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Shallow affect, no remorse: The shadow of trauma in the inner city.

2013; American Psychological Association; Volume: 19; Issue: 2 Linguagem: Inglês

10.1037/a0032530

1532-7949

Christopher B. Roach,

Child and Adolescent Psychosocial and Emotional Development

This article looks at a psychotherapist’s lessons learned at the intersection of trauma and antisocial behavior in 20 years of working in American prisons, forensic hospitals, and trauma centers. Typically, posttraumatic stress disorder (PTSD) presents as an anxiety disorder with the symptom triad of avoidance, reexperiencing, and hyperarousal. Therapy can proceed once some level of safety has been achieved. But many potential patients do not have a safe space for the work to proceed. Instead, they are living in conditions of ongoing exposure to trauma that has been variously described as complex PTSD and continuous traumatic stress. Anxiety would hardly be adaptive for survival in this environment and, in fact, the symptom picture is often dominated by anger, aggression, and callousness. When these potential patients are found in jails, prisons, and hospital emergency rooms, their outward presentation, instead of centering on anxiety, can appear more like conduct disorder or even criminal psychopathy. They may have been victims, but they frequently have also been perpetrators of violence. These patients need and deserve a trauma-centered treatment, but exposure therapy is hardly appropriate for someone who is experiencing ongoing traumatic conditions. Therapy can proceed, however, and be successful, but the techniques that the therapist uses may be quite different from those found in other settings. A theory of how trauma connects to antisocial presentations will be described, and some of the lessons learned in working with this population will be shared.