**Sexual Abuse Histories Among Incarcerated Older Adult Offenders: A Descriptive Study**

Mary Beth Morrissey, Deborah Courtney and Tina Maschi *Fordham University, Graduate School of Social Service USA* 

#### **1. Introduction**

20 Sexual Abuse – Breaking the Silence

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In the United States today, there are over 2.2 million incarcerated adults held in custody in U.S. state or federal prisons or local jails (Glaze, 2010). Prison facilities are oftentimes filled to capacity or in some cases, so overcrowded that conditions violate the constitutional rights of adults in prison (Brown v. Plata, 2011; Sabol & West, 2009; West & Sabol, 2008). Official statistics paint a contemporary portrait of the 1.5 million adult sentenced prisoners under state or federal jurisdiction who are mostly male (93%) and from diverse racial and ethnic backgrounds including Black American (36%), Caucasian (31%), and Latino (20%)(West & Sabol, 2008). Black males continue to have the highest incarceration rates across all age categories compared to White or Latino males (Sabol & Couture, 2008). There is a growing number of older adults in both state and federal prisons, approaching nearly 5% of inmates 55 and older in custody of state prisons in 2007, and over 7% of inmates 56 and older in federal prison in 2009 (Cox & Lawrence, 2010; Sabol & Couture, 2008). This aging prisoner population, which is five times larger than in 1990, presents a significant public health challenge that the correctional system is not adequately equipped to address (Falter, 1999; Reimer, 2008). Moreover, the high prevalence of trauma among older adults in prison and psychological distress associated with trauma experiences raise serious concerns about the well-being of this population (Krause, 2004). Studies have shown that approximately 93% of juvenile and adult prisoners have had prior exposure to trauma, such as being a victim of and/or witness to sexual abuse (Harlow, 1999).

The high prevalence of trauma histories, especially earlier life sexual victimization, within the incarcerated older adult offenders is a major concern. If these traumatic histories go unidentified and untreated, it is likely that unresolved subjective distress about these past events may be heightened, resulting in persistent or resurfacing of post-traumatic stress symptoms or increased likelihood of criminal offending including the perpetration of sexual abuse (Leach, Burgess, Holmwood, 2008). Identifying the types of traumatic experiences, particularly sexual abuse histories, experienced by older adult offenders is important to developing comprehensive approaches to assessment, treatment and program planning for older adults in prison (Dawes, 2009; Rikard & Rosenberg, 2007; Shimkus, 2004). While there are various types of traumatic and stressful experiences in the lives of incarcerated older adults, sexual victimization is an area that demands individualized attention, especially given the high rates of sexual victimization histories prior to prison that occur within this population. For instance, traumatic sexual victimization experiences among offenders occur

Sexual Abuse Histories Among Incarcerated Older Adult Offenders: A Descriptive Study 23

health disorders. It is imperative to consider such theoretical understandings of trauma in the discussion of incarcerated offenders as difficulty regulating affect and inability to control

More recent studies have begun to expose the life course experience of older adults in the criminal justice system (Maschi, Dennis, Gibson, MacMillan, Sternberg, Hom, 2011). For example, in a review of case records, Haugebrook, Zgoba, Maschi, Morgen, & Brown (2010) found upwards of 80% of older males in prison had documented histories of one or more traumatic or stressful life events that occurred during childhood and/or adulthood. About 20% had childhood sexual or physical assault histories. These traumatic experiences ranged from a single event to multiple traumatic and related stressful life events. Being a victim of childhood physical or sexual abuse is an example of a singular traumatic event of significant magnitude that has been linked to later life adverse mental and physical health among older adults (Lamet, Szuchman, Perkel, & Walsh, 2009; Shmotkin & Barilan, 2002). Other studies with incarcerated women find an even higher rate of sexual abuse histories (McDaniel-Wilson & Belknap, 2008). For example, McDaniels-Wilson and Belknap (2008) found that 70% of their sample of 391 incarcerated women had been raped at least once, while half of them endorsed a history of childhood sexual abuse. Not only do many prisoners come into the system with a history of sexual abuse, but there are also frequent reports of sexual

For trauma victims in prison, the prison environment itself is an additional source of trauma and stress, especially among older offenders (Goff. Rose, Rose, & Purves, 2007; Stojkovic, 2007). Struckman-Johnson and colleagues (1996) report that in a sample of 1,800 adult offenders (in which 8% of the sample was aged 48 and older), 1 out of 5 were found to have been pressured or forced to have at least one unwanted sexual contact, including anal, vaginal, or oral intercourse, or being a victim of gang rape. The agency, Stop Prisoner Rape, also reports that there were frequent rapes and other forms of sexual abuse being perpetrated by correction officers within the prisons (Stop Prisoner Rape Report, 2003). In addition, offenders with histories of sexual abuse compounded with other traumas are more vulnerable while in prison. For example, Hochstetler, Murphy, and Simons (2004) found

It is imperative to consider the additional risk that older age places on incarcerated offenders with regard to past and present sexual victimization. For instance, incarcerated older adults are considered at the highest risk for victimization because of their decreasing ability to defend themselves against younger prisoners or staff (Dawes, 2009). Along the same lines older adults in frail health are at higher risk of all forms of elder abuse, which could include sexual assaults, in prison (Goff et al., 2007; Stojkovic, 2007). Furthermore, older adult offenders also have additional age specific stressors, such as concerns over failing health and the fear of dying in prison (Aday, 2006; Marushak, 2008), in addition to the physical vulnerabilities presented by the aging process. This cumulative effect of trauma and stress can have a significant adverse

These age related health and mental health factors are extremely important to consider for a number of reasons. First, Draper and colleagues (2008) found that older adults in the community with childhood physical and sexual abuse histories were at the highest risk of later poor physical health and mental health compared to those who did not have these

impulse can lead to many illegal behaviors and consequently a prison sentence.

**3. Sexual abuse among older adults in prison and the community** 

violence occurring within the prison systems (Maschi et al., 2011).

that prior victimization experiences predicted revictimization in prison.

effect on their physical and mental well-being (Maschi et al., 2011).

at much higher rates than in the general population (Teplin, 1990). Individuals who experienced traumatic experiences prior to prison have a greater likelihood of experiencing revictimization while in prison (Struckman-Johnson, Struckman-Johnson, Rucker, Bumby, and Donaldson, 1996). Failure to recognize and design appropriate responses and interventions to address sexual abuse and the cycle of "retraumatization" and its concomitant risks of sexual abuse perpetration, may result in ongoing uninterrupted trends of trauma experiences among older adults in prison who themselves are victims in urgent need of specialized care (Maschi, Gibson, Zgoba, & Morgen, 2011).

#### **2. Trauma, sexual abuse, and life course consequences**

Research indicates that childhood or adult trauma, such as being a victim or witness to sexual abuse, may have a persistent or intermittent mental or physical effect, such as continued revictimization, psychiatric disorders, maladaptive stress responses, physical disabilities, and even early death (Acierno, Hernandez, Amstadter, Resnick, Steve, Muzzy, & Kilpatrick, 2010; Gagnon & Hersen, 2000; Maschi, 2006). The type and timing of symptoms may vary. For example, subjective traumatic experiences that first occur in childhood may be accompanied by feelings of intense fear, helplessness, or horror (APA, 2000; Hiskey, Luckey, Davies, & Brewin, 2008). These feelings may occur immediately following the childhood traumatic event or remain dormant and then resurface in later life (Hiskey, Luckey, Davies, & Brewin, 2008). Evidence also suggests that when a traumatic experience is marked by intensity, duration, and chronicity, such as a prolonged exposure to sexual abuse, the likelihood of post-traumatic stress symptoms is prolonged, and may extend into later years in life (Neal et al., 1995). Research on the temporal effects of childhood trauma, especially on later life functioning, has been minimally explored. While the data are scant, findings indicate that childhood trauma exposure may result in minor psychological distress or lead to more severe mental health consequences, such as posttraumatic stress disorder (PTSD), depression, anxiety, and cognitive impairment (Maschi et al., 2011, Neal et al., 1995; Shmotkin & Litwin, 2009). It is important to note that age plays a significant role in this relationship, as older adults with earlier life trauma have been shown to have a higher risk of revictimization for elder abuse, especially if their social support network is limited (Acierno et al., 2007). Evidence suggests that older adults in prison are at an even increased risk of sexual victimization by other prisoners or staff (Dawes, 2009).

These types of childhood experiences have been found to have pronounced and long-lasting effects, especially among criminal justice populations (Abram et al., 2007; Ford et al., 2004; James & Glaze, 2006). Several mental health theoreticians have explanations for the impact of psychosocial stressors (such as being a victim and/or witness to violence, or losing a loved one) on mental health and aggressive and self-destructive behaviors (van der Kolk, McFarlane, & Weisaeth, 1996). Bessel van der Kolk (1987) offers a biopsychosocial explanation for the impact of psychosocial stressors on mental health. He sees mental health disorders as more complex than the diagnostic label given to the client. In other words, mental health disorders are not interpreted as solely biologically or genetically driven, but in fact are understood as multidimensional in nature and influenced by one's ability to cope with adverse life experiences. Van der Kolk (1987) asserts that when children experience trauma they can be deeply affected and develop jaded expectations about the world and the safety and security of their lives, and such experiences and responses may compromise their psychological, emotional, social and behavioral functioning (van der Kolk & Fisler, 1994). More specifically, van der Kolk et al. (1996) explained that traumatic experiences can consequently impact individuals' ability to regulate affect and control impulse, manifesting in symptoms of mental

at much higher rates than in the general population (Teplin, 1990). Individuals who experienced traumatic experiences prior to prison have a greater likelihood of experiencing revictimization while in prison (Struckman-Johnson, Struckman-Johnson, Rucker, Bumby, and Donaldson, 1996). Failure to recognize and design appropriate responses and interventions to address sexual abuse and the cycle of "retraumatization" and its concomitant risks of sexual abuse perpetration, may result in ongoing uninterrupted trends of trauma experiences among older adults in prison who themselves are victims in urgent

Research indicates that childhood or adult trauma, such as being a victim or witness to sexual abuse, may have a persistent or intermittent mental or physical effect, such as continued revictimization, psychiatric disorders, maladaptive stress responses, physical disabilities, and even early death (Acierno, Hernandez, Amstadter, Resnick, Steve, Muzzy, & Kilpatrick, 2010; Gagnon & Hersen, 2000; Maschi, 2006). The type and timing of symptoms may vary. For example, subjective traumatic experiences that first occur in childhood may be accompanied by feelings of intense fear, helplessness, or horror (APA, 2000; Hiskey, Luckey, Davies, & Brewin, 2008). These feelings may occur immediately following the childhood traumatic event or remain dormant and then resurface in later life (Hiskey, Luckey, Davies, & Brewin, 2008). Evidence also suggests that when a traumatic experience is marked by intensity, duration, and chronicity, such as a prolonged exposure to sexual abuse, the likelihood of post-traumatic stress symptoms is prolonged, and may extend into later years in life (Neal et al., 1995). Research on the temporal effects of childhood trauma, especially on later life functioning, has been minimally explored. While the data are scant, findings indicate that childhood trauma exposure may result in minor psychological distress or lead to more severe mental health consequences, such as posttraumatic stress disorder (PTSD), depression, anxiety, and cognitive impairment (Maschi et al., 2011, Neal et al., 1995; Shmotkin & Litwin, 2009). It is important to note that age plays a significant role in this relationship, as older adults with earlier life trauma have been shown to have a higher risk of revictimization for elder abuse, especially if their social support network is limited (Acierno et al., 2007). Evidence suggests that older adults in prison are at an even increased risk of sexual

These types of childhood experiences have been found to have pronounced and long-lasting effects, especially among criminal justice populations (Abram et al., 2007; Ford et al., 2004; James & Glaze, 2006). Several mental health theoreticians have explanations for the impact of psychosocial stressors (such as being a victim and/or witness to violence, or losing a loved one) on mental health and aggressive and self-destructive behaviors (van der Kolk, McFarlane, & Weisaeth, 1996). Bessel van der Kolk (1987) offers a biopsychosocial explanation for the impact of psychosocial stressors on mental health. He sees mental health disorders as more complex than the diagnostic label given to the client. In other words, mental health disorders are not interpreted as solely biologically or genetically driven, but in fact are understood as multidimensional in nature and influenced by one's ability to cope with adverse life experiences. Van der Kolk (1987) asserts that when children experience trauma they can be deeply affected and develop jaded expectations about the world and the safety and security of their lives, and such experiences and responses may compromise their psychological, emotional, social and behavioral functioning (van der Kolk & Fisler, 1994). More specifically, van der Kolk et al. (1996) explained that traumatic experiences can consequently impact individuals' ability to regulate affect and control impulse, manifesting in symptoms of mental

need of specialized care (Maschi, Gibson, Zgoba, & Morgen, 2011).

**2. Trauma, sexual abuse, and life course consequences** 

victimization by other prisoners or staff (Dawes, 2009).

health disorders. It is imperative to consider such theoretical understandings of trauma in the discussion of incarcerated offenders as difficulty regulating affect and inability to control impulse can lead to many illegal behaviors and consequently a prison sentence.

### **3. Sexual abuse among older adults in prison and the community**

More recent studies have begun to expose the life course experience of older adults in the criminal justice system (Maschi, Dennis, Gibson, MacMillan, Sternberg, Hom, 2011). For example, in a review of case records, Haugebrook, Zgoba, Maschi, Morgen, & Brown (2010) found upwards of 80% of older males in prison had documented histories of one or more traumatic or stressful life events that occurred during childhood and/or adulthood. About 20% had childhood sexual or physical assault histories. These traumatic experiences ranged from a single event to multiple traumatic and related stressful life events. Being a victim of childhood physical or sexual abuse is an example of a singular traumatic event of significant magnitude that has been linked to later life adverse mental and physical health among older adults (Lamet, Szuchman, Perkel, & Walsh, 2009; Shmotkin & Barilan, 2002). Other studies with incarcerated women find an even higher rate of sexual abuse histories (McDaniel-Wilson & Belknap, 2008). For example, McDaniels-Wilson and Belknap (2008) found that 70% of their sample of 391 incarcerated women had been raped at least once, while half of them endorsed a history of childhood sexual abuse. Not only do many prisoners come into the system with a history of sexual abuse, but there are also frequent reports of sexual violence occurring within the prison systems (Maschi et al., 2011).

For trauma victims in prison, the prison environment itself is an additional source of trauma and stress, especially among older offenders (Goff. Rose, Rose, & Purves, 2007; Stojkovic, 2007). Struckman-Johnson and colleagues (1996) report that in a sample of 1,800 adult offenders (in which 8% of the sample was aged 48 and older), 1 out of 5 were found to have been pressured or forced to have at least one unwanted sexual contact, including anal, vaginal, or oral intercourse, or being a victim of gang rape. The agency, Stop Prisoner Rape, also reports that there were frequent rapes and other forms of sexual abuse being perpetrated by correction officers within the prisons (Stop Prisoner Rape Report, 2003). In addition, offenders with histories of sexual abuse compounded with other traumas are more vulnerable while in prison. For example, Hochstetler, Murphy, and Simons (2004) found that prior victimization experiences predicted revictimization in prison.

It is imperative to consider the additional risk that older age places on incarcerated offenders with regard to past and present sexual victimization. For instance, incarcerated older adults are considered at the highest risk for victimization because of their decreasing ability to defend themselves against younger prisoners or staff (Dawes, 2009). Along the same lines older adults in frail health are at higher risk of all forms of elder abuse, which could include sexual assaults, in prison (Goff et al., 2007; Stojkovic, 2007). Furthermore, older adult offenders also have additional age specific stressors, such as concerns over failing health and the fear of dying in prison (Aday, 2006; Marushak, 2008), in addition to the physical vulnerabilities presented by the aging process. This cumulative effect of trauma and stress can have a significant adverse effect on their physical and mental well-being (Maschi et al., 2011).

These age related health and mental health factors are extremely important to consider for a number of reasons. First, Draper and colleagues (2008) found that older adults in the community with childhood physical and sexual abuse histories were at the highest risk of later poor physical health and mental health compared to those who did not have these

Sexual Abuse Histories Among Incarcerated Older Adult Offenders: A Descriptive Study 25

The DOC generated the sampling frame for the study with a list of names, so that invitations and anonymous surveys could be mailed to potential participants and return

The final sample size consisted of 667 English-speaking prisoners (aged 50 and older) who responded to the survey, which resulted in a response rate of 43%. This estimate falls within the higher range of expected mail response rates, which are 20-40% for prison populations (Hochstetler et al., 2004). The project was part of the Hartford Geriatric Social Work Faculty Scholars Program Award, which is funded by the Gerontological Society of America and the John A. Hartford Foundation. The study was approved by the Fordham University Institutional Review Board (IRB) and met the standards for conducting research with a

The Dillman et al. (2009) method for mailed surveys was used to maximize response rates. Specifically, potential participants received: (1) a letter of invitation; (2) a packet with a cover letter, consent form, survey, and a self-addressed electronically stamped envelope (SASE) seven days later; (3) two thank you cards and reminders sent seven days apart that included

Sexual victimization was measured using the 5 item subscale of the 31-item Life Stressors Checklist (LSC-R) (McHugo et al., 2005). The LSC-R sexual abuse subscale estimates the frequency of lifetime sexual abuse which is consistent with DSM IV-TR Criterion A for post trauma stress symptoms (APA, 2000). The LSC-R has good psychometric properties, including for use with diverse age groups and criminal justice populations. Researchers have reported that the LSC-R has demonstrated good criterion-related validity for detecting traumatic events, such as sexual abuse, among prisoners (McHugo et al., 2005). For example, McHugo et a1. (2005) collected data on 2,729 women in which a test-retest sample was completed on a subset of 186 women who completed the measure on average 7 days later.

The LSC-R enables the measurement of 'objective' sexual abuse, which is defined in this study as whether or not one or more types of sexual abuse have occurred. Sexual abuse experiences are defined as those objective events that are consistent with DSM IV-TR Criterion A for PTSD (APA, 2000). Participants endorsed across 5 items as to whether or not each of these events occurred (0 = no; 1 = yes). These items included sexual touch before and after the age of 16, sexual harassment, and sexual assault before and after the age of 16 and

1. Sexual touch before the age of 16 - "Before age 16, were you ever touched or made to touch someone else in a sexual way because he/she forced you in some way or

2. Sexual assault before the age of 16 – "Before age 16, did you ever have sex (oral, anal, genital) when you didn't want to because someone forced you in some way or

correspondence could be received.

**5.3 Constructs and study measures** 

Kappa's range averaged .70 for different items.

threatened to harm you if you didn't?"

threatened to hurt you if you didn't?"

were operationalized as follows.

**5.3.1 Objective occurrences of sexual victimization** 

**5.2 Data collection** 

special population of older prisoners and on sensitive topics.

an enclosed self-addressed envelope to request a survey replacement.

experiences. Second, Yehuda and colleagues (1995) found a positive association between childhood trauma combined with current experiences of age-related stress and the severity of post-traumatic stress symptoms among older adults in the community. Third, Hiskey and colleagues (2008) report that older adults older adults in the community, who were childhood trauma survivors, experienced later life reactivation of traumatic memories, which had intense and vivid aspects with the same subjective potency as the original traumatic event. In sum, the age-related stressors that incarcerated adults are coping with while in prison, such as increased risk of sexual victimization, can likely trigger earlier traumatic memories and experiences leading to significant impairment and potential post-traumatic stress symptoms.
