Dr Paul McLaren (MBBS, FRCPsych, MA, BA, MSc), Consultant Psychiatrist and Medical Director at Priory Hospital Hayes Grove, discusses how child abuse can affect people as adults.
Many of the children abused in the Rotherham case are now adults.
How does child abuse impact life and relationships as an adult?
The experiences of child abuse can stay with survivors for a long time. Adults who have buried their history of child abuse can continue to suffer in ways that can include post-traumatic stress disorder (PTSD), eating disorders, substance misuse, depression, anxiety, low self-esteem, anger, guilt, learning disabilities, physical illness, disturbing memories and dissociation. One particular issue is the challenge of forming and keeping adult relationships. Recent research has suggested that the lifetime onset of psychiatric disorders is attributable to adverse childhood experiences in nearly a third of cases.
Child abuse can adversely affect the development of the personality of the survivor and their ability to regulate their emotions, which can lead to self-destructive and impulsive behaviour, such as repeated self-harm or recurrent suicide attempts. Those who have been repeatedly abused over time can suffer dissociation and go into trance-like states, often triggered by reminders of the abuse, in which they relive abusive experiences.
What help is available?
Shame is a major barrier to survivors seeking help. This is often exacerbated if their appeals for help or disclosure about their abuse as children were ignored or dismissed by family or professionals. Knowing that effective treatment is available is important.
Counselling is a useful starting point and can help survivors by providing a safe environment to develop a trusting therapeutic relationship. It is often the first experience that survivors have of being truly understood in a way that others who haven’t been abused are unable to manage. They are heard and believed and experience empathy rather than judgement.
Cognitive behavioural therapy (CBT) is a fast growing and widely recognised treatment used to help people deal with a variety of psychological difficulties. The evaluation of CBT has shown a 50% success rate in treating anxiety and depression – significantly higher than other talking therapies – and studies have also shown that it can be more effective than medication alone when treating such disorders.
CBT is a structured, action-oriented and problem solving approach which helps people to manage their thoughts, behaviour and mood more effectively. In general, patients will meet with their therapist on a weekly basis for a period of roughly 6-20 sessions which will follow a structured process including the completion of homework and behavioural experiments. CBT has been modified to offer specific help to those suffering from PTSD. It can help survivors process their traumatic experiences in ways that reduce their impact in the present.
Dialectical behaviour therapy (DBT) is a psychological treatment developed for those who experience problems with emotional control after traumatic experiences. It is very focused on teaching skills to improve self-regulation.
Childhood trauma often leads to re-experiencing of painful memories which are difficult to ignore. Eye movement desensitisation and re-processing (EMDR) is a psychological intervention which has been developed to process painful memories. Sessions are sometimes longer than CBT for PTSD, but treatment can be completed in fewer sessions for some cases. Those more severely affected by PTSD may benefit from psychiatric treatment with medication, usually antidepressants.