Adverse Childhood Experiences and Treatability in Dutch Patients with Cluster B Personality Disorders Mandated to Forensic Clinical Care: A Comparison of Men Convicted for Sexual and Violent Offenses

Abstract

Adverse childhood experiences (ACEs) have been consistently linked to interpersonal violence and are highly prevalent in correctional populations, particularly in men who perpetrate (sexual) violent behavior. Although exposure to ACEs is common in men who perpetrate interpersonal violence, less is known about the differences between men who commit sexual versus non-sexual violence. This cross-sectional study reports on the differences in prevalence of adverse childhood experiences in Dutch men who committed sexual offenses (N = 29) versus those who committed (non-sexual) violent offenses (N = 29), all who have been mandated to forensic clinical care. Drawing on data from a RCT-study among male forensic psychiatric inpatients with cluster B personality disorders from seven forensic hospitals in the Netherlands, the study explored potential differences in ACEs, and its relationship to treatability in the first year of forensic treatment. No significant differences were found in prevalence of childhood abuse and neglect among men convicted for sexual offenses versus those convicted for violent offenses. In our study, ACEs were not predictive of risk relating to treatability at the start of forensic treatment. Our findings suggest that taking into account trauma histories is of equal importance for both offending groups. Implications regarding trauma-informed forensic care are discussed.

Keywords:

• Adverse childhood experiences (ACEs)
• treatability
• sexual violence
• violence
• mandated care

Acknowledgements

We kindly thank all patients for their time and effort spent on the RCT study and the clinical director of the participating forensic hospitals for their support.

Conflict of interest

The authors have no conflicts of interest to report.

Data availability statement

The data is not available because it is property of the participating forensic hospitals.

Box 1 Case examples

1. Michael was born on the Antilles/Curaçao where he resided with his mom and five brothers. He never met his father. When Michael was eight years old, the family moved to the Netherlands. His mom had to work double shifts to cover the bills and left the boys home alone a lot. His older brothers went out on the street to commit petty crimes and deal drugs, leaving Michael alone often. A neighbor, calling himself “uncle”, came over and helped him with homework and provided him with food. After a while, the uncle took a sexual interest in Michael and performed sexual acts on him and his friends.

2. Max was placed into foster care after his parents physically abused and neglected him. His parents were teenage parents who used a lot of drugs and forgot to take care of Max when they were high. In foster care he was sexually abused by several group leaders. The men visited him at night and touched him. Also, some of the older boys residing in the foster home took advantage of him. They forced him to perform sexual acts on them and threatened him to expose this “secret” if he didn’t do as they asked.

3. Sam lived with his parents and his older brother as a kid. Both parents suffered from alcohol addiction, his father would get angry and hit the kids. When Sam was twelve years old he found out that not his parents but his brother was his biological father. This reveal caused a lot of friction in the family home, resulting in the parents divorcing. Mother then faced the upbringing on her own and suffered from depression. She neglected the household and attempted to commit suicide several times, after which Sam had found his mother.