Child Abuse, Sexual and Emotional Health Article

Emotional abuse

Abuse of children is not limited to the physical body. Children who are repeatedly called names, insulted, belittled, intimidated, rejected, criticized, terrorized, or corrupted by those upon whom they are dependent for nurturance have little opportunity to develop any sense of self-worth.

Emotional abuse may also be the result of actions not directed specifically at the child. The prevalence of domestic and community violence exposes children to intimidating and frightening scenes every day. A study at Boston City Hospital found that one in ten children living in an inner city neighborhood had observed a shooting or a knifing by the age of six; half of these incidents occurred in the home and half in the streets. Studies have shown that when children live in homes in which domestic violence is a problem, 75-87% of them witness the violence and 40-60% of them experience abuse themselves, often as a result of being "caught in the middle" of a parental altercation. Children who observe violence react with many of the same psychological symptoms as children who have experienced it directly.

Neglect

Children who are not provided with basic food, shelter, and clothing to the best of their parent's ability are considered neglected. Not surprisingly, neglect is more prevalent in areas of extreme poverty than in other socioeconomic strata. Neglect may be evidenced in undernourishment or failure to thrive. Children may not be able to attend or learn in school because of lack of food or sleep. They may develop rashes or infections that go untreated. Failure to send children to school or otherwise provide for their education may also be considered neglect.

What are the outcomes of child abuse?

It is important to remember that there are often multiple factors to consider when discussing the results of child abuse. Abuse seldom occurs in isolation; there may be other problems in the family such as alcoholism or the stress of unemployment. Children may also experience multiple forms of abuse. Children may or may not have a supportive relationship with another adult to whom they can turn for support. Children may be abused for an acute period before there is some intervention, or they may experience the trauma chronically and for many years. The child's age and resources, the kind of relationship between the child and the perpetrator, the length and chronicity of the abuse, and the availability of therapy or other intervention services are all factors that contribute to the wide range of long- and short-term outcomes associated with child abuse.

Nonetheless, most children who have been abused experience some symptoms of Post Traumatic Stress Disorder (PTSD). PTSD in children and adolescents may be acute or delayed, that is, the child may experience symptoms immediately or after a period of time has passed, perhaps when the child feels safe. Symptoms may include re-experiencing the abusive episodes at some level, feeling emotionally numb, or becoming physiologically aroused (elevated heart rate, respiration, and so forth). Children may experience disassociation and appear to "space out" when reminded of the abuse or perpetrator. They may have physical symptoms. They may become enraged or feel guilt at having provoked the episodes or survived them. They may have invasive memories, repeated behaviors, or fears related to the abusive situations. They may act out some of their issues in play—punishing the bad guy or victimizing another character while playing with dolls or action figures. In severe cases of chronic trauma, the child may develop serious or prolonged disassociation or depression. Severe and chronic abuse has also been implicated in cases of multiple personality disorder.

Once the abuse has stopped, most of these symptoms can be treated with some form of counseling or therapy. Some have argued that full recovery is a lifelong task. Adults who have been abused as children may have to face issues long after the abuse has stopped, when they enter into their own sexual relationships, or when they raise their own children.

Do abused children become abusing adults? The de facto intergenerational transmission of child abuse is not supported by the facts. It appears that the cycle of abuse can be broken, and often is. Social workers David Gil found that only 11% of the abusing parents he studied reported having been abused themselves as children. More importantly, prospective studies of parents who have been abused as children or who were at high risk for abusing their own children found that about 70-80% of parents were able to break the cycle.