Tell me about the treatment of abuse in adults.

October 28, 2009 11:08 AM

What are some of the effects of long term child abuse? What methods are used to help adults recovers from the effects of said child abuse?

I need to develop the background of a fictional character who has suffered from child abuse (haven't decided on a specific type, will go with whatever sounds interesting), so details are needed concerning A) What sort of effects of does child abuse have on the behavior, attitude and personality of an adult and B) on psychiatric approaches used to help mid 20s male confront, deal with and over come the long term effects of child abuse suffered throughout his life until he left home sometime between 16-18

Specifically, what sort of treaments are there for adults to recover from abuse they suffered as a child? Are there established "stages" like the 5 stages of grief, which shrinks use as a guide post for treating adults who are still suffering the effects of long term abuse? Does that vary, based on the treatment method used? Does the type of treatment vary greatly based on whether it was sexual, physical or emotional abuse or is it similar?

posted by Brandon Blatcher to human relations (22 answers total)

From personal experience working with endangered youth...

Some are angry. Some are complacent. Some are the most amazingly sweet people you'll ever meet in your life. Most have self-worth issues. Some are sadistic. Some torture animals. Some rescue everything they can get their hands on, from people to animals to dolls. Some have an inability to see the world from beyond their own perspective. Some believe their own perspective doesn't matter. Many are sexually assaulted as adults. Some are ultra conservative, some are so meek they don't have any opinions on anything. Some are sociopathically determined to cause grief. Some are obsessively compelled to prevent it.
posted by TomMelee at 11:19 AM on October 28, 2009 [2 favorites]

IANAD or a Psychiatrist. Just a social worker who works alot with survivors of abuse. I suggest that you read up on the following:

Reactive Attachment Disorder: the wikipedia article is actually not bad.

Borderline Personality Disorder; actually any of the cluster B personality disorders are a possiblity. It looks like your character is male. You're likely to see Anitsocial or Narcisstic traits in an adult male with history of abuse.

(none of the above is intended to imply that all survivors of abuse develop mental illness. In working with some woman recovering from abuse, I've relabeled Borderline Personality Disorder as Strong Survivor Syndrome since that's what it really is.)

Of course, PTSD.

DBT (link to a pdf by the author of Stop Walking on Eggshells) and CBT are going to be the most common treatment options.

I'm pretty familiar with the behavior patterns you're likely to see in someone with an abuse history. If you want to, you can memail me and I'll address how your character might react to specific situations.
posted by dchrssyr at 11:30 AM on October 28, 2009 [1 favorite]

Oh! Also read: The Drama of the Gifted Child.
posted by dchrssyr at 11:34 AM on October 28, 2009 [1 favorite]

It depends a lot on the personalities involved, the type of abuse, and the person's distance from the abusive situation at the time they are seeking counseling. It would help if you narrowed down something about what you're looking for besides the age and sex:

abused by a parent? elder sibling? teacher?
for how long?
were they outgoing or shy before the abuse?
what kind of motive did the abuser have (were they crazy, cruel, evil, an abuse victim acting out their power struggles from the other side)?
is the person still in contact with the abuser?
is the abuse continuing (especially possible in the case of emotional abuse)?
does the character have a support network of adults who can help them outside of counseling or are they all alone?

As far as I know, treatment will depend on a combination of the practice of the counsellor and the presentation of the symptoms. Someone with uncontrollable rage will probably be treated differently from someone who goes randomly into a self-hypnotic state in the middle of conversations.
posted by carmen at 11:40 AM on October 28, 2009

I suggest you check out The Boy Who Was Raised as a Dog, by Bruce Perry. It's an amazing analysis of how (certain types of) abuse affect (certain) children, and how Perry has worked to treat them. It gave me an incredible insight into what child psychiatry is like, how early treatment affects children, and what can be done to help rectify problems caused by abuse.

(Also, it's not nearly as depressing as the title may make it sound... There's a fair bit of hope and joy in the book, as children who have suffered immensely learn to grow into happy, well-adapted people.)
posted by Ms. Saint at 11:58 AM on October 28, 2009

Another indication in the abused is an aversion to intimacy or sabotaging their relationships. Either shying away from contact or undermining the ones they have - consciously or un - simply by virtue of not know how to relate in a loving way due to their early conditioning. Many are avoidants, seeking solitude and the healing that would provide to an overly stimulated psyche, alleviating the need to relate and therefore bypass the uncomfortability factors that would entail - abandonment, rage, feelings of impending doom etc. In staying aloof there is gaining of some sense of control, a dominant factor sought out in most abuse survivors' lives.
posted by watercarrier at 12:13 PM on October 28, 2009 [8 favorites]

I'm currently doing background research for a study on childhood sexual abuse. A lot of the literature I've been reading points to high levels of depression, substance abuse, relationship difficulties (as well as sexual outcomes including higher numbers of sex partners, STDs, and more frequent sex while under the influence), and higher incidence of an lethality of suicide attempts.
posted by bluloo at 12:27 PM on October 28, 2009

It would help if you narrowed down something about what you're looking for besides the age and sex:

Ok, how about this:
Physical and emotional abuse from the ages of 6 to about 16 from an overly controlling male step-father. His mother wasn't very protective as she wanted the picture perfect life they had. He is no longer in contact with the abuser and does have a small network of friends.

Personality wise the character is angry and resentful and doesn't trust people, often pushing them away. He would definitely suffering from self esteem issues and working at shit job just to make ends meet, not living up to his potential. He's intelligent, never been in therapy before (probably wouldn't trust it enough to go). Doesn't sleep much because he's haunted by the memories.

Based on the above, what course of treatment would work well? Is there a general road map, like the Five stages of grief that would used? Or is it a matter of first acknowledging there's a problem, a willingness to confront it, confronting, resolution and then growth?
posted by Brandon Blatcher at 12:28 PM on October 28, 2009

I keep thinking about this. The movies Ordinary People and White Oleander might give you some perspectives on both personality issues and what treatment might look like. The main characters in both movies are adolescents so you can get an idea of where your character might have been emotionally at age 16. Both movies are decent depictions of narcissitic family systems. There are different types of narcisstic family systems, some are more overtly abusive than others.

Have you considered that your character might have addiction issues? Lots of abuse survivors do.

Also, I find that abuse survivors tend to lie a bunch. Not always intentionally. It appears to be a defensive measure to keep people away.

Watercarrier is correct: establishing and maintaining control is a huge factor. Avoiding the appearance of vunerability is a big deal too. Anger often becomes the most accessible emotion for adolescents, although some become overly accomodating in an attempt to blend in and draw as little attention to themselves as possible. These teens are usually the ones who lie the most.
posted by dchrssyr at 12:48 PM on October 28, 2009 [1 favorite]

Treatment is very indivualistic. There are no cut and dry approaches to this or even stages. Simply, each path is different, each trauma has its own time, dimension and space. What does work is a holographic approach - where the trauma, body, psyche and spirit are all engaged in the healing of the self and bringing light into the dark chasms of memory.

Trauma - especially in early childhood is energy that stays frozen, causing blockages in memory recall, illness of the physical body and leaves imprints which manifest throughout life as depression and anxiety. Any healing modality would need to find the places not effected by trauma - seek the inner Child archetype that would respond to care and help develop a positive image by employment of the inner Hero that would work in tandem with a trusted therapist to gain some solid footing in approaching the pain. From there unraveling and rebuilding the psyche, one memory at a time can begin via creating new memories (new neuropathways) and connecting them back to the Self, to Other and to a Higher Power. Music, art and nature are all safe gateways that can be utilized in healing.
posted by watercarrier at 12:54 PM on October 28, 2009 [2 favorites]

PS - if medication is warranted, it should be used, though there are always dangers in these cases because of the tendency to self-destruct via self-harming activities - risk taking, drugs, alcohol, cutting etc. The hope is that once trust, belief and self love are discovered and developed from within, the need for medication would diminish as the memories and their triggers lessen.
posted by watercarrier at 1:00 PM on October 28, 2009

BPD requires CBT.
posted by jefficator at 1:05 PM on October 28, 2009

Another good movie about child abuse and its effects: Mysterious Skin
posted by cotesdurhone at 1:29 PM on October 28, 2009

Okay, given your extended description (and assuming that your goal is to have the therapy work, at least to some degree), I think the key component is not going to be the style of therapy per se, but rather what it is that allows your character to establish a bond of trust with his therapist. That bond is going to be two-fold: there has to be something that allows him to start believing that therapy will help, and then something that makes this therapist in particular a person that he can trust.

I think that bonds of trust with therapists are a bit like friendship, not in the content of the relationship per se, but in the subtle rapport that makes pursuing a relationship worthwhile. What makes a particular therapist helpful for a particular person is a combination of circumstance, need, openness, and personality that isn't at all formulaic (which is good news for you as a writer).

If you are writing this from the man's perspective, then, for me as a reader, it would be just as convincing to talk about his emotional reaction to the therapist as to detail the therapist's approach. I mean, depending on what you want to say you may want to/have to do some extended research, but regardless of how much attention you give to the mechanics of therapy, I think believability would come from the human core of the relationship.
posted by carmen at 1:42 PM on October 28, 2009

BPD requires CBT.

I've heard DBT is better.
posted by Sticherbeast at 1:58 PM on October 28, 2009 [1 favorite]

Check out kaigou's three-part series on livejournal. It's about what it's like to be a street kid, but in one whole section she talks about street kids that come from abusive backgrounds, and much of what she says about living in a high-danger environment may also apply. (I recently found this via Mefi, but I can't find where right at this moment.)
posted by salvia at 2:00 PM on October 28, 2009 [1 favorite]

This paper on behavioral patterns that echo the traumatic experience (re-enactment, revictimization, masochism etc., including a short chapter on treatment implications) might be of interest as something to explore. Maybe the abuse is somehow still present in your character's life, only in disguise.
posted by sively at 3:33 PM on October 28, 2009 [2 favorites]

A) What sort of effects of does child abuse have on the behavior, attitude and personality of an adult

Avoidance and Withdrawal. You want to have relationships, friendships as well as romantic, but when things become too intense you disappear.

You don't want people to touch you and your responses to being touched will vary. In a social situation when someone hugs you unexpectedly, you stiffen and pull away. It would be reasonable to assume that your character would respond violently if another male were to grab his arm in an aggressive way.

You never tell anyone. When you were a child you never actually told your parents and as an adult you might not understand why you did not. You were certainly sending out signals, acting out, but your parents had addiction problems and were unavailable. Hopefully, another adult in your life eventually figured out something very wrong was happening.

You might reach a point where you realize that what happened to you was not your choice and you are blameless and so maybe you might want to share that with people in your life. You have spent almost all of your life feeling bad about yourself so it feels liberating. But it can also feel wrong, the sharing, and you might think you have overshared or disclosed too much in the wrong setting, so you return to where you never tell anyone.

You also feel guilty and a crushing self-loathing at the same time. You are afraid that if you tell someone close to you, they will not want you around their children, because we have all heard of an offender who himself was abused as a child. It does not matter that you know you would never do what was done to you.

Most of all, you learn that when you need help the people who are supposed to help you do not. You are learning this and it is being absorbed into your personality before you even know you are learning it. So as an adult you have problems with authority figures and a insidious kind of distrust of other people.
posted by Scale 0 at 4:01 PM on October 28, 2009 [9 favorites]

I have met a lot of victims. The short answer is that child abuse causes serious damage to the child's sense of their own boundaries. This can lead to a lot of different behavior and feelings, may of which are spelled out above in other responses .

What I would really suggest is that you find a local advocacy/treatment agency and spend some time talking to the folks who counsel victims.
posted by bearwife at 4:13 PM on October 28, 2009

Thanks all, especially carmen for looking at it from a storytelling perspective
posted by Brandon Blatcher at 5:28 AM on October 29, 2009

He'll have spells of funk, when he plays imaginary conversations in his head, with family. Things he'd like to say now, or things he wish he'd said then. Or things he wonders what would happen if he spoke them then, or now. The nature of these vary. Anger, hurt, sorrow, grief, even love, may be at the core of moment.
posted by Goofyy at 10:29 AM on October 29, 2009

*Now that I've written this all out, I want to say it's very long. But there is no self pity and no graphic recounting of violence. It's safe for work, unless you cry easily. I've spent more than an hour writing it, and more than a day thinking about what I would write in this space. It is heavily edited. I'm sure I could cut a lot, but if I spend more time with this I will chicken out and not post it. So. here goes.

I will give my unique perspective of how the abuse of my childhood impacts my daily life. I'm female, 28 now. I'll just say that my email address is attached to this account, so I know that what I'm saying is not anonymous. The reality of this background needs to be acknowledged, so I invite anyone who has questions to send me a me-mail. I'm done being silent out of fear that my parents will track me down and hurt me some more.

I'm surprised how little personal anecdata there is here. I avoided reading this thread because I was afraid I'd see the same story as mine told over and over by others on the green. But the tone of this thread is very....clinical. Don't worry, I won't get into the violence here. (Again, email me if you want to know, or if you want to share a story with me of your own awful childhood.)

First, the character's relationship to his mother may be all over the map. By far the biggest reason that I don't communicate with my own mother is that she did not protect me from some of the truly awful things that happened in my childhood. I know your character wasn't also abused by his mother (ok, in my mind her failure to protect him is a form of abuse, but...well, this is such a tough topic to find vocabulary for). Despite all the terrible things that my mother did to me, it is her refusal to acknowledge the other terrible shit that was going on that damns her. My younger brother says ''we all made a lot of mistakes back then." He tortured animals when we were kids and I couldn't stop him. My younger sister calls me and screams and cries that the world is out to screw her. My older sister maintains a relationship with our mother, and her children spend a bit of time with our mother. These are four very different responses in one family.

I told. I told my mother about what my cousin was doing to me, she did nothing. I told the school about everything everyone was doing to and around me. Once we were removed from my mother's home and put on a plane to my father's home. Not an improvement. Now, as an adult it's difficult for me to tell. If someone is mean to me, I suck it up. If I've been wronged, I believe that it's my fault and there isn't anything anyone can or will do to fix things.

Emotions are so scary and I have so few role models of healthy emotional displays. Until two or three years ago I didn't know how angry I was (am) because I believed that anger = throwing things, screaming, and saying mean things. No way in hell I wanted to be angry person. So I focused on intellectualizing. This allowed me to examine the issues without actually being close to them. My family made fun of me for being smart, so intellectualizing, on some level, was a way of reclaiming that as a positive thing that they couldn't take from me. The could make me a afraid, but they couldn't make me stupid.

Boundaries. I'm hyper sensitive to intrusions on my personal space, cannot stand to be approached from behind. Do not touch my neck. At the same time, I am finally able to articulate what is a difficulty being certain of where my body stops. Anyone who has read Orbach's book Bodies may recognize this. Speech boundaries. As a child I had an enormous vocabulary and was fond of performing intellectual feats for adults outside the family. I wanted acceptance. I talked a lot. With my peers this was not functional. As a teenager and entering my early twenties I played what I refer to as a "cocktail party game." The winner had the most horrifying childhood. This was decided after the crowd had been silent or someone else had been reduced to tears by an event from my past. I never lost. I stopped playing this "game" because I realized a few things. 1. When other people share that they're mother called them fat, they aren't hoping to have that awful feeling invalidated. Once I realized that was what I was doing I had to stop. Because I know how it feels, and it's awful. The captivating story of "what I have overcome" was making their pain less real in the eyes of our shared audience. And this wasn't fair. 2. I realized that if I kept this up, eventually someone would pipe up in a crowd with a story as bad as any of mine, and I would really lose my shit and cry all over them. Around the same time as that, I realized that surely I have met people with worse stories who are not able to voice them yet. I felt I had stealing from them, in a way. I realize that last thing isn't so rational, but it was what I saw then.

I was displaying my grief and my pain so publicly to prove that I was alive. But when I told these stories I felt myself breaking inside over and over again.

I'm working very very hard on interpersonal skills, and I expect that I will be for a long time. because I make conscious efforts at this every day, it gets easier. I have a strong desire for metacommunication, that is, discussing my relationships, and discussing language, and discussing conversations. I'm also acutely aware of metamessages - when is the conversation about what to have for dinner not really about what to have for dinner?

I threw myself into Speech and Debate in high school, and it saved my life by getting me out of the house and making it cool for me to be smart (I didn't have any chance of getting in with a cool crowd, Smoking made me physically ill and I had no interest in drinking. I did eventually learn to pretend to drink. You just carry the same red cup of beer around all night. Then your friends think you drink like a fish.). I thought that excelling in this type of communication would save me from the pain of the styles of communication I learned at home. Unfortunately, the arenas are so different, that you can't make deciding where to eat dinner into a Lincoln Douglas style debate. Trust me, I tried. (This is where you laugh. please laugh.) So, your character may be very good at standing up for himself at work and very bad at handling romantic relationships. Or vice versa. He doesn't have to be a failure at every single kind of communication. I'm not.

I've never had any eating disorders, but it's common among abuse survivors, even males. It's a control issue. (You can't even guess what the bad guy might say or do, but you sure can control what you put in your mouth.) Jaw pain (search "tempro-mandibular joint) and gastrointestinal discomfort are also (you've got your anal retentives and your anal expulsives, both are about control), at least folklorically, linked to the stresses of these childhood uncertainties. I have some mild jaw issues, but thankfully, no bowel issues. (As an interesting aside, one of my specialties within anthropology/sociology is food. This was not an accident. Food equals community, comfort, sharing and nurturing. All things that I missed so much as a kid.)

I do have some control issues. I like to be early. I get upset (internally) when people are late. I like to make plans. I don't like loud places - the mall, the arrivals car pick up at airports, football games.

I have frighteningly little respect for police. Every single time I called them when I was a child they told me, "I'm sorry, that's your mom. Our job is to keep families together." School teachers, social services workers, my childhood therapist. All made it very clear that their number one goal was to keep my pitiful family together. In hindsight, I'm aware of some of the awful things that happen to children in foster care. If you have seen those news stories, know that my home life was so bad that I would turn back the clock and risk it. In fact, at 16 I argued a police officer into taking me to foster care because I would not go back to my mother. I was a runaway, I knew that being a runaway was illegal. I also knew that she would kill me after what I had seen her do to my brother that night. I spent more than an hour repeating that his choices were to take me to jail or take me to foster care. He insisted my only choice was go back to my mother. Eventually he took me to a foster care assignment, but he was pissed about it.

Where I am now: Dialectical Behavior Therapy in a program that specializes in Trauma Reduction and Integration. This is my third year in the program and I haven't advanced to the integration part. I suspect that it's going to be reliving some awful things. I want it to be done, but I think I'm not ready for it. My group in any given module has 7-10 members plus two co-leaders. We talk about the skills we're learning and practicing. We practice these skills (grab a copy of the handbook by Marsha Linehan, the back is full of worksheets that we use. the front is for the therapists.) The idea is that you practice the skills in low stress situations so that when high stress times you can reach for them and have competence. The other idea is to reduce anxiety. If you're constantly at a hypervigilant 8, it doesn't take much (spilling a glass of water, getting cut off in traffic) to ratchet you up to a ten. So if we can slowly reset ourselves closer to even a 6 or a 7, we have a bit of extra "space" to absorb some stress. Mindfulness skills are the first module. What is really happening in my surroundings? What is happening inside me? How am I feeling? Very important to learn not to judge these feelings. Also very difficult when all your life you've been told you're stupid, imagining things, selfish, lazy, or worse.

We've just started the interpersonal effectiveness module. Managing relationships in ways that meet our needs while not compromising our self esteem. Also, not always easy. Especially for those of us with a history of not having even our most basic physical needs met. I have two tendencies. Stuff everything and pretend I don't have any needs while over accommodating the needs of others, or Hide.

My Adult ADHD was finally diagnosed this summer as a result of my depression not clearing despite medication and intense therapy. I'm still having some anger that my therapists didn't figure it out, that it took a psychiatrist and a friend to put all those pieces together. (When you complete a battery of paperwork that averages 9 hours to fill out, you expect that they'll review it...and find you in there.) What a relief. But also, pretty scary.

I cycle through the stages of grief, and I expect I always will. I'm angry that my childhood was not pleasant. I bargain, if I'm good now, maybe I can forget. My denial tends to be along the lines of maybe it wasn't that bad, or maybe I'm misremembering this, that or the other thing. Acceptance comes in being able to tell other people what happened to me. That it was real, and I made it through to this side. Acceptance comes in finding some humor. Acceptance is with me when I can remember the moments of fun that I experienced with my parents. Acceptance is knowing that I have skills my parents didn't have. They did the best they could, and it wasn't enough. But I am doing better.

On a final note. My life has not been pleasant. But. My life is meaningful. I volunteer. I teach. And now I share this story. If anyone is interested in listening to a humorous live reading I gave in Miami you can find it at lipservicestories.com click on stories, go to the number 6, and then choose my name from the list of readers (I'm near the bottom. If you've read this far, you can figure out my name in my profile.) For some reason lipservice isn't set up to let us link directly to the individual story, so you do have to go through all the maze of the site, but it's pretty user friendly. I hope you listen. That event was the single most helpful night in all of my recovering. I promise, you will laugh if you listen to the clip.
posted by bilabial at 4:24 PM on October 29, 2009 [8 favorites]