Child Maltreatment Exam Study PDF

**Society Mind and Health Exam Study** **Child Maltreatment and Health** **Potential Exam Questions Based on the Lecture Content** **Discuss the differences between traumatic and non-traumatic memories, referencing the findings of Van der Kolk & Fisler (1995).** - Traumatic memories are often...

**Society Mind and Health Exam Study** **Child Maltreatment and Health** **Potential Exam Questions Based on the Lecture Content** **Discuss the differences between traumatic and non-traumatic memories, referencing the findings of Van der Kolk & Fisler (1995).** - Traumatic memories are often dissociated and fragmented, unlike non-traumatic memories which are typically organized as coherent narratives12. Van der Kolk & Fisler (1995) found that traumatic memories are not always resolved through verbal expression, challenging earlier theories by Breuer and Freud13. **Evaluate the impact of childhood maltreatment on adult mental health, using evidence from the Adverse Childhood Experience study.** - The ACE study by Edwards et al. (2003) highlights a dose-response relationship between the number of maltreatment types and adult mental health issues43. This study found significant associations between childhood maltreatment and adult mental health problems, such as depression and anxiety41. **Analyse the role of resilience in mitigating the effects of child maltreatment on adult psychopathology, as discussed by Collishaw et al. (2007).** - Collishaw et al. (2007) identified factors like supportive relationships that can protect against adult psychopathology following child maltreatment45. Good relationship functioning can reduce or eliminate the negative mental health impacts of child maltreatment46. **Examine the physiological consequences of child maltreatment, with a focus on telomere erosion and chronic inflammation.** Shalev et al. (2013) found that exposure to violence in childhood is linked to telomere erosion, which has negative health implications18. Additionally, Osborn & Widom (2020) reported that childhood maltreatment predicts higher levels of C-Reactive Protein, indicating chronic inflammation19. **Discuss the historical development of the understanding of child maltreatment and its impact on mental health, referencing key figures and studies.** - The understanding of child maltreatment has evolved significantly since the 19th century, with early contributions from figures like Pierre Janet and Sigmund Freud51. The Battered Child Syndrome, introduced by Kempe in 1962, marked a pivotal moment in recognizing physical abuse as a clinical condition2. **Evaluate the relationship between child maltreatment and physical health outcomes in adulthood, as reviewed by Wegman & Stetler (2009).** - Wegman & Stetler (2009) conducted a meta-analysis showing that child abuse is associated with increased risk of various physical health issues, including cardiovascular and neurological problems21. Emotional abuse, in particular, is a strong predictor of ischemic heart disease46. **Child Abuse: Development of the Debate and Research in the last 60 Years** - Henri Kempe: The battered child syndrome in 1962. It was defined as a clinical condition in young children who have received physical abuse, generally from a parent or foster parent. Eventually changed to child abuse and neglect. - 1960 to mid-1970's: sexual abuse normally excluded from the events comprised by child maltreatment. Basically, absent from discussions of child maltreatment. - 1970's to 1980's: child sexual abuse started being stressed and eventually became a widely debated aspect of child abuse. - Early to mid-90's: positions on child sexual abuse polarised, with some minimising it (false memory syndrome foundation) and some identifying so strongly with victims as to lose objectivity. - 21^st^ century: polarised views on sexual child abuse gradually shifted to more middle ground. Interest in other forms of abuse emerged like emotional abuse and exposure to domestic violence developed. Research has expanded from an exclusive interest in mental health consequences to physical health consequences. **World Health Organisation (2016) definition of Child Maltreatment** Child maltreatment is the abuse and neglect that occurs to children under 18 years of age. It includes all types of physical and/or emotional ill-treatment, sexual abuse, neglect, negligence and commercial or other exploitation, which results in actual or potential harm to the child's health, survival, development or dignity in the context of a relationship of responsibility, trust or power. **Forms of Child Maltreatment (Gilbert et al., 2009)** - Physical abuse: Intentional use of physical force or implements against a child that results in, or has the potential to result in, physical injury Includes hitting, kicking, punching, beating, stabbing, biting, pushing, shoving, throwing, pulling, dragging, shaking, strangling, smothering, burning, scalding, and poisoning. - Sexual abuse: Any completed or attempted sexual act, sexual contact, or non-contact sexual interaction with a child by a caregiver or a substitute caregiver in a temporary custodial role (eg, teachers, coaches, clergy, and relatives). - Psychological (emotional) abuse: Intentional behaviour that conveys to a child that he/she is worthless, flawed, unloved, unwanted, endangered, or valued only in meeting another's needs - Neglect: Failure to meet a child's basic physical, emotional, medical/dental, or educational needs; failure to provide adequate nutrition, hygiene, or shelter; or failure to ensure a child's - Intimate partner violence: Any incident of threatening behaviour, violence, or abuse (psychological, physical, sexual, financial, or emotional) between adults who are, or have been, intimate partners or family members, irrespective of sex or sexuality **Prevalence of Self-Reported Child Maltreatment Across the Globe: Child Abuse Review (2015)** - Sexual Abuse (Male): 7.6% - Sexual Abuse (Female): 18% - Physical Abuse: 22.6% - Emotional Abuse: 36.3% - Neglect (physical): 16.3% - Neglect (emotional): 18.4% **Can Child Abuse be Forgotten? Can Memories of Childhood Abuse that had been Forgotten be subsequently 'recovered'?** **Williams (1995) Recovered memories of abuse in women with documented child sexual victimisation histories.** - **Sample:** 119 women who had been seen in the early 1970s following a report of sexual abuse, were interviewed 17 years later (in 1990-92) about the abuse. The age at time of abuse was 10 months to 12 years and at time of re-interview, they were 18 to 31 years. 86% were African-American. - **Findings:** 62% of the women recalled the victimisation. 16% of those who recalled the abuse reported that at some time in the past they had forgotten about the abuse. - Those with a prior period of forgetting were younger at the time of abuse and were less likely to have received support from their mothers than the women who reported that they had always remembered their victimisation. - The women who had recovered memories and those who had always remembered had the same number of discrepancies when their accounts of the abuse were compare to the reports from the early 1970's. **Are traumatic memories different from non-traumatic memories?** **Van der Kolk & Fisler (1995) Dissociation and the fragmentary nature of traumatic memories: overview and exploratory study.** **46 American adults who had experience a trauma recruited via a newspaper advert.** **Types of traumas:** - **Sexual:** adult (1) and childhood (29) - **Physical abuse:** adult (0) childhood (11) - **Witnessing death of someone close:** adult (4) childhood (1) - **Being injured:** adulthood (3) childhood (1) - **Other:** adult (3) childhood (2) **Participants were asked:** can you tell us about an event in your life that you think you will always remember but that is not traumatic: birth of child, wedding day etc Then participants were asked questions concerning their recollections and sensory details of those events. At this point, participants were asked about the trauma that had brought them into the sutyd, and whether they happened to suddenly remember sensory details (e.g., smell of the rapist), or whether they had ever re-experienced the same physical sensations. Participants were also asked how they recalled their trauma at three points in time: - Right after it happened - When they were most troubled by their symptoms - During the week before the study Memories for positive events - **Organisation:** recalled as events from the past and reported as stories with a beginning, a middle and an end. - **Physical Reactions to the Memory:** Complete absence of olfactory, visual, and auditory reliving of event. Environmental triggers do not suddenly bring back vivid memories. Memories for traumatic events - **Organisation:** Initial difficulties in remembering (some details remembered too clearly while other vital details like the first person who arrived to help are not recalled. What happened immediately after the event is forgotten) - Narrative memory starts to emerge at the pick of intrusive recollections, when all sensory modalities are enhanced. - **Physical Reactions to the Memory:** Somatosensory or emotional flashbacks. Images, sensations and emotions are overwhelming. **Conclusions** - Study confirmed the dual memory system suggesting that traumatic memories are fundamentally different from the stories we tell about the past. They are dissociated: the different sensations that entered the brain at the time of the trauma are not properly assembled into a story, a piece of autobiography. - Remembering the trauma, with all its dissociated effects, does not, necessarily resolve it. Our research does not support the idea that language can substitute for action. Finding words to describe what has happened to you can be transformative, but it does not always abolish flashbacks or improve concentration or reduce hypersensitivity to disappointments and perceived injuries. **Child Maltreatment and Maladaptive Coping Behaviour in Adulthood** Kisely et al. (2020) Child Maltreatment and Persistent Smoking from Adolescence into Adulthood: A birth Cohort Study. - Nearly 4000 participants from Brisbane Australia, assessed at both 14 and 21 years of age for smoking and nicotine use disorder. - Child maltreatment assessed by linkage with state child protection agency data. **Findings:** - Physical abuse: 2.36 more likely to develop nicotine use disorder by age 21 compared to no maltreatment. - Sexual Abuse: 1.45 risk of developing nicotine use disorder: not statistically significant. - Emotional Abuse/Neglect: 2.38 times more likely to develop a nicotine use disorder at age 21. - Findings robust across different backgrounds. - Findings for sexual abuse -\> severity of sexual abuse may have a stronger association with substance abuse disorders / sexual abuse can lead to a range of psychological disorders such as PTSD/Depression/anxiety which can manifest differently in individuals leading to coping mechanisms other than nicotine uses (other forms of substance abuse or behavioural issues). **Child Maltreatment and Health-Damaging Physiological Changes in Late Childhood and Adulthood.** **Shalev et al. (2013) Exposure to violence during childhood is associated with telomere erosion from 5 to 10 years of age: a longitudinal study.** **Telomere is a region of repetitive DNA sequences at the end of a chromosome which is a long DNA molecule with part or all of the genetic material of an organism. Telomeres protect the ends of chromosomes from becoming frayed or tangled. Telomere erosion has negative consequences for health.** - 236 British children born in 1994-1995 (tested at 5 and 10 years) - Findings: children exposed to two or more forms of violence showed more telomere erosion between 5 and 10 years of age, even after adjusting for sex, socioeconomic status and BMI, than their counterparts. Ridout et al., (2018) conducted a meta-analysis which found that early adversity such as abuse, socioeconomic status and neglect and telomere length were negatively associated. **Osborn and Widom (2020) Do documented records and retrospective reports of childhood maltreatment similarly predict chronic inflammation?** - 443 young adults were assessed for C-Reactive Protein (CRP) -- a marker of inflammation -- through blood spot. - Official reports of maltreatment abstracted from Child Protective Services records. 17% had official reports. - **Findings:** results suggest that experience of child maltreatment particularly physical abise, are associated with higher levels of inflammation in young adulthood. This can have long-term health implications, such as chronic inflammation, later in life. This may be due to chronic stress responses or other physiological changes induced by maltreatment. Results for sexual abuse and neglect warrant further investigation. **Child Maltreatment and Physical Disease in Adulthood.** **Wegman and Stetler (2009) A meta-analytic review of the effects of childhood abuse on medical outcomes in adulthood.** - 24 studies (48,801 individuals). - Child abuse was associated with increased risk of negative physical health outcomes in adulthood with an effect size d = 0.42 (small to medium/moderate effect warranting further investigation into the other factors affecting medical outcomes). - Neurological and musculoskeletal problems yielded the largest effect sizes, followed by respiratory problems, cardiovascular disease, gastrointestinal and metabolic disorders. - Effect was larger when the sample was exclusively female and when the abuse was assessed via self-report rather than objective procedures. This might reflect gender differences in the experience or reporting of abuse or in the physiological or psychological responses to abuse. - Externalising vs. Internalising Behaviours: Externalising behaviours more common in men, which may include aggression, substance use and delinquency (more commonly observed in men) and internalising behaviours are more commonly seen in women where anxiety, depression and withdrawal are observed. These behaviours may lead to physiological stress responses, potentially increasing the risk of health problems like inflammation. - Mne may externalise their distress through behaviours like smoking or substance use. Women may internalise their experiences, leading to chronic responses and inflammation possibly leading to stronger associations between childhood abuse and health outcomes observed in females. **Goodwin et al. (2003) Association between childhood physical abuse and gastrointestinal disorders and migraine in adulthood.** - 2407 adults (25-74) in the noninstitutionalised civilian population in the US (1995-1996). - Any childhood physical abuse was linked to more recurring stomach problems (OR = 3.5), Migraine ( 2.7) and Ulcer (4.2), which remained statistically significant after adjusting for sociodemographic characteristics and mental disorders. - Suggestive of inflammation. **Soares et al. (2020) Sex Differences in the association between childhood maltreatment and cardiovascular disease in the UK Biobank.** **UK Biobank is a large long-term study in the UK, which began in 2006. It investigates the impact\ of genetic predisposition and environmental exposure (e.g., nutrition, lifestyle, medications etc.)\ on the development of disease. The study is following about 500,000 volunteers in the UK,\ enrolled at ages from 40 to 69. Volunteers will be followed for at least 30 years thereafter.** - 157,311 participants from the UK Biobank. - Information about CVD collected in 2006-10 (extracted from self-report, blood pressure measurements, hospital register and death register). Age of participants: 40-69 years. - Information on child maltreatment self-reported in 2016. - Confounding Variables: age, ethnicity, Townsend deprivation index, maternal smoking around birth and family history or CVD. **Child Physical Abuse and Mental Health in Adulthood** **Sugaya et al. (2012) Child physical abuse and adult mental health: a national study.** - 34,653 of US adult population, assessed in two waves. - Psychiatric diagnosis: DSM-IV - Child abuse and Trauma: participants asked about childhood adversities that occurred in their first 17 years of life. - 8% of the sample reported a history of childhood physical abuse. - 84% had a life history of at least one psychiatric disorder. **Push, grab, shove, slap, or hit:** - **Never:** used as the reference group with an OR, indicating no increased risk beyond baseline (OR: 1.00) - **Almost Never:** shows a moderate increase in the odds of developing mood disorders, anxiety disorders, substance use disorders and suicide attempts. - **Sometimes:** The odds increase further for the above. - **Often:** the highest odds, indicating a strong association: Mood disorders (OR: 4.45), Anxiety (4.68), substance abuse (2.73), and a dramatic increase in suicide attempts (OR 8.60). **Hit hard enough to have marks or be injured:** - **Never:** reference group - **Almost never:** increased odds for mood disorders - **Sometimes:** increasing odds - **Often:** significantly increased odds: extremely high odds for suicide attempts (OR: 9.42). The study highlights a clear dose-response relationship, where both the frequency and severity of physical abuse are associated with increased odds of developing psychiatric disorders. More frequent and severe abuse is linked to higher odds of adverse outcomes. The results indicate that individuals who experience physical abuse have significantly higher odds of developing mood and anxiety disorders, substance use disorders and attempting suicide. Abused individuals have notably higher rates of disorders like MDD, bipolar, panic disorder, social anxiety, PTSD, psychosis, ADHD and suicide attempts. **Need for Interventions**: These findings underscore the critical need for early intervention and support for individuals who have experienced physical abuse to prevent or mitigate long-term mental health consequences. Overall, the study by Sugaya et al. provides robust evidence of the significant impact of child physical abuse on lifetime mental health outcomes, reinforcing the need for targeted interventions and policy measures. **Child Sexual Abuse and Mental Health in Adulthood** **Cutajar et al. (2010) investigates the long-term mental health outcomes of children who experienced sexual abuse, using a large cohort from the Victorian Institute of Forensic Medicine records:** - 2,688 (80.1% females) who were sexually abused before the age of 16. Average age was slightly above 10 with males on average being 1 year younger. - **Affective Disorder**: No significant difference in males (OR = 0.96). In females, the odds were significantly higher for abuse survivors (OR = 2.44). - **Post-Traumatic Stress Disorder (PTSD)**: Higher odds in both males (OR = 2.19) and females (OR = 7.25), indicating a strong association between abuse and PTSD. - **Psychosis**: Increased odds in both genders, with males (OR = 2.50) and females (OR = 2.04). - **Alcohol Abuse**: Higher odds in males (OR = 3.41) and significantly higher in females (OR = 8.96). - **Borderline Personality Disorder**: Significant only in females (OR = 7.62). - **Antisocial Personality Disorder**: Higher odds in males (OR = 3.84). - **Significant Gender Differences**: The impact of childhood sexual abuse on mental health outcomes appears to be more pronounced in females, particularly for affective disorders, PTSD, and alcohol abuse. - **Severity and Context Matter**: The severity of abuse (e.g., penetration, multiple offenders) and the victim\'s relationship to the offender significantly influence long-term mental health outcomes. - **Need for Targeted Interventions**: These findings highlight the necessity for targeted mental health interventions for abuse survivors, taking into account the severity, frequency, and relational context of the abuse. - **Long-term Impact**: The study demonstrates the profound and lasting impact of childhood sexual abuse on mental health, necessitating ongoing support and resources for survivors well into adulthood. - **Depression:** emotional abuse is most strongly associated with depression, followed by neglect and abuse. This suggests that the psychological impact of emotional maltreatment has a profound effect on depression risk. - **Anxiety:** similar to depression, emotional abuse shows the strongest association with anxiety, indicating that the emotional and psychological aspects of maltreatment can significantly contribute to anxiety disorders. - **Eating Disorder:** all types of abuse have strong associations with eating disorders: neglect having the highest, potentially being suggestive of issues of control, self-worth and coping mechanisms. - **Suicidal Behaviour:** both physical and emotional abuse are strongly associated with suicidal behaviour, reflecting the severe psychological distress and hopelessness that can result from these experiences. Subsequent meta-analyses by Mandelli et al. (2015), Infurna et al. (2016), and Humphreys et al. (2020) confirm that emotional maltreatment (including emotional abuse and neglect) is a stronger predictor of depression than sexual or physical abuse. This reinforces the significant impact of emotional maltreatment on mental health, emphasizing its role in the development of depression. - **Impact of Emotional Maltreatment**: The findings consistently highlight the severe effects of emotional abuse and neglect on mental health, particularly in relation to depression and anxiety. This underscores the need for greater attention to emotional maltreatment in prevention and intervention efforts. - **Complexity of Abuse Impacts**: The study illustrates the multifaceted impacts of different abuse types on various mental health outcomes. It suggests that while physical abuse has significant effects, the emotional and psychological dimensions of maltreatment may have even more profound long-term consequences. **Childhood Trauma and Psychosis** **Arsenault et al (2011) Childhood Trauma and Children's emerging psychotic symptoms: a genetically sensitive longitudinal cohort study.** Data from 2,127 either mono/dizygotic twins born in mid-90's Britain. At the age of 12, children and mother were interview to see whether the child had ever been: - Harmed by an adult - Bullied - Involved in a seriously harmful or frightening accident. When children were 12 years old, their psychotic symptom (e.g., felt like being under control of special powers; hearing voices that other people cannot hear) were assessed. When combined, bullying and maltreatment had a high risk ratio for risk of psychotic symptoms. **Multiple Forms of Child Maltreatment and Mental Health in Adulthood** **Edwards et al., (2003) Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: Results from the Adverse Childhood Experience study.** Data derived from the ACE study, involving patients in a health maintenance organisation. The study involved 8,667 adults. - **Types of ACEs Assessed:** sexual abuse, physical abuse, witnessing maternal battering. Mental health assessed with 5 items focussing on both depression and anxiety. Key Findings: - Sexual Abuse: more prevalent among women - Physical abuse: more prevalent among men - Maternal battering: more prevalent among women. The study assessed the mean mental health score based on the number of reported types of childhood maltreatment. The findings suggest a dose-response relationship, where increasing numbers of maltreatment types are associated with poorer mental health outcomes. The analysis of ANOVA found significant main effects, supporting the hypothesis that the impact of childhood maltreatment on adult mental health increases with the number of maltreatment types experienced. Child Maltreatment and Resilience to Adult Psychopathology Collishaw et al. (2007) explores resilience to adult psychopathology in individuals who experienced child maltreatment. The research focuses on identifying factors that may protect these individuals from developing psychiatric problems later in life. - Maltreatment was assessed using retrospective reports, allowing participants to reflect on their childhood experiences. - The primary aim was to assess/identify factors that contribute to resilience against adult psychopathology. - The study identified an index of relationship functioning - parental care, normal adolescent peer relationships, good adult friendships, supportive first partner, stable relationship history. - The research identified that success in these relationship domains was associated with greater resilience to adult psychopathology, suggesting positive relational experiences can buffer against the negative impacts of early maltreatment. - It highlighted that individuals who were able to form healthy relationships and maintain stable social connections were less likely to develop psychiatric issues, even if they had experienced maltreatment in childhood. **Importance of Relationships**: The findings underscore the critical role of relationship quality and social support in promoting resilience. Positive interactions across different life stages, from childhood to adulthood, appear to provide protective effects against mental health problems. **Topic** **Study/Reference** **Details** -------------------------------------- ------------------------------ --------------------------------------------------------------------------------------------------------------------------------------- **Traumatic Memories** Van der Kolk & Fisler (1995) Discusses the dissociation and fragmentary nature of traumatic memories, contrasting them with non-traumatic memories**101113**. **Child Maltreatment and Smoking** Kisely et al. (2020) Examines the link between child maltreatment and persistent smoking from adolescence into adulthood**4816**. **Long-term Health Consequences** Norman et al. (2012) Systematic review and meta-analysis of the long-term health consequences of child physical abuse, emotional abuse, and neglect**48**. **Chronic Inflammation** Osborn & Widom (2020) Investigates whether documented records and retrospective reports of childhood maltreatment predict chronic inflammation**4819**. **Cardiovascular Disease** Soares et al. (2020) Studies sex differences in the association between childhood maltreatment and cardiovascular disease**4823**. **Prevalence of Child Maltreatment** Stoltenbergh et al. (2015) Reviews the prevalence of child maltreatment across the globe**486**. **Telomere Erosion** Shalev et al. (2013) Links exposure to violence during childhood with telomere erosion**4818**. **Adult Mental Health** Sugaya et al. (2012) National study on child physical abuse and adult mental health**482728**. **Resilience to Psychopathology** Collishaw et al. (2007) Investigates resilience to adult psychopathology following child maltreatment**4745**. **Psychiatric Disorders** Cutajar et al. (2010) Examines psychopathology in a large cohort of sexually abused children followed up to 43 years**473132**. **Adverse Childhood Experiences** Edwards et al. (2003) Explores the relationship between multiple forms of childhood maltreatment and adult mental health**474143**. **Chronic Pain** Walsh et al. (2007) Studies the link between child abuse and chronic pain in a community survey of women**4854**. **Psychotic Symptoms** Arsenault et al. (2011) Investigates childhood trauma and children's emerging psychotic symptoms**4739**. **Study** **Gender Differences Identified** **Page Reference** ----------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------- **Soares et al. (2020)** Examined sex differences in the association between childhood maltreatment and cardiovascular disease, using data from the UK Biobank**23**. **23** **Edwards et al. (2003)** Reported that 25.1% of women experienced any sexual abuse compared to 17.5% of men, and 19.7% of women reported any physical abuse compared to 21.7% of men**42**. **42** **Cutajar et al. (2010)** Found that borderline personality disorder was seven times more common among female victims, while males were more likely to develop antisocial personality disorder**35**. **35** **Sugaya et al. (2012)** Highlighted gender differences in the prevalence of psychiatric disorders such as major depression and bipolar disorder among victims of childhood physical abuse**29**. **29** **Wegman & Stetler (2009)** Found that effects of childhood abuse on medical outcomes were larger when the sample was exclusively female**21**. **21** **Consideration** **Relevant Studies** **Details** ----------------------------------- ------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------- **Historical Context** Kempe et al. (1962) Introduced the concept of Battered Child Syndrome, marking a pivotal moment in recognizing child abuse as a clinical condition**2**. **Types of Maltreatment** Stoltenborgh et al. (2015) Reviewed the global prevalence of different forms of child maltreatment, highlighting emotional abuse as the most common**6**. **Gender Differences** Edwards et al. (2003) Reported gender differences in the prevalence of sexual and physical abuse**42**. **Long-term Health Consequences** Norman et al. (2012) Conducted a systematic review and meta-analysis on the long-term health consequences of child maltreatment**48**. **Psychological Impact** Sugaya et al. (2012) Explored the association between child physical abuse and adult psychiatric disorders**27**. **Resilience Factors** Collishaw et al. (2007) Investigated resilience to adult psychopathology following child maltreatment, identifying protective factors**45**. **Memory and Trauma** Van der Kolk & Fisler (1995) Discussed the dissociation and fragmentary nature of traumatic memories**13**. **Methodological Considerations** Wegman & Stetler (2009) Highlighted the impact of methodological approaches, such as retrospective reports, on understanding the effects of child maltreatment**21**.