Challenging Injustice, Advancing Human Rights

New Report: Complex Trauma Disorder in Detained Refugee Mothers, Children

Nota de prensa en español

CAMBRIDGE, Mass. — Monday, October 19, 2015 — Mothers and children asylum seekers being held in U.S. detention centers are experiencing or are at risk of complex trauma disorder and interrelated health risks, according to a new report from human rights agency the Unitarian Universalist Service Committee (UUSC).

Their condition, say the team of psychologist researchers, is due in part to traumas experienced on U.S. soil at the hands of those the refugees turned to for protection.

“What this report captures is overwhelming evidence that the U.S. is violating the human rights of asylum seekers, and directly contributing to fragile states of mental health resilience,” said UUSC President and Chief Executive Officer Rev. William Schulz.

“No Safe Haven Here: Mental Health Assessment of Women and Children Held in U.S. Immigration Detention,” the UUSC report, is based on extensive, standard psychological testing, trauma assessments, and interviews with Central American parents and children in detention and newly released from Dilley and Karnes family detention centers in south Texas.

[Read the full report and the executive summary.]

Those and other released families are now awaiting their asylum case court hearings. Some were detained for more than a year.

The abuses of refugees by the privately owned detention centers’ staff have been chronicled across national media, with reports of sexual abuse, lack of medical care, threats of deportation, threats of separating mothers and children, and obstructing detainees’ rights of access to legal counsel.

“These exceptionally vulnerable, multiply traumatized refugees are subjected to human rights abuses that are endemic in how the U.S. is criminalizing the asylum process,” said UUSC’s Schulz.

The mental health assessment’s findings of a high prevalence of complex trauma disorder detail the impacts and damage to the families’ mental and physical health, resulting from cascading and varying traumas experienced first in their violent homelands of Guatemala, Honduras and El Salvador, followed by further traumas during their dangerous flights to asylum in the U.S.

Traumas continued, not relieved, on entry to U.S.

Those experiences were heightened by parents’ and children’s fresh traumas on arrival, in harsh U.S. border holding facilities — with cells infamously referred to as perreras and hieleras (dog kennels and ice boxes) — and then the subsequent and continued documented abuses the refugee families experienced during protracted detention in jail-like facilities in south Texas and Pennsylvania.

The UUSC study’s mental health research team reported “a shocking lack of mental health care at the family detention centers,” which, they say, increases the likelihood of negative mental health outcomes in already traumatized adults and children.

Complex trauma: more than PTSD

The psychologists, who assessed depression, anxiety, post-traumatic stress and other psychological and somatic markers among the adult parents and children, concluded that the experiences and physical and psychological conditions of both parents and children demonstrate the effects of complex trauma, referred to clinically as “disorders of extreme stress not otherwise specified” or DESNOS. *

Kathleen O’Connor, Ph.D., staff member of the University of Texas at El Paso School of Nursing and a member of the research team, said the researchers entered the survey project with ‘fresh eyes … open minds,” and “a neutral position on ICE and the Department of Homeland Security (DHS), and without having pored over earlier news coverage of the situation.

“That our research supports the findings in the literature as well as those of other agencies … strengthens the case for considering these centers as inhumane and counter to U.S. moral values and for closing them,” O’Connor said.

The report’s methodological testing and transcripts of family member narratives record the health and medical conditions and related poor treatment by facility staff and caregivers that have impacted the families’ mental and emotional health.

Complex trauma disorder results from repeated and often multiple kinds of traumas experienced over years, such as neglect, physical and sexual abuse, witnessing or directly experiencing domestic violence, and community violence.

In that way, it differs from symptoms of post-traumatic stress disorder (PTSD), which tends to develop from one major trauma that can be restimulated by similar, even minor, events happening in the present. As such, PTSD may also occur within the DESNOS cluster of symptoms.

Symptoms of complex trauma include but are not limited to problems with emotional regulation, difficulty with memory, chronic pain, dizziness, digestive problems, cardiovascular issues, feelings of despair and hopelessness, detachment from others and minimization.

Those symptoms were noted frequently by participants in the study and observed by the investigators.

The “No Safe Haven” report found the following:

  • The greatest stressors to mothers and children held in detention centers resulted from intense separation anxiety, threats and humiliation at the hands of prison staff, and woefully inadequate care.
  • Nearly half of all respondents reported clinically significant symptoms of PTSD.
  • More than half of all mothers and children in the study reported symptoms of depression and anxiety at rates that indicate clinically significant symptoms for anxiety and depression.

The ‘dose effect’ of multiple traumas

Experiencing multiple traumatic events has what is termed a “dose effect.” With each successive event, the individual tends to experience more intense symptoms of PTSD, depression, anxiety and behavior problems.

Mothers and children who participate in the UUSC study reported suffering as many as 15 or 20 traumatic events in their home country and during travel to the U.S. Their arrival in the U.S. was little better.

“The results of this study clearly show that these families are survivors of trauma and not criminals to be jailed,” said UUSC’s Schulz. “They are not being provided the trauma-informed care they need and deserve.”


UUSC’s Schulz said the agency’s recommendations based on the mental health report echo its broader advocacy calls concerning detention of asylum seeking families:

  • End family detention
  • Decriminalize the asylum process
  • Mandate trauma training

UUSC urges that all who participate in families’ asylum-seeking process have trauma training, including but not limited to Department of Homeland Security and border patrol agents, private prison contractors and attorneys.

Family detention trauma research: part of UUSC’s advocacy work

Kathleen O’Connor, Ph.D., University of Texas at El Paso School of Nursing; Claire Thomas-Duckwitz, Ph.D., L.P., adjunct faculty at the University of Northern Colorado; and Guillermina Gina Nuñez-Mchiri, Ph.D., University of Texas at El Paso Department of Women’s Studies, served as investigative team for the study and coauthored the report.

UUSC commissioned the mental health report as part of the agency’s vocal national advocacy on behalf of the human rights and legal rights of asylum seekers and specifically the rights of Central American mothers and children who crossed the U.S. southern border over the past year, fleeing violence in their home countries of Guatemala, Honduras and El Salvador.


* DSM-5: CONCEPTS, CHANGES, AND CRITIQUE© by Joan Turkus, M.D., (August 3, 2013), p. 3

van der Kolk, B. A., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005). Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma. J Trauma Stress, 18(5), 389-399. doi:10. 1002/jts.20047