Abuse hides in plain sight

November 23, 2014

Consider the shocking recent stories of Bill Cosby and Honey Boo Boo. We assume those we see in the public eye to behave in line with their public images. In situations like these, when we discover that abuse was occurring, we often discover that there was coverup and fear by the victim of revealing the truth. Victims feel ashamed. They may be threatened by their abusers.

Victimization is often a pattern. Abusers and those who allow abusers to cover up are living their own negative and dangerous patterns.

The Honey Boo Boo situation sounds incredible, yet this terrible pattern is not unusual. We see similar patterns in child welfare court on a regular basis. Child sexual abuse involving a parent who is not protective recurs in certain families. It is not uncommon for a parent to fall in love with a child abuser and to allow the abuser into the family home, as well as to allow the abuser around the children. The more unusual thing is that this time it came to light. Abuse often hides.

The Cosby example is an illustration of this principle. I’ve heard people ask why now – why are the victims coming forward now?

The answer is that victims are afraid to reveal their truth, abusers often bully, abusers often blame the victim, abusers often threaten the victim that coming forward will lead to dire consequences. Sometimes, abusers even bribe to maintain silence. Victims are afraid, victims are ashamed to be victimized, victims are afraid to be re-victimized, victims are afraid of retaliation, victims live a private hell of personal distress. They came forward now because there are others and because this provides safety and lessens fear.

Perhaps surprisingly, studies show that victims are often re-victimized and even that prior victimization is a risk factor for recurring victimization. Victims were often abused first in early childhood – and then re-abused. Protecting their parents and blaming themselves is a standard behavior on the part of child victims – in part because children need their parents for survival. In addition, denial is perpetuated because dissociation and avoidance are common physiological responses to trauma in the brain.

When it comes to abuse, maintaining silence is a recurring theme. The rest of us are often clueless, except in unusual cases when the truth is revealed.

Early life stress may lead to PTSD despite loss of memory of the trauma

November 10, 2014

A recently published study out of the University of California at Los Angeles and the University at Albany has shown that Post Traumatic Stress Disorder (“PTSD”) may develop in people who have no memory of the trauma. These findings are significant on the subject of dissociation. It supports the understanding that the process people undergo when they suffer serious or ongoing trauma may include dissociation from the the pain or intensity of the experience which may lead to long-term memory loss of the incident. However, dysfunction in the body’s stress response system nonetheless occurs.

The researchers found that levels of the stress hormone corticosterone in the brain were increased in those who underwent early-life traumatic events and that despite the lack of memory of the event itself, the subjects continued to experience anxiety and fear when faced with similar situations. Stating that early life stress is particularly impactful, the study made the finding that traumatic experiences may cause life-long harm to “the ability to cope with future stressors and emotionally salient events.”

The study is published in the recent issue of the journal of Biological Psychiatry: Amnesia for Early Life Stress Does Not Preclude Adult Development of Posttraumatic Stress Disorder Symptoms in Rats.

Domestic violence does affect the children

October 25, 2014

Numerous studies have shown that domestic violence has a negative impact on children in the home, even where there is no additional direct abuse to the children, and that children who are so young that they are preverbal and cannot yet understand the significance of the violence are nonetheless harmed.

Among other things, scientists have shown that observing domestic violence constitutes a trauma which becomes programmed into a child’s developing brain and body leading among other things to significantly increased likelihood that the child will relive domestic violence relationships and ultimately negatively impacts the physical and mental health of the child throughout life.

The Washington University Institute for Learning and Brain Sciences has posted a very interesting video that shows a toddler responding to anger which is not directed to the toddler. The video has gone viral. It is enlightening to observe a preverbal child reacting and adapting to avoid being harmed by anger even though the anger is directed toward another person. The study reflected in this video made similar observations as to 149 other toddlers.

With regard to the principle and understanding that domestic violence harms children, this study is important in that one can observe the preverbal toddler’s reaction to anger though it is not being directed at the child. It is important to keep in mind, however, that the harm caused to a child who observes domestic violence is many-fold and all of its implications are not observable on a video.

Trauma informed care

October 10, 2014

“Trauma” is becoming a buzzword in the child welfare, mental health, and even medical communities. As the dissemination of the results of numerous recent studies on the subject continues, nonprofit organizations and governments are developing ways to incorporate trauma-informed practices in their work.

Reviewing recent studies, including MRI scans showing direct impact of early life trauma on brain structure and function, it has become apparent that such trauma impacts individuals and families in fundamental ways. Early life trauma is literally programmed into the brains and bodies of traumatized individuals during fetal life and the earliest years, and thereafter has been shown to affect their behaviors and experiences in negative ways, including, among other things, by leading or contributing to the development of Post-Traumatic Stress Disorder (PTSD), by leading to self-destructive behaviors, such as substance abuse or engagement in high-risk relationships, and even by leading to physical and mental health issues and premature cell deterioration and aging in part through its effect on telomeres at the ends of chromosomes.

The word about these issues and their significance is finally spreading, facilitated in large part by the revolutionary ACE study (the Adverse Childhood Experiences Study out of Kaiser Permanente and the Centers for Disease Control and led by Vincent Felliti and Robert Anda), which has shown that adverse childhood experiences lead to numerous adverse adult experiences and that the effect is proportional.

In one current initiative, Georgetown University has teamed with JBS International to create a web-based tool to support leaders and decision makers in government and private organizations in becoming more “trauma-informed” in serving their populations. I recommend taking a look at this important web-based resource: National Technical Assistance Center for Children’s Mental Health, Georgetown University Center for Child and and Human Development.

Study confirms high rates of adverse childhood experiences in juvenile offenders

September 10, 2014

The Florida Office of Juvenile Justice and Delinquency Prevention and the University of Florida recently conducted a study that showed starkly higher rates of Adverse Childhood Experiences in Juvenile Justice offenders than in the general population.

While the ACE Study (the “Adverse Childhood Experiences Study”) out of Kaiser Permanente and the Centers for Disease Control previously made showings proportionately connecting adverse childhood experiences with adverse adult experiences using large samples, the recent Florida study was the first in the United States to focus specifically on juvenile offenders. Out of over 64,000 juvenile offenders surveyed, only 2.8 percent reported no childhood adversity. This very strong finding does not even account for the potential for underreporting, which is common, and acknowledged by the study’s authors.

The Florida study appeared in the Spring 2014 issue of the Journal of Juvenile Justice and looked at 10 types of childhood adversity, including emotional, physical, and sexual abuse; emotional and physical neglect; household substance abuse; witnessing a mother being abused; household mental illness; losing a parent to separation or divorce; and having an incarcerated family member.

Dr. Michael Baglivio, co-author of the study, said importantly as follows: “This shows that youth in the juvenile justice system were indeed victims of child abuse, neglect, and dysfunctional homes, prior to, or at least current with, being ‘offenders'”.

The study’s authors recommend, among other things, that our juvenile justice systems, child welfare systems, and governments in general become more “trauma informed”.

Please take a look at the study’s findings described at the following link: The Prevalence of Adverse Childhood Experiences in the Lives of Juvenile Offenders

Successful model for recovery and healing in San Antonio

August 23, 2014

In Texas, practitioners and government staff working in the mental health system and law enforcement were seeing individuals and families repeatedly cycle through with substance abuse problems, mental health issues, and law enforcement involvement. Leon Evans, director of the community mental health system for Bexar County, Texas, encompassing San Antonio joined with other leaders to create an integrated system in the county involving a comprehensive protocol and plan for cooperative effort by a number of agencies to improve these issues applying a data-focused, coordinated approach to recovery and healing. Statistics are showing significant success, including lowered prison populations, demonstrated and lasting recovery from substance abuse problems, and improvement in functioning and health for those with mental health diagnoses.

A significant component of the effort involves the Center for Health Care Services in San Antonio. The Center is operating pursuant to the agreements and directives of the Quality Management Plan which can be viewed at this link. Center for Health Care Services, San Antonio, TX, Quality Management Plan.

It is impressive that the plan includes behavioral health and substance abuse treatment interventions coordinated among agencies, as well as early childhood intervention programs, event for infants and toddlers. It is a well-thought out thoroughly coordinated effort applying evidence-based practices to a complex problem, as to which leaders in Bexar County seem to have deep insight and understanding.

This coordinated approach should serve as a model to other states and counties. Bexar County is demonstrating that rather than applying limited services and punishments to the same individuals in a piecemeal fashion, it is more logical and effective to view troubled individuals and families in an integrated manner, to improve communication and planning among agencies, and to coordinate efforts with a comprehensive plan designed to address the whole individual. It is also important the the plan is based on recent research demonstrating that an individual’s behaviors and problems do not exist in isolation but in fact develop in the context of intergenerational problematic behaviors in families that affect the entire individual. In addition, this should serve as a model approach because it involves proactively taking control of a complex problem rather than defensively reacting to problems as they come up in a fragmented, punitive fashion, which is shown to be ineffective.

Moving portrait of abuser father

August 8, 2014

I have learned from my work in the child welfare system, from my conversations with people who have suffered childhood abuse and neglect, and from reading the research in the field of brain development that people generally tend to love their parents no matter how poorly the parents may have treated them as children. I have seen people abused severely, treated in shocking ways by their own parents, even from infancy, yet unable to resist a strong feeling of attachment and need for the parents despite the terrible things they did to them. I have seen children make efforts to turn away from the parents who mistreat them, and still be unable to control that feeling, that draw, and that need to see them and to be with them, to “come home” as they tend to call it. In fact, these patterns become re-created in people’s lives in adult relationships when they cannot resist the attachment to a person who treats them terribly in a relationship context.

When I recently read by this powerful article written by a woman who was sexually abused by her own father in childhood, I was deeply moved. As an adult, she reflects on her father after his death. She reflects on the confusing and bittersweet nature of the fact that she loved him, that she has some good memories of him, that he was her father no matter what, and that he violated her innocence and took advantage of his position of control and power in a horrific way. It is sad how prevalent the sexual abuse of children is.

I strongly recommend this article. I think it can make us all (even those of us who were not abused) reflect on our own perceptions of our parents, their imperfections, their complexities, their flaws, and how that affects us throughout life.

The Death of My Molester Father by Christina Enevoldsen, July 28, 2014.

A majority of gun violence deaths stem from domestic violence

July 20, 2014

Michael Bloomberg’s gun violence prevention group called “Every Town for Gun Safety” has completed a study¬†on statistics concerning gun violence. The group found that the majority of mass gun violence deaths stem from domestic violence incidents.

Identifying 110 mass shootings, defined as shootings with four or more deaths caused by a firearm, the group found that 57 percent of those deaths were related to domestic or family violence. Specifically, the finding was that in at least 63 of the cases (57%), the shooter killed a current or former spouse, intimate partner, or other family member, and in at least 20 incidents the shooter had a prior domestic violence charge.

This serves as sobering evidence that gun safety laws need to be strengthened, as well as evidence of the extent and seriousness of domestic violence, contrary to general public understanding.

Statistics belie the common understanding of domestic violence issues as a lower level concern. Numerous recent studies have shown its prevalence and severity to be massive. It is also insidious and frequently passed down through the generations. In addition, victims of domestic violence tend to continue to subconsciously engage and re-engage in domestic violence relationships thereafter exposing their children to violence in their home environment.

It is dangerous. The following are some stark statistics about domestic violence as presented by Soraya Chemaly in the Huffington Post.

1. Number of U.S. troops killed in Afghanistan and Iraq: 6,614

2. Number of women, in the same period, killed as the result of domestic violence in the US: 11,766

3. Number of people per minute who experience intimate partner violence in the U.S.: 24

4. Number of workplace violence incidents in the U.S. annually that are the result of current or past intimate partner assaults: 18,700

5. Number of women in the U.S. who report intimate partner violence: 1 in 4

6. Number of men in the U.S. who report intimate partner violence: 1 in 7*

7. Number of women who will experience partner violence worldwide: 1 in 3

8. Order of causes of death for European women ages 16-44: domestic violence, cancer, traffic accidents

9. Increase in likelihood that a woman will die a violent death if a gun in present in the home: 270 percent

10. Number of women killed by spouses who were shot by guns kept by men in the home in France and South Africa: 1 in 3

11. Percentage of the 900 million small arms that are kept in the home, worldwide: 75

12. Country in which 943 women were killed in honor killings in 2011: Pakistan

13. Percentages of people killed in the U.S. by an intimate partner: 30 percent of women, 5.3 percent of men.

14. Estimated number of children, worldwide, exposed to domestic violence everyday: 10,000,000

15. Worldwide, likelihood that a man who grew up in a household with domestic violence grows up to be an abuser: 3 to 4 times more likely than if he hadn’t.

16. Chance that a girl of high school age in the U.S. experiences violence in a dating relationship: 1 in 3

17. Percentage of teen rape and abuse victims who report their assailant as an intimate: 76

18. Percentage of U.S. cities citing domestic abuse as the primary cause of homelessness: 50

19. Percentage of homeless women reporting domestic abuse: 63

20. Percentage of homeless women with children reporting domestic abuse: 92

21. Percentage of women with disabilities who report violence: 40

22. Annual cost of domestic violence in the U.S. related to health care: $5.8 billion

23. Annual cost of domestic violence in the U.S. related to emergency care pluslegal costs, police work, lost productivity: 37 billion dollars

24. Annual number of jobs lost in the U.S. as a result of intimate partner violence: 32,000

25. Percentage change between 1980 and 2008 of women and men killed by intimate partners in the U.S.: (w) 43 percent to 45 percent; (m) 10 percent to 5 percent

26. Average cost of emergency care for domestic abuse related incidents for women and men according to the CDC: $948.00 for women, $387 for men

27. Increase in portrayals of violence against girls and women on network TV during a five year period ending in 2009: 120 percent

28. The number one cause of death for African American women ages 15-34 according to the American Bar Association: homicide at the hands of a partner

29. Ratio of women shot and killed by a husband or intimate partner compared to the total number of murders of men by strangers using any time of weapon, from 2002 homicide figures: 3X

30. Number of people who will be stalked in their lifetimes: 1 in 45 men and 1 in 12 women (broken out: 17 percent of American Indian and Alaska Native women; 8.2 percent of white women, 6.5 pecent of African American women, and 4.5 percent of Asian/Pacific Islander women)

31. Percentage of stalkers identified as known to victims: 90.3

32. Percentage of abused women in the U.S. who report being strangled by a spouse in the past year: 33 to 47.3 (this abuse often leaves no physical signs)

33. According to one study, percentage of domestic abuse victims who are tried to leave after less severe violent and nonviolent instances of abuse: 66 versus less than 25

34. Average number of times an abuser hits his spouse before she makes a police report: 35

35. No. 1 and No. 2 causes of women’s deaths during pregnancy in the U.S.: Domestic homicide and suicide, often tied to abuse

36. Number of women killed by spouses who were shot by guns kept by men in the home in the United States: 2 in 3

37. Percentage of rape and sexual assault victims under the age of 18 who are raped by a family member: 34

38. Number of women killed everyday in the U.S. by a spouse: 3+

Another recent study confirms that early life stress impacts brain structure

July 4, 2014

A study out of the University of Wisconsin-Madison and published recently in the journal Biological Psychiatry, made findings that childhood stress leads to brain abnormalities. Such findings have been made by a number of studies in recent years. However, each study uses a unique approach and methodology and further confirms these concepts providing a more complete understanding of the issues.

Specifically, the Wisconsin-Madison study, led by Jamie L. Hanson, examined four samples of children. Three of the sample groups were identified to have suffered physical abuse, early neglect, and low socio-economic status. The researchers then used a fourth sample group who were not identified to have been subject to any of the other three criteria.

The researchers interviewed the children and their parents or guardians regarding the children’s experiences with early life stress and then examined images of the brains of these groups of children. Specifically focusing on two regions of the brain, the hippocampus and the amygdala, the researchers found measurably smaller volume in the amygdalas and hippocampi of the children in the groups subject to early life stress in contrast with the control group.

The study found smaller amygdala volumes in all three of the early life stress groups and smaller hippocampal volumes in the children who had been physically abused and those from lower socio-economic backgrounds. Higher overall early life stress and behavior problems were linked directly to lower volumes of the hippocampus and the amygdala.

The hippocampus is the area of the brain responsible for forming, storing, and processing memory and information. Among other things, it is involved in spacial orientation and navigation. It is part of the brain’s limbic system which is involved in emotion control and expression. The amygdala, also part of the limbic system, is shown to play a key role in emotion processing and expression. Its size is correlated with aggressive behavior across species.

You can see the abstract and complete text of the publication here: Behavioral Problems After Early Life Stress: Contributions of the Hippocampus and Amygdala

Yale study links childhood trauma to decreased gray matter volume in the brain

June 16, 2014

Numerous studies have shown that childhood trauma, including child abuse and neglect, lead to brain abnormalities, changes in brain structure and function. Recent studies have used modern technologies such as MRI and fMRI scans to make these showings.

A number of studies have focused on damage to the hippocampus, the area of the brain involved with emotion, memory, and consolidation of information. Research has shown that the hippocampus is affected and damaged by excessive continuing stress caused by continuing trauma such as child abuse or ongoing violence in the home.

A recent study out of Yale University, published in the the journal JAMA Psychiatry on June 11, 2014, focused on the affect of the hippocampal damage of subjects who experienced childhood maltreatment on recalcitrant drug addiction and likelihood of relapse. Performing brain scans on 175 patients undergoing drug treatment and on controls who were not currently drug addicted, the Yale researchers found that individuals who has undergone childhood maltreatment suffered damage to the hippocampal region of the brain. They also made the finding that those who had suffered childhood maltreatment and had damage to their hippocampus were more likely to relapse in their substance disorder.

You can read the results of this study online at the following link: Childhood Maltreatment, Altered Limbic Neurobiology, and Substance Use Relapse Severity via Trauma-Specific Reductions in Limbic Gray Matter Volume