Things that happen in childhood can have devastating consequences, long term effects lasting well into adulthood. As occupational medicine deals with the working lives of people, practitioners need to be aware that people have pasts.
There are certainly a number of consequences of childhood abuse. These include emotional difficulties, mood disorders, personality disorders, unhealthy coping skills, relationship and intimacy problems and a sense of seeing the world as a place to be feared.
The long-term consequences of child abuse and neglect can be both chronic and debilitating. This is especially so when there has been chronic maltreatment, which is a recurrence of maltreatment over a prolonged period. Studies have shown that this can lead to worse outcomes than single episodes of maltreatment and abuse. However, for many survivors of abuse, they have often been exposed to more than one type of abuse. They may also be exposed to poly-victimisation, such as bullying by their peers. Those that have experienced poly-victimisation and abuse tend to have worse outcomes than those that have had a single episode of abuse. That said, any type of abuse, whether it is chronic or single, can leave lasting trauma for its survivor.
One of the worst consequences of abuse is complex trauma. This refers to traumatic symptoms that encompass multiple disorders and adverse experiences. A person may have Post-Traumatic Stress Disorder (PTSD) and depression and anxiety. They may also develop agoraphobia, which is a fear of leaving their safe space (usually their home). There are complex trauma services to help survivors of abuse or maltreatment and they offer highly specialised trauma-focused therapy.
Other factors that impact on survivors of abuse include:
· The age of the individual when they experienced the abuse
· The developmental stage they were at at the time of maltreatment
· The severity of the abuse
· Type or types of abuse
· Survivors perception of the abuse: do they self-blame, feel shame, were blamed by others?
· The relationship the survivor had with their abuser
· How the abuse was discovered
· Protective factors for the child. Do they have family or peer support?
· Whether they have therapy to help
While most survivors of abuse do not go on to abuse others (i.e. their own children), those that were abused as children are at increased risk of abusing others, and of being abused again themselves. The former is known as intergenerational abuse and the latter is known as re-victimisation.
Studies have suggested that those who were abused as children are more likely to be abused as adults. Women, in particular, are at risk of re-victimisation. Studies also suggested that those who were abused as children had a higher risk of experiencing sexual assault and abuse, stalking or kidnapping and having a friend murdered or commit suicide. Those that were abused or witnessed domestic violence as children were more likely to experience low self-esteem, which is a risk factor in being the victim of violence. They may also think that violence is a normal response to conflict.
Adults that have experienced childhood maltreatment are also at increased risk of physical health problems such as diabetes, headaches, gynaecological problems, hepatitis, heart disease, arthritis, gastrointestinal problems, and stroke. There may also be neurological and musculoskeletal problems too. The reasoning for these poor health outcomes is unknown, but some researchers have speculated that it is a result of stress compromising the immune system or that adult survivors engage in risky behaviours and may make poor health choices.
It goes without saying that poor mental health is a consequence of child abuse and maltreatment. A wide range of mental health disorders have been associated with childhood abuse, and these include PTSD, ADHD, personality disorders, anxiety and depression, dissociative disorders and psychosis. Depression is seen to be the most likely outcome, but many survivors also experience PTSD.
There is a lot of evidence highlighting the link between suicidal behaviour (attempts and ideation) and childhood abuse. Both eating disorders and obesity are also common amongst those that have been abused. Alcohol and substance abuse are also problematic and may be linked to self-medicating and unhealthy coping skills.
Aggression, violence and criminal behaviour are other consequences of childhood abuse, with anti-social personality disorder being a possible psychiatric issue. One issue is that those that witnessed family violence may also use violence to handle conflict, thinking this is normal behaviour. High-risk sexual behaviour is another issue, with many of those that experienced childhood abuse at greater risk of promiscuity. Issues around passiveness, feeling unworthy and needing affection and acceptance may be linked to high-risk sexual behaviours. Those that were abused as children are also more likely to be homeless. They may have difficulties securing employment and have poor academic achievement, as well as worse mental health outcomes that leave it difficult to lead a stable, functioning life.
Neurological changes to the brain at key developmental stages can be linked to worse health outcomes later in life. A child is highly vulnerable, not least because they are young and scared, but because this is a time of great brain development. Neural pathways are being developed and the child is learning key things about the world that will form the lens they see the future with.
Some scientists have looked into the neurological changes in the brain of those that have experienced abuse. Several brain regions have two periods of key sensitivity; one in early childhood and one during puberty. It is said that ‘the brain wires itself up for adulthood based on experience in childhood.’ The amygdala, the emotional capital of the brain, has shown heightened vigilance to stress in EEGs. There are also structural differences in the brain between those who have been abused and those that have not, including a smaller sized hippocampus; the memory processing part of the brain. Various other changes can be seen, for instance, in the reduction of grey matter associated with those that have experienced verbal abuse.
As you have read, there can be lasting changes for those that are survivors of abuse. Those working with individuals with mental health disorders that have a history of past abuse should take account of this when helping them find work or vocations. Measures need to be put in place to help those that are experiencing trauma manage their symptoms.
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