The Effects of Abuse Resulting in Long-Term Psychological Disorders
Introduction A long-term study by Silverman, Reinherz, & Giaconia (1996) has indicated that “as many as 80 percent of young adults who had been abused met the diagnostic criteria for at least one psychiatric disorder at age 21” (Child Welfare Information Gateway).
There are many long-term problems that stem from abuse as children, such as depression, anxiety, eating disorders, and attempts at suicide, but this Extended Essay will investigate only the three most prominent, long-term psychological effects of child abuse, focusing specifically on the types of abuse that may lead to the following disorders: dissociation, multiple-personality disorder (as well as borderline personality disorder), and post-traumatic stress disorder.
Abuse is herewith defined as a methodic pattern of behaviors used to acquire and preserve control and power over another, and is typically split into three different categories: emotional abuse, sexual abuse, and physical abuse. For the purposes of keeping this evaluation properly focused and more easily analyzed, examination of disorders in adults resulting from abuse as children (ages 5 through 15) will be limited to physical and sexual abuse because these are more easily assessed, though any other branches might be mentioned throughout this investigation.
Child abuse is known to be a cause of brain damage which can lead to mental handicap in the victim as well as social handicap due to lack of self-esteem and overriding fear (Smith, 85). It is also widely accepted among psychologists that “… when child victims become adults the violence can be a life sentence requiring great control to keep the potential aggressive behavior contained and controlled” (ibid).
Along with the precursor of self-perpetuating continuation of abuse through generations (meaning that those who had been abused as children are more likely than most to abuse their own children as adults), abuse of one’s progeny can also lead to therapeutic problems, such as those that would impede a psychologist’s ability to help the victim. These problems might include amnesia, dissociation, shifts in personality during help sessions, simple unwillingness to discuss past abuse, and other such difficulties that can be brought about and faced during therapy.
Generally, however, the most problematic complications caused by abuse, in due course, are more severe disorders such as those that will be discussed further in the body of this investigation: dissociation, Multiple Personality Disorder, and Post-Traumatic Stress Disorder. The subject of psychology itself is open to analysis through reasoning, much like any other scientific discipline.
Such findings can be summarized through both large-scale studies, as well as smaller investigations of specific cases, but while some of these publications succeeded in pointing out the disorders found to be associated with child abuse, none proved helpful in outlining exactly to what extent these disorders in adults relate to having been abused as children. Other related research has been documented, but as with most observations in psychology, some experiments themselves are focused on specific cases and subsequently less reliable than larger-scale.
In this way, few reliable studies have been made as to the causes of certain psychological disorders, and to what extent child abuse plays a role in the long-term mental health of those victims, leaving much to be desired in the field of psychology as pertains to child abuse. Thus, the focused question that this Extended Essay will attempt to answer is, to what does extent are certain long-term psychological disorders found in adult victims a result of child abuse?
The aim of this essay is to fill in some of the aforementioned statistical gaps with in-depth analysis, and simplify what data can be found for a more easily facilitated study of the specific, long-term outcomes of child abuse. Of course, not all abuse automatically results in long-term psychological maladies. There are always at least a few people, in a general populace, who are unaffected or who have fought through their maltreatment and exploitation, and who report few long-term consequences (Briere, 50).
In this way, existing literature is only limited to those who have been untreated or not been through therapy for their traumatic experiences: those who have indeed been treated for such are unlikely to present with long-term problems in adulthood. “Nevertheless, as has been presented, there are many women and men whose childhood experiences were so destructive that they continue to suffer as adults” (50). This is what causes disorders such as those discussed in this investigation, and as such will only be focused on untreated victims who, even in adulthood, continue to suffer through the difficulties of their childhood trauma.
It is appropriate to mention the differences between correlation and causation when evaluating psychological studies. This is to say that if two variables are correlated, it cannot be automatically assumed that one causes the other. Any relation found between two different variables in psychology, then, must be examined in order to prevent a fallacy of this sort from occurring, so in this evaluation, additional research will be made so to ensure that such occurrences are avoided, and maintain valid information for interpretation.
Dissociative Disorders Dissociation is defined by the American Psychiatric Association’s (the APA’s) The Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, otherwise known as the DSM-IV) as “a disruption in consciousness, memory, identity, or perception” and includes such disorders as psychogenic amnesia/fugue, multiple personality disorder, and depersonalization disorder .
Dissociation in general is a fairly effective initial response to abuse, as in each form it works by creating an alternate psychological situation, either by completely forgetting the afflictive event, figuratively ‘stepping away’ from the body (or the separation of oneself from the body being abused during this aforementioned event), or even creating an alternate personality to suffer in the child’s place.
There are two common themes in each of these branches of dissociation: the ultimate ability for the victim to place a barrier between him/herself and the physical abuse he/she has suffered at the hands of someone else, and the eventual tendency for these disorders to be counterproductive later in life when counseling becomes necessary (Gil, 137). Dissociation, simply put, is a personality disorder that allows the patient to avoid the confrontation of abuse.
It is most common among survivors of psychical and sexual abuse, victims of more than one abuser, and victims of ritualistic or bizarre abuse, and according to Kluft (1986), it is “promoted by an inborn bio-psychological capacity to dissociate… from trauma that is perceived as unpredictable and overwhelming” (137). As previously mentioned, dissociation is a category of psychological disorder that accompanies three more specific illnesses: psychogenic fugue, depersonalization, and Multiple Personality Disorder (MPD; which, for all intents and purposes will be treated as a separate topic due to its unique nature and larger scope given he variation of its symptoms, causes and logic given poor mental stability from abuse). The inability to remember certain crucial moments of abuse, or even large expanses of time (as the case may be in cases of MPD) has been dubbed psychogenic amnesia or fugue (137), and plays a much larger role in the psychology of abuse as a whole, though these sorts of commonalities will be further discussed in the Analysis.
The concept dubbed ‘conditional reality’ can also be detrimental when working with a dissociative patient, as well, and is a significant consideration in treatment of dissociation, as it reflects a poor foundation in reality. A bout of extreme dissociation can cause such severe detachment and, in turn, the feeling of conditional reality. Multiple Personality Disorder Multiple Personality Disorder (MPD) is a rather intuitive concept, at its core.
It is defined by the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) as “the existence within the person of two or more distinct personalities or personality states”, when personality is defined as an enduring concept of self, including a way of “thinking about the environment and one’s self that is exhibited in a wide range of important social and personal contexts” (American Psychiatric Association). MPD is caused by trauma or abuse, and is a very creative response to extremely sinister and abusive situations (Gil, 155).
Putnam (1985) has identified a number of specific personalities found in patients suffering from MPD, each of whom provide a different layer of consciousness, and perform a certain task. For example, the child personality serves as to buffer the traumatic experience, whereas the helper personality works toward a healthy goal by providing advice or insight during therapy, the persecutor personality harms and inflicts punishment upon the patient, and the memory personality provides an underlying record of memories and maintains conscious awareness despite amnesia that may be present in other personalities (Gil, 151).
In the experience of John Briere, PhD. , as he mentions on page 36 of his book Therapy for Adults Molested as Children, “[Borderline Personality Disorder] is perhaps the most common label attached to individuals who present with severe post-sexual-abuse trauma in psychiatric settings”. Borderline Personality Disorder is defined in the DSM-IV as a chronic disturbance exhibiting “a pervasive pattern of instability of self-image, interpersonal relationship, and mood, beginning by early adulthood and present in a variety of contexts” (American Psychicatric Association).
Post-Traumatic Stress Disorder According to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition), Post-Traumatic Stress Disorder (PTSD) is caused by the existence of a psychologically stressful event (which could influence anyone in a similar fashion), and is diagnosed by the occurrence of symptoms such as “… ater re-experiencing of the trauma in one’s mind (for example, ‘flashbacks’ to the original traumatic situation), numbing of general responsiveness to, or avoidance of, the external world (for example, dissociation, withdrawal, restricted effort, or loss of interest in daily events), and a wide variety of other reactions or symptoms” (American Psychiatric Association). The most common trauma that leads to PTSD is that which involves a threat to the victim’s life (Gil, 157).
Because of this, the disorder is also closely linked with trauma associated with military combat (159). The nature of this disorder is a means of escape for the victim, given the tendency to shut down his or her emotions and/or physical awareness to achieve psychological withdrawal (Briere, 8). Evidential of this are other associated symptoms in victims suffering PTSD, such as chronic sleep disturbance, loss of reactivity, social detachment and limited emotionality.
It is important to note that during therapy sessions with a patient suffering from PTSD, there is a higher likelihood that the victim will experience a sense of overwhelm, and will ‘shut-down’, “the immediate result [of which] is a dissociative episode or a period of depression or withdrawal” (11). Analysis It appears that, after abuse as children, adult victims tend to develop disorders that create a boundary between the victim and her abuser. This boundary can be as simple as an emotional detachment from the situation, or as complex as Multiple-Personality Disorder.
In this way, it is intuitive that dissociative tendencies are also found in other psychological disorders stemming from child abuse. Dissociative behaviors such as these can be subconscious defense strategies and autonomous symptoms as well. Dissociation itself tends to be a common thread throughout the psychology of abuse, exemplary of this its presence in the symptoms of Post-Traumatic Stress Disorder (Briere, 5) as well as Multiple Personality Disorder (Gil, 155).
Dissociation in its most primitive is simply disengagement, and involves a “cognitive separation of the individual from his environment at times of stress” (Briere, 112). This fundamental theme plays a crucial role in major psychological disorders such as Multiple Personality Disorder and Post-Traumatic Stress Disorder, because all they are, essentially, is a means of escape from a stressful situation.
The same goes for dissociative tendencies toward detachment, as it is “used by most people at one time or another as a way of handling acute stress” (113). This sort of numbing of emotion also acts as a protection from old pain or against responses to current abuse-related trauma. In its more extreme form, detachment becomes a complete shutdown. This is more primitive as well, and takes control when the victim feels she has no control over the situation.
Shutdown involves withdrawal into a mute and nonresponsive mental state, but is not a retreat into neutrality as its numbing effects might infer: instead, it is the inner “fight” with the victim’s own sentiments, “motivating a need to stop ‘being’” (117). Therapy for Adults Molested as Children (Briere, 1989) says that “PTSD refers to those characteristic psychological reactions that frequently follow disaster or extreme psychological stress” (5). In this way, we can extrapolate that PTSD can be seen in many patients having suffered abuse, or suffered any extreme trauma.
The symptoms of this disorder, then, are encountered frequently, and given the symptoms of dissociation and MPD it seems as though there are many common themes between the disorders. That is not to say, however, that they are all the same: each is unique in its specific traits, but since they do tend to have some symptoms in common, we can reason that a patient that has suffered child abuse will generally exhibit at least one of the two following symptoms: amnesia and a personality-based buffer that will allow the patient to ‘step way’ from the abuse. Both of these symptoms indicate that dissociation is the easiest way for a patient to avoid emotional damage due to past trauma: if one experiences abuse through another’s eyes (having stepped away from her own body) almost as if it were just a movie and not really a part of her life, it would be easier to deal with, mentally (Briere, 114). Also, if the same patient cannot recall the event, it is obviously not an active concern and cannot harm the victim. Without the ability to dissociate children might develop long-term psychiatric illnesses and impaired functioning” (Gil, 155). Along the topic of commonalities between disorders stemming from child abuse, amnesia that is present in patients exhibiting dissociative behavior is also a symptom in patients suffering from Post-Traumatic Stress Disorder and Multiple Personality Disorder (Briere, 9). The Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) indicates that “… f [amnesia] occurs primarily in identity, the person’s customary identity is temporarily forgotten, and a new identity may be assumed or imposed”. It is at this point that dissociation escalates to Multiple Personality Disorder. Hypersensitivity is also a common symptom among patients abused as children, given that it is caused by the inherent need to observe the abuser, since rapid and correct assessment of the abuser’s psychological state may aid in avoiding an abuse incident by some sort of escape, or placation of the abuser’s demands in lieu of a more aversive consequence (Briere, 40).
This can in turn lead to Multiple Personality Disorder, because the victim’s aforementioned need to please the abuser can bring about a change in her personality. A victim might stop being herself and start living for her abuser instead, which would involve a confusion of self; this plays an important role in Borderline Personality Disorder. Chronic perception of danger and increased alertness to the victim’s surroundings is also a psychological adaptation to an abusive environment, and can lead to suspicion and poor social skills when interacting with others (42).
Conditional reality, as discussed earlier on page 4, is also a common factor among these disorders. In patients suffering from Multiple Personality Disorder, the realities experienced by each personality are different, and consequently cannot be construed as the truth because it is just a part of reality. In patients with Post-Traumatic Stress Disorder, flashbacks may occur in which the abusive environment appears so real that it influences the way the patient reacts in reality (46).
This can also happen in period of time when the environment itself appears unreal to the patient, or during period of detachment so severe that she must “struggle” or fight her way back to consensual reality. In this way, a patient suffering from PSTD and experiencing a bout of conditional reality may appear catatonic or even psychotic to an outside observer, and can lead to misdiagnosis. Conclusion
The aim of this Extended Essay was to determine the extent of which child abuse results in long-term psychological disorders (limited to dissociation, Multiple Personality Disorder and Post-Traumatic Stress Disorder), and in order to conclude this, each disorder has been defined and discussed, and their similarities outlined. Thus, the ultimate conclusion of this investigation is that child abuse is generally the cause of disorders that allow the patient to detach from past trauma, though disorders of this sort can also be caused by other types of trauma not limited to child abuse.
The existence of these conditions is just as likely to be caused by persistent life-threatening situations, and is not limited to only past trauma. Thus, it can be said that while child abuse is ultimately prone to bring about dissociation, MPD and PTSD, these maladies are by no means limited simply to causation by child abuse. The reason for this is the intuitive nature of these psychological disorders. They inherently provide an outlet to the victim of abuse, and allow a means of escape from this confrontation even as it happens.
Dissociation, MPD and PTSD have a few key components in common, as discussed in the Analysis: detachment, amnesia, conditional reality, and the fundamental means of escape from the traumatic experience. Throughout this investigation of the association between psychiatric disorders and childhood abuse, one particular theme has remained constant: a person with a traumatic childhood will generally have grown up differently than one who was not abused.
The difference is that the personality of an abused child will be shaped by “adaptation to victimization rather than in response to the usual environmental demands” (Briere, 40). This initial progression elaborates and generalizes over time, and ultimately results in maladaptive patterns of perception and behavior in adulthood. This is the process that leads to becoming dissociative, or suffering from MPD or PTSD.