The Lingering Trauma of Child Abuse

In an earlier article, I talked about child neglect (known as an "act of omission".) On the other end of the spectrum of child abuse is physical abuse, an act of commission. 

According to U.S. Department of Health and Human Services statistics for 2006, approximately 905,000 U.S. children were found to have been maltreated that year, with 16% of them reported as physically abused (the remainder having suffered sexual abuse or neglect.)¹ In other studies, it's been noted that approximately 14-43% of children have experienced at least one traumatic abusive event prior to adulthood.² And according to The American Humane Association (AHA), an estimated 1,460 children died in 2005 of abuse and neglect.³

How is child abuse defined?

The AHA defines physical child abuse as "non-accidental trauma or physical injury caused by punching, beating, kicking, biting, burning or otherwise harming a child."³ However, it can be challenging to draw the line between physical discipline and child abuse. When does corporal punishment cease to be a style of parenting and become an abusive behavior that is potentially traumatizing for its child victims in the long-term?

 A recent episode of the popular television show Dr. Phil featured a woman whose extreme disciplinarian tactics later resulted in her arrest and prosecution for child abuse. A featured video showed her forcing her young adopted son to hold hot sauce in his mouth and take a cold shower as punishment for lying. Audience members were horrified—as was Dr. Phil—but the woman insisted that she couldn't find a better way to control her child. Many child abusers are not aware when their behavior becomes harmful to a child or how to deal with their own overwhelm before they lose their tempers.

At its core, any type of abuse of children constitutes exploitation of the child's dependence on and attachment to the parent. 

Another therapeutic term that is used in conjunction with child abuse is "interpersonal victimization." According to the book Childhood victimization: violence, crime, and abuse in the lives of young people by David Finkelhor, interpersonal victimization can be defined as "...harm that comes to individuals because other human[s] have behaved in ways that violate social norms."⁵ This sets all forms of abuse apart from other types of trauma-causing-victimization like illness, accidents, and natural disasters.

Finkelhor goes on to explain: "Child victimizations do not fit neatly into conventional crime categories. While children suffer all the crimes that adults do, many of the violent and deviant behaviors engaged in by human[s] to harm children have ambiguous status as crimes. The physical abuse of children, although technically criminal, is not frequently prosecuted and is generally handled by social-control agencies other than the police and criminal courts."⁵

What happens to abused children?

In some cases—depending on the number of reports made, the severity of the abuse, and the available community resources—children may be separated from their parents and grow up in group homes or foster care situations, where further abuse can happen either at the hands of other abused children who are simply perpetuating a familiar patterns or the foster parents themselves. In 2004, 517,000 children were living in foster homes, and in 2005, a fifth of reported child abuse victims were taken out of their homes after child maltreatment investigations.⁶ Sometimes, children do go back to their parents after being taken away, but these statistics are slim. It's easy to imagine that foster care and group home situations, while they may ease the incidence of abuse in a child's life, can lead to further types of alienation and trauma.

How does child abuse turn into Post Traumatic Stress Disorder?

Statistics show that females are much more likely than males to develop PTSD as a result of experiencing child abuse. Other factors that help determine whether a child victim will develop PTSD:⁷

• The degree of perceived personal threat

• The developmental state of the child: Some professionals surmise that younger children, because they are less likely to intellectually understand and interpret the effects of a traumatic situation, may be less at risk for long-term PTSD)

• The relationship of the victim to the perpetrator

• The level of support the victim has in his day-to-day life as well as the response of the caregiver(s)

• Guilt: A feeling of responsibility for the attack ("I deserve it") is thought to exacerbate the changes of PTSD

• Resilience: the innate ability to cope of the individual

The child's short-term response to abuse: For instance, an elevated heart rate post-abuse has been documented as increasing the likelihood that the victim will be later suffer from PTSD.

Carolyn Knight wrote a book called Working With Adult Survivors of Childhood Trauma that states: "Trauma, by definition, is the result of exposure to an inescapably stressful event that overwhelms a person's coping mechanisms."⁶ She points out that an important aspect of an event (or pattern of events) is that it exceeds the victim's ability to cope and is therefore overwhelming. A child should not have to cope with abuse, and when abuse occurs, a child is not equipped psychologically to process it. The adults in their lives are meant to be role models on how to regulate emotions and provide a safe environment.

According to the American Academy of Child & Adolescent Psychiatry, some of the particular symptoms of child PTSD include:⁸

• Frequent memories and/or talk of the traumatic event(s)

• Bad dreams

• Repeated physical or emotional symptoms whenever the child is confronted with the event

• Fear of dying

• Loss of interest in activities

• Regular physical complaints such as headaches or stomachaches

• Extreme emotional reactions

• Trouble sleeping

• Irritability, anger, violence

• Difficulty concentrating

• Constant or often clingy or whiny behavior and regression to a younger age

• Increased vigilance or alertness to their environment

Once a child has grown to be an adult, however, symptoms of PTSD can become more subtle as he or she learns how to cope with this in day-to-day life. The symptoms of PTSD can be quite general and can mimic other disorders: depression, anxiety, hypervigilance, problems with alcohol and drugs, sleep issues, and eating disorders are just a few. Many have problems in their relationships and trusting another person again. Many even end up in abusive relationships and find themselves re-enacting the past.

Community support is a vital tool in preventing child abuse and the PTSD that can result from it. If you suspect that you or a loved one is suffering from child abuse, please report it to your local Child Protection Services - or the police, if a child is in immediate danger. The longer that abuse continues, the higher the risk of causing severe symptoms.

For more information about actions to take if you suspect a case of child abuse, visit the Dreamcatchers website.

If you or a loved one may be suffering from delayed effects of trauma due to childhood abuse, I encourage you to make a therapy appointment with someone who specializes in trauma and who can put you on a path of healing.
 

Citations:

1. Child Maltreatment 2006. Washington DC: US Department of Health and Human Services Administration for Children and Families, Administration on Children Youth and Families Children's Bureau; 2008. 1-194

2. http://emedicine.medscape.com/article/916007-overview

3. http://www.americanhumane.org/

4. http://www.americanhumane.org/children/stop-child-abuse/fact-sheets/chil...

5. http://www.americanhumane.org/children/stop-child-abuse/fact-sheets/chil...

6. United States Department of Health and Human Services

7. "Child Abuse and Neglect, Post Traumatic Stress Disorder" by Angelo P Giardino, MD, PhD, Clinical Associate Professor, Department of Pediatrics, Baylor College of Medicine; Medical Director, Texas Children's Health Plan, Inc

8. http://www.aacap.org/

First published on Psychology Today.