Children who witness the homicide of a parent

Shattered Voices: Daughters' Meaning Reconstruction in Loss of a Mother to Intimate Partner Homicide

Intimate partner homicide is a major public health concern around the world and the most lethal outcome of domestic violence. Its impact on the surviving bereaved offspring is immense, yet there is a significant gap in the literature regarding the long-term effects of this type of loss. The current qualitative study is aimed at filling this gap. The study used the constructivist paradigm of bereavement as a theoretical background to reveal the meanings constructed by bereaved Israeli daughters whose biological mothers were killed in acts of intimate partner homicide by their biological fathers. Three main themes of meaning emerged from 12 in-depth semi-structured interviews: "destruction of one's home"; "blast injury"; and "in doubt". An examination of the three themes in the current study reveals a deep shatter in participants' world of meaning to its very basic foundations. In light of intense psychological and social forces, the participants constructed and reconstructed such narratives of meaning in a continuous process of meaning making throughout their lives, years, and decades post loss. Derived from the findings are implications for practice. Mental healthcare professionals must attend to this basic shatter with an extreme level of caution, as they help homicide survivors reconstruct a world of meaning shattered by loss. Moreover, the long-lasting effects emphasize an appropriate legal and political involvement; specifically, policy regulations and rights should provide psychosocial care programs that are suited to the needs of offspring co-victims of intimate partner homicide in particular. In light of the strong social influence on participants' loss experience, further efforts are required to raise social awareness about this burning social concern and to fight the stigmatization of co-victims of homicide in general and co-victims of intimate partner homicide in particular.

Interventions for child and adolescent survivors of intrafamilial homicide: A review of the literature

The nature of intrafamilial homicide is complex and traumatic. Child survivors are at significant risk for maladjustment, including negative psychological sequela, grief complications, and contextual challenges associated with the homicide. Thus, children may benefit from services addressing specific psychosocial challenges following intrafamilial homicide. In this paper, we review the literature to identify trauma- and grief-informed interventions implemented for youth following violent bereavement. Given limited research on this vulnerable population, we discuss interventions that show promise for child survivors, exploring specific needs, challenges, and potential implications of these interventions for treating children and families experiencing intrafamilial homicide bereavement.

Remembering the forgotten victims: Child-Related themes in domestic violence fatality reviews

BACKGROUND

The needs of children exposed to domestic violence have been historically overlooked. One way in which service provision for children exposed to this violence can be explored is through an examination of Domestic Violence Fatality Review Teams (DVFRT's), who review cases of fatal domestic violence to identify possible areas for improvement.

OBJECTIVE

This study explored key themes relative to children exposed to domestic violence and homicide published by DVFRT's in order to identify the services that exist for children exposed to domestic violence, barriers to providing these services, and recommendations for improvement.

PARTICIPANTS AND SETTING

This study reviewed annual reports from three DVFRT jurisdictions with regular annual reports from 2004 to 2016.

METHODS

A generic thematic analysis was performed by the primary author, in consultation with the second author, in order to identify dominant themes present in the DVFRT annual reports. The analysis utilized a codebook that was created beforehand in order to capture pertinent information within the reports. Trustworthiness of the data was established through a consistent application and thorough reporting of the coding procedures.

RESULTS

The analysis highlighted key barriers to child-specific service provision among agencies involved (e.g., lack of professional training and public awareness), recommendations for enhanced intervention (e.g., enhanced child-specific services) and promising practices (e.g., policy and legislation development).

CONCLUSIONS

The three DVFRTs identified several gaps in service provision for children affected by fatal domestic violence that will require increased engagement and resources targeting these vulnerable children.

Development and testing of the Hogan Inventory of Bereavement short form for children and adolescents

To reduce response burden for bereaved children and adolescents, we provide data on the development and psychometric testing of a short form of the Hogan Sibling Inventory of Bereavement (HSIB). The resulting measure of grief symptoms and personal growth was renamed the Hogan Inventory of Bereavement - Short Form (Children and Adolescents; HIB-SF-CA). Psychometric properties were evaluated in a sample of 86 bereaved siblings. Instrument development and validation research design methods were used. Evidence of strong reliability and convergent validity indicates that the 21-item HIB-SF-CA is comparable to the original 46-item HSIB in measuring grief and personal growth in this population.

Trauma-Informed Care and Posttraumatic Growth Among Bereaved Youth: A Pilot Study

Although a fair amount has been written about posttraumatic stress disorder among bereaved children and adolescents, less has been written about posttraumatic growth (PTG) and its predictors among this population. This study examines predictors of PTG and the impact of trauma-informed care on PTG among bereaved youth. A preexperimental, pretest-posttest design was applied to measure PTG among bereaved children (N = 32) before and after attending a healing camp that provides trauma-informed care. A regression model was applied to examine predictors of PTG. Results showed that children participating in the camp increased their PTG scores to a statistically significant degree. Circumstance of death (sudden or expected) was a predictor in this study. The results are discussed in relation to limitations, implications for future research, and practice.

Children bereaved by fatal intimate partner violence: A population-based study into demographics, family characteristics and homicide exposure

BACKGROUND

In the context of violence against women, intimate partner homicide increasingly receives research and policy attention. Although the impact of losing a parent due to intimate partner homicide is intuitively obvious, little is known about the children involved. We aimed to identify all children bereaved by parental intimate partner homicide in the Netherlands in the period 2003-2012, describe their demographics and family circumstances, and assess their exposure to prior violence at home and to the homicide itself.

METHODS AND FINDINGS

We cross-examined 8 national data sources and extracted data about children's demographics and circumstances prior to, and during the homicide. Our primary outcomes were prior violence at home (child maltreatment, neglect or domestic violence) and homicide witness status (ranging from being at a different location altogether to being present at the scene). During the decade under study, 256 children lost a biological parent due to 137 cases of intimate partner homicide. On average, the children were 7.4 years old at the time of the homicide (51.1% were boys; 95% CI 47.3-54.7) and most lost their mother (87.1%; full population data). Immigrant children were overrepresented (59.4%; 95% CI 52.8-66.0). Of the children for whom information about previous violence at home was gathered, 67.7% (95% CI 59.7-73.7) were certainly exposed and 16.7% (95% CI 11.3-22.2) probably. Of the children who had certainly been exposed, 43.1% (95% CI 41.1-60.9) had not received social services or mental health care. The majority of the children (58.7%; 95% CI 52.1-65.3) were present at the location of the homicide when the killing took place, with varying levels of exposure. Homicide weapons mostly involved cutting weapons and firearms, leading to graphic crime scenes.

CONCLUSIONS

Care providers need capacity not only to help children cope with the sudden loss of a parent but also with unaddressed histories of domestic violence and exposure to graphic homicide scenes, in a culture-sensitive way. Future directions include longitudinal monitoring of children's mental health outcomes and replication in other countries.

Children's perspectives on life and well-being after parental intimate partner homicide

Background: While there is no doubt that parental intimate partner homicide is associated with strong grief and post-traumatic stress reactions among the children who have been bereaved, there is little in-depth insight into how children and young people see and describe their circumstances and needs. Objective: Our aim was to shed light on children's and young people's perspectives on their life after parental intimate partner homicide. In particular, we were interested in how they experienced their living arrangements, social environment, and general well-being. Method: We conducted semi-structured interviews with 23 children and young people (8-24 years old; 15 females and eight males) who had been younger than 18 years when one of their parents killed the other (21 children lost their mother, two children lost their father). We used thematic analysis to synthesize the findings. Results: While most participants were fairly content with themselves and their living arrangements, they also expressed substantial and persistent difficulties, including distress, conflicts between family members, and feelings of unsafety. Most importantly, children's self-image, their perspectives on their biological parents, and their views on their broader (family) environment varied considerably from participant to participant, and also between siblings. Conclusions: It is unlikely that straightforward guidelines can be given with regard to where the children should live after parental homicide, or whether they should be in contact with the perpetrating parent. Rather, this study's findings underline the need to explore children's individual viewpoints carefully during decision-making processes.

Children's Mental Health and Well-Being After Parental Intimate Partner Homicide: A Systematic Review

When one parent kills the other, children are confronted with multiple losses, involving their attachment figures and their direct living environment. In these complex situations, potentially drastic decisions are made, for example, regarding new living arrangements and contact with the perpetrating parent. We aimed to synthesize the empirical literature on children's mental health and well-being after parental intimate partner homicide. A systematic search identified 17 relevant peer-reviewed articles (13 independent samples). We recorded the theoretical background, methodology, and sample characteristics of the studies, and extracted all child outcomes as well as potential risk and protective factors. Children's outcomes varied widely and included psychological, social, physical, and academic consequences (e.g., post-traumatic stress, attachment difficulties, weight and appetite changes, and drops in school grades). Potential risk and protective factors for children's outcomes included 10 categories of pre-, peri-, and post-homicide characteristics such as cultural background of the family, whether the child witnessed the homicide, and the level of conflict between the families of the victim and the perpetrator. We integrated the findings into a conceptual model of risk factors to direct clinical reflection and further research.

Parental death during childhood and depression in young adults - a national cohort study

BACKGROUND

There are few prospective, population-based studies on childhood parental death and psychiatric disorders in adulthood, and previous findings are inconclusive. This study investigated the association between parental death from natural and external (suicides, accidents or homicides) causes before 18 years and the risk of clinical depression in young adults, in relation to age at loss and gender of both child and parent.

METHODS

In this register-based study, a national cohort born in Sweden during 1973-1982 (n = 862,554) was followed with regard to hospital admissions and outpatient care for depression during 2006-2013. Multivariate Cox proportional hazards models were used to estimate the impact of parental death, taking sociodemographic and parental psychosocial covariates into account.

RESULTS

Maternal death from natural causes was associated with a hazard ratio (HR) of outpatient care for depression of 1.19 [95% confidence interval (CI), 1.02-1.40] in men and 1.15 (1.01-1.31) in women, after adjustment for sociodemographic confounders, with similar effect sizes for paternal natural death. Death from external causes consistently had higher effect size compared with natural deaths, in particular in relation to risk of hospital admissions for depression where they were as high as HR 3.23 (2.38-4.38) for men, and 1.79 (1.30-2.47) for women after a loss of a mother. Losing a parent in preschool age, compared with losing a parent as a teenager, was associated with higher risks of both hospitalization (p = .006) and outpatient care (p = .001) for depression.

CONCLUSIONS

This study indicates that parental loss to death from natural causes during childhood is associated with a small increased risk of long-term consequences for psychological health. Children who lose their parents to death from external causes, that is suicides, accidents or homicides, and children losing a parent in young ages are, however, at particular risk and should be given priority in preventive interventions after parental loss.

An Exploratory Study of Post-Traumatic Stress Disorder Symptoms among Bereaved Children

Purpose:

This study reports on the incidence of post-traumatic stress disorder (PTSD) symptoms among a sample ( n = 46) of bereaved children. PTSD symptoms in children who have experienced loss due to an expected death through illness have not been previously studied.

Method:

An exploratory cross-sectional design was used to compare Impact of Event Scale (IES) scores between two groups of bereaved children. One group experienced the sudden, unexpected death of a family member; the second group experienced the expected death of a family member following protracted illness.

Findings:

Overall, almost two-thirds of the children were found to be experiencing moderate to severe levels of PTSD related symptoms of intrusion and avoidance as measured by the IES. Additionally, there was no significant difference in the IES scores of the two groups of children.

Implications:

Findings are discussed in relation to current practice with and research on bereaved children.

Parental intimate partner homicide and its consequences for children: protocol for a population-based study

BACKGROUND

The loss of a parent due to intimate partner homicide has a major impact on children. Professionals involved have to make far-reaching decisions regarding placement, guardianship, mental health care and contact with the perpetrating parent, without an evidence base to guide these decisions. We introduce a study protocol to a) systematically describe the demographics, circumstances, mental health and wellbeing of children bereaved by intimate partner homicide and b) build a predictive model of factors associated with children's mental health and wellbeing after intimate partner homicide.

METHODS/DESIGN

This study focuses on children bereaved by parental intimate partner homicide in the Netherlands over a period of 20 years (1993 - 2012). It involves an incidence study to identify all Dutch intimate partner homicide cases between 1993 and 2012 by which children have been bereaved; systematic case reviews to describe the demographics, circumstances and care trajectories of these children; and a mixed-methods study to assess mental health, wellbeing, and experiences regarding decisions made and care provided.

DISCUSSION

Clinical experience and initial research suggest that the children involved often need long-term intensive mental health and case management. The costs of these services are extensive and the stakes are high. This study lays the foundation for an international dataset and evidence-informed decision making.

Coping with violence: a comprehensive framework and implications for understanding resilience

Interpersonal violence is present at all levels of influence in the social ecology and can have comprehensive and devastating effects on child and adolescent development through multiple simultaneous channels of exposure. Children's experiences with violence have been linked with a range of behavioral and mental health difficulties including posttraumatic stress disorder and aggressive behavior. In this article, we offer a conceptual framework delineating the ways in which children and adolescents might encounter violence, and a theoretical integration describing how violence might impact mental and behavioral health outcomes through short- and long-term processes. We propose that coping reactions are fundamental to the enduring effects of violence exposure on their psychosocial development and functioning. Finally, we discuss the manner in which coping efforts can support resilience among children exposed to violence and suggest new directions for research and preventive intervention aimed at optimizing outcomes for children at risk of exposure.

Traumatic death at work: consequences for surviving families

Research and policy on occupational health and safety have understandably focused on workers as the direct victims of workplace hazards. However, serious illness, injury, or death at work also has cascading psychological, social, and economic effects on victims' families and close friends. These effects have been neglected by researchers and policymakers. The number of persons immediately affected by workplace death is significant, even in rich countries with relatively low rates of workplace fatality. Every year, more than 5,000 family members and close friends of Australian workers become survivors of traumatic work-related death (TWD). This study investigated the health, social, and financial consequences of TWD on surviving families. In-depth exploratory interviews were conducted with seven family members who had experienced TWD from one to 20 years before the interviews, with an average of three years. All reported serious health, social, and financial consequences, including prolonged grief and unresolved loss, physical health problems, family disruption and behavioral effects on children, immediate financial difficulties, and disturbance of longer-term commitments such as retirement planning. Recommendations for policy development and improved practice are proposed to minimize the trauma and suffering experienced by families, mitigate consequences, and improve outcomes following a TWD.

Healing components of a bereavement camp: children and adolescents give voice to their experiences

This qualitative study is the follow-up to a quantitative controlled study which showed a decrease in childhood traumatic grief and posttraumatic stress disorder symptoms in parentally bereaved children participating in a bereavement camp. The purpose of this study was to identify the healing components of this camp model. Semi-structured interviews with 19 children and 13 parents/guardians were conducted 3 to 9 months after participation in the bereavement camp. Therapeutic Interventions and Traditional Camp Activities emerged as themes. The themes are discussed in relation to previous research as are limitations of the study and the implications for theory, practice, and future research.

Associations between prolonged grief disorder, depression, posttraumatic stress disorder, and anxiety in Rwandan genocide survivors

A number of studies have demonstrated that symptoms of prolonged grief disorder (PGD) represent a symptom cluster distinct from bereavement-related depression, anxiety, and posttraumatic stress disorder (PTSD). The aim of the present study was to confirm and extend these findings using the most recent criteria defining PGD. The authors interviewed a total of 400 orphaned or widowed survivors of the Rwandan genocide. The syndromes were strongly linked to each other with a high comorbidity. Principal axis factoring resulted in the emergence of 4 different factors. The symptoms of depression, along with the cognitive, emotional, and behavioral symptoms of PGD, loaded on the first factor, symptoms of anxiety on the second factor, symptoms of PTSD on the third factor, and the separation distress symptoms of PGD on the fourth factor. This indicates that the concept of PGD includes symptoms that are conceptually related to depression. However, the symptom cluster of separation distress presents a grief-specific dimension that may surface unrelated to depressive symptoms.

Adolescents' experiences with uxoricide

The purpose of this study was to describe the experiences of individuals who survived the loss of one or both parents through parental homicide or homicide/suicide as adolescents. Participants (N = 34) were aged between 12 and 19 years at the time of the death and were aged between 29 and 64 years at the time of the interview. Participants were interviewed twice and asked to tell the story of their lives. Data were analyzed in the hermeneutic phenomenological tradition using a stepwise process of developing categories and then a single complex theme. Common categories of participants' childhoods included abuse both before and after the uxoricide and vivid memories of the homicide. As adults, most participants reported difficulties with intimate relationships, legal problems, and substance use. Integrity was an overarching theme for these participants. Among those who had integrated the story of the homicide into their adult lives, some believed that they were doing well whereas others did not. Some participants had isolated the event and considered that they were doing well as a result. These findings are limited by the convenience sample but offer a rich portrait of the lives of individuals who experienced uxoricide as adolescents. Clinicians might be advised to tread carefully if individuals report that they have isolated rather than integrated the uxoricide into their adult lives. No evidence exists in support that either stance is preferable.

The Prevalence of Childhood Traumatic Grief—A Comparison of Violent/Sudden and Expected Loss

The purpose of this study was to examine the prevalence of childhood traumatic grief (CTG) and posttraumatic stress disorder (PTSD) symptoms in parentally bereaved children and compare scores between those who had lost a parent to a sudden/violent death and those who had lost a parent to an expected death. Asample of 158 parentally bereaved children ages 7–16 completed the Extended Grief Inventory (EGI); 127 of those also completed the UCLA PTSD Index. A large number of children were experiencing CTG symptoms at moderate and severe levels. There was no significant difference in EGI or UCLA PTSD Index scores between the two types of losses. Findings are discussed in relation to trauma theory, research on parentally bereaved children and implications for practice.

Prolonged Grief Disorder and Depression in Widows Due to the Rwandan Genocide

Should pathological grief be viewed as a nosological category, separate from other forms of mental diseases? Diagnostic criteria for “Prolonged Grief Disorder” (PGD) have recently been specified by Prigerson and her coworkers. We interviewed a total of 40 widows who had lost their husbands during the Rwandan genocide in 1994. We assessed Major Depression using the Mini-International Neuropsychiatric Interview (M.I.N.I.) and prolonged grief reactions with the PG-13. In order to examine the distinctiveness of the two syndromes we performed a multitrait correlational matrix analysis using modified versions of Generalized Proximity Functions (GPFs). 12.5% ( n = 5) of the sample fulfilled the criteria for a diagnosis of PGD; 40% ( n = 16) met criteria for Major Depressive Episode. The two syndromes were strongly associated. No discriminant validity was found between the two constructs suggesting that PGD may rather be an appearance of depression than a separate nosological entity.

Forgiveness, and other themes, in women whose fathers killed their mothers

The purpose of this article is to describe the experiences of adult women who, when they were children, experienced the homicide of their mother by their father. Two qualitative interviews were conducted with a convenience sample of 31 women survivors of uxoricide to create a qualitative description of the phenomenon. A number of themes have emerged including descriptions of the daughter "seeking understanding," "forgiving the father" (or not), and descriptions of the father in terms of his being her father or in terms of his behavior and the homicide.

Adult perspectives on growing up following uxoricide

The purpose of this article is to provide an overview of the state of the science on uxoricide, including qualitative findings on 47 survivors. Two qualitative interviews were conducted between January 2004 and January 2005 with 47 convenience sample adult survivors of uxoricide. Data were analyzed using hermeneutic analysis. A number of themes emerge, such as later experiences with violence, including sexual abuse as a child; family difficulties in speaking about the death; the need to learn about the homicide as an adult as well as a need to reconnect with and forgive the assailant; and the importance of a caring adult to provide stability.

Talking about talk: the experiences of boys who survived intraparental homicide

This article describes the experiences of men who experienced intraparental homicide (one parent killing the other parent) when they were boys. Twenty-one men were interviewed twice and data were analyzed using a hermeneutic approach. In this article we examine a topic that emerged as a core problem for these men, specifically, how they talked (or did not talk) about the homicide. Understanding intraparental homicide may provide information to guardians and professionals about what some male children need after such an event.

The long-term consequences of early childhood trauma: a case study and discussion

There is a great need to better understand the impact of traumatic events very early in life on the course of children's future development. This report focuses on the intriguing case of a girl who witnessed the murder of her mother by her father at the age of 19 months and seemed to have no recollection of this incident until the age of 11, when she began to exhibit severe symptoms of posttraumatic stress disorder (PTSD) in response to a traumatic reminder. The case presentation serves as the basis for a discussion regarding pertinent issues involved in early childhood trauma. This case and accompanying discussion were originally presented at the 19th Annual Meeting of the International Society for Traumatic Stress Studies and were transcribed and revised for use in this article. Specific topics include early childhood memory and trauma, learning and the appraisal of danger, and PTSD and traumatic grief in early childhood. Clinical and public health implications are also discussed. This case illustrates the dramatic impact that "preverbal" traumatic memories can have on children's later functioning and speaks to the importance of assisting very young children in the immediate aftermath of traumatic events.

Cries from the morgue

TOPIC

Family member homicide.

PURPOSE

To explore the unique facets of bereavement for a family member of a homicide victim in order to assist clinicians during assessment, evaluation, and intervention with children.

SOURCES

The authors' experience in working with children at a child grief center and published literature.

CONCLUSIONS

Children experience grief uniquely and use differing methods of coping and adaptation. Knowledge of these differences can assist clinicians with promotion of adaptive coping and grieving in children who have been exposed to murder.

BEREAVEMENT BY TRAUMATIC MEANS: THE COMPLEX SYNERGY OF TRAUMA AND GRIEF

When people lose intimates unexpectedly, in particular from malicious acts of violence, they are at risk for chronic grief reactions. The phenomenology, clinical symptoms, clinical needs, and risk factors associated with loss by traumatic means and the combined influences of loss and trauma exposure are yet to be systematically studied. We review the complex interplay between trauma and loss by traumatic means. The distinctions between normal and traumatic loss, and complicated and traumatic grief, are contrasted with the traditional conceptualization of posttraumatic stress disorder. The role of various mediators such as concurrent or life-span trauma exposure and interpersonal factors, particularly the degree of attachment to the individual or group traumatically lost, is discussed. We offer a more integrated and focused view of traumatic grief, its predictors, and future directions for the integrative study of trauma and loss outcomes.

Child and Adolescent Homicide Survivors

The act of homicide may influence the worldviews of children and adolescents. Problematic beliefs of uncertainty, inadequacy, perceiving the world as dangerous, self-denial, and lack of control can contribute to complicated grief in children and adolescents, and can potentially disrupt their normal psychosocial growth and development. Mental health professionals' understanding of grief after the homicide of a family member enhances their ability to intervene with and support young people struggling to cope with and adapt to a sudden loss.

Mental health service utilization by victims of crime

Records of 318 adult and 608 child victims of crime, eligible for Crime Victims Compensation (CVC) in Washington State, were examined. Demographic, crime, and mental health information was collected. A majority of child victims had experienced sexual assault (88%); adults were victims of both sexual (38%) and physical assault (40%). The median number of mental health sessions used by children was 23 sessions, at an average cost of $975 per case to the CVC program. Adults used a median of 15 mental health sessions at a cost of $905. Patterns of treatment utilization were associated with some demographic, crime, and psychological variables. Sexual assault and PTSD diagnosis were associated with greater use for both children and adults. Therapist variables were unrelated to use. Findings are discussed in light of concerns about coverage of mental health services.

Precursors of lethal violence: a death row sample

A qualitative methodology based on the standards of criminal defense investigation was used to analyze the social and family histories of 16 men sentenced to death in California. Using a multisource cross-validation methodology, we assessed patterns of impairment, injury and deficit at each of four ecological levels: family, individual, community and social institutions. Investigation documented consistent and pervasive patterns of serious impairment, injury and deficit across the cases and levels. The men share numerous risk factors and few resiliency factors associated with violence. We found family violence in all 16 cases, including severe physical and/or sexual abuse in 14 cases; individual impairments in 16, including 14 with post-traumatic stress disorder, 13 with severe depression and 12 with histories of traumatic brain injury; community isolation and violence in 12; and institutional failure in 15, including 13 cases of severe physical and/or sexual abuse while in foster care or under state youth authority jurisdiction. Appropriate interventions might have made a difference in reducing lethal violence and its precursor conditions.

Autobiographical memory and trauma in adolescents

Several clinicians who work with traumatized children have noted that these children exhibit a poor autobiographical memory. The present study was a first attempt to subject this clinical impression to formal testing. Memory for autobiographical facts (i.e., semantic autobiographical memory) was assessed in 10 adolescents with an alleged history of trauma and 17 adolescents without such a background. Results suggest that traumatized adolescents, indeed, have more difficulty with semantic personal memory than non-traumatized adolescents. Implications of the present findings for future research on trauma and autobiographical memory in children and adolescents are discussed.

The impact of children witnessing violence

Over the past decade, Americans have recognized that violence has deeply permeated the lives of the most vulnerable among us--children. There is great concern over the effect these terrible experiences will have on present and future generations. It has also awakened the collective consciousness of our society that the impact of violence extends well beyond the child who is physically victimized to other larger groups of children such as those who witness these events. This article reviews the impact violence has on children.

Post-traumatic stress and coping in an inner-city child. Traumatogenic witnessing of interparental violence and murder

Violence today appears to be ubiquitous: it even enters the clinical session, deeply internalized within child victims who were exposed to often unspeakable horror. Violence and its pernicious, horrific effects are observed in the streets, schools, parks, playgrounds, and homes of some inner-city communities. This article introduces the use of Anna Freud's Diagnostic Profile system with an inner-city child who, at the age of four, witnessed his mother fatally stab his father with a kitchen knife and at age eleven was assessed and treated by the author. Clinicians may wonder whether any kind of therapy could ever undo the serious fixations, regressions, developmental arrests, and integrate trauma-shattered ego functions observed in children exposed to visual horror and affective terror. Application of the Profile may offer some direction with these children: a panoramic view of their painful mood, their hypervigilance and distrust, fears, separation and annihilation anxieties, nightmares (with murder imagery), developmental anomalies and arrests is presented with clarity and force. The therapist uses countertransference responses to monitor the affect tolerance in the child and to determine the appropriate dosages of awareness the child can integrate from one moment to the next. The therapist also serves as the child's external stimulus barrier and explores feelings about media-driven portrayals of violence, stereotypes, and inner-city children and youths. The unsurpassed utility of the Profile as a diagnostic system that documents vital economic, dynamic, structural, genetic and adaptive-coping information about the child is discussed in detail as is the Profile's added benefit of possibly guarding against misdiagnosis and charting a course for psychotherapy in difficult city-violence trauma cases.