My therapy practice is in Fairfax County, one of the wealthiest counties, with some of the best schools, in the nation. It is diverse and densely populated with well-educated residents who are overwhelmingly employed in business and professional services. Fairfax County is home to the Central Intelligence Agency (CIA) and the National Counterterrorism Center (NCTC), and is only a short distance from the nation’s government and leading policy makers. The town in which I work was voted one of the best cities for raising families in the state of Virginia.

Despite the wealth, access to education, and proximity to the country’s main resources for enforcing security in our nation, not all children here are safe. Like children everywhere, they are vulnerable to the atrocities of child abuse.

In 2016, SafeSpot, a local children’s advocacy center that supports families and facilitates the investigation of child sexual and severe physical abuse allegations, served more than 375 children who were impacted by abuse, the overwhelming majority of whom alleged sexual abuse. SafeSpot also worked with children who were traumatized by witnessing domestic violence.

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Most people would agree child abuse is a heartbreaking issue, yet many believe it’s not something that could happen to anyone they know or love. On the contrary, child abuse happens everywhere—in all types of homes, families, neighborhoods, schools, churches, and communities. No population, culture, or socioeconomic group is immune. Child abuse is likely present somewhere in your very own network.

National statistics show more than 700,000 children are abused annually in the United States, with 90% of alleged abusers in some way related to the victims. RAINN (Rape, Abuse & Incest National Network) reports that every 98 seconds, an American is sexually assaulted. Every eight minutes, that victim is a child. One in four women and one in six men are sexually abused as children.

People who abuse children are not just creepy strangers who lurk behind bushes or abduct children in vans. They often include people we encounter every day, people their victims know, love, and trust. People who abuse can be grandparents, uncles, aunts, cousins, moms, dads, teachers, coaches, mentors, neighbors, and family friends.

The effects of child abuse are devastating and typically long-lasting, including a lifetime of potential struggles with mental health issues, low self-esteem, increased risk of drug abuse/addiction, and patterns of dysfunctional and unhealthy relationships.

The realities of child abuse are alarming, but developing an awareness of the problem brings the increased ability to prevent or at least identify when child abuse occurs.

The effects of child abuse are devastating and typically long-lasting, including a lifetime of potential struggles with mental health issues, low self-esteem, increased risk of drug abuse/addiction, and patterns of dysfunctional and unhealthy relationships.

Tips for Parents to Prevent and Address Child Abuse

• Educate yourself on the statistics of child abuse and understand that even your own children could be at risk. You may know somebody who is or has the potential to be abusive, so know where to go or who to call in your community if at any time you suspect or discover a child is being hurt or threatened.
• Listen and validate when a child reveals abuse. Very rarely do children lie about abuse. Try to remain open, calm, curious, and nonjudgmental if a child reports or alludes to having been abused.
• I cannot stress enough how important it is to remain calm. It’s obviously gut-wrenching to hear your child may have been hurt, and it’s further challenging and complicated when the allegations are made against somebody you know and trust. But your initial reaction may determine whether the child shuts down and bottles up the violation, or reports and ultimately ends the trauma to seek healing.
• Often, children will report only parts of what happened or may pretend it happened to someone else in order to gauge how an adult will react. Be patient and allow the child to feel safe enough to continue opening up. Responding emotionally or with judgment, blame, or disbelief may cause the child to shut down and avoid talking about the abuse.
• From early on, begin facilitating conversations with your children, letting them know they can come to you about anything, no matter what anyone else says. Abuse is hard for children to comprehend, let alone talk about. They often internalize a sense of fear, embarrassment, and shame, and wind up believing they are at fault or somehow to blame for what happened. Further, people who abuse frequently coerce silence via emotional abuse, warnings the victim won’t be believed, and by threats of harm to the victim or their loved ones. Teach your children it’s your job to protect them, not the other way around, and demonstrate unconditional love so they feel safe enough to talk to you.
• Use age-appropriate language and find moments to educate your children about their bodies, about appropriate versus inappropriate touch, and about sexuality as they get older. Sex and sexuality are often awkward, uncomfortable, or taboo topics in many families; however, it’s important that you, as the adult, demonstrate and model that embarrassing or difficult topics are still important and do not need to be off-limits or avoided.
• While it’s unhealthy to isolate or shelter our children, we can be selective about what daycares, schools, and activities they participate in. Ensure that background checks are done on any individuals working directly with children, and advocate for staff trainings on the prevention, recognition, and reporting of child abuse. Communicate regularly with your children about the other adults and peers in their lives.
• The signs of abuse are not always easy to recognize without hindsight; however, step in and talk to your child if you notice any emotional or behavioral changes, such as increased anxiety, withdrawal, isolating, rebellion, or angry outbursts. It’s important to explore any signs of physical abuse, including bruises, rashes, or swelling. Pay attention to physical problems, such as urinary tract infections, or frequent complaints of things like headaches or stomachaches that aren’t medically explained. Understand it’s normal for children to be inquisitive and exploratory regarding gender and sexuality, but watch out for any sexual behavior, language, or curiosity that does not seem age-appropriate.

Help for Perpetrators of Child Abuse

If you are someone who has abused or believe you have the potential to abuse a child, I urge you to get help from a mental health professional who can assist you in exploring the roots of this insidious problem. While most children who are abused do not go on to repeat the cycle of abuse, many abusers were, in fact, victims of child abuse themselves. This history of abuse needs to be dealt with so you can attain a life free from the guilt, shame, and destruction of hurting others.

Spreading Awareness of Child Abuse Prevention

April is National Child Abuse Prevention Month. Prevent Child Abuse America has designated the pinwheel as the national symbol for child abuse prevention. Please help spread awareness of the realities of child abuse by displaying a pinwheel in your workplace, organization, or community. The more we talk about and spread awareness regarding the realities of child abuse, the closer we come to ending it.

References:

1. National statistics on child abuse. (2014). Retrieved from http://www.nationalchildrensalliance.org/media-room/media-kit/national-statistics-child-abuse
2. Pinwheels for prevention. (n.d.). Retrieved from http://preventchildabuse.org/resource/pinwheels-for-prevention
3. Scope of the problem: Statistics. (2016). Retrieved from https://www.rainn.org/statistics/scope-problem

It is the nature of abuse within families to be as behaviorally nuanced and emotionally complex as the individuals involved. Relationship abuses nearly inevitably reveal a life-draining and self-perpetuating dynamic of power and control. It is within this dynamic that abuse is perpetuated.

Abuse may manifest as physical (throwing, shoving, grabbing, blocking pathways, slapping, hitting, scratches, bruises, burns, cuts, wounds, broken bones, fractures, damage to organs, permanent injury, even murder), sexual (suggestive flirtatiousness, propositioning, undesired or inappropriate holding, kissing, fondling of sexual parts, masturbation, oral sex, or any kind of forceful sexual activity), or emotional (neglect, harassment, shaming, threatening, malicious tricks, blackmail, unfair punishments, cruel or degrading tasks, confinement, abandonment).

Abuse may also involve what I call strategic accusation in an attempt to maintain perceived leverage in the context of families and social circles—for instance, communicating to family and friends that the victim has engaged in affairs that have not occurred, or even using the mere threat of spreading such a rumor. There may also be implicit threats, such as, for instance, the open display of weapons. Perpetrators may drive recklessly in order to generate fear and emphasize a position of control.

Financial or what you might call economic abuses may also exist. For instance, many perpetrators maintain individual, or even secret, bank accounts as a way to withhold money. They may also ensure that bills and credit cards be placed under the name of the victim as a measure of self-protection.

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In all of these, the dynamic of abuse commonly takes shape in varying modes of manipulation, intimidation, aggression, and terrorism.

And though we often think of abuse as being inflicted by a perpetrator on a victim, or else between two perpetrators, we must be careful to recognize another disposition, an often secretly performed dynamic of abuse, that is inflicted by an emotionally troubled person onto himself or herself.

Recognizing that those trapped in such dynamics embody varying forms of what psychology has long referred to as sadism and masochism, psychologist David Shapiro (1981) instructed:

Each disposition involves, in its own way, a defensive, usually angry assertion of will; each is driven by a sense of inferiority, shame, or humiliation; each is deeply and self-consciously concerned with relative position, rank, and measure, with superiority and inferiority—but the sadistic person from the superior position, and the masochistic person from the inferior one.

The sadistic impulse occurs when a person dominates others as a way of attempting to gain in a surrogate what they lack within themselves and in life: control. The masochistic impulse occurs when a person grasps for such control through harmful forms of self-soothing.

Eating disorders, cutting, and substance abuse are indicative of a masochistic coping style and often of entrenched emotional dominance or avoidance within a family system.

Child abuse occurs far more commonly than most people realize. The Centers for Disease Control and Prevention began a study in the 1990s that has tracked child abuse and reported that there are more than three million reports made each year involving more than six million children, and that between four and seven children die each day due to abuse or neglect in the United States.

And then there is violence between lovers. Michael Johnson (2006) identified four major types of intimate partner violence—situational couple violence, intimate terrorism, violent resistance, and mutual violent control—and defined them “in terms of the control motives of the violent member[s] of the couple, motives that are identified operationally by patterns of controlling behavior that indicate an attempt to exercise general control over one’s partner.”

Intimate terrorism, which most frequently involves men abusing women, is the most extreme form of domestic violence. Another form of chronic domestic violence is a pattern in which both husband and wife are controlling and physically violent, two intimate terrorists battling for control, what Johnson labeled “mutual violent control.” These types of chronic abuse are products of two quite different evolutionary histories and psychological profiles: “one type broadly sociopathic and violent, the other deeply emotionally dependent on their relationship with their partner” (Skolnick and Skolnick, 2003).

Lipman-Blumen (1984) defined power in relationships as “the process by which individuals gain the ability to impose their will on others.” Abuse is often preceded by a more subtle power dynamic. Newman (1999) noted that early stages of abuse may be primarily emotional and difficult to detect:

For instance, when a husband anticipates his wife’s angry response to his desire for her to do more around the house, he may decide not to voice his concerns in order to avoid conflict. Thus, she has successfully exerted power over him [by preventing him from speaking his mind] without any direct confrontation. Such invisible power is important since it can maintain inequality even in those marriages that appear harmonious and conflict free.

Victims of relationship abuses often enter into therapy in the midst of a dualistic emotional experience—an affectionate emotional bond interlaced with anger, resentment, and fear.

Those who find themselves in therapy are obviously often experiencing painful and isolating feelings and possibly ambiguity of emotions, such as love and anger, which may be felt simultaneously. Unless a therapist is highly empathic, victims may be unwilling to expose themselves. The first tasks in therapy should always be to empathize with the person amid the emotions brought into the therapy room and to ensure an immediate plan for safety should a disclosure of abuse be made.

References:

1. Centers for Disease Control. Adverse Childhood Experiences (ACE) Study. Retrieved from http://www.cdc.gov/violenceprevention/acestudy/index.html.
2. Johnson, M.P. (2006). Conflict and control: Gender symmetry and asymmetry in domestic violence. In Violence Against Women (12) 11, 1003-1018. Thousand Oaks, CA: Sage Publications.
3. Lipman-Blumen, J. (1984). Gender roles and power. Englewood Cliffs, NJ: Prentice-Hall.
4. Newman, D.M. (1999). Sociology of families. Pine Forge Press: Thousand Oaks, CA.
5. Shapiro, D. (1981). Autonomy and rigid character. United States: Basic Books.
6. Skolnick, A. S., and Skolnick, J. H. (2003). Family in transition (12th ed.). Boston: A&B.

The topic of domestic violence entered the media spotlight well ahead of Domestic Violence Awareness Month this year. October has been dubbed domestic violence awareness month since 1987, and each October, we see a flurry of media content dedicated to raising awareness about the alarming numbers of people who are affected by violence in the home. This year, widespread media coverage of a professional football star’s appalling abuse of his then fiancée, made more horrific through video footage, rallied forces to stand up and speak out against domestic violence several weeks ahead of October.

But domestic abuse, or intimate partner violence, is not limited to sports stars or to any particular month. Domestic violence occurs in millions of households every day, and a huge number of these incidents go unreported. Violence in the home affects everyone within the household, whether or not family members are victims of abuse themselves, and it extends well beyond the confines of the home, affecting neighbors, family, friends, coworkers, and the community at large.

The sources of domestic violence are many, and both the abuser’s and the victim’s backgrounds play a part. Over the years, GoodTherapy.org has published a number of articles addressing the complexity of intimate partner violence. This October, we’re highlighting our top five picks that help illuminate statistics, dispel myths, and illustrate the nature of violent relationships.

Why Do Abuse Victims Stay with Their Abusers?

Our GoodTherapy.org correspondent, Zawn Villines, addresses the recent media coverage of the physical abuse Baltimore Ravens’ Ray Rice inflicted on his partner, Janay, and the popular response, or bafflement, as to why Janay chose to stay with her abuser. Villines outlines some of the reasons an abuse victim might choose to remain in an abusive relationship.

The Psychological Wounds of Domestic Violence [fat_widget_right]

This comprehensive article takes a look at intimate partner violence in the United States today, examining the characteristics and complications associated with violent relationships. Statistics and data on prevalence, psychological outcomes, and resources are provided as well.

Seen, Heard, Felt, Hidden: Recognizing Domestic Violence Signs

A therapist provides a case example to highlight the ways that people in violent relationships can’t see or refuse to see the signs of abuse. Particularly in the absence of physical abuse, it may be difficult to identify controlling behaviors, put-downs, and emotional manipulation as ongoing abuse.

Emotional Outcomes for Child Witnesses to Domestic Violence

The psychological ramifications for children who witness domestic violence in the home can be damaging and lasting. They may experience social or academic problems, anxiety, depression, behavioral issues, or somatic symptoms, such as stomachaches. Later in life, children who witness abuse may end up as abusers or victims themselves.

Domestic Violence in Same-Sex Couples

Therapist and LGBT issues Topic Expert Susan Leviton dispels the myth that domestic abuse is solely a heterosexual issue, and she addresses some of the misconceptions surrounding domestic violence in same-sex couples, such as the notion that violence between LGBT partners is always mutual. She also points out that internalized homophobia may account for some couples’ experiences and acceptance of abuse.

GoodTherapy.org also offers readers an opportunity to share their experiences with issues like intimate partner violence and the therapeutic interventions that helped them along the way through the Share Your Story section of the Good Therapy Blog. Several readers have shared their experiences with domestic abuse, including one woman who found she was brought back to life with therapy: ‘I Don’t Need Therapy:’ Why I Was Wrong.

Editor’s note: This article is an excerpt from Sarah Burleton’s New York Times bestselling child abuse memoir Why Me. The article contains sensitive detail about physical violence and abuse that some readers may wish to avoid.

My name is Sarah Burleton and I am the spokesperson for Prevent Child Abuse Illinois. Looking at me now, one would never guess that I endured such a horrific childhood—a childhood full of extreme physical beatings and mental abuse at the hands of my own mother. One would never guess that my own mother pushed me into an electric fence and watch me writhe on the ground in agony.

One would never guess that my beloved animals were murdered cruelly at the hands of my mother for her own sick enjoyment. And one would never guess that not once in my life did I hear my mother say the words “I love you” or feel her arms wrapped around me in a loving, warm, motherly embrace.

One would never guess this about me and my life because I made the conscious choice at a very young age not to let my child abuse define me. I refused to walk around like a victim and wear my child abuse as a badge for the world to see and pity me for.

As many of you can relate, the last thing a child abuse victim wants is pity from people who have no idea what we have had to endure. We don’t want anyone to know what we have been through because there is a shame attached to child abuse, a sense of self-blame, as if we deserved to be beaten or called names. Personally, I would bottle my emotions up inside and put on a tough façade to everyone around me, masking my true feelings of pain with sarcasm and aloofness.

[fat_widget_right]When it became too much for me to bottle up my emotions anymore, I opened my laptop and poured out my life story into a Word document, self-published it, and fell over the day I found out my little book had made the New York Times. Being on the list was great; however, the most rewarding part of my job has been traveling and speaking to adult survivors, CPS workers, and foster children.

I realize that there are many of us out there, thousands of us who have been hurt by people who were supposed to love and protect us the most. But I’m here to tell you that we are not victims; we are survivors. We are here today because of our will to survive and our determination to overcome the demons from our childhood.

Each of us has the power to use our horrible pasts as stepping stones to our bright, positive futures and as examples of how not to act. Every story matters and every voice should be heard. I love you all.

Following a traumatic event, several symptoms may arise in a person. Posttraumatic stress manifests in a variety of ways: reexperiencing the trauma via nightmares and flashbacks, avoidance of people and places that trigger memories of the event, elevated states of anxiety and arousal, and being in near-constant fight-or-flight mode, to name a few. These symptoms may last days, weeks, months, or years following traumatic experiences such as wartime combat, childhood abuse, rape, kidnapping, natural disaster, traumatic injury, or sudden death of a loved one.

Processing the emotions tied to these memories is often unsettling, and recovering from traumatic experiences typically requires a great deal of support and guidance. The good news is that there are several websites and organizations devoted to helping those who have been subject to trauma. Many are geared toward military veterans; however, plenty of sites focus on recovery for those who were victims of other forms of trauma, such as abuse or assault, whether as children or adults.

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We’ve compiled a list of the 10 best online resources for PTSD and trauma—GoodTherapy.org excluded—in 2013. As with our previous top 10 lists, our selections are based on quality and depth of content, presentation, and functionality.

• National Center for PTSD: The U.S. Department of Veterans Affairs hosts this site dedicated to research and education on trauma and PTSD in the lives of veterans. There is an informational section for veterans and their loved ones, as well as for professionals who are researching and providing care for those experiencing PTSD.
• Make the Connection: This site focuses specifically on offering “shared experiences and support” for veterans. The emphasis is on the power of support in the recovery process; veterans can locate local resources and access a wide range of information on dealing with PTSD as well as transitioning from service, the death of family or friends, and alcohol or drug problems. The video gallery features several personal stories of military veterans who have found hope and recovery in spite of flashbacks and other experiences. Online self-assessment screenings are also available to determine if a veteran has PTSD, depression, or a substance-abuse issue.
• Posttraumatic Stress Disorder Alliance: This network of professional and advocacy organizations has come together to provide an array of educational resources for those experiencing PTSD and their friends and family. In addition to combat veterans, the site is geared toward those who have experienced rape, physical assault, other forms of sexual assault, domestic or intimate partner violence, serious injury or accident, shooting or stabbing, sudden death of a loved one, childhood illness, witnessing a serious crime, and natural disaster. The PTSD Alliance also offers two free, downloadable booklets in their “resource center” to guide people through recovery.
• Gift From Within: This international nonprofit for survivors of trauma and victimization is in its 20th year of service. The site is rich with resources, information, and useful tools for those recovering from trauma of many kinds. In the “trauma support” section, tips from survivors for therapists, guided meditations, and stories from “support pals” can be accessed. In the bookstore, visitors can sift through a number of titles organized by topics, such as children and teens; healing and recovery from illness; healing and recovery for survivors and supporters; PTSD treatment, trauma, and violence; sexual abuse—male and female; and sexual assault, rape, and domestic violence.  There are also DVDs on PTSD available for purchase.
• Real Warriors: Another site devoted to combat veterans and their loved ones, Real Warriors is an engaging, content-rich resource for help with the “invisible wounds” of war. The general message is that no one goes into combat and comes home unchanged, and that cultivating resilience and “real strength” is essential to recovery. Videos and podcasts are available for viewing and download, and veterans are encouraged to reach out and get the help they need. Several veterans share their personal stories of PTSD on the site, and others are encouraged to do the same. There is also a military crisis line and live chat number for those who need immediate assistance.
• My PTSD: This site is primarily a network of forums for those who are experiencing PTSD. Specific forums are designated for combat, domestic violence, sexual abuse, and traumatic stress, as well as a general PTSD discussion thread. There are also smaller threads for topics such as book clubs, events, studies and research, and recommending trauma physicians. In the “articles” section of the site, several insightful pieces are available on a variety of helpful topics such as finding negative core beliefs, recovery, effective treatments for PTSD, and treating the trauma of rape with cognitive behavioral therapy, among others.
• Trauma Survivors Network: In partnership with hospitals across the United States, the American Trauma Society created this community-oriented network of people and their families recovering from trauma. Through the Trauma Survivors Network, people can access local trauma center information, peer support groups, peer visitation opportunities, a parent and family handbook, survivor stories, a community forum, and more. TSN’s “NextSteps” program helps survivors to become autonomous self-managers while recovering from trauma. There is also a “family class” for those who are in caregiver and support roles for those who are experiencing PTSD.
• Sidran Institute: The Sidran Institute is a nonprofit organization devoted to helping people understand and recover from PTSD, dissociation, and co-occurring issues such as substance abuse, self-harm, and suicidal ideation. The site offers educational articles, resources, and information for adults, adolescents, and children who have survived trauma, as well as for schools, community support groups, and mental health and victims services professionals. Trainings are also available through the site for those who wish to deepen their knowledge of PTSD and other trauma-related issues.
• PTSD Association: Along with being greeted by a PTSD self-assessment test, visitors to this site will find a large body of useful information pertaining to PTSD. Founded by Ute Lawrence-Fisher, who survived the “most horrific car pile-up in Canadian history” in 1999, the PTSD Association aims to help those who are recovering from trauma to reclaim their lives. Clinical information, personal stories, coping strategies, and related links are among the resources available.
• National Child Traumatic Stress Network: With informational sections for parents and caregivers, medical professionals, military children and their families, and educators, the National Child Traumatic Stress Network (NCTSN) covers all bases of child traumatic stress. Established by the U.S. Congress in 2000, the NCTSN offers guidance, tools, and links for coping with and recovering from neglect, natural disasters, sexual or physical abuse, terrorism, grief, refugee and war-zone trauma, traumatic illness, early childhood trauma, and school, community, or domestic violence. Numbers for various child and adolescent crisis lines are also provided.

Have a website you would like to see in our Top 10? Recommend it here.

Although jail time might seem like a distant possibility for most people, incarceration rates in the United States are steadily rising. One study published in the journal Pediatrics found that 41% of young adults have been arrested by the time they are 23. The U.S. Department of Justice (DOJ) reports that 6.6% of people serve time in prison at some point in their lives, and the statistic rises to a shocking 32% for African-American men. More than half of inmates are diagnosed with a mental health disorder.

As state mental hospitals continue to close and mental health services remain financially out of reach for many people, this number may rise. Moreover, prison itself can exacerbate preexisting mental health issues and create new mental health challenges among those who had never experienced them.

Mental Health Care Behind Bars

Jails and prisons are required to provide basic health care for inmates, but the quality of this care varies greatly. Often, prison-based mental health care focuses on stabilizing, rather than treating, inmates. A person experiencing hallucinations or psychosis might get medication to control the most severe symptoms, but people with anxiety issues, depression, posttraumatic stress, and other mental health conditions that don’t cause radical changes in behavior may go untreated. Prisoners rarely, if ever, get therapy or comprehensive treatment, so mental health issues that were previously controlled with medication and therapy may get much worse during incarceration.

Prison and Trauma

Even for the most hardened criminals, prison can be a scary place. The DOJ reports that 70,000 prisoners are sexually abused every year, and assaults, fights, and other acts of violence are common in a prison setting. But violence isn’t limited to inmates; prison guards work in a high-stress environment that can increase their likelihood of becoming violent. With little hope for reporting abuse by guards, some inmates may endure verbal abuse, threats of physical violence, and even severe attacks. Women inmates are at an increased risk of being sexually assaulted by jail and prison guards. This ongoing climate of trauma can create anxiety, depression, phobias, and PTSD in prisoners who previously had no serious mental health issues.

Lack of Support

Prisoners are, by definition, cut off from the rest of society, and their access to supportive friends and family may be limited. Many jails have instituted mail policies prohibiting letters and magazine subscriptions, and these policies can eliminate prisoners’ ability to communicate with and receive support from loved ones. Phone calls from jail can be costly, and prisoners from impoverished backgrounds may have families who can’t afford to cover the costs of collect calls, however infrequent. There’s little hope for getting any support in prison, as many prisoners are concerned more with gaining respect and avoiding fights in a relentless pursuit of safety. Support from loved ones can play a critical role in helping people overcome mental challenges, and isolation can increase a person’s risk of mental health issues such as depression and anxiety.

Getting Out

Most prisoners have ignored basic rules of society, so it can be difficult for prisoner rights issues to garner much public sympathy. But many prisoners are incarcerated for nonviolent drug crimes that are the result of substance addiction. And even inmates incarcerated for violent crimes do not typically serve life sentences. Most prisoners are ultimately released, and the mental health issues they develop in prison can increase their risk of reoffending and make it difficult to reenter society as a productive, nonthreatening citizen. Almost 70% of people who have been incarcerated are arrested again within three years, and the dire state of mental health care in prisons could play a significant role in this high rate of recidivism.

A mental health professional can help people who have come into contact with the prison system. A therapist can help prisoners reenter society or reestablish bonds with friends and family. Loved ones of incarcerated individuals can also get necessary emotional support in therapy. Therapy is a safe and confidential place for any and all people to get help.

References:

1. Chaddock, G. R. (2003, August 18). US notches world’s highest incarceration rate. The Christian Science Monitor. Retrieved from http://www.csmonitor.com/2003/0818/p02s01-usju.html
2. Gann, C. (2011, December 19). Study: Significant number of young Americans get arrested. ABC News. Retrieved from http://abcnews.go.com/Health/arrests-increasing-us-youth/story?id=15180222
3. James, D. J., & Glaze, L. E. (2006, December 14). Mental health problems of prison and jail inmates [PDF]. Washington, D.C.: U.S. Department of Justice Bureau of Justice Statistics.
4. Purdy, M. (1995, December 19). Brutality behind bars. The New York Times. Retrieved from http://www.nytimes.com/1995/12/19/nyregion/brutality-behind-bars-special-report-prison-s-violent-culture-enveloping-its.html?pagewanted=all
5. Recidivism. (n.d.). Bureau of Justice Statistics (BJS). Retrieved from http://bjs.ojp.usdoj.gov/index.cfm?ty=tp
6. Sakala, L. (2013, February 7). Return to sender: Postcard-only mail policies in jails. Prison Policy Initiative. Retrieved from http://www.prisonpolicy.org/postcards/report.html
7. U.S.: Federal justie statistics show widespread prison rape. (2007, December 16). Human Rights Watch. Retrieved from http://www.hrw.org/news/2007/12/15/us-federal-statistics-show-widespread-prison-rape
8. U.S.: Number of mentally ill in prisons quadrupled. (2006, September 6). Human Rights Watch. Retrieved from http://www.hrw.org/news/2006/09/05/us-number-mentally-ill-prisons-quadrupled

Children who have been victims of maltreatment can develop emotion regulation problems that affect many areas of their lives. Some survivors of abuse can experience symptoms of posttraumatic stress, anxiety, and depression throughout life. Coping and relational skills learned in childhood form the foundation from which future behaviors evolve. It has been hypothesized that women who survived maltreatment, in the form of physical or sexual abuse or neglect, will have sexual challenges in adult relationships. To test this theory, Alessandra H. Rellini of the Department of Psychology at the University of Vermont conducted a study involving 192 women ranging in age from 18 to 25.

The study focused on how emotional regulation, childhood maltreatment, sexual expression, sexual satisfaction, and relationship intimacy were associated in the context of committed adult relationships. The women in the study completed online surveys describing the type of abuse they experienced and their level of intimacy, affectionate expression, and sexual satisfaction in their current relationships. Rellini found that the more severe the childhood abuse was that the women experienced, the more unsatisfied they were in their adult relationships. This was true with respect to general and sexual relationship satisfaction. The severity of abuse also directly predicted the severity of emotional regulation impairment, which could be indirectly influential of satisfaction.

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In contrast to Rellini’s predictions, however, the findings did not demonstrate any association between emotional regulation impairment and intimacy or emotional expression. This was rather surprising, as previous research has suggested that abuse survivors tend to have challenges sustaining emotionally healthy sexual relationships. One factor that may have contributed to these results is the broad categorization of abuse used in this study. Specifically, this study did not examine sexual abuse separately from emotional or physical abuse to determine each type of abuse’s independent effect on emotional regulation. Despite this limitation, Rellini believes her findings provide evidence of unique correlations between childhood maltreatment and adult relationships for women, but more work needs to be done. “Research is now needed to explore the stability of such findings over time in order to determine the time course and sequencing of change between the studied variables,” she said.

Reference:
Rellini, Alessandra H., Anka A. Vujanovic, Myani Gilbert, and Michael J. Svolensky. Childhood maltreatment and difficulties in emotion regulation: Associations with sexual and relationship satisfaction among young adult women. Journal of Sex Research 49.5 (2012): 434-42. Print.

Adults who have survived childhood abuse are more likely to experience mental health problems than those who were not abused during their youth. Depression, anxiety, panic, posttraumatic stress, eating and food issues, and substance abuse are just some of the psychological conditions that these survivors face. Another consequence of childhood abuse is diminished physical health. Research has shown that negative psychological well-being decreases physical health and can lead to serious health problems, including hypertension and heart disease. But few studies have examined how specific types of childhood abuse affect physical health directly.

To address this gap in research, Cathy Spatz Widom, Ph.D., of the Psychology Department at John Jay College at the City University of New York recently conducted a study that sought to determine the link between three individual types of abuse and later physical health problems. Widom analyzed data from adults who had been abused prior to their 12th birthday. The average age of the participants was 41. Each participant underwent a complete physical examination and blood test in adulthood. Based on documented reports of the abuse, Widom compared how sexual abuse, neglect/maltreatment, and physical abuse in childhood affected the participants’ health in adulthood.

She found that the adults who had experienced neglect and maltreatment had poorer oral and visual health as well as impaired airflow and increased risk for diabetes. The adult survivors of sexual abuse were more likely than the other participants to develop oral health issues and hepatitis C. They also had higher rates of HIV and malnutrition. Those who had survived physical abuse were also at increased risk for malnutrition and diabetes. Although some of these conditions could be attributed to maladaptive coping techniques, such as smoking, drug or alcohol use, and poor nutrition, the findings clearly show that adults who have survived childhood abuse are still at increased risk for significant physical health problems. Widom believes that these findings have strong clinical implications. She said, “Understanding the mechanisms that place abused and neglected children at higher risk for these adult physical health outcomes will help focus these efforts.”

Reference:
Widom, C. S., Czaja, S. J., Bentley, T., Johnson, M. S. (2012). A prospective investigation of physical health outcomes in abused and neglected children: New findings from a 30-year follow-up. American Journal of Public Health, 102.6, 1135-1144.

People who have suffered childhood trauma are at increased risk for psychological problems resulting from extreme stress. Borderline personality disorder (BPD) is one such condition that has been linked to severe childhood trauma. When the trauma is inflicted by a caregiver, the child’s ability to cope is significantly impaired. The effects of unhealthy coping, attachment dysfunction, and emotional regulation can affect many areas of the child’s life as they continue into adulthood. Affect dysregulation is the inability to control one’s moods and emotions and has been linked to BPD and other mental illnesses. Underregulation of emotions is expressed by lack of control, extreme emotional overwhelm; while overregulation is the result of numbing and is exhibited by an inability to express emotions. To determine which of these factors is more indicative of BPD in adults who suffered trauma during childhood by their primary caregiver (TPC), Annemiek van Dijke of the Delta Psychiatric Hospital in the Netherlands conducted a study of 472 clients with a diagnosis of BPD.

The participants’ levels of affect regulation were documented and they were evaluated for various forms of TPC, including sexual abuse, physical abuse, and emotional trauma. Van Dijke found that 63% of the participants had experienced some form of TPC and that those with underregulation had more symptoms of BPD than the participants with overregulated affect. Although the study did not consider other factors that could influence BPD, such as family history, other traumas, and the mental health of the caregivers, the results clearly emphasize the importance of examining emotional regulation, and specifically underregulation, in clients with a history of TPC.

The findings also showed that the participants with TPC were at increased risk for posttraumatic stress (PTSD). But Van Dijke noted that no research has been conducted to determine exactly how specific forms of TPC affect the severity of PTSD symptoms or how they are indirectly affected through affect regulation as a result of TPC. In sum, Van Dijke believes that these results can benefit clients who have suffered TPC by educating clinicians on the importance of helping clients build more secure relationships and develop healthier emotional expressions.

Reference:
Van Dijke, A., Ford, J. D., van Son, M., Frank, L., & van der Hart, O. (2012). Association of childhood-trauma-by-primary caregiver and affect dysregulation with borderline personality disorder symptoms in adulthood. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. doi: 10.1037/a0027256

Even though there can be life long debilitating psychological effects, sibling abuse may be the most ignored—if not accepted—form of domestic abuse (i.e. sexual, physical, emotional). Why is this kind of abuse ignored or minimized? There is a lot that is swept under the rug in the guise of “sibling rivalry.” And American law does not consider this a prosecutable offense unless a child is turned in by their parent(s). In other words, parents would have to be willing to file an assault charge against their own child. So parents keep this type of abuse within the family. And a lot of the time, they even blame the victim.

First some statistics: In an article entitled “A Major Threat to Children’s’ Mental Health,” Hart & Brassard reported that “There is evidence that brother-sister sexual relationships may be five times as common as father-daughter incest.” Finklehor and Baron, who are prominent researchers in the area of child abuse, state that “sibling sexual abuse is prevalent in a remarkably large quantity of individuals from virtually all social and family circumstances.” And a survey of 796 undergraduates of six New England colleges found that 15% of the females and 10% of the males reported having some type of sexual experience involving a sibling (Sibling Abuse – Wiehe). In this same publication it states that parents are aware of sexual abuse among siblings 18% of the time, emotional abuse 69% of the time and physical abuse 71% of the time.

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Sexual abuse aside, how do we define or recognize abuse among siblings? When there is an inequity in power between two adolescents and one uses control over the other to repeatedly hurt, threaten, or degrade, that is abusive behavior. Even name calling and ridicule can wear away at a child’s self worth and self-esteem. “Children are especially vulnerable to degrading remarks because it is during their childhood years that they are developing a positive sense of self.” Unfortunately, most parents see this behavior as sibling rivalry. And while most emotional and even physical abuse, should and can be handled by parents rather than the law, first parents have to recognize that it is abuse.

Sexual abuse is another story. Most incidents of sexual abuse by siblings go not only unreported but also undetected by parents. Most times, the siblings themselves recognize that what is happening is wrong and certainly it is recognized by society as wrong. So unlike physical and emotional abuse, this should be easier to detect by parents. But most kids don’t tell. They don’t tell because the older sibling is an authority figure, or because they are threatened or scared, or because they don’t realize that it is abuse because they blame themselves as much as their sibling for what is happening. And unlike physical or emotional abuse, it is happening secretly because the older sibling knows that they have crossed a line.

What causes one sibling to abuse another?

1. Acting out anger at parents on sibling or acting out anger at an older sibling on a younger sibling.
2. Parents overwhelmed by their own problems not paying attention.
3. Inappropriate expectations – older sibling given too much responsibility or freedom.
4. Mirroring parents behavior.
5. Viewing the behavior as normal by parents.
6. Socialization of males as dominant over females.
7. Contribution of victim. “Research supports the hypothesis that the behavioral patterns of the abused child tend to invite further abuse” (Wiehe). It becomes a vicious cycle.
8. “It is important to note that this interactional cycle theory does not blame the victim!” Rather it identifies a pattern in order to treat and help prevent further abuse.

What are the long-term effects of sibling abuse?

Time does not necessarily heal. Adult victims of childhood sibling abuse generally have lower self-esteem and are overly sensitive and insecure. They have trouble with relationships and repeat the victim role in their other relationships. They can have sexual functioning problems. There is continued self-blame at the same time that anger at their perpetrator is played out with others.

So how do parents and other family members distinguish between abusive and normal (sibling rivalry) behavior?

1. Is it age appropriate?
2. Does one child appear to be a constant victim?
3. Is the purpose of the behavior humiliation, sadism, to cause suffering, a result of a continual explosive anger?
4. Was the behavior planned, has it happened before, does the perpetrator feel remorseful?
5. Was property destroyed or animals abused?
6. The length and the degree of the behavior. One-time incidents, if serious enough (i.e. sexual abuse), can create a life long problem. Whereas name calling, ridiculing, and even teasing if done consistently and at certain vulnerable ages (i.e. between six and seven years and/or between eleven and twelve years of age) can also create life long problems.

We need to build awareness and educate families about the difference between abusive and normal behavior among siblings. Listen to children and believe them. Good supervision and encouraging openness about discussing sex while informing children to “own their own bodies” and respect others are simple, logical steps towards protecting our children from abuse by siblings, cousins and other children.