Family risk factors and prevalence of dissociative symptoms among homeless and runaway youth

Abstract

Objective: To examine family risk factors associated with dissociative symptoms among homeless and runaway youth.

Method: Three hundred and twenty-eight homeless and runaway youth were interviewed using a systematic sampling strategy in metropolitan Seattle. Homeless young people were interviewed on the streets and in shelters by outreach workers in youth service agencies.

Results: The current study revealed widespread prevalence of dissociative symptoms among these young people. Multivariate analyses revealed that sexual abuse, physical abuse, and family mental health problems were all positively associated with dissociative symptoms. No gender differences were found for any of the models.

Conclusions: Dissociative behavior is widespread among these youth and may pose a serious mental health concern. Some young people experience numerous stressors, and with few resources and little support available, many may invoke maladaptive strategies such as dissociative behavior to handle such situations, which may in turn be detrimental to their mental health. Unless youth are provided with programs and intervention, the cycle of abuse that they have experienced at home is likely to continue on the street.

Résumé

Objectif: Examiner les facteurs de risques familiaux associés aux symptômes de dissociation, dans une population de jeunes qui fuient leurs foyers ou qui sont sans abris.

Méthode: Des travailleurs oeuvrant dans des agences de services à la jeunesse ont interviewé un échantillon aléatoire de 328 jeunes fuyant leur foyer ou sans abris, dans la région métropolitaine de Seattle. Les entrevues ont eu lieu sur la rue ou dans des abris pour jeunes.

Résultats: L’étude révèle une prévalence importante de symptômes de dissociation parmi cette population de jeunes. Une analyse de variables multiples indique qu’il existe un lien entre ces symptômes et les agressions sexuelles, les mauvais traitements physiques et les problèmes de santé mentale dans leur famille. On n’a noté aucune différence entre les filles et les garçons.

Conclusions: Le comportement dissociatif est commun dans cette population de jeunes et pourrait leur poser des difficultés mentales sérieuses. Certains jeunes vivent des stress nombreux et ont peu de ressources et d’appuis; plusieurs ont recours à des solutions nocives telles que le comportement dissociatif, ce qui en retour peut occasionner des difficultés mentales. À moins que les jeunes aient à leur portée des programmes et des interventions aidantes, le cycle des sévices vécus dans leurs familles pourra se répéter dans les rues.

Resumen

Objetivo: Examinar los factores de riesgo familiar asociados con sı́ntomas disociativos entre jóvenes “sin techo” y que se han fugado del domicilio.

Método: Un total de 328 jóvenes “sin techo” y que se han fugado del domicilio fueron entrevistados utilizando una estrategia de muestreo sistemático en el Area Metropolitana de Seattle. Los jóvenes fueron entrevistados en las calles y en los albergues por trabajadores de las agencias de atención a la juventud.

Resultados: El estudio reveló una amplia prevalencia de sı́ntomas disociativos entre esta población de jóvenes. Los análisis multivariados revelaron que el abuso sexual, maltrato fı́sico y los problemas de salud mental en la familia estaban positivamente asociados con la existencia de sı́ntomas disociativos. No se observaron diferencias de género en ninguno de los modelos.

Conclusiones: La conducta disociativa es frecuente entre estos jóvenes y puede constituir un serio problema de salud mental. Algunos jóvenes están expuestos a numerosas situaciones estresantes y disponen de pocos recursos y apoyo accesible. Muchos de ellos pueden desarrollar estrategias desadaptativas, como la conducta disociativa, para afrontar la situación, lo cual puede afectar negativamente a su salud mental. A menos que se les proporcione a los jóvenes programas e intervenciones, el ciclo de maltrato que han experimentado en casa puede continuar en la calle.

Introduction

High rates of physical abuse, sexual abuse, neglect, and parental rejection have been found among homeless and runaway youth (McCormack, Burgess, & Gaccione, 1986; Powers, Eckenrode, & Jaklitsch, 1990; Tyler, Hoyt, & Whitbeck, 2000; Whitbeck, Hoyt, & Ackley, 1997), and many young people cite these factors as reasons for leaving home (Janus, Archambault, Brown, & Welsh, 1995). Although some studies on homeless and runaway adolescents (cf. Cauce et al., 1998; Whitbeck, Hoyt, & Bao, 2000), have investigated the link between early maltreatment and mental health (e.g., depression, PTSD), none of this research has examined dissociative behavior as a mental health outcome despite its strong link with early maltreatment (cf. Carlson & Putnam, 1993, Kisiel & Lyons, 2001, Zlotnick et al., 1994). Given that a large number of homeless adolescents run from abusive family situations, they are an ideal sample for studying the broader issues of dissociative symptoms including prevalence and family correlates.

Dissociation may be viewed as an adaptive coping mechanism that can protect people who have been exposed to severe trauma (Putnam, 1993). This process is thought to alter an individual’s thoughts or actions by separating feelings from memories of specific traumatic incidents, such as sexual abuse (Irwin, 1994). Although dissociation typically peaks at ages 9–10 and then declines rapidly in adolescence, and leveling off by early adulthood (Putnam, 1993), exposure to early trauma may impede the normal age-related decline in dissociation leading to an increased likelihood of dissociating in adulthood.

Much of the research on dissociative behavior, which focuses on clinical samples, has found high levels of dissociation among children who have been sexually abused (Atlas & Hiott, 1994; Kirby, Chu, & Dill, 1993), while others have found an association between higher dissociative scores and histories of both sexual and physical abuse (Chu & Dill, 1990, Zlotnick et al., 1994). Among adult men and women in the general population as well as amongst college students, early sexual abuse has been linked with higher scores on dissociation (Irwin, 1994, Sandberg & Lynn, 1992). Recent findings also indicate that dissociation acts as a mediator between child abuse (i.e., sexual abuse, emotional abuse) and psychopathology such as eating disorders and various mental health outcomes (Kent, Waller, & Dagnan, 1999; Kisiel & Lyons, 2001). A meta-analysis on the Dissociative Experiences Scale (DES) found females were not more dissociative than their male counterparts (Van Ijzendoorn & Schuengel, 1996). Few age differences were found in dissociative symptoms in a study of boys and girls pre-school through late adolescence (Putnam, Hornstein, & Peterson, 1996).

The family environment in which children grow up is likely to influence their behavior. Some research finds that parents who suffer from mental health problems are likely to be neglectful, abusive, and/or inconsistent in their parenting (Kluft, 1987). Inconsistent parenting can cause the child to be stressed and confused, which may lead to dissociative tendencies (Mann & Sanders, 1994). According to Kisiel and Lyons, “A natural, protective response to overwhelming traumatic experiences, dissociation can become an automatic response to stress” (2001, p. 1034). Given the numerous stressors that many young people experience, stress theory provides a useful framework for explaining the link between family background characteristics and dissociative behaviors. According to Wheaton, stressors are … “conditions of threat, demands, or structural constraints that, by their very occurrence or existence, call into question the operating integrity of the organism” (Wheaton, 1999, p. 177). Although the majority of people adapt to stress and do not develop serious mental illness or behavioral problems, there are a number of individuals who become hopeless and engage in maladaptive behavior (e.g., dissociation). A central issue then is to explain why some individuals are negatively affected by stress while others are not (Aneshensel, 1999). If two people are exposed to similar stressors but each has different resources, the impact of the stressors is expected to be less for the person with more resources (Pearlin, 1999). While some people are successful in dealing with stress, others are poorly equipped because they have not acquired efficient coping strategies (Thoits, 1999). Stressors, such as physical abuse, neglect, and sexual abuse that many homeless and runaway youth have been exposed to in their family of origin (Janus et al., 1995, Tyler et al., 2000), may be too much to cope with and a breakdown may occur whereby some youth invoke dissociative behaviors, which can affect their functioning.

Although much of the research cited above finds a link between abuse and higher dissociative scores, many of the studies have not included multiple forms of maltreatment. Other problems include small sample sizes, exploratory and/or descriptive findings, and a focus only on small clinical samples. Further, we are unaware of any research to date that has investigated the link between family factors and dissociative symptoms among homeless and runaway youth.

The current study improves upon previous research by examining the prevalence of dissociative symptoms among a large sample of homeless youth who typically experience widespread trauma including high rates of abuse, neglect, parental rejection, and parents with mental health problems. Second, we use multivariate analyses to examine family factors and their association with dissociative behaviors. Specifically, we hypothesized that parental rejection, neglect, physical abuse, sexual abuse, and family mental health problems would be significantly associated with higher levels of dissociative symptoms. Based on a review of the literature, we did not expect age or gender differences.