Apr 24, 2014 — The short-term consequences of child abuse and neglect often are seen in physical injuries to a child’s body. But the long-term mental consequences, which can be extremely dangerous, are not always visible. Psychiatrist Dr. Jason Hunziker talks about the long-term mental harm and consequences of child abuse. He also discusses why some children in the same abusive environment exhibit different signs of abuse and experience dissimilar outcomes.

Interview

Dr. Jason Hunziker: Today we're going to talk about the long-term consequences of child abuse and neglect.
I'm Jason Hunziker from the University of Utah Department of Psychiatry and this is what's coming up next on The Scope.

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Dr. Jason Hunziker: Information from the Child Welfare Gateway and the U.S. Department of Health and Human Services suggests that in the physical year of 2011 over 650,000 children were the victims of abuse and neglect. Those injuries that those children suffer can take many different forms, including physical, behavioral, societal, and psychological and have consequences that ripple through their families for generations to come.
It is often difficult at times to separate out which of the physical, behavioral, societal, or psychological injuries are responsible for the signs and symptoms that we see in our children as they are growing up and turn into adults.
An example of this would be let's say a child gets brain injury and ends up causing significant psychological issues such as depression, emotional problems, and cognitive problems. Those emotional problems or cognitive problems can then go on to lead to poor decision making and risk taking behavior that we wouldn't normally see. And those then can lead on to more societal problems such as long-term disability or crime.
There are several different factors that can lead to these consequences from abuse and neglect that we can possibly see and a few of those include age and developmental status when the abuse occurred. So if the abuse occurs younger we could see different problems than if it occurs at an older age.
The types of abuse or mistreatment; physical abuse leaves different long-term scars than sexual abuse would. The frequency, the duration or severity of the abuse; if it happens more often or if it's very severe that trauma can also be significant in long-term consequences.
And then of course who the perpetrator is makes a big difference. Often it's a family member and that is much worse than someone that you don't know who is causing this severe abuse.
While it is not yet really understood why some children have long-term consequences and others don't, even when they have similar circumstances, so often siblings will experience the same abuse in the same household environment, and may not have the same consequence. And they postulated that resilience is often used or the term used to describe why these children are able to cope with this abuse or neglect. Most children are not born with the resilience; it comes from either within themselves or from the family environment or from the community in which they live.
There are often a lot of different things that can contribute to resilience including good self esteem, having a good sense of humor, strong positive attachments with people around you, and good emotional regulation.
Some of the psychological consequences of abuse can occur immediately after the abuse. These things that we would see are children isolating from their friends or from their family or having extreme fear around strangers; or the loss of ability to trust anyone. These immediate emotional effects can lead to depression, anxiety, long-term trust issues, relationship instability, and self doubt. When the abuse occurs in an infant and in younger children it primarily affects their ability to form strong healthy attachments.
In a document titled, Call to Action On Behalf of Maltreated Infants and Toddlers it reported that half of infants in foster care who have been mistreated experience some type of cognitive delay. Of these they all have lower IQ scores, language difficulties, learning disabilities, and other challenges compared to other children who have not been abused.
Later in childhood the abuse can lead to formation of borderline personality disorder, severe major depression, anxiety disorders, and in some cases PTSD. There have been some studies that show a connection in suicide rate and depression rates in women associated with child and adolescent sexual abuse. Other studies have shown that over 50% of women that have an eating disorder have suffered some type of sexual abuse.
While not all children of abuse will struggle with emotional or behavioral problems, more than half of the youth reported some type of abuse and therefore were at increased risk of emotional or behavioral problems.
Some of those behavioral problems that can occur in adolescents include having to repeat a grade because they keep failing and have to start over, using illicit substances, alcohol, tobacco, prescription drugs, criminal activity of any type, skipping school and early teenage pregnancy.
Some studies have also shown an increase in this high-risk sexual behavior and there is a nine times increase in the criminal activity of adolescents and in adults who have suffered childhood abuse or neglect.
As mentioned briefly, substance abuse is a huge problem in this population. There is a lot of research that consistently reports the increased likelihood of abuse and neglect will lead to cigarette smoking, drinking alcohol, and using street drugs and other prescription drug abuse in men that have greater than six episodes of abuse or neglect in their lifetime. They have an increased likelihood of more than 4,000% that they will use IV drugs later in their life.
Lastly this abuse behavior seems to create a cycle of abuse that is passed down from generation to generation to generation. Girls from physically abusive homes were 1% to 7% more likely to perpetrate youth violence; and 8% to 10% more likely to perpetrate interpersonal violence.
In boys who experience sexual violence in their adolescence or childhood were 3% to 12% more likely to commit youth violence, and 1% to 17% more likely to commit an interpersonal violence.
Abuse and neglect in childhood clearly leads to a range of different consequences later in life. Even though some children seem to escape the long-term problems from abuse, everyone suffers the short term. The cost to the individual, the family, the community is so high when abuse or neglect goes unnoticed, and the symptoms go untreated. It is important to recognize when abuse is happening and to seek help from counselors, primary care providers, pediatricians, psychologists, psychiatrists, and anyone who can help and perhaps avoid more long-term problems from childhood abuse and neglect.

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