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Flashcards in Neglect and Abuse Deck (14)
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1

What is classified as Severe maltreatment

includes physical violence, emotional abuse, neglect and contact sexual abuse. Abuse is classified as severe depending on: who the perpetrator was; how often it happened; if there was more than one type of abuse; if it resulted in a physical injury; if a weapon had been used; if it placed the child at risk of harm; or if it is defined by the victim as abuse

2

What is classified as Severe neglect

includes emotional neglect or lack of physical care or supervision that would place a child at risk.

3

What is classified as Verbal aggression

defined as: being embarrassed or humiliated, being shouted or screamed at, sworn at, called stupid or lazy, threatened with smacking or threatened with being sent away.

4

Statistics (Radford et al., 2009)

∗ 1 in 4 young adults (aged 18-24) have experienced severe maltreatment during childhood∗ 1 in 7 young adults mistreated by a parent/guardian∗ I in 9 young adults have experienced severe physical violence from an adult∗ 1 in 9 young adults have experienced contact sexual abuse during childhood∗ Nearly 1 in 10 were severely neglected by a parent/guardian during childhood∗ Levels of regular physical discipline and verbal aggression have decreased between late nineties and late noughties (10% to 2.8%, and 14.5% to 6%)

5

Who is responsible?

∗ 90% of CSA is perpetrated by someone known to the victim∗ 30% are relatives∗ 60% known authority figures∗ 10% of abusers are strangers∗ 90% are men & 10% women

6

Cross-Generational Abuse

∗ Up to 70% of abusive parents were themselves abused as children (Vince, 2005) - New Scientist article ∗ However the chances of those abused becoming abusers is low e.g. 12% of a male sample (Skuse et al., 2003) - BBC article∗ Becoming an abuser associated with:∗ Little supervision during childhood ∗ Abuse by a female ∗ Violence within the family∗ 1 in 3 had a history of cruelty to animals vs. 1 in 20 of non-abusers

7

Global Prevalence of CSA

∗ Global prevalence of CSA is 19.7% for females & 7.9% for males, according to a meta-analytic study (Pereda et al., 2009) which examined 65 studies from 22 countries. The highest prevalence rate of child sexual abuse geographically was found in Africa (34.4%), with particularly high rates in South Africa. Europe had the lowest prevalence rate (9.2%); America and Asia had rates of between 10.1% & 23.9%.

8

How many mental health service users have had these experiences?

∗ 50-60% of in-patients and 40-60% of out-patients in mental health services having been sexually abused as children ∗ Prevalence of CSA amongst users of mental health services is 40-50% (Mitchell et al., 1996) ∗ Read (1997) reported that 64% of female in-patients had histories of childhood physical or sexual abuse ∗ Background of CSA twice as likely in male in-patients (Read, 1997) *Roughly 60% female in-patients have experienced emotional abuse as children (Pribor et al., 1993

9

Effects of Abuse and Neglect

∗ Those who seek help have a variety of different problems e.g. ∗ Depression∗ Anxiety disorders, e.g. PTSD or OCD∗ Relationship difficulties∗ Eating disorders∗ Personality disorders∗ Self-harm∗ Low self-esteem∗ Substance misuse∗ Dissociative disorders

10

Risk & Resilience

∗ As many as 80% of those who experience childhood abuse & neglect may show signs of psychopathology by the age of 21 years (Silverman et al., 1996)∗ Not everyone who experiences abuse & neglect develops psychological problems!∗ Idea of post-traumatic growth (Haidt, 2006; Joseph & Lindley, 2010)

11

Biological factors

∗ Hormone system ∗ Stress leads to atypical responsiveness of HPA system (CRH & ACTH)∗ Structural brain changes∗ E.g. reduced corpus callosum volume ∗ Functional brain changes∗ Hyperactivity of the amygdala∗ Genetics∗ Epigenetics

12

Interventions

∗ Usually organised according to chief presenting problems e.g.s∗ EMDR for PTSD∗ IPT or CBT for depression∗ DBT for self-harm∗ ∗ RCP (2003) report that CBT most widely researched intervention for children with CSA history and that this shows benefits over other approaches (Jones & Ramchandani, 1999)

13

Compassion Focused Therapy

∗ Developed by Paul Gilbert who has a long-standing interest in shame, and in depression, as an integrated and multi-modal approach∗ People with shame engage with CBT but outcome may be limited due to a mismatch between cognition and emotion∗ CFT influenced by DBT, CBT, neuroscience, evolutionary psychology, developmental psychology, social psychology, and models of emotion∗ CFT applied to shame-based trauma as well as problems such as depression & eating disorders

14

Therapeutic Strategies in CFT

∗ Emotional capacity building – viewed as physiotherapy for the mind∗ Aims to balance affect regulation systems (circles)∗ ∗ Increase resilience by increasing ability to self-soothe∗ Increasing behavioural repertoire to include more self-caring behaviours which relieve distress∗ Uses imagery∗ Psycho-education∗ Cognitive restructuring