CHAPTER V

Early effects: if child abuse could be considered a disease, it would have the greatest mortality rate of all childhood diseases. (Drue, et all., 1969; Bershorow, 1977) LoPriesti (1968) stated that most half of the battered infants who are returned to their original environments are murdered. Younger (1976) commented on the seriousness of child abuse:

Child abuse is a leading cause of infant mortality in the United States and it is estimated that nearly one million American children are suffering from abuse and neglect at any given time. Moreover, approximately one quarter of those million children will be permanently injured for life as a result of being maltreated. (p. 6)

In addition to the effects of child abuse discussed earlier in this paper in the sections on descriptions and detection of child abuse is the consistent observation of denial of pain to avoid real or imaginary pain in young children. Holter and Frieman (1968) questioned a four year old boy who had not made any attempt to cry out or to get away when he was being scalded. The boy said that he never behaved in this way because he did not wish to be spanked. The author has encountered this same time phenomenon in numerous cases. One patient, a fifteen year old male, had "sunk" out of his parent’s house to see his girlfriend. On his way back home he was struck by a car. He got up, ran way from the driver of the car, crawled through his bedroom window into bed and for several days pretended that he had a cold. After six days he lapsed into unconsciousness and was taken to the hospital where it was discovered that had had an infected compound fracture of the hip. When he was asked why he didn’t let the drive of the car help him or tell his parents, his reply was, "I didn’t want to get a whipping."

Effects on Test Performance: Elmer and Gregg (1967) studied thirty-two abused and non-abused children on frequency of anger. Eight of the abused children obtained deviant scores; four children had unusual frequent outburst of anger. Thirteen of the abused children had normal scores whereas all of the non-abused children had normal scores.

The same authors (1967) investigated fifty abused children who were admitted to the Children’s Hospital of Pittsburgh between 1959 and 1962. The criteria used for selection of the abused children had been 91) multiple bone injures discovered by radiograph extremity exams; (2) absence of clinical disease; (3) history of traumatic abuse or neglect. Of the original fifty children selected for the study only twenty were available. Each of the twenty abused children was tested or rated on physical development and intellectual function. The Columbia Mental Maturity Scale, the Rorschach test, and a review of school records were employed to evaluate intellectual function. The children failed to respond to the Columbia test and were given the Stanford Binet or WISC. The results indicated that only 10% of the children were normal in all areas. 50% of the children had an I.Q. score of eighty or less. 10% of the children had an I.Q. score of eighty or less. 10% of the children had I.Q. scores between 100 and 110. The remainders of the children were below 100. Elmer and Gregg (1967) concluded in later reports that some of the children observed were having increasing trouble as they approached adolescence and that five predictably would become public charges, some operating only in a sheltered environment.

Hurley (1967) investigated the relationship between parental malevolence as measured by an independent interview of the mothers and fathers using four indexes of malevolent behavior and intelligence. The California Test of Mental Maturity was used along with the I.Q. scores of 433 third grade children as indexes of intelligence. The following results were obtained:

…Parent malevolence and child’s I.Q. scores were negatively correlated;… mother and daughter pairs showed the strongest association between parental malevolence and the child’s I.Q. parental social economic, and education accounted for little covariance between child’s I.Q. and parental malevolence is more apparent among parents having less than a high school education than those who attended college (p. 200).

As parental violence and abuse increase, the intelligence of the child decreases.

Long-Range Effects: Green (1968) investigated self destructive schizophrenic children to see of there was a relationship between the self destructive behavior and a history of prior abuse. Seventy school-age schizophrenic children were divided into male and female groups, and into destructive and mom-destructive groups. Self-mutilation in the boys was significantly related to a prior history of trauma abuse. A significant relationship between self-mutilation and a prior history of trauma abuse in girls was not evident. There was, however, a trend in that direction, and all the girls who had been abused were self-mutilators. Green observed that the parents in the traumatic abuse cases alternated between withdrawal of affection and traumatic abusive behavior. He speculates that the child hurts himself mainly to re-experience the pleasurable elements of the parental attacks in the absence of any parental contact. He described the role of tactile and kinesthetic stimulation as the "most potent positive reinforcer for childhood behavior, especially when the child has been through a period of depravation (p. 174)." A child seeks out painful verbal, touching, and movement stimulation when there has not been any pleasurable stimulation. If the parent only pay attention to the child when they punish the child then the child will repeat the offensive behavior in order to feel something. Thus the development of the sadmasochistic personality, which in the teen-age years contributes to the extremely high rate of suicide.

The children who experience abuse in their early lives frequently retaliated with anti-social behavior. "Dr. Carl Menninger believed that every criminal was an unloved and maltreated child. The criminal appeared to be the child who had survived physically but not mentally" (Fontana, 1964:18).). He concluded that imitation and identification with violent patents could lead to adult abnormal behavior, beginning with the Physical Abuse of individuals and leading to ultimate murder. Other investigators, Duncan et al., (1958) studied etiological factors as they might have affected cases of first degree murder. They concluded that many murders had a constant experience of remorseless physical brutality at the hands of their parents.

In a study of criminal social violence, Bettelheim and Jenowitz (1950) report that

A significant association was found between tolerance toward minority groups and the recollection of love and affection from the parents, while intolerance toward minority groups was associated with the recall of lack of parental love and harsh discipline (p. 105).

Bain 91963) like wise observed that the unloved child, the emotionally traumatized child, the socially and emotionally deprived child became part of a pool of neurotically disturbed, retarded or delinquent adults.

The author was found that almost without exception the child abuser is sexually dysfunctional. The genesis of part of their sexual dysfunction is from childhood spankings. Every time a child is spanked on the "bottom’ the child’s genitals traumatized. Genitalia traumatization coupled with the conditioning program not to cry, reinforced the child to inhibit the sensation of pain from the genitalia and response to that pain. After enough learning trails the child feels a sense of relief when they have been able to "quit". Unfortunately stimulus generalization occurs to pleasurable genitalia sensations. A child so conditioned will become a non-orgasmic adult.

Primary anorexia nervosa is a disease found mainly in twelve to eighteen year old females in which a behavior involving the irrational fear of becoming fat result in severe weight loss from starvation and is fatal in five to twenty percent of known cases (Bargman, 1981; Brunch, 1977; Halmi, 1980; Lucas, 1981). Family pathology is clearly involved in the genesis of anorexia nervosa. Wilson (1980) observed a number of characteristics common in the families of anorexics. Among these characteristics were parents with concern for perfectionism, fear of being fat, and control of the anorexic child who exhibited repression of emotions caused by the overly conscientious morality of the parents. Mintz (1980) has found that parents are rigid, controlling, demanding, infantilizing and very attached to their children and involvement usually takes the form of intrusiveness and interference in their growing up and becoming independent. One feature of familial pathology is the parents’ persistent acting out of their own unresolved childhood and marital conflicts through the child. Often the child is caught in a cycle of split loyalties between feuding parents who use this pressure for loyalty as another method of control. The anorexic’s preoccupation with weight loss may represent an early childhood conflict that developed over forced feeding and may contribute to her striking denial of hunger. In addition, nurturing during infancy and childhood which is totally inadequate pathologically reinforces the denial of feeling (Rampling, 1980). Indeed, early punishment over body stimulation and waste elimination before the child is maturationally able to control these functions may result in a fear of sexual development and exploration at adolescence. Hovde (1982) stated:

…Starvation and weight loss result in the loss of body curves and enlargement of the breast, which gives the anorexic the appearance of a younger child. Through the development of this childlike physical state, the anorexic unconsciously flees from sexuality and learns to cope with the control of her hyper-moral parents’ (p. 4)

 

Child sexual abuse has been linked to negative health effects and has been identified as an antecedent to suicide attempt, depression, sexually transmitted diseases, and subsequent sexual assaults. Research indicated that 15% to 40% of females and up to 10% of males are victims of child sexual abuse (Bradley & Wood, 1996).

Child sexual abuse is associated with a wide range of mental health, interpersonal, and sexual problems in adult life. Sexual abuse is more frequent in those from disturbed and disrupted family backgrounds (Mullen, 1996). The frequency and extent of negative experiences in childhood and adolescence correlates significantly with outcomes such as dissociation, depression, difficulties in interpersonal relationships, and victimization. (Sanders, 1995)

Anderson, LaPorte, Grantd, & Crawford (1997) in researching sexual abuse and bulimic patients found "abused subjects exhibited higher levels of depression, and eating disordered attitudes… relative to nonabused subjects".

Profile analyses, discriminate analyses, clinically descriptive comparisons, and host hoc analyses of individual scales all reveal that psychopathology is much more evident in those who have experienced sexual abuse (Gregory, Bills & Rhodenback, 1995).

Psychiatric patients who were sexually abused during childhood have repeatedly been described as being more anxious and depressed than psychiatric patients who were not sexually abused during childhood (Beitchman, 1991, Lipovsky, Saunders, & Murphy, 1998). Additionally, sexually abused patients are said to have higher rates of hospital readmission and more episodes of deliberate self-harm (Rose, 1991).

Palmer (1996) concludes that dysfunctional familial patterns arise from child sexual abuse and that they are learned by the victim's children. "There is a potential risk conferred to the children of becoming victims of child sexual abuse. Certain physical manifestations, psychosocial behaviors, and relational patterns typify the personae of adults who experienced sexual abuse as children".

The effect of child and adult sexual abuse on adult sexuality was examined with the Golombok Rust Inventory of Sexual Satisfaction (GRISS) and a sexual experience questionnaire. The GRISS was administered to 201 psychology students at the University of South Florida, of which 175 were retained in the study. GRISS variables that were analyzed consisted of anorgasmia, sexual avoidance, sexual dissatisfaction, sexual noncommunication, nonsensuality, and vaginismus. Women who had a history of sexual abuse in childhood were less satisfied with the overall quality of their most recent sexual relationship than non-abused women and had higher numbers of unsafe sexual partners (Bartori & Kinder, 1998).

Loneliness has been shown be a serious long term and behavioral consequence of sexual abuse. McWhirter, (1984 defines loneliness as "an enduring conditional of emotional distress that a person feels estranged from, misunderstood, or rejected by others". He states, "Women who were victimized as children report feelings of fear, disgust, and intense shame". Jehu (1988) reports victims of childhood sexual abuse have feelings of isolation or alienation, mistrust of others, insecurity in relationships, and limited social skills. A belief endorsed by 92% of his sample felt it was dangerous to get close to anyone because they always betray, exploit, or hurt you. Concluded "that both loneliness and trust in others would be affected by abuse."

Based on findings of the National Women's Study, delayed post-traumatic stress disorder is evidenced in mothers following the disclosure of sexual abuse of their children. Awareness of the sexual abuse of their daughters catalyzed a reliving of their own childhood victimization (Green, et al., 1995). Parents reactions to child sexual abuse are anger, directed at the perpetrator or onto the family member, helplessness, vulnerability, guilt, self-blame, panic, shock, embarrassment, a desire for secrecy, and fear for the child (Green et al., 1995). Parent adjustment was assessed using self-report measures of psychological distress, parent competence, family functioning, marital functioning, life stressors, and environmental support. Results revealed that mothers of sexually abused children, in comparison to mothers of nonabused children, experienced greater overall emotional distress, poorer family functioning, and lower satisfaction in their parenting role. Fathers of sexually abused children also experienced greater overall emotional distress relative to comparison fathers but their level of distress remained below that of mothers. Standard and hierarchical multiple regressions on maternal self-reports revealed that mothers' dissatisfaction with their parenting role and their perceived level of environmental support predicted their emotional functioning. Abuse-related variables did not contribute to the prediction of emotional functioning (Green et al., 1995).

During 1989-1990, of all forcible rapes, 29% occurred when the victim was aged 11 years and 32% when the victim was aged 11-17 years. Overall, 84% of all rape victims did not report the crime to police (Tabachnic, 1997).

The Back Depression, Beck Anxiety Inventory, and the Achenbach Youth Self-Report were administered to 111sexualy abuse psychiatric patients between ages 13 and 17. Sixty percent reported drinking alcohol more than twice a month and admitted to elicit drug usage within the past month. Twenty-two percent had been previously hospitalized for psychiatric problems. Thirty-four percent described one prior suicide attempt. Additionally, a history of childhood physical abuse was described by 70% of the patients (Kumar, Steer, & Deblinger, 1996).

Forty percent of adolescent inpatients had mood disorders and had 67% other types of disorders. Twenty-three percent have comorbid clinical disorders. Four percent have posttraumatic stress disorders, and 7% have alcohol and drug abuse disorders. Thirty-three percent of the girls had been sodomized by their biological father and 58% of the girls had experienced penile penetration of the anus or vagina. The average age of abuse had occurred before 10 years of age and lasted 1.5 years. Physical abuse was positively associated with sexual abuse for both boys and girls. (Kumar et al., 1996). A high proportions of psychiatric inpatient report a history of childhood sexual abuse. More than twice as many inpatients had been abused before the age of 10 than in the general population (Baker & Duncan, 1985).

The Diagnostic Inventory of Personality and Symptoms (DIPS) was used to access a clinical sample of 30 women with histories of intra-familial sexual victimization. The sexually abused could be characterized as suffering an Affective Depressed-Dissociative Disorder. (Gregory-Bills & Rhodenback, 1995).

Case studies of 249 victims of sexual abuse who were identified by one of the following three strict inclusion criteria: (1) positive medical evident; (2) confession by the perpetuator, or (3) criminal conviction were studied (Sorrensen & snow, 1991). The crucial issue in this study was the nature of the disclosure process. Each interview of the victim by the police was scored for the following disclosure events: (1) denial; (2) general reluctance and specific reluctance; (3) first disclosure and new disclosure; (4) repetition of the same information; (5) total recantation and partial recantation; (6) re-affirmation; (7) police contact without any other disclosure event. Fifteen victims had not been interviewed because the child was too young or had moved to another locale. These cases were eliminated from the analyses, leaving a sample of 234 (82% female; 18% male). Twenty percent of the victims were 1 to 5 years old, 36% were 6 to 10, 36% were 11 to 14, and 7% were 15 to 18 (mean age = 10.5; SD = 3.8). Seventy-six of the victims were Hispanic, 15% were non-Hispanic White, and 9% were either African American or a member of another ethnic group. In 96% of the sample, the primary caretaker was an immediate family member, most often the mother (92%). Most households contained three to five members (88%). Most cases involved one victim (78%) and/or one perpetuator (95%). No cases involved more than two perpetuators. The number of abuse incidents was one in 19% of cases, two to five in 26%, six to nine in 16%, and 10 or more in 40%. The perpetrator was an immediate family member in 34% of the cases and an extended family member in 32% the cases. Forty-nine percent of cases involved penetration (anal, vaginal, oral). Fondling of the genitals was the most common type of abuse (55%) and fondling of clothed genitals the second most common (36%). (Sorrensen & Snow, 1991).

This concludes the discussion on the effects of child abuse. A review of the needs of the developing child and cross-cultural definition of child abuse follows.