Posttraumatic Stress Disorder and Trauma-Informed Care
Introduction
Prison and jail populations have dense and patterned concentrations of childhood and adult trauma (Wolff, 2022). The maturing effects of childhood trauma have been extensively studied for decades, with robust evidence documenting that exposure to trauma, especially during childhood, increases the likelihood of behavioral health disorders such as depression, anxiety, posttraumatic stress disorder (PTSD), and substance use disorders (SUDs; Anda et al., 2006). Related behavioral problems, including aggression and violence, may culminate in criminality (Altintas & Bilici, 2018; Widom, 1989). The connection between trauma and criminality explains, in part, the high concentrations of trauma and behavioral health disorders within incarcerated populations, but it also suggests that trauma is being criminalized (Simkins & Katz, 2002; Thordarson & Rector, 2020; Wolff, 2022). Although the interdependencies between trauma, behavioral disorders, and criminality are well established in the literature, in practice, incarcerated persons (IPs) are treated less as people in need of therapeutic help and more as threats to society. With predictability, correctional settings, replicating the traumatic stressors of childhood (Wolff, 2022), instigate criminogenic behaviors and pathologies that immediately challenge corrections management and eventually are exported back into the community upon release (Listwan et al., 2011). The cycle of violence and victimization risk continues because, when in the presence of trauma and its hydra-headed effects, the perceived threat response of IPs overrides and dominates their need for therapeutic intervention.
This chapter provides a blueprint that recognizes the reluctance of the correctional system to address trauma, the lack of funding and staffing expertise to support and sustain a therapeutically sensible response to trauma, and the superseding public health imperative to treat and rehabilitate trauma in cost-effective ways. The blueprint for action identifies promising trauma-focused interventions and recommends access and allocation principles for rationing scarce resources. It furthermore addresses principles of engagement that serve to establish and sustain the therapeutic bond between those in need and those promoting the voluntary use of available services. For the purposes of this chapter, the term “prison” refers to any correctional setting.
Citation
Wolff, N., & Lewis, C. (2025). Posttraumatic stress disorder and trauma-informed care. In R. Kapoor, A. C. Tamburello, J. L. Knoll IV, & J. L. Metzner (Eds.), Oxford textbook of correctional psychiatry (2nd ed., pp. 223โ229). Oxford University Press.