PSYCHIATRIC DAMAGE EVOKED BY HARSH CHILD ABUSE

Psychiatric Damage Evoked By Harsh Child Abuse

Adolescence is a critical period with high levels of emotion, risk-taking, and interpersonal stress. Moreover, sexual violence among adolescents is ~28% (Finkelhor et al., 2009; Scher et al., 2004) and evokes dependency, suicidality, violence, impulsivity, substance abuse, pain and negative affect (Fillingham et al., 2005; Finkelhor et al., 2009). This is the period in life in which individuals are most vulnerable to abuse (Keiley et al., 2001), although adults also suffer from such treatment.

A particularly noteworthy study of the condition of adolescents that have been harshly abused is presented by Grilo et al. (1999). The abstract from this study is shown in the first box below and the critical Table 2 shown in the next box (Notice the very significant p values; <0.0001).

Objective:The Purpose of this study was to examine psychological and behavioral functioning in psychiatrically hospitalized adolescents who report histories of childhood
abuse.
Method:Three hundred twenty-two subjects completed an assessment battery of psychometrically well-established instruments.Childhood abuse was assessed by using the childhood abuse scale of the million Adolescent Clinical Inventory.Childhood abuse scores of 30 or less and 70 or greater were used to create two study groups-no abuse(N=93) and high abuse(N=70),respectively. The two study groups were compared demographically and on the bettery of instruments.
Results:The two groups differed substantially on most measures of psychological distrubance examined by the assessment battery.;When age and depression level were controlled,the high-abuse group was characterized by significantly higher levels of dependency, suicidality, violence, impulsivity, substance use problems, and borderline tendency.Correlational analyses with the entire study group(n=322)revealed that higher levels of these psychological problems were positively associated with higher levels of childhood abuse .
Conclusions:psychiatrically hospitalized adolescents who report childhood abuse present with a constellation of symptoms that, after removing the effects of depression, are consistent with borderline personality in statu nascendi.
(AM J Psychiatry 1999, 156:538-543)

The above study emphasizes that abuse is prominent among patients with borderline personality disorder (BPD). Indeed, controlling for the effects of depression, the pattern of behavior appears to be dominated by BPD. These patients experience intense emotions, often show a deficiency of emotion regulation, and high prevalence of self-injurious behavior, also termed cutting. This figure shows the perspective of the internal struggle of a survivor of adolescent physical abuse. Self-loathing, intent for self-injury, a cry for help, and the bondage of being locked in a world of turmoil are all apparent.

Various types of childhood adverse events are reported by patients with BPD and the most frequent is sexual abuse reported by 40–71% of inpatients and the severity of borderline psychopathology has been linked to the severity of childhood sexual abuse (Lieb et al., 2004). Patients with BPD who currently injure themselves show lower pain sensitivity than those who have stopped self injury (Ludascher et al., 2009). Patients with BPD have higher pain thresholds than controls in response to identical heat stimuli. Thermal pain produces neural deactivation in the anterior cingulate cortex and amygdala (Schmahl et al., 2006).
Patients report engaging in self-injurious behavior due to its immediate relief effects on emotional tension. Pain in BPD has further been observed to lead to a reduction in neural activity in anterior cingulate cortex, which may be attributed to patients’ perception of relaxation.

Clearly, adolescents suffer severe psychiatric damage following their abusive events. Unfortunately, these outcomes are associated with many adult-onset psychiatric, chronic pain and stress syndromes as discussed in the next section.

Reference
  • Fillingim RB, Edwards RR (2005) Is self-reported childhood abuse history associated with pain perception among healthy young women and men? Clin J Pain 21:387-397.
  • Finkelhor D, Turner H, Ormrod R, Hamby SL (2009) Violence, abuse, and crime exposure in a national sample of children and youth. Pediatrics 124:1411-1423.
  • Grilo CM, Sanislow C, Fehon DC, Martino S, McGlashan TH (1999) Psychological and behavioral functioning in adolescent psychiatric inpatients who report histories of childhood abuse. Am J Psychiatry 156:538–543.
  • Keiley MK, Howe TR, Dodge KA, Bates JE, Pettit GS (2001) The timing of child physical maltreatment: A cross-domain growth analysis of impact on adolescent externalizing and internalizing problems. Develop Psychopathol 13:891-912.
  • Lieb K, Zanarini MC, Schmahl C, Linehan MM, Bohus M (2004) Borderline personality disorder. Lancet 364:453-461.
  • Ludaescher P, Greffrath W, Schmal C, et al. (2009) A cross-sectional investigation of discontinuation of self injury and normalizing pain perception in patients with borderline personality disorder. Acta Psychiatr Scand 120:62-70.
  • Scher CD, Forde DR, McQuaid JR, Stein MB (2004) Prevalence and demographic correlates of childhood maltreatment in an adult community sample. Child Abuse Neg 28:167-180.
  • Schmahl C, Bohus M, Espoito F, et al. (2006) Neural correlates of antinociception in borderline personality disorder,. Arch Gen Psychiatry 63:659-667.