"It's Not What's Wrong With You — It's What Happened To You"

Complex Trauma, Criminalisation, and Practical Implications for Frontline Practice and Policy

Dr. Denise Ruprai Dr. Richard Summers

Women Crime and Justice Research Group

University of Birmingham

Women in the Criminal Justice System

Complex needs that are distinctly different to men's
Complex histories of trauma and mental health difficulties
60% have experienced domestic abuse
Interpersonal violence has the greatest propensity for generating complex trauma

Observations from the field

Observed Behaviours

WJRC WRNA Evaluation, University of Birmingham

Common presentations on the frontline:

Unmotivated

Over-sensitive

Abusive-relationship patterns

Aggressive

Avoidant

Disengaged

Help-refusing

Reactive

What is cPTSD?

A response to prolonged, repetitive events that are extremely threatening or horrific — where escape is difficult or impossible.

Events such as:

Torture
Slavery
Prolonged domestic violence
Repeated childhood (sexual) abuse

Symptoms of cPTSD

PTSD vs. Complex PTSD

PTSD: response to a single index trauma
cPTSD: response to multiple or prolonged traumatic situations — that's what makes it "complex"

Core Symptoms

Persistent perception of threat
Re-experiencing
Avoidance
Affect dysregulation
Negative self-concept
Relationship difficulties

A Cognitive Neuroscience Perspective

If you spent some time in a woods…

…with bears

Our Research

Our Research: What We Did

Prevalence of cPTSD in Criminal Justice-Involved women
What predicts it — beyond single traumatic events

91 Criminal Justice-Involved women
3 Women's Centres
Measures: WRNA + International Trauma Questionnaire

Our Research: What We Found

cPTSD in Criminal Justice-Involved Women

83%

of our cohort

1–8%

of the world's population

Our Research: What We Found

cPTSD in Criminal Justice-Involved Women

Strongest predictors: homelessness, childhood abuse, residential care, child removal
Cumulative adversity outweighed single traumatic events as a predictor
Needs are interconnected — not discrete clusters

Shifting the Perspective

Category	Observed Behaviour	Trauma-Informed Perspective
Affect Dysregulation	Over-sensitive Reactive Aggressive	Trauma response triggers overwhelming emotion Hyper-vigilance; anger as a safety strategy
Negative Self-Concept	Help-refusing Abusive relationship patterns	Offers of help trigger shame Low self-worth normalises abusive dynamics
Relationship Difficulties	Avoidance Unmotivated Disengagement	Managing triggers; deep distrust Emotional exhaustion and fear of change Dissociation; protective withdrawal

What This Means

What This Means for Services

The most complex needs are the most likely to be excluded — "too difficult", "too high risk"
Services see index problems, not whole people — needs that don't fit a single threshold go unmet
Consequences of trauma get criminalised rather than treated — compounding the cycle
We need tools that see the whole person from the start

The WRNA & GWA

WRNA

Gender-responsive assessment for Criminal Justice-Involved women
Strengths-based — not just deficits
Validated in the UK with MoJ-linked outcomes

GWA

Extends the same approach beyond the Criminal Justice System
Addresses trauma, complex needs, social determinants of health
Being implemented across Greater Manchester now

Practical Takeaways

Holistic assessment and trauma-informed practice go hand in hand — you can't address trauma you don't know about
People shouldn't have to repeat their story across every service — it drives disengagement
Siloed services focus on index problems (substance use, mental health) — and miss the whole picture
Ask "what happened?" — not "what's wrong?"
Problematic behaviour is often a trauma signal — not resistance
Consistency and safety reduce risk more than enforcement
Shared tools and shared language across services break the cycle

Thank You

Any questions?

d.ruprai@bham.ac.uk r.summers@bham.ac.uk

Women Crime and Justice Research Group

University of Birmingham