Childhood Maltreatment

3 Diagnosis and Treatment Indications (p. 20-21)

Research links childhood maltreatment with a wide range of psychological and behavioral difficulties. Maltreatment can disrupt the normal course of development and can have short- and long-term implications requiring assessment and intervention. The most common diagnoses are in the areas of mood, anxiety, substance use, and antisociality (MacMillan & Munn, 2001).

A maltreated child is prone to revictimization and psychiatric symptomatology across the course of his or her life. It is important to note that while not all children and adolescents suffer psychological consequences related to earlier maltreatment, many children do in fact experience significant psychological impairment. Maltreated children and youth carry a long-term high personal burden of suffering and cost to service systems that has important consequences for the next generation. While maltreated youth are at higher risk for single disorders, they also are more likely to experience co-occurring or overlapping problems in adulthood.

There are few consistent linkages between maltreatment and problem behavior profiles, with two exceptions: (1) sexual abuse and sexual acting out, and (2) physical abuse and aggression. Children who are sexually abused engage in sexualized behaviors beyond what is developmentally appropriate. Such behaviors include sexualized play with dolls, inserting objects into genitalia, excessive masturbation, seductive behavior, age-inappropriate sexual knowledge, and seeking sexual stimulation from others. A sexually inappropriate behavior is one key factor that distinguishes sexually abused children from a clinic population without a history of abuse. This suggests that sexualized behavior may be a unique consequence of sexual abuse compared to other types of abuse.

Due to the pernicious impact of violence on females, with higher rates of sexual abuse and incest, childhood maltreatment is a critical risk factor for many of the problems women face: partner violence, ill health (e.g., gynecological health, chronic pain, arthritis, irritable bowel syndrome), depression, self-harming (cutting) and suicidal behaviors, anxiety, substance abuse, disordered eating, and posttraumatic stress disorder. In terms of risky sexual practices, childhood maltreatment is associated with adolescent females’ greater number of partners, earlier onset of "wanted" sex, and larger age differentials between partners. While adolescent girls are less likely to be risk takers than boys, those who do get involved in substance use and risky sexual behavior tend to suffer poor health outcomes and problems throughout life. A subset of at-risk girls will emerge street-involved, homeless, and/or working in the sex trade, elevating their chances of further victimization and disease exposure. Perhaps because females rely more on relationships for personal development and self-definition, maltreatment may be experienced as more disruptive to role functioning due to the impact of social betrayal.

3.1 Psychiatric Impairment and Specific Disorders Associated with Childhood Maltreatment

3.1.1 Mood Disorders

Depressive symptoms have commonly been associated with childhood maltreatment. Individuals with a history of child abuse and neglect report two- to three-fold increased likelihood of dysthymia and major depressive disorder during adolescence and young adulthood, as compared to nonabused individuals. Child sexual abuse victims exhibit significantly greater social withdrawal and internalizing symptoms such as depressed mood, anhedonia (i.e., lack of pleasure in previously reinforcing activities, like leisure, sex etc.), and feelings of worthlessness and guilt. Common emotional effects include guilt (i.e., feeling responsible for the abuse), helplessness and hopelessness, sleep disturbance, appetite disturbance, and low self-esteem.