Clinical Summary

The pattern of separation of mothers from their children and violation of legal rights by ICE officials was supported by testimonies of the women interviewed by this team. These experiences at detention facilities likely contributed to a preexisting level of trauma and very likely exacerbated complex trauma symptomology experienced by these women and children. Forced separation between a parent and child for an indefinite period of time is, by its very nature, traumatic. The separation of family members may have resulted in a sense of reexperiencing past traumatic events associated with fear of not being able to protect one’s children. For parents who experienced the very real possibility of kidnapping and murder of their children in their countries of origin, the potential for trauma and mental anguish is intensified. The severity of parental anguish may be magnified when occurring in a detention center, in an unfamiliar culture and language, and in the context of a history or prior trauma. For individuals who have been trapped and in hiding to avoid being killed by gang members, the sense of being trapped and confined in a detention center may also bring about flashbacks or a sense of reexperiencing the event.

The aggregated data show a mean score of .02% below the cutoff score for clinically significant PTSD symptoms. It is likely that this score is a low estimate of their traumatic symptomology, particularly when qualitative narratives are correlated with quantitative symptoms reported on surveys. Many of the women seemed to struggle with comprehending the survey questions and seemed unaware of the physiological sensations they were experiencing. For example, one participant denied experiencing specific physiological symptoms associated with anxiety, but was observed fidgeting, looking around the room (hypervigilance), trembling, and rapid breathing. It is likely that because they are not in a position of stabilization, as they are still coping with the trauma and anxiety of possible deportation to a country where they will almost certainly be killed, refugees are still in “survival mode” and are not tuned into some of the physiological sensations associated with trauma.

Approximately half of respondents reported clinically significant symptoms of post-traumatic stress, sufficient to warrant a diagnosis of PTSD. All reported having experienced multiple traumatic events sufficient to warrant further clinical follow-up. However, PTSD assessment and criteria may not sufficiently capture the trauma as it has been experienced by these refugees. Van der Kolk et al. (2005) noted the insufficiency of PTSD criteria in capturing what they termed complex trauma (van der Kolk, Roth, Pelcovitz, Sunday, & Spinazzola 2005), or what they described as “disorders of extreme stress not otherwise specified” (DESNOS). DESNOS relates to trauma that has been experienced over years, such as neglect, physical and sexual abuse, witnessing or directly experiencing domestic violence, and community violence. The exposure of these women and children to community violence for much of their lives as well the trauma and sexual assault described by many of the women are consistent with this form of long-term trauma. Symptoms of DESNOS include but are not limited to problems with emotional regulation difficulty with memory somatic symptoms such as chronic pain, dizziness, digestive problems, cardiovascular issues feelings of despair and hopelessness detachment from others and minimization. These symptoms were noted frequently by the participants of this study and were observed by the investigators.

In addition to the chronic trauma experienced by many of the women and children in their countries of origin, all reported some level of trauma associated with their reason for fleeing their countries. Many of them also experienced traumatic events such as witnessing rapes and murder, fear of paying bribes, and wandering lost in the desert without food and water. This likely had a compounding impact on the trauma already experienced in the refugees’ countries of origin. Experiencing multiple traumatic events has what is termed a “dose effect,” in which the individual experiences more intense symptoms of PTSD, depression, anxiety, and behavior problems.

The impact of trauma goes beyond the symptomology typically associated with traumatic events. The effects of trauma, detainment, and the uncertainty of the possibility of deportation pose risks to the parent-child relationship. Many of the women interviewed for this project described a sense of general worry that preoccupied their thoughts because of a commitment to the welfare of their children that led them to take greater risks with their own health and safety. Uncertainty of their future and the future well-being of their children likely contributed significantly to general sense of disquiet and anxiety. Because of this level of worry, it is likely that the extent to which they were attuned to their children and their emotional needs was compromised. Difficulty with attunement due to trauma, depression, or general anxiety over time has the potential to negatively impact the attachment relationship between a child and primary caregiver. Insecure attachment leads to long-term effects such as difficulty regulating emotions and connecting to others in relationships later in life.

Moreover, the possibility of transferring traumatic symptomology onto their children via the attachment relationship is of particular concern. Research indicates that traumatic symptoms experienced by primary caregivers can also be experienced by their children via microlevel interactions and that parental mental health outcomes are predictive of child outcomes. This phenomenon is referred to as the intergenerational transmission of trauma. Children who experience trauma for long periods of time may experience adverse impact on meeting their developmental milestones, generally.

Trauma also impacts the learning and memory of children over time (Siegel & Solomon 2003) as well as the development of executive functioning skills associated with the prefrontal cortex. In short, children who have been exposed to traumatic events do not simply experience the emotional sequelae commonly associated with these events. They experience long-term, adverse impact on their development. When the trauma is chronic and impacts the parent-child relationship, this contributes to additional difficulties in managing emotions and having healthy relationships later in life.

In terms of traumatic events, many of the women described extreme violence in their countries of origin sufficient to push them to risk their lives to journey to the United States. For example, extortion was frequently mentioned along with the inability to pay and consequent threat of death. Mothers reported that the consequence of nonpayment of extortion fees was either the assassination of a family member or the mothers themseves, or conscription (“delivery”) of one or more of their children to the gang. Refusal to comply meant death. Others were told explicitly that if their children did not join the gang, they would murder the child and one other member of their families. The women and children were exposed to shootings, had lost family members to the gangs either by conscription or by murder, and reported witnessing bodies in the streets of victims who did not obey the gangs or belonged to rival gangs. Because of this extreme violence, the women interviewed felt the only way to protect their children was to leave their countries of origin.

Additionally, the journey to and arrival in the United States were traumatic for many of the women and children interviewed for this study. Participants described witnessing murder and rape as they took the trains northward. One witnessed an elderly man being thrown off the train. Others described wandering in the desert with their guides without food and water, certain that they were going to die. Arrival in the United States was little better. Upon being arrested by immigration authorities, many of the participants described being shuttled to a facility that was extremely cold, to which they referred as hieleras (freezers) and then to a place with cells that were like cages, which they called perreras (kennels). They reported significant distress among the children in the freezers and stated that their children cried a lot because they were so cold. These locations are consistent with those described in 2014 by eminent social work scholar Luis Zayas (Zayas 2014) in his interviews with 10 families detained at Karnes County Residential Center after fleeing their countries of origin.