Gender differences in victimization and the

relation to personality disorders and MID Results from a multicentre study in forensic psychiatry

Vivienne de Vogel & Anouk Bohle

ECVCP, October 2015, Copenhagen

Presentation outline

I. Victimization

II. Study 1 Gender differences in

victimization in forensic psychiatry

and relation to personality disorders

III. Study 2 Victimization in patients with

mild intellectual disabilities

• Abuse (active)

- Emotional abuse

- Physical abuse

- Sexual abuse

• Neglect (passive)

- Emotional neglect

- Physical neglect

Different types of victimization

De Ruiter, & De Jong, 2005; Kellogg, 2005; Wolzak, & Ten Berge, 2005

Victimization during childhood risk factor for:

• Mental health problems

• Revictimization

• Self destructive behavior

• Substance abuse

• Criminal behavior

• Violent behavior

I. Victimization

Anumba et al., 2012; Douglas et al., 2013; Finkelhor et al., 2007; Serbin, & Karp, 2003; Temcheff et al., 2008; Widom, & Maxfield, 2001

Model Process of TraumaBloom & Covington, 2003

• More prevalent in women, especiallysexual victimization

• Stronger impact on women?

• Victimization during adulthood more prevalent and strong risk factor forviolence / criminal behavior in women

Gender issues victimization

Benda, 2005; Bender, 2010; de Vogel et al., 2012

Mothers with a history of violent offenses are more likely to raise children with

disruptive, aggressive behavior

(Kim et al., 2009; Serbin, et al., 1998)

Intergenerational transfer

Victimization and the relation to personality disorders

Bohle & de Vogel, under review

II. Study 1

• Five Dutch forensic psychiatric hospitals 1984-2014

• N = 280 women, 275 men, matched on year of birth, year

of admission, judicial status

• Extensive questionnaire and various assessment tools

Dutch multicentre study

With the cooperation of:

• Vivienne de Vogel (Van der Hoeven, project leader)

• Gerjonne Akkerman-Bouwsema (GGz Drenthe)

• Anouk Bohle (Van der Hoeven)

• Yvonne Bouman (Oldenkotte)

• Nienke Epskamp (Van der Hoeven)

• Susanne de Haas (Van der Hoeven)

• Loes Hagenauw (GGz Drenthe)

• Paul ter Horst (Woenselse poort)

• Marjolijn de Jong (Trajectum)

• Stéphanie Klein Tuente (Van der Hoeven)

• Marike Lancel (GGz Drenthe)

• Eva de Spa (Van der Hoeven)

• Jeantine Stam (Van der Hoeven)

• Nienke Verstegen (Van der Hoeven)

Multicentre

This study is a collaboration between researchers from

various forensic psychiatric hospitals in the Netherlands

• Gain more insight into the criminal and

psychiatric features of female forensic

psychiatric patients and how they are different

from male forensic psychiatric patients.

• Possible implications for psychodiagnostics, risk

assessment and treatment in (forensic)

psychiatric care.

Multicentre study General aim

• Psychopathy

• Borderline Personality Disorder

• Intellectual disability

• Motives for offending

• Criminal history

• Victimization

Research topics

For more information: www.violentwomen.com

• 436 tbs-patients (218 ♀, 218 ♂)

• Mean age = 35.2 years

• Serious violent offenses (e.g., homicide, arson)

• Psychopathology- Axis I: 8%

- Axis II: 18%

- Axis I & II: 62%

- 17% PTSD

Sample Study 1

• Borderline Personality Disorder (BPD)

• Women 59%

• Men 17%

• Antisocial Personality Disorder (APD)

• Women 15%

• Men 39%

• Psychopathy; mean PCL-R score

- Women 16.6 (19% ≥ 23)

- Men 21.5 (20% ≥ 30)

Gender differences psychopathology

p < .01

Prevalence victimization during

childhood (< 17 years)

p < .05

Prevalence victimization during

adulthood (≥ 17 years)

p < .01

• Relationship, especially Axis II

• Emphasis on cluster B PDs

• If childhood victimization increases the risk of developing a personality disorder, patients with childhood victimization are more likely to be diagnosed with a PD compared to patients without childhood victimization

• Cluster B and psychopathy

Association between childhood

victimization and psychopahology

Affifi et al., 2011; Bradley et al., 2005; Spataro et al., 2004

Antisocial Personality Disorder men

p < .01

Borderline Personality Disorder women

p < .01

Psychopathy

Mean PCL-R scorep < .01

Victimization and MIDde Jong, Hogeveen, de Vogel, & Didden, 2014

III. Study 2

• Forensic psychiatric patients admitted 1990-2014

• Comparisons:

– 126 women with MID (IQ < 85)

– 76 women no MID (IQ > 95)

– 50 men with MID (IQ < 85)

– 61 men no MID (IQ > 95)

Mild Intellectual Disability (MID)De Jong, Hogeveen, de Vogel, & Didden, 2014

• Personal histories

• More problematic; work, finances, relationships,

prostitution (♀), victimization

• Psychiatric histories

• More often admitted, PTSD, self-harm

• Criminal histories

• More stranger victims, less homicide

Women and men with MID

versus without MID

Vulnerable group, high prevalence of victimization

Prevalence victimization during

childhood (< 17 years)

0

10

20

30

40

50

60

70

80

Emotional Physical Sexual Neglect

Women ID Women no ID Men ID Men no ID p < .01

Prevalence victimization during

adulthood (≥ 17 years)

0

5

10

15

20

25

30

35

40

45

Emotional Physical Sexual

Women ID Women no ID Men ID Men no ID p < .01

• High prevalence of victimization in forensic psychiatry

- No gender differences in physical and emotional abuse

during childhood (< 17 years)

- Women more often childhood sexual abuse; more often

continuation in adulthood; pattern of victimization

• Association between victimization and Axis II

personality disorders

- Men: APD and psychopathy (especially physical abuse)

- Women: BPD (especially sexual abuse)

• Women (and men) with MID extra vulnerable

Overall conclusions Dutch studies

• Treatment should consider processing these

(childhood) traumas

- Both men and women

- Gender-responsive treatment

- Locus of control, parenting, financial management

• Awareness of the risk of revictimization in mixed

treatment settings

• Frequently conduct risk assessment

Implications

• Longitudinal studies

• Comparison with different populations

– Psychiatry, population based samples

– Resilience

• Self-report measures

– Juvenile Trauma Questionnaire (Finkelhor et al., 2005)

• Other types of psychopathology

Recommendations for future research

Thank you for your attention

vdevogel@dfzs.nl

www.violencebywomen.com