Child abuse and mental disorders

What is Abuse?

The APA Dictionary of Psychology provides this description of abuse"interactions in which one person behaves in a violent, demeaning or invasive manner towards another person (e.g. child or partner)" :

interactions in which one person behaves in a violent, demeaning or invasive manner towards another person (e.g. child or partner)."^[6]

Abuse can occur at any age. Child abuse, including neglect, is understood to be either a major cause of a contributing factor to many different psychiatric diagnoses. Abuse as an adult can also cause mental disorders, and is a major cause of posttraumatic stress disorder. The abuse can take many different forms including sexual, physical, emotional and psychological. Not all abuse involves physical contact.

Types of Abuse

These include:

• Physical abuse
• Sexual abuse and rape
• Emotional abuse
• Psychological abuse
• Spiritual abuse
• Ritual abuse - also known as organized abuseNo precise definition of organised abuse exists, but definitions typically refer to situations with multiple victims and multiple perpetrators (abusers), particularly involved sexual abuse alongside other types of abuse.{{Rp|1-2}}
• Neglect is the most common type of abuse, this includes emotional neglect
• Financial abuse - for example in domestic violence

Sexual Abuse and Child Sexual Abuse - How does it happen?

"the abuser's desire to abuse is not created by the child - it is there before the child appears^[1]

Child sexual abuse is not spontaneous or "accidental" in any way.^[1] Finkelhor developed a model that outlined four preconditions of child sexual abuse.^[7] These preconditions are:

• motivation to abuse a child sexually, sometimes because they fear rejection from adults or to make themselves feel more powerful by victimizing someone else^[1]
• the overcoming of internal inhibitions on the part of the perpetrator, for example: convincing themselves it is not harmful to the child, using alcohol to overcome their own inhibitions, discussing abuse with other pedophiles which encourages them to see child sexual abuse as acceptable, looking for other justifications to act on their desires^[1]
• the overcoming of external inhibitions on the part of the perpetrator, for example: arranging to be alone with the child or gaining the trust of child's family
• the overcoming of the child's inhibitions, for example: coercion, use of force, drugs/alcohol, child's lack of awareness of abuse, targeting a child emotionally deprived

The Impact of Child Sexual Abuse

Many Survivors blame themselves for the abuse and continue to feel responsible and guilty for anything bad that happens to them or to other people they know. Survivors often feel bad about themselves and different from other people. They therefore isolate themselves from other people and avoid making close friendships.^{(Ainscough, 1993)}

Child abuse, particularly child sexual abuse, can have significant long term effects on survivors, many of which may not be recognized as related to the abuse by survivors.

Finkelhor and Browne^[8] stated that sexual abuse constituted a form of posttraumatic stress disorder, but with more extensive effects. They developed the traumagenic dynamic model,^[8] which consists of four trauma-causing factors above. Briefly, these terms can be explained as follows:

• traumatic sexualization - distress, confusion, pain, may be lead to fear or obsession with sex
• betrayal - loss of trust, grief at loss of relationship, future difficulties with trust
• powerlessness - inability to stop the abuse, can lead to lashing out or controlling behavior
• stigmatization - guilt, shame, self-blame, society stigma ("damaged goods")

A number of studies support for the idea that symptoms of Complex PTSD characterize survivors of sexual abuse.^[2] Zlotnick ⁽¹⁹⁹⁶⁾ found that survivors of sexual abuse showed increased severity of:

• somatization
• dissociation
• hostility
• anxiety
• alexithymia"inability to difficulty in describing or being aware of one's emotions or moods; elaboration of fantasies associated with depression, substance abuse and posttraumatic stress disorder"{{Rp|22}} People with alexithymia are incapable of soothing themselves when under stress.{{Rp|259}}
• social dysfunction
• maladaptive schemas
• self-destruction
• adult victimization

Children are unable to consent to sexual activity with an adult

Sexual contact between an adult and a child is always abusive and exploitative, due to the perceived power and authority and adult holds over a child. Some victims of child sexual abuse may underestimate the coercive elements in such situations, leading them to minimize the perceived harm flowing from the experience.^[9]

Child abuse/neglect and its Physical and Mental Health Impacts

Herrenkohl et al. ⁽²⁰¹³⁾ used a longitudinal study to assess the effects of child abuse and neglect over a 30 year period. The physical health of adults who were involved with child welfare services due to either abuse or neglect at ages of between 18 months and 6 years were compared with those who with no known child welfare involvement. Those who has been abused or neglected in early childhood reported increased depression, anxiety, and poorer general health, and had three times as much risk of moderate to high substance use than those who were not reported as abused/neglected. These longstanding adverse effects were found to be independent of gender, childhood poverty/socioeconomic status and to occur regardless of the person's age, marital status, and years of education (high school graduation).^[3]

The same study also described negative effects on physical health included lower physical functioning, more pain, and poorer general health; more than twice as many of those who were abused/neglected as children reported their current health as poor/fair compared to the comparison group. Sachs-Ericsson, Blazer, Plant, and Arnow (2005) researched the link between childhood physical and sexual abuse and serious physical health problems in adults using the National Comordbidy Study. This analysis showed that both physical and sexual abuse (before age 15) were independently associated with a higher rates of physical health problems, including hypertension (high blood pressure) and diabetes.^[3]

Child Abuse and its link to Trauma and Dissociative Disorders

What is traumatic stress? Confronted with experience to horrifying to be assimilated, the brainThe brain is a approximately a 1300-gram organ containing 100-billion neurons. It is the control center of the central nervous system. The mind and brain are not the same thing. (see mind) The mind emerges out of interactions between the brain and relationships during the earliest years of childhood. Different child-parent attachment relationships form differing physiological responses, patterns for interpersonal relationship and how an individual views the world. {{Rp|9}} (see attachment) has mechanisms which provide the greatest possible chance that the human organism will survive. In a situation of trauma these mechanisms are activated automatically in parts of the brain generally regarded as primitive in terms of human evolution. They are, we may guess, the legacy to us all of our ancient ancestors who did not get eaten by sabre tooth tigers." Cairns ^(1999):12

Dissociative Identity Disorder is thought to be caused by early and prolonged child abuse and/or trauma^[10], as is OSDD,^[11] formerly known as dissociative disorder not otherwise specified (DDNOS).^[12] The abuse or trauma must be severe for Dissociative Identity Disorder or a dissociative disorder to occur, and often involves many different types of abuse. Child sexual abuse is assumed to be the most important cause of Dissociative Identity Disorder.^{[13]:56[14]:262-263} The traumatic and dissociative effects of abuse are worse if there is no attachmentThe communication of emotion between an infant and their primary caregiver(s) is essential to shaping the developing mind. "Emotion serves as a central organizing process within the brain. In this way, an individual's abilities to organize emotions - a product in part, of early attachment relationships directly shapes the ability of the mind to integrate experience and to adapt to future stressors." {{Rp|9}} Interruption in the attachment pattern of young children with their caretaker(s) has been shown to be a primary precursor to Dissociative Disorder pathology. (see etiology) {{Rp|85}} {{Rp|97}} figure available to comfort a child, for example when the child is isolated or the abuser itself is also an attachment figure. ^{(citation needed)}

Many different types of trauma and stressor-related disorders can occur as a result of abuse. Early childhood abuse can also cause personality disorders. ^{(citation needed)}

All forms of child abuse have been associated with mental health disorders in adults, with posttraumatic stress disorder being very commonly caused by abuse of either an adult or a child.

There have been news reports of cases in which childhood sexual abuse continues until late in adulthood. Such cases may seem rare, but about 13% of patients with Dissociative Identity Disorder have been sexually abused until in adulthood. Considering that Dissociative Identity Disorder is thought to be present in about 1 - 3% of the general population, this gives a general idea of how widespread childhood sexual abuse is ^{(Middleton, 2013): 194}. (It should be noted that these are only estimates, so no precise number can be concluded from this.)

References

1. ^ ^{a b c d e} Ainscough, Carolyn (1993) (coauthors: Toon, Kay). Breaking Free: Help for survivors of child sexual abuse. .
2. ^ Cairns, Kate (1999). Surviving Paedophilia: Traumatic Stress After Organised and Network Child Sexual Abuse Author Kate Cairns Publisher Trentham Books. .
3. ^ ^{a b c} Herrenkohl, Todd I.; Hong, Seunghye, Klika, J. Bart, Roy, C., Russo, M. Jean (2013). Developmental Impacts of Child Abuse and Neglect Related to Adult Mental Health, Substance Use, and Physical Health. J Fam Violence, volume 28, issue 2, 1 February 2013. (doi:10)
4. ^ Middleton, Warwick. Parent–Child Incest That Extends Into Adulthood: A Survey of International Press Reports, 2007–2011. Journal of Trauma & Dissociation, volume 14, issue 2, 1 March 2013, page 184–197. (doi:10.1080/152941)
5. ^ ^{a b} Zlotnick, Caron; Zakriski, Audrey L., Shea, M. Tracie, Costello, Ellen, Begin, Ann, Pearlstein, Teri, Simpson, Elizabeth (1996). The long-term sequelae of sexual abuse: Support for a complex posttraumatic stress disorder. Journal of Traumatic Stress, volume 9, issue 2, page 195-205.
6. ^ VandenBos, Gary R. (Ed), American Psychological Association (2006). APA Dictionary of Psychology. .
7. ^ Finkelhor, D. "Four preconditions-a model." Child Sexual Abuse: New Theory and Research (1984): 53-68.
8. ^ ^{a b} Browne, Angela, and David Finkelhor. "Impact of child sexual abuse: A review of the research." Psychological bulletin 99.1 (1986): 66.
9. ^ Grover, Sonja. "On power differentials and children's rights: A dissonance interpretation of the Rind and associates (1998) study on child sexual abuse." Ethical Human Sciences and Services 5.1 (2003): 21-33.
10. ^ Howell, Elizabeth F. Understanding and treating Dissociative Identity Disorder: A relational approach. Routledge, 2011.
11. ^ Miller, Alison (2012). Healing the Unimaginable: Treating Ritual Abuse and Mind Control. 827.
12. ^ Diagnostic and Statistical Manual of Mental Disorders-5.
13. ^ van der Hart, Onno; Bolt, Hilde; van der Kolk, Bessel A. (2005). Memory Fragmentation in Dissociative Identity Disorder. Journal of Trauma & Dissociation, volume 6, issue 1, 7 March 2005, page 55–70. (doi:10.1300/J229v06n01_04)
14. ^ Spiegel, David. Dissociation in the DSM5. Journal of Trauma & Dissociation, volume 11, issue 3, 28 June 2010, page 261–265. (doi:10.1080/15299731003780788)