Neglect and Abuse Flashcards
What is classified as Severe maltreatment
includes physical violence, emotional abuse, neglect and contact sexual abuse. Abuse is classified as severe depending on: who the perpetrator was; how often it happened; if there was more than one type of abuse; if it resulted in a physical injury; if a weapon had been used; if it placed the child at risk of harm; or if it is defined by the victim as abuse
What is classified as Severe neglect
includes emotional neglect or lack of physical care or supervision that would place a child at risk.
What is classified as Verbal aggression
defined as: being embarrassed or humiliated, being shouted or screamed at, sworn at, called stupid or lazy, threatened with smacking or threatened with being sent away.
Statistics (Radford et al., 2009)
∗ 1 in 4 young adults (aged 18-24) have experienced severe maltreatment during childhood
∗ 1 in 7 young adults mistreated by a parent/guardian
∗ I in 9 young adults have experienced severe physical violence from an adult
∗ 1 in 9 young adults have experienced contact sexual abuse during childhood
∗ Nearly 1 in 10 were severely neglected by a parent/guardian during childhood
∗ Levels of regular physical discipline and verbal aggression have decreased between late nineties and late noughties (10% to 2.8%, and 14.5% to 6%)
Who is responsible?
∗ 90% of CSA is perpetrated by someone known to the victim ∗ 30% are relatives ∗ 60% known authority figures ∗ 10% of abusers are strangers ∗ 90% are men & 10% women
Cross-Generational Abuse
∗ Up to 70% of abusive parents were themselves abused as children (Vince, 2005) - New Scientist article
∗ However the chances of those abused becoming abusers is low e.g. 12% of a male sample (Skuse et al., 2003) - BBC article
∗ Becoming an abuser associated with:
∗ Little supervision during childhood
∗ Abuse by a female
∗ Violence within the family
∗ 1 in 3 had a history of cruelty to animals vs. 1 in 20 of non-abusers
Global Prevalence of CSA
∗ Global prevalence of CSA is 19.7% for females & 7.9% for males, according to a meta-analytic study (Pereda et al., 2009) which examined 65 studies from 22 countries. The highest prevalence rate of child sexual abuse geographically was found in Africa (34.4%), with particularly high rates in South Africa. Europe had the lowest prevalence rate (9.2%); America and Asia had rates of between 10.1% & 23.9%.
How many mental health service users have had these experiences?
∗ 50-60% of in-patients and 40-60% of out-patients in mental health services having been sexually abused as children
∗ Prevalence of CSA amongst users of mental health services is 40-50% (Mitchell et al., 1996)
∗ Read (1997) reported that 64% of female in-patients had histories of childhood physical or sexual abuse
∗ Background of CSA twice as likely in male in-patients (Read, 1997) *
Roughly 60% female in-patients have experienced emotional abuse as children (Pribor et al., 1993
Effects of Abuse and Neglect
∗ Those who seek help have a variety of different problems e.g.
∗ Depression
∗ Anxiety disorders, e.g. PTSD or OCD
∗ Relationship difficulties
∗ Eating disorders
∗ Personality disorders
∗ Self-harm
∗ Low self-esteem
∗ Substance misuse
∗ Dissociative disorders
Risk & Resilience
∗ As many as 80% of those who experience childhood abuse & neglect may show signs of psychopathology by the age of 21 years (Silverman et al., 1996)
∗ Not everyone who experiences abuse & neglect develops psychological problems!
∗ Idea of post-traumatic growth (Haidt, 2006; Joseph & Lindley, 2010)
Biological factors
∗ Hormone system
∗ Stress leads to atypical responsiveness of HPA system (CRH & ACTH)
∗ Structural brain changes
∗ E.g. reduced corpus callosum volume
∗ Functional brain changes
∗ Hyperactivity of the amygdala
∗ Genetics
∗ Epigenetics
Interventions
∗ Usually organised according to chief presenting problems e.g.s
∗ EMDR for PTSD
∗ IPT or CBT for depression
∗ DBT for self-harm
∗
∗ RCP (2003) report that CBT most widely researched intervention for children with CSA history and that this shows benefits over other approaches (Jones & Ramchandani, 1999)
Compassion Focused Therapy
∗ Developed by Paul Gilbert who has a long-standing interest in shame, and in depression, as an integrated and multi-modal approach
∗ People with shame engage with CBT but outcome may be limited due to a mismatch between cognition and emotion
∗ CFT influenced by DBT, CBT, neuroscience, evolutionary psychology, developmental psychology, social psychology, and models of emotion
∗ CFT applied to shame-based trauma as well as problems such as depression & eating disorders
Therapeutic Strategies in CFT
∗ Emotional capacity building – viewed as physiotherapy for the mind
∗ Aims to balance affect regulation systems (circles)
∗
∗ Increase resilience by increasing ability to self-soothe
∗ Increasing behavioural repertoire to include more self-caring behaviours which relieve distress
∗ Uses imagery
∗ Psycho-education
∗ Cognitive restructuring
