How Common are PTSD and Complex PTSD in Male Prisoners?

What you need to know

• Posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) are common but often unrecognized in male prisoners
• CPTSD was more prevalent than PTSD in this study of UK male prisoners (16.7% vs 7.7%)
• CPTSD was associated with more extensive trauma history and psychiatric comorbidities compared to PTSD
• Improved identification and tailored treatment approaches are needed for trauma-related disorders in prison settings

Understanding PTSD and Complex PTSD

Posttraumatic stress disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing a traumatic event. Symptoms include reliving the trauma through flashbacks or nightmares, avoiding reminders of the trauma, negative changes in thinking and mood, and being easily startled or on edge.

Complex PTSD (CPTSD) is a related but distinct disorder that was recently added to the International Classification of Diseases (ICD-11). CPTSD includes the core symptoms of PTSD, but also involves difficulties with:

• Emotional regulation (e.g. intense or volatile emotions)
• Self-perception (e.g. feelings of worthlessness or shame)
• Relationships (e.g. difficulty feeling close to others)

CPTSD is thought to result from repeated or prolonged trauma exposure, particularly during childhood or in situations where escape is difficult.

Prevalence in Male Prisoners

This study aimed to determine how common PTSD and CPTSD are among sentenced male prisoners in the UK. The researchers surveyed 221 prisoners in a medium-security prison using validated questionnaires.

They found that:

• 7.7% met criteria for PTSD
• 16.7% met criteria for CPTSD

This means nearly 1 in 4 prisoners qualified for a trauma-related disorder. The higher rate of CPTSD compared to PTSD aligns with findings from other high-risk populations.

Importantly, the vast majority of prisoners with PTSD (82.4%) or CPTSD (75.7%) had not been previously identified by prison mental health staff. This highlights a significant gap in recognizing and treating trauma-related disorders in prison settings.

Differences in Trauma History

The study examined how different trauma characteristics related to PTSD versus CPTSD:

PTSD was associated with:

• More recent trauma (within the past year)
• Childhood physical abuse
• Childhood emotional neglect

CPTSD was associated with more extensive trauma, including:

• Childhood abuse (verbal, physical, emotional neglect)
• Repeated or prolonged trauma
• Multiple types of trauma exposure over the lifespan
• Interpersonal violence
• Sexual victimization

Interestingly, childhood sexual abuse was not significantly associated with either disorder in this male prison sample. The researchers suggest this could reflect male prisoners being less likely to report sexual victimization.

One of the strongest predictors of CPTSD compared to PTSD was a history of childhood physical neglect. This aligns with theories that CPTSD often stems from chronic childhood trauma and disrupted attachment relationships.

Psychiatric Comorbidities

The study also looked at how PTSD and CPTSD related to other mental health conditions:

PTSD was associated with:

• Anxiety
• Alcohol dependence
• Cluster B personality disorders (e.g. borderline, antisocial)

CPTSD showed more extensive comorbidity, including:

• Depression
• Anxiety
• Substance abuse
• Psychosis
• ADHD

These findings highlight that prisoners with CPTSD often have complex mental health needs that may require comprehensive treatment approaches.

Implications for Prison Mental Health

This research has several important implications:

1. Improved screening and assessment

Given that most cases were previously undetected, prisons should implement better screening procedures to identify prisoners with PTSD and CPTSD. This could involve brief questionnaires during intake or periodic mental health check-ins.

2. Staff training

Prison staff, including correctional officers and healthcare providers, should receive training on recognizing signs of trauma-related disorders. This can help ensure that prisoners receive timely referrals for assessment and treatment.

3. Trauma-informed care

Prisons should adopt trauma-informed approaches that take into account the high prevalence of trauma histories among prisoners. This includes:

• Creating a sense of safety in the prison environment
• Avoiding practices that may re-traumatize prisoners
• Offering opportunities for prisoners to rebuild a sense of control and empowerment

4. Tailored treatment approaches

The distinct profiles of PTSD and CPTSD suggest a need for tailored treatment approaches:

• PTSD treatment may focus more on processing specific traumatic events and managing acute symptoms
• CPTSD treatment may require longer-term approaches that also address emotional regulation, self-concept, and relationship difficulties

5. Addressing comorbid conditions

Given the high rates of comorbidity, especially with CPTSD, treatment plans should comprehensively address co-occurring mental health and substance use issues.

6. Further research

More studies are needed to understand the specific treatment needs and outcomes for prisoners with CPTSD. This can help inform the development of targeted interventions for this population.

Limitations to Consider

While this study provides valuable insights, there are some limitations to keep in mind:

• The sample was from a single prison in the UK, so findings may not generalize to all prison populations
• The study relied on self-report measures, which can be influenced by factors like recall bias or deliberate misreporting
• The relatively small sample size, particularly for PTSD, limited some analyses

Despite these limitations, this research represents an important step in understanding trauma-related disorders in prison populations.

Conclusions

• PTSD and especially CPTSD are common but under-recognized in male prisoners
• CPTSD is associated with more extensive trauma history and psychiatric comorbidities
• Improved identification and tailored treatment approaches are needed in prison settings
• Adopting trauma-informed practices can help address the needs of prisoners with trauma-related disorders

By better recognizing and addressing PTSD and CPTSD, prisons have an opportunity to improve mental health outcomes and potentially reduce negative behaviors associated with untreated trauma. This not only benefits individual prisoners but may also contribute to safer prison environments and improved rehabilitation outcomes.