Abused child

Trauma of Abuse: Important to Have in Mind

There is a number of definitions of child abuse and neglect (medical, psychological, social-protective, legal). Defining the meaning of child abuse and neglect, it is important to take into account two assessments: parental/carer behaviours on one, and impact on the child on the other hand. Child abuse includes everything individuals, institutions or processes do or fail to do, which directly or indirectly harms the child or imposes risks for his/her healthy and safe development into adulthood. If we analyse it more narrowly, child abuse is interaction or a lack of interaction among family members which results in non-incidental harm impinging upon the child’s physical and developmental status.

Nowadays we know that traumatic childhood experience includes various forms of abuse which are intrinsically or directly aimed at the child, or which result from a lack of appropriate parenting and child care. Both direct abuse and failure to act, i.e. neglect, bear many risks for further development. Some of the consequences result from psychological damage, others result from unsuccessful coping of the child with trauma related to abuse and neglect.

Forms of child abuse include physical, sexual and emotional abuse and neglect. These forms of abuse and neglect often overlap, i.e. they are simultaneous, and the reality of child experience is significantly more complex than the existing classifications of abuse.

Data in literature about the prevalence of child abuse and neglect reflect several factors: the level of public awareness, ability to recognise the problem and report it, research and, finally, epidemiology of the phenomenon itself. These result in differences in the recorded prevalence of the phenomenon in different countries. Official data on the prevalence of child neglect in developed countries is 30 to 40%, physical abuse is 19 to 28%, sexual abuse 9 to 16% and emotional abuse is 7 to 34%. Study conducted by the Child Protection Centre of Zagreb showed that the youth in Croatia estimated that 15.9% they were exposed to physical abuse, 16.5% were exposed to emotional abuse, 14.8% were exposed to witnessing domestic abuse, and 14% of them were exposed to sexual abuse. Unfortunately, in state statistics, many cases are overlooked and thus data on prevalence depends on many factors.

Consequences of abuse as traumatic child experience occur in, at least, three phases:

• early reaction to victimisation (includes post-traumatic stress reactions, deviation from expected development, disturbing feelings and cognitive deviations),

• adaptation to abuse (coping mechanisms aiming at an increase of safety and/or alleviation of painful feelings and reactions related to victimisation),

• long-tem processing and secondary adaptation (the impact of early reactions and adaptations to abuse on later psychological development of the individual on one hand and, on the other hand, development of mechanisms to cope with feelings and conditions related to abuse).

Among the long-term consequences of abuse and neglect, the most frequent psychological conditions in children and youth are post-traumatic stress reactions, cognitive distortions, changed emotional status (depression, anxiety), dissociation, poor self-image, difficulties in social relationships and academic accomplishments, risks of delinquent behaviours and avoidance of stimuli related to abuse. Research into the prevalence, incidence and consequences of traumatic events in childhood and youth shows that the occurrence of psychiatric disorders in adulthood is related to exposure to traumatic events, especially to childhood abuse experience.

To conclude, child abuse is considered to be one of the most significant psycho-social risks to which children may be exposed.

There are relatively good legislation and practice in our country. However, it is still necessary to develop cross-sectoral cooperation and encourage the community to provide conditions to act according to the legal framework and agreed strategy.

Being professionals who work with children traumatised with experienced abuse, we believe that additional efforts need to be invested in the development of professional competences of all those working with children and families. It certainly includes improvements of working conditions for professionals and their better regional distribution throughout the country.

Despite increased public awareness, additional traumatisation of children who have been exposed to abuse is still present (multiple testimonies of abused children, too long court procedures and delay of decisions crucial for the existential issues of children, tolerating child manipulations in family disputes, abuse in divorce, shifting of responsibility for child protection and support, etc.). Such behaviours are typically not recognised and named as abuse and are, therefore, more difficult for the institutions of the system to prevent and deal with in order to eliminate them.

Written by: Bruna Profaca, Psy.D.