Childhood trauma includes child abuse in all its forms, neglect, witnessing or experiencing domestic violence in childhood as well as other adverse childhood experiences.
What is child abuse? The World Health Organisation (1999) defines child abuse as:
Child abuse or maltreatment constitutes all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child's health, survival, development or dignity in the context of a relationship of responsibility, trust or power.
Child abuse can be a single incident, but usually takes place over time (Richardson, 2004).
As explained by the women participants in a study by Van Loon and Kralik (2005a):
We were told throughout our lives that we were ‘useless’, ‘good for nothing’ and ‘deserving of everything we got’. This was reinforced by ‘betrayal’ from our family and ‘manipulation’ from the perpetrator/s who ‘dominated’ us from their position of power and trust, making us feel ‘powerless’, ‘worthless’, ‘ashamed’, ‘guilty’ and ‘to blame somehow’. We were ‘used’ and treated as ‘objects’ or ‘meat’. When other children were developing ‘the building blocks for a strong identity’ and understanding that they were unique and worthwhile, ‘able and OK’. We were ‘stuck’ in a world that taught us ‘we would never amount to anything’. But worse, we still carry the burden of ‘shame’ and ‘guilt’, ‘confusion’ and ‘sadness’ which continually diminishes our ‘self-worth’ and ‘shatters our identity’.
While definitions of abuse remain ambiguous, some behaviours are objectively deleterious to healthy child development. All the same acceptability around behaviour varies widely from one social group to another (Tucci, Saunders, & Goddard, 2002) and from culture to culture.
Types of child abuse:
- Emotional abuse: The failure of caregivers and adults to nurture a child and provide them with the love and security that they require, and where a child's environment and relationships with caregivers are unstable, coercive or unable to support the child's healthy development.
- Neglect and negligent treatment: Where a child is deprived of essential needs, such as love, nutrition, clothing, warmth, shelter, security, protection, medical and dental care, education and supervision.
- Physical abuse: The infliction of bodily injury upon a child which is not accidental.
- Family violence: Where one partner uses violence, and the threat of violence, to control their partners, children and other family members.
- Sexual abuse: The involvement of a child in any sexual activity with an adult, or with another child who is in a relationship of responsibility, trust and power over that child. Sexual abuse includes, but is not limited to, the manipulation or coercion of a child into sexual activity, child prostitution and child pornography.
Organised abuse: This form is very complex and can involve multiple forms of abuse and occur in the context of abusive family groups and perpetrator networks. Different terms including 'organised abuse', 'sadistic abuse' and 'ritual abuse' have previously been used.
Other forms of childhood trauma:
The Adverse Childhood Experiences Study (Felliti and Anda, 1998) classifies childhood trauma in ten categories:
- Abuse of child: psychological, physical, sexual
- Trauma in child's household environment: substance abuse, parental separation and/or divorce, mentally ill or suicidal household member, violence to mother, imprisoned household member
- Neglect of child: abandonment, child's basic physical and/or emotional needs unmet
Domestic violence: Witnessing and experiencing family violence is a form of psychologically abusive behaviour and has been related to subsequent psychological disturbances (Briere, 1992).
Children are often exposed to harmful behaviours from one or more of these categories of abuse (Higgins & McCabe, 2000). The nature of the abuse and the duration of exposure of harmful behaviours may affect the long-term effects of the abuse into adulthood (Higgins, 2004). However, the type and duration of abuse are not the only factors determining the long-term effects of the abuse.
Child abuse and neglect occurs in a range of situations, for a range of reasons. Children are rarely subject to one form of abuse at a time. Adults can experience a range of psychological, emotional and social problems related to childhood abuse.
Research by McGill University (published October 14, 2015) showed that emotional abuse of a child may be equally harmful as physical abuse and neglect, while child sexual abuse often co-occurs with other forms of poor treatment. Click here to read the full article.
Emotional abuse refers to the psychological and social aspects of child abuse; it is the most common form of child abuse.
Many parents are emotionally abusive without being violent or sexually abusive, However, emotional abuse invariably accompanies physical and sexual abuse. Some parents who are emotionally abusive parents practice forms of child-rearing that are orientated towards fulfilling their own needs and goals, rather than those of their children. Their parenting style may be characterised by overt aggression towards their children, including shouting and intimidation, or they may manipulate their children using more subtle means, such as emotional blackmail.
Emotional abuse does not only occur in the home. Children can be emotionally abused by teachers and other adults in a position of power over the child. Children can also be emotionally abused by other children in the form of "bullying". Chronic emotional abuse in schools is a serious cause of harm to victimised children and warrants ongoing active intervention.
- How many children are emotionally abused or neglected? One American survey found that a quarter of the sample of undergraduate students reported some form of emotional abuse by their parents. Another quarter reported other forms of emotional abuse outside the home, such as bullying (Doyle 1997).
- Who is most likely to be emotionally abused?Boys and girls are equally likely to be victims of emotional abuse by their parents, and emotional maltreatment has been reported to peak in the 6- to 8- year old range and to remain at a similar level throughout adolescence (Kaplan and Labruna 1998).
- What are the characteristics of emotionally abusive parents?Research findings suggest that emotionally abusive parents have negative attitudes towards children, perceive parents as unrewarding and difficult to enjoy, and that they associate their own negative feelings with the child's difficult behaviour, particularly when the child reacts against their poor parenting methods. *Emotional abuse has increasingly been linked to parental mental health problems, domestic violence, drug and alcohol misuse, being abused or having been in care as children (Iwaneic and Herbert 1999).
Signs in childhood
From infancy to adulthood, emotionally abused people are often more withdrawn and emotionally disengaged than their peers, and find it difficult to predict other people's behaviour, understand why they behave in the manner that they do, and respond appropriately.
Emotionally abused children exhibit a range of specific signs. They often:
- feel unhappy, frightened and distressed
- behave aggressively and anti-socially, or they may act too mature for their age
- experience difficulties with academic achievement and school attendance
- find it difficult to make friends
- show signs of physical neglect and malnourishment
- experience incontinence and mysterious pains.
Signs in adulthood
Adults emotionally abused as children are more likely to experience mental health problems and difficulties in personal relationships. Many of the harms of physical and sexual abuse are related to the emotional abuse that accompanies them, and as a result many emotionally abused adults exhibit a range of complex psychological and psychosocial problems associated with multiple forms of trauma in childhood (Glaser 2002).
Significant early relationships in childhood shape our response to new social situations in adulthood. Adults with emotionally abusive parents are at a disadvantage as they try to form personal, professional and romantic relationships, since they may easily misinterpret other people's behaviours and social cues, or misapply the rules that governed their abusive relationship with their parent to everyday social situations (Berenson and Anderson 2006).
Complaints of neglect constitute a significant proportion of notifications and referrals to child protection services, However, there is no single definition of child neglect in Australia. It is generally understood that "neglect" refers to a range of circumstances in which a parent or caregiver fails to adequately provide for a child's needs:
- through the provision of food, shelter and clothing
- by ensuring their access to medical care when necessary
- by providing them with care, love and support
- by exercising adequate supervision and control of the child
- by showing appropriate moral and legal guidance
- by ensuring that the child regularly attends school
One of the contentious aspects of "neglect", as a category of child abuse, is that it is closely related to socioeconomic status. Many parents lack the money and support to meet the standards outlined above. Parents in financial need are also more likely to be in contact with welfare services, which in turn are more likely to scrutinise their parenting practices, and therefore more likely to make a report of abuse or neglect. As a result of these factors, poor communities and poor families have often been stigmatised as epicentres of child abuse and neglect. In fact, when adults in the community are asked to make retrospective reports, emotional abuse and neglect occurs in all families, rich or poor.
Physical abuse has been a normal aspect of domestic life in Australia for a long time. Physical assaults that would be serious criminal offenses if committed by one man against another - for instance, hitting, slapping, or striking with an object - have been legally and socially sanctioned when committed by a man against his wife and child, or by parents against their children. Today, incidents of domestic violence committed against both women and children remain at epidemic proportions, although there is increasing recognition within the Australian community of the prevalence and harms of violence against women and children.
Whilst community attitudes to violence against women and children have changed for the better, Australian policy-makers have failed to outlaw physical assaults against children by caregivers. According to the 2007 report of the Global Initiative to End All Corporal Punishment of Children, Australia is one of a number of countries that has failed to prohibit violence against children, and has failed to commit to legislative reform. In particular, the legal defences of "reasonable correction" and "reasonable chastisement" are still available to adults who are charged with violent offenses against children in many jurisdictions.
- How many children are physically abused? A large sample of American families found that 2.4% of children had been kicked, bitten, punched, beaten up, burned, scalded, or threatened or attacked with a knife or a gun by their parents. An additional 8.5% had been hit with an object by their parents (Straus and Gelles 1990).
- What are the characteristics of parents who physically abuse children? Characteristics of physical child abusers include emotional impairment, substance abuse, lack of social support, presence of domestic violence and a history of childhood abuse (English, Marshall et al. 1999).
- What are the characteristics of physically abused children? Boys and girls are equally likely to be physically assaulted by their parents, and whilst research suggests that physical abuse peaks when children are aged 4- to 8-years old, physical assault resulting in death occurs most often to infants and toddlers (Kaplan and Labruna 1998).
Signs in childhood
Physically abused children find it difficult relating to their peers and the adults around them. The constant threat of violence at home makes them perpetually vigilant and mistrustful, and they may be overly domineering and aggressive in their attempts to predict and control other people's behaviour. They are also vulnerable to "emotional storms", or instances of overwhelming emotional responses to everyday situations (Berenson and Anderson 2006). These "storms" can take the form of profound grief, fear, or rage.
Physically abused children may also have problems with:
- academic achievement
- physical development and coordination
- developing friendships and relationships
- aggression and anger management
- depression, anxiety and low self-esteem.
Signs in adulthood
Adults physically abused in childhood are at increased risk of either aggressive and violent behaviour, or shy and avoidant behaviour leading to rejection or re-victimisation. This polarised behaviour is often driven by hyper-vigilance and the anticipation of threat and violence even in everyday situations. Men with a history of physical abuse in childhood are particularly prone to violent behaviour, and physically abused men are over-represented amongst violent and sexual offenders (Malinosky-Rummell and Hansen 1993).
Family violence, or domestic violence, usually refers to the physical assault of children and women by male relatives, usually a father and husband/partner. In these situations, a man uses violence to control his partner and children, often in the belief that violence is a male perogative ("I'm a guy, I can't control myself"), or that his victims are responsible for his behaviour ("You bought it on yourself"). Whilst women may also be perpetrators of family violence, they are usually "fighting back" against a physically abusive partner, and it is unusual for violent women to inflict the same scale of harm as violent men.
- How many children witness domestic violence?The only Australian population-based survey on domestic violence found that 2.6% of women who currently had partners had experienced an incident of violence in the previous 12 months, and 8.0% had experienced violence at some stage in their relationship.*From these figures, we can surmise that a significant minority of Australian children witness family violence.
- Who commits domestic violence? Research overwhelmingly suggests that family violence is enacted by men against women and children.* Whilst women can and do commit violent offences within families, rates of female-initiated violence are much lower than male violence, and it is rarely as severe and brutal.
Signs in childhood
A child witnessing family violence, and domestic violence, is at risk of:
- Behavioural and emotional difficulties
- Learning difficulties
- Long-term developmental problems
- Aggressive language and behaviour
- Restlessness, anxiety and depression*
Signs in adulthood
Adults exposed to domestic violence as children can carry with them a legacy of trauma-related symptoms and developmental delays. Women who grew up in an environment of family violence are more likely to be victimised in adulthood, whilst men who grew up in a violent environment are more likely to commit violent offences in adulthood (Edleson 1999).
Sexual abuse describes any incident in an adult engages a minor in a sexual act, or exposes the minor to inappropriate sexual behaviour or material. Sexual abuse also describes any incident in which a child is coerced into sexual activity by another child. A person may sexually abuse a child using threats and physical force, but sexual abuse often involves subtle forms of manipulation, in which the child is coerced into believing that the activity is an expression of love, or that the child bought the abuse upon themself. Sexual abuse involves contact and non-contact offences.
- How many children are sexually abused? Approximately one third of women surveyed in Australia have reported sexual abuse in childhood (Flemming 1997; Glaser 1997; Mazza, Dennerstein et al. 2001). Approximately 10% of Australian men report sexual abuse in childhood (Goldman and Goldman 1988).
- Who is most likely to be sexually abused? Whilst all children are vulnerable to sexual abuse, girls are more likely to be sexually abused than boys. Disabled children are up to seven times more likely to be abused than their non-disabled peers (Briggs 2006).
- How often is sexual abuse reported to the authorities? In one study of Australian women, only 10% of child sexual abuse experiences were ever reported to the police, a doctor, or a health agency (Flemming 1997).
- Who sexually abuses children? Across all community-based studies, most abusers are male and related to the child (Flemming 1997). Most adults who sexually abuse children are not mentally ill and do not meet the diagnostic criteria for "paedophilia".
Signs in childhood
Sexually abused children exhibit a range of behaviours, including:
- Withdrawn, unhappy and suicidal behaviour
- Self-harm and suicidality
- Aggressive and violent behaviour
- Bedwetting, sleep problems, nightmares
- Eating problems e.g. anorexia nervosa and bulimia nervosa
- Mood swings
- Pains for no medical reason
- Sexual behaviour, language, or knowledge too advanced for their age
Signs in adulthood
Adults sexually abused as children have poorer mental health than other adults. They are more likely to have a history of eating disorders, depression, substance abuse, and suicide attempts. Sexual abuse is also associated with financial problems in adulthood, and a decreased likelihood to graduate from high school or undertake further education (Silverman, Reinherz et al. 1996).
Organised sexual abuse
Organised sexual abuse refers to the range of circumstances in which multiple children are subject to sexual abuse by multiple perpetrators. In these circumstances, children are subject to a range of serious harms that can include child prostitution, the manufacture of child pornography, and bizarre and sadistic sexual practices, including ritualistic abuse and torture.
- What are the circumstances in which children are subject to organised sexual abuse? Many children subject to organised abuse are raised in abusive families, and their parents make them available for abuse outside the home. This abuse may include extended family members, family "friends", or people who pay to abuse the child (Cleaver and Freeman 1996). Other children are trafficked into organised abuse by perpetrators in schools, churches, state or religious institutions, or whilst homeless or without stable housing.
- Who is most likely to be sexually abused in organised contexts? Children who are vulnerable to organised abuse include the children of parents involved in organised abuse, and children from unstable or unhappy family backgrounds who may be targeted by abusers outside the family.
- Who sexually abuses children in organised contexts? Organised abuse, like all forms of child abuse, is primarily committed by parents and relatives. Organised abuse differs from other forms of sexual abuse in that women are often reported as perpetrators. Research with female sexual abusers has found that they have often grown up in environments, such as organised abuse, where sexual abuse is normative, and, as adults, they may sexually abuse in organised contexts alongside male offenders (Faller 1995).
Signs in childhood
Young children subject to organised sexual abuse often have severe traumatic and dissociative symptoms that inhibit disclosure or help-seeking behaviour. They are often very withdrawn children with strong suicidal ideation. They may exhibit disturbed behaviours while at play or when socialising with their peers or other adults.
Signs in adulthood
Organised abuse, and ritual abuse, is a key predisposing factor the development of Dissociative Identity Disorder and other dissociative spectrum disorders. Adults with histories of organised abuse frequently have long histories of suicide attempts and self-harm, and they often live with a heavy burden of mental and physical illnesses.
Child abuse remains prevalent. The question is: how prevalent? Secrecy, silence and social stigma mean that abuse often goes unreported. We know how many cases of abuse are reported and how many cases are substantiated each year. However, it is impossible to access true figures of the number of children being abused every day. Many are fearful of disclosing. Often, when they do disclose they are not believed.
In response to growing awareness around child abuse, mandatory reporting laws have been introduced in every State. (Higgins, Bromfield, & Richardson, 2007) These laws have mandated that certain professionals working with children are legally obliged to report any child they suspect is being harmed or is at risk of being harmed. Although these laws differ between States, they are in place Australia-wide.
Rates of substantiated child abuse and neglect have remained relatively stable since 2012-13, at around 8.0 per 1,000 children. 151,980 children, a rate of 28.6 per 1,000 children, received child protection services (investigation, care and protection order and/or were in out-of-home care); three-quarters (73%) of these children had previously been the subject of an investigation, care and protection order and/or were in out-of-home care.
This is despite an increase in the number of children who were the subject of substantiations, which has risen by 35% since 2010-11 (from 31,527 to 42,457 in 2014-15). (Child Protection Australia report 2014-15; AIHW 2016).
Myth: Child abuse is rare
Fact: We now know that many traditional childrearing practices, such as hitting, threatening or shouting at children, are harmful to children's physical and psychological health. We also know that between a quarter and third of children will experience sexual assault before the age of 18.
Myth: It is only abuse if it is violent
Fact: Child abuse does not necessarily involve violence or anger. Abuse often involves adults exploiting their power over children, and using children as objects rather then respecting their rights as young people.
Myth: People lie about child abuse for attention and sympathy
Fact: Research shows that it is very rare for a person of any age to state they were abused when they were not. However, “false negative reports” of abuse are common e.g. many adults state that they were not abused as children when they were. Police and court statistics also demonstrate that it is very rare for a person to fabricate a claim of child abuse.
Myth: Children grow out of bad experiences in childhood
Fact: Adults are often deeply affected by childhood trauma and abuse. You cannot just “get over” it. Survivors need the right care and support to overcome the impacts of abuse, recover and live full and healthy lives.
Myth: People who sexually abuse children are mentally ill
Fact: Most people who sexually abuse children are not mentally ill. They are often married or have sexual relationships with adults as well. In anonymous surveys, a significant minority of men in the community indicate a sexual interest in children.
Myth: People who sexually abuse children have been sexually abused themselves.
Fact: The majority of sexually abused children are female, and yet the majority of sexual abusers are male. Some studies have found that sexually abusive men are more likely to report a history of sexual abuse than other men. However, the majority of men who sexually abuse children do not report being sexually abused in childhood.
Myth: People do not “forget” child abuse, therefore “recovered memories” are false
Fact: For over one hundred years, traumatic amnesia has been documented amongst war veterans, survivors of natural and man-made disasters, and adult survivors of child abuse. These memories can later resurface through flashbacks, nightmares and intrusive thoughts. These memories have sometimes been called “recovered memories”.
Myth: Children are very suggestible and they can easy "make up" stories of abuse
Fact: Children are no more suggestible than adults, and can clearly distinguish between reality and fantasy. Research has shown that children resist making false reports during leading and suggestive interviewing techniques. Since the early 1990s, training has been available to social workers and psychotherapists in relation to neutral and evidence-based interviewing techniques with children who disclose abuse.
The USA Surgeon General states under the category of mental health:
… severe and repeated trauma during youth may have enduring effects upon both neurobiological and psychological development altering stress responsivity and altering adult behaviour patterns … these individuals experience a greatly increased risk of mood, anxiety and personality disorders throughout adult life.
When humans are young, their world revolves around their parents or primary care-givers. Parents or care-givers are the primary source of safety, security, love, understanding, nurturance and support. Child abuse violates the trust at the core of a child’s relationship with the world (Walker, 1994). When the primary relationship is one of betrayal, a negative schema or set of beliefs develops. This negative core schema often affects an individual’s capacity to establish and sustain significant attachments throughout life. Survivors often experience conflictual relationships and chaotic lifestyles, frequently report difficulties forming adult intimate attachments and display behaviours that threaten and disrupt close relationships (Henderson, 2006).
Many survivors’ lives are characterized by frequent crises e.g. job disappointments, relocations, failed relationships, financial setbacks. Many are the result of unresolved childhood abuse issues. The reasons are complex, but for many survivors ongoing internal chaos prevents the establishment of regularity, predictability and consistency. Many survivors function in ‘crisis mode’, responding with stopgap measures which don't resolve the underlying issues. This can be exhausting and dispiriting and contribute to feelings of helplessness and hopelessness (The Morris Center, 1995).
Professor Bessel van Der Kolk, Harvard Medical School conducted a five year study of 528 trauma patients from American hospitals. This study identified a range of symptoms that correlated well with prolonged severe childhood sexual abuse:
… the inability to regulate emotions like rage and terror, along with intense suicidal feelings, somatic disorder, negative self-perception, poor relationships, chronic feelings of isolation, despair and hopelessness; and dissociation and amnesia'.
The implications are that real-world childhood… trauma may be responsible for many psychopathologies usually considered to have endogenous origins, including various kinds of phobic, depressive, anxiety and eating disorders, not to mention borderline personality, antisocial personality and multiple personality disorder.
A number of studies have explored the relationship between childhood trauma and later health concerns. Research has found that childhood abuse contributes to the likelihood of depression, anxiety disorders, addictions, personality disorders (Spila, Makara, Kozak, & Urbanska, 2008) eating disorders, sexual disorders and suicidal behaviour (Draper et al., 2007). A study by Palmer, Brown, Rae-Grant, & Loughin (2001) with 384 survivors of childhood abuse found that survivors of child abuse tended to be depressed, have low-self esteem, and to have problems with family functioning. A recent study found that almost 76% of adults reporting child physical abuse and neglect have at least one psychiatric disorder in their lifetime and nearly 50% have three or more psychiatric disorders (Harper et al., 2007). Adults with abuse histories also present with physical problems more frequently than those who have not experienced abuse (Draper et al., 2007). Furthermore, child sexual abuse has been found to be a key factor in youth homelessness with between 50-70% of young people within Supported Accommodation Assistance Programs having experienced childhood sexual assault (van Loon & Kralik, 2005b).
The long-term impact of child abuse is far-reaching; some studies indicate that, without the right support, the effects of childhood abuse can last a lifetime. This study by (Draper et al., 2007) found:
- Child abuse survivors demonstrate
- Poor mental health: are almost two and a half times as likely to have poor mental health outcomes,
- Unhappiness: are four times more likely to be unhappy even in much later life
- Poor physical health: are more likely to have poor physical health.
- Childhood physical and sexual abuse
- Medical diseases: increases the risk of having three or more medical diseases, including cardiovascular events in women
- Relationships: causes a higher prevalence of broken relationships, lower rates of marriage in late life,
- Isolation/social disconnection: cause lower levels of social support and an increased risk of living alone
- Behavioural health effects: is associated with suicidal behaviour, increased likelihood of smoking, substance abuse, and physical inactivity.
The impact of child abuse does not end when the abuse stops and the long-term effects can interfere with day-to-day functioning. However, it is possible to live a full and constructive life, and even thrive – to enjoy a feeling of wholeness, satisfaction in your life and work as well as genuine love and trust in your relationships. Understanding the relationship between your prior abuse and current behaviour is the first step towards ‘recovery’.
Over two decades of research have demonstrated potential negative impact of child abuse and neglect on mental health including:
use of illicit drugs
Victims of child abuse and neglect are more likely to commit crimes as juveniles and adults.
Child abuse is rarely an isolated event. It often occurs in the context of other factors which may harm a child's development, such as poverty, or parents with mental health or alcohol and drug problems. As children grow up within abusive environments, they develop adaptive ways of thinking and behaving to survive their childhood. In adulthood, however, the defenses and coping mechanisms that helped protect the child from the full impact of their abuse are often less constructive.
Briere & Scott (2006) identified six key areas in which child abuse affects psychological function in adult life:
1. Negative pre-verbal assumptions and relational schemata: Children who are abused internalise profoundly negative messages about themselves, their place in the world and other people. These negative messages often persist into adulthood, and powerfully influence how survivors interact with others and how they feel about themselves. As a result, survivors often lack the skills to mediate close relationships. They may be too defensive, aggressive, scared or shy to fully connect with the people around them.
2. Conditioned emotional responses to abuse-related stimuli: When adult survivors encounter situations, words, or experiences that remind them of their childhood abuse, they may become emotionally overwhelmed. Everyday situations may trigger intense feelings of guilt, shame, grief or anger that take a long time to fade away. These "emotional storms" can make the day-to-day life of a survivor very unpredictable and frightening.
3. Implicit/sensory memories of abuse: Child abuse often involves experiences of fear, betrayal and powerlessness - experiences that a child cannot understand or explain. Such experiences become "implicit" memories (sometimes called "body memories") which means that, when the memory returns, it does so with the physical sensations and emotional force of the original experience. These experiences, sometimes called "flashbacks", can be terrifying.
4. Narrative/autobiographical memories of maltreatment: For many adults, abuse is a part of their life history. Making sense of this abuse poses a number of challenges. Why did it happen? What does it say about my family? What does the abuse say about me? These are common questions for many survivors.
5. Suppressed or "deep" cognitive structures involving abuse-related material: Physical or sexual violence are overwhelming experiences for children. They do not understand abuse, nor do they have the resources to protect themselves. Trapped in a dangerous situation, children often respond to abuse with a "last ditch" psychological defense: they suppress their knowledge of the abuse. As they grow, their knowledge of their abuse may remain "split off" from awareness, but it deeply shapes the survivor's thinking patterns and ways of relating to others.
6. Inadequately developed affect regulation skills: Deprived of natural patterns of learning and development, survivors frequently find themselves overwhelmed by everyday situations and relationships. They often develop "avoidant" coping styles in order to lessen the pain of their past abuse and escape the discomfort of the present. This avoidance can take any number of forms, including withdrawing from social situations, avoiding/sabotaging personal relationships, self-medication through alcohol or drugs, or self-harming in order to dissociate and/or express pain.
The psychological impact of childhood trauma and abuse does not only depend on the type of trauma experienced, but differs as a result of a number of variables. The extent and nature of the impact varies from person to person. A number of reviews have estimated that between a third to half of all individuals who have experienced sexual abuse no longer exhibit adult psychiatric or psychological problems. It has been suggested that they can therefore be referred to as ‘resilient’ (Fergusson & Mullen, 1999; McGloin & Widom, 2001). Resilience has been used to describe behaviour, intellect, emotional well-being, social functioning or all of the above (Houshyar, 2005). A number of variables may influence how abuse has an impact, such as:
- the gender of the victim and perpetrator
- the type and severity of the abuse
- the duration of and time since the abuse
- bio-psychological factors (Futa, Nash, Hansen, & Garbin, 2003).
Other factors that consistently appear to be relevant include:
- Cognitive ability and personality factors: Research suggests that high self-esteem, internal locus of control, external attributions of blame, and individuals' coping strategies all predict more positive outcomes (see Collishaw et al., 2007).
- Family reactions and background: Research shows that the family's reaction following identification of the abuse and the general family environment can influence the long-term impact of abuse (Futa et al., 2003). Most studies suggest that the more sensitive, caring and safe the home environment, the more adaptive the outcome can be (Collishaw et al., 2007). A study of hundreds of University students who had experienced childhood abuse found that family characteristics (family conflict or cohesion) affected resilience in adult-life far more than the length or type of abuse (McClure, Chavez, Agars, Peacock, & Matosian, 2007).
- Supportive Relationships: Research has consistently shown that perceived social support buffers against poor mental health outcomes (Futa et al., 2003; Krause, Kaltman, Goodman, & Dutton, 2008). Social reactions to abuse experiences are related to trauma symptom severity (Ullman, Filipas, Townsend, & Starzynski, 2007). A study by Collishaw et al. (2007) found that those individuals with good relationship experiences across different domains and across childhood, adolescence and adulthood are prone to demonstrate resilience. Social support, both inside and outside the nuclear family can facilitate recovery from trauma (Lauterbach, Koch, & Porter, 2007). The ability to find supportive relationships outside of the family helps overcome the sequelae of abuse (Lauterbach et al., 2007). The availability of emotional support at the time of the abuse strengthens a person's ability to elicit support in adulthood, engendering resilient functioning. (Collishaw et al., 2007).
Studies considering the long-term outcomes for adults abused as children have identified factors associated with an increased likelihood of a negative outcome (risk factors) and those that are associated with a decreased likelihood of negative outcomes (protective factors) (Foley et al., 2000).
Protective factors include:
- personality, having a good sense of humour, a strong intellect or an active imagination (Pickering, Farmer, & McGuffin, 2004).
- genetic; a biological tendency not to develop depressive or stress disorders.
- features of a child’s environment; such as a loving family, a strong community or good teachers (Collishaw et al., 2007; Jaffee, Caspi, & Moffitt, 2004).
Did you know?
In 2014-15, 1 in 35 children received child protection services, with 73% being repeat clients (AIHW 2016)
Aboriginal and Torres Strait Islander children are 7 times as likely as non-Indigenous children to be receiving child protection services.
Emotional abuse and neglect were the most common primary and co-occurring types of substantiated abuse and neglect.
During 2014-15, there were 12,948 foster carer households and 18,401 relative/kinship carer households with a placement.
Imagine a society afflicted by a scourge which struck down a quarter of its daughters and up to one in eight of its sons. Imagine also that this plague, while not immediately fatal, lurked in the bodies and minds of these young children for decades, making them up to sixteen times more likely to experience its disastrous long-term effects. Finally, imagine the nature of these effects: life-threatening starvation, suicide, persistent nightmares, drug and alcohol abuse and a whole host of intractable psychiatric disorders requiring life-long treatment.
What should that society's response be?
In Australia, thirty years of child abuse prevention efforts have not reduced the prevalence of childhood trauma and abuse. Investment in primary prevention has been limited, and secondary and tertiary forms of prevention have targeted the poor, implicitly locating the burden of abuse in impoverished and marginalised communities. Public health and health promotion principles have been inconsistently applied to child abuse prevention, and child abuse is often framed as a symptom of family dysfunction and disadvantage, rather then a set of harmful behaviours that need to be identified and changed.
Primary prevention requires simultaneous effort on multiple levels to promote, and sustain, lasting social and behavioural change. We need approaches that accept that child abuse is a widespread and harmful social practice that is reinforced every day by long-standing and problematic cultural beliefs and values.
To view a Resource Sheet prepared by the Australian Institute of Family Studies outlining the different Mandatory Reporting Requirements throughout Australia click here.
If you are concerned that a child is being abused you can speak anonymously with the government authorities in your state or territory using the phone numbers below
ACT: Care and Protection Services, 1300 556 729.
NSW: Child Protection Helpline, 13 21 11.
NT: Child Abuse Prevention Service, 1800 688 009.
Qld: Child Safety Services, 1800 811 810 (business hours) or 1800 177 135 (after hours).
SA: Child Abuse Report Line, 13 14 78. Tas: Child and Family Services Line, 1800 001 219.
Vic: Child Protection Crisis Line, 13 12 78.
WA: Crisis Care, (08) 9325 1111; 1800 199 008 (for callers outside Perth).
Young people can call Kids Helpline on 1800 551 800. NAPCAN lists state services and national helplines. Visit www.napcan.org.au.
The majority of people who present to services with trauma-related problems have multiple unresolved traumas (complex trauma) which often leads to severe, diverse and persistent impacts.
Complex trauma can be caused by childhood abuse in all its forms as well as neglect and growing up with family violence or dysfunction.
Any form of violence experienced within the community – civil unrest, war trauma, genocide, cultural dislocation, sexual exploitation or re-traumatisation of victims later in life can also cause complex trauma.
In complex trauma the traumatic stressors are usually interpersonal – the trauma is premeditated, planned, and often repeated and prolonged and the impacts are cumulative.
It’s important to differentiate single incident trauma often classified in terms of PTSD from complex trauma and deliver service responses accordingly as responses to complex trauma based on a diagnosis of PTSD alone are often seriously inadequate.
For resources on Complex Trauma click here
We have all heard the sayings: "What doesn't kill you makes you stronger" and "time heals all wounds". Although trials and tribulations can build character, they can also compromise biological, neurological and psychological processes (Cozolino, 2002). The impact of traumatic events on infants and young children is often minimized in this way. In fact infancy and childhood is the time of the greatest vulnerability to the effects of trauma and the effects of early and severe trauma are often widespread (Cozolino, 2002; Giarratano, 2004a).
Childhood trauma interrupts the integration of sensory, emotional and cognitive information into a cohesive whole and sets the stage for sensitised reactions to subsequent stress. Children who have experienced abuse or neglect often lack the capacity for emotional self-regulation (Streeck-Fischer & van der Kolk, 2000). Childhood trauma has profound impact on the emotional, behavioural, cognitive, social and physical functioning of children. Among other impacts, a traumatised child may, over time, exhibit motor hyperactivity, anxiety, behavioural impulsivity, sleep problems, and hypertension (Perry et al., 1995).
Similarly, adult survivors of childhood trauma and abuse often experience impacts on pervasive functioning including on adult physical and mental health (Draper et al., 2007).
Although the association between childhood abuse and adult mental and physical health problems is well documented, less is known about the pathways through which health is compromised. Pathways linking childhood trauma and abuse with adult health outcomes include emotional, behavioural, social, cognitive, and biological.
Primary attachment to help modulate stress
Caring and secure environments help to moderate the negative impact that stress places on the developing brain (Gunnar, 1998). Because safety and bonding are crucial factors in brain development, childhood trauma compromises core neural networks (Cozolino, 2002).
Normal play and exploratory activity in children requires a familiar attachment figure who can help modulate the child's physiological arousal by providing a balance between soothing and stimulation (Streeck-Fischer & van der Kolk, 2000). Children feel secure when the caregiver provides consistent, warm and sensitive care (Davila & Levy, 2006). In secure environments, stressed children who seek and receive comfort from their primary caregiver can then return to their exploratory activity away from the primary caregiver. The caregiver's appropriate soothing response not only protects the child from the effects of stressful situations but also enables the child to develop the biological framework for dealing with future stress (Schore, 1994; cited in Streeck-Fischer & van der Kolk, 2000).
Children who do not have a secure base, learn that they cannot rely on the primary caregiver for comfort. They may become incapable of calming themselves down when threatened. In addition, if children are exposed to unmanageable stress and the caregiver does not help modulate the child's arousal (as in situations of family violence) the child will be unable to organise his/her experiences in a coherent fashion (Streeck-Fischer & van der Kolk, 2000). If the child cannot regulate his/her emotional states, or rely on others to help: he/she will respond with fight or flight reactions.
Cognitive understanding of events also helps modulate emotions and enables the formulation of a flexible response. Both cognition and emotions are important. Children who are denied parental care or comfort for long periods of time, can suffer extreme mental and emotional deficits (Van Der Horst, LeRoy, & Van Der Veer, 2008).
Our first intimate or loving relationship with our primary caregiver informs our expectations and patterns of future behaviour. Bowlby (1988) identified a strong relationship between the attachment pattern in young children and patterns of intimate relationships in later life. When the first attachment is negative it establishes a model for future relationships and affects a survivor's capacity to establish and sustain significant attachments throughout life. Survivors often experience conflictual relationships and chaotic lifestyles, frequently report difficulties forming adult intimate attachments and display behaviours that threaten and disrupt close relationships (Henderson, 2006).
Attachment theory, a theory of personality development emanating from John Bowlby's work (1988) helps explain the challenges survivors often experience in relationships. Attachment theory suggests that early childhood relationships are internalised and inform an internal working model of the self, others and any relationships. This internal attachment model influences attachment styles used in adult life. "Abusive acts thereby serve as an etiologic reservoir for the development of later psychological disorder" (Briere, 2002). Bowlby described different patterns of attachment with primary care-givers: secure attachments, ambivalent attachments, avoidant attachments and disorganised attachments.
Secure attachments: 'securely attached' children develop inner working models that see others as positively available and themselves as lovable, valued and socially effective (Bowlby1988). Overall, adults with secure attachments have effective strategies for regulating affect (Alexander & Anderson, 1994).
Ambivalent attachments: 'Ambivalent' children experience parenting that is inconsistent, unreliable and emotionally neglectful. Persistent experiences of both emotional and physical neglect may lead children to suffer psychological distress resulting in feelings such as abandonment and rejection. The ambivalent child clings to the primary caregiver and exaggerates affect in order to take advantage of the intermittent responsiveness of their inconsistent parent. As an adult, the 'ambivalent child' may be described as clinging, jealous, obsessive, dependent, self-sacrificing, and describe love as a series of emotional highs and lows (Alexander & Anderson, 1994). Ambivalent' adults may be especially sensitive to the possibility of abandonment, rejection or isolation (Bowlby1988).
Avoidant attachments: 'Avoidant' children experience parenting that is hostile, rejecting and controlling. They experience little warmth or love and their emotional needs remain largely unmet. Parents of the avoidant child were not necessarily consistently rejecting; however, their coldness and lack of responsiveness invariably emerged when the child needed help. The primary caregiver of the avoidant child may respond positively to the child's autonomous behaviours but misattune to the child's request for nurturance (Alexander & Anderson, 1994). Therefore, the learned response of the avoidant child is to hold back when feeling needy so as not to elicit even more rejection from the parent. This reluctance to express negative affect becomes internalised and may take form of compulsive self-reliance. As an adult the 'avoidant child' may be uncomfortable with intimacy, not confident about others' availability, highly self-reliant, seen as hostile to others, easily frustrated with partners, and overtly denying of problems while exhibiting covert symptoms of anxiety, distress, and dysfunction (Alexander & Anderson, 1994).
Disorganised attachments: The primary caregiver of the disorganised child tends to be frightening and/or frightened in his/her interactions with the child. Consequently, the disorganised child is in the untenable position of having to approach the very caretaker who is the source of the child's anxiety and fearfulness (Alexander & Anderson, 1994). Unable to regulate their affect, these children adopt coping strategies such as dissociation when interacting with the parent. As adults 'disorganised children' they may see themselves as truly bad, responsible for the trauma and inherently flawed. They may experience significant distress, depression, and poor social adjustment (Alexander & Anderson, 1994).
Early patterns of attachment set the stage for how children process information and have powerful effects across the lifespan. Secure infants usually grow up being able to rely on both their emotions and thoughts to help them determine reactions to any given situation. Children in abusive environments may learn to either ignore what they feel (emotion) or what they perceive (cognition) (Streeck-Fischer & van der Kolk, 2000). For example, avoidant children ignore their distress and deal with their needs by relying upon the logic of what they can observe. Being able to inhibit their distress protects them from further harm (Streeck-Fischer & van der Kolk, 2000). Ambivalent children may tend to grow up relying on what they are feeling, without much thought about the consequences of their actions. Confused about what they perceive, they tune into their feelings, at the expense of being able to think about the meaning of their experiences (Streeck-Fischer & van der Kolk, 2000).
Behavioural pathways link childhood trauma and abuse and adult health outcomes through health-related behaviours, such as smoking, substance abuse, overeating, high-risk sexual behaviour, and suicidal behaviour (Draper et al., 2007). Survivors are more likely to engage in high-risk behaviours that are deleterious to health.
These high risk behaviours can be viewed as 'coping strategies', initially adopted in childhood, to manage rejection, betrayal and abuse. The trauma of child abuse can lock survivors into the avoidant coping strategies they used during their childhood (such as detaching, denying, forgetting, dissociating, fantasising and withdrawing). The tendency to dissociate remains with the child as he/she grows into adulthood and impairs the development of other coping mechanisms (Briere, 2002). Some of the impacts of childhood abuse observed in adult survivors can be the result of the coping strategies used by children in abusive environments (Henderson, 2006). The extreme coping strategies required to manage the extremes of traumatic stress can create serious symptoms (adaptations) with possible disruptions in identity, attachments, relationships, meaning and spirituality (Saakvinte, Gamble, Pearlman, & Tabor, 2000).
As explained by the women participants in a study by Van Loon and Kralik (2005a):
We spent our childhood maintaining a shroud of 'silence and secrecy' around our perverse experiences of child abuse. We coped by 'suppressing memories', 'learning to forget', 'disengaging', disassociating', 'isolating ourselves emotionally and relationally', 'trying to please everyone', 'trying to adapt' and accommodate our 'weird' situation', because there was 'no escape anyway'. This allowed us to survive our childhood. But as we became teenagers we came 'unstuck'. We knew we 'didn't fit in'. So we 'numbed our rotten feelings' by using alcohol, drugs and/or gambling.
Cognitive pathways include the beliefs and attitudes one adopts that shape daily life. Some of the long-term impacts of child abuse are grounded in the rejection and betrayal the child experienced, and their impact on cognitive patterns. As children, survivors of child abuse have often been betrayed, manipulated and silenced by the adult/s they should have been able to trust.
Most cognitive theories of development acknowledge that we organise the world according to emotion. We have a natural bias towards the positive, especially when evaluating ourselves (Ayoub et al, 2006). Children who experience severe and/or ongoing maltreatment will tend to develop this negative bias especially towards themselves (Ayoub et al, 2006). Children experiencing childhood trauma and abuse tend to attribute blame to themselves and internalize abusive behaviours (Quas, Goodman, & Jones, 2003). These tendencies become cognitive patterns that can continue long into adulthood, and contribute to challenges in the development of self-esteem and a healthy identity (van Loon & Kralik, 2005b).
Cognitive pathways are clearly intertwined with biological pathways. Children who are abused go immediately from (fearful) stimulus to fight/flight responses without learning from the experience because they can't grasp what is going on. Adult survivors' reactions to hostility or silence are often conditioned by the past with survivors tending to experience current stressors with an emotional intensity that belongs to past rather than present experiences (Streeck-Fischer & van der Kolk, 2000).
Social pathways link childhood trauma and abuse and its negative health outcomes through difficulties in establishing intimate relationships. Trauma in childhood can lead to chronic, negative expectations and perceptions around safety, trust, esteem, intimacy and control which are readily activated by interpersonal interactions in the present environment (Henderson, 2006).
Children exposed to trauma, and lacking an adult to provide continuity, can have a problem understanding themselves or others (Streeck-Fischer & van der Kolk, 2000). Without a clear appreciation of who they or others are, such children do not know how to enlist other people as allies; people are perceived as sources of terror or gratification, but rarely fellow human beings with their own sets of needs and desires (Streeck-Fischer & van der Kolk, 2000). Unable to regulate their feelings, abused children are prone to scare other children (and in time adults) away and hence lack reliable playmates (Streeck-Fischer & van der Kolk, 2000). Parental child abuse not only traumatises children, but also deprives them of healing interactions (Cozolino, 2002).
Two-thirds of the long-term negative mental health effects of child abuse are related to poor education, work choices and deficiencies in intimate relationships, with poor intimate relationships and career choices being among the most influential. This suggests that the social development pathway is significantly impacted by childhood trauma and abuse causing negative emotional or psychological outcomes in adulthood (Schilling, Aseltine, & Gore, 2007). A study by Schilling, Aseltine & Gore (2007) concluded that developing strong social supports was an important factor in ameliorating the effects of depression in a group of adult adolescents who had experienced severe abuse.
Neural development and social interactions are inextricably intertwined. As Tucker says "for the human brain, the most important information for successful development is conveyed by the social rather than the physical environment" (cited in Streeck-Fischer & van der Kolk, 2000). For example, a study by Valentino, Cicchetti, Toth, & Rogosch (2006) found that mothers in abusive families were less available to play and interact socially with their infants even when they were 12 months of age. As a consequence, infants from abusive families demonstrated more imitative and less independent play than infants from non-abusing families.
Vulnerability to hyperarousal makes it difficult to tolerate uncertainty. Avoiding novelty also leads to avoiding social contact. Hence, abused children miss out on the normal transmission of social skills (Streeck-Fischer & van der Kolk, 2000).
Seventy percent of our genetic structure is added after birth (Schore, 1994; cited in Cozolino, 2002). Experience shapes the structure in which the brain is being organised (Streeck-Fischer & van der Kolk, 2000, Perry et al., 1995). A child's interaction with the outside environment facilitates connections between brain cells (McLean Hospital, 2000). Because the developing brain organizes and internalizes new information in a use-dependent fashion, the more a child is in a state of hyper-arousal or dissociation, the more likely he/she is to be impacted following trauma.
IMPACT ON THE CORTEX AND LIMBIC SYSTEM
Research shows that children and adults with histories of child abuse often respond excessively to minor triggers. Traumatised children (and adult survivors) become increasingly responsive to relatively minor stimuli as a result of decreased frontal lobe functioning (learning and problem solving) and increased limbic system (amygdala) sensitivity (impulsiveness) (Streeck-Fischer & van der Kolk, 2000).
Decreased cortex activity
The cortex or the more rational, outer-layer of the brain is the seat of our thinking capacity. The cool, rational cortex is in constant communication with the amygdala and the hippocampus (the limbic system). The frontal lobes are situated in the cortex and are responsible for learning and problem solving. The capacity to learn from experience requires events to be registered in the prefrontal cortex, compared with other experiences and evaluated for an appropriate response (Streeck-Fischer & van der Kolk, 2000).
When children are under threat, the fast tracts of the limbic system are likely be to activated before the slower prefrontal cortex has a chance to evaluate the stimulus (Streeck-Fischer & van der Kolk, 2000). Only a state of non hyper-arousal allows activation of the prefrontal cortex needed for learning and problem solving.
Increased limbic system sensitivity
The limbic system is sometimes called 'the emotional brain'. It controls many of the most fundamental emotions and drives for survival (McLean Hospital, 2000). The limbic system initiates the fight, flight or freeze responses to threat. The amygdala and the hippocampus are part of the limbic system. A study by Teicher et al. (1993) found a 38% increased rate of limbic abnormalities ('emotional brain') following physical abuse, 49% after sexual abuse, and 113% following abuse of more than one type combined (cited in Streeck-Fischer & van der Kolk, 2000).
The amygdala processes emotions before the cortex gets the message that something has happened. For example, the sound of a loved one's voice is communicated to the amygdala, and the amygdala generates an emotional response to that information (for example, pleasure) by releasing hormones. When someone is threatened, the amygdala perceives danger and sets in motion a series of hormone releases that lead to the defensive responses of fight, flight or freeze. Because the amygdala is immune to the effects of stress hormones it may continue to sound an alarm inappropriately, as is the core of PTSD (Rothschild, 2004).
The amygdala's role in the encoding, storage and retrieval of emotionally-arousing material (and corresponding hormonal changes) primes animals to remember emotionally charged or threatening events better than every-day events (Howe, Cicchetti and Toth, 2006).
Decreased hippocampal volume
The hippocampus helps to process information and lends time and spatial context to memories and events. The hippocampus assists the transfer of initial information to the cortex which works to make sense of the information. However the hippocampus is vulnerable to stress hormones, in particular the hormones released by the amygdala's alarm. When those hormones reach a high level, they suppress the activity of the hippocampus and it loses its ability to function. Information that would make it possible to differentiate between a real and imagined threat never reaches the cortex and a rational evaluation of the information isn't possible (Rothschild, 2004).
If a particular stimulus is misinterpreted as a threat, this leads to immediate fight/flight/freeze responses (to non-threatening stimuli). This causes this system to respond to minor irritations in a totalistic manner (Streeck-Fischer & van der Kolk, 2000).
Research shows that environments of extreme stress lead to increased cortisol levels (Murray-Close, Han, Cicchetti, Crick, & Rogosch, 2008) which can lead to decreased hippocampal volume. Decreased hippocampal volume has been associated with poorer declarative memory which places adults at greater risk of developing PTSD-like symptoms, and is closely correlated with experiences of depression and physical inflammations (Danese, Pariante, Caspi, Taylor & Poulton, 2006).
IMPACT ON THE LEFT AND RIGHT HEMISPHERE
Underdevelopment of left brain
A study by McLean Hospital (2000) found that children with histories of abuse were twice as likely as non-abused children to have abnormal electroencephalograms (EEGs). EEG is a medical test used to measure the electrical activity of the brain, via electrodes applied to your scalp. Research shows evidence of deficient development of the left brain hemisphere in abused patients (which controls language), suggesting that the right hemisphere may be more active than in healthy individuals.
A smaller corpus callosum
The corpus callosum is a major information pathway connecting the two hemispheres of the brain (McLean Hospital, 2000). A number of studies have found that the corpus callosum is smaller in abused children than in healthy children (De Bellis et al., 1999; McLean Hospital, 2000; Teicher, Ito, Glod, & Andersen, 1997). Furthermore, McLean Hospital (2000) found that abused patients shifted the degree of activity between the two hemispheres to a much greater extent than normal. They theorised that a smaller corpus callosum leads to less integration of the hemispheres. This can lead to dramatic shifts in mood or personality.
Brain development is affected by stress early in development. Extensive research has been carried about the neuro-biology of stress. The link between a history of childhood abuse and neglect and neuro-endocrine impacts is well established. Research tells us that the bodies of children who are being abused react and adapt to the unpredictable dangerous environments to which they are exposed. Stress can set off a ripple of hormonal changes that permanently wire a child's brain to cope with a malevolent world (Teicher, 2002). Through this chain of events, violence and abuse pass from generation to generation (Teicher, 2002).
The neuro-endocrine system refers to the system of interaction between our brain/ nervous system and the hormones in our bodies. This system helps regulate our moods, our stress response, our immune system, and our digestion, amongst other things. Any disruption to the neuro-endocrine system affects a range of basic psychological and physiological functions.
Research suggests that many of the long-term impacts of child abuse experienced by adult survivors result from the chronic neuro-endocrine dysregulation caused by prolonged exposure to abuse and violence (Kendall-Tackett, 2001).
IMPACT ON STRESS HORMONES (INCLUDING IMPACT ON CORTISOL PRODUCTION)
A number of studies have identified alterations in cortisol production in both children and adults who experienced childhood abuse (Carpenter et al., 2007; Joyce et al., 2007; Linares et al., 2008; McLean Hospital, 2000). Alteration in cortisol levels, either an increase or decrease, can cause a number of long-term physical and psychological health concerns.
Even in utero foetuses experience stress (Cozolino, 2002). Tests have found that foetuses express a biological response indicative of a stress response well before birth (Gunnar, 1998).
The nervous systems of children who are abused run on a constant high because they are constantly anticipating further danger. Their bodies are flooded with fight-or-flight hormones (Cozolino, 2002). A study by Linares et al. (2008) shows alterations in cortisol production in children with histories of abuse and neglect. This state of chronic 'hyper-arousal' persists for many survivors throughout their adult years as well. Even when the abuse and violence has ceased and the environment is 'safe', many adult trauma survivors still perceive the threat to be present; their fear is maintained and becomes pathological (Giarratano, 2004b). A study by Joyce et al. (2007) found that experiences of childhood abuse were associated with high cortisol levels in depressed adult survivors.
IMPACT ON THYROID PRODUCTION
Studies conducted by McLean Hospital (2000) have found that neglect can also decrease production of thyroid hormone. This can lead to a number of health concerns as the thyroid gland secretes hormones which modulate metabolism.
Trauma is biologically encoded in the brain in a variety of ways. Changes in structures like the hippocampus, and the coordination and integration of neural network functioning have been identified. These changes are reflected in the victim's physiological, psychological and interpersonal experiences (Cozolino, 2002). Deficit in psychological and interpersonal functioning then create additional stress which further compromises neurobiological structures. In this way, adaptation to trauma, especially early in life, becomes a "state of mind, brain, and body" around which subsequent experience organises (Cozolino, 2002).
IMPACT ON GENE EXPRESSION
A research study, led by Michael Meaney from Douglas Mental Health University Institute in Montreal examined samples from the hippocampus region of the brain, which is associated with memory function, and is known to develop differently in abused children. (Meaney, 2009) They found a gene - NR3CI, which influences the brain's susceptibility to stress hormones - was less likely to be activated in people who have been abused. This study as the first to demonstrate that a genetic process appears to underlie such changes. Those who have been abused had lower levels of expression of the gene for the glucocorticoid (cortisol) receptor, which is critical for the stress response pathway. Children who are abused early are flooded with stress hormones like adrenaline and cortisol, impacting on how the brain develops and the stress regulation method. This in turn impacts on the hippocampus, the area which controls feelings, meaning that adult survivors will be more likely to be highly stressed, have difficulties with anger and emotions, and be prone to self-harm, anxiety, suicide and depression.
"Recovered" or "repressed" memories are terms that refer to the recall of traumatic events, typically but not exclusively, of child sexual abuse, by adults who have exhibited little or no previous awareness of such experiences. This is also called "traumatic amnesia".
The phenomenon of traumatic amnesia has been noted in a variety of populations over the last century, including war veterans, Holocaust survivors, and survivors of natural disasters. By the mid-1980s, a significant body of research indicated that many adult survivors of child sexual abuse also suffer from traumatic amnesia. While some people always remember having been abused, others do not remember anything about their experiences for many years, whilst others recall some but not all of the details of their abuse.
Traumatic amnesia can be a major obstacle to the prosecution of child sexual abuse. Prior to the 1980s, survivors were often unable to pursue civil charges, because the crime had occured so long previously that they were not permitted to sue by law. In criminal cases, defendants often claimed that adult survivors were unreliable witnesses because they had not reported the abuse until years or decades later.
By the late 1980s, lawyers argued that the limitation period (or the "statute of limitations") for child sex offenses should be extended in cases where a complainant has suffered from traumatic amnesia. Parents accused of sexual abuse sought defence lawyers and psychological experts to help defend against these claims. A new concept, “False Memory Syndrome”, was created to explain delayed memories of sexual abuse in court.
The debate on "recovered memories" and "false memories" dominated the media coverage of child abuse for much of the 1990s. In the media, proponents of the "false memory" position argued that there was no evidence for traumatic amnesia, and that "recovered memories" of sexual abuse were unreliable, and often the product of overly zealous therapists, and hysterical, malicious or confabulating women. Since then, this debate has become less heated, with science increasingly affirming the existence of traumatic amnesia and the reliability of "recovered memories".
While it has been established that false memories can and do occur their existence does not negate that of recovered memories. The validity of "False Memory Syndrome" per se has not however been established.
If you are interested in reading more about the debate on "recovered memory", please see two articles by Dr. Kenneth Pope: 'Questioning Claims about the False Memory Syndrome Epidemic' and 'Science as Careful Questioning'.
The definition of the syndrome is vague, and Pamela Freyd was unable to provide a list of symptoms or signs a year after establishing the Foundation.*It was later defined by Kilhstrom as:
“a condition in which a person's identity and interpersonal relationships are centered around a memory of traumatic experience which is objectively false but in which the person strongly believes.”
There have been a number of criticisms of FMS, such as:
- The definition of the syndrome did not evolve from clinical studies, but instead it is based on the accounts of parents claiming to be false accused of sexual abuse.*
- The syndrome is based on vague, unsubstantiated generalisations that do not hold up to scientific scrutiny. *
- The primary purpose of the syndrome is to discredit the testimony of people alleging child sexual abuse in court.*
- No empirical validation has been offered for the syndrome, nor have the symptoms been described and studied.*
- Where empirical evidence has been preferred for “False Memory Syndrome”, it has involved evidence of general memory errors rather then evidence of vivid, confabulated memories of child sexual abuse.*
- The syndrome has never been accepted as a valid diagnosis by any professional organisation, and use of the term in academic literature has prompted heated criticism.*
The FMSF claims that “False Memory Syndrome” is caused by “Recovered Memory Therapy”. There is no psychological therapy called “Recovered Memory Therapy”, and the term was invented by the Foundation in 1992 to describe any form of therapy in which a client might disclose memories of sexual abuse in childhood.
The FMSF argues that a recovered memory is likely to be a false memory, and that recovered memories are usually caused by therapists practing “Recovered Memory Therapy”. A number of criticisms can be made of this argument:
- The FMSF lumps evidence-based treatment for traumatic amnesia with fringe therapies under the term RMT, in an apparent attempt to discredit all treatment modalities for people with traumatic amnesia.
- A substantial proportion of those who recover memories do so without ever having participated in therapy, and where people recover memories whilst participating in therapy, most memories are recalled outside of therapy and without the use of specific memory techniques.*
- In a review of 30 former patients who sued their therapists for implanting false memories, Scheflin and Brown (1999) found that none of the cases involved therapy that could be characterised as “recovered memory therapy” e.g. a single-minded focus on recovering memories, or a client being misled in treatment.*
- After undertaking a review of research, Lindsay and Read (1994) concluded “there is little reason to fear that a few suggestive questions will lead psychotherapy clients to conjure up vivid and compelling illusory memories of childhood sexual abuse”. *
- It is extremely difficult to make people believe that a painful or graphic event occurred in their lives when it did not.*
Whitfield (2001) and Brown (2001) provides an excellent summaries of the manner in which accused child abusers attempt to defend themselves in court using “false memory” arguments and other defences:
- The “looking good” defence: Emphasises that the accused is an upstanding member of the community, a family man/woman, religious, hard working, respectable.
- The accused is the “real victim”: Inverts the allegations by suggesting that the accused is the person who is being victimised (by a false allegation), rather then plaintiff who claims to have been abused. Often goes hand-in-hand with claims that the accused does not blame the plaintiff, loves the plaintiff or forgives the plaintiff.
- Choose someone else to blame: Blame for the “false allegation” is usually laid at the feet of the therapist or social worker, or else at books, newspapers, the media and other venues.
- Blame the plaintiff: The person making the allegation of abuse is often blamed, particularly if their allegations are unusual. Often, the natural symptoms of trauma (such as self-harm, dissocation, or amnesia) are used to characterise the plaintiff as untrustworthy or unreliable.
- Plaintiff has not shown “hard” evidence of sexual abuse: In cases of child sexual abuse, it is rare for there to be eyewitness testimony, physical evidence, or other forms of evidence such as photos, diaries or confessions. The plaintiffs is often criticised for not having this evidence, as though such evidence would be an expected feature of their case. Meanwhile, indirect evidence of abuse (such as symptoms of post-traumatic stress disorder) are often dismissed.
- Hire a “false memory” expert: There are a range of “expert witnesses” who will make “false memory” arguments in court in exchange for money, regardless of the merits of the argument or the case.
- Inappropriate introduce extreme elements: In court, false memory advocates often introduce extreme situations, such as ritual abuse, alien abduction and past lives, in order to discredit the plaintiff’s claims of abuse, even where such situations have nothing to do with the case.
- Misinterpret the effects of trauma: False memory advocates often demonstrate a poor understanding of the effects of trauma and sexual abuse, often using the symptoms of trauma to characterise the plaintiff as unstable and unreliable.
- Negate or confuse traumatic amnesia: It is a common tactic of the FMSF to deliberately confuse traumatic amnesia with a concept that they call “repression”, which they then claim does not exist. The two concepts are distinct, and there is over a century of evidence for traumatic amnesia.
- Propose other explanations for accuser’s symptoms: False memory advocates commonly try to dismiss symptoms of trauma by suggesting they are related to everyday problems, such as an unhappy marriage or job difficulties. Some false memory “experts” have argued that there is no link between child sexual abuse and adult mental illness.
- Use contrived terms and other pseudo-scientific jargon: In court, accused molestors often try to use invented terms and concepts like “false memory syndrome”, “recovered memory therapy” or “parental alienation syndrome”.
- Make up categories with no scientific support: Acused molestors have often engaged “experts” who use new categories or terms that they invent in court e.g. “robust repression” vs “partial repression”.
- Equate retraction with proof of false memory: It is common for children or adults who were sexually abused, at some point in their lives, to claim that they were not sexually abused. Many accused molestors and their defence team have used retractions as “proof” that the initial disclosure was false, or that the plaintiff cannot be trusted.
- Play on our individual and collective wishes and doubts: Sexual abuse is difficult to hear about, and it is natural to wish that it did not occur. Many people harbour doubts that an adult would really harm a child, particularly their own. Many child abusers play on these doubts and wishes in the courtroom.