use disorders had more trauma symptoms and life problems, and a lower quality of life and global level of functioning than participants with no diagnoses.

3.249With respect to demographic and historical variables the groups differed significantly on age (Group 1: M = 58.25, Group 2: M = 63.67, t(106) = 3.94, p<.01); age when first child was born (Group 1 M= 24.73, Group 2 M = 27.71, t(142) = 2.80, p<.01); current membership of an SES group of skilled manual work or higher (Group 1: 6.30%, Group 2: 22.20%, Chi Square (4, N=144) = 15.37, p<.001); membership of an SES group higher than skilled manual work since leaving school (Group 1: 4.40%, Group 2: 24.40%, Chi Square (4, N=144) = 22.80, p<.0001); and entering an institution because their parents died (Group 1: 8.20%, Group 2: 25.60%, Chi Square (3, N=144) = 15.01, p<.01). These results show that compared with group 2, participants in group 1 were in their 50s (not their 60s); had had their first children in their early 20s (not their late 20s); were of lower SES; and fewer had entered an institution because their parents had died.

3.250Summary. Participants with alcohol and substance use disorders, more than half of whom had a co-morbid anxiety disorder, reported greater institutional sexual and emotional abuse; and greater institutional severe sexual abuse than participants with no diagnoses. They also reported having experienced greater family-based physical and emotional abuse. Participants with alcohol and substance use disorders had more trauma symptoms and life problems, and a lower quality of life and global level of functioning than participants with no diagnoses. Compared with those with no diagnoses, participants with alcohol and substance use disorders were younger (in their 50s not their 60s); had had their first children in their earlier (in early, not their late 20s); were of lower SES; and fewer had entered an institution because their parents had died.

Personality disorders

3.251In this section results are presented of analyses which address the question: Do adult survivors of institutional living with personality disorders report more institutional and family-based child abuse compared to those with no diagnoses and what is the profile of participants with personality disorders? A series of analyses were conducted to address this question in which cases with personality disorders were compared with cases with no diagnoses. 75 participants had a personality disorder; 52 had avoidant personality disorder; 17 had antisocial personality disorder; 14 had borderline personality disorder; and 4 had dependent personality disorder. 9 cases had two or more comorbid personality disorders. In the three larger groups, there were 48 with avoidant personality disorder only; 10 with antisocial personality disorder only; and 6 with borderline personality disorder only. In view of this pattern of single and co-morbid personality disorder diagnoses, it was decided that cell sizes would be too small to validly compare profiles of three largest groups with distinct personality disorders. Instead, three separate analyses were conducted. In the first of these, 52 cases with avoidant personality disorder were compared with 45 cases with no diagnosis. In the second, 17 cases with antisocial personality disorder were compared with 45 cases with no diagnosis. In the third, 14 cases with borderline personality disorder were compared with 45 cases with no diagnosis.

Avoidant personality disorder

3.252From Table 5.12 it may be seen that compared with group 2, group 1 obtained significantly higher mean scores on the emotional abuse scale of the institution and family versions of the CTQ.

3.253Among the 52 cases with avoidant personality disorder, comorbid disorders were common. Almost all cases (98%) had a co-morbid anxiety, mood or substance use disorder. Just over three quarters (78.8%) had a current anxiety disorder. Just over half had a current mood disorder (53.8%). And just over a third (36.5%) had a lifetime diagnosis of a substance use disorder.

3.254From Table 5.13 it may be seen that for the total number of Trauma symptoms on the TSI and the total number of life problems on the LPC, the mean scores for group 1 were significantly higher than those of group 2. For the total score on the WHOQOL and the GAF, the mean scores for group 1 were significantly lower than those of group 2. These results show that participants with avoidant personality disorder had more trauma symptoms and life problems, and a lower quality of life and global level of functioning than participants with no diagnoses.

3.255From Table 5.14 it may be seen that on the ECRI compared with group 2, significantly more members of group 1 had a fearful adult attachment style and significantly fewer members of group 1 had a secure adult attachment style.

3.256With respect to demographic and historical variables, the groups differed significantly on age (Group 1: M = 57.90, Group 2: M = 63.67, t(95) = 2.31, p<.01); being placed in an institution because their parents could not provide care (Group 1: 64.00%, Group 2: 20.93%, Chi Square (3, N=97) = 18.08, p<.0001); and placement in an institution run by nuns (Group 1: 61.5%, Group 2: 42.2%, Chi Square (2, N=97) = 11.41, p<.01). These results show that compared with group 2, participants in group 1 were in their 50s (not their 60s); more had been placed in an institution because their parents could not care for them; and more were placed in an institution run by nuns.

3.257Summary. Participants with avoidant personality disorders reported greater institutional and family-based emotional abuse than those with no diagnoses. Almost all participants with an avoidant personality disorder had a co-morbid anxiety, mood or substance use disorder. Participants with avoidant personality disorder had more trauma symptoms and life problems, and a lower quality of life and global level of functioning than participants with no diagnoses. Compared to those with no diagnoses, more participants with an avoidant personality disorder had a fearful adult attachment style and fewer had a secure adult attachment style. Compared to participants with no diagnoses, participants with avoidant personality disorder were younger (in their 50s, not their 60s) and more had been placed in institutions run by nuns because their parents could not care for them.

Antisocial personality disorder

3.258From Table 5.15 it may be seen that compared with group 2, group 1 obtained significantly higher mean scores on the total and sexual abuse scales of the institution version of the CTQ, and on the severe sexual abuse scale of the institution version of the SPSA.

3.259All 17 participants with antisocial personality disorder had co-morbid anxiety, mood or substance use disorders. Just over three quarters (76.5%) had a lifetime diagnosis of substance use disorder. 70% had a current anxiety disorder and 64% had a lifetime diagnosis of an anxiety disorder. 41% had had a mood disorder at some point in their life. Just over a third (35.3%) had comorbid borderline personality disorder.

3.260From Table 5.16 it may be seen that for the total number of Trauma symptoms on the TSI and the total number of life problems on the LPC, the mean scores for group 1 were significantly higher than those of group 2. For the total score on the WHOQOL, the GAF, and the KPS the mean scores for group 1 were significantly lower than those of group 2. These results show that participants with antisocial personality disorder had more trauma symptoms and life problems; and a lower quality of life, global level of functioning, and parental satisfaction than participants with no diagnoses.

3.261With respect to demographic variables, the groups differed on age (Group 1: M = 57.24, Group 2: M = 63.67, t(60) = 2.98, p<.01); number of years spent in an institution (Group 1: M = 5.56, Group 2: M = 9.86, t(60) = 3.28, p<.01); currently unemployed (Group 1: 56.30%, Group 2: 11.10%, Chi Square (4, N=62) = 15.17, p<.01); and membership of a higher SES group than skilled workers since leaving school (Group 1: 0%, Group 2: 24.44%, Chi Square (3, N=62) = 11.45, p<.01). These results show that compared to those with no diagnoses, participants with antisocial personality disorder were younger (in their 50s, not their 60s); had spent fewer years in institutions (five and a half, not nearly 10 years); more were unemployed; and more were of low SES.

3.262Summary. Participants with antisocial personality disorder reported greater institutional sexual abuse than participants with no diagnoses. All participants with antisocial personality disorder had co-morbid anxiety, mood or substance use disorders. Participants with antisocial personality disorder had more trauma symptoms, more life problems, a lower quality of life, a lower global level of functioning, and lower parental satisfaction than participants with no diagnoses. Compared to those with no diagnoses, participants with antisocial personality disorder were younger (in their 50s, not their 60s); had spent fewer years in institutions (5 1/2 not nearly 10 years); more were unemployed; and more were of low SES.

Borderline personality disorder

3.263When the significance of differences between scores of participants with borderline personality disorder and no diagnoses was evaluated with MANOVA on indices of both institutional and family-based child abuse, the two groups were found not to differ significantly. The MANOVA on all subscales of the institution versions of the IAS, CTQ, and SPSA was not significant nor was the MANOVA on all subscales of the family versions of the CTQ and SPSA. These results showed that participants with borderline personality disorder and those with no diagnoses, did differ in their reported levels of institutional or family-based child abuse.

3.264All 14 cases of borderline personality disorder had co-morbid anxiety, mood or substance use disorders. Just over three quarters (78.6%) had a current diagnosis of an anxiety disorder. Just over three quarters (78.0%) had a current diagnosis of a mood disorder and half had a lifetime diagnosis of a substance use disorder. 42.9% had comorbid antisocial personality disorder.

3.265From Table 5.17 it may be seen that for the total number of trauma symptoms on the TSI and the total number of life problems on the LPC, the mean scores for group 1 were significantly higher than those of group 2. For the total score on the WHOQOL and the GAF, the mean scores for group 1 were significantly lower than those of group 2. These results show that participants with borderline personality disorders had more trauma symptoms and life problems, and a lower quality of life and global level of functioning than participants with no diagnoses.

3.266From Table 5.18 it may be seen that on the ECRI compared with group 2, significantly more members of group 1 had a fearful adult attachment style.

3.267With respect to demographic and historical variables, the groups differed on age (Group 1: M = 54.54, Group 2: M = 63.67, t(57) = 3.93, p<.0001); current unemployment (Group 1: 53.80%, Group 2: 11.10%, Chi Square (4, N=59) = 19.22, p<.01); and the age when the worst form of abuse began (Group 1: M = 7.04, Group 2: M = 10.42, t(57) = 3.06, p<.01). Compared to those with no diagnoses, participants with borderline personality disorder were younger (in their 50s, not 60s), more were unemployed, and on average reported being abused from an earlier age (from about 7, not 10 years).

3.268Summary. Participants with borderline personality disorder and those with no diagnoses, did not differ in their reported levels of institutional or family-based child abuse, although both reported a high level of child abuse. All participants with borderline personality disorder had co-morbid anxiety, mood or substance use disorders. Participants with borderline personality disorders had more trauma symptoms, more life problems, a lower quality of life, a lower global level of functioning, and more had a fearful adult attachment style than participants with no diagnoses. Compared to those with no diagnoses, participants with borderline personality disorder were younger (in their 50s, not 60s), more were unemployed, and on average reported being abused from an earlier age.

Conclusions

3.269Table 5.19 summarizes patterns of institutional and family-based child abuse and neglect reported by participants with multiple co-morbid diagnoses, mood disorders, PTSD, substance use disorders, and personality disorders. The table also profiles the adult psychological adjustment of participants in each of these groups.

3.270The first main conclusion that can be drawn from the table is that there was an association between having psychological disorders and reporting both institutional and family-based child abuse and neglect.

3.271The second conclusion is that certain patterns of psychological disorders were associated with institutional abuse alone, and other patterns were associated with institutional and family-based child abuse and neglect. For participants with multiple co-morbid diagnoses and mood disorders, greater institutional, but not family-based physical, sexual and emotional abuse was reported. Participants with PTSD, alcohol and substance use disorders, avoidant and antisocial personality disorder reported both institutional and family-based abuse or neglect.

3.272A remarkable finding, in this context, was that participants with borderline personality disorder reported similar levels of abuse to participants with no diagnosis, since the link between child abuse and personality disorder is well established. It should be emphasized that normatively the group with no diagnosis had experienced significant abuse, and the profile of the borderline personality disorder group (along with all other profiles in Table 5.19) is relative to the group with no diagnosis, not to a normal control group.

3.273The third main finding was that participants with multiple diagnoses had the poorest adult psychological adjustment and those with no diagnoses were the best adjusted. Subgroups selected by diagnosis showed an intermediate level of adult psychological adjustment between these extremes.

Table 5.1. Recollections of child abuse among participants with 4 or more diagnoses, 1-3 diagnoses and no diagnoses

Variable			Group 1 4+ Diagnoses	Group 2 1-3 Diagnoses	Group 3 0 Diagnoses	ANOVA F	Group Diffs
			N=83	N=119	N=45
INSTITUTIONAL ABUSE
IAS >(N=247)	Specific institutional abuse	M	52.89	49.01	47.28	5.96**	1>2,3
		SD	9.65	9.91	9.80

CTQ-Institution >(N=247)	Total institutional abuse	M	54.04	48.38	46.83	11.51***	1>2,3
		SD	9.37	9.37	10.58

	Physical abuse	M	52.06	49.06	48.67	2.73	NS
		SD	9.66	10.21	9.66

	Sexual abuse	M	53.69	48.23	47.92	9.06***	1>2,3
		SD	11.25	8.92	8.42

	Emotional abuse	M	53.46	49.32	45.43	10.73***	1>2,3
		SD	7.46	9.75	12.48

	Physical neglect	M	51.23	49.06	50.14	1.16	NS
		SD	9.07	10.40	10.55

	Emotional neglect	M	51.21	49.73	48.51	1.14	NS
		SD	9.90	10.09	9.98

SPSA-Institution >(N=247)	Total severe institutional abuse	M	51.87	49.43	48.07	7.55**	1>2,3
		SD	6.50	5.41	5.03
	Severe institutional physical abuse	M	51.87	49.81	46.97	3.62	NS
		SD	10.74	9.69	8.66

	Severe institutional sexual abuse	M	52.78	48.85	47.85	5.23**	1>2,3
		SD	10.48	9.74	8.66

CHILD ABUSE IN FAMILY
CTQ-family (N=121)	Total family abuse score	M	50.46	51.31	46.31		NS
		SD	9.66	11.56	5.52

	Physical abuse	M	51.20	50.63	46.37		NS
		SD	10.49	10.80	5.88

	Sexual abuse	M	48.58	52.47	47.44		NS
		SD	5.48	14.15	1.91

	Emotional abuse	M	50.90	51.30	45.49		NS
		SD	10.55	10.95	4.10

	Physical neglect	M	50.60	49.66	49.57		NS
		SD	10.32	10.17	9.34

	Emotional neglect	M	50.28	50.72	47.91		NS
		SD	10.72	10.24	7.97

SPSA-family >(N=121)	Total severe family abuse	M	50.82	50.99	46.37		NS
		SD	8.78	11.94	6.64

	Severe family physical abuse	M	51.87	49.88	46.65		NS
		SD	10.37	10.18	8.24

	Severe family sexual abuse	M	48.39	52.46	47.77		NS
		SD	5.44	13.99	3.91

Note: Group1 had four or more current or lifetime diagnoses as assessed with the SCID I (First, M., Spitzer, R., Gibbon, M., and Williams, J. (1996). Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-I). Washington, DC: American Psychiatric Press) and SCID II (First, M., Spitzer, R., Gibbon M., & Williams, J. (1997). Structured Clinical Interview for DSM-IV Personality Disorders, (SCID-II). Washington, DC: American Psychiatric Press). Group 2 had 1-3 current or lifetime diagnoses. Group 3 had no diagnoses. CTQ=Childhood Trauma Questionnaire (Bernstein, D. & Fink, L. (1998). Childhood Trauma Questionnaire: A retrospective self-report. Manual. San Antonio, TX: The Psychological Cooperation). IAS=Institutional abuse scale. SPSA=Most severe forms of physical and sexual abuse. To aid profiling, all variables were transformed to T-scores with means of 50 and standard deviations of 10 before ANOVAs were conducted. T-score for variable X = ((X-M)/SD)X10)+50), where X is the score of a case on variable X; M is the mean for all cases on variable X and SD is the standard deviation for all cases on variable X. F values are from one-way analyses of variance and inter-group differences are based on Scheffe post hoc tests for comparing groups with unequal Ns that were significant at p<.05. For the MANOVA on all subscales of the institution versions of the CTQ, SPSA & the IAS, F (14, 476) = 2.89, p<0.0001. For the MANOVA on all subscales of the family versions of the CTQ and SPSA, F (12, 226) = 1.30, NS. **p<0.01 ***p<0.001. NS=Not significant.

Table 5.2. Current adjustment of participants with 4 or more diagnoses, 1-3 diagnoses and no diagnoses

		Group 1 4+ Diagnoses	Group 2 1-3 Diagnoses	Group 3 0 Diagnoses	ANOVA F	Group Diffs
		N=83	N=119	N=45

Total trauma symptoms (TSI)	M	57.74	48.51	39.66	84.28***	1>2>3
(N=247)	SD	7.89	8.21	5.83

Total No of life problems (LPC)	M	55.73	48.27	43.99	28.92***	1>2>3
(N=247)	SD	10.30	8.93	6.30

Total quality of life (WHOQOL)	M	42.74	52.12	57.79	54.86***	1<2<3
(N=247)	SD	8.69	8.45	7.32

Global functioning (GAF)	M	42.98	51.40	58.87	56.43***	1<2<3
(N=235)	SD	9.39	8.00	6.44

Marital satisfaction (KMS)	M	50.56	51.62	53.51	0.68	NS
(N=136)	SD	9.98	10.90	10.26

Parental satisfaction (KPS)	M	47.33	50.70	49.43	1.93	NS
(N=212)	SD	11.61	10.21	12.59

Note: Group1 had four or more current or lifetime diagnoses as assessed with the SCID I (First, M., Spitzer, R., Gibbon, M., and Williams, J. (1996). Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-I). Washington, DC: American Psychiatric Press) and SCID II (First, M., Spitzer, R., Gibbon M., & Williams, J. (1997). Structured Clinical Interview for DSM-IV Personality Disorders, (SCID-II). Washington, DC: American Psychiatric Press). Group 2 had 1-3 current or lifetime diagnoses. Group 3 had no diagnoses. TSI=Trauma Symptom Inventory (Briere, J. (1996). Trauma Symptom Inventory. Odessa, FL: Psychological Assessment Resources). LPC=Life Problems Checklist. WHOQOL= World Health Organization Quality of Life 100 UK (Skevington, S. (2005). World Health Organization Quality of Life 100 UK Version. Bath, UK: WHO Centre for the Study of Quality of Life, University of Bath). GAF=Global assessment of functioning scale (Luborsky, L. (1962). Clinicians’ Judgements of Mental Health. Archives of General Psychiatry, 7, 407–417). KMS=Kansas Marital Satisfaction Scale (Schumm, W.R., Paff-Bergen, L.A., Hatch, R.C., Obiorah, F.C., Copeland, J.M., Meens, L.D., Bugaighis, M.A. (1986) Concurrent and discriminant validity of the Kansas Marital Satisfaction Scale. Journal of Marriage & the Family, 48, 381-387). KPS=Kansas Parenting Satisfaction Scale (James, D. E., Schumm, W. R., Kennedy, C. E., Grigsby, C. C., Shectman, K. L., Nichols, C. W. (1985). Characteristics of the Kansas Parental Satisfaction Scale among two samples of married parents. Psychological Reports, 57, 163-169). To aid profiling across variables, all variables were transformed to T-scores with means of 50 and standard deviations of 10 before ANOVAs were conducted. T-score for variable X = ((X-M)/SD)X10)+50), where X is the score of a case on variable X; M is the mean for all cases on variable X and SD is the standard deviation for all cases on variable X. F values are from one-way analysis of variance and inter-group differences are based on Scheffe post hoc tests for comparing groups with unequal Ns that were significant at p<.05. **p<0.01 ***p<0.001. NS=Not significant.

Table 5.3. Adult attachment styles of participants with 4 or more diagnoses, 1-3 diagnoses and no diagnoses Table 5.3. Adult attachment styles of participants with 4 or more diagnoses, 1-3 diagnoses and no diagnoses

Adult Attachment Style		Group 1 4+ Diagnoses	Group 2 1-3 Diagnoses	Group 3 0 Diagnoses	Group Differences
		N= 83	N= 119	N=45
Secure	f	6.00	22.00	13.00
	%	7.20	18.50	28.90	1<2<3

Dismissive	f	10.00	39.00	17.00	1<2,3
	%	12.00	32.80	37.80

Fearful	f	54.00	43.00	12.00
	%	65.10	36.10	26.70	1>2,3

Preoccupied	f	13.00	15.00	3.00	NS
	%	15.70	12.60	6.70

Table 5.4. Recollections of child abuse among participants with mood disorders and no diagnoses

Variable			Group 1 Mood Disorder	Group 2 No Diagnosis	t	Group Diffs
			N=142	N=45
INSTITUTIONAL ABUSE
IAS >(N=187)	Specific institutional abuse	M	51.49	47.28	2.50	NS
		SD	9.87	9.80

CTQ- Institution >(N=187)	Total institutional abuse	M	52.01	46.83	3.00**	1>2
		SD	9.95	10.58

	Physical abuse	M	51.04	48.67	1.37	NS
		SD	10.32	9.66

	Sexual abuse	M	52.07	47.92	2.71**	1>2
		SD	10.45	8.42

	Emotional abuse	M	51.64	45.43	3.10**	1>2
		SD	8.97	12.48

	Physical neglect	M	50.59	50.14	0.26	NS
		SD	10.16	10.55

	Emotional neglect	M	50.23	48.51	0.99	NS
		SD	10.18	9.98

SPSA-Institution >(N=187)	Total severe institutional abuse	M	51.21	48.07	3.16**	1>2
		SD	6.03	5.03

	Severe institutional physical abuse	M	50.72	46.97	2.28**	1>2
		SD	9.91	8.06

	Severe institutional sexual abuse	M	52.14	47.85	2.77**	1>2
		SD	10.22	8.66
CHILD ABUSE IN FAMILY
CTQ-family (N=92)	Total family abuse score	M	51.88	46.31		NS
		SD	11.60	5.52

	Physical abuse	M	51.63	46.37		NS
		SD	11.43	5.88

	Sexual abuse	M	50.70	47.44		NS
		SD	11.19	1.91

	Emotional abuse	M	52.05	45.49		NS
		SD	11.39	4.10

	Physical neglect	M	51.18	49.57		NS
		SD	10.97	9.34

	Emotional neglect	M	51.28	47.91		NS
		SD	11.06	7.97

SPSA-family >(N=92)	Total severe family >abuse	M	51.41	46.37		NS
		SD	11.32	6.64

	Severe family physical abuse	M	51.64	46.65		NS
		SD	10.77	8.24

	Severe family sexual abuse	M	50.19	47.77		NS
			10.95	3.91

Note: Group1 had current or lifetime mood disorder diagnoses as assessed with the SCID I (First, M., Spitzer, R., Gibbon, M., and Williams, J. (1996). Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-I). Washington, DC: American Psychiatric Press). Group 2 had no diagnoses. CTQ=Childhood Trauma Questionnaire (Bernstein, D. & Fink, L. (1998). Childhood Trauma Questionnaire: A retrospective self-report. Manual. San Antonio, TX: The Psychological Cooperation). IAS=Institutional abuse scale. SPSA=Most severe forms of physical and sexual abuse. To aid profiling, all variables were transformed to T-scores with means of 50 and standard deviations of 10 before t-tests were conducted. T-score for variable X = ((X-M)/SD)X10)+50), where X is the score of a case on variable X; M is the mean for all cases on variable X and SD is the standard deviation for all cases on variable X. t values are from t-tests for independent samples. For the MANOVA on the total scores of the institution versions of the CTQ, SPSA & the IAS, F (3, 183) = 4.22, p<0.01. For the MANOVA on total scores of the family versions of the CTQ and SPSA, F (2, 89) = 2.65, NS. **p<0.01 ***p<0.001. NS=Not significant.

Table 5.5. Current adjustment of participants with mood disorders and no diagnoses

		Group 1 Mood Disorder	Group 2 No Diagnosis	t-value	Group Diffs
		N=142	N=45
Total trauma symptoms (TSI) >(N=187)	M	53.77	39.66	12.19***	1>2
	SD	9.09	5.83

Total No of life problems (LPC) (N=187)	M	52.37	43.99	6.71***	1>2
	SD	9.80	6.60

Total quality of life (WHOQOL) (N=187)	M	46.21	57.79	8.61***	1<2
	SD	9.35	7.32

Global functioning (GAF) (N=180)	M	46.78	58.88	7.76***	1<2
	SD	9.77	6.44

Marital satisfaction (KMS) (N=99)	M	50.09	53.51	1.47	NS
	SD	10.64	10.26

Parental satisfaction (KPS) (N=159)	M	48.49	51.50	1.58	NS
	SD	10.45	9.03

Note: Group1 had current or lifetime mood disorders as assessed with the SCID I (First, M., Spitzer, R., Gibbon, M., and Williams, J. (1996). Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-I). Washington, DC: American Psychiatric Press). Group 2 had no diagnoses. TSI=Trauma Symptom Inventory (Briere, J. (1996). Trauma Symptom Inventory. Odessa, FL: Psychological Assessment Resources). LPC=Life Problems Checklist. WHOQOL= World Health Organization Quality of Life 100 UK (Skevington, S. (2005). World Health Organization Quality of Life 100 UK Version. Bath, UK: WHO Centre for the Study of Quality of Life, University of Bath). GAS=Global assessment of functioning scale (Luborsky, L. (1962). Clinicians’ Judgements of Mental Health. Archives of General Psychiatry, 7, 407–417). KMS=Kansas Marital Satisfaction Scale (Schumm, W.R., Paff-Bergen, L.A., Hatch, R.C., Obiorah, F.C., Copeland, J.M., Meens, L.D., Bugaighis, M.A. (1986) Concurrent and discriminant validity of the Kansas Marital Satisfaction Scale. Journal of Marriage & the Family, 48, 381-387). KPS=Kansas Parenting Satisfaction Scale (James, D. E., Schumm, W. R., Kennedy, C. E., Grigsby, C. C., Shectman, K. L., Nichols, C. W. (1985). Characteristics of the Kansas Parental Satisfaction Scale among two samples of married parents. Psychological Reports, 57, 163-169). To aid profiling across variables, all variables were transformed to T-scores with means of 50 and standard deviations of 10 before t-tests were conducted. T-score for variable X = ((X-M)/SD)X10)+50), where X is the score of a case on variable X; M is the mean for all cases on variable X and SD is the standard deviation for all cases on variable X.t values are from t-tests for independent samples. **p<0.01 ***p<0.001. NS=Not significant.

Table 5.6. Adult attachment styles of participants with mood disorders and no diagnoses Table 5.6. Adult attachment styles of participants with mood disorders and no diagnoses

Adult Attachment Style		Group 1 Mood Disorder	Group 2 No Diagnosis	Group Diffs
		N=142	N=45
Secure	f	14.00	13.00	1<2
	%	9.90	28.90

Fearful	f	76.00	12.00	1>2
	%	53.50	26.70

Preoccupied	f	19.00	3.00	NS
	%	13.40	6.70

Dismissive	f	33.00	17.00	NS
	%	23.20	37.80

Table 5.7. Recollections of child abuse among participants with PTSD and no diagnoses

Variable			Group 1 PTSD	Group 2 No Diagnosis	t	Group Diffs
			N=63	N=45
INSTITUTIONAL ABUSE
IAS >(N=108)	Specific institutional abuse	M	52.23	47.28	2.74***	1>2
		SD	8.88	9.80

CTQ-Institution >(N=108)	Total institutional abuse	M	55.47	46.83	4.59***	1>2
		SD	8.92	10.58

	Physical abuse	M	54.46	48.67	3.47**	1>2
		SD	7.86	9.66

	Sexual abuse	M	54.61	47.92	3.55**	1>2
		SD	11.18	8.42

	Emotional abuse	M	53.46	45.43	3.91***	1>2
		SD	6.95	12.48

	Physical neglect	M	51.58	50.14	0.72	NS
		SD	9.97	10.55

	Emotional neglect	M	52.12	48.51	1.83	NS
		SD	10.14	9.98

SPSA-Institution >(N=108)	Total severe institutional abuse	M	52.87	48.07	4.32***	1>2
		SD	6.12	5.03

	Severe institutional physical abuse	M	52.80	46.97	3.25**	1>2
		SD	9.54	8.06

	Severe institutional sexual abuse	M	54.33	47.85	3.42**	1>2
		SD	10.40	8.66
CHILD ABUSE IN FAMILY
CTQ-family (N=57)	Total family abuse score	M	51.53	46.31	2.56	NS
			9.75	5.52

	Physical abuse	M	51.93	46.37	2.62	NS
		SD	10.06	5.88

	Sexual abuse	M	50.31	47.44	1.61	NS
		SD	10.02	1.91

	Emotional abuse	M	51.48	45.49	2.97**	1>2
		SD	10.54	4.10

	Physical neglect	M	51.02	49.57	0.51	NS
		SD	11.47	9.34

	Emotional neglect	M	51.46	47.91	1.39	NS
		SD	11.31	7.97

SPSA-family >(N=57)	Total severe family abuse	M	52.67	46.37	2.85**	1>2
		SD	10.03	6.64

	Severe family physical abuse	M	53.32	46.65	2.65	NS
		SD	10.74	8.24

	Severe family sexual abuse	M	49.99	47.77	1.30	NS
		SD	8.71	3.91

Note: Group1 had current or lifetime PTSD diagnoses as assessed with the SCID I (First, M., Spitzer, R., Gibbon, M., and Williams, J. (1996). Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-I). Washington, DC: American Psychiatric Press). Group 2 had no diagnoses. CTQ=Childhood Trauma Questionnaire (Bernstein, D. & Fink, L. (1998). Childhood Trauma Questionnaire: A retrospective self-report. Manual. San Antonio, TX: The Psychological Cooperation). IAS=Institutional abuse scale. SPSA=Most severe forms of physical and sexual abuse. To aid profiling, all variables were transformed to T-scores with means of 50 and standard deviations of 10 before t-tests were conducted. T-score for variable X = ((X-M)/SD)X10)+50), where X is the score of a case on variable X; M is the mean for all cases on variable X and SD is the standard deviation for all cases on variable X. t values are from t-tests for independent samples. For the MANOVA on the total scores of the institution versions of the CTQ, SPSA & the IAS, F (3, 104) = 8.04, p<0.001. For the MANOVA on total scores of the family versions of the CTQ and SPSA, F (2, 54) = 3.84, p<0.05. **p<0.01 ***p<0.001. NS=Not significant.

Table 5.8. Current adjustment of participants with PTSD and no diagnoses

		Group 1 PTSD	Group 2 No Diagnosis	t-value	Group Diffs
		N=63	N=45
Total trauma symptoms (TSI) (N=108)	M	55.32	39.66	11.37***	1>2
	SD	8.48	5.83

Total No of life problems (LPC) (N=108)	M	52.63	43.99	5.28***	1>2
	SD	5.28	6.30

Total quality of life (WHOQOL) (N=108)	M	45.25	57.79	7.66***	1<2
	SD	9.06	7.32

Global functioning (GAF) (N=103)	M	45.27	58.88	8.07***	1<2
	SD	9.79	6.44

Marital satisfaction (KMS) (N=66)	M	53.05	53.51	0.18	NS
	SD	9.78	10.26

Parental satisfaction (KPS) (N=90)	M	48.72	51.50	1.27	NS
	SD	10.99	9.03

Note: Group1 had current or lifetime PTSD as assessed with the SCID I (First, M., Spitzer, R., Gibbon, M., and Williams, J. (1996). Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-I). Washington, DC: American Psychiatric Press). Group 2 had no diagnoses. TSI=Trauma Symptom Inventory (Briere, J. (1996). Trauma Symptom Inventory. Odessa, FL: Psychological Assessment Resources). LPC=Life Problems Checklist. WHOQOL= World Health Organization Quality of Life 100 UK (Skevington, S. (2005). World Health Organization Quality of Life 100 UK Version. Bath, UK: WHO Centre for the Study of Quality of Life, University of Bath). GAS=Global assessment of functioning scale (Luborsky, L. (1962). Clinicians’ Judgements of Mental Health. Archives of General Psychiatry, 7, 407–417). KMS=Kansas Marital Satisfaction Scale (Schumm, W.R., Paff-Bergen, L.A., Hatch, R.C., Obiorah, F.C., Copeland, J.M., Meens, L.D., Bugaighis, M.A. (1986) Concurrent and discriminant validity of the Kansas Marital Satisfaction Scale. Journal of Marriage & the Family, 48, 381-387). KPS=Kansas Parenting Satisfaction Scale (James, D. E., Schumm, W. R., Kennedy, C. E., Grigsby, C. C., Shectman, K. L., Nichols, C. W. (1985). Characteristics of the Kansas Parental Satisfaction Scale among two samples of married parents. Psychological Reports, 57, 163-169). To aid profiling across variables, all variables were transformed to T-scores with means of 50 and standard deviations of 10 before t-tests were conducted. T-score for variable X = ((X-M)/SD)X10)+50), where X is the score of a case on variable X; M is the mean for all cases on variable X and SD is the standard deviation for all cases on variable X. t values are from t-tests for independent samples. **p<0.01 ***p<0.001. NS=Not significant.

Table 5.9. Adult attachment styles of participants with PTSD and no diagnoses Table 5.9. Adult attachment styles of participants with PTSD and no diagnoses

Adult Attachment Style		Group 1 PTSD	Group 2 No Diagnosis	Group Diffs
		N=63	N=45
Secure	f	9.00	13.00	NS
	%	14.30	28.90

Fearful	f	36.00	12.00	NS
	%	57.10	26.70

Preoccupied	f	10.00	3.00	NS
	%	15.90	6.70

Dismissive	f	8.00	17.00	1<2
	%	12.70	37.80

Table 5.10. Recollections of child abuse among participants with alcohol and substance use disorders and no diagnoses

Variable			Group 1 Alcohol and Substance use Disorders	Group 2 No Diagnosis	t	Group Diffs
			N=99	N=45
INSTITUTIONAL ABUSE
IAS >(N=144)	Specific institutional abuse	M	51.83	47.28	2.65**	1>2
		SD	9.49	9.80

CTQ-Institution >(N=144)	Total institutional abuse	M	52.71	46.83	3.21**	1>2
		SD	10.03	10.58

	Physical abuse	M	51.43	48.67	1.55	NS
		SD	10.00	9.66

	Sexual abuse	M	53.53	47.92	3.39**	1>2
		SD	10.69	8.42

	Emotional abuse	M	51.15	45.43	2.76**	1>2
		SD	9.10	12.48

	Physical neglect	M	50.80	50.14	0.38	NS
		SD	9.40	10.55

	Emotional neglect	M	49.89	48.51	0.77	NS
		SD	10.00	9.98

SPSA-Institution >(N=144)	Total severe institutional abuse	M	51.66	48.07	3.40**	1>2
		SD	6.22	5.03

	Severe institutional physical abuse	M	49.62	46.97	1.50	NS
		SD	10.29	8.06

	Severe institutional sexual abuse	M	53.90	47.85	3.57***	1>2
		SD	9.75	8.66

CHILD ABUSE IN FAMILY
CTQ-family	Total family abuse score† >(N=87)	M	50.80	46.31	2.70**
		SD	9.70	5.52	Z=1.8	NS

	Physical abuse	M	52.18	46.37	3.15**	1>2
		SD	11.15	5.88

	Sexual abuse	M	50.10	47.44	2.10	NS
		SD	9.58	1.91

	Emotional abuse	M	50.39	45.49	3.27**	1>2
		SD	9.84	4.10

	Physical neglect	M	50.20	49.57	0.28	NS
		SD	9.48	9.34

	Emotional neglect	M	50.59	47.91	1.15	NS
		SD	10.26	7.97

SPSA-family >(N=87)	Total severe family abuse	M	51.80	46.37	2.91**	1>2
		SD	10.18	6.64

	Severe family physical abuse	M	52.18	46.65	2.57	NS
		SD	10.70	8.24

	Severe family sexual abuse	M	50.08	47.77	1.62	NS
		SD	9.31	3.91

Note: Group1 had current or lifetime diagnoses of alcohol or substance use disorders as assessed with the SCID I (First, M., Spitzer, R., Gibbon, M., and Williams, J. (1996). Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-I). Washington, DC: American Psychiatric Press). Group 2 had no diagnoses. CTQ=Childhood Trauma Questionnaire (Bernstein, D. & Fink, L. (1998). Childhood Trauma Questionnaire: A retrospective self-report. Manual. San Antonio, TX: The Psychological Cooperation). IAS=Institutional abuse scale. SPSA=Most severe forms of physical and sexual abuse. To aid profiling, all variables were transformed to T-scores with means of 50 and standard deviations of 10 before t-tests were conducted. T-score for variable X = ((X-M)/SD)X10)+50), where X is the score of a case on variable X; M is the mean for all cases on variable X and SD is the standard deviation for all cases on variable X. t values are from t-tests for independent samples. For the MANOVA on the total scores of the institution versions of the CTQ, SPSA & the IAS, F (3, 140) = 4.63, p<0.01. For the MANOVA on total scores of the family versions of the CTQ and SPSA, , F (2, 141) =3.77, p<0.05. †Scores on the family version of the CTQ total scale violated the t-test assumption of normality and a Mann Whitney indicated that the intergroup differences on this variable were not statistically significant (Z=1.8, p>.05), so the significant t-test result may be disregarded. **p<0.01 ***p<0.001. NS=Not significant.

Table 5.11. Current adjustment of participants with alcohol and substance use and no diagnoses

		Group 1 Alcohol and Substance use Disorders	Group 2 No Diagnosis	t-value	Group Diffs
		N=99	N=45
Total trauma symptoms (TSI) (N=144)	M	54.93	39.66	12.23***	1>2
	SD	8.93	5.83

Total No of life problems (LPC) (N=144)	M	56.41	43.99	8.95***	1>2
	SD	10.17	6.30

Total quality of life (WHOQOL) (N=144)	M	46.64	57.79	7.48***	1<2
	SD	10.09	7.32

Global functioning (GAF) (N=136)	M	46.59	58.88	8.73***	1<2
	SD	9.82	6.44

Marital satisfaction (KMS) (N=83)	M	52.31	53.51	0.52	NS
	SD	9.75	10.26

Parental satisfaction (KPS) >(N=123)	M	47.92	51.50	1.73	NS
	SD	11.09	9.03

Note: Group1 had current or lifetime alcohol or substance use disorders as assessed with the SCID I (First, M., Spitzer, R., Gibbon, M., and Williams, J. (1996). Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-I). Washington, DC: American Psychiatric Press). Group 2 had no diagnoses. TSI=Trauma Symptom Inventory (Briere, J. (1996). Trauma Symptom Inventory. Odessa, FL: Psychological Assessment Resources). LPC=Life Problems Checklist. WHOQOL= World Health Organization Quality of Life 100 UK (Skevington, S. (2005). World Health Organization Quality of Life 100 UK Version. Bath, UK: WHO Centre for the Study of Quality of Life, University of Bath). GAS=Global assessment of functioning scale (Luborsky, L. (1962). Clinicians’ Judgements of Mental Health. Archives of General Psychiatry, 7, 407–417). KMS=Kansas Marital Satisfaction Scale (Schumm, W.R., Paff-Bergen, L.A., Hatch, R.C., Obiorah, F.C., Copeland, J.M., Meens, L.D., Bugaighis, M.A. (1986) Concurrent and discriminant validity of the Kansas Marital Satisfaction Scale. Journal of Marriage & the Family, 48, 381-387). KPS=Kansas Parenting Satisfaction Scale (James, D. E., Schumm, W. R., Kennedy, C. E., Grigsby, C. C., Shectman, K. L., Nichols, C. W. (1985). Characteristics of the Kansas Parental Satisfaction Scale among two samples of married parents. Psychological Reports, 57, 163-169).To aid profiling across variables, all variables were transformed to T-scores with means of 50 and standard deviations of 10 before t-tests were conducted. T-score for variable X = ((X-M)/SD)X10)+50), where X is the score of a case on variable X; M is the mean for all cases on variable X and SD is the standard deviation for all cases on variable X. t values are from t-tests for independent samples. **p<0.01 ***p<0.001. NS=Not significant.

Table 5.12. Recollections of child abuse among participants with avoidant personality disorder and no diagnoses

Variable			Group 1 Avoidant Personality Disorder	Group 2 No Diagnosis	t	Group Diffs
			N=52	N=45
INSTITUTIONAL ABUSE
IAS >(N=97)	Specific institutional abuse	M	51.76	47.28	2.28	NS
		SD	9.58	9.80

CTQ-Institution >(N=97)	Total institutional abuse	M	50.41	46.83	1.89	NS
		SD	8.12	10.58

	Physical abuse	M	50.86	48.67	1.15	NS
		SD	9.13	9.66

	Sexual abuse	M	49.50	47.92	0.83	NS
		SD	10.05	8.42

	Emotional abuse	M	51.58	45.43	2.84**	1>2
		SD	7.96	12.48

	Physical neglect	M	48.25	50.14	0.99	NS
		SD	8.36	10.55

	Emotional neglect	M	51.38	48.51	1.42	NS
		SD	9.93	9.98

SPSA-Institution >(N=97)	Total severe institutional abuse	M	49.95	48.07	1.71	NS
		SD	5.67	5.03

	Severe institutional physical abuse	M	51.40	46.97	2.40	NS
		SD	9.38	8.66

	Severe institutional sexual abuse	M	48.87	47.85	0.52	NS
		SD	10.35	8.66

CHILD ABUSE IN FAMILY
CTQ-family (N=45)	Total family abuse score	M	53.36	46.31	2.66	NS
		SD	46.31	5.52

	Physical abuse	M	50.63	46.37	1.67	NS
		SD	10.31	5.88

	Sexual abuse	M	50.06	47.44	1.49	NS
		SD	7.88	1.91

	Emotional abuse	M	54.32	45.49	3.33**	1>2
		SD	11.53	4.10

	Physical neglect	M	52.90	49.57	1.02	NS
		SD	12.46	9.34

	Emotional neglect	M	55.61	47.91	2.51	NS
		SD	11.91	7.97

SPSA-family >(N=45)	Total severe family abuse	M	49.87	46.37	1.49	NS
		SD	8.78	6.64

	Severe family physical abuse	M	50.37	46.65	1.34	NS
		SD	10.13	8.24

	Severe family sexual abuse	M	48.98	47.77	0.78	NS
		SD	6.37	3.91

Table 5.13. Current adjustment of participants with avoidant personality disorder and no diagnoses

		Group 1 Avoidant Personality Disorder	Group 2 No Diagnosis	t-value	Group Diffs
		N=52	N=45
Total trauma symptoms (TSI) (N=97)	M	56.29	39.66	11.37***	1>2
	SD	8.48	5.83

Total No of life problems (LPC) (N=97)	M	50.25	43.99	4.01***	1>2
	SD	8.67	6.30

Total quality of life (WHOQOL) (N=97)	M	44.19	57.79	8.60***	1<2
	SD	8.13	7.32

Global functioning (GAF) (N=93)	M	43.17	58.87	10.42***	1>2
	SD	7.97	6.44

Marital satisfaction (KMS) (N=55)	M	49.12	53.51	1.10	NS
	SD	8.88	10.26

Parental satisfaction (KPS) (N=80)	M	49.03	51.50	1.10	NS
	SD	10.82	9.03

Note: Group1 had avoidant personality disorder as assessed with the SCID II (First, M., Spitzer, R., Gibbon M., & Williams, J. (1997). Structured Clinical Interview for DSM-IV Personality Disorders, (SCID-II). Washington, DC: American Psychiatric Press). Group 2 had no diagnoses. TSI=Trauma Symptom Inventory (Briere, J. (1996). Trauma Symptom Inventory. Odessa, FL: Psychological Assessment Resources). LPC=Life Problems Checklist. WHOQOL= World Health Organization Quality of Life 100 UK (Skevington, S. (2005). World Health Organization Quality of Life 100 UK Version. Bath, UK: WHO Centre for the Study of Quality of Life, University of Bath). GAS=Global assessment of functioning scale (Luborsky, L. (1962). Clinicians’ Judgements of Mental Health. Archives of General Psychiatry, 7, 407–417). KMS=Kansas Marital Satisfaction Scale (Schumm, W.R., Paff-Bergen, L.A., Hatch, R.C., Obiorah, F.C., Copeland, J.M., Meens, L.D., Bugaighis, M.A. (1986) Concurrent and discriminant validity of the Kansas Marital Satisfaction Scale. Journal of Marriage & the Family, 48, 381-387). KPS=Kansas Parenting Satisfaction Scale (James, D. E., Schumm, W. R., Kennedy, C. E., Grigsby, C. C., Shectman, K. L., Nichols, C. W. (1985). Characteristics of the Kansas Parental Satisfaction Scale among two samples of married parents. Psychological Reports, 57, 163-169). To aid profiling across variables, all variables were transformed to T-scores with means of 50 and standard deviations of 10 before t-tests were conducted. T-score for variable X = ((X-M)/SD)X10)+50), where X is the score of a case on variable X; M is the mean for all cases on variable X and SD is the standard deviation for all cases on variable X. t values are from t-tests for independent samples. **p<0.01 ***p<0.001. NS=Not significant.

Table 5.14. Adult attachment styles of participants with avoidant personality disorder and no diagnoses Table 5.14. Adult attachment styles of participants with avoidant personality disorder and no diagnoses

Adult Attachment Style		Group 1 Avoidant Personality Disorder	Group 2 No Diagnosis	Group Diffs
		N=52	N=45
Secure	f	3.00	13.00	1<2
	%	5.80	28.90

Fearful	f	35.00	12.00	1>2
	%	67.30	26.70

Preoccupied	f	4.00	3.00	NS
	%	7.70	6.70

Dismissive	f	10.00	17.00	NS
	%	19.20	37.80

Table 5.15. Recollections of child abuse among participants with antisocial personality disorder and no diagnoses

Variable			Group 1 Antisocial Personality Disorder	>Group 2 No Diagnosis	t	Group Diffs
			N=17	N=45
INSTITUTIONAL ABUSE
IAS	Specific institutional abuse >(N=62)	M	52.08	47.28	1.72	NS
		SD	9.86	9.80

CTQ-Institution	Total institutional abuse >(N=62)	M	55.17	46.83	2.87**	1>2
		SD	9.10	10.58

	Physical abuse	M	50.94	48.67	0.85	NS
		SD	8.62	9.66

	Sexual abuse	M	59.23	47.92	4.63***	1>2
		SD	9.00	8.42

	Emotional abuse	M	51.72	45.43	1.93	NS
		SD	8.00	12.48

	Physical neglect	M	49.11	50.14	0.37	NS
		SD	9.07	10.55

	Emotional neglect	M	50.18	48.51	0.58	NS
		SD	10.52	9.98

SPSA-Institution >(N=62)	Total severe institutional abuse	M	51.15	48.07	1.98	NS
		SD	6.53	5.03

	Severe institutional physical abuse	M	44.27	46.97	1.03	NS
		SD	10.54	8.66

	Severe institutional sexual abuse	M	56.55	47.85	3.80**	1>2
		SD	7.79	8.66

CHILD ABUSE IN FAMILY
CTQ-family (N=38)	Total family abuse score	M	52.97	46.31	2.18	NS
		SD	10.64	5.52

	Physical abuse	M	55.38	46.37	2.57	NS
		SD	12.33	5.88

	Sexual abuse	M	50.73	47.44	1.23	NS
		SD	9.88	1.91

	Emotional abuse	M	54.28	45.49	2.91	NS
		SD	10.86	4.10

	Physical neglect	M	49.38	49.57	0.06	NS
		SD	9.49	9.34

	Emotional neglect	M	52.25	47.91	1.21	NS
		SD	11.93	7.97

SPSA-family >(N=38)	Total severe family abuse	M	54.54	46.37	2.85	NS
		SD	9.44	6.64

	Severe family physical abuse	M	54.47	46.65	2.30	NS
		SD	11.09	8.24

	Severe family sexual abuse	M	52.17	47.77	1.50	NS
		SD	10.59	3.91

Table 5.16. Current adjustment of participants with antisocial personality disorder and no diagnoses

		Group 1 Antisocial Personality Disorder	Group 2 No Diagnosis	t	Group Diffs
		N=17	N=45
Total trauma symptoms (TSI) (N=62)	M	56.62	39.66	6.00***	1>2
	SD	11.09	5.83

Total No of life problems (LPC) (N=62)	M	69.28	43.99	14.06***	1>2
	SD	6.37	6.30

Total quality of life (WHOQOL) (N=62)	M	44.25	57.79	5.54***	1<2
	SD	11.36	7.32

Global functioning (GAF) (N=60)	M	42.45	58.87	5.32***	1<2
	SD	11.37	6.44

Marital satisfaction (KMS) (N=36)	M	53.74	53.51	0.06	NS
	SD	9.59	10.26

Parental satisfaction (KPS) (N=51)	M	35.84	51.50	5.07***	1<2
	SD	11.83	9.03

Note: Group1 had antisocial personality disorder as assessed with the SCID II (First, M., Spitzer, R., Gibbon M., & Williams, J. (1997). Structured Clinical Interview for DSM-IV Personality Disorders, (SCID-II). Washington, DC: American Psychiatric Press). Group 2 had no diagnoses. TSI=Trauma Symptom Inventory (Briere, J. (1996). Trauma Symptom Inventory. Odessa, FL: Psychological Assessment Resources). LPC=Life Problems Checklist. WHOQOL= World Health Organization Quality of Life 100 UK (Skevington, S. (2005). World Health Organization Quality of Life 100 UK Version. Bath, UK: WHO Centre for the Study of Quality of Life, University of Bath). GAS=Global assessment of functioning scale (Luborsky, L. (1962). Clinicians’ Judgements of Mental Health. Archives of General Psychiatry, 7, 407–417). KMS=Kansas Marital Satisfaction Scale (Schumm, W.R., Paff-Bergen, L.A., Hatch, R.C., Obiorah, F.C., Copeland, J.M., Meens, L.D., Bugaighis, M.A. (1986) Concurrent and discriminant validity of the Kansas Marital Satisfaction Scale. Journal of Marriage & the Family, 48, 381-387). KPS=Kansas Parenting Satisfaction Scale (James, D. E., Schumm, W. R., Kennedy, C. E., Grigsby, C. C., Shectman, K. L., Nichols, C. W. (1985). Characteristics of the Kansas Parental Satisfaction Scale among two samples of married parents. Psychological Reports, 57, 163-169). To aid profiling across variables, all variables were transformed to T-scores with means of 50 and standard deviations of 10 before t-tests were conducted. T-score for variable X = ((X-M)/SD)X10)+50), where X is the score of a case on variable X; M is the mean for all cases on variable X and SD is the standard deviation for all cases on variable X. t values are from t-tests for independent samples. **p<0.01 ***p<0.001. NS=Not significant.

Table 5.17. Current adjustment of participants with borderline personality disorder and no diagnoses

		Group 1 Borderline Personality Disorder	Group 2 No Diagnosis	t	Group Diffs
		N=14	N=45
Total trauma symptoms (TSI) (N=59)	M	61.79	39.66	11.12***	1>2
	SD	8.38	5.83

Total No of life problems (LPC) (N=59)	M	61.16	43.99	5.50***	1>2
	SD	11.13	6.30

Total quality of life (WHOQOL) (N=59)	M	41.27	57.79	6.85***	1<2
	SD	9.53	7.32

Global functioning (GAF) (N=59)	M	38.07	58.87	6.04***	1<2
	SD	12.38	6.44

Marital satisfaction (KMS) (N=34)	M	48.12	53.51	0.93	NS
	SD	15.16	10.26

Parental satisfaction (KPS) (N=47)	M	46.21	51.50	1.50	NS
	SD	12.93	9.03

Note: Group1 had borderline personality disorder as assessed with the SCID II (First, M., Spitzer, R., Gibbon M., & Williams, J. (1997). Structured Clinical Interview for DSM-IV Personality Disorders, (SCID-II). Washington, DC: American Psychiatric Press). Group 2 had no diagnoses. TSI=Trauma Symptom Inventory (Briere, J. (1996). Trauma Symptom Inventory. Odessa, FL: Psychological Assessment Resources). LPC=Life Problems Checklist. WHOQOL= World Health Organization Quality of Life 100 UK (Skevington, S. (2005). World Health Organization Quality of Life 100 UK Version. Bath, UK: WHO Centre for the Study of Quality of Life, University of Bath). GAS=Global assessment of functioning scale (Luborsky, L. (1962). Clinicians’ Judgements of Mental Health. Archives of General Psychiatry, 7, 407–417). KMS=Kansas Marital Satisfaction Scale (Schumm, W.R., Paff-Bergen, L.A., Hatch, R.C., Obiorah, F.C., Copeland, J.M., Meens, L.D., Bugaighis, M.A. (1986) Concurrent and discriminant validity of the Kansas Marital Satisfaction Scale. Journal of Marriage & the Family, 48, 381-387). KPS=Kansas Parenting Satisfaction Scale (James, D. E., Schumm, W. R., Kennedy, C. E., Grigsby, C. C., Shectman, K. L., Nichols, C. W. (1985). Characteristics of the Kansas Parental Satisfaction Scale among two samples of married parents. Psychological Reports, 57, 163-169). To aid profiling across variables, all variables were transformed to T-scores with means of 50 and standard deviations of 10 before t-tests were conducted. T-score for variable X = ((X-M)/SD)X10)+50), where X is the score of a case on variable X; M is the mean for all cases on variable X and SD is the standard deviation for all cases on variable X. t values are from t-tests for independent samples. **p<0.01 ***p<0.001. NS=Not significant.

Table 5.18. Adult attachment styles of participants with borderline personality disorder and no diagnoses Table 5.18. Adult attachment styles of participants with borderline personality disorder and no diagnoses

Adult Attachment Style		Group 1 Borderline Personality Disorder	Group 2 No Diagnosis	Group Diffs
		N=14	N=45
Secure	f	1.00	13.00	NS
	%	7.10	28.90

Fearful	f	11.00	12.00	1>2
	%	78.60	26.70

Preoccupied	f	1.00	3.00	NS
	%	7.10	6.70

Dismissive	f	1.00	17.00	NS
	%	7.10	37.80

Table 5.19. Institutional and family child abuse and neglect reported by participants with multiple co-morbid diagnoses, mood disorders, PTSD, substance use disorders, and personality disorders; and profiles of adult psychological adjustment

	Multiple Co-morbid Diagnoses (4+)	Mood Disorders	PTSD	Alcohol and Substance Use Disorders	Avoidant Personality Disorder	Antisocial Personality Disorder	Borderline Personality disorder	No Diagnosis
Institutional child abuse & neglect
Physical institutional abuse	+	+	+	-	-	-	-	-
Sexual institutional abuse	+	+	+	+	-	+	-	-
Emotional institutional abuse	+	+	+	+	+	-	-	-
Physical institutional neglect	-	-	-	-	-	-	-	-
Emotional institutional neglect	-	-	-	-	-	-	-	-
Family-based child abuse & neglect
Physical family abuse	-	-	-	+	-	-	-	-
Sexual family abuse	-	-	-	-	-	-	-	-
Emotional family abuse	-	-	+	+	+	-	-	-
Physical family neglect	-	-	-	-	-	-	-	-
Emotional family neglect	-	-	-	-	-	-	-	-
Adult psychological adjustment
>50% comorbid anxiety disorder	+	+	+	+	+	+	+	-
>50% co-morbid mood disorder	+	+	-	-	+	-	+	-
>50% comorbid substance use disorder	+	-	+	-	-	+	+	-
>50% comorbid personality disorder	+	-	-	-	-	-	-	-
Multiple trauma symptoms	+	+	+	+	+	+	+	-
Multiple life problems	+	+	+	+	+	+	+	-
Low quality of life	+	+	+	+	+	+	+	-
Low parenting satisfaction	-	-	-	-	-	+	-	-
Fearful adult attachment style	+	+	-	-	+	-	+	-
Low socio economic status	+	-	-	+	-	+	-	-

Note: +=the feature was a significant element of the group profile. - the feature was not a significant element of the group profile.

Part 6 Psychological processes and coping strategies associated with institutional abuse

Summary of Part 6

3.274Six scales were developed to measure past and present psychological processes theoretically purported to arise from the experience of institutional abuse, and associated functional and dysfunctional coping strategies. The scales were (1) traumatization which assesses negative emotions arising from abuse, betrayal and loss of trust, stigmatization, shame, guilt, and disrespect of authority; (2) re-enactment which assesses re-enactment of abuse, powerlessness, coping by opposing and coping by using alcohol and drugs; (3) spiritual disengagement which assesses disengagement from religious practice and not using spiritual coping strategies; (4) positive coping which assesses coping through planning, skill mastery and social support; (5) coping by complying which assesses coping by complying with the wishes of people in authority; and (6) avoidant coping which assesses coping by avoiding thoughts and situations associated with abuse.

3.275All participants reported a reduction in traumatization and re-enactment and an increase in spiritual disengagement from childhood to adult life. They also reported an increase in the use of positive coping strategies and a reduction in the use of coping by complying and avoidant coping.

3.276The psychological processes of traumatization and re-enactment as experienced now or remembered from childhood were associated multiple indices of institutional abuse, but not family-based child abuse.

3.277Time spent living with one’s family in childhood was a protective factor and was associated with reduced traumatization in adulthood, whereas severe family-based child abuse was associated with avoidant coping in adulthood.

3.278Participants for whom severe physical and sexual abuse, or severe sexual abuse alone were the worst things that happened to them in institutions, reported greater past re-enactment of abusive experiences, than those for whom worst experiences involved severe physical or emotional abuse.

3.279Traumatization and re-enactment as experienced now or remembered from childhood were associated multiple indices of adult adjustment including the presence of multiple trauma symptoms, multiple adult life problems, global functioning, quality of life, interpersonal anxiety and interpersonal avoidance.

3.280Participants with four or more psychological disorders reported greatest past and present traumatization and re-enactment; greatest current use of avoidant coping; and least current use of positive coping. Participants with no diagnoses, reported least present traumatization, re-enactment and use of avoidant coping; and the greatest reduction in traumatization from past to present. However, they showed a negligible increase in the use of positive coping strategies from past to present.

3.281Positive coping was associated with marital satisfaction and quality of life. Participants who spent 5-11 years in an institution and placement occurred through the courts reported greater use of positive coping strategies in the past, than those who spent 5-11 years in an institution and placement occurred because parents couldn’t cope or died. These in turn reported greater use of these strategies than participants who spent more than 12 years in an institution and entered before age 5.

3.282Participants who reported that severe physical abuse was the worst thing that happened to them in institutions, reported greatest coping by complying, and lowest levels of coping by complying occurred among those that reported that severe sexual abuse was the worst thing that happened to them in institutions. For present coping by complying, intermediated between these extremes was the group that reported that severe emotional abuse was the worst thing that happened to them in institutions.

3.283A model was developed which shows how childhood institutional abuse is associated with the processes of traumatization, re-enactment and spiritual disengagement, which in turn are associated with adult mental health and quality of life. The model also shows how childhood years within the family and current use of positive coping strategies are associated with quality of life.

Introduction

3.284In this Part an account is given of the development of a set of 6 scales to measure past and present psychological processes theoretically purported to arise from the experience of institutional abuse, and associated functional and dysfunctional coping strategies. These scales are then used to address a series of five questions about the association between abuse processes and coping strategies on the one hand and the following variables (1) recollections of institutional abuse and family-based child abuse; (2) adult adjustment; (3) duration of time spent in institutions and circumstances of entry to institutions; (4) types of worst abusive experiences in institutions (5) number of psychological disorders. The Part closes with the presentation of a model which links childhood experiences of institutional abuse with adult adjustment, via psychological processes and coping strategies.

Theoretical basis for development of scales to measure abuse processes and coping strategies

3.285Professor David Wolfe has argued that the long-term outcomes of child abuse are probably mediated by distinctive psychological processes (Wolfe et al., 2003) including traumatization, betrayal , disrespect for authority, stigmatization, powerlessness, avoidance of reminders of abuse, and re-enactment of abuse on self or others. The research literature on clerical abuse indicates that in addition to the processes identified by Wolfe, survivors of clerical abuse may also disengage from religious and spiritual beliefs and practices (e.g. Bottoms et al., 1995; Fater & Mullaney, 2000; Farrell & Taylor, 2000; McLaughlin, 1994, Wolfe et al., 2006). The research literature on stress and coping in children exposed to early childhood adversity suggests that children may use both functional and dysfunctional coping strategies to deal with institutional abuse (Luthar, 2003; Rutter et al., 1990). Functional coping strategies include social support, skill mastery, planning and spiritual support. Dysfunctional coping strategies may include either fully complying with the abusive regime or aggressively opposing it without due regard to the risks of further abuse entailed by this. Excessive consumption of alcohol, drugs and food are other potentially dysfunctional coping strategies.

Rational subscales included in the Institutional Abuse Processes and Coping Inventory (IAPCI)

3.286In light of these insights from the broad literature on child abuse and coping, the Institutional Abuse Processes and Coping Inventory (IAPCI) was developed for the present study, to facilitate investigation of psychological processes and coping strategies in survivors of institutional abuse. The IAPCI contained rational subscales to assess the following processes: (1) traumatization, (2) betrayal, (3) disrespect of authority, (4) religious disengagement, (5) stigmatization, (6) powerlessness, (7) avoidance, and (8) re-enactment. The following functional coping strategies were assessed with the IAPCI: (1) social support, (2) skill mastery, (3) planning, and (4) spiritual support. The inventory also assessed these dysfunctional coping strategies: (1) overcomplying, (2) aggressively opposing, and (3) substance abuse. Two versions the IACPI were developed for the present study. The first inquired about processes and coping strategies used while living in an institution and the second inquired about the same processes and coping strategies in the person’s present life. The IAPCI is part of the protocol contained in Appendix 1, which was completed by the 247 participants in this study.

Development of IAPCI factor scales

3.287A series of analyses were conducted on the IAPCI with the aim of developing a set of factorially valid and psychometrically reliable factor scales which contained the same items for past and present versions.

3.288Initially, principal component analyses (PCA) of total scores from rational scales for past and present versions of the IAPCI were conducted. These PCAs each yielded similar, although not identical, five factor solutions. The five factors were named traumatization; re-enactment; spiritual disengagement; positive coping; and coping by complying.

3.289The next step involved conducting factor analyses on items from past and present versions of the IAPCI. These each yielded very similar (though not identical) 5 factor solutions The five factors were very similar to those identified through principal components analysis of total scores from rational scales. The five factors were named in a similar manner, i.e., traumatizaiton, re-enactment, spiritual disengagement, positive coping, and coping by complying.

3.290Internal consistency alpha reliability co-efficients were obtained for rational scales and factor scales from the factor analyses of items. The reliability analyses pointed to a number of significant problems. Few of the narrowband rational scales were reliable for both past and present versions. Not all of the factor scales were reliable. Past and present versions had different item compositions, so past and present scores could not be compared. Also avoidant coping, which is a clinically and theoretically important coping strategy did not emerge in a coherent way in the PCA or factor analysis solutions.

3.291To design the final 6 IAPCI factor scales, in 4 instances rational scales were combined in coherent ways consistent with the results of PCAs of rational scale totals, factor analyses of items, and trauma theory. Items were dropped if they keyed differently for past and present versions of the IAPCI or detracted from scale internal consistency reliability in alpha reliability analyses. The four scales constructed in this way were named traumatization, re-enactment, spiritual disengagement, and positive coping. The remaining two scales were each rational scales: coping by complying and avoidant coping. What follows are brief descriptions of the six IAPCI factor scales.

3.292Traumatization is a 14 item scale which assesses truamatization; betrayal and loss of trust; stigmatization, shame and guilt; and disrespect of authority.

3.293Re-enactment is an 9 item scale which assesses re-enactment of abuse, powerlessness, coping by opposing and coping by using alcohol and drugs.

3.294Spiritual disengagement is a 5 item scale which assesses disengagement from religious practice and not using spiritual coping strategies.

3.295Positive coping is a 9 item scale which assesses coping through planning, skill mastery and social support.

3.296Coping by complying is a 3 item scale which assesses coping by complying with the wishes of people in authority.

3.297Avoidant coping is a 3 item scale which assesses coping by avoiding thoughts and situations associated with abuse.

Confirmatory factor analyses

3.298The item composition of past and present versions of the 6 IAPCI factor scales is presented in Table 6.1. Two confirmatory factor analyses were conducted to evaluate the factorial validity of past and present versions of the 6 IAPCI factor scales. Two confirmatory factor models, using the structure in Table 6.1, were specified and estimated using LISREL 8.72 (Jöreskog & Sörbom, 2005a). Model 1 was the Present IAPCI and Model 2 was the Past IAPCI. Analyses were based on a covariance matrix and an asymptotic weight matrix (the distribution of all IAPCI items deviated significantly from normality in terms of skewness and kurtosis) computed using PRELIS 2.72 (Jöreskog & Sörbom, 2005b) and the parameters estimated using maximum likelihood. The use of an asymptotic weight matrix allows for weaker assumptions regarding the distribution of the observed variables and results in improved fit and test statistics (Satorra, 1992; Curran, West, & Finch, 1996). All models were specified to allow the factors to correlate, have no cross-factor loadings, and initially have no correlated errors.

3.299Following the guidelines suggested by Hoyle and Panter (1995) the goodness of fit for each model was assessed using the Sattora–Bentler scaled chi-square (S-Bχ²), the Incremental Fit Index (IFI: Bollen, 1989), and the Comparative Fit Index (CFI: Bentler, 1990). A non-significant chi-square, and values greater than .90 for the IFI and CFI are considered to reflect acceptable model fit. In addition, the Root Mean Square Error of Approximation (RMSEA: Steiger, 1990) with 90% confidence intervals (90%CI) were reported, where a value less than .05 indicates close fit and values up to .08 indicating reasonable errors of approximation in the population (Jöreskog & Sörbom, 1993). The standardized root-mean-square residual (SRMR: Jöreskog & Sörbom, 1981) has been shown to be sensitive to model mis-specification and its use recommended by Hu and Bentler (1999). Values less than .08 are considered to be indicative of acceptable model fit (Hu & Bentler, 1998).

3.300Model 1 was considered to be an reasonable description of the sample data (S-Bχ²=1767, df=845, p=.00; RMSEA=.07 (90%CI .06-.07); CFI=.86; IFI=.86; SRMR=.08) although the residuals indicated that the Institutional Traumatization factor was not adequately explaining the covariation between two item pairs (DC2 &DC3 and SC2 &SC3), and the Positive Coping factor was not adequately explaining the covariation between items CTC1 and CTC2. The inclusion of three correlated errors improved the fit of the model (S-Bχ²=1544, df=842, p=.00; RMSEA=.06 (90%CI .05-.06); CFI=.90; IFI=.90; SRMR=.08). The improvement in model fit was statistically significant (S-Bχ²=223, df=3, p=.00). The standardized factor loading are reported in Table 6.2. All factor loading are statistically significant (p<.05). The factor correlations are reported below in Table 6.3.

3.301Model 2 was considered to be an reasonable description of the sample data (S-Bχ²=1383, df=845, p=.00; RMSEA=.05 (90%CI .05-.06); CFI=.86; IFI=.86; SRMR=.08) although the residuals indicated that the Powerless Re-enactment factor was not adequately explaining the covariation between two item pairs (XP1 & XP2 and XP3 & XP4). The inclusion of two correlated errors improved the fit of the model (S-Bχ²=1292, df=843, p=.00; RMSEA=.05 (90%CI .04-.05); CFI=.90; IFI=.90; SRMR=.08). The improvement in model fit was statistically significant (S-Bχ²=223, df=2, p=.00). The standardized factor loading are reported in Table 6.2. With the exception of two items (BP1 and PP3) all factor loading are statistically significant (p<.05). The factor correlations are reported in Table 6.3.

3.302Thus, the confirmatory factor analyses supported the factorial validity of the six factor scales of the past and present versions of the IAPCI shown in Table 6.1

Reliability analyses

3.303Internal consistency alpha reliability coefficients were calculated for past and present versions of each of the 6 IACPI factor scales. Also, for 52 cases inter-rater reliability was evaluated using the split-half method, treating ratings by each rater as two halves of the same scale. From Table 6.4 it may be seen that alpha reliabilities ranged from .51 to .87 (with 7 of the 12 alpha coefficients close to, or above .7) indicating moderate to good internal consistency reliability for all IAPCI scales. 11 of the 12 inter-rater reliability coefficients were above .7 indicating good inter-rater reliability for 11 scales and moderate inter-rater reliability for one scale (past coping by complying).

Questions investigated with the IAPCI

3.304Having developed a set of IAPCI factor scales to measure past and present psychological processes theoretically purported to arise from the experience of institutional abuse, and associated functional and dysfunctional coping strategies, a series of analyses were conducted to answer the questions listed below.

3.305The first question was: Are past and present institutional abuse processes and coping strategies (as evaluated by the IAPCI factor scales) associated with recollections of institutional abuse but not family-based child abuse?

3.306The second question was: Are past and present institutional abuse processes and coping strategies (as evaluated by the IAPCI factor scales) associated with indices of adult adjustment?

3.307The third question was: Do participants who had spent different amounts of time in institutions and entered under different circumstances differ in their experience of past and present institutional abuse processes and coping strategies as evaluated by the IAPCI factor scales?

3.308The fourth question was: Do participants who had different types of worst abusive experiences in institutions differ in their experience of past and present institutional abuse processes and coping strategies as evaluated by the IAPCI factor scales?

3.309The fifth question was: Do participants who with multiple co-morbid psychological disorders, fewer disorders and no disorders differ in their experience of past and present institutional abuse processes and coping strategies as evaluated by the IAPCI factor scales?

The IAPCI scales and institutional and family abuse

3.310The following analyses were carried out to address the first question which was: Are past and present institutional abuse processes and coping strategies (as evaluated by the IAPCI factor scales) associated with recollections of institutional abuse but not family-based child abuse? First, Pearson product moment correlations were conducted between IAPCI scales on the one hand, and indices of institutional abuse on the other. These analyses are summarized in Table 6.5. Next, Pearson product moment correlations were conducted between IAPCI scales on the one hand, and indices of family-based child abuse on the other. These analyses are summarized in Table 6.6. In these analyses, the indices of institutional and family-based abuse were: the number of years spent living in an institution; the total, severe physical and severe sexual abuse scale scores of the institution and family versions of the Severe Physical and Sexual Abuse scale (SPSA); the total score on the Institutional Abuse Scale (IAS); and the total, physical abuse, sexual abuse, emotional abuse, physical neglect and emotional neglect scale scores of the institution and family versions of the Childhood Trauma Questionnaire (CTQ). Correlations with an absolute value above .3 and significant at p<.01 were interpreted as indicating a moderate association between variables.

3.311From Table 6.5 it may be seen that 16 correlations with an absolute value above .3 and significant at p<.01 occurred when IAPCI scales were correlated with indices of institutional abuse and neglect. In contrast only two such correlation occurred between IAPCI scales and indices of family-based child abuse and neglect. Thus, IAPCI scale scores were far more strongly associated with recollections of institutional abuse than family-based child abuse.

3.312From Table 6.5, it may be seen that both past and present versions of the traumatization scale, and the past version of the re-enactment scale had large significant correlations with multiple indices of institutional abuse. Specifically, the past and present version of the IAPCI traumatization scale correlated with the total, physical and emotional abuse scales of the institution version of the CTQ. The past version of the IAPCI traumatization scale also correlated with the SPSA severe institutional physical abuse scale, the IAS total scale, and the physical neglect scale of the institution version of the CTQ. The present version of the IAPCI traumatization scale also correlated with the SPSA total severe institutional abuse scale. The past version of the IAPCI re-enactment scale correlated with the SPSA total and severe institutional sexual abuse scales; the IAS total scale; and the total, physical and sexual abuse scales of the institution version of the CTQ.

3.313From Table 6.6 it may be seen that the present IAPCI traumatization scale correlated negatively with the number of years spent living with the family before 16. The present IAPCI avoidant coping scale correlated with SPSA total severe family-based abuse scale. Thus children who lived longer with their families as children reported less current traumatization as adults; and children who experienced severe child abuse within the family used greater avoidant coping as adults.

3.314The analysis reported in this section provided an answer to the question about the association between past and present abuse processes and coping strategies on the one hand and recollections of institutional abuse but not family-based child abuse on the other. Collectively the results show that the psychological processes of traumatization and re-enactment as experienced now or remembered from childhood were associated multiple indices of institutional abuse, but not family-based child abuse. Time spent living with one’s family in childhood was a protective factor and was associated with reduced traumatization in adulthood, whereas severe family-based child abuse was associated with avoidant coping in adulthood.

The IAPCI scales and adult adjustment

3.315The following analyses were carried out to address the second question which was: Are past and present institutional abuse processes and coping strategies (as evaluated by the IAPCI factor scales) associated with indices of adult adjustment? Pearson product moment correlations were conducted between IAPCI scales on the one hand and indices of adult adjustment on the other. These analyses are summarized in Table 6.7. In these analyses the indices of adjustment were: total number of current and lifetime psychological disorders; the total score on the Life Problems Checklist (LPC); the score on the Global Assessment of Functioning (GAF) scale; the total score on the Trauma Symptom Inventory (TSI); Socio economic status (SES); the number of failed marital or cohabiting relationships in a participants life; the total score on the Kansas Marital Satisfaction scale (KMS); scores on the interpersonal anxiety and avoidance scales of the Experiences in Close Relationships Inventory (ECRI); the total score on the Kansas Parent Satisfaction scale; and the total score on the World health Organization Quality of Life Scale. Correlations with an absolute value above .3 and significant at p<.01 were interpreted as indicating a moderate association between variables.

3.316From table 6.7 it may be seen that 17 correlations with an absolute value above .3 and significant at p<.01 occurred and 15 of these involved the traumatization and re-enactment scales.

3.317Past and present versions of the traumatization and re-enactment scales correlated with the total number of trauma symptoms on the TSI. Past and present versions of the re-enactment scale correlated with the total number of life problems on the LPC. The present version of the traumatization and re-enactment scales correlated positively with the total number of disorders and negatively with global functioning on the GAF and the total quality of life score of the WHOQOL 100 UK. The present version of the traumatization scale correlated with the ECRI interpersonal anxiety and avoidance scales. The present version of the re-enactment scale correlated with the ECRI interpersonal anxiety scale. The present version of the positive coping scale correlated with the KMS marital satisfaction score and the total quality of life score of the WHOQOL 100 UK.

3.318The analysis reported in this section provided an answer to the question about the association between past and present abuse processes and coping strategies on the one hand and adult adjustment on the other. Collectively the results show that the psychological processes of traumatization and re-enactment as experienced now or remembered from childhood were associated multiple indices of adult adjustment including the presence of multiple co-morbid psychological disorders, multiple trauma symptoms, multiple adult life problems, global functioning, quality of life, interpersonal anxiety and interpersonal avoidance. Positive coping was associated with marital satisfaction and quality of life.

IAPCI profiles of groups of participants who had spent different amounts of time in institutions and entered under different circumstances

3.319The following analyses were carried out to address the third question which was: Do participants who had spent different amounts of time in institutions and entered under different circumstances differ in their experience of past and present institutional abuse processes and coping strategies as evaluated by the IAPCI factor scales? The four groups included in this set of analyses, were those referred to in the main analysis in Part 4. Group 1 contained 110 participants who spent more than 12 years in an institution and entered before age 5. Group 2 contained 67 participants who spent 5-11 years in an institution and placement occurred because parents couldn’t cope or died. Group 3 contained 22 participants who spent 5-11 years in an institution and placement occurred through the courts, in most instances for petty crime. Group 4 contained 48 participants who spent 4 or fewer years in institution. To aid profiling, all IAPCI scales were scored so they each had a range of 1-5. This was obtained for each scale by summing items and dividing by the number of items. A series of twelve one-way analyses of variance (ANOVAs) were used to test for significant (p<.05) variation between groups on either past or present versions of each IAPCI scales, and Scheffe post hoc tests for comparing groups with unequal Ns were used to identify significant (p<.05) intergroup differences. Dunnett’s post hoc tests were used where the assumption of homogeneity was violated. In addition to the one-way ANOVAs, a series of six 4X2, Groups X Time repeated measures ANOVAs were used to identify significant changes from past to present on each IAPCI scale.

3.320From Table 6.8 it may be seen that in the one-way ANOVAs, past positive coping was the only IAPCI scale on which the four groups differed significantly, with group 3 obtaining higher scores than group 2, who in turn obtained higher scores than group 1. There were no significant Group X Time interactions in the repeated measures ANOVAs, indicating that there were no significant intergroup differences in the pattern of past and present scores. All four of the groups showed the same pattern of change. In all of the repeated measures ANOVAs significant time effects occurred. For traumatization and re-enactment, mean scores decreased from the past to the present, but for spiritual disengagement, they increased. Positive coping mean scores increased from past to present, but coping by complying and avoidant coping mean scores decreased.

3.321The analysis reported in this section provided an answer to the question about differences in IAPCI profiles of participants who had spent different amounts of time in institutions and entered under different circumstances. Participants who spent 5-11 years in an institution and placement occurred through the courts reported greater use of positive coping strategies in the past, than those who spent 5-11 years in an institution and placement occurred because parents couldn’t cope or died. These in turn reported greater use of these strategies than participants who spent more than 12 years in an institution and entered before age 5. Participants from all four groups reported a reduction in traumatization and re-enactment and an increase in spiritual disengagement from childhood to adult life. They also reported an increase in the use of positive coping strategies and a reduction in the use of coping by complying and avoidant coping.

IAPCI profiles of groups of participants who reported different types of worst abusive experiences in institutions

3.322The following analyses were carried out to address the fourth question which was: Do participants who reported different types of worst abusive experiences in institutions differ in their experience of past and present institutional abuse processes and coping strategies as evaluated by the IAPCI factor scales? The four groups included in this set of analyses, were those referred to in the second analysis in Part 4. Group 1 contained 23 cases where the worst thing reported was severe physical and sexual abuse. Group 2 contained 99 cases where the worst thing they had experienced was severe physical abuse. Group 3 contained 40 cases where the worst thing they had experienced was severe sexual abuse. Group 4 contained 85 cases where the worst thing they had experienced was severe emotional abuse. Participant’s statements were classified as severe physical abuse if the person reported physical violence, beating, slapping, or being physically injured, but not having medical attention withheld. Statements were classified as severe sexual abuse if the person reported the words sexual abuse or mentioned rape; genital, anal or oral sex; masturbation; or other coercive sexual activities involving either staff or older pupils. Statements were classified as severe physical and sexual abuse if they involved both severe physical abuse and severe sexual abuse as defined earlier. Statements of actions involving humiliation, degradation, severe lack of care, withholding medical treatment, witnessing the traumatization of other pupils and adverse experiences that were not clearly classifiable as severe sexual or physical abuse were classified as severe emotional abuse. Inter-rater agreement greater than 90% was achieved for a sample of 10% of statements. To aid profiling, all IAPCI scales were scored so they each had a range of 1-5. This was obtained for each scale by summing items and dividing by the number of items. A series of twelve one-way analyses of variance (ANOVAs) were used to test for significant (p<.05) variation between groups on either past or present versions of each IAPCI scales, and Scheffe post hoc tests for comparing groups with unequal Ns were used to identify significant (p<.05) intergroup differences. Dunnett’s post hoc tests were used where the assumption of homogeneity was violated. In addition to the one-way ANOVAs, a series of six 4X2, Groups X Time repeated measures ANOVAs were used to identify significant changes from past to present on each IAPCI scale.

3.323From Table 6.9 it may be seen that in the one-way ANOVAs, past re-enactment and both past and present coping by complying were the only IAPCI scales on which the four groups differed significantly. Mean past re-enactment scores for groups 1 and 3 were significantly greater than those for groups 2 and 4. Group 2’s mean past and present coping by complying scores were significantly greater that those of group 3, with group 4 obtaining a mean score between these extremes for present, but not past, coping by complying.

3.324There were no significant Group X Time interactions in the repeated measures ANOVAs, indicating that there were no significant intergroup differences in the pattern of past and present scores.

3.325The analysis reported in this section provided an answer to the question about differences in IAPCI profiles of participants who reported different types of worst abusive experiences in institutions. Participants for whom severe physical and sexual abuse, or severe sexual abuse alone were the worst things that happened to them in institutions, reported greater past re-enactment of abusive experiences, than those for whom worst experiences involved severe physical or emotional abuse. Participants who reported that severe physical abuse was the worst thing that happened to them in institutions, reported greatest past and present coping by complying, and lowest levels of coping by complying occurred among those that reported that severe sexual abuse was the worst thing that happened to them in institutions. For present coping by complying, intermediate between these extremes was the group that reported that severe emotional abuse was the worst thing that happened to them in institutions.

IAPCI profiles of groups of participants who groups of participants who had different numbers of psychological diagnoses

3.326The following analyses were carried out to address the fifth question which was: Do participants who had different numbers of psychological diagnoses differ in their experience of past and present institutional abuse processes and coping strategies as evaluated by the IAPCI factor scales? The three groups included in this set of analyses, were those referred to in the first analysis in Part 5. Group 1 contained 83 participants who had four or more current or lifetime diagnoses as assessed with the SCID I and SCID II. Group 2 contained 119 participants who had 1-3 current or lifetime diagnoses. Group 3 contained 45 participants who had no diagnoses. To aid profiling, all IAPCI scales were scored so they each had a range of 1-5. This was obtained for each scale by summing items and dividing by the number of items. A series of twelve one-way analyses of variance (ANOVAs) were used to test for significant (p<.05) variation between groups on either past or present versions of each IAPCI scales, and Scheffe post hoc tests for comparing groups with unequal Ns were used to identify significant (p<.05) intergroup differences. Dunnett’s post hoc tests were used where the assumption of homogeneity was violated. In addition to the one-way ANOVAs, a series of six 4X2, Groups X Time repeated measures ANOVAs were used to identify significant changes from past to present on each IAPCI scale.

3.327From Table 6.10 it may be seen that in the one-way ANOVAs, the three groups differed significantly in their mean scores on the past and present versions of the traumatization and re-enactment scales, and on the present versions of the positive and avoidant coping scales. On the past and present versions of the traumatization and re-enactment scales, group 1 obtained a significantly higher mean scores than groups 2 and 3. On the present versions of the traumatization and re-enactment scales, group 2 obtained a significantly higher mean score than groups 3. On the present version of the positive coping scale, group 1 obtained a significantly lower mean score than group 2. On the present version of the avoidant coping scale, group 1 obtained a significantly higher mean score than group 3.

3.328On the repeated measures ANOVAs there were significant Group X Time interactions for traumatization and positive coping. From the first panel in Figure 6.1 it may be seen that group 3 with no disorders showed a greater reduction in traumatization from past to present, than the other two groups, who had multiple co-morbid psychological disorders. From the second panel in Figure 6.1 it may be seen that for positive coping, group 3 with no disorders showed a negligible increase in the use of positive coping strategies from past to present, compared with the other two groups who showed a marked increase in positive coping from past to present.

3.329The analysis reported in this section provided an answer to the question about differences in IAPCI profiles of participants who had different numbers of psychological diagnoses. Participants with four or more disorders reported greatest past and present traumatization and re-enactment; greatest current use of avoidant coping and least current use of positive coping. Participants with no diagnoses, reported least present traumatization, re-enactment and use of avoidant coping; and the greatest reduction in traumatization from past to present. However, they showed a negligible increase in the use of positive coping strategies from past to present.

Model of childhood institutional abuse, psychological processes, and adult adjustment

3.330A theoretical model of childhood institutional abuse, psychological processes, and adult adjustment is presented in Figure 6.2. The model shows how childhood institutional abuse is associated with the processes of truamatization, re-enactment and spiritual disengagement, which in turn are associated with mental health and quality of life. The model also shows how childhood years within the family and current use of positive coping strategies are associated with quality of life. The reliabilities of the composite scores used in the model were incorporated using the method suggested by Jöreskog and Sörbom (1993).The model presented in Figure 6.2 was specified and estimated using LISREL8.52 (Jöreskog & Sörbom, 2002). A covariance matrix and an asymptotic weight matrix were computed using PRELIS2.3 (Jöreskog & Sörbom, 1999) and the parameters estimated using maximum likelihood. Following the guidelines suggested by Hoyle and Panter (1995) the goodness of fit for each model was assessed using the chi-square, the Goodness of Fit Index (GFI: Jöreskog & Sörbom, 1981), the Incremental Fit Index (IFI: Bollen, 1989), and the Comparative Fit Index (CFI: Bentler, 1990). A non-significant chi-square, and values greater than 0.90 for the GFI, IFI and CFI, are considered to reflect acceptable model fit. In addition, the Root Mean Square Error of Approximation (RMSEA: Steiger, 1990) with 90% confidence intervals (90%CI) were reported, where a value less than 0.05 indicates close fit and values up to 0.08 indicating reasonable errors of approximation in the population (Jöreskog & Sörbom, 1993). The standardised root-mean-square residual (SRMR: Jöreskog & Sörbom, 1981) has been shown to be sensitive to model mis-specification and its use recommended by Hu and Bentler (1999). Values less than .08 are considered to be indicative of acceptable model fit. The fit indices are reported in Table 6.11. On the basis of the RMSEA, IFI, CFI, SRMR and the GFI the model is judged to be an acceptable description of the sample data. Although the chi-square for this model is large relative to the degrees of freedom, and statistically significant, this should not lead to the rejection of the model as the large sample size increases the power of the test (Tanaka, 1987). The standardized model parameters are presented in Table 6.12.

Conclusions

3.331Six scales were developed to measure past and present psychological processes theoretically purported to arise from the experience of institutional abuse, and associated functional and dysfunctional coping strategies. The scales were (1) traumatization, (2) re-enactment, (3) spiritual disengagement, (4) positive coping, (5) coping by complying, and (6) avoidant coping.

3.332All participants reported a reduction in traumatization and re-enactment and an increase in spiritual disengagement from childhood to adult life. They also reported an increase in the use of positive coping strategies and a reduction in the use of coping by complying and avoidant coping.

3.333The psychological processes of traumatization and re-enactment as experienced now or remembered from childhood were associated multiple indices of institutional abuse, but not family-based child abuse.

3.334Time spent living with one’s family in childhood was a protective factor and was associated with reduced traumatization in adulthood, whereas severe family-based child abuse was associated with avoidant coping in adulthood.

3.335Participants for whom severe physical and sexual abuse, or severe sexual abuse alone were the worst things that happened to them in institutions, reported greater past re-enactment of abusive experiences, than those for whom worst experiences involved severe physical or emotional abuse.

3.336Traumatization and re-enactment as experienced now or remembered from childhood were associated multiple indices of adult adjustment including the presence of multiple trauma symptoms, multiple adult life problems, global functioning, quality of life, interpersonal anxiety and interpersonal avoidance.

3.337Participants with four or more psychological disorders reported greatest past and present traumatization and re-enactment; greatest current use of avoidant coping; and least current use of positive coping. Participants with no diagnoses, reported least present traumatization, re-enactment and use of avoidant coping; and the greatest reduction in traumatization from past to present. However, they showed a negligible increase in the use of positive coping strategies from past to present.

3.338Positive coping was associated with marital satisfaction and quality of life. Participants who spent 5-11 years in an institution and placement occurred through the courts reported greater use of positive coping strategies in the past, than those who spent 5-11 years in an institution and placement occurred because parents couldn’t cope or died. These in turn reported greater use of these strategies than participants who spent more than 12 years in an institution and entered before age 5.

3.339Participants who reported that severe physical abuse was the worst thing that happened to them in institutions, reported greatest coping by complying, and lowest levels of coping by complying occurred among those that reported that severe sexual abuse was the worst thing that happened to them in institutions. For present coping by complying, intermediated between these extremes was the group that reported that severe emotional abuse was the worst thing that happened to them in institutions.

3.340A model was developed which shows how childhood institutional abuse is associated with the processes of traumatization, re-enactment and spiritual disengagement, which in turn are associated with adult mental health and quality of life. The model also shows how childhood years within the family and current use of positive coping strategies are associated with quality of life.

Table 6.1. Item composition of the 6 factor scales from the Institutional Abuse Process and Coping Inventory.

ITEM CODE	PAST VERSION	ITEM CODE	PRESENT VERSION
	PAST TRAUMATIZATION		PRESENT TRAUMATIZATION
	Traumatization		Traumatization
1TP1	I felt hurt then	2TC1	I feel hurt now
3TP2	I felt frightened then	4TC2	I feel frightened now
5TP3	I felt sad then	6TC3	I feel sad now
7TP4	I felt humiliated then	8TC4	I feel humiliated now
	Betrayal and loss of trust		Betrayal and loss of trust
9BP1	I trusted everyone then (-)	10BC1	I trust everyone now (-)
11BP2	I felt betrayed then	12BC2	I feel betrayed now
13BP3	I cut myself off from other people then	14BC3	I cut myself off from other people now
	Stigmatization shame and guilt		Stigmatization shame and guilt
29SP1	I felt I was worthless then	30SC1	I feel I am worthless now
31SP2	I felt I was dirty then	32SC2	I feel I am dirty now
33SP3	I felt ashamed then	34SC3	I feel ashamed now
35SP4	I felt guilty and believed the abuse was my fault then	36SC4	I feel guilty and believe the abuse was my fault now
	Disrespect of authority		Disrespect of authority
15DP1	I was angry at everyone in authority then	16DC1	I am angry with everyone in authority now
17DP2	I liked people in authority then (-)	18DC2	I like people in authority now (-)
19DP3	I respected everyone in authority then (-)	20DC3	I respect everyone in authority now (-)

	PAST RE-ENACTMENT		PRESENT RE-ENACTMENT
	Re-enactment		Re-enactment
49XP1	I felt the urge to attack or abuse other people then	50XC1	I feel the urge to attack or abuse other people now
51XP2	I hurt other people then	52XC2	I hurt other people now
53XP3	I felt the urge to harm or injure myself then	54XC3	I feel the urge to harm or injure myself now
55XP4	I harmed or injured myself then	56XC4	I harm or injure myself now
	Powerlessness		Powerlessness
39PP2	I believed that my life was controlled by others then	40PC2	I believe that my life is controlled by others now
41PP3	I thought I could do nothing to change my situation then	42PC3	I think I can do nothing to change my situation now
	Coping by opposing		Coping by opposing
71COP3	I planned revenge on my abusers then	72COC3	I am planning revenge on my abusers now
	Coping by alcohol, drugs and food		Coping by alcohol, drugs and food
91CDP1	I drank alcohol to cope then	92CDC1	I drink alcohol to cope now
93CDP2	I took other drugs to cope then	94CDC2	I take other drugs to cope now

	PAST SPIRITUAL DISENGAGEMENT.		PRESENT SPIRITUAL DISENGAGEMENT.
	Religious Disengagement		Religious Disengagement
21RP1	I had faith in God then (-)	22PC1	I have faith in God now (-)
23RP2	I had faith in the church then (-)	24RC2	I have faith in the church now (-)
25RP3	I stopped praying then	26RC3	I do not pray now
27RP4	I only went mass then because I would be punished if I did not to	28RC4	I do not go to mass now
	Coping through spiritual support		Coping through spiritual support
57CSP1	I prayed to God then, and that made the abuse bearable (-)	58CSPC1	I pray to God now, and that makes the abuse bearable (-)

	PAST POSITIVE COPING.		PRESENT POSITIVE COPING
	Coping through planning		Coping through planning
85CLP1	Then I planned each day very carefully to avoid abuse and make good things happen (like having a laugh, getting well fed, and keeping warm)	86CLC1	Now I plan each day very carefully to avoid bad feelings and make good things happen (like having a laugh, getting well fed, and keeping warm)
87CLP2	When I was leaving school I followed a plan to get a job that would suit me and make my situation better	88CLC2	Now I still follow a plan to make sure my job suits me and makes my situation better
89CLP3	When I was settling down with my partner, I waited for at least 6 months to make sure we were well suited to live together	90CLC3	When my partner and I are planning something important we take time to plan it very carefully
	Coping though skill mastery		Coping though skill mastery
79CMP1	I put my energy into my school work and that made me feel better then	80CMC1	I put my energy into my work and that makes me feel better now
81CMP2	I put my energy into sports or music and that made me feel better then	82CMC2	I put my energy into sport or music and that makes me feel better now
83CMP3	I put my energy into a skill that I could do well that made me feel better then	84CMC3	I put my energy into a skill that I can do well that makes me feel better now
	Coping through social support		Coping through social support
73CTP1	I had a good friendship with a close friend I could trust and this made the abuse bearable then	74CTC1	I have a good friendship with a close friend I can trust and this made the abuse bearable now (This friend is not my partner, husband or wife)
75CTP2	I had a good friendship with an adult I could trust and this made the abuse bearable then	76CTC2	I have a good friendship with a person I trust and look up to and this makes the abuse bearable now (this could be doctor or counsellor but not a partner)
77CTP3	I reminded my self that my mother or father was still alive, cared about me, and this made the abuse bearable then	78CTC3	I have a good relationship with my partner who I know cares about me and who I can tell my troubles to now and this makes the abuse bearable ( A partner is a wife /husband/ cohabitee /lover)

	PAST COPING BY COMPLYING		PRESENT COPING BY COMPLYING
	Coping by complying		Coping by complying
61CCP1	I tried to behave well for the teachers /nuns /brothers /priests so I would not be punished then	62CCC1	I try to behave well and fit in with people at work and in my family now to avoid conflict and arguments
63CCP2	I was careful never to break a rule then	64CCC2	I am careful never to break a rule now
65CCP3	I was careful always to show respect to the brothers, priests, nuns and teachers then (even if I didn’t feel respect)	66CCC3	I am careful always to show respect to people in authority now (even if I do not feel respect)

	PAST AVOIDANT COPING		PRESENT AVOIDANT COPING
	Avoidance of reminders of abuse		Avoidance of reminders of abuse
43AP1	I avoided thinking about the abuse then	44AC1	I avoid thinking about the abuse now
45AP2	I avoided situations that reminded me of abuse then	46AC2	I avoid situations that reminded me of abuse now
47AP3	I avoided people who reminded me of the abuse then	48AC3	I avoid people who remind me of the abuse now

Note: Headings in bold lowercase are the names of IAPCI rational scales containing the items beneath them. Headings in bold uppercase are the name of the six factor scales supported by confirmatory factor analyses.

Table 6.2. Factor loadings for confirmatory factor analysis of the past and present forms of the Institutional Abuse Processes and Coping Inventory

Past version							Present version
Item	Trauma	Reinact	Disengag	PosCope	ComCope	AvCope	Item	Trauma	Reinact	Disengag	PosCope	ComCope	AvCope
TP1	0.62						TC1	0.56
TP2	0.52						TC2	0.70
TP3	0.62						TC3	0.72
TP4	0.73						TC4	0.77
BP1	0.04						BC1	0.41
BP2	0.56						BC2	0.65
BP3	0.43						BC3	0.52
SP1	0.60						SC1	0.65
SP2	0.56						SC2	0.52
SP3	0.65						SC3	0.61
SP4	0.37						SC4	0.37
DP1	0.46						DC1	0.60
DP2	0.19						DC2	0.42
DP3	0.14						DC3	0.30
XP1		0.55					XC1		0.42
XP2		0.31					XC2		0.47
XP3		0.46					XC3		0.79
XP4		0.33					XC4		0.71
PP2		0.19					PC2		0.46
PP3		0.09					PC3		0.35
COP3		0.59					COC3		0.28
CDP1		0.57					CDC1		0.34
CDP2		0.41					CDC2		0.40
RP1			0.83				RC1			0.42
RP2			0.77				RC2			0.47
RP3			0.35				RC3			0.79
TP4			0.33				TC4			0.71
CSP1			0.51				CSPC1			0.46
CLP1				0.38			CLC1				0.35
CLP2				0.53			CLC2				0.49
CLP3				0.32			CLC3				0.49
CMP1				0.43			CMC1				0.61
CMP2				0.51			CMC2				0.51
CMP3				0.52			CMC3				0.60
CTP1				0.16			CTC1				0.21
CTP2				0.30			CTC2				0.17
CTP3				0.39			CTC3				0.32
CCP1					0.68		CCC1					0.67
CCP2					0.78		CCC2					0.60
CCP3					0.57		CCC3					0.41
AP1						0.45	AC1						0.34
AP2						0.73	AC2						0.77
AP3						0.74	AC3						0.68

Note. N=247. Trauma=Traumatization; Reinact= Re-enactment; Disengag= Spititual Disengagement; PosCope=Positive Coping; ComCope=Coping by Complying; AvCope=Avoidant Coping.

Table 6.3. Factor correlations for confirmatory factor analysis of the past and present forms of the Institutional Abuse Processes and Coping Inventory

Past version							Present version
Scale	Trauma	Reinact	Disengag	PosCope	ComCope	AvCope	Scale	Trauma	Reinact	Disengag	PosCope	ComCope	AvCope
Reinact	.39	1.00					Reinact	.58	1.00
Disengag	.05	.07	1.00				Disengag	.17	.11	1.00
PosCope	.05	.33	-.30	1.00			PosCope	-.28	-.29	-.27	1.00
ComCope	.24	-.06	-.21	.09	1.00		ComCope	.19	.04	-.13	.32	1.00
AvCope	.35	.33	.02	.30	.07	1.00	AvCope	.38	.17	.02	.12	.25	1.00

Note. N=247. Trauma=Traumatization; Reinact=Re-enactment; Disengag= Spiritual Disengagement; PosCope=Positive Coping; ComCope=Coping by Complying; AvCope=Avoidant Coping. Correlations significant at p<.01 and greater than an absolute value of .3 are in bold.

Table 6.4. Reliability of 6 factor scales from past and present versions of the Institutional Abuse Processes and Coping Inventory

Instrument	Constructs and variables	No. of items in the scale	Possible range	M	SD	Internal consistency Reliability Alpha	Inter-rater reliability
IAPCI-Past version	Traumatization	14	1-5	4.19	0.65	.75	.97
	Re-enactment	9	1-5	2.50	0.70	.62	.95
	Spiritual disengagement	5	1-5	2.93	0.78	.69	.80
	Positive coping	9	1-5	2.43	0.82	.62	.99
	Coping by complying	3	1-5	4.58	0.78	.71	.51
	Avoidant coping	3	1-5	3.90	1.24	.59	.91

IAPCI-Present version	Traumatization	14	1-5	3.23	0.89	.87	.90