Childhood Abuse and Mental Illness Part I
(Column: Ask the Doctor)
Exploring the possible link
Stephen M. Goldfinger, M.D. & Ellen Tabor, MD
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Question: Is there a relationship between childhood abuse and mental illness?”
To begin with, not all abuse is the same. Children can experience emotional abuse, physical abuse, sexual abuse, or some combination of the three. Emotional abuse is when parents, caregivers or significant adults make the child feel inadequate, ashamed and worthless. This can happen through criticism, harsh discipline, and so on.
Physical abuse is hurting a child physically, but since different cultures have different opinions about what is abusive, this can be very hard to quantify. For example, some cultures recommend spanking as a means of disciplines, some allow it and some forbid it. So is spanking abusive? And what about spanking with a bare hand or a belt? Are those different? Is one abusive and one not?
Sexual abuse can occur at the hand of a trusted adult (family member, babysitter, teacher, clergyperson, etc.), an acquaintance or a stranger and it might matter which it is, when it comes to later ramifications. Abuse can also happen at the hand of a person of the same sex or a different sex from the victim.
One of the most important factors in making sure that abuse is not permanently damaging is whether or not the child victim has an adult they can trust, who will believe the child, will believe that abuse occurred and will aid the child in getting the abuse to stop. Unfortunately, the child victim does not always have a trusted adult, and so will have to live with the problem. And that can be damaging indeed.
Another important factor is the personality structure of the child victim. As people differ in all kinds of qualities, one quality that varies among people is resilience. Resilience is that ability to roll with the punches, to recover from problems, to deal with what life hands you and end up all right. It’s something we are born with, and some of us are just naturally more resilient than others. So we can expect that people who are more resilient will be less affected by abuse; they will certainly be affected at the time, and for some time after, but they will recover their equilibrium more quickly and have less lasting damage from the abuse they suffered. Resilience is supported by a structured and safe environment, and no matter how resilient one is and the more stable the external environment is, the better off the victim will be. Actually, the better off we ALL will be, but even more so for the victims of abuse.
One psychiatric disorder, borderline personality disorder (BPD), often occurs in people with a history of sexual and physical abuse. Although most people with borderline personality disorder can recall a history of such abuse, most people who have been abused have symptoms not severe enough to diagnose, or no disorder at all. One characteristic symptom of BPD is dissociation, which is when one feels removed from one’s environment, is particularly common after physical abuse, but less so after sexual abuse. In general, research has shown that emotional and sexual abuse are less likely to result in adult psychiatric and emotional problems than physical abuse.
However, there is a lot of research to show that certain kinds of trauma can disrupt normal bonding between infants and their mothers and other caregivers. These kinds of traumas would include very inconsistent parenting, in which the baby does not learn to depend on the mother. The mother does not have to be perfect, just “good enough” to allow the baby to develop trust. When the baby doesn’t have that kind of mother, or the baby and mother don’t “match,” then the baby can experience this mismatch as traumatic and go on to develop a series of symptoms relating to this. Early childhood disruptions can lead to psychiatric problems later on, particularly borderline personality disorder, with its attendant difficulties in making relationships, trusting others, being unable to soothe oneself and so using cutting, alcohol, drugs or food as soothing agents.
In addition, evidence exists that early parental loss, particularly loss of the father before age 10 can predispose the surviving children to depression. It has been thought that this had to do with the loss of the father’s earnings, which drove the family into poverty or straightened circumstances, which leads to feelings of helplessness and hopelessness in the children.
Most mental illnesses have a biological and genetic basis but also require an environmental stress to become fully activated. This means that if you have the genes for schizophrenia, it would take less stress to begin to have symptoms than if you don’t, but if the environmental stress is severe enough, even someone without the genes for schizophrenia might become temporarily psychotic.
Part II of this interesting discussion about the link between abuse and mental illness will conclude in the summer 2007 edition of New York City Voices. If you have your own questions for our Ask the Doc columnists, please email them to askdoc@newyorkcityvoices.org or fax to (413) 647-6758.
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