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Emotional and behavioral sequelae of childhood maltreatment
Abstract
To summarize research on the emotional and behavioral consequences of childhood maltreatment published between January 2009 and April 2010.
Many studies published during this time frame replicated prior research studies that have shown that childhood maltreatment is a nonspecific risk factor for a range of different emotional and behavioral problems. Two research groups highlighted the high revictimization rate among abused girls, with more than one in five abused girls found to have subsequent experiences of rape by young adulthood. The association between physical and sexual abuse and subsequent perpetration of violence toward self and other was also demonstrated, with one study noting the particular vulnerability of sexually abused boys to these negative outcomes. In this study, sexually abused boys had a 15-fold increased risk of making a suicide attempt, and a 45-fold increased risk of perpetrating domestic violence. A three-generation longitudinal study of the intergenerational transmission of abuse is also highlighted in the review, together with emerging findings on genetic and environmental risk and protective factors associated with variability in child outcomes.
Maltreated children are at-risk for a host of negative outcomes. Although marked gains have been made in treating trauma-related psychopathology, these recent studies highlight the need to examine long-term outcomes of youths who have received state-of-the-art evidence-based interventions, and determine if there is a need for more comprehensive and sustained intervention approaches.
... Emotional (and behavioral) regulation requires an individual to first identify and understand their emotional state and, subsequently, to use that understanding to constructively change emotions and/or behaviors (Matthews et al., 2012). Research on EI and emotion regulation to date has primarily focused on stress and coping strategies (Zeidner & Saklofske, 1996;Peña-Sarrionandia et al., 2015; see also Chap. 4 by Zeidner & Matthews, this volume). In this context, individuals who are able to use adaptive emotion regulation strategies (e.g., breathing, mediating, reflecting, cognitive reappraisal) to adjust their emotional state are able to constructively cope with stress (John & Gross, 2007). ...
... A history of childhood maltreatment is associated with deficits in numerous areas across the life cycle, including disturbances in attachment relations, deficits in frustration tolerance, problems with self-esteem and peer relations, and reduced educational and vocational attainment in adulthood (Briere & Jordan, 2009;Weich, Patterson, Shaw, & Stewart-Brown, 2009). Maladaptive family functioning is one of the strongest predictors of psychological maladjustment and is usually implicated in most cases of maltreatment McLaughlin et al., 2010;Perepletchikova & Kaufman, 2010); as such, it is helpful to understand how family dysfunction may contribute to problems with social-emotional development in this group. For example, negative parenting practices-specifically harsh discipline-are related to lower emotional understanding and regulation (Perepletchikova & Kaufman, 2010). ...
... Maladaptive family functioning is one of the strongest predictors of psychological maladjustment and is usually implicated in most cases of maltreatment McLaughlin et al., 2010;Perepletchikova & Kaufman, 2010); as such, it is helpful to understand how family dysfunction may contribute to problems with social-emotional development in this group. For example, negative parenting practices-specifically harsh discipline-are related to lower emotional understanding and regulation (Perepletchikova & Kaufman, 2010). Further, maltreated children were significantly more likely to display difficulties in emotional regulation when compared to "typical" controls (80% of maltreated vs. 37% of controls; see Maughan & Cicchetti, 2002), indicating that this is a clear area of concern for emotional development. ...
Current educational trends reflect an increased focus on developing social and emotional competencies of school children as a means of reducing underachievement and school violence and promoting positive development and well-being. Atypically developing children—those with a diagnosed mental health condition, intellectual exceptionality, or history of maltreatment—are at an increased risk for experiencing academic, social, and/or emotional difficulties. Further, the challenges associated with atypical development may impede the acquisition and/or application of core socioemotional skills. In this chapter, we provide an overview of the current research on emotional intelligence (EI) and social-emotional learning (SEL) with an explicit focus on students’ mental health. After briefly outlining the concepts of SEL and EI, we review relevant research with several atypical populations, including children with Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder, Specific Learning Disorder, intellectual giftedness and disability, history of maltreatment, or behavioral and social-emotional difficulties. Descriptions of selected SEL and mindfulness-based school programs that target socioemotional competencies of both children and teachers are presented, followed by a discussion of their utility and challenges in addressing the needs of both typical and atypical learners.
... In both short and long term maltreatment can affect adversely children's health and development [7,8]. Injuries by maltreatment, particularly traumatic brain injury, can result in significant long-term disability including seizures, spasticity, blindness, paralysis and mental retardation [1]. ...
... In practice, dating injuries is inaccurate [15]. The absolute age of lesion is virtually impossible to estimate, abrasion, and sensitivity or edema suggest a recent injury [7]. It can be said that bruises with less than 24 hours show no yellow tint, but red bruises may persist for a week [15]. ...
The literature states that maltreatment in childhood and youth make up a problem on a global scale that exceeds ethnicities, religions, cultures, social and economic classes. It is also said that more than half of the injuries from maltreatment occur in the head and face. Assuming the particular relevance of orofacial structures, the dentist must know how to observe and recognize the indicators and properly diagnose the injury by maltreatment. This scientific review aimed to understand what types of intraoral lesions, signs or external lesions of the head or neck can be associated with child maltreatment. One primary database was searched so that systematic review articles and meta-analysis, case reports or case series of intraoral lesions, signs or external lesions of the head or neck by child maltreatment could be acquired. The references in the works acquired by electronic search were manually
researched and the authors of all possibly relevant papers were contacted. In all searches inclusion and exclusion criteria were applied. Of the twenty two papers included two were systematic reviews and twenty were case reports or case series. The twenty articles of case reports or case series exposed information from thirty-five clinical cases included. Despite the limitations of scientific evidence it can be concluded that oral cavity, head and neck regions are home to multiple and diverse injuries by maltreatment of children and youngsters.
... Exposure to trauma is associated with significant emotional and behavioral difficulties among children (Perepletchikova & Kaufman, 2010). Overall, reports of trauma and violence experienced ...
... concordance; trauma; orphans; low-income countries; POFO Background Childhood exposure to trauma creates profound emotional and behavioral sequelae and impacts overall well-being (Perepletchikova & Kaufman, 2010). Recent studies of orphaned and abandoned children in low-and middle income countries (LMICs) demonstrate that orphaned children are at higher risk than those not orphaned for experiencing potentially traumatic events (PTEs) due to lack of adequate adult protection (Ahmad, et al., 2005;Cluver, Fincham & Seedat, 2009;Cluver & Gardner, 2006;Cluver, Gardner & Operario, 2007). ...
Exposure to trauma is associated with significant emotional and behavioral difficulties among children (Perepletchikova & Kaufman, 2010). Overall, reports of trauma and violence experienced by children are discrepant from those of their caregivers (Lewis et al., 2012). Even less is known about the extent of concordance between orphans and their caregivers. This study examines the correlates of concordance in reported traumatic experiences between 1,269 orphaned and abandoned children (OAC) and their caregivers. The OAC lived in family-settings in 5 low and middle income countries and were part of a longitudinal study, "Positive Outcomes for Orphans" (POFO) that enrolled children aged 6 to 12 at baseline. By examining concordance with respect to specific types of trauma reported, this study expands the understanding of who reports which types of traumas experienced by orphaned and abandoned children, thereby improving the potential to provide targeted interventions for children who have experienced such events. In this study, children and caregivers were asked separately if the child had experienced different types of potentially traumatic events. Children were significantly more likely to report physical abuse, sexual abuse and family violence than were caregivers. Caregivers were significantly more likely than children to report natural disasters and accidents. High levels of concordance were found in the reporting of wars, riots, killings, and deaths in the family. The impacts of trauma on behavior and mental health are profound, and highly effective interventions targeting sequelae of childhood trauma are currently being developed for use in low resource areas. Findings from this study demonstrate that it is feasible to conduct screening for potentially traumatic events utilizing child self-report in resource limited settings and that child self-report is crucial in evaluating trauma, particularly family violence and physical or sexual assault.
... Tal discussão teve início através de estudos longitudinais e da observação clínica, quando alguns autores questionaram o fato de abusos psicológicos crônicos na infância estarem altamente relacionados com a possibilidade de as vítimas futuramente desenvolverem psicopatologias 14,[35][36][37] . Evidenciou-se que pacientes expostos a uma contínua carga de negligência apresentavam determinados sintomas, tais como: sintomas somáticos (dor de cabeça, distúrbios gastrintestinais, dores abdominais, lombares e pélvicas, tremores, sensações de choque e náusea), dissociativos (alteração da realidade, alteração de personalidade, alucinações, confusão temporal entre presente e passado) e afetivos (sintomas depressivos, insônia, apatia, desamparo, culpa, difi culdades de concentração, comportamentos suicidas, alteração na visão de si e dos outros). ...
... Rev Psiquiatr Rio Gd Sul. 2011;33(1) -59 Crianças expostas a contínuas vivências traumáticas de natureza interpessoal irão experimentar emoções intensas de raiva, medo, resignação, vergonha, sensação de derrota e traição 35 . Tais crianças desenvolvem certos comportamentos a fi m de evitar ao máximo a recorrência dessas emoções. ...
A exposição prolongada a múltiplos eventos traumáticos de natureza interpessoal, sobretudo durante o desenvolvimento, tem demonstrado consequências e sintomas psiquiátricos não considerados pelo atual diagnóstico de transtorno de estresse pós-traumático (TEPT). Essas situações negativas e crônicas durante a infância e adolescência evidenciam a existência de uma síndrome psicopatológica associada a complexas (des)adaptações a efeitos traumáticos diversos. A ausência de um diagnóstico coeso e fidedigno para essas vítimas interfere negativamente na identificação sintomatológica e no método de tratamento. O presente trabalho visa revisar a definição de trauma, apresentando o conceito de trauma complexo, explorando suas implicações clínicas, bem como as categorias diagnósticas derivadas desse constructo. Importantes questões são levantadas acerca das diferenças entre trauma complexo e TEPT, investigando os sintomas e transtornos comórbidos ao diagnóstico de TEPT, assim como as limitações inerentes a esse diagnóstico. Considerando o impacto psicopatológico relacionado ao trauma complexo, discute-se a possível inserção de uma nova categoria diagnóstica na 5ª versão do Manual Diagnóstico e Estatístico dos Transtornos Mentais, adjunta ao espectro de psicopatologias pós-traumáticas.
... Tal discussão teve início através de estudos longitudinais e da observação clínica, quando alguns autores questionaram o fato de abusos psicológicos crônicos na infância estarem altamente relacionados com a possibilidade de as vítimas futuramente desenvolverem psicopatologias 14,[35][36][37] . Evidenciou-se que pacientes expostos a uma contínua carga de negligência apresentavam determinados sintomas, tais como: sintomas somáticos (dor de cabeça, distúrbios gastrintestinais, dores abdominais, lombares e pélvicas, tremores, sensações de choque e náusea), dissociativos (alteração da realidade, alteração de personalidade, alucinações, confusão temporal entre presente e passado) e afetivos (sintomas depressivos, insônia, apatia, desamparo, culpa, difi culdades de concentração, comportamentos suicidas, alteração na visão de si e dos outros). ...
... Rev Psiquiatr Rio Gd Sul. 2011;33(1) -59 Crianças expostas a contínuas vivências traumáticas de natureza interpessoal irão experimentar emoções intensas de raiva, medo, resignação, vergonha, sensação de derrota e traição 35 . Tais crianças desenvolvem certos comportamentos a fi m de evitar ao máximo a recorrência dessas emoções. ...
Prolonged exposure to multiple traumatic events of an interpersonal nature, particularly during development, has shown psychological consequences and symptoms not included among the current diagnostic criteria of post-traumatic stress disorder (PTSD). These negative and chronic situations during childhood and adolescence provide further evidence of the existence of a psychopathological syndrome associated with complex (dis)adaptations to a number of traumatic effects. The absence of a cohesive and reliable diagnosis for these patients negatively affects symptom identification and treatment planning. The aim of the present study was to review the definition of trauma, presenting the concept of complex trauma and investigating its clinical implications and the diagnostic categories deriving from this construct. Important questions are raised about differences between complex trauma and PTSD, followed by an investigation of PTSD symptoms and comorbid disorders, as well as the limitations of PTSD diagnosis. Taking into consideration the psychopathological impact associated with complex trauma, the article discusses the possibility of including a new diagnostic category in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders is discussed, as part of the spectrum of post-traumatic psychopathologies.
... Burton et al [13] conducted a psychological intervention with DBT therapy, suggesting that the depression clinical scores had improved of the participants in the intervention group. DBT therapy has achieved some effects in helping improve behavioral problems in children [14] and alcohol problems among college students [15]. However, face-to-face and group-based CBT or DBT needs to be carried out by professionals, and the existing qualified health care providers and infrastructures are limited in meeting the challenge in China. ...
Background
Young adults (15-24 years old) living with HIV may experience pressure both from HIV infection and social role change problems, resulting in a series of psychological problems such as depression and anxiety. Effective psychological intervention can improve their mental health and quality of life.
Objective
The study aims to explore the effectiveness of VR-based mental intervention on young adults living with HIV. The application and advantages of virtual reality (VR) in children’s psychotherapy provide new ideas for psychological intervention for young adults living with HIV.
Methods
We use the qualitative interviews and questionnaire results as well as guided by classical psychotherapy to create a personalized psychological intervention system for young adults living with HIV through VR technology, which is based on the long-term AIDS treatment cohort and infectious diseases cohort of children. We use the mental scales and biochemical indexes as the outcomes, conducting a prospective randomized controlled trial to verify the feasibility and effectiveness of the VR psychological intervention system.
Results
The study began enrollment in September 2023. To date, 160 participants have finished the baseline questionnaires.
Conclusions
The study results might provide a scientific basis for accurate psychological treatment among young adults living with HIV in the future.
International Registered Report Identifier (IRRID)
DERR1-10.2196/55633
... In addition, decedents who had a mental health disorder as an adult were more likely to have a history of child maltreatment. This is also consistent with prior research demonstrating that maltreated children are at increased risk for several behavioral and emotional difficulties, including Post-Traumatic Stress Disorder, mood disorders such as anxiety and depression, disruptive behavioral disorders, and high-risk behaviors including self-harm and suicidal behaviors (Kalmakis and Chandler 2015;Petruccelli et al. 2019;Segal et al. 2021;Bellis 2002;Fry et al. 2012;Lindert et al. 2014;Perepletchikova and Kaufman 2010;Ruch et al. 2021;Turner and Colburn 2022). The relationship between early adversity and future substance use or mental health disorders is thought to stem, in part, from the development of risky (Day et al. 2013). ...
Background
Limited information is known about the impact of childhood maltreatment on lifetime risk of violent death. This study aimed to compare manner of death, demographics, age at time of death, and the presence of a mental health or substance use disorder among decedents of violent deaths with a history of child maltreatment to those without.
Methods
This cross-sectional study compared characteristics of pediatric and adult violent deaths with and without a history of child maltreatment that were captured in the National Violent Death Reporting System from 2014 through 2018.
Results
Decedents who were male, multiracial, and had adulthood substance or mental health disorders were more likely to have a history of maltreatment. All-age decedents with a history of maltreatment were more likely to die by homicide. Adult decedents with a history of maltreatment were more likely to die by suicide. Maltreated decedents died significantly younger than non-maltreated decedents.
Conclusions
Among victims of violent deaths, an identified history of child maltreatment was associated with increased risk of homicide across the lifespan, adult suicide, and earlier death. A history of child maltreatment was also associated with mental health and substance use disorders, which may reflect one of the pathways through which the child maltreatment-to-death association functions.
... Adolescents were frequently interviewed with their parents present which may have led to an underestimation of the frequency of these behaviors. Similarly, the frequency of sexual abuse was below expectations given its known association with symptoms of depression and risky behaviors (34). It is well known that revealing early traumatic events may take time and requires a solid therapeutic alliance, which may have led to underreporting in this study. ...
Background
Dialectic behavioral therapy (DBT) is a psychotherapeutic treatment to address emotional dysregulation (EDys) through acceptance and change strategies. It has been specifically adapted for use in adolescents (DBT-A). The aim of this study was to determine the effectiveness of a DBT-A skills training program in two different group formats, compared with standard care, for the treatment of EDys and depressive symptoms in adolescents.
Methods
We carried out a prospective cohort study on adolescents who were exposed to DBT-A skills training compared with standard care. The program included 14 sessions, two hours in duration, fortnightly. We examined clinical outcomes and measures of EDys (with the Difficulties in Emotion Regulation Scale - DERS) and depression (with the Children’s Depression Inventory - CDI) in three groups: Group A corresponded to separate DBT group skills training for patients and their caregivers; Group B-Multifamily, in which adolescents and their caregivers participated in the same sessions; and Group C was the treatment as usual group, with no DBT skills training. Group assignment was non-random and was subject to training group availability at time of inclusion. Linear models were used to control the effect of potential confounders.
Results
We identified a final sample of 130 subjects. Groups were significantly different only in sex distribution, and problematic alcohol/substance use. Significant differences in DERS and CDI scores were observed when comparing training groups (A and B) with the control (ANOVA p value < 0.001). The adjusted model for the difference in DERS scores showed a significant association between either of the intervention groups vs. treatment as usual. The model for change in the CDI scores showed a significant effect of Group B assignment over treatment as usual, but not of group A. Age showed a significant effect with an average decrease in the difference between pre and post scores of -1.207 per year (95%CI -2.292;-0.122). The use of antidepressants showed a significant effect with a magnitude of 5.411 (95%CI 1.415;9.407).
Conclusions
The implementation of DBT-A skills training, in either a separate or multifamily format, was both effective and safe for EDys treatment. DBT-A skills training delivered in a multifamily format may have the added benefit of impacting symptoms of depression.
... Adolescents were frequently interviewed with their parents present which may have led to an underestimation of the frequency of these behaviors. Similarly, the frequency of sexual abuse was below expectations given its known association with symptoms of depression and risky behaviors (34). It is well known that revealing early traumatic events may take time and requires a solid therapeutic alliance, which may have led to underreporting in this study. ...
Background
Dialectic behavioral therapy (DBT) is a psychotherapeutic treatment to address emotional dysregulation (EDys) through acceptance and change strategies. It has been specifically adapted for use in adolescents (DBT-A). The aim of this study was to determine the effectiveness of a DBT-A skills training program in two different group formats, compared with standard care, for the treatment of EDys and depressive symptoms in adolescents.
Methods
This study is a prospective cohort on adolescents who were exposed to DBT-A skills training compared with standard care. The program included 14 sessions, two hours in duration, fortnightly. We examined clinical outcomes and measures of EDys (with the Difficulties in Emotion Regulation Scale - DERS) and depression (with the Children’s Depression Inventory - CDI) in three groups: Group A corresponded to separate DBT group skills training for patients and their caregivers; Group B-Multifamily, in which adolescents and their caregivers participated in the same sessions; and Group C was the treatment as usual group, with no DBT skills training.
Results
We identified 331 adolescents who met the inclusion criteria, 201 subjects were excluded, leaving a final sample of 130 subjects. Groups were significantly different only in sex distribution, and problematic alcohol/substance use. Significant differences in DERS and CDI scores were observed when comparing intervention groups A and B with control Group C (ANOVA p value < 0.001). The adjusted model for the difference in DERS scores showed a significant association between either of the intervention groups vs. treatment as usual. The model for change in the CDI scores showed a significant effect of Group B assignment over treatment as usual, but not of group A. Additionally, age showed a significant effect with an average decrease in the difference between pre and post scores of -1.207 per year (95%CI -2.292; -0.122). The use of antidepressants also showed a significant effect with a magnitude of 5.411 (95%CI 1.415; 9.407).
Conclusions
The implementation of DBT-A skills training, in either a separate or multifamily format, was both effective and safe for EDys treatment. DBT-A skills training delivered in a multifamily format may have the added benefit of impacting symptoms of depression.
... Maltreatment in childhood has been shown to impact brain development (Carrion & Wong, 2012;Harden, 2004;Schore, 2013), and is associated with behavioral health challenges (Hillis et al., 2017;Kim, Lee, & Farber, 2019;Miller, Esposito-Smythers, Weismoore, & Renshaw, 2013;Negriff, Schneiderman, & Trickett, 2015;Perepletchikova & Kaufman, 2014). Relational trauma such as maltreatment has been linked to the development of internalizing and externalizing behaviors for youth (Del Vecchio, Slep, & Heyman, 2012;Greeson et al., 2011). ...
... Child maltreatment can contribute to devastating and long-lasting physical, psychological, and behavioral outcomes (English, Bangdiwala, & Runyan, 2005;Perepletchikova & Kaufman, 2010). Over a five-year period, the rates of investigated child maltreatment have nearly doubled in Canada from 135,261 maltreatment investigations in 1998 to 235,842 maltreatment-related investigations in 2008, a rate of 39.2 maltreatment-related investigations per 1,000 children (Trocmé et al., 2010). ...
Child welfare workers and organizations are the direct link between legislation and families, thus, key to service effectiveness. However, little is known about the role of organizational learning, risk tolerance, and psychological safety, especially in Canadian child welfare. The aim of this study is to identify senior leaders' perceptions of these constructs in the context of child welfare service delivery and family outcomes. This qualitative study included interviews with senior leaders (n= 8) from separate child welfare organizations in Ontario. Findings suggest that participants are constantly trying to address organizational learning through multiple strategies. Further, risk and risk tolerance are concepts at the core of child welfare work, but rarely explicitly discussed. Psychological safety is not embedded in discussions similar to learning and risk. Research exploring workers and supervisors' perspectives and research that examines the link between these concepts and family outcomes are required. ARTICLE HISTORY
... In Italy, a national survey on child maltreatment reported that 77,000 children are victims of maltreatment, namely 9 children per 1000 residents [3]. Children who experience maltreatment often show emotional, behavioral, physical, and mental health problems [4][5][6][7] with serious life-long consequences on multiple developmental domains and functions [8]. ...
The cumulative effects of proximal family risk factors have been associated with a high
number of adverse outcomes in childhood maltreatment, and DNA methylation of the serotonin
transporter gene (SLC6A4) has been associated with child maltreatment. However, the relationships
between proximal family risk factors and SLC6A4 methylation remains unexplored. We examined the
association among cumulative family risk factors, maltreatment experiences and DNA methylation
in the SLC6A4 gene in a sample of 33 child victims of maltreatment. We computed a cumulative
family risk (CFR) index that included proximal family risk factors, such as drug or alcohol abuse,
psychopathology, parents’ experiences of maltreatment/abuse in childhood, criminal history, and
domestic violence. The majority of children (90.9%) experienced more than one type of maltreatment.
Hierarchical regression models suggested that the higher the CFR index score and the number of
maltreatment experiences, and the older the children, the higher the SLC6A4 DNA methylation levels.
Although preliminary, our findings suggest that, along with childhood maltreatment experiences per
se, cumulative proximal family risk factors are seemingly critically associated with DNA methylation
at the SLC6A4 gene.
... In Italy a national survey on child maltreatment reported that 77,000 children are victims of maltreatment, 9 children per 1,000 residents [3]. Children who experience maltreatment often show emotional, behavioral, physical, and mental health problems [4][5][6][7] with serious life-long consequences on multiple developmental domains and functions [8]. ...
Exploring the contribution of proximal family risk factors on SLC6A4 DNA methylation in children with a history of maltreatment
... Amongst personality disorders (PDs), ASPD is most strongly associated with a risk of violence (review, Yu et al., 2012). Individuals who as children suffered maltreatment (physical, psychological or sexual abuse, neglect), compared to those who did not, are also more likely to commit violence towards themselves and others (reviews, Perepletchikova andKaufman, 2010, McMahon et al., 2018;Smyth et al., 2017;Li et al., 2019) and have an increased risk of developing a range of mental disorders, including psychosis and ASPD (e.g. Bendall et al., 2008;Bebbington et al., 2011;Dhakal et al., 2019Muniz et al., 2019Pandey et al., 2020). ...
Aberrations in stress-linked hypothalamic-pituitary-adrenal axis function have been independently associated with schizophrenia, antisocial behaviour and childhood maltreatment. In this study, we examined pituitary volume (PV) in relation to childhood maltreatment (physical abuse, sexual abuse, neglect) in men (i) with schizophrenia and a history of serious violence (n=13), (ii) with schizophrenia but without a history of serious violence (n=15), (iii) with antisocial personality disorder (ASPD) and a history of serious violence (n=13), and (iv) healthy participants without a history of violence (n=15). All participants underwent whole-brain magnetic resonance imaging. Experiences of childhood maltreatment were rated based on interviews (for all), and case history and clinical/forensic records (for patients only). There was a trend for smaller PV, on average, in schizophrenia patients (regardless of a history of violence), compared to the healthy group and the ASPD group; other group differences in PV were non-significant. Sexual abuse ratings correlated negatively with PVs in ASPD participants, but no significant association between childhood maltreatment and PV was found in schizophrenia participants. Our findings are consistent with previous evidence of smaller-than-normal PV in chronic schizophrenia patients, and suggest that illness-related influences may mask the possible sexual abuse-smaller PV association, seen here in ASPD, in this population.
... 4,5 Childhood maltreatment has been considered a risk factor for different psychopathologies in adult life, such as mood and anxiety disorders, post-traumatic stress disorder, suicidal ideation, self-harm behavior and antisocial personality disorder. [6][7][8] This kind of emotional turmoil can also be seen during the bereavement process of a loss of a significant other by suicide, which in turn can increase suicide risk in the survivors. 9 In addition, children exposed to maltreatment can suffer from poor social skills and emotional dysregulation, which can influence worse outcomes in mental health. ...
Introduction:
Gender dysphoria (GD) is characterized by a marked incongruence between experienced gender and one's gender assigned at birth. Transsexual individuals present a higher prevalence of psychiatric disorders when compared to non-transsexual populations, and it has been proposed that minority stress, i.e., discrimination or prejudice, has a relevant impact on these outcomes. Transsexuals also show increased chances of having experienced maltreatment during childhood. Interleukin (IL)-1β, IL-6, IL-10 and tumor necrosis factor-alpha (TNF-α) are inflammatory cytokines that regulate our immune system. Imbalanced levels in such cytokines are linked to history of childhood maltreatment and psychiatric disorders. We compared differences in IL-1β, IL-6, IL-10 and TNF-α levels and exposure to traumatic events in childhood and adulthood in individuals with and without GD (DSM-5).
Methods:
Cross-sectional controlled study comparing 34 transsexual women and 31 non-transsexual men. They underwent a thorough structured interview, assessing sociodemographic information, mood and anxiety symptoms, childhood maltreatment, explicit discrimination and suicidal ideation. Inflammatory cytokine levels (IL-1β, IL-6, IL-10 and TNF-α) were measured by multiplex immunoassay.
Results:
Individuals with GD experienced more discrimination (p = 0.002) and childhood maltreatment (p = 0.046) than non-transsexual men. Higher suicidal ideation (p < 0.001) and previous suicide attempt (p = 0.001) rates were observed in transsexual women. However, no differences were observed in the levels of any cytokine.
Conclusions:
These results suggest that transsexual women are more exposed to stressful events from childhood to adulthood than non-transsexual men and that GD per se does not play a role in inflammatory markers.
... In future research, we recommend to include constructs of psychopathy and sadism, as well as individual risk factors such as self-control and behavioral disorders while investigating appetitive aggression. In addition, childhood maltreatment may lead to deteriorated cognitive functioning, including lower selfcontrol (e.g., Cowell, Cicchetti, Rogosch, & Toth, 2015;Kort-Butler, Tyler, & Melander, 2011), and also increases the risk for behavioral disorders (e.g., Dvir, Ford, Hill, & Frazier, 2014;Perepletchikova & Kaufman, 2010) therefore future research is needed to address those concepts in combination with appetitive aggression. ...
Individuals who perpetrate violence may likely perceive violence as appealing and infliction of violence to derive pleasure is termed as appetitive aggression. Individuals who were abducted as children into an armed group often experience a higher number of traumatic event types, that is traumatic load and are usually socialized in a violence-endorsing environment. This study aims to investigate the interaction between age at initial abduction with that of traumatic load, and their influence on appetitive aggression along with perpetration of violent acts by former members of an armed rebel group of both sexes. Semi-structured interviews were conducted among a target group of formerly abducted rebel-war survivors (including participants with and without combat experience) from Northern Uganda. Participants included 596 women and 570 men with N = 1,166 (M age = 32.58, SD age = 9.76, range: 18-80 years). We conducted robust linear regression models to investigate the influence of age at initial abduction, traumatic load, combat experience, and biological sex on appetitive aggression as well as their perpetrated violent acts. Our study shows, appetitive aggression and the number of perpetrated violent acts were specifically increased in individuals who were abducted young, experienced several traumatic events in their lifetime, and with previous combat experience. For perpetrated violence men showed increased levels whereas for appetitive aggression the association was independent of biological sex. Therefore, early abducted individuals with a higher traumatic load, who have combat experience, need to be given special intervention to prevent any further violence.
... Children and youth exposed to violence also have an increased risk of developing aggressive attitudes, engaging in drug and alcohol abuse, or committing suicide and violence (Reid 2018). The long-term, detrimental effects of ETV during childhood and adolescence have been substantiated by large bodies of research from various fields (e.g., Perepletchikova and Kaufman 2010;Piquero et al. 2006;Putnam 2006;Reid and Loughran 2019a). Specific to this study, Farrell and Zimmerman (2017) found that contemporaneous and acute ETV was significantly related to long-term future violent offending. ...
Early exposure to violence (ETV) has been repeatedly linked to violence in intimate relationships later in life. However, this association has rarely been explored among young men involved in the justice system, a group that is of significant policy concern. Methods. Drawing from four waves of data collected from 808 young men with histories of serious offending, this study examined rates of physical and emotional intimate partner violence (IPV) victimization and perpetration. Next, the rates of IPV victimization-perpetration overlap were examined. Lastly, the associations between IPV in young adulthood and ETV in early adolescence were explored using standard difference-in-means tests. Findings show that victimization and perpetration of emotional IPV are common experiences among the men. Seventy-three percent of the sample report emotional IPV victimization and 70% report emotional IPV perpetration. Physical IPV is less common than emotional IPV with 44% of young men reporting being victims of physical IPV and 29% reporting perpetration of physical IPV. Strong linkages were observed between IPV victimization and IPV perpetration. Lastly, associations exist between exposure to violence as a witness or a victim and both emotional and physical IPV victimization and perpetration. IPV involvement as a victim and/or perpetrator is more common than not among young men involved in the justice system. Both emotional and physical forms of IPV are associated with witnessing and experiencing violence during adolescence. Intervention during adolescence is critical to avoid IPV during young adulthood.
... [1][2][3] When children experience maltreatment, it can contribute to poor physical, psychological, and behavioral outcomes. [4][5][6] It is therefore recognized as a significant public health problem. 7,8 Infancy and early childhood are critical periods of development which lay the foundation for future learning, behavior, and physical and mental health. 1 Environmental factors and experiences during this developmentally sensitive period can permanently alter gene expression and function and can have devastating consequences on brain architecture, formation, and long-term development. ...
Early childhood is an important developmental period, which lays the foundation for future learning, behaviour, physical and mental health and gene expression. The most vulnerable children in society are often referred to and receive services from the child welfare system because of a concern of abuse and neglect and/or a poor developmental trajectory. This paper presents an organizing framework for how the child welfare system, in concert with allied partners, can support interventions for young children and families by acknowledging its crucial role in improving their development and well-being. The framework is informed by research amassed from numerous disciplines, including child welfare, development, neuroscience, neurobiology and epigenetics. Although the notions of protection and well-being are central considerations in child welfare legislation in Ontario, Canada, the operationalization of wellbeing has proven challenging in child welfare practice, policy and research. The framework proposes ten key indicators and priorities for identifying and promoting optimal child development. Findings from the 2013 cycle of the Ontario Incidence Study of Reported Child Abuse and Neglect (OIS-2013), the only provincial source of aggregated child welfare investigation data, are presented to articulate the divide between the environmental context of a population of at-risk children and the conditions that both protect children and increase the likelihood that they will thrive in adulthood. This paper argues there are different points of entry and intervention across sectors and provides a foundation for further discussion on how to promote well-being for society's most vulnerable children.
... Several possible pathways between exposure to trauma have been suggested in the literature, including the mediating role of posttraumatic symptoms, depression, psychiatric comorbidity, and the impact on personality and cognitive development. Much attention has been paid to early trauma as risk factors for suicide in adolescence and adulthood, such as physical and sexual abuse, and parental neglect (Brodsky & Stanley, 2008;Bruffaerts et al., 2010;Perepletchikova & Kaufman, 2010;Roy, 2001;Sarchiapone et al., 2007). Other familial factors, such as parental suicide, parental psychiatric disorder, alcohol abuse and socioeconomic indicators have been associated with increased suicide risk in the offspring (von Borczyskowski et al., 2010). ...
Multiple risk factors have been involved in the risk for suicide and multiple trajectories have been hypothesized leading to suicidal behaviour. Consistent evidence suggests the involvement of heritable factors, as well as a critical role of life stress and early adversity. In the present article we will review the evidence for the involvement of genetic, environmental as well as personality traits in the risk for suicide, together with recent evidence supporting an interaction between these different factors.
... The link between child maltreatment and persistent physical, psychological, social, and behavioural consequences has been well documented (Gilbert et al., 2009;Perepletchikova & Kaufman, 2010;Teicher, Samson, Anderson, & Ohashi, 2016). Researchers have suggested that the assessment, treatment, and impact of maltreatment should be informed by a number of factors, including and especially the child's developmental context (Belsky, 1993;Wulczyn, Barth, Yuan, Harden, & Landsverk, 2005). ...
Although studies have documented the pronounced and negative impact of adolescent maltreatment on short and long-term development, there is limited research about the risk factors and experiences of adolescents who are reported to the child welfare system. This study addresses this knowledge gap by using data from the provincially representative Ontario Incidence Study of Reported Child Abuse and Neglect (OIS-2013) to identify the characteristics of the alleged maltreatment, functioning concerns, caregiver risk factors, and socioeconomic conditions associated with the decision to provide ongoing child welfare services to adolescents and their families. In 2013, there were an estimated 34,968 investigations of maltreatment-related concerns involving adolescents and 26.5% of these cases were transferred to ongoing services. A number of factors were associated with this decision, including: adolescents’ race/ethnicity, internalizing problems, and difficulties in the quality of the relationship with their primary caregiver; investigations involving potential abandonment, exposure to intimate partner violence, and co-occurring maltreatment; and caregivers’ social isolation, mental health concerns, and substance abuse. A multivariable tree-classification found that the presence of internalizing problems was a primary factor influencing the decision to provide ongoing child welfare services, followed by caregiver social isolation, relationship difficulties between the caregiver and the adolescent, caregiver mental health concerns, and co-occurring maltreatment. The results suggest that adolescents investigated by Ontario child welfare authorities are experiencing troubling circumstances coupled with their caregivers’ challenges, which may be impacting their relationships to the point that it determines their need for ongoing child welfare services.
... As maltreated youth enter adulthood, they are more likely to engage in maltreatment of their own children (Jonson-Reid, Kohl, & Drake, 2012;Perepletchikova & Kaufman, 2010) representing a cross generational transmission of maltreatment, substance abuse, delinquency, and risky sexual behavior. These negative health consequences extend throughout adult life (Lucenko et al., 2015;Miller, Chen & Parker, 2011). ...
This evaluation compared the efficiency and effectiveness of Functional Family Therapy-Child Welfare (FFT-CW®, n = 1625) to Usual Care (UC: n = 2250) in reducing child maltreatment. FFT-CW® is a continuum of care model based on the family's risk status. In a child welfare setting, families received either UC or FFT-CW® in a quasi-experimental, stepped wedge design across all five boroughs of New York City. The families were matched using stratified propensity scoring on their pre-service risk status and followed for 16 months. The ethnically diverse sample included African American (36%), Asian (4%); Hispanic (49%), and Non-Hispanic White (6%) or Other (6%) participants. Referral reasons included abuse or neglect (57.4%), child service needs (56.9%) or child health and safety concerns (42.8%). Clinical process variables included staff fidelity, service duration, and number of contacts. Positive outcomes included whether all clinical goals were met and negative outcomes included transfers, outplacement, recurring allegations and service participation within 16 months of the case open date. Families receiving FFT-CW® completed treatment more quickly than UC and they were significantly more likely to meet all of the planned service goals. Higher treatment fidelity was associated with more favorable outcomes. Fewer FFT-CW® families were transferred to another program at closing, and they had fewer recurring allegations. FFT-CW® had fewer out-of-home placements in families with higher levels of risk factors. The FFT-CW® program was more efficient in completing service, and more effective than UC in meeting treatment goals while also avoiding adverse outcomes.
... Parental factors such as young caregiver age, substance abuse, and mental health concerns are also established as risk factors for child maltreatment [32][33][34][35]. Child maltreatment can have long-term consequences for children's physical and mental health, substance misuse, and other risk behaviors [36][37][38][39]. Children living in families facing economic hardship who are also involved with child welfare due to confirmed or suspected maltreatment may represent a particularly vulnerable group and therefore warrant further study. ...
There is strong evidence that poverty and economic disadvantage are associated with child maltreatment; however, research in this area is underdeveloped in Canada. The purpose of this paper is to examine the relationship between economic hardship and maltreatment for families and children identified to the Ontario child protection system for a maltreatment concern. Secondary analyses of the Ontario Incidence Study of Reported Child Abuse and Neglect-2013 (OIS-2013) were conducted. The OIS-2013 examines the incidence of reported maltreatment and the characteristics of children and families investigated by child welfare authorities in Ontario in 2013. Descriptive and bivariate chi-square analyses were conducted in addition to a logistic regression predicting the substantiation of maltreatment. In 9% of investigations, the household had run out of money for food, housing, and/or utilities in the past 6 months. Children in these households were more likely to have developmental concerns, academic difficulties, and caregivers with mental health concerns and substance use issues. Controlling for key clinical and case characteristics, children living in families facing economic hardship were almost 2 times more likely to be involved in a substantiated maltreatment investigation (OR = 1.91, p < 0.001). The implications in regard to future research and promoting resilience are discussed.
... Of note, girls reported four times more sexual abuse than boys, possibly due to girls' higher chances of being sexually abused within their family (Coble et al., 1993) or the higher reluctance of boys (versus girls) to report this type of abuse (Sorsoli, Kia-Keating, & Grossman, 2008). In addition to gender differences in the percentage reporting sexual abuse, and in line with prior work in general, clinical and forensic populations (King et al., 2011; Perepletchikova & Kaufman, 2010), our findings are suggestive of gender-specific associations of sexual abuse with internalizing and externalizing mental health problems. In support of the idea that females are more sensitive to developing internalizing problems as a result of adversity (Edwards et al., 2003; Keyes et al., 2012; MacMillan & Munn, 2001; Maschi et al., 2008), sexual abuse in girls was robustly associated with internalizing problems, while in boys it was significantly, though weakly related with externalizing problems (Garnefski & Arends, 1998; King et al., 2011). ...
Mounting evidence indicates that emotional maltreatment is at least as harmful as physical and sexual abuse. Notwithstanding their high occurrence among detained adolescents, the link between emotional maltreatment and mental health problems in these youths is not well researched. This study, therefore, was designed to examine the unique link between emotional maltreatment and mental health problems, with particular attention to gender differences. Well validated self-report measures of maltreatment experiences (Childhood Trauma Questionnaire) and mental health problems (Youth Self Report) were completed by 341 detained adolescents (156 boys, 185 girls) aged 12 to 18 years. As expected, girls reported higher levels of maltreatment experiences and internalizing and externalizing mental health problems than boys. Blockwise multiple linear regression analyses indicated that in both genders emotional abuse was uniquely and positively associated with internalizing and externalizing mental health problems, over and above the influence of other types of maltreatment. Furthermore, sexual abuse was uniquely related with internalizing problems in girls only, whereas only in boys this type of abuse was uniquely related with externalizing problems. Detained adolescents who have been the victim of emotional abuse in combination with another type of maltreatment may be the worst subgroup in terms of mental health problems. Therefore, emotional maltreatment experiences in adolescents who offend should receive more research and clinical attention.
... In humans, adolescence marks a sensitive time frame in which the risk of depression as well as other psychopathologies increases dramatically compared with childhood (Hankin et al. 1998;Kessler et al. 2001;Nemeroff et al. 2006). Although not always the case, the occurrence of childhood trauma in adolescent clinical cases of depression (Gunnar 2003;Nemeroff et al. 2006) and antisocial behavior (Jonson-Reid et al. 2010;Perepletchikova and Kaufman 2010;Haller et al. 2014) is high and treatment efficacy in depressed individuals with childhood trauma differs from those without early life trauma exposure (Nemeroff et al. 2003). ...
Traumatic experiences early in life can contribute to the development of mood and anxiety disorders that manifest during adolescence and young adulthood. In young rats exposed to acute fear or stress, alterations in neural development can lead to enduring behavioral abnormalities. Here, we used a modified extinction intervention (retrieval+extinction) during late adolescence (post-natal day 45 [p45]), in rats, to target auditory Pavlovian fear associations acquired as juveniles (p17 and p25). The effects of adolescent intervention were examined by assessing freezing as adults during both fear reacquisition and social transmission of fear from a cagemate. Rats underwent testing or training at three time points across development: juvenile (p17 or p25), adolescent (p45), and adult (p100). Retrieval+extinction during late adolescence prevented social reinstatement and recovery over time of fears initially acquired as juveniles (p17 and p25, respectively). Adolescence was the only time point tested here where retrieval+extinction prevented fear recall of associations acquired 20+ days earlier.
... In fact, recent studies show that rodents subjected to stressinducing models during adolescence are more anxious and less motivated, symptoms similar to those seen in humans with depression or anxiety disorders [29,48]. In addition, situations of fear and ill-treatment during adolescence in humans increase the risk of aggressive behavior and impairment of social interaction in adulthood [14,40,47], as well in other species [17,41,62,63,66]. ...
Adolescence is one of the critical periods of development and has great importance to health for an individual as an adult. Stressors or traumatic events during this period are associated with several psychiatric disorders as related to anxiety or depression and cognitive impairments, but whether negative experiences continue to hinder individuals as they age is not as well understood. We determined how stress during adolescence affects behavior and neurochemistry in adulthood. Using an unpredictable paradigm (2 stressors per day for 10 days) in Balb/c mice, behavioral, hormonal, and neurochemical changes were identified 20 days after the cessation of treatment. Adolescent stress increased motor activity, emotional arousal and vigilance, together with a reduction in anxiety, and also affected recognition memory. Furthermore, decreased serotonergic activity on hippocampus, hypothalamus and cortex, decreased noradrenergic activity on hippocampus and hypothalamus, and increased the turnover of dopamine in cortex. These data suggest behavioral phenotypes associated with emotional arousal, but not depression, emerge after cessation of stress and remain in adulthood. Social-environmental stress can induce marked and long-lasting changes in HPA resulting from monoaminergic neurotransmission, mainly 5-HT activity.
... La elevada frecuencia de psicopatología en niños y adolescentes que sufrieron maltrato ha llevado a mencionar al maltrato como predictor de ésta. 5,10 Los estudios prospectivos como el de Ethier et al. reportaron mayor frecuencia de trastornos afectivos, ansiosos y conductuales en sujetos vícti-mas de maltrato crónico. 11 Yanos et al. reportaron que los pacientes con antecedentes de maltrato utilizaban los servicios de salud mental con mayor frecuencia y que la presencia de depresión mayor o abuso de sustancias incrementaba el uso de servicios médicos en estos pacientes. ...
Child abuse is defined as causing or permitting any harmful or offensive contact on a child's body; and any communication or transaction of any kind which humiliates, shames, or frightens the child. Some child development experts go a bit further and define child abuse as any act or omission, which fails to nurture or in the upbringing of the children. The Child Abuse Prevention and Treatment Act defines child abuse and neglect as: at a minimum, any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm.. Child abuse can be classified as physical, emotional, neglect or sexual. Physical Abuse:This type of abuse can be defined as the inflicting of physical injury upon a child. This may include burning, hitting, punching, shaking, kicking, beating, or otherwise harming a child. The parent or caretaker may not have intended to hurt the child, the injury is not an accident. It may, however, been the result of over-discipline or physical punishment that is inappropriate to the child's age. Emotional Abuse (also known as verbal abuse, mental abuse, and psychological maltreatment): This type of abuse includes acts or the failures to act by parents or caretakers that have caused or could cause serious behavioral, cognitive, emotional, or mental disorders. Neglect: This type is defined as the failure to provide for the child's basic needs. Neglect can be physical, educational, or emotional. Physical neglect can include not providing adequate food or clothing, appropriate medical care, supervision, or proper weather protection (heat or coats). It may include abandonment. Educational neglect includes failure to provide appropriate schooling or special educational needs, allowing excessive truancies. Sexual Abuse: It refers to the inappropriate sexual behavior with a child. It includes fondling a child's genitals, making the child fondle the adult's genitals, intercourse, incest, rape, sodomy, exhibitionism and sexual exploitation. To be considered child abuse these acts have to be committed by a person responsible for the care of a child (for example a baby-sitter, a parent, or a daycare provider) or related to the child. The prevalence of child abuse has been reported as 4.5% to 21.6% in epidemiological studies and 14.6% to 48% in clinical studies. An epidemiological study in Mexico found at 16% to 20% prevalence, being the physical and emotional abuse the more frequently reported. This study also showed that the mother is the perpetrator in a high percentage of cases and mentioned some characteristics of the patients and their families which were associated with the different types of abuse. There are many factors that may contribute to the occurrence of child abuse and neglect, such as an inadequate family environment, the history of illness or any disability in the children or the presence of psychopathology in the parents. Parents may be more likely to maltreat their children if they abuse drugs or alcohol. They also may not be able to cope with the stress associated with Heir children care . Child abuse has been associated with psychopathology. The impairments in significant areas of child development caused by maltreatment may account for the elevated symptoms of depression, anxiety, conduct disorders and substance abuse among children and adolescents with histories of physical and sexual abuse. In particular, children and adolescents with externalizing disorders such as Attention Deficit Hyperactivity Disorder (ADHD), oppositional defiant disorder or conduct disorder may be in a higher risk for maltreatment. The objectives of this study were to examine the frequency of maltreatment reported by adolescents with psychiatric disorders and explore their demographic characteristics and family functioning. Methods The sample included male and female adolescents (13 to 17 years old) attending the inpatient and outpatient services at the Child Psychiatric Hospital in Mexico City. After giving their informed consent, the patients and their parents were assessed with the Semistructured Interview for Adolescents, a diagnostic interview which follows DSM-IV criteria for 17 major diagnoses. After that, adolescents were asked to fulfill a survey for child abuse, a previously designed questionnaire to explore the presence of physical, emotional, sexual abuse, and neglect. This questionnaire also assesses some characteristics of the parents and the family (income, educational level, family structure and conflict resolution, among others). The obtained data were analyzed with descriptive statistics. Results One hundred patients (50% male, mean age 14.79+/-1.60 years old, with a mean of 7.8+/-1.68 years of school) were evaluated. Most of them (56%) were living with both parents, the parents educational level more frequently reported was middle school (32% of the mothers and 30% of the fathers). Intimate partner violence was reported by 22% of the sample. According to the psychiatric diagnostic interview, the most frequent diagnoses in the sample were major depressive disorder (61%), ADHD (39%), conduct disorder (31%), substance abuse (31%) and anxiety disorders (17%). The rates of the different types of abuse reported by this sample of adolescents were as follows: Emotional abuse (77% perpetrated by the mother and 61% by the father), physical abuse (41% perpetrated by the mother and 34% by the father), severe physical abuse (29% perpetrated by the mother and 26% by the father), neglect (8%) and sexual abuse (24%). A 19% of the sample reported to be physically abused by the mother before the age of 5, while 11% reported to be physically abused by the father by the age of 5. Patients with ADHD and those with conduct disorder reported the highest frequencies of abuse. The adolescents with substance abuse disorders reported high frequency of emotional abuse. When patients were asked to give their opinion about the frequency with which they were physically punished, the investigators found that a high percentage of adolescents agreed to receive physical punishment (22% considered to be punished,,with reason,, and 12% considered normal to be hit). Only 8% to 11% considered that their parents hit them excessively. The sample was divided according to their diagnoses in patients with externalizing disorders, internalizing disorders and substance abuse/dependence and the frequency of the different types of abuse was calculated. The physical abuse by the mother was more frequent in patients with externalizing disorders and substance abuse; the physical abuse by the father was more frequent in patients with externalizing disorders. These patients also reported the highest frequency of severe physical abuse and emotional abuse by the mother. The frequency of sexual abuse was reported by 22% or each diagnostic group. When the patients were asked to explain why were they physically punished, the main reasons exposed were disobedience and disrespect; however, more than 20% explained that their parents were intoxicated with alcohol or drugs while punishing them. Conclusions The frequency of abuse reported by this sample of adolescents with psychiatric disorders was higher than the reported in an epidemiologic sample, particularly in the rates of sexual abuse. The present sample also exhibited unfavorable social, demographic and familial characteristics. Emotional abuse was the most frequently reported in this sample. The mother was the more frequently perpetrator for physical and emotional abuse.
... FV also has consequences for the individuals directly involved. For example, there is an alarmingly high rate of revictimization (repeatedly being a victim of FV or falling victim to nonintimate violence) and intergenerational transmission of abuse (Laslett, Room, Dietze, & Ferris, 2012;Perepletchikova & Kaufman, 2010). ...
This review examines the association between alcohol and illicit drug use and the perpetration of intimate partner violence (IPV) and child maltreatment (CM). In clinical populations, alcohol use is related to IPV, although other variables are also known to influence this relationship. Studies in specialized social/health care and in the community have also demonstrated the association between alcohol use and IPV. Although data on the association between illicit drug use and IPV are less clear, in most studies perpetration seems related to the use of cannabis and cocaine. The occurrence of CM is related to alcohol use in specialized social/health care and community populations but has not been extensively investigated in clinical samples. These findings also apply to studies on the association between illicit drug use and CM. Moreover, many studies on CM fail to distinguish between the effects of alcohol and those of illicit drugs. This review concludes with recommendations for future research about substance use and family violence and discusses implications for prevention and treatment.
© The Author(s) 2015.
... The increased prevalence of PTSD symptoms and behavioral disorders and the impaired HRQoL seen among girls living in a Chilean foster home highlight the special needs these children have. That the child welfare system is asked to provide care for a large number of children and adolescents with a history of childhood adversity and mental health problems emphasizes the need for more comprehensive educational and psychotherapeutic measures to buffer against later negative life outcomes like mental illness, substance abuse, homelessness, unemployment, poverty, criminality, revictimization, and suicide (McMillen et al., 2005;Perepletchikova & Kaufman, 2010). Structural assistance may be offered in terms of education and knowledge transfer, better training of caregivers in foster homes, and the employment of more social workers and mental health professionals in foster homes. ...
In Latin America, little research has been conducted regarding exposure to adverse childhood experiences (ACEs), mental health, and health-related quality of life (HRQoL) among foster children. This study examined the association between ACEs and mental health, posttraumatic stress disorder (PTSD), and HRQoL in Chilean foster girls relative to age-matched Chilean family girls. Data were obtained from 27 Chilean foster girls and 27 Chilean girls ages 6 to 17 years living in family homes. Standardized self- and proxy-report measures were used. Foster girls reported more ACEs than controls in terms of familial and nonfamilial sexual abuse and both emotional and physical neglect. Girls living in foster care had a significantly higher rate of PTSD, displayed greater behavioral and emotional problems, and reported a lower HRQoL. Analysis confirmed the well-known cumulative risk hypothesis by demonstrating a significant positive association between the number of ACEs and PTSD symptom severity and a significant negative association with HRQoL. Chilean foster girls endured more ACEs that impair mental health and HRQoL than age-matched peers living with their families. These findings have implications for out-of-home care services in Latin America, highlighting the need to implement not only appropriate trauma-focused treatments but also appropriate prevention strategies. (PsycINFO Database Record
(c) 2015 APA, all rights reserved).
... Maltreatment during childhood, inflicted by family 182 or peers [183][184][185] , is linked to social anxiety, impaired social skills and loneliness in adulthood 182 , and is a robust predictor of adolescent and adult antisocial behaviours 186 . However, not all individuals are equally affected 187 , which suggests that genetic factors interact with early adversity to mediate these effects 135,186 . A direct causal effect of childhood adversity on aggression was suggested by findings from longitudinal twin studies 188 . ...
Stress often affects our social lives. When undergoing high-level or persistent stress, individuals frequently retract from social interactions and become irritable and hostile. Predisposition to antisocial behaviours - including social detachment and violence - is also modulated by early life adversity; however, the effects of early life stress depend on the timing of exposure and genetic factors. Research in animals and humans has revealed some of the structural, functional and molecular changes in the brain that underlie the effects of stress on social behaviour. Findings in this emerging field will have implications both for the clinic and for society.
... Victims of child maltreatment are also more likely to be involved in intimate partner violence, experience teen parenthood, and have difficulties parenting their children. Child maltreatment is also a nonspecific risk factor for multiple forms of psychopathology (Briere & Jordan, 2009;Perepletchikova & Kaufman, 2010;Weich, Patterson, Shaw, & Stewart-Brown, 2009). Child abuse must be detected early in order to minimize its negative effects. ...
The purpose of this study was to facilitate home visits to assess the current rate of child abuse in order to provide an agenda for the early detection and prevention of child abuse and neglect in Korea.
... The relationship among PTSD, MDD, and suicidal behavior may be influenced by environmental factors, such as childhood maltreatment, a known risk factor for many types of psychopathology (Chen, Murad, Paras et al., 2010;Gilbert, Widom, Browne et al., 2009;Perepletchikova & Kaufman, 2010). Sexual, physical, and emotional abuse and neglect all increase the risk of suicidal behavior, with the most consistent findings related to childhood sexual abuse (Brodsky & Stanley, 2008;Enns, Cox;Afifi et al., 2006;Mandelli, Carli, Roy et al., 2011;Molnar, Berkman, & Buka, 2001;Ystgaard, Hestetun, Loeb et al., 2004). ...
Posttraumatic stress disorder and major depressive disorder are well-established risk factors for suicidal behaviour. This study compared depressed suicide attempters with and without comorbid posttraumatic stress disorder with respect to additional diagnoses, global functioning, depressive symptoms, substance abuse, history of traumatic exposure and suicidal behaviour. Adult patients consecutively admitted to a general hospital after a suicide attempt were interviewed and assessed for DSM-IV diagnosis and clinical correlates. Sixty-four patients (71%) were diagnosed with depression; of them, 21 patients (32%) had posttraumatic stress disorder. There were no group differences in social adjustment, depressive symptoms, or suicidal intent. However, the group with comorbid depression and posttraumatic stress disorder had more additional Axis I diagnoses, a higher degree of childhood trauma exposure, and more often reported previous suicide attempts, non-suicidal self-harm and vengeful suicidal motives. These findings underline the clinical importance of diagnosis and treatment of posttraumatic stress disorder in suicide attempters.
... Tais elementos lançam luzes sobre as hipóteses, levantadas nas teorias aqui apresentadas, de autoculpabilização por parte da vítima que, impotente diante da violência sofrida, não encontra referências sólidas para protegê-la, de modo que o pensamento e a tentativa de suicídio seriam interpretados como uma linha de fuga ao poder sofrido (Bedi et al., 2011;Fuks, 1998;Perepletchikova & Kaufman, 2010). Tal fato nos chama a atenção para a necessidade de empreendimento de novos estudos, inclusive qualitativos, que nos permitam compreender as trajetórias da violência, desde sua produção até seus efeitos em diversos níveis. ...
This paper aims to discuss the types of Child Sexual Abuse (CSA) occurred in childhood and/or adolescence and their consequences in a sample of 236 high school students of both sexes living in the countryside of the State of São Paulo, Brazil, who declared to have suffered one or more types of CSA. We observed that among the 234 adolescents with report of SV, 39 (16.5%) declared to have attempted suicide, being 35 (89.7%) of them auto declared heterosexual (27 [77.1%] female) and 4 (19.0%) non-heterosexual (3 bisexuals and 1 "other"; all female). Most of the victims reported the event to their friends and adults in charge, but little (or nothing) was done in terms of protective measures to them.
... Stressful events can strongly impact an individual's development, physiology and behavior, and are major risk factors for mental health disorders later in life and across generations (Heim et al., 2008;Perepletchikova and Kaufman, 2010). Several studies in humans have documented inheritance of the effects of early experiences. ...
Epigenetic marks in mammals are essential to properly control the activity of the genome. They are dynamically regulated during development and adulthood, and can be modulated by environmental factors throughout life. Changes in the epigenetic profile of a cell can be positive and favor the expression of advantageous genes such as those linked to cell signaling and tumor suppression. However, they can also be detrimental and alter the functions of important genes, thereby leading to disease. Recent evidence has further highlighted that some epigenetic marks can be maintained across meiosis and be transmitted to the subsequent generation to reprogram developmental and cellular features. This short review describes current knowledge on the potential impact of epigenetic processes activated by environmental factors on the inheritance of neurobiological disease risk. In addition, the potential adaptive value of epigenetic inheritance, and relevant current and future questions are discussed.
... There is robust epidemiological evidence of an increased risk of violent offending, relative to the general population, in men with antisocial personality disorder (ASPD; Eronen et al., 1998) and schizophrenia (Arseneault et al., 2000). Individuals who as children suffered adversity, in particular sexual or physical abuse, have a heightened risk of developing mental disorders (Bebbington et al., 2011;Janssen et al., 2004;Maniglio, 2009), and, although the majority of these do not commit any violent offences as an adult, they are, on average, more likely to commit violent crimes than those who were not abused (Perepletchikova and Kaufman, 2010). Morphological variation in multiple brain structures, particularly the frontal and temporal lobes, have been linked in individual studies with violence (Dolan et al., 2010), ASPD (Bassarath, 2001;Yang and Raine, 2009) and schizophrenia (Honea et al., 2005;Leung et al., 2011;Shenton et al., 2001) as well as a history of childhood abuse (examined mainly in the context of post-traumatic stress disorder, depression or borderline personality disorder; McCrory et al., 2010). ...
Objective:
Antisocial personality disorder (ASPD) and schizophrenia, as well as childhood abuse, are associated with violent behaviour and show marked volumetric reduction in the anterior cingulate (AC), a brain region implicated in regulation of violence through its involvement in decision making, empathy, impulse control, and emotion regulation. The present study examined, for the first time to the authors' knowledge, the grey matter volume of the AC in relation to seriously violent behaviour and childhood psychosocial deprivation (including physical and sexual abuse) in the context of a mental disorder (schizophrenia or ASPD).
Methods:
Fifty-seven men [14 with ASPD and a history of serious violence; 13 with schizophrenia and a history of serious violence (VSZ); 15 with schizophrenia without a violence history (SZ); 15 nonviolent healthy participants] underwent whole-brain magnetic resonance imaging and were rated on the presence of physical abuse, sexual abuse, neglect, extreme poverty, foster home placement, criminal parent, severe family conflict, and broken home (collectively 'psychosocial deprivation'). Stereological volumetric ratings of the AC were examined for group differences and their association with childhood psychosocial deprivation.
Results:
A higher proportion of ASPD and VSZ patients had suffered psychosocial deprivation as children, in particular severe physical abuse, relative to SZ patients and healthy participants. ASPD and VSZ, but not SZ, patients had significantly lower AC volume relative to healthy participants. AC volumes correlated negatively with (total) psychosocial deprivation as well as physical and sexual abuse ratings. Group differences in AC volume became nonsignificant when psychosocial deprivation ratings were covaried for.
Conclusions:
Violent mentally disordered individuals with ASPD or schizophrenia suffer from a significant AC volume loss and this deficit, at least in part, is explained by their histories of stressful childhood experiences. Current and future therapies aiming to reduce violence in such populations would benefit by attending to biological (and other) correlates of childhood abuse.
... Animal models have recapitulated similar symptoms (Pick and Richter-Levin, 2010; Schmidt et al., 2011; Cordero et al., 2012; Márquez et al., 2013). In addition, exposure to fear or maltreatment during childhood and puberty increases the risk of developing violent behaviors in adulthood, as also shown in humans (Caspi et al., 2002; Jonson-Reid et al., 2010; Perepletchikova and Kaufman, 2010) and animals (Wommack and Delville, 2003; Veenema and Neumann, 2009; Cordero et al., 2012; Márquez et al., 2013). These observations suggest that stress levels of corticosterone at peripuberty could play a key role in the programming of ...
Stress during childhood and adolescence enhances the risk of psychopathology later in life. We have previously shown that subjecting male rats to stress during the peripubertal period induces long-lasting effects on emotion and social behaviors. As corticosterone is increased by stress and known to exert important programming effects, we reasoned that increasing corticosterone might mimic the effects of peripubertal stress. To this end, we injected corticosterone (5 mg/kg) on 7 scattered days during the peripuberty period (P28-P30, P34, P36, P40 and P42), following the same experimental schedule as for stress administration in our peripubertal paradigm. We measured play behavior in the homecage and, at adulthood, the corticosterone response to novelty and behavioral responses in tests for anxiety- and depression-like behaviors, aggression and social exploration. As compared to vehicle, corticosterone-treated animals exhibit more aggressive play behavior during adolescence, increased aggressive behavior in a resident-intruder test while reduced juvenile exploration and corticosterone reactivity at adulthood. Whereas the corticosterone treatment mimicked alterations induced by the peripuberty stress protocol in the social domain, it did not reproduce previously observed effects of peripuberty stress on increasing anxiety-like and depression-like behaviors, respectively evaluated in the elevated plus maze and the forced swim tests. Our findings indicate that increasing corticosterone levels during peripuberty might be instrumental to program alterations in the social domain observed following stress, whereas other factors might need to be recruited for the programming of long-term changes in emotionality. Our study opens the possibility that individual differences on the degree of glucocorticoid activation during peripuberty might be central to defining differences in vulnerability to develop psychopathological disorders coursing with alterations in the social realm.
The present investigation examined associations of childhood maltreatment, anxiety sensitivity (AS), and sleep disturbance among a diverse sample of adults in psychiatric inpatient treatment. We hypothesized that childhood maltreatment would be indirectly associated with greater sleep disturbance through elevated AS. Exploratory analyses examined the indirect effect models with three AS subscales (i.e., physical, cognitive, and social concerns) as parallel mediators. A sample of adults in acute-care psychiatric inpatient treatment (N = 88; 62.5% male; Mage = 33.32 years, SD = 11.07; 45.5% White) completed a series of self-report measures. After accounting for theoretically relevant covariates, childhood maltreatment was indirectly associated with sleep disturbance through AS. Parallel mediation analyses revealed that no individual subscale of AS significantly accounted for this association. These findings suggest that heightened levels of AS may explain the association between childhood maltreatment and sleep disturbance among adults in psychiatric inpatient treatment. Interventions targeting AS can be brief and efficacious and have the potential to improve clinical outcomes among psychiatric populations.
Esta investigación tuvo como mira la pregunta ¿Cuáles son los dilemas bioéticos presentes en las prácticas discursivas de los psicoterapeutas que atienden el maltrato infantil? Se planteó como objetivos: visibilizar en las prácticas discursivas del psicoterapeuta su saber y su producción de sentido sobre el cuerpo del niño y la niña para discernir qué prácticas discursivas se constituyen en dilemas bioéticos. Extraer de esas prácticas discursivas la subjetividad de la familia, la subjetividad del maltratador y el niño y niña maltratado, su nexo con las relaciones de poder propias de las instituciones judiciales. En perspectiva Bioética, desde el establecimiento de bases conceptuales que potencien espacios en la reflexión de los psicoterapeutas, proponer rutas de manejo psicoterapéutico de niños y niñas maltratados Empleó para la metodología un enfoque crítico, con un diseño de análisis histórico del discurso, a través de entrevistas no directivas sobre las prácticas discursivas de los psicoterapeutas. Los hallazgos muestran que la vida del niño o niña está en constante riesgo y que los daños permanentes en la estructura del cerebro, en la mente del niño o niña, se continúan durante toda la vida de esa persona. De adulto tendrá mayor riesgo de repetir el maltrato intergeneracional y mayor probabilidad de sufrir diversas enfermedades físicas y mentales. En perspectiva bioética la capacidad de un obrar adecuado y correcto, de relacionarse y aportar socialmente están en alto riesgo de deterioro en las comunidades y por ende socialmente se exhorta atender esta situación que deteriora nuestra capacidad como especie. Se requiere que los adultos atiendan al niño y a la niña sin desconocer la dignidad, el respeto, la autonomía, la justicia, el amor, la paz que merecen para lograr en colectivo el proyecto de humanidad que poseemos.
En nuestro taller de cine, actividad docente semanal para internos de la carrera de medicina, hemos elegido esta película Rio Místico, a través de ella hacemos un análisis del impacto en el desarrollo de la personalidad y los vínculos. Clint Eastwood nos relata la historio de tres amigos, que presencia el rapto y abuso sexual de uno de ellos, 25 años después los personajes se encuentran por otro hecho trágico, revelándose el que ocurrió hace 25 años. El tiempo y el silencio marco y determino la vida de sus protagonistas
A violência intrafamiliar precoce, crônica e recorrente pode levar ao desenvolvimento de transtornos mentais, incluindo o Transtorno de Estresse Pós- Traumático (TEPT) e o Trauma Complexo. Os efeitos da exposição à violência intrafamiliar comumente não são limitados à infância e à adolescência, podendo impactar o funcionamento psicológico, social e ocupacional na vida adulta. As intervenções com maior eficácia para esses casos envolvem psicoterapia individual (psicoterapia cognitivo-comportamental) e psicoterapia familiar (sistêmica e cognitivo-comportamental). Na abordagem cognitivo-comportamental-sistêmica, a técnica da linha de vida pode se caracterizar como uma estratégia útil na avaliação do curso temporal da exposição a eventos estressores, bem como das respostas adaptativas e desadaptativas dos diferentes membros do sistema familiar. O objetivo deste trabalho é apresentar um processo de psicoterapia familiar breve com o uso da técnica da linha de vida em uma família exposta a múltiplas situações de violência intrafamiliar como estratégia terapêutica.
Intrafamily violence when precocious, chronic and recurrent may lead to the development of mental disorders, including Posttraumatic Stress Disorder (PTSD) and Complex Trauma. The effects of exposure to intrafamily violence commonly are not limited to childhood and adolescence, and may impact psychological, social and occupational functioning in adulthood. The most effortful intervention to these cases involves individual psychotherapy (cognitive-behavioral psychotherapy) and family psychotherapy (systemic and cognitive-behavioral). In the cognitive-behavioral-systemic approach, the lifeline technique can be characterized as a useful strategy in the evaluation of the temporal course of the exposure to stressor events, as well as the adaptive and maladaptive answers from the members of the family system. The aim of this paper is to present a brief family psychotherapy process with a family exposed to multiple situations of intrafamily violence with the use of lifeline’s technique as a therapeutic approach.
Children and Emotional Abuse is a research-informed learning resource for students in social work about the dynamics and consequences of psychological abuse-especially as it occurs in dysfunctional families and affects children and adolescents. Emotional abuse is still not widely understood or recognized. Helping professionals need to recognize emotional abuse, understand the damage it does, the theories that account for it, and be prepared to help children and families where the abuse often occurs along with physical and sexual abuse. This text will draw upon current peer-reviewed literature and evidence-based studies and summarize essential information to prepare students for careers in helping professions. Each chapter will also contain brief vignettes to illustrate some of the key points. This book is for courses in child welfare and child abuse/neglect, as well as other social work courses that focus on children.
Child abuse is defined as causing or permitting any harmful or offensive contact on a child's body; and any communication or transaction of any kind which humiliates, shames, or frightens the child. Some child development experts go a bit further and define child abuse as any act or omission, which fails to nurture or in the upbringing of the children. The Child Abuse Prevention and Treatment Act defines child abuse and neglect as: «at a minimum, any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm.» Child abuse can be classified as physical, emotional, neglect or sexual. Physical Abuse: This type of abuse can be defined as the inflicting of physical injury upon a child. This may include burning, hitting, punching, shaking, kicking, beating, or otherwise harming a child. The parent or caretaker may not have intended to hurt the child, the injury is not an accident. It may, however, been the result of over-discipline or physical punishment that is inappropriate to the child's age. Emotional Abuse (also known as verbal abuse, mental abuse, and psychological maltreatment): This type of abuse includes acts or the failures to act by parents or caretakers that have caused or could cause serious behavioral, cognitive, emotional, or mental disorders. Neglect: This type is defined as the failure to provide for the child's basic needs. Neglect can be physical, educational, or emotional. Physical neglect can include not providing adequate food or clothing, appropriate medical care, supervision, or proper weather protection (heat or coats). It may include abandonment. Educational neglect includes failure to provide appropriate schooling or special educational needs, allowing excessive truancies. Sexual Abuse: It refers to the inappropriate sexual behavior with a child. It includes fondling a child's genitals, making the child fondle the adult's genitals, intercourse, incest, rape, sodomy, exhibitionism and sexual exploitation. To be considered child abuse these acts have to be committed by a person responsible for the care of a child (for example a baby-sitter, a parent, or a daycare provider) or related to the child. The prevalence of child abuse has been reported as 4.5% to 21.6% in epidemiological studies and 14.6% to 48% in clinical studies. An epidemiological study in Mexico found at 16% to 20% prevalence, being the physical and emotional abuse the more frequently reported. This study also showed that the mother is the perpetrator in a high percentage of cases and mentioned some characteristics of the patients and their families which were associated with the different types of abuse. There are many factors that may contribute to the occurrence of child abuse and neglect, such as an inadequate family environment, the history of illness or any disability in the children or the presence of psychopathology in the parents. Parents may be more likely to maltreat their children if they abuse drugs or alcohol. They also may not be able to cope with the stress associated with their children care. Child abuse has been associated with psychopathology. The impairments in significant areas of child development caused by maltreatment may account for the elevated symptoms of depression, anxiety, conduct disorders and substance abuse among children and adolescents with histories of physical and sexual abuse. In particular, children and adolescents with externalizing disorders such as Attention Deficit Hyperactivity Disorder (ADHD), oppositional defiant disorder or conduct disorder may be in a higher risk for maltreatment. The objectives of this study were to examine the frequency of maltreatment reported by adolescents with psychiatric disorders and explore their demographic characteristics and family functioning. Methods: The sample included male and female adolescents (13 to 17 years old) attending the inpatient and outpatient services at the Child Psychiatric Hospital in Mexico City. After giving their informed consent, the patients and their parents were assessed with the Semistructured Interview for Adolescents, a diagnostic interview which follows DSMIV criteria for 17 major diagnoses. After that, adolescents were asked to fulfill a survey for child abuse, a previously designed questionnaire to explore the presence of physical, emotional, sexual abuse, and neglect. This questionnaire also assesses some characteristics of the parents and the family (income, educational level, family structure and conflict resolution, among others). The obtained data were analyzed with descriptive statistics. Results: One hundred patients (50% male, mean age 14.79±1.60 years old, with a mean of 7.8±1.68 years of school) were evaluated. Most of them (56%) were living with both parents, the parents educational level more frequently reported was middle school (32% of the mothers and 30% of the fathers). Intimate partner violence was reported by 22% of the sample. According to the psychiatric diagnostic interview, the most frequent diagnoses in the sample were major depressive disorder (61%), ADHD (39%), conduct disorder (31%), substance abuse (31%) and anxiety disorders (17%). The rates of the different types of abuse reported by this sample of adolescents were as follows: Emotional abuse (77% perpetrated by the mother and 61% by the father), physical abuse (41% perpetrated by the mother and 34% by the father), severe physical abuse (29% perpetrated by the mother and 26% by the father), neglect (8%) and sexual abuse (24%). A 19% of the sample reported to be physically abused by the mother before the age of 5, while 11% reported to be physically abused by the father by the age of 5. Patients with ADHD and those with conduct disorder reported the highest frequencies of abuse. The adolescents with substance abuse disorders reported high frequency of emotional abuse. When patients were asked to give their opinion about the frequency with which they were physically punished, the investigators found that a high percentage of adolescents agreed to receive physical punishment (22% considered to be punished «with reason» and 12% considered normal to be hit). Only 8% to 11% considered that their parents hit them excessively. The sample was divided according to their diagnoses in patients with externalizing disorders, internalizing disorders and substance abuse/dependence and the frequency of the different types of abuse was calculated. The physical abuse by the mother was more frequent in patients with externalizing disorders and substance abuse; the physical abuse by the father was more frequent in patients with externalizing disorders. These patients also reported the highest frequency of severe physical abuse and emotional abuse by the mother. The frequency of sexual abuse was reported by 22% or each diagnostic group. When the patients were asked to explain why were they physically punished, the main reasons exposed were disobedience and disrespect; however, more than 20% explained that their parents were intoxicated with alcohol or drugs while punishing them. Conclusions: The frequency of abuse reported by this sample of adolescents with psychiatric disorders was higher than the reported in an epidemiologic sample, particularly in the rates of sexual abuse. The present sample also exhibited unfavorable social, demographic and familial characteristics. Emotional abuse was the most frequently reported in this sample. The mother was the more frequently perpetrator for physical and emotional abuse.
The burden of child maltreatment in the U.S. remains a substantial problem with life-course implications, yet systematic efforts to prevent its occurrence and the associated impairments have been limited. The review of universal and targeted child maltreatment prevention interventions to address child physical abuse by Nelson and Caplan provide a thoughtful critique of the child maltreatment prevention efforts and a recognition of the importance of developing a public health framework to address this problem. An overriding prevention strategy should be derived from a systems level approach, which embraces the socio-ecological, and public health frameworks (with integration of policy and practice).
The policy implications of these interventions is important to grasp, with opportunities to foster policies supportive of a public health approach to child maltreatment prevention.
Child abuse and neglect is a public health problem and usually associated with family dysfunction due to multiple psychosocial, individual, and environmental factors. The diagnosis of child abuse may be difficult and require a high index of suspicion on the part of the practitioners encountering the child and the family. System-related factors may also enable abuse or prevent the early recognition of abuse. Child abuse and neglect that goes undiagnosed may give rise to chronic abuse and increased morbidity-mortality. In this report, we present two siblings who missed early diagnosis and we emphasize the importance of systems issues to allow early recognition of child abuse and neglect.
Child abuse is defined as causing or permitting any harmful or offensive contact on a child's body; and any communication or transaction of any kind which humiliates, shames, or frightens the child. Some child development experts go a bit further and define child abuse as any act or omission, which fails to nurture or in the upbringing of the children. The Child Abuse Prevention and Treatment Act defines child abuse and neglect as: <<at a minimum, any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm.>> Child abuse can be classified as physical, emotional, neglect or sexual.
Previous studies have found an association between childhood maltreatment (CM) and health-related quality of life (HRQoL), and to a lesser extent have considered whether psychiatric symptoms may explain the relationship. This study aimed to further our understanding of the link between CM and HRQoL by testing whether posttraumatic stress disorder (PTSD) or depressive symptoms mediate the relationship between childhood maltreatment and physical HRQoL. Mediation models were examined in a sample of male Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) active duty and combat veterans (n = 249). PTSD and depressive symptoms mediated the relationship between CM and overall physical HRQoL, as well as participation in daily activities due to physical health, bodily pain, and social functioning. Mediation of the relationship between childhood maltreatment and physical and social functioning by depression and PTSD symptoms may lend support to neurobiological hypotheses that childhood maltreatment sensitizes the nervous system and after repeated trauma may lead to the development of psychiatric symptoms, which have a major impact on morbidity and mortality.
Many studies have showed that childhood maltreatment is associated with several negative consequences in the development and clinical manifestations, including posttraumatic stress disorder (PTSD). The symptomatology is complex, thus requiring an explanatory model of post-traumatic syndrome identified in some children. The present study aims to a) contextualize the diagnosis of PTSD in children, b) compare the model proposed by Scheeringa in 1995 and the DSM-5 proposed diagnosis of PTSD in preschool children, and c) discuss these changes in relation to current diagnostic criteria in DSM-IV-TR. Therefore, the model proposed in the DSM-5 retains many of the suggestions made in 1995 by Scheeringa and significantly differs from the current model of the DSM-IV-TR, especially regarding to the inclusion of symptoms which comprise development issues and affective and cognitive changes
Resistance to the development of depression during difficult periods of life may be a manifestation of the manifestation of the 5-HTT gene, which detects the transport of serotonin in the brain. A person can have two versions of the 5-HTT gene - long and short.
There is a growing body of data indicating that Gene x Child Maltreatment interactions at monoamine oxidase A (MAOA) play a role in vulnerability to symptoms of antisocial personality disorder (ASPD) but not major depression (MD). Using a sample of 538 participants from the Iowa Adoption Studies, we introduce a conceptual model that highlights two distinct pathways from child maltreatment to symptoms of MD, suggesting that maltreatment has different effects depending on genotype and highlighting the importance of including the indirect pathway through ASPD. As predicted by the model, high activity alleles predispose to symptoms of MD in the context of child maltreatment whereas low activity alleles predispose to symptoms of ASPD. We conclude that the Gene x Environment interplay at this locus (MAOA) contributes to both symptoms of ASPD and MD and that careful specification of child maltreatment may be essential if genetic association research is to produce replicable results.
To investigate whether genotypic variation of the serotonin transporter gene-linked promoter region (5-HTTLPR) moderates the effect of maltreatment on suicidal ideation in school-aged children.
Eight hundred and fifty low-income children (478 maltreated; 372 non-maltreated) provided DNA samples and self-reported depressive and suicidal symptoms. Genotypes of 5-HTTLPR (s/s or s/l vs. l/l) were determined by fragment analyses.
Higher suicidal ideation was found among maltreated than non-maltreated children; the groups did not differ in 5-HTTLPR genotype frequencies. Children with one to two maltreatment subtypes and s/s or s/l genotypes had higher suicidal ideation than those with the l/l genotype; suicidal ideation did not differ in non-maltreated children or children with three to four maltreatment subtypes based on 5-HTTLPR variation. The results were applicable to emotionally maltreated/neglected and to physically/sexually abused children. Gene-environment interaction was not found for depressive symptoms.
The protective effect of the 5-HTTLPR l/l genotype on suicidal ideation was limited to maltreated children experiencing fewer subtypes.
This article reviews the complex relationship between child maltreatment and later psychosocial difficulties among adult women. Specifically addressed are (a) the various forms of childhood maltreatment, (b) the range of potential long-term psychological outcomes, and (c) important contextual variables that mediate or add to these maltreatment-symptom relationships. Among the latter are characteristics of the abuse and/or neglect; effects of impaired parental functioning; premaltreatment and postmaltreatment psychobiology; qualities of the parent-child attachment; abuse and/or neglect-related affect dysregulation that may lead to further symptomatology; the extent to which the child responds with significant emotional or behavioral avoidance; and whether later traumas are also present. Also relevant are sociocultural contributors to both child maltreatment and maltreatment effects, especially poverty and marginalization. Clinical and research implications are considered.
A previous study reported a gene x environment interaction in which a haplotype in the corticotropin-releasing hormone receptor 1 gene (CRHR1) was associated with protection against adult depressive symptoms in individuals who were maltreated as children (as assessed by the Childhood Trauma Questionnaire [CTQ]).
To replicate the interaction between childhood maltreatment and a TAT haplotype formed by rs7209436, rs110402, and rs242924 in CRHR1, predicting adult depression.
Two prospective longitudinal cohort studies.
England and New Zealand.
Participants in the first sample were women in the E-Risk Study (N = 1116), followed up to age 40 years with 96% retention. Participants in the second sample were men and women in the Dunedin Study (N = 1037), followed up to age 32 years with 96% retention. Main Outcome Measure Research diagnoses of past-year and recurrent major depressive disorder.
In the E-Risk Study, the TAT haplotype was associated with a significant protective effect. In this effect, women who reported childhood maltreatment on the CTQ were protected against depression. In the Dunedin Study, which used a different type of measure of maltreatment, this finding was not replicated.
A haplotype in CRHR1 has been suggested to exert a protective effect against adult depression among research participants who reported maltreatment on the CTQ, a measure that elicits emotional memories. This suggests the hypothesis that CRHR1's protective effect may relate to its function in the consolidation of memories of emotionally arousing experiences.
To determine whether an interactive curriculum that integrates dating violence prevention with lessons on healthy relationships, sexual health, and substance use reduces physical dating violence (PDV).
Cluster randomized trial with 2.5-year follow-up; prespecified subgroup analyses by sex.
Grade 9 health classes.
A total of 1722 students aged 14-15 from 20 public schools (52.8% girls). Intervention A 21-lesson curriculum delivered during 28 hours by teachers with additional training in the dynamics of dating violence and healthy relationships. Dating violence prevention was integrated with core lessons about healthy relationships, sexual health, and substance use prevention using interactive exercises. Relationship skills to promote safer decision making with peers and dating partners were emphasized. Control schools targeted similar objectives without training or materials.
The primary outcome at 2.5 years was self-reported PDV during the previous year. Secondary outcomes were physical peer violence, substance use, and condom use. Analysis was by intention-to-treat.
The PDV was greater in control vs intervention students (9.8% vs 7.4%; adjusted odds ratio, 2.42; 95% confidence interval, 1.00-6.02; P = .05). A significant group x sex interaction effect indicated that the intervention effect was greater in boys (PDV: 7.1% in controls vs 2.7% in intervention students) than in girls (12.1% vs 11.9%). Main effects for secondary outcomes were not statistically significant; however, sex x group analyses showed a significant difference in condom use in sexually active boys who received the intervention (114 of 168; 67.9%) vs controls (65 of 111 [58.6%]) (P < .01). The cost of training and materials averaged CA$16 per student.
The teaching of youths about healthy relationships as part of their required health curriculum reduced PDV and increased condom use 2.5 years later at a low per-student cost.
Serotonin plays a central role in mood regulation and the development of depressive disorders. The present study investigated whether a functional polymorphism (5HTTLPR) of the serotonin transporter gene interacts with maltreatment in the prediction of depression. A cohort of 17-18 years old students (n = 1,482) anonymously completed the Survey of Adolescent Life and Health in Vestmanland 2006 and gave a saliva sample for DNA extraction. An association between maltreatment and adolescent depression was found independent of sex. When the whole population was analyzed, no main effect of 5HTTLPR in association with depression was found. When separated by sex, a significant main effect and a G x E interaction effect of the SS allele was found among girls. No gene main effect or G x E interaction effect was found among boys. The present study confirms previous findings of sex differences in interaction effects between the 5HTTLPR polymorphism and maltreatment in the prediction of adolescent depression.
Substantial resources are being devoted to identify candidate genes for complex mental and behavioral disorders through inclusion of environmental exposures following the report of an interaction between the serotonin transporter linked polymorphic region (5-HTTLPR) and stressful life events on an increased risk of major depression.
To conduct a meta-analysis of the interaction between the serotonin transporter gene and stressful life events on depression using both published data and individual-level original data.
Search of PubMed, EMBASE, and PsycINFO databases through March 2009 yielded 26 studies of which 14 met criteria for the meta-analysis.
Criteria for studies for the meta-analyses included published data on the association between 5-HTTLPR genotype (SS, SL, or LL), number of stressful life events (0, 1, 2, > or = 3) or equivalent, and a categorical measure of depression defined by the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) or the International Statistical Classification of Diseases, 10th Revision (ICD-10) or use of a cut point to define depression from standardized rating scales. To maximize our ability to use a common framework for variable definition, we also requested original data from all studies published prior to 2008 that met inclusion criteria. Of the 14 studies included in the meta-analysis, 10 were also included in a second sex-specific meta-analysis of original individual-level data.
Logistic regression was used to estimate the effects of the number of short alleles at 5-HTTLPR, the number of stressful life events, and their interaction on depression. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated separately for each study and then weighted averages of the individual estimates were obtained using random-effects meta-analysis. Both sex-combined and sex-specific meta-analyses were conducted. Of a total of 14,250 participants, 1769 were classified as having depression; 12,481 as not having depression.
In the meta-analysis of published data, the number of stressful life events was significantly associated with depression (OR, 1.41; 95% CI,1.25-1.57). No association was found between 5-HTTLPR genotype and depression in any of the individual studies nor in the weighted average (OR, 1.05; 95% CI, 0.98-1.13) and no interaction effect between genotype and stressful life events on depression was observed (OR, 1.01; 95% CI, 0.94-1.10). Comparable results were found in the sex-specific meta-analysis of individual-level data.
This meta-analysis yielded no evidence that the serotonin transporter genotype alone or in interaction with stressful life events is associated with an elevated risk of depression in men alone, women alone, or in both sexes combined.
The objective of the study was to determine the risk factors for Internet-initiated victimization of female adolescents. In particular, it was expected that girls who experienced childhood abuse would show higher vulnerability than their nonabused peers. In addition, the study examined how provocative self-presentations might be related to online sexual advances and offline encounters.
Adolescent girls aged 14 to 17 years who had experienced substantiated childhood abuse (N = 104) were demographically matched with nonabused girls (N = 69) and surveyed regarding Internet usage, maternal and paternal caregiver presence, substance use, high-risk sexual attitudes, and involvement with high-risk peers. To measure online self-presentation, participants each created avatars, which were quantified according to the degree of provocative physical features.
Forty percent of the sample reported experiencing online sexual advances, and 26% reported meeting someone offline who they first met online. Abused girls were significantly more likely to have experienced online sexual advances and to have met someone offline. Having been abused and choosing a provocative avatar were significantly and independently associated with online sexual advances, which were, in turn, associated with offline encounters.
A history of childhood abuse may increase Internet-initiated victimization vulnerability. Parents should be aware of the ways in which their adolescents are presenting themselves online. Making adolescent girls and their parents aware that provocative online self-presentations may have implications for sexual solicitation might help to ward off sexual advances and might help prevent Internet-initiated victimizations. Practitioners should consider standard inquiry into Internet and media usage an aspect of comprehensive care.
Most evidence for associations between childhood adversity and adult mental illness is retrospective.
To evaluate prospective evidence of associations between poor parent-child relationships and common psychiatric disorders in later life.
Systematic review of studies published between 1970 and 2008 including: (a) more than 100 participants; (b) measures of relationships in the home during childhood; (c) at least 10 years between assessment of exposures; and (d) measures of anxiety, depression, suicide, suicidal ideation or post-traumatic stress disorder (PTSD). Analysis was by narrative synthesis.
Twenty-three papers were identified reporting data from 16 cohorts. Abusive relationships predicted depression, anxiety and PTSD. Maternal emotional unavailability in early life predicted suicide attempts in adolescence. Results of studies investigating less severe relationship problems were suggestive but not conclusive of causal association, due partly to methodological heterogeneity.
Given the prevalence and disabling nature of common psychiatric problems, these studies highlight the need to minimise harm associated with dysfunctional parent-child relationships.
The present study investigated underlying processes of the effect of maltreatment on psychopathology (i.e., internalizing and externalizing problems) in a group of 111 maltreated and 110 nonmaltreated 7-10 year-old children (60% boys). We tested the moderating and/or mediating roles of emotion regulation and the mother-child relationship quality (pattern of relatedness) using Structural Equation Modeling. Emotion regulation, but not the pattern of relatedness, mediated the relation between maltreatment and psychopathology. This mediation was moderated by the pattern of relatedness: For the group of children with an insecure pattern of relatedness, maltreatment was related to lower levels of emotion regulation, which was predictive of higher levels of internalizing and externalizing symptomatology. In contrast, for the secure relatedness group, there was no mediation by emotion regulation since the impact of maltreatment on emotion regulation was not significant. Implications of the mediating role of emotion regulation and the buffering role of the mother-child relationship quality were discussed.
Childhood adversity has been shown to interact with monoamine oxidase-A (MAOA) genotype to confer risk for antisocial behavior. Studies examining this gene-by-environment (G x E) association, however, have produced mixed results.
Relevant research is reviewed, and results of a study with 114 children (73 maltreated and 41 control subjects) are presented. The maltreated children represent the extreme on a continuum of adversity and were assessed at a time of extreme stress-shortly after removal from their parents' care due to abuse. Measures of aggressive behavior were obtained using standard research instruments, and monoamine oxidase-A MAOA genotypes were obtained from saliva-derived DNA specimens. Population structure was controlled for using ancestral proportion scores computed on the basis of genotypes of ancestry informative markers.
Many prior investigations appear to have had reduced power to detect the predicted G x E interaction because of low base rates of maltreatment and antisocial behavior in their samples and failure to use optimal procedures to control for population structure in ethnically diverse cohorts. In this investigation, a significant interaction was detected between exposure to moderate trauma and the "low-activity" MAOA genotype in conferring risk for aggression. Children with exposure to extreme levels of trauma, however, had high aggression scores regardless of genotype.
Our study suggests that problems in aggressive behavior in maltreated children are moderated by MAOA genotype, but only up to moderate levels of trauma exposure. Extreme levels of trauma appear to overshadow the effect of MAOA genotype, especially in children assessed at time of acute crisis.
In January 1988, Oregon became the first state to require hospital-based reporting of attempted suicide (AS) in all adolescents less than 18 years old. From January to December 1988, 644 cases of AS were reported (annual rate of 214 per 100,000 population, ages 10 to 17 years). We compared these 644 cases of AS with all 137 Oregon adolescents less than 18 years old who committed suicide in Oregon during the 10-year-period 1979 through 1988, and found that the strongest predictor of outcome was method used.
The aim of this study was to identify variables that distinguish mothers who broke the cycle of abuse from mothers who were abused as children and who also abused their own children. Based on maternal interviews and questionnaires completed over a 64-month period, measures of mothers' past and current relationship experiences, stressful life events, and personality characteristics were obtained. Abused mothers who were able to break the abusive cycle were significantly more likely to have received emotional support from a nonabusive adult during childhood, participated in therapy during any period of their lives, and to have had a nonabusive and more stable, emotionally supportive, and satisfying relationship with a mate. Abused mothers who reenacted their maltreatment with their own children experienced significantly more life stress and were more anxious, dependent, immature, and depressed.
The belief that abused children are likely to become abusive parents is widely accepted. The authors review the literature cited to support this hypothesis and demonstrate that its unqualified acceptance is unfounded. Mediating factors that affect transmission are outlined and the findings of several investigations are integrated to estimate the true rate of transmission.
The study estimates the relative importance of specific types of traumas experienced in the community in terms of their prevalence and risk of leading to posttraumatic stress disorder (PTSD).
A representative sample of 2181 persons in the Detroit area aged 18 to 45 years were interviewed by telephone to assess the lifetime history of traumatic events and PTSD, according to DSM-IV. Posttraumatic stress disorder was assessed with respect to a randomly selected trauma from the list of traumas reported by each respondent, using a modified version of the Diagnostic Interview Schedule, Version IV, and the World Health Organization Composite International Diagnostic Interview.
The conditional risk of PTSD following exposure to trauma was 9.2%. The highest risk of PTSD was associated with assaultive violence (20.9%). The trauma most often reported as the precipitating event among persons with PTSD (31% of all PTSD cases) was sudden unexpected death of a loved one, an event experienced by 60% of the sample, and with a moderate risk of PTSD (14.3%). Women were at higher risk of PTSD than men, controlling for type of trauma.
The risk of PTSD associated with a representative sample of traumas is less than previously estimated. Previous studies have overestimated the conditional risk of PTSD by focusing on the worst events the respondents had ever experienced. Although recent research has focused on combat, rape, and other assaultive violence as causes of PTSD, sudden unexpected death of a loved one is a far more important cause of PTSD in the community, accounting for nearly one third of PTSD cases.
This investigation tested a program to reduce women's risk for sexual revictimization. Participants were 66 women with histories of sexual victimization as adolescents or adults who were randomly assigned to a preventive intervention group or a no-treatment control group. They completed initial measures assessing history of sexual assault, self-efficacy, and psychological functioning, returning approximately 2 months later for follow-up assessment using the same measures. Results suggest that the prevention program may be effective in reducing the incidence of sexual assault revictimization in this population. In addition, participants in the intervention group displayed significant improvement in psychological adjustment and self-reported self-efficacy.
We studied a large sample of male children from birth to adulthood to determine why some children who are maltreated grow
up to develop antisocial behavior, whereas others do not. A functional polymorphism in the gene encoding the neurotransmitter-metabolizing
enzyme monoamine oxidase A (MAOA) was found to moderate the effect of maltreatment. Maltreated children with a genotype conferring high levels of MAOA expression were less likely to develop antisocial problems. These findings may partly explain why not all victims of maltreatment
grow up to victimize others, and they provide epidemiological evidence that genotypes can moderate children's sensitivity
to environmental insults.
In a prospective-longitudinal study of a representative birth cohort, we tested why stressful experiences lead to depression
in some people but not in others. A functional polymorphism in the promoter region of the serotonin transporter (5-HT T) gene
was found to moderate the influence of stressful life events on depression. Individuals with one or two copies of the short
allele of the 5-HT T promoter polymorphism exhibited more depressive symptoms, diagnosable depression, and suicidality in
relation to stressful life events than individuals homozygous for the long allele. This epidemiological study thus provides
evidence of a gene-by-environment interaction, in which an individual's response to environmental insults is moderated by
his or her genetic makeup.
In this study, measures of the quality and availability of social supports were found to moderate risk for depression associated with a history of maltreatment and the presence of the short (s) allele of the serotonin transporter gene promoter polymorphism (5-HTTLPR). The present investigation (i) replicates research in adults showing that 5-HTTLPR variation moderates the development of depression after stress, (ii) extends the finding to children, and (iii) demonstrates the ability of social supports to further moderate risk for depression. Maltreated children with the s/s genotype and no positive supports had the highest depression ratings, scores that were twice as high as the non-maltreated comparison children with the same genotype. However, the presence of positive supports reduced risk associated with maltreatment and the s/s genotype, such that maltreated children with this profile had only minimal increases in their depression scores. These findings are consistent with emerging preclinical and clinical data suggesting that the negative sequelae associated with early stress are not inevitable. Risk for negative outcomes may be modified by both genetic and environmental factors, with the quality and availability of social supports among the most important environmental factors in promoting resiliency in maltreated children, even in the presence of a genotype expected to confer vulnerability for psychiatric disorder.
• child maltreatment
• gene-by-environment interaction
Potential precursors to borderline personality disorder (BPD) were investigated in a sample of 185 maltreated and 175 nonmaltreated school-aged children attending a summer camp research program. Self-report, peer-report, and counselor-report measures were utilized to assess developmental constructs conceptualized to constitute vulnerability for later emerging BPD. These areas, including personality features, representational models of self, parent, and peers, interpersonal relationship difficulties with peers and adults, and suicidal/self-harm behavior, were used to develop a BPD precursors composite. Additionally, the efficiency of three attention networks was assessed with a computerized task. Maltreated children had higher mean scores on the BPD precursors composite, and children classified as having high levels of these precursors were more prevalent in the maltreatment group. No maltreatment group differences were found for the efficiency of the three attention networks; however, children with high levels of BPD precursors evinced less efficient processing of the conflict attention network, comparable to findings observed among adult patients with BPD. Child maltreatment and efficiency of the conflict attention network independently predicted scores on the BPD precursors composite. Experiential and biological contributions to risk for BPD and recommendations for prevention and intervention are discussed.
One of the most consistent findings in the epidemiology of posttraumatic stress disorder (PTSD) is the higher risk of this disorder in women. Explanations reviewed within a psychobiological model of PTSD suggest that women's higher PTSD risk may be due to the type of trauma they experience, their younger age at the time of trauma exposure, their stronger perceptions of threat and loss of control, higher levels of peri-traumatic dissociation, insufficient social support resources, and greater use of alcohol to manage trauma-related symptoms like intrusive memories and dissociation, as well as gender-specific acute psychobiological reactions to trauma. This review demonstrates the need for additional research of the gender differences in posttraumatic stress. Recommendations are made for clinical practice.
Disasters are associated with increased risk of posttraumatic stress disorder (PTSD) and major depression, but no study, to the authors' knowledge, has determined whether genotype interacts with disaster exposure and social support to moderate risk of these phenotypes. The authors tested the hypothesis that a polymorphism in the serotonin transporter gene (locus, SLC6A4; variant, serotonin 5-HTTLPR) moderates risk of posthurricane PTSD and major depression given high hurricane exposure and low social support.
The authors interviewed a household probability sample of adults 6-9 months after the 2004 hurricanes about hurricane exposure, social support, and posthurricane PTSD and major depression. DNA was collected from a subset of participants. Participants were 589 adults ages 18 and older from 38 Florida counties who provided valid DNA samples. Outcome measures were DSM-IV diagnoses of posthurricane PTSD and major depression derived from structured interviews.
The low-expression variant of the 5-HTTLPR polymorphism increased risk of posthurricane PTSD and major depression but only under the conditions of high hurricane exposure and low social support after adjustment for sex, ancestry (as determined by Bayesian clustering of genotypes), and age. Similar effects were found for major depression. High-risk individuals (high hurricane exposure, the low-expression 5-HTTLPR variant, low social support) were at 4.5 times the risk of developing PTSD and major depression of low-risk individuals.
The low-expression variant of the 5-HTTLPR polymorphism modifies risk of postdisaster PTSD and major depression under conditions of high hurricane exposure and low social support, confirming and extending previous research.
We studied a large sample of male children from birth to adulthood to determine why some children who are maltreated grow up to develop antisocial behavior, whereas others do not. A functional polymorphism in the gene encoding the neurotransmitter-metabolizing enzyme monoamine oxidase A (MAOA) was found to moderate the effect of maltreatment. Maltreated children with a genotype conferring high levels of MAOA expression were less likely to develop antisocial problems. These findings may partly explain why not all victims of maltreatment grow up to victimize others, and they provide epidemiological evidence that genotypes can moderate children's sensitivity to environmental insults.
Chapter 8 addresses how experiences of early life stress confer vulnerability to psychiatric problems later in life.
The battered-child syndrome, a clinical condition in young children who have received serious physical abuse, is a frequent cause of permanent injury or death. The syndrome should be considered in any child exhibiting evidence of fracture of any bone, subdural hematoma, failure to thrive, soft tissue swellings or skin bruising, in any child who dies suddenly, or where the degree and type of injury is at variance with the history given regarding the occurrence of the trauma. Psychiatric factors are probably of prime importance in the pathogenesis of the disorder, but knowledge of these factors is limited. Physicians have a duty and responsibility to the child to require a full evaluation of the problem and to guarantee that no expected repetition of trauma will be permitted to occur.
Recognition of the existence of a high incidence of suicide among youth stimulated study of the developmental characteristics of suicidal behavior. A developmental psychopathologic framework offers opportunities to delineate features of suicide and nonfatal suicidal behavior for distinct age-specific intervals along the human life cycle and to discern continuities and discontinuities in predictors, precipitants, and correlates of suicidal behavior. In addition, it provides insights into designing prevention and intervention strategies for suicidal behavior appropriate to age and context of specific groups of people. This article presents empiric information about the phenomenology of suicidal behavior among prepubertal children, describes early predictors of suicidal behavior apparent in childhood for incidence of suicidal behavior in adolescence, and discusses retrospectively identified risk factors present in the childhoods of youth who commit suicide.
A randomized clinical trial was conducted to evaluate whether Dialectical Behavior Therapy (DBT), an effective cognitive-behavioral treatment for suicidal individuals with borderline personality disorder (BPD), would also be effective for drug-dependent women with BPD when compared with treatment-as-usual (TAU) in the community. Subjects were randomly assigned to either DBT or TAU for a year of treatment. Subjects were assessed at 4, 8, and 12 months, and at a 16-month follow-up. Subjects assigned to DBT had significantly greater reductions in drug abuse measured both by structured interviews and urinalyses throughout the treatment year and at follow-up than did subjects assigned to TAU. DBT also maintained subjects in treatment better than did TAU, and subjects assigned to DBT had significantly greater gains in global and social adjustment at follow-up than did those assigned to TAU. DBT has been shown to be more effective than treatment-as-usual in treating drug abuse in this study, providing more support for DBT as an effective treatment for severely dysfunctional BPD patients across a range of presenting problems.
The battered-child syndrome, a clinical condition in young children who have received serious physical abuse, is a frequent cause of permanent injury or death. The syndrome should be considered in any child exhibiting evidence of fracture of any bone, subdural hematoma, failure to thrive, soft tissue swellings or skin bruising, in any child who dies suddenly, or where the degree and type of injury is at variance with the history given regarding the occurrence of the trauma. Psychiatric factors are probably of prime importance in the pathogenesis of the disorder, but knowledge of these factors is limited. Physicians have a duty and responsibility to the child to require a full evaluation of the problem and to guarantee that no expected repetition of trauma will be permitted to occur.