Psychological Injury and Law

, Volume 3, Issue 2, pp 155–163

Traumatic Event Exposure and Behavioral Health Disorders among Incarcerated Females Self-Referred to Treatment

  • Nancy Wolff
  • Roshnee Vazquez
  • B. Christopher Frueh
  • Jing Shi
  • Brooke E. Schumann
  • Douglas Gerardi


At least half of the women inside prison have mental health problems, have experienced physical, sexual, or emotional abuse during their formative years and often in adulthood, and have addiction problems. Only a minority of these women receive treatment for their behavioral health problems associated with trauma while incarcerated, even though these problems are risk factors for returning to prison after release. This study focuses on the traumatic experiences and behavioral health problems of a group of female inmates who volunteered in August 2009, to be screened for admission into an integrated trauma-reentry program implemented at an adult female correctional facility. Of the 278 women who self-referred for screening, 196 preliminarily met the time eligibility criterion of residing at the prison for eight to 24 more months. Half of these women (n = 97) were actually time-eligible for screening and agreed to be screened. Of this sample of treatment-seeking soon-to-be-released female prisoners, the vast majority (93%) reported significant and complex histories of traumatic event exposure and high rates of either posttraumatic stress disorder (PTSD) or sub-threshold PTSD, past alcohol and other substance abuse or dependence, other axis I psychiatric disorders, and subjective distress. Identifying trauma exposure histories and associated behavioral health problems within this population and providing effective interventions holds potential promise for preparing incarcerated women to manage their post-release lives in ways that will keep them safe, healthy, and in the community.


Traumatic event exposure Axis I mental disorder Behavioral health disorders Incarcerated females PTSD Abuse Addiction 


  1. Abbott, J., Johnson, R., Koziol-McLain, J., et al. (1995). Domestic violence against women: Incidence and prevalence in an emergency department population. J Am Med Assoc, 273, 1763–1767.CrossRefGoogle Scholar
  2. Allen, J. G. (1995). Coping with trauma: A guide to self-understanding. Washington: American Psychiatric Press.Google Scholar
  3. American Psychiatric Association. (1980). Diagnostic and Statistical Manual of Mental Disorders (3rd ed.). Washington: American Psychiatric Association.Google Scholar
  4. American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Orders (4th ed.). Washington: American Psychiatric Association.Google Scholar
  5. Blitz, C. L., Wolff, N., Pan, K., & Pogorzelski, W. (2005). Gender-specific behavioral health and community release patterns among New Jersey prison inmates: Implications for treatment and community reentry. Am J Public Health, 95, 1741–1746.CrossRefPubMedGoogle Scholar
  6. Bloom, B., Owen, B., & Covington, S. (2003). Gender-responsive strategies: Research, practice, and guiding principles for women offenders. Washington: National Institute of Corrections, US Department of Justice.Google Scholar
  7. Breslau, N. (2002). Gender differences in trauma and posttraumatic stress disorder. J Gend-Specif Med, 5, 34–40.PubMedGoogle Scholar
  8. Breslau, N., Kessler, R. C., Chilcoat, H. D., et al. (1998). Trauma and posttraumatic stress disorder in the community: Detroit area survey of trauma. Arch Gen Psychiatry, 55, 626–632.CrossRefPubMedGoogle Scholar
  9. Bromet, E., Sonnega, A., & Kessler, R. C. (1998). Risk factors for DSM-III-R posttraumatic stress disorder: Findings from the National Comorbidity Survey. Am J Epidemiol, 147, 353–361.PubMedGoogle Scholar
  10. Brown, A., Miller, A., & Maguin, E. (1999). Prevalence and severity of lifetime physical and sexual victimization among incarcerated women. Int J Law Psychiatry, 22, 301–322.CrossRefGoogle Scholar
  11. Chilcoat, M. D., & Breslau, N. (1998). Posttraumatic stress disorder and drug disorders: Testing causal pathways. Arch Gen Psychiatry, 559, 13–17.Google Scholar
  12. Child Abuse Prevention and Treatment Act of 1974 (PL 93-237). Available at:, Accessed on: Jan 10, 2009.
  13. Children's Bureau (2008). Maltreatment types of victims, 2006. Children's Bureau, US Department of Health and Human ServicesGoogle Scholar
  14. Covington, S. S. (2003). A woman’s journey home: Challenges for female offenders. In J. Travis & M. Waul (Eds.), Prisoners once removed (pp. 67–104). Washington: Urban Institute Press.Google Scholar
  15. Crisanti, A.S., Frueh B.C., Gundaya, D., Salvail, F.R., & Triffleman, E. 2010. Racial disparities in sexual assault among Asian-Americans and Native Hawaiians/Other Pacific Islanders. Journal of Clinical Psychiatry (in press)Google Scholar
  16. Davidson, J. R., Hughes, D., Blazer, D. G., et al. (1991). Post-traumatic stress disorder in the community: An epidemiological study. Psychol Med, 21, 713–721.CrossRefPubMedGoogle Scholar
  17. Eisenstat, S., & Bancroft, L. (1999). Domestic violence. N Engl J Med, 341, 886–892.CrossRefPubMedGoogle Scholar
  18. Fletcher, B. R., Shaver, L. D., & Moon, D. G. (1993). Women prisoners: A forgotten population. Portsmouth: Greenwood.Google Scholar
  19. Foa, E. B. (2006). Psychosocial therapy for posttraumatic stress disorder. J Clin Psychiatry, 67(Suppl. 2), 40–45.PubMedGoogle Scholar
  20. GAINS. (2002). The prevalence of co-occurring mental health and substance use disorders in jail. Delmar: National GAINS Center for People with Co-Occurring Disorders in the Justice System and Substance Abuse and Mental Health Services Administration.Google Scholar
  21. Girshick, L. B. (2003). Abused women and incarceration. In B. H. Zaitzow & J. Thomas (Eds.), Women in prison: Gender and social control (pp. 95–118). London: Lynne Rienner.Google Scholar
  22. Greenfeld, L. & Snell, T.L. (December 1999). Bureau of Justice Statistics Special Report: Women Offenders. Washington, DC: Bureau of Justice Statistics, Office of Justice Programs, US Department of Justice, NCJ 175688.Google Scholar
  23. Grubaugh, A. L., Magruder, K. M., Waldrop, A. E., Elhai, J. D., Knapp, R. G., & Frueh, B. C. (2005). Subthreshold PTSD in primary care: Prevalence, psychiatric disorders, healthcare use, and functional status. J Nerv Ment Dis, 193, 658–664.CrossRefPubMedGoogle Scholar
  24. Hartwell, S. W. (2001). Female mentally ill offenders and their community reintegration needs: An initial examination. Int J Law Psychiatry, 24, 1–11.CrossRefPubMedGoogle Scholar
  25. Herman, J. L. (1992). Trauma and recovery: The aftermath of violence—from domestic abuse to political terror. New York: Basic Books.Google Scholar
  26. Helzer, J. E., Robins, L. N., & McEvoy, L. (1987). Post-traumatic stress disorder in the general population: Findings of the Epidemiologic Catchment Area Survey. N Engl J Med, 317, 1630–1634.PubMedGoogle Scholar
  27. Kessler, R. C., Sonnega, A., Bromet, E., et al. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry, 52, 1048–1060.PubMedGoogle Scholar
  28. James, D.J., & Glaze, L.E. (September 2006). Bureau of Justice Statistics Special Report: Mental Health Problems of Prison and Jail Inmates. Washington, DC: Bureau of Justice Statistics, Office of Justice Programs, US Department of Justice, NCJ 213600.Google Scholar
  29. Krug, E.G., Dahlberg, J.A., Mercy, J.A., et al. (Eds.) (2002). World health report on violence and health. Geneva, Switzerland: World Health Organization. Available at Accessed on: May 25, 2008.
  30. Lasiuk, G. C., & Hegadoren, K. M. (2006). Posttraumatic stress disorder: Development of the construct within the North American psychiatric taxonomy. Perspect Psychiatr Care, 42, 72–81.CrossRefPubMedGoogle Scholar
  31. London, K., Bruck, M., Ceci, S. J., & Shuman, D. W. (2005). Disclosure of child sexual abuse: What does the research tell us about the ways that children tell? Psychol Public Policy Law, 11(1), 194–226.CrossRefGoogle Scholar
  32. Magruder, K. M., Frueh, B. C., Knapp, R. G., Johnson, M. R., Vaughan, J. A., Carson, T. C., et al. (2004). PTSD symptoms, demographic characteristics, and functional status among veterans treated in VA primary care clinics. J Trauma Stress, 17, 293–301.CrossRefPubMedGoogle Scholar
  33. Najavits, L. M. (2002). Seeking safety: A new psychotherapy for posttraumatic stress disorder and substance use disorder. In P. Ouimette & P. Brown (Eds.), Trauma and substance abuse: Causes, consequences, and treatment of comorbid disorders (pp. 147–170). Washington: American Psychological Association Press.Google Scholar
  34. New Jersey Reentry Roundtable. (2003). Coming home for good: Meeting the challenge of prisoner reentry in New Jersey: Final report of the New Jersey Reentry Roundtable. Newark: New Jersey Institute for Social Justice.Google Scholar
  35. Norris, F. H., Friedman, M. J., & Watson, P. J. (2002). 60,000 disaster victims speak: Part I. an empirical review of the empirical literature, 1981–2001. Psychiatry, 65(3), 207–239.PubMedGoogle Scholar
  36. Peters, R. H., & Matthews, C. O. (2003). Substance abuse treatment programs in prisons and jails. Thousand Oaks: Sage Publications.Google Scholar
  37. President's New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America. Rockville: President's New Freedom Commission on Mental Health.Google Scholar
  38. Schnurr, P. P., & Green, B. L. (Eds.). (2004). Trauma and health: Physical health consequences of exposure to extreme stress. Washington: American Psychological Association.Google Scholar
  39. Teplin, L., Abram, J. M., & McClelland, G. M. (1996). Prevalence of psychiatric disorders among incarcerated women: Pretrial jail detainees. Arch Gen Psychiatry, 53, 505–512.PubMedGoogle Scholar
  40. Terr, L. C. (2003). Childhood traumas: An outline and overview. Focus, 1, 322–333.Google Scholar
  41. Tjaden, P., & Thoennes, N. (1998). Prevalence, incidence, and consequences of violence against women: Findings from the national violence against women survey. Research in Brief. Washington, DC: Office of Justice Programs, National Institute of Justice.Google Scholar
  42. Wolff, N. (2008). Rebuilding “Person-First” reentry strategies for women leaving prison from the perspectives of the end users: The returning women. In R. Gido, L. Dalley, & D. McDonald (Eds.), Women’s mental health issues across the criminal justice system (pp. 226–243). Upper Saddle River: Prentice Hall.Google Scholar
  43. Wolff, N., & Shi, J. (2010). Trauma and incarcerated person. In C. L. Scott (Ed.), Handbook of correctional mental health (2nd ed., pp. 277–320). Washington: American Psychiatric Publishing, Inc.Google Scholar
  44. Wolff, N., & Shi, J. (2009). Victimization and feelings of safety among male and female inmates with behavioral health problems. J Forensic Psychol, 20((1), Supplement 1), S56–S77.CrossRefGoogle Scholar
  45. Wolff, N., Blitz, C. L., Shi, J., Bachman, R., & Siegel, J. (2006). Sexual violence inside prisons: Rates of victimization. J Urban Health, 83, 835–848.CrossRefPubMedGoogle Scholar
  46. Wolff, N., Blitz, C., & Shi, J. (2007a). Rates of sexual victimization inside prison for inmates with and without mental disorder. Psychiatr Serv, 58(8), 1087–1094.CrossRefPubMedGoogle Scholar
  47. Wolff, N., Blitz, C. L., Shi, J., Siegel, J. A., & Bachman, R. (2007b). Physical violence inside prisons: Rates of victimization. Crim Justice and Behav, 34, 588–599.CrossRefGoogle Scholar
  48. Wolff, N., Shi, J., & Siegel, J. (2009). Patterns of victimization among male and female inmates: Evidence of an enduring legacy. Violence and victims, 24(4), 469–484.Google Scholar

Copyright information

© Springer Science + Business Media, LLC. 2010

Authors and Affiliations

  • Nancy Wolff
    • 1
  • Roshnee Vazquez
    • 1
  • B. Christopher Frueh
    • 2
  • Jing Shi
    • 1
  • Brooke E. Schumann
    • 1
  • Douglas Gerardi
    • 3
  1. 1.Center for Behavioral Health Services and Criminal Justice ResearchRutgers UniversityNew BrunswickUSA
  2. 2.Department of PsychologyUniversity of HawaiiHiloUSA
  3. 3.Office of Policy and PlanningNew Jersey Department of CorrectionsTrentonUSA

Personalised recommendations