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Complex Trauma Among Psychiatrically Impaired Children: A Cross-Sectional, Chart-Review Study

Julian D. Ford, PhD; Daniel F. Connor, MD; and Josephine Hawke, PhD

Published: June 30, 2009

Article Abstract

Objective: To identify subgroups of severely psychiatrically impaired children on the basis of the complexity of their histories of exposure to abuse and other potential traumatic stressors, and to examine the relationship of complex trauma histories to DSM-IV-TR psychiatric diagnoses.

Method: In a sample of 397 consecutive inpatient child psychiatry admissions, cluster analysis was used to identify subgroups on the basis of measures of documented physical or sexual abuse, parental impairment (arrest, violence, and/or substance use), and disrupted attachment (ie, out-of-home placement). Data were collected for the years 1992 through 2002.

Results: Four subgroups were identified. Two "low trauma" subgroups had infrequent histories of abuse and out-of-home placement but were distinguished by low/moderate versus high levels of parental impairment. Two "complex trauma" subgroups were characterized by histories of either physical abuse or sexual abuse with multiple perpetrators, as well as extensive out-of-home placement and severe parental impairment. All subgroups had similar profiles of psychiatric diagnoses. Complex trauma status was associated with behavior problem severity and lower body mass index over and above the effects of psychiatric diagnoses, gender, and ethnicity. Although abuse history was a factor in subgroup membership, the multiple out-of-home placements variable was the most consistent correlate of externalizing and internalizing problems and psychosocial impairment.

Conclusions: Childhood adversity that may constitute complex trauma was associated with externalizing behavior problems and psychosocial impairment among psychiatrically hospitalized children, and this association cannot be accounted for fully by existing psychiatric diagnoses, gender, or ethnicity.

Submitted: October 6, 2008; accepted January 19, 2009.

Online ahead of print: June 30, 2009.

Corresponding author: Julian D. Ford, PhD, 263 Farmington Ave, MC1410, Farmington, CT 06030 (

Volume: 70

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