The negative impact of child abuse on adult mental health has been documented for over 150 years, and, over the last thirty years, in particular, numerous research studies have documented the link between child abuse and mental illness in later life. At present, there is no single diagnosis or condition that describes the psychological effects of child abuse. When in contact with mental health services, many adult survivors of child abuse find themselves diagnosed with multiple psychological conditions, many of which have considerable overlap.
The psychological impact of abuse on a child depends on a range of factors, including: the type of abuse, the severity of abuse, the relationship of the child to the abuser/s, the child's family environment and their relationship with their parents or other caregivers, and whether the child has previous experiences of abuse, or a history of support, care and love. These factors can soften, or exacerbate, the impact of abuse on a child's psychological wellbeing, and the likelihood that they will develop mental illness later in life.
Below is a list of a range of psychological conditions that are associated with child abuse. Please read on to find out more about them.
Post-Traumatic Stress Disorder (PTSD) is a psychological condition that develops after a person has been harmed or exposed to danger, and they have been unable to protect themselves. PTSD is particularly likely to develop when a person experiences fear, helplessness and powerless, which are all common features of child abuse.
PTSD has three main symptoms:
- Hyperarousal is similar to the jumpy feeling that drinking too much coffee causes. We might experience it as anxiety, agitation or irritability. It is commonly known as the state of ‘fight or flight’.
- Intrusions occur when traumatic experiences dating from a person’s past, break through into their consciousness and are experienced as though they are occurring in the present. They are called "flashbacks".
- Avoidance is an attempt to defend oneself against danger by limiting contact with the world. This can involve withdrawing from others or narrowing the range of thoughts and feelings a person allows him/herself to acknowledge. Avoidance can take the form of repression (locking the memory of a traumatic event away), denial (failing to acknowledge that an event which occurred, actually happened), dissociation (altered perception) or amnesia (memory loss). Survivors subconsciously use any or all of these techniques to survive the trauma of their abuse.
Other indicators of PTSD may include:
- Panic attacks
- Uncontrollable crying
- Uncontrollable rages
- Eating disorders
- Suicidal feelings
- Self mutilation
- Somatic pain
- Addictions (alcohol, drugs, sex)
- Overreaction to minor stress
- Sleep disorders
- Sense of defilement or stigma
- State of fight or flight
- Extreme mood swings
- High risk behaviours
- Shame, guilt and blame
Anxiety is a feeling of apprehension associated with symptoms of tension. It is different to fear as fear is a response to perceived present danger. When fear occurs inappropriately anxiety can escalate and a panic attack can occur. People who have experienced childhood abuse are more likely to experience frequent or generalised anxiety or panic attacks than those who haven’t.
Panic attacks occur when an individual experiences a sudden period of intense fear or discomfort, in which four or more of the following symptoms rapidly develop:
- palpitations/ pounding heart or racing heart
- feeling of choking or trouble breathing
- chest pain or discomfort
- nausea or abdominal distress
- feeling dizzy or faint
- feelings of unreality or of being detached from oneself
- fear of losing control or going crazy
- fear of dying
- numbness or tingling
- chills or hot flushes
Depression is common. People who are depressed can feel discouraged about the future, dissatisfied with life (maybe even wishing they were dead) or isolated from others. They might lack the energy to get things done or to even get out of bed, be unable to concentrate or to eat or sleep normally. Feeling depressed is often a response to past and current losses. To feel bad as a reaction to a tragedy (such as a significant loss) is to be expected. Major depressive disorder, however, occurs when signs of depression (including lethargy, worthlessness, or loss of interest in family, friends and activities) last two weeks or more for no apparent reason. Symptoms include:
Feelings of worthlessness or excessive or inappropriate guilt
Markedly diminished interest in all or almost all activities
Significant weight loss when not dieting or weight gain, or decrease or increase in appetite
Insomnia or hypersomnia
Diminished pleasure from usual activities
Feelings of hopelessness
Lack of motivation
Diminished ability to think or concentrate, or indecisiveness
Recurrent thoughts of death, suicidal ideation or attempts
Psychomotor agitation (observable restlessness) or retardation
Dissociative disorders are characterised by alterations in perception; a sense of detachment from one's own self (depersonalisation), from the world (derealisation) or from memories. Dissociative amnesia occurs when the individual is unable to remember important personal information. In extreme cases, new identities (alters) are formed. (Dissociative Identity Disorder or D.I.D.)
The more severe or protracted the abuse, the more the child will use dissociation to escape the horror or pain of a given situation. Survivors carry this skill into their adult life, continuing to use it as a way of avoiding difficulties in their lives. Many are not aware that they are dissociating as the process has become so automatic. Part of the journey of recovery from the trauma of child abuse involves learning to stay present while facing the reality of one's trauma.
People with D.I.D. can adopt many new identities, all simultaneously co-existing inside one body and mind. In some cases these identities are well-defined, each with its own behaviour, tone of voice and physical gestures. In other cases, only a few characteristics are distinct, because the identities are only partially independent.
This condition occurs less commonly than major depression. A person suffering from bipolar disorder will tend to alternate between the hopelessness and lethargy of depression and the hyperactive, wildly optimistic and impulsive phase of mania. The onset of bipolar disorder is usually in the twenties, although it sometimes starts in adolescence. Treatment for bipolar disease, which may include medication, psychotherapy and lifestyle changes, tends to be effective. Maintenance treatment between episodes may greatly reduce or even prevent further episodes.
Schizophrenia refers to a group of severe disorders in which a person loses touch with reality, experiencing grossly irrational ideas or distorted perceptions. It is a potentially serious mental illness which affects almost one person in 100. The first onset is usually in adolescence or early adulthood but the disorder can develop later. The onset may be rapid, developing over weeks, or slow in which case it develops over months or years. Some people only experience one or more brief episodes and recover fully while others have to deal with schizophrenia throughout their lives. The management of schizophrenia has improved a lot in recent years. Medication, psychotherapy, social and family support are all helpful and contribute to returning the person to work, education and personal life. Symptoms of schizophrenia include:
- Disorganised thinking – fragmented or bizarre and distorted by false beliefs called delusions. Thought and speech may be jumbled and difficult to follow, with conversation jumping from one subject to another without any obvious logic.
- Delusions can include ideas of persecution (paranoia) or ideas of grandeur.
- Disturbed perceptions including hallucinations: perceiving things that aren’t there – often auditory i.e. hearing voices although hallucinations can involve any of the five senses.
- Inappropriate emotional responses and actions
- Withdrawal from other people
- Loss of drive, initiative and motivation
- Lack of insight into own behaviour and thinking, and denial of the illness
The principle feature of eating disorders is a preoccupation with control over eating, body weight and food. Conversely, `out of control’ eating can likewise become a form of disorder. Both overeating and extreme restriction of food intake can be seriously injurious to health.
Overeating and `binge’ eating can lead to obesity and the many health implications that stem from it.
In relation to extreme restriction of food intake, anorexia nervosa includes features such as self-induced weight loss (through starvation, purging and exercise) and an intense fear of becoming fat.
Bulimia nervosa features repeated bouts of uncontrolled over-eating (bingeing), intense fear of gaining weight, engaging in excessive exercise to prevent weight gain, self-induced vomiting and the use of laxatives and fluid tablets.
Treatment for eating disorders includes nutritional management, cognitive-behavioural therapy around beliefs and distorted body image, psychotherapies and in some instances medication.
Personality disorders are long-lasting, maladaptive patterns of behaviour that impair social functioning. They are thought to originate in childhood and then continue into adult years.
Types include (this list is not exhaustive):
- Paranoid personality disorder: a pervasive distrust and suspicion of others
- Antisocial personality disorder: a pervasive pattern of disregard for and violation of the rights of others
- Borderline personality disorder: a pervasive pattern of instability of interpersonal relationships, self-image, affects, and control over impulses. A website - the Borderline Mother explains this disorder in more detail.
- Narcissistic personality disorder: a pervasive pattern of grandiosity, need for admiration, and lack of empathy
- Obsessive-compulsive personality disorder: a pervasive preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness and efficiency.
Treating people with personality disorders is often difficult as those with a personality disorder often do have little or no insight into the fact that their difficulties are a result of the way they relate to others.