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Adult adjustment of survivors of institutional child abuse in Ireland

2010-07, Carr, Alan, Dooley, Mark, Flanagan, Edel, Flanagan-Howard, Roisín, Tierney, Kevin, White, Megan, Daly, Margaret, Egan, Jonathan

Method Two hundred and forty-seven adult survivors of institutional abuse with a mean age of 60 were interviewed with a protocol that included the Childhood Trauma Questionnaire, modules from the Structured Clinical Interview for Axis I Disorders of DSM IV and the Structured Clinical Interview for DSM IV Personality Disorders, the Trauma Symptom Inventory, and the Experiences in Close Relationships Inventory. Results The prevalence of psychological disorders among adult survivors of institutional abuse was over 80% and far higher than in the normal population, with anxiety, mood and substance use disorders being the most prevalent diagnoses. Survivors also had high rates of trauma symptoms and insecure adult attachment styles, and these were higher for those who had experienced both institutional and intrafamilial abuse. Conclusions There was an association between the experience of institutional abuse in childhood and the prevalence of adult mental health problems, particularly anxiety, mood and substance use disorders. Practice implications Policies, practices and procedures should be regularly reviewed and revised to maximize protection of young people in institutional care. Evidence-based psychological treatment should be made available to adult survivors of institutional abuse.

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Profiles of resilient survivors of institutional abuse in Ireland

2009-09, Flanagan, Edel, Carr, Alan, Dooley, Barbara A., Fitzpatrick, Mark, Flanagan-Howard, Roisín, Shevlin, Mark, Tierney, Kevin, White, Megan, Daly, Margaret, Egan, Jonathan

In a group of 247 survivors of institutional abuse in Ireland, 45 cases (18%) did not meet the diagnostic criteria for common DSM IV axis I or II disorders. This resilient group was compared with a poorly adjusted group of 119 participants who met the criteria for 1-3 DSM IV axis I or II diagnoses, and a very poorly adjusted group of 83 participants who had 4 or more disorders. Compared with the very poorly adjusted group, the resilient group was older and of higher socio-economic status; had suffered less sexual and emotional institutional abuse; experienced less traumatization and re-enactment of institutional abuse; had fewer trauma symptoms and life problems; had a higher quality of life and global level of functioning; engaged in less avoidant coping; and more resilient survivors had a secure adult attachment style. The resilient group differed from the poorly adjusted group on a subset of these variables. The results of this study require replication in other contexts. Therapeutic interventions with survivors should focus on facilitating the use of non-avoidant coping strategies and the development of a secure adult attachment style.

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Development and initial validation of the Institutional Child Abuse Processes and Coping Inventory among a sample of Irish adult survivors of institutional abuse

2009-09, Flanagan-Howard, Roisín, Carr, Alan, Shevlin, Mark, Dooley, Barbara A., Fitzpatrick, Mark, Flanagan, Edel, Tierney, Kevin, White, Megan, Daly, Margaret, Egan, Jonathan

Objective. To develop a psychometric instrument to evaluate psychological processes associated with institutional abuse and coping strategies used to deal with such abuse. Methods. As part of a comprehensive assessment protocol, an inventory containing theoretically derived multi-item rational scales which assessed institutional abuse-related psychological processes and coping strategies were administered to 247 Irish adult survivors of institutional child abuse. Exploratory and confirmatory factor analyses were used to derive 6 factor scales, the reliability and validity of which were assessed. Results. Factor scales to assess the following constructs were developed (1) traumatization, (2) re-enactment, (3) spiritual disengagement, (4) positive coping, (5) coping by complying, and (6) avoidant coping. There were varying degrees of support for the validity of the scales with most support for the traumatization and re-enactment scales. Conclusions. The Institutional Child Abuse Processes and Coping Inventory (ICAPCI), particularly its traumatization and re-enactment scales, may be used in future research on adult survivors of institutional child abuse because they are currently the only scales that have been developed with this population to provide reliable and valid assessments of these constructs. Practice implications. The ICAPCI may be used, cautiously, to assess adult survivors of institutional child abuse.

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Body-centred countertransference in female trauma therapists

2008-08, Egan, Jonathan, Carr, Alan