Psychological and Neurobiological Consequences of Child Abuse, college aantekeningen

Lecture 1 – psychological and neurobiological consequences of child
abuse
Empirical evidence: numerous findings that childhood abuse and neglect have
pervasive consequences for mental and physical health
1950s: already stated that a warm childhood is significant to forming later
relationships.
Maltreatment = abuse (mishandeling) and neglect (verwaarlozing)
Childhood maltreatment: any act of commission/omission by a parent or other
caregiver that results in harm, potential for harm, or threat of harm to a child.
Harm does not need to be intended.
Omission (neglect): failure to meet child’s needs
 Physical neglect: not enough food, clothing
 Emotional neglect: no warmth/care, no fulfilment of emotional needs
 Denial of access to education.
Commission (intentional behavior): actively doing something harmful
 Physical abuse: hit child
 Emotional abuse: yell at child, make them feel worthless
 Sexual abuse: rape/unwanted touching, etc.
 Shaken Baby Syndrome: brain injury when a baby/young child is shaken
violently
Prevalence of childhood maltreatment: World Health Organisation
1. Emotional abuse
2. Physical abuse
3. Sexual abuse
4. Physical neglect
High comorbidity of abuse and neglect  physically abused, often also emotional
abused
DSM V: classification system for psychological disorders based on standard
criteria. Focus on objective description, not much etiology (cause).
Psychological consequences of child maltreatment:
 Internalizing (depression, anxiety) and externalizing (aggression,
addiction) problems
 Personality disorders (BPD, anti-social)
 Psychotic symptoms
 Suicide & self-injury
Often earlier onset, more severe/chronic, harder to treat. Type of abuse/neglect is
less relevant.
Symptoms not bound to 1 disorder: can be multiple different
symptoms!!
Childhood maltreatment  depression, agitated, flashbacks, low self-esteem,
sleeping problems, fear, dissociation, problems forming relationships, etc.

,  Can take long-time for correct diagnosis
o Enhance recognition amongst psychologists/medical specialists
 Comorbidity of disorders
o Importance to treat underlying trauma(s)
 Improve treatment options
o Importance of understanding underlying mechanisms to develop
specific interventions
Psycho-social consequences
 Interpersonal problems
 Self-image
 Re-victimization
Intergenerational transmission
 Consequences of maltreatment can be a risk factor for abusive/neglectful
behavior (30% of maltreated cases perpetuate own child)
o If one has developed a depressive disorder because of own childhood
maltreatment, you can be less sensitive to own child which can lead to
neglecting your own child
 Stresses the importance of timely preventing abuse itself, but also of its
consequences
o Pregnant woman who has suffered from child maltreated  work on it
before the baby is born
Conclude:
 Childhood abuse and neglect important transdiagnostic risk factors for
development of psychological problems
o Internalizing symptoms (depression & anxiety)
o Externalizing symptoms (drug & alcohol addiction, aggression)
 Consequences of emotional abuse and neglect at least as pervasive as
physical or sexual abuse
o Depressed patients with history of maltreatment have more severe
problems (more chronic, suicidality, comorbidity, profit less from
treatment)
 Increased threat sensitivity, decreasing responsivity to reward, deficits in
emotion recognition and understanding
 Resilience: when a person has overcome traumatic experiences or was
able to process those
 Socially supported relationships  as a buffer for maltreatment
Lecture 2 – psychological consequences and methodology
 Psychological disorders
o Childhood maltreatment is a transdiagnostic risk factor (symptoms
overlap with other disorders)
o Lots of comorbidity
o Higher risk for earlier onset and more severe symptoms (suicidality)
 Intergenerational transmission (30% of abused cases perpetrate own
children)
 Interpersonal problems

, o Negative self-image
o Attachment at younger and later age
o Social exclusion
o Re-victimization

Long-term consequences of child maltreatment
Possible underlying mechanisms:
A. Exposure  outcome
B. Exposure  mediator  outcome
Who reports what?
 Self vs informant
 Parent vs child (perpetrator – victim)
 Retrospective vs prospective
 Subjective report vs observing
When measuring intergenerational transmission of maltreatment, it matters who
you ask to report  for neglect it’s less clear (children might not notice what they
are missing)
 Only transmission of abuse was found in all reports
 Neglect only found through self-report
Human research methods:
Retrospective (what happened in the past)
 Advantages: practical in the case of long-term consequences (in adults)
 Disadvantages:
o Memory = erroneous (wrong)
o Potential ‘recall bias’: memory = negative when in a bad mood;
positive when in a good mood
o Consequences and abuse are assessed at same moment: causality
regarding cause and effect unclear
Prospective (longitudinal research: follow individuals)
 Advantages:
o Temporal order abuse & consequences
o Objective identification of abuse
o No recall bias
o No selective inclusion based on outcomes
 Disadvantages
o Selective inclusion based on exposure
o On-ethical without intervening in the situation
o Duration, costs
o Drop-out
 Combination of both methods is best!
Maltreatment in childhood substantially increases risk of adult depression and
anxiety in prospective cohort studies/documented abuse