Long term effects of Child Abuse

1. Long term effects of Child Abuse JHatlevig Ph.D., RNC

2. Post-traumatic Effects • Ann is a first year college student and comes into the college counselor saying that she is going crazy. Ann is anxious and shaky and she holds her arms in front of her. She reports having nightmares for the past three years along with panic attacks, difficulty concentrating and the sudden intrusion of sexual pictures into her thoughts. She sees erect penises, feels like she is suffocating and blood in the bathrrom sink. She reports being sexually and physically abused by her stepfather and was frequently locked in the garage when she misbehaved.

3. Symptoms • Reexperiencing the event via nightmares, intrusive thoughts or flashbacks (sensory memories) • Trauma event has transpired • Numbing of general responsiveness or avoidance of current events in the world • Persistent symptoms of increased arousal such as anxiety, sleep disturbances, concentration, and startle response

4. Cognitive Disturbances • Eric is a 30 year old man who has been in therapy intermittantly for 5 years. He constantly tells himself that he is “dumb, stupid, ugly, disgusting, filthy, gross” and other disparaging remarks. This internal monologue is constant and engenders feelings of unworthiness, inadequacy, fear of failure, and wanting to be dead. He denies having been abused and calls his parents perfect. They used psychological methods of control.

5. Cognitive symptoms • Cognitive distortions • Low self-esteem/self image • Self blame • Worthlessness • Vulnerability • Decreased self efficacy/powerlessness • Stigma/internalized judgement of self • Self messages-dichotomy

6. Self regulation/emotionality • Lisa is a 20 year old female who presents as a sad, slightly obese college student at the health center. Her parents divorced when she was 15 years of age due following discovery of the sexual abuse which had occurred since Lisa was 12. Her mother is lonesome and dating someone. Lisa has no siblings. She is becoming increasingly depressed and has started to return to cutting herself. Physical abuse occurred from both parents her whole life and she is glad to be at college.

7. Problems with emotions • Depression-#1 in the literature • Dysthymia • Alcoholism/CD • Cognitive distortions • Withdrawal • Anxiety • Rage • Psychosomatic disorders

8. Dissociation • Kari is a 16 year old who was referred for therapy following the discovery of sexual/physical/psychological abuse from a stepfather. Kari has a 15 year old sister, Jan, and a 9 year old half-sister, Becky. Jan was also abused and Becky was being groomed for abuse. Their stepfather would drink and hold a knife or gun while they performed oral sex. She says she spaces out, self-mutilates, is anxious or hypervigalent, gagging and self-disgust.

9. Dissociation • Dissociative episodes-disengagement and detachment • Hypervigalence/anxiety • Sensory memories • Self-mutilation • Fragmented memories-amnesia • Overwhelming emotions, e.g. fear • Depersonalization

10. Impaired Sense of self • Emily is a 25 year old female who was sexually/physically abused by foster families most of her childhood. She works as a clerk and has lost several jobs. She is lesbian and has had many abusive relationships where she is the victim. She has been diagnosed with a dependent personality disorder and frequently stalks her former lovers.

11. Sense of self • Identity problems • Negative self definition • Confused boundaries • Feelings of emptiness • Difficulty maintaining any personal relationships • Hypervigalence/other directed

12. Disturbed relationships • Jan is a 44 year old supervisor at a retail store. She is in a group for incest survivors. She has been married 3 times and states that she has to have a man in her life. She acts like a child and flirts when men are around. With women she is angry, sarcastic and distrustful. She seeks out violent men who harm her before they leave. No one can get too close.

13. Disturbed relatedness • Intimacy disturbances • Altered sexuality • Aggression in relationships • Adversality • Manipulation • Sexual preoccupation

14. Avoidance • Amy is a 42 year old female sexually and physically abused by her stepmother as long as she remembers. Her stepmother had adopted her when her parents married and then her father left and would not take her. Her stepmother was brutal, frequently tying her up, burning her with cigarettes, and giving her to boyfriends. She suffered many broken bones, etc. but she said nothing to the authorities. She is chemically dependent and has treated several times.

15. Avoidance • Chemical use and abuse • Suicide • Impulse control • Tension-reducing responses to numb, self soothe, interrupt dissociative state, restore control, fill emptiness, relief from guilt, alter sensory input, numb psychic pain, etc. • Self-mutilation • Sexually compulsive behavior • Binging and purging

16. Other DSMIV • PTSD • Borderline Personality Disorder • Dependant Personality Disorder • Acute Stress Responses. • Eating Disorders

17. Classify Depression • Major Depression ( Clinical term )Depression in people who have no ability to cheer themselves up. • Postpartum DepressionDepression that occurs in women soon after giving birth.( Generally the same as Major Depression. ) • Primary DepressionDepression alone with no other medical illness / disorder. • Psychotic Depression ( Clinical term )Depression accompanied by delusions and/or hallucinations. • Secondary DepressionDepression that occurs after the onset of another medical illness / disorder. • Unipolar DepressionDepression with no manic episode.

18. Continued • Atypical Depression ( Clinical term )Depression in people who have an ability to cheer themselves up by doing certain things. • Bipolar Depression ( Clinical term )Depression with manic episode(s). • Endogenous DepressionAcute Depression with no obvious cause(s). • Involutional DepressionDepression that occurs in the elderly.( Generally the same as Major Depression. ) • Reactive DepressionDepression caused by an obvious traumatic life episode(s).

19. Anxiety Disorders Types Acute Stress DisorderAgoraphobiaAgoraphobia Without History of Panic DisorderAnxiety Disorder Due to a General Medical ConditionAnxiety Disorder Not Otherwise Specified ( Anxiety Disorder NOS )Generalized Anxiety Disorder ( GAD )Obsessive-Compulsive Disorder ( OCD )Panic AttackPanic Disorder With Agoraphobia.Panic Disorder Without Agoraphobia.Posttraumatic Stress DisorderSocial PhobiaSpecific PhobiaSubstance-Induced Anxiety Disorder

20. Factitious Disorders Types • Factitious Disorders are characterized by feign symptoms or disorders. This is not for the purpose of any particular gain but because there is an inner need to maintain a role of being sick. • With Combined Psychological and Physical Signs and Symptoms.With Predominantly Physical Signs and Symptoms.With Predominantly Psychological Signs and Symptoms.

21. Impulse-Control Disorders • Impulse-Control Disorders are disorders in which a person act on a certain impulse, that is potentially harmful, but they cannot resist. • Impulse-Control Disorder Not Otherwise Specified.  ( NOS )Intermittent Explosive Disorder.Kleptomania.Pathological Gambling.Pyromania.Trichotillomania.

22. Sleep disorders • Sleep disorders are divided into four categories, Primary Sleep Disorders, Sleep Disorder Due to a General Medical Condition, Sleep Disorder Related to Another Mental Disorder, and Substance-Induced Sleep Disorder. Primary Sleep Disorders consist of two subtypes, Dyssomnias and Parasomnias.  Dyssomnias is characterized by problems in getting the right amount of sleep, in the quality of sleep, and in the time sleep takes place. Parasomnias is characterized by problems in behavioral or the physiological aspect of sleep.

23. Dissociative Disorders Types Dissociative Amnesia.Depersonalization Disorder.Dissociative Fugue.Dissociative Identity Disorder.Dissociative Disorder Not Otherwise Specified.  ( NOS )

24. Case Studies • The Landers Family (Child with unidentified anger issues) p.156-160. Please answer the questions on p. 160-161.