With the exception of sexual abuse, which may be driven by premeditative and sexual motivations, child abuse has rarely been found to be intentional, but more commonly occurs as a result of the offender’s inability to manage childrearing demands (Azar & Wolfe, in press). Parental characteristics include information processing disturbances that reflect unrealistic expectations, distorted perceptions and attributions of negative intent concerning normal child behaviour, leading to increased levels of aggressive and inappropriate disciplinary measures (Azar, 2002; Milner 2003). In such cases, abuse may be rationalized by the perpetrator as a legitimate strategy to maintain control (ibid).
An individual’s lack of exposure to positive models of parenting, and / or history of 'learned’ / experienced abuse, may contribute to the adoption of negative parental strategies with abusive aspects (Mash & Wolfe, 2005). Limited coping resources are also reinforced with common offender-complaints such as chronic physical ailments, pervasive mood conditions and general discontentment (ibid). Parental alcoholism and unemployment are also identified as offender based risk factors of abuse (National Clearinghouse of Child Abuse and Neglect Information, 1994). The potentially cyclical and cross-generational link between abuse, offender personality and parenting style is thus exposed.
Nevertheless, there exists no single child / offender originating risk factor to be solely implicated in a causal relationship with child abuse, without first considering the matrix of variables that may interact unpredictably to precipitate such abuse. Wolfe’s (1999) integrated model of physical child abuse outlines three transitional stages of maladaptive interactions between parental, victim and situational factors. Variables may include child characteristics, parental personality and style, the parent-child relational background (e.g. chaotic family life; step-family relations; absence of the mother), and the level of support available to the child / offender / family in a broader context (ibid). Also identified are ‘destabilising factors’, such as a child’s habituation to punishment, that may act as a catalyst to increasing measures of abuse (ibid). Situational / environmental family risk factors have been evidenced in a large body of incidence / prevalence research to incorporate aspects such as social isolation, community-violence, low socioeconomic status, lack of access to health care / child care, exposure to racism / discrimination, poverty, etc (National Child Protection Clearinghouse, 1998; Mash & Wolfe, 2005).
The implications of abuse upon a child’s developmental course and adult life are extensive. Herman (1992) reflects:
“The child trapped in an abusive environment is faced with formidable tasks of adaptation. She must find a way to preserve a sense of trust in people who are untrustworthy, safety in a situation that is unsafe, control in a situation that is terrifyingly unpredictable, power in a situation of helplessness...”
(Herman, 1992; p98)
However, a child’s maladaptive, disorganised, and unpredictable adaptation to developmental challenges within an abusive context, does not necessarily follow a consistent course. Beginning with the child’s mastery of physiological regulation, and throughout further developments of skills, and interpersonal, emotional, behavioural and physical milestones, the abused child faces the risk of multiple impairments. The extent of impact upon a child is also influenced by the nature, severity and chronicity of the abuse (Mash & Wolfe, 2005). Coping mechanisms may also decrease the impairments upon a child, such as the distorted view of the offender to be ‘more well meaning’ and focusing on positive attributions in order to adapt and promote loyalty in an environment where the child has no other standard of comparison (Wilson & Melton, 2002).
The presence of at least one significantly positive / supportive / protective relationship may also reduce the effects of maltreatment (Mash & Wolfe, 2005), especially when this person is the child’s mother (Leifer, Kilbone & Kalick, 2004). This may act as a protective factor even in such circumstances where the perpetrator of abuse is indeed the mother, should the child perceive this parent to be, in particular situations, a source of knowledge or love with which the child feels an attachment (Wekerle & Wolfe, 2003).
Nevertheless, the absence of an organised attachment strategy may often characterise abuse, leaving the child at a greater risk of insecure, self-regulation impairments such as a disrupted combination of approach and avoidance, helplessness, apprehension and/or general disorientation (Barnett, Ganiban & Cicchetti, 1999). Impaired emotion regulation can also prove a secondary effect of disrupted attachment, where the child does not learn to control the intensity and expression of impulses and emotions in an adaptive manner (Maughan & Cicchetti, 2002). Depressive tendencies and aggressive outbursts may escalate with age, as the child confronts new situations and interpersonal challenges – leading to other maladaptive internal/external behaviours such as self-harming, depression and anxiety disorders, hostility and ‘acting-out’ (Wekerle & Wolfe, 2003; Cicchetti & Rogosch, 2001).
The appearance of inhibited emotional expression is also a common factor for victims of child abuse, as are increased levels of alertness and anxiety in comparison to peers, indicating increased attention to signals of stress/ disapproval / abuse and adapted behaviour to minimize / avoid such triggers (Pollak & Tolley-Schell, 2003; Klorman, Cicchetti, Thatcher & Ison, 2003). The fundamental self-efficacy, will and needs of a child may become rebuked and increasingly suppressed, which correlates with increased manifestations of fears, worries and depressive perceptions (Miller, 1991). The child’s core emotional growth may thus be compromised by a contradictory hunger for closeness and fear of it (Wolfe, Jaffe, Jette & Poisson, 2003)
Up to fifty percent of children/adolescents with histories of maltreatment of a sexual nature or sexual combined with physical abuse have been found to meet the criteria for Post Traumatic Stress Disorder (Scott, Wolfe & Wekerle, 2003). Certainly, the child’s responsiveness to stress has permanent neurological implications for development, such as changed cortisol levels, increased sensitivity of the neuroendocrine system to stress, and long-term alterations to the hypothalamic-pituitary-adrenal Axis & Norepinephrine systems, which affect response to stress, and leading to a greater risk of emerging psychiatric / mental health problems throughout the individual’s lifetime (Brenmer, 2003).
A central developmental consequence of child abuse presents itself in the form of distorted self awareness and maladaptive perceptions of the world in which the child exists (Feiring, Taska & Lewis, 2002). Fundamental childhood beliefs that reflect a sense of well-being, safety, self-esteem and empathy are frequently absent in abused children, replaced instead by negative representational models, emphasising self-identity features of guilt (e.g. for failing to recognise / avoid / control / protect against the abuse), shame, rage or other such disempowering components (ibid).
A child’s ability to recognise and empathise / respond productively to distress in others may also be impaired (Wolfe & Mash, 2005). As a result abused children are also more likely to misread the (often amicable) intentions of peers/academic authority figures, become isolated / avoid interaction, socialize in ‘atypical’ groups demonstrating increased levels of anti-social behaviour within a wider context, and less overall popularity with peers (e.g. Haskett & Kistner, 1991; Mash & Wolfe, 2005). Academic difficulties and cognitive/intellectual delays may also be indicators of child abuse, where interpersonal and self-regulatory aspects are problematic (Mash & Wolfe, 2005).
Such betrayal / exploitation of a child’s vulnerability may, however, lead to different behavioural outcomes according to victim gender. For example, females have been found to internalise signs of distress, leading to salient identity features of shame and self-blame manifest in behavioural patterns such as self-harm, promiscuity (in situations of sexual abuse; e.g. ‘sexual traumatisation’), and eating disorders for example, whereas males have become more likely to express heightened levels of physical and verbal aggression (Kaplan, Pelcovitz & Labruna, 1999; Mash & Wolfe, 2005). Such negative behavioural / emotional patterns are often enduring, leading to a greater risk of personality disorders in adulthood (ibid). Symptoms of depression, emotional distress and suicidal ideation for example, may increase throughout childhood and adolescence into adulthood, and where if left unrecognised / addressed, may result in severe outcomes such as self-mutilating behaviour and suicide (Kolko, 2002).
A significant number of adult survivors of childhood abuse experience long-term stress-related disorders (Scott, Wolfe & Wekerle, 2003). Symptoms may include intrusive thoughts, ‘emotional numbing’, feelings of entrapment – mirroring aspects of coping mechanisms which may have been created during childhood to mentally ‘escape’ the pain or fear associated with occurring / anticipated acts of abuse (ibid). Studies show up to a third of childhood victims of sexual / physical abuse or neglect meet the criteria for lifelong Post Traumatic Stress Disorder (Kilpatrick et al, 2003). This disorder may hold further abuse-specific characteristics such as a fear of men, fears associated with specific abusive memories (e.g. sleeping problems) etc (Terr, 1991).
Adult pervasive and chronic psychiatric disorders may also stem from the developmental impairments associated with child abuse, including anxiety and panic disorders, eating disorders, sexual problems and personality disturbances (Kendler et al, 2000). Sexual abuse, in particular, increases the likelihood of carrying maladaptive perceptions of ‘self’ and impairments of self-esteem and emotional/behavioural regulation into adult life, leading to severe outcomes of mood / affect disturbances and Dissociative states (Koenig, Doll, O’Leary & Pequegnat, 2004).
Dissociation is a term used to describe an altered state of consciousness frequently utilised by victims of abuse to detach themselves from occurring maltreatment. Nevertheless, children who overtly rely upon this coping strategy may risk profound effects upon memory, and disruptions to self-concept, which over time may develop into borderline / multiple personality disorder (Briere, 2002; Macfie, Cicchelle & Toth, 2001).
The cycle of violence hypothesis refers to the victim’s potential to become the perpetrator of violence later in life (Widom, 1989). In contrast, victims of abuse may also be viewed to be of greater vulnerability to future victimisation due to a lack of self-protection skills and distorted self awareness (Mash & Wolfe, 2005). Perhaps such long term outcomes are contingent with the direction of a child’s adaptation and mechanisms demonstrating resilience. For example, an adult with a history of experienced abuse is at greater risk of developing interpersonal problems, becoming abusive towards others, and acting with aggression and violence in particular (Mash & Wolfe, 2005; Widom, 1989). And yet, up to 20% of maltreated children have been labelled ‘resilient’ in adulthood, defined by no criminal arrests, no periods of homelessness, and consistent employment (ibid). This suggests that although at greater risk than the general population to crime and antisocial activities, the majority of child abuse victims (some 70%) do not follow such negative behavioural patterns into adolescence and adulthood (Mash & Wolfe, 2005).
Nevertheless, victims of child abuse remain at great risk of developing a number of long-term disorders and psychopathology, which does not follow a homogeneous pattern (Mash & Wolfe, 2005). The ramifications of abuse are widespread, impacting a child’s emotional, intellectual and physical developmental course, with negative implications for self-concept, relationships, parenting, and multiple aspects of functioning throughout childhood into adult life (ibid). The matrix of potential risk-factors of abuse may further demonstrate the complexity of this problem, incorporating victim-offender characteristics, family factors, socioeconomic considerations and other situational/ environmental factors. The psychological factors involved in child abuse interact in unpredictable ways to precipitate abuse and are manifest in a wide-spectrum of effects for the child and adult. No single cause and effect relationship may be implicated without first considering the complex matrix of psychological factors involved, and the multi-dimensional nature of abuse, integral to the application of interventional strategies in this instance.
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