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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