Long term effects of Child
Abuse
JHatlevig Ph.D., RNC
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.
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
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.
Cognitive symptoms
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Cognitive distortions
Low self-esteem/self image
Self blame
Worthlessness
Vulnerability
Decreased self efficacy/powerlessness
Stigma/internalized judgement of self
Self messages-dichotomy
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.
Problems with emotions
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Depression-#1 in the literature
Dysthymia
Alcoholism/CD
Cognitive distortions
Withdrawal
Anxiety
Rage
Psychosomatic disorders
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.
Dissociation
• Dissociative episodes-disengagement and
detachment
• Hypervigalence/anxiety
• Sensory memories
• Self-mutilation
• Fragmented memories-amnesia
• Overwhelming emotions, e.g. fear
• Depersonalization
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.
Sense of self
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Identity problems
Negative self definition
Confused boundaries
Feelings of emptiness
Difficulty maintaining any personal
relationships
• Hypervigalence/other directed
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.
Disturbed relatedness
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Intimacy disturbances
Altered sexuality
Aggression in relationships
Adversality
Manipulation
Sexual preoccupation
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.
Avoidance
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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
Other DSMIV
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PTSD
Borderline Personality Disorder
Dependant Personality Disorder
Acute Stress Responses.
Eating Disorders
Classify Depression
• Major Depression ( Clinical term )
Depression in people who have no ability to cheer themselves up.
• Postpartum Depression
Depression that occurs in women soon after giving birth.
( Generally the same as Major Depression. )
• Primary Depression
Depression alone with no other medical illness / disorder.
• Psychotic Depression ( Clinical term )
Depression accompanied by delusions and/or hallucinations.
• Secondary Depression
Depression that occurs after the onset of another medical illness /
disorder.
• Unipolar Depression
Depression with no manic episode.
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 Depression
Acute Depression with no obvious cause(s).
• Involutional Depression
Depression that occurs in the elderly.
( Generally the same as Major Depression. )
• Reactive Depression
Depression caused by an obvious traumatic life
episode(s).
Anxiety Disorders Types
Acute Stress Disorder
Agoraphobia
Agoraphobia Without History of Panic Disorder
Anxiety Disorder Due to a General Medical Condition
Anxiety Disorder Not Otherwise Specified ( Anxiety Disorder NOS )
Generalized Anxiety Disorder ( GAD )
Obsessive-Compulsive Disorder ( OCD )
Panic Attack
Panic Disorder With Agoraphobia.
Panic Disorder Without Agoraphobia.
Posttraumatic Stress Disorder
Social Phobia
Specific Phobia
Substance-Induced Anxiety Disorder
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.
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.
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.
Dissociative Disorders Types
Dissociative Amnesia.
Depersonalization Disorder.
Dissociative Fugue.
Dissociative Identity Disorder.
Dissociative Disorder Not Otherwise
Specified. ( NOS )
Case Studies
• The Landers Family (Child with
unidentified anger issues) p.156-160.
Please answer the questions on p. 160161.