The Experiences of Adults Exposed to Intimate Partner Violence as Children: An Exploratory Qualitative Study of

Resilience and Protective Factors

Staci L. Suzuki Robert Geffner

Steven F. Bucky

ABSTRACT. Research indicates a large percentage of children exposed to intimate partner violence (IPV) experience psychological, social, cognitive, behavioral, and physical problems. These deficits can have overwhelming long-term problems for children. Although there is some evidence of the

Staci Suzuki, PsyD, has worked as a group facilitator with both children and adults throughout her career. Her work has included domestic violence intervention, program management, special education services, and the delivery of cognitive- behavioral therapy. She is currently a treatment coordinator and licensed psycholo- gist at Alvarado Parkway Institute in San Diego, CA.

Robert Geffner, PhD, ABPN, ABPP, is the Founding President of both the Family Violence & Sexual Assault Institute, and the Institute on Violence, Abuse, and Trauma at Alliant International University in San Diego. He is also a Clinical Research Professor at the California School of Professional Psychology at Alliant.

Steven F. Bucky, PhD, is Professor of Psychology, the Director of Profes- sional Training, and the Interim Systemwide Dean at the California School of Professional Psychology, Alliant International University, San Diego, CA.

The authors would like to thank Nancy E. Johnson, PhD, JD, for her assis- tance and guidance in the completion of this research study.

Submitted for publication 4/18/2007; revised 10/21/2007; accepted 1/6/2008. Address correspondence to: Staci L. Suzuki, Alvarado Parkway Institute Out-

patient Services El Cajon, 215 West Madison Avenue, El Cajon, CA 92020 (E-mail: [email protected]).

Journal of Emotional Abuse, Vol. 8(1/2) 2008 Available online at http://jea.haworthpress.com

© 2008 by The Haworth Press. All rights reserved. doi: 10.1080/10926790801984523 103

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intergenerational cycle of violence, not all children exposed to IPV encounter abuse in their adult relationships. This study qualitatively explored the protective factors or resiliencies that contribute to adaptive outcomes of adults exposed to IPV as children. Ten major and five minor themes emerged from this analysis. These themes were organized into internal factors/individual characteristics, family factors, and external fac- tors. Implications for practice are also discussed.

KEYWORDS. Risk factors, exposure to intimate partner violence, exposure to intimate partner abuse, qualitative research

Approximately 3 to 10 million children are exposed to intimate partner violence (IPV) annually (Carlson, 1984; Straus, 1992). According to a recent study, 16-25% of children in two-parent households reported exposure to IPV (Osofsky, 2003). Furthermore, children exposed to IPV usually observe more than one abusive incident between their parents (Straus, 1992).

Studies indicate that the effects of exposure to IPV can lead to emo- tional, behavioral, social, cognitive, and physical health problems (Fantuzzo & Mohr, 1999; Miller-Perrin & Perrin, 1999; see also Kracke & Hahn, 2008, this issue) both in the short and the long term. Children exposed to IPV often leam abusive behaviors and responses to violence from modeling and watching their parents problem-solve. As a result, many of these children become aggressive and/or passive in their later intimate relationships (Kantor & Jasinski, 1998).

Most research focusing on the short- and long-term effects of child- hood maltreatment has investigated the negative pathways and psychopa- thology associated with development (e.g.. Heller, Larrieu, D'Imperio, & Boris, 1999; see also Gewirtz & Medhanie, 2008, this issue). However, these studies have led to "many negative assumptions and deficit-focused models about children growing up under the threat of disadvantage and adversity" (Masten, 2001, p. 227). In contrast, resiliency research investi- gates the strengths of children exposed to trauma and has since reversed some ofthe negative hypotheses (Heller et al., 1999; Masten, 2001).

Resilieney and Assoeiated Protective Factors

"The Chinese symbol for the word 'crisis' is a composite of two picto- graphs: the symbols for 'danger' and 'opportunity'" (Walsh, 1998, p. 7).

Suzuki, Geffner, and Bucky 105

Resilience can thus be conceptualized as a process that encapsulates these two symbols. Individuals exposed to trauma overcome adversity in their lives by tapping into their strengths and utilizing effective coping mecha- nisms (Rutter, 1993). Children who demonstrate the ability to overcome the negative effects associated with exposure to IPV are considered resilient.

Protective factors associated with resilience are assumed to assist with adaptive functioning when facing adversity. Protective factors are those aspects that help to moderate the effects of stress. These factors also have varying definitions. Heller et al. (1999) noted that many researchers view protective factors based on three general principles of the ecological model: "(1) dispositional/temperamental attributes of the child [e.g., responsiveness, independence, intellectual abilities]; (2) a warm and secure family relationship; and (3) the availability of extrafamilial support [e.g., peers, teachers]" (p. 326). The current study identified these areas as internal factors/individual characteristics, family factors, and external factors.

The Current Study

The purpose of the present research was to qualitatively investigate the protective factors that assist in the resiliency process for individuals exposed to IPV as children. In-depth semi-structured interviews with adults exposed to IPV as children provided an understanding into the experiences and perceptions of resilience. By understanding the protec- tive factors in the family that contribute to resilience, clinicians may be better equipped to assist children in overcoming the trauma associated with exposure to IPV.

METHODS

Criteria for Inelusion/Exclusion

The following were the inclusion criteria for this study. Eligible partic- ipants had to be adults who: (a) were exposed to IPV in the household in which they were reared; (b) were in nonviolent heterosexual romantic relationships; and (c) had normative mental health, as assessed by the Detailed Assessment of Post-traumatic Stress (DAPS; Briere, 2001) and the Personality Assessment Screener (PAS; Morey, 1997). Adults who were the victims of childhood physical/sexual abuse and those with

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substance/alcohol abuse problems, as measured by the Michigan Alcohol- ism Screening Test (MAST; Selzer, 1971) and the Drug Abuse Screening Test (DAST; Skinner, 1982), were excluded.

Participants

Participants were two men and eight women who met the above eligi- bility criteria. They ranged in age from 23 to 35 years (M = 29.5, SD = 3.8). Table 1 provides a complete demographic description of the 10 participants.

Measures

Revised Conflict Tactics Scale-Form CA (CTS2-CA)

The CTS2-CA Straus, Hamby, & Warren, 2003 was used to confirm participants' perceptions of exposure to IPV as a child. It is a paper-and-pen measure consisting of 62 items that takes approximately 15 minutes to administer (31 statements assess paternal conflict strategies and 31 items measure maternal conflict strategies). The items are answered on an eight-point Likert scale based on a timeline from "once that year" to "this never happened." The CTS2-CA consists of four scales. The negotiation scale represents the amount of problem-solving strategies used in intimate relationships, with raw scores ranging from 8 to 120. The psychological aggression scale indicates the amount of "verbal and symbolic acts" expected to cause psychological harm, with raw scores ranging from 0 to 117. The physical assault scale represents the amount of physical abuse in an intimate relationship, with raw scores ranging from 0 to 61. Finally, the injury scale indicates the amount of injuries that occurred as a result of IPV, with raw scores ranging from 0 to 4.

Each participant was asked to rate a series of statements about their mothers' and fathers' (or stepmothers' and stepfathers') relationship when they were approximately 12 years old. They were also given the option of endorsing any item that occurred prior to or after the age of 12. Any endorsement that happened before or after the stipulated age was tal- lied and recorded.

The Detailed Assessment of Posttraumatic Stress (DAPS)

The DAPS was used to assess the amount of trauma that participants perceived to result from exposure to IPV and to screen for Acute Stress Disorder (ASD) and Post-traumatic Stress Disorder (PTSD) {Briere,

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2001). The measure consists of 104 statements and takes approximately 20-30 minutes to complete. Respondents are asked to select one of five categories ranging from "in the last day" to "a year ago or longer" based on the time that is most accurate for each statement. The DAPS is com- posed of 2 validity and 11 clinical scales. It also includes three PTSD symptom clusters (re-experiencing, avoidance, hyperarousal) and three associated features of PTSD (dissociation, substance abuse, suicidality) related to a particular traumatic event. Results on the DAPS produce a provisional diagnosis of PTSD or ASD based on the Diagnostic and Statistical Manual of Mental Disorders (APA, 2000) criteria.

Personality Assessment Screener (PAS)

The PAS was used to assess for normative mental health, and was developed by Morey as both a brief assessment of mental health and a tool to identify clinical issues Morey, 1997. It consists of 22 items, each assessing the degree to which a particular symptom has caused discomfort in the respondent. Symptom distress is rated on a four-point Likert scale ranging from "false" to "very true." The items generate a total score and 10 "element" subscales that correspond to psychological symptoms including: negative affect, psychotic features, suicidal thinking, anger control, acting out, social withdrawal, alienation, health problems, hostile control, and alcohol problems. High scores indicate a high likelihood of problematic psychological functioning in the participant. Any score above 50 is considered in the clinical range (Morey, 1997). Raw scores on the PAS were converted into P-scores. A P-score of 50 or more indicates that a person has a 50% chance of exhibiting some type of clinical problems. For the purpose of the current study, a person who exhibited normative mental health was considered resilient.

The Michigan Alcoholism Screening Test (MAST) and the Drug Abuse Screening Test (DAST)

The MAST and DAST were used to assess for alcohol abuse and abuse of prescription and illegal drugs, respectively, in the past 12 months; (Selzer, 1971; Skinner, 1982). The MAST consists of 25 items and the DAST 28 items measured on dichotomous (yes/no) scales. The MAST is scored by adding the points for each "yes" answer. Items are weighted and behaviors or feelings that are especially indicative of a problem with alcohol are weighted more heavily. An overall score of three or less indi- cates no difficulties with alcohol, while a score of four indicates possible

Suzuki, Geffner, and Bucky 109

alcoholism and a score of five or more is indicative of alcoholism (Selzer, 1971). For the DAST, the total score is achieved by adding all endorsed items in the direction of drug abuse problems within the past 12 months. Each item is weighted equally, and total scores can range from 0 to 28, with higher scores indicating a greater degree of problems with drug abuse. Individuals scoring five points or more are very likely to be sub- stance abusers or substance dependent. For the purpose of the current study, a person who did not have an alcohol or substance abuse problem was considered resilient.

Procedures

Flyers were placed around college campuses in San Diego, California, as well as free and paid advertisements in local newspapers. Potential par- ticipants voluntarily completed a demographic screener/questionnaire. Individuals who qualified were then invited to participate. A total of 121 people were screened and 19 qualified for further participation in the study. Of the 19 qualifying participants, three missed their scheduled appointments (one declined to reschedule and two could not be contacted to reschedule) and six did not meet the established criteria based on the written measures, resulting in 10 participants who met eligibility criteria.

After completion of the eligibility screening measures, eligible partici- pants completed a semi-structured, in-depth interview. Interview topics included the participant's experiences of exposure to IPV as a child and the internal/individual characteristics, family, and external factors that contributed to his/her resilience. Interview questions were based on themes suggested by the literature regarding resilience. After completion of the interview, each participant was verbally debriefed. At the end of debriefing, interview participants received a $50 incentive. All proce- dures were reviewed and approved by the Institutional Review Board at the California School of Professional Psychology at Alliant International University.

RESULTS

Eligibility Screening

Table 2 depicts the scores of each participant on the CTS2-CA. Based on a clinical interpretation of these data, results indicate that all partici- pants were exposed to IPV as children. Table 3 displays participants'

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T-scores on the DAPS scales. Of the 10 participants, none met the criteria for a diagnosis of either PTSD or ASD.' Several of the participants did, however, experience some type of trauma as a result of the exposure to IPV. Seven of the participants' T-scores were clinically significant in the Peritraumatic Distress scale (PDST; T-scores 65-75), indicating that the individual experienced emotional and cognitive stress during the time of the traumatic event. Three participants endorsed items for the Peritrau- matic Dissociation scale (PDIS), suggesting that the individuals dissoci- ated during the traumatic event. P-scores on the PAS ranged from 5.7 to 48.9, with a mean of P-score of 31. The scores for Kirsten and Roseanne (P-scores of 5.7 and 14.1, respectively) indicated that it is unlikely that they have any identifiable clinical problems. Lastly, participants' scores on the MAST and DAST ranged from 0-3, indicating that substance or alcohol abuse issues were unlikely.

Major and Minor Research Findings Based on Interviews

The results of the qualitative analyses of the interview data yielded major and minor themes that were grouped into three categories. These categories included internal factors/individual characteristics, family fac- tors, and external factors. Major themes were defined as being endorsed by 80% or more of the participants, and minor themes were endorsed by 50-70% of the participants.

Internal Factors/Individual Characteristics

Planning and Pursuing Goals

Nine participants viewed themselves as oriented to achieving future goals. They were optimistic and hopeful of the future and planned to achieve their personal and professional objectives. Josie and Roseanne indicated that planning for the future was their way of creating structure and having a stable environment. In fact, Roseanne believed her unstable childhood experiences may have carried over into her adult life and now she "wants everything to be very stable, very goal-oriented, organized."

Academic Success

Nine participants reported that they were successful academically. The demographic information obtained from the participants provided some supporting evidence for this factor. All 10 participants had finished high school, two completed some college, three were college graduates, and

Suzuki, Geffner, and Bucky 113

four earned Master's degrees. The participants also valued education as a way to improve their lives, and indicated that they were smart. Marissa, Cindy, and Roseanne stated that they were in accelerated classes, while Josie, Kirsten, and Gina reported that they experienced educational diffi- culties but had managed to overcome those challenges. These two opposing experiences exemplified the complexity of this factor. A person may feel adept because they earn high grades or they may feel proficient because they met and exceeded expectations despite the learning difficulties. In either case, the participants believed that their academic success was a factor to their resilience.

Internal Locus of Control

An internal locus of control was identified as important by eight participants. They described having control and structure in their lives. Additionally, the participants attributed their success to their perseverance and hard work. They also reported that they often felt unstable and encountered unpredictable family situations when growing up. Thus, it is reasonable to consider that they felt the need to control their environments in order to maintain stability in their lives.

Regulating Emotions

Eight participants reported that they adequately controlled their emotional states and were able to do so with relative ease. In particular, they believed that it was easier to control positive feelings rather than negative emotions. For example, Marissa, Gina, and Kirsten disclosed that it was difficult to manage their anger. The participants described avoiding negative emotional experiences, especially feelings they associ- ated with the IPV (e.g., anger), and did not believe that they handled those feelings adequately. Thus, these individuals were focused on maintaining a more stable emotional state.

Generally Positive Perception of Self

Many participants described having generally positive self-perceptions. Additionally, they characterized their self-esteem as usually high or ade- quate. They demonstrated their confidence in a variety of professional and personal situations. For the participants, having a strong sense of self was related to overall positive perceptions of their persona. These individual characterized themselves as caring, sensitive to others, intelligent, easy- going, good-humored, and light-hearted. Additionally, these favorable

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characteristics were associated with other protective factors identified during their interviews. For example, Marissa identified being intelligent and reported that she experienced a high degree of academic success, which then reinforced her positive self-image.

Learning from Past Experiences

The aggression experienced in childhood was not a strong reinforcer for the adults in this study, and eight participants shared how they had learned from their past experiences. Although Claire, Cindy, and Kirsten admitted having abusive relationships in the past, their current intimate relationships were not violent. In fact, participants who endorsed this theme suggested that they did not desire to behave or observe their partner engaging in a manner similar to the IPV to which they were exposed during childhood. Each individual described how they made a strong commitment not to engage in IPV.

Family Factors

Closeness to Someone in their Family of Origin

Despite childhood exposure to IPV, nine participants stated that they were close to a member of their families of origin. Two of these nine indi- viduals identified a general closeness in their families of origin. Seven participants were close to a parent, while five reported being connected to a sibling. Kirsten described being particularly close to her mother when her father acted out aggressively. Some participants identified characteris- tics of respect and nurturing in their relationships with family members. For example, Cindy appreciated the care and availability of her mother. Thus, it appears that closeness to a family member is an essential buffer for adults exposed to IPV as children.

Physical Distance from Family of Origin

Six participants revealed that physically distancing themselves from their families of origin was important to their positive adjustment. This minor theme presents potentially new information about resilience among adults exposed to IPV as children. It appears logical that these individuals needed to individuate from their families of origin. In fact, Peter and Kirsten specifically addressed separation and individuation. Another rea- son for removing themselves physically from their families of origin was a means to create and maintain manageable boundaries with their parents.

Suzuki, Geffner, and Bucky 115

For example, Claire reinforced her decision to move 3000 miles away from her parents and added that she was in control of how much time she invested speaking with her parents.

This theme interacted with others presented previously, particularly the internal factors or individual characteristics. High self-esteem and posi- tive perceptions of self are concepts associated with the task of develop- ing a strong sense of self while separating and individuating from the family of origin. Having an internal locus of control is a factor that relates to being able to manage relationships with family members while main- taining a sense of self. Thus, individuation from family members appears to be an important feature to the resilient process.

Accepting Family of Origin Imperfections

The ability to accept flaws in their families of origin was a factor endorsed by six participants. These individuals recognized the imperfections of their parents and their parents' relationship. This finding is interesting as it demonstrates a unique concept associated with resilience among adults exposed to IPV as children. That is, participants demonstrated the ability to evaluate and accept the imperfections in their families of origin while developing a sense of self separate from them. For example, Marissa shared that while she did not always understand her parents' rela- tionship, she felt a part of the family.

Retaining Family of Origin Values

Five participants reported that they maintained values that they learned from their families of origin. Evaluating the beliefs learned from the family of origin is a component of developing autonomous values. For example, Josie recognized that her orientation toward future goals was directly related to being raised in an environment that values pursuing goals. Thus, retaining family of origin values is connected to the development of a sense of self that is related to the process of resilience among adults exposed to IPV as children.

Developing a Closer Relationship with a Parent

Reconnecting with a parent was identified by five participants as a pos- itive step in their development. For example, Gina described confronting her father about her negative experiences in childhood. Through this open dialogue, she was able to reconnect with her father and increase a level of emotional intimacy.

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External Factors

Social Support System

Probably the most significant finding in the current study is that all 10 participants addressed the importance of a social support system. They felt secure in their relationships with others and described maintaining stable friendships. Social support is a critical component to resilience for several reasons. First, the individual searches for support outside the more unstable and volatile family system. For example, Cindy recognized that her friends were the support that she created outside her family of origin. Additionally, developing peer relationships provides an opportunity to experience different beliefs and values from those of the family of origin. Marissa identified having friends "who came from totally different places.... very different lives" and found it a fascinating aspect of her relationships. Peer relationships also allowed for the free expression of emotional expe- riences. For instance, Gina reported that her peer relationships gave her the chance to communicate her feelings freely. The ability to obtain alter- native opinions and advice is another feature of social support networks. Lydia characterized her peer relationships as honest; she and her friends were able to share opposing viewpoints during their conversations. Lastly, peer relationships provided a secure and stable environment for individuals. For example, Claire reported that she trusts her friends "incessantly."

Important Adult Figures in Childhood

Another external factor that emerged was the presence of a positive adult figure in childhood. Nine participants described extended family members, teachers, coaches, and friends' parents as instrumental adults in their childhood. Some viewed the adult figures in their lives as role mod- els for parenting and strength. Additionally, the adults present during their childhoods also modeled healthy relationship interactions.

Spiritual Beliefs

Nine participants reported having spiritual beliefs that allowed them to feel more connected to themselves and others. Spirituality was also con- sidered a foundational component to their understanding of themselves and their interactions with their environment. A spiritual belief system is an important factor to resilience because it strengthens the perception of

Suzuki, Geffner, and Bucky 117

self For example, Peter disclosed that he meditates in order to be more aware of himself and to hear his "inner voice." Spiritual beliefs are also important structures for individuals who experience adversity. Josie stated that her religion, Judaism, provided a structure for self-growth. Addition- ally, spiritual beliefs are used to connect with others. For instance, Cindy reported that her spirituality allowed her to connect with other people and help them on their lifelong paths.

Extracurricular Activities

This factor was noted by seven participants as instrumental to their resilience. The extracurricular activities described by participants included after-school activities, sports, and art. These activities increased self-esteem, were positive reinforcements, and were ways to escape from their families of origin. Internal factors or individual characteristics such as a positive perception of self or internal locus of control are seemingly related to outside interests. For example, Marissa described that her involvement in artistic expression assisted her in developing competencies and increased her self-esteem. It is reasonable to assume that extracurricu- lar activities also link with other protective factors previously mentioned that promote resilience among adults exposed to IPV as children.

DISCUSSION

The present study increased our understanding of resilience among individuals exposed to IPV as children. A significant finding was the abil- ity of the participants to learn from previous experiences and to change their behaviors and attitudes as they grew up. This concept is a central feature of resilience. It represents the ability to find meaning and live pro- ductively in spite of experiencing adversity (Werner, 1990). One of the main reasons the participants seemed to be resilient to the trauma was their ability to regulate emotions during their development. This major theme may also relate to having an internal locus of control for these indi- viduals. Future research in this area of resilience may be able to delineate the relationship between regulating emotions and having an internal locus of control among adults exposed to IPV as children.

In addition, all 10 participants identified having a social support net- work as an important feature to their resilience. This protective factor is an established component of resilience and has been identified in multiple studies for other areas of childhood trauma (ParappuUy, Rosenbaum, Van

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Den Daele, & Nzewi, 2002; Valentine & Feinauer, 1993; Werner, 1990). However, specific ways to promote the use of this factor have yet to be explored for children exposed to IPV. It would be helpful to determine ways to promote social support for such children in schools or in clinical settings.

A prevention approach based on the present findings could be useful in developing programs to promote resilience among children currently exposed to IPV. Treatment with children can be imple- mented in individual, family, and group therapy modalities. As 60% of violent men reported being exposed to IPV as children (Delsol & Margolin, 2004), it is also important to intervene early to prevent the intergenerational transmission of abuse. Clinical treatment should include interventions with offenders, victims, and their children. New assessment tools that measure resilience among individuals who expe- rience adversities are expected to assist with clinical intervention by identifying strengths at early ages (Tedeschi & Kilmer, 2005). These measures can be implemented in addition to recommended treatment in order to foster resilience among these individuals. Lastly, under- standing the perceived trauma associated with exposure to IPV is also necessary in order to provide appropriate therapeutic interventions with this population.

The purpose of using the DAPS in the present study was to collect col- lateral information about participants' perceived level of trauma. The information provided from the DAPS indicates that exposure to IPV can be cognitively and emotionally distressing to individuals, as indicated by high T-scores on the PDST and PDIS scales. These findings suggest that individuals exposed to IPV have unique needs that should be addressed during treatment.

Limitations ofthe Research

Due to the small sample size and qualitative nature of this study, the present findings cannot be generalized to the larger population nor do they allow for group comparisons (e.g., men versus women). The use of qualitative methods also precludes interpreting causality based on the results. Participants were mainly Caucasian and all were heterosexual; future research should thus explore resiliency and protective factors among racial, ethnic, and sexual minority groups. This study was based on a voluntary, self-selected population and therefore not representative of the demographics of the general population of California or the United

Suzuki, Geffner, and Bucky 119

States. Finally, this study depended upon the participants' recollection of events from their childhood; such retrospective recall could result in memory biases or inaccuracies.

Strengths of the Research

Despite the limitations, this study enhanced the current literature pertaining to resilience. More specifically, this research explored the pro- tective factors associated with resilience among adults exposed to IPV as children. To date, there are few, if any, studies that specifically investi- gated protective factors associated with resilience in this population. Most research in this area has examined resilience with individuals exposed to a variety of other adversities and traumas, such as maltreated or at-risk children (Werner & Smith, 2001).

To date, the information about the long-term effects of exposure to IPV in later adulthood has focused on negative trajectories, such as the inter- generational cycle of violence (Delsol & Margolin, 2004). Margolin (2005) suggested that future research investigate individuals who experi- ence alternative developmental pathways. The present study investigated individuals who had positive outcomes despite being exposed to IPV and examined the protective factors they identified that contributed to their resilience. The findings of this qualitative research provide areas of focus for future research.

SUGGESTIONS FOR EUTURE RESEARCH

The present findings provide a foundational component to under- standing this phenomenon, and future research may provide a more comprehensive awareness of resilience in this population. Future quali- tative research should explore the key resilience and protective factors present in more racially, ethnically, and sexually diverse populations. In addition, the major and minor themes that emerged in this study should be tested quantitatively with a larger sample to examine whether the protective factors identified will hold up in other adults exposed to IPV as children. Finally, once the validity of these themes has been more established, it will be important to develop and imple- ment therapeutic techniques that utilize and enhance these factors among individuals from a variety of different adverse experiences in childhood.

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NOTE

1. It should be noted that two of the protocols in the current study may be invalid due to inflated scores on the DAPS' validity scales. Peter had an elevated score on the negative bias scale, suggesting that he presented himself in an overly symptomatic way (T-score = 88). Lydia had an elevated T-score on the positive bias scale, suggesting that she responded in a defensive manner (T-score = 100+). While the normative sample of the DAPS was com- parable in ethnicity and race to the larger population (Briere, 2001), it is important to note that the two invalid profiles in this study were from Latino and African-American partici- pants. It is uncertain if this measure is culturally sensitive and to date there is no informa- tion about the validity of the DAPS with ethnic or racial groups. However, data from these two participants were included in the study despite the elevated validity scores because the results from the PAS indicated that they were most likely not experiencing any clinical problems.

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American Psychiatric Association (APA). (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

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