The Effects of Domestic Violence on Mothers, Young Children

1
The Effects of Domestic Violence on Mothers,
Young Children, and the Attachment Relationship

• Alissa C. Huth-Bocks1, Carolyn J. Dayton2,
• Alytia A. Levendosky3 G. Anne Bogat3
• 1 Eastern Michigan U., 2 U. of Michigan, 3
  Michigan State U.
• Presented at the Michigan Association for Infant
  Mental Health 31st Biennial Conference
• April 26, 2009

2
Overview of Presentation

• Background on domestic violence (DV) during the
  childbearing years
• Effects on mothers
• Effects on young children
• Background on development of mother-infant
  relationship
• Maternal caregiving system
• Infant-mother attachment
• Overview of the Mother-Infant Study (MIS)
• Results Part I (pregnancy to 1 year)
• Results Part II (1 year to preschool years)
• Clinical Implications of Findings

3
Domestic Violence during the Childbearing Years

• Lifetime prevalence ranges from 20-38
• Rates of DV during pregnancy upwards of 20
• Rates may increase during pregnancy
• DV may become more severe during pregnancy
• If battered during pregnancy, the majority also
  experience violence post-partum (one study found
  gt90)

4
Domestic Violence during the Childbearing Years

• Children under 5 are disproportionally
  represented in DV households
• Parental age
• Increased marital stress
• Maternal attention directed toward young child
  leads to jealousy, feelings of inadequacy
• Over 10 million children are exposed to DV in US
• Under-estimate
• Parents may have minimal awareness of direct vs.
  indirect exposure

5
Domestic Violence during the Childbearing Years

• The trajectory of DV varies in these families
• One-time, multiple, on-off, chronic DV
• For example, in our study, over 7 years, many
  women moved in and out of violent relationships
• Also, our findings suggest that women with
  multiple abusive partners, more chronic DV, and
  more recent DV show the worst outcomes
• Thus, effects vary across time for families it
  is critical to assess for history of DV

6
Effects of DV on Mothers

• Battered mothers of young children show a range
  of responses
• Generally suffer from
• More depression anxiety
• Higher trauma symptoms, including complex trauma,
  i.e., somatic, interpersonal, and vulnerability
  to harm
• Lower self-esteem
• Trouble parenting
• Less healthy psychological preparation for
  motherhood
• More parenting stress
• Less maternal self-efficacy
• Less effective and more harmful parenting
  practices
• Maternal child maltreatment history may
  exacerbate symptoms

7
Effects of DV on Young Children

• Common Misconception Babies and young children
  arent affected by DV because they cannot
  cognitively comprehend it
• Both direct and indirect (via parental
  functioning) exposure affects infants
• Eating and sleep disturbances, biological
  dysregulation
• Trauma symptoms
• Early externalizing behavior problems
• Heightened sensitivity to observed conflict

8
Effects of DV on Young Children

• In preschoolers
• All of the above, plus
• Internalizing symptoms
• Cognitive difficulties
• Social maladjustment with peers
• Problems in school settings
• The functioning of the primary caregiver, usually
  the mother, is central to how well the child is
  or is not doing

9
Development of the Mother-Infant Relationship

• The Maternal Caregiving System
• Parents make a critical psychological shift
  towards parenthood during pregnancy
• They shift from receiver of care to provider of
  care
• This is a goal-corrected system
• The goal is to provide care protect offspring
• The system is activated when there is a threat
  to this goal (e.g., think DV)
• The system is de-activated when the threat
  subsides and/or the goal is achieved

10
The Maternal Caregiving System

• Representations are formed during pregnancy about
  the baby and self-as-mother and relationship with
  baby
• Increase in richness specificity with onset of
  fetal movement
• Representations may be specific to each child
  based on things such as birth order, contextual
  factors, etc.
• They also likely reflect mothers more general
  working models of relationships
• The caregiving system also includes actual
  caregiving behavior

11
Development of the Mother-Infant Relationship

• The Infant Attachment System
• Another goal-corrected system
• The goal is to receive care and protection from
  attachment figure
• The system is activated when there is a threat
• The system is de-activated when the threat
  subsides and/or the goal is achieved
• Initially the goal is proximity later it is
  felt security which allows for exploration
• Helps to regulate affect and arousal
• Leads to internal working models of self others

12
The Mother-Infant Study

• Ongoing, longitudinal, prospective study
• 206 women first interviewed in their last
  trimester of pregnancy
• Over-sampled for DV 50 had prenatal DV
• Critical time for evolution of caregiving system
  and earliest time to assess effects of DV
• Women and children assessed yearly starting at
  the childs 1st birthday through 7th birthday
• Purposes
• To understand risk and protective factors for
  women and young children exposed to DV
• To examine the risk and protective factors
  involved in the intergenerational transmission of
  trauma (family violence) and attachment

13
Characteristics of Participants

• Mean Age 25
• Gender of Child equal split
• First time mothers 29 (others - avg. of
  children 1.4)
• Median Monthly Income 1,500
• Race/Ethnicity Caucasian/White 64
• African American/Black 25
• Marital Status
• Single, Never Married 50
• Married 40
• Educational Level
• High School Grad or Less 45
• Some College or Associates Degree 42

14
Description of Key Measures

• Domestic violence
• Severity of Violence Against Women Scales
  (Marshall, 1992)
• 46 items including psychological, physical, and
  sexual abuse by partner
• Maternal Caregiving Representations
• Working Model of the Child Interview (WMCI
  Zeanah et al., 1994)
• 1 hour semi-structured interview about feelings
  thoughts regarding baby, relationship with baby
  and self as a mother
• Tape-recorded, transcribed, coded
• Administered prenatally and when baby was 1 year
• Yields 3 classifications

15
Categories of Maternal Representations

• Balanced
• Accepting of positive and negative emotions that
  are experienced and expressed by her child and
  herself in parenting
• Positive emotional connection with her child
• Coherent and rich narrative about childs
  behavior and/or personality and the relationship
• I dont think it will bother me. You know, I
  wont want my baby to be upset, and Im going to
  do what I can to figure out why and remedy the
  problem, but as far as upsetting me, I dont
  think that will happen.

16
Categories of Maternal Representations

• Distorted (non-balanced)
• Unable to be open to the childs ongoing needs
  and experiences
• Over-activated affective tie to the child
• High level of emotional lability
• Inability to focus on the actual personality
  characteristics of the child
• Pervasive distortion of infant or relationship
  with infant
• Id probably sit and hold it, rock it. . . like
  my kids right now, if I get where Im depressed
  or something, Ill just tell them I need a hug. .
  . just sit there, hold it, rock back and forth,
  you know. Just to feel close and feel secure.
  You know, adults need that, too. Um, it just
  makes me feel good, knowing that, you know, my
  kids are there for me. . .

17
Categories of Maternal Representations

• Disengaged (non-balanced)
• De-activated relational style with her child
• Perceives and describes her child in a rigid and
  often stereotyped manner
• Unable to be open to the childs individual needs
  and personality development
• Cool, aloof, and indifferent
• Shallow and impoverished descriptions of the
  infant
• Ill just deal with it. Just like, all right,
  I see you have attitude today. All Ill say
  is, todays the day for the attitude
  (laughs).

18
Description of Key Measures

• Infant/Child Attachment Quality
• Strange Situation Procedure (Ainsworth et al.,
  1978)
• 21 minute lab-based procedure consisting of two
  brief separations and two reunions with mother
• Taped and coded later for classifications
• Secure, Preoccupied/Ambivalent, Avoidant,
  Disorganized
• Administered at 1 year and 4 years of age
• Parenting
• Video-taped play interactions at multiple times
• Coded for various maternal and infant behaviors

19
Results Part ICase Introduction

• Laura
• Mid-20s
• Single/Never been Married
• First-time mother
• Low income at pregnancy high school educated
• Not living with partner, but
• Experienced severe DV by her partner both during
  the current pregnancy and prior to the pregnancy
• No reported depression, but high trauma symptoms
• Notably, DV diminished after the birth of her
  baby, but she stayed with this partner for
  several more years

20
Results Part I Pregnancy

• Domestic Violence Maternal Caregiving
  Representations
• Women with DV had significantly more problematic
  prenatal representations
• Marked by more rigidity, less coherence, less
  acceptance of the infant, more negative affective
  states during discourse
• More likely to be classified as Disengaged or
  Distorted
• DV appeared to interfere with the normative
  evolution of caregiving representations

21
Lauras Prenatal WMCI

• How have you felt during your pregnancy? Sad
  sometimes. A lot of the times. Uhm, happy Most
  of the time, madIts mixed emotion. Its very
  uncomfortable. I get all kinds of emotions.
  Lonely, theres a lotta mixed emotions
• What have been your impressions about the baby
  while youre pregnant? Ooh. At first I was
  nervous and having dreams, thinking it would come
  out mental or something. But I dont, it dont
  have any reason to be cause I dont drink or
  anything. And Ive been following the book
  (laughs), and then, thats not my real mom.
  Thats like my mother-in-law. And shes very
  protective, so I dont do anything
• What do you sense the baby might be like? its
  very stubborn right now. Like me. I dont
  know-its hard to say

22
Lauras Prenatal WMCI

• What will you do if the baby is a boy or girl?
  If the babys a boy, I mean, Ill still love it
  the same. So, cause its part of me. So Ill
  still love it. But, Ive really got my heart set
  on a girl. So Im not trying to think of it as a
  boy.
• What are you most concerned about during the
  first year of your babys life? spoiledness
  theyre gonna want this and that. And the whining
  and tantrums. I dont think I got the patience
  for that How will you feel if your child acts
  this way? I dont know, upset, then I feel like
  Im doing something wrongprobably upset. Why
  do you think shell act like that? everybody
  else gonna spoil her. Thats why. Gonna give her
  what she wants. What do you imagine will
  happen to this as the child gets older? Itll go
  away. Mine did. I mean, Im still spoiled but I
  dont throw my tantrums.

23
Lauras Prenatal WMCI

• What pleases you most about your relationship
  with your unborn baby? That shes helping me
  grow up, as Im helping her grow up. So thats
  what pleases me most. Has your relationship
  changed during the pregnancy? yeah, before I
  wasnt really into it as much, as she growing, so
  it grows on you. I mean some people it do. I grow
  on me Its, at first I didnt.
• Do you ever worry about your unborn baby? All
  the time, I mean, its natural. What do you
  worry about? Am I gonna be a good mother, am I
  gonna be able to do this or that. How am I gonna
  react towards the baby Like they should be cared
  forevery woman goes through that when theyre
  pregnant. They have their worries

24
Results Part I Pregnancy to 1 year post-partum

• Stability of Maternal Representations
• Representations evolve from the prenatal to the
  postnatal period
• In our sample, 62 had the same exact category
  (71 remained balanced vs. non-balanced)
• Women who moved from Balanced to Non-Balanced had
  lower income, more single parenthood, more DV
  during pregnancy than Balanced-Balanced group
• Women who moved from Non-Balanced to Balanced had
  less depression, less single parenthood, and
  higher income than Non-Balanced-Non-Balanced

25
Lauras Postnatal WMCI

• Describe your impressions of your childs
  personality now. Umm, grown. Shes momma. I just
  provide everything. Otherwise, she regulate the
  housefor as spoiled as she is, she shares ummm,
  she picks out her own clothes, uh, she act like
  shes grown. Thats all Im saying. Shes a
  little woman. Shes not my baby anymore. Pick 5
  words to describe her personality. Shes a
  little lady. Uhsassy. Short-tempered. Ummm,
  kind. And loving That was tough.
• What behavior of hers is the most difficult for
  you to handle?... her tantrums I guess, but I
  know how to deal with those.

26
Lauras Postnatal WMCI

• What do you feel like doing when she reacts this
  way? I just laugh. I think its funny. I cant
  get mad cause I used to do the same thing. I
  still do sometimes (giggles). Im like a big kid
  that hurt myself, so.. How do you feel when she
  reacts this way? I dont have a feeling towards
  it cause its funny, cause it reminds me of
  myself. So, I just laugh. I think its cute.
  What do you do when she does this? When she
  throws tantrums? Get it for her! Shes the momma.
  Thats ok though What do you think will happen
  to this behavior as she gets older? hopefully
  itll go away, but then again, I dont know cause
  mine didnt.

27
Lauras Postnatal WMCI

• How would you describe your relationship with
  her? Im attached to her, but shes not attached
  to me. And that hurts my feelings, but then
  again, no it dont because it shows me shes
  independent, so theres hope for her yet. Pick 5
  words to describe your relationship. Shes the
  mom and Im the daughter (giggles). I let her
  rule me. I love her real-- too much. A little too
  much. Im like addicted to her. We have a bond.
  We like to do the same things.
• Do you ever worry about your child? all the
  time. What do you worry about? like when shes
  away from me. Im like (whispering) Oh God,
  something might happen. I worry all the time. I
  think every mother worries, Im just extreme
  though. Im attached to her.

28
Results Part I Pregnancy to 1 year post-partum

• Prenatal Representations and Later Parenting
  Behavior
• Balanced mothers were later observed to be more
  positive (warm, responsive, sensitive) with
  their infants
• Disengaged mothers were later observed to be more
  controlling with their infants
• Distorted mothers were later observed to be more
  hostile with their infants
• As expected, representations predicted actual
  parenting behavior!

29
Description ofLaura and Claire in the 1 Year
Mother-Infant Play Interaction
30
Results Part I Pregnancy to 1 year post-partum

• Prenatal Representations and Age 1 Infant-Mother
  Attachment Quality
• Three-Way Match
• 69 of Balanced mothers had Secure infants
• 27 of Disengaged mothers had Avoidant infants
• 22 of Distorted mothers had Ambivalent infants
• 50 matched
• Two-Way Concordance
• 60 matched for Balanced/Secure and
  Non-Balanced/Insecure

31
Age 1 Strange SituationAttachment
Disorganization with Avoidance
32
Results Part II Age 1 to Age 4

• Age 1 to Age 4 Child-Mother Attachment Quality
  Stability Instability
• Mothers with balanced representations at both
  times were much more likely to have secure
  children at both times
• Overall (and for Laura), higher rates and more
  severe DV during pregnancy predicted the
  stability of insecure attachment over time
• Mothers with unstable representations or
  non-balanced representations at both times were
  more likely to have insecure children at age 1
  and/or age 4

33
Age 4 Strange SituationAttachment
Disorganization- Controlling/Punitive Subtype
34
Summary of Findings

• Domestic Violence has long-term and pernicious
  effects on mothers young children
• It disrupts the maternal caregiving system at a
  critical sensitive period
• DV during pregnancy may be particularly
  problematic, influencing later parenting
  behaviors and future infant/child attachment
  quality
• This may be true even if violence ends after
  birth of the child (as in Lauras case)
• Sets in motion a troubled relationship the dyad
  gets on a maladaptive developmental path very
  early on

35
Clinical Implications

• DV is highly prevalent among families receiving
  IMH services
• Important to assess (at multiple time points) and
  work with maternal experiences of DV including
  types of DV, severity, etc
• Consider possible sensitive periods for
  exposure
• The infant does not have to directly witness the
  violence to be affected maternal functioning is
  crucial
• Thus, relationship-based IMH interventions are
  well-suited to treating DV-exposed mothers and
  young children

36
Summary of Findings

• While results and the case example point to a
  very dark picture, our findings also
  demonstrate
• Not all women children exposed to DV had
  problematic representations or insecure
  attachment
• Representations do evolve and some women move
  from having non-balanced to balanced
  representations (20 from total sample)
• Likewise, some children move from insecurity to
  security by the preschool years (24 from total
  sample)

37
Clinical Implications

• Protective factors
• absence of maternal childhood history of
  maltreatment
• easy infant temperament
• less severe DV and termination of DV
• less maternal depression and trauma symptoms
• Less economic disadvantage
• more positive responsive maternal behaviors
  (despite representations)
• Higher levels of social support around parenting
• May be important targets for treatment

38
Clinical Implications

• There are multiple ports of entry
• labels arrows show ports of entry
• social-contextual environment is missing here
  may provide other ports of entry
• Try the simplest and most direct intervention
  first
• Encourage parent to intervene on behalf of child
  whenever possible

T/rep
T/beh
M/beh
M/rep1
B/beh
B/rep
M/rep2
39
Acknowledgements

• Mother Infant Study PIs Alytia Levendosky, Anne
  Bogat, Alexander von Eye and William Davidson
• The families who dedicated their time to the
  project
• Grant Support
• National Institute of Justice (8-7958-MI-IJ)
• Centers for Disease Control (R01/CCR518519-03-1)
• Institute for Health Care Studies, Michigan
  State University
• Office of the Vice President for Research and
  Graduate Studies,
• Michigan State University
• American Psychoanalytic Association
• Past and Present Graduate Student Collaborators
• Alissa Huth-Bocks, Sally Theran, Robin
  Weatherill, Erika DeJonghe, Kerry Leahy, Carolyn
  Dayton, Shallimar Jones, Mariam Mourad, Janeen
  DeMarte, Archana Basu, Johanna Malone, Cecilia
  Martinez-Torteya, Lia Field, Parker Huston, Audie
  Black, and Saleem Hue-Penney