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Addiction

Originally posted by Brain for Business

Addiction: a life long illness not lifestyle choice

Addiction is a major health problem that costs as much as all other mental illnesses combined (about £40 billion per year) and about as much as cancer and cardiovascular disorders also.

At its core addiction is a state of altered brain function that leads to fundamental changes in behavior that are manifest by repeated use of alcohol or other drugs or engaging in activities such as gambling. These are usually resisted, albeit unsuccessfully, by the addict. The key features of addiction is therefore a state of habitual behaviour such as drug taking or gambling that is initially enjoyable but which eventually becomes self-sustaining or habitual. The urge to engage in the behaviour becomes so powerful that it interferes with normal life often to the point of overtaking work, personal relationships and family activities. At this point the person can be said to be addicted: the addict’s every thought and action is directed to their addiction and everything else suffers.

If the addictive behaviour is not possible e.g. because they don’t have enough money then feelings of intense distress emerge. These can lead to dangerously impulsive and sometimes aggressive actions. In the case of drug/alcohol addiction the situation is compounded by the occurrence of withdrawal reactions which cause further distress and motivate desperate attempts to find more of the addictive agent. This urge to get the drug may be so overpowering that addicts will commit seemingly random crimes to get the resources to buy more drug. It has been estimated that about 70% of all acquisitive crime is associated with drug and alcohol use.

Addiction is driven by a complex set of internal and external factors. The external factors are well understood: the more access to the desired drug or behaviour e.g. gambling the more addiction there is.

The internal factors are less clear. Although most addiction is to alcohol and other drugs, addiction to gambling and other behaviours such as sex or shopping can occur. These tell us that the brain can develop hard-to-control urges independent of changing its chemistry with drugs. All addictions share a common thread in that they are initially pleasurable activities, often extremely enjoyable. This results in these behaviours hijacking the brain’s normal pleasure systems so that naturally enjoyable activities such as family life, work, exercise become devalued and the more excessive addiction behaviours take over.

However, not everyone who engages in drug use or gambling becomes addicted to them so clearly other factors are important. These are not yet understood but are now being actively studied. Some people may be particularly sensitive to the pleasurable effects of alcohol, drugs or gambling, perhaps because of coming from deprived backgrounds. In others, addiction may occur because of an inability to adopt coping strategies. Others may have an underlying predisposition to develop compulsive behaviour patterns. Some unfortunate people may have several of these vulnerability factors and there are also genetic predispositions to some of them.

Also a significant amount of drug use is for self-medication, examples include cannabis for insomnia, alcohol to reduce anxiety, opioids for pain control etc. This therapeutic use can escalate into addiction in some people though by no means all. Not all drugs which are used for recreational purposes are addictive. LSD and magic mushrooms seem not addictive at all, and some have a low risk of addiction (MDMA/ecstasy; cannabis). The most addictive drugs are nicotine, heroin and crack cocaine plus metamfetamine (crystal meth) although this is not much used in the UK.

Just because some people – including leading politicians – have used drugs but stopped before they became addicted does not mean that anyone can stop that easily. Starting to use drugs may be a lifestyle choice but once addiction sets in, choosing to stop is very much more difficult if not impossible.

We are beginning to understand how addictions start in the brain. The pleasurable or rewarding effects of addictions are mediated in the brain through the release of chemicals such as dopamine [by cocaine, amphetamines, nicotine] or endorphins [heroin] or both [alcohol]. The pleasures are then laid down as deep-seated memories, probably through changes in other neurotransmitters such as glutamate and GABA that make memories. These memories link the location, persons and experiences of the addiction with the emotional effects. These memories are often the most powerfully positive ones the person may ever experience, which explains why addicts put so much effort into getting them again. When the memories re-occur, which is common when people are still using drugs or gambling, as well as when in recovery/abstinence, they are experienced as cravings. These can be so strong and urgent that they lead to relapse.

A great deal of research has been conducted into the role of dopamine in addiction and we now know that the number of dopamine receptors seems to predispose to excessive pleasure responses from stimulant use. This excessive response is thought to initially occur in the reward centre of the brain – [the nucleus accumbens] – but then move into other areas where habits are laid down. This shift from voluntary (choice use) to involuntary (habit-use) explains a common complaint of addicts that they don’t want to continue with their addictions, and even that they don’t enjoy them anymore, but cant stop themselves. In this sense addiction can be seen as a loss-of-control over what starts out as a voluntary behavior. Thus addiction is not, as some like to suggest, simply a “lifestyle” choice. It is a serious, often lethal, disease caused by an enduring (probably permanent) change in brain function.

We know that personality traits especially impulsivity, predict excess stimulant use and in animals this can be shown to correlate with low dopamine and high opioid receptor levels. Similarly in humans low dopamine and high opioid receptor levels in brain predict drug use and craving. These observations give new approaches to treatment, both psychological interventions such as behavioural control, and anti-impulse drugs such as those used for ADHD e.g. atomoxetine and modafinil, are being tested.

For some addictions, especially heroin, the risk to the addict (life expectancy less than that from many cancers) and to society (from crime and infections), is so high that the prescription of substitute opioid drugs or even heroin itself saves lives and reduces crime. These substitute drugs are methadone and buprenorphine [Subutex]. As well as reducing crime and social costs by removing the need for addicts to commit offences to feed their habit, they also protect from accidental overdose and reduce risk of infections such as HIV and hepatitis. Similar substitute pharmacological approaches exist for other addictions e.g. gammahydroxybutyrate (Alcover) and baclofen for alcohol addiction, and varenicline (Champix) for nicotine dependence.

Another major reason for relapse in addiction is stress. This may work through increasing dopamine release in brain so priming this addiction pathway or by interactions with other neurotransmitters such as the peptide substance P. As antagonists of these neurotransmitters are now available they are being tested in human addictions and may offer an alternative to substitution treatments.

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Believe Her

Originally posted at http://shessomebodysdaughter.wordpress.com/2013/04/19/believe-her
April 19, 2013 · by

redsneakers

Would you know the signs to look for if you suspected that someone – a child – in your life was being sexually abused?

It has been our observation that perpetrators of child sexual abuse are often frequent users of pornography. And unfortunately, the victims too often suffer in silence.

It is our desire to speak truth and help raise awareness about this issue, to empower others to offer help, and so we put the above question out recently on our social media sites. Through those connections, a courageous college student, a sexual abuse survivor, answered us by writing the following article, and shares bits and pieces of her personal journey.

Please note that this is for raising awareness and informational purposes only. We strongly urge you to speak with a professional directly if you have any questions or concerns about sexual abuse (resources available here).

And so with that, we will let guest blogger Magali, share for herself:

When writing about the signs that would help create awareness on the topic of sexual abuse, it was hard to make a distinction between emotional and physical symptoms because they are so linked together.

This article is written from a female survivor’s point of view.

Sexual abuse is a wound that affects a girl wholly: psychologically, emotionally, physically and spiritually. It also affects the way we see sexuality and men.  The damage done runs deep and much time is needed to recover.

We are all different and every one of us react to things in different ways. The following are common signs one can take notice of in a girl who is a victim of sexual abuse.

When something, such as a sexual abuse, happens to anyone, it affects the body first: feelings of being defiled and dirty – the hardest thing is that your body has been attacked – and you cannot get rid of this. You cannot put this in a room somewhere and not think about it. What happened lives in your flesh.

The pain is often unbearable…and these signs and symptoms are simply ways to cope and/or to deal with that pain.

DISSOCIATION

A lot of people resort to dissociation, separating the body and the mind in order not to think about what happened in our bodies or feel the pain. For me, I hated what the person did to me and my body; I hated my body and so I started dissociating.  There was my physical body, which I didn’t want to think about, and there was me – a thinking, feeling being.

Dissociation is also a way to protect oneself of all the emotions too painful to feel. To make it simple, there was my body, my mind and my emotions  – all separate. I used to think of me as just a mind, I didn’t want to think of me as a woman, with a body. I didn’t want to think of me attracting boys or men.

mirrorGUILT SHAME AND DENIAL

After the abuse, a victim also feels a great deal of guilt and shame. We cannot believe it happened to us; we’re ashamed, we feel it happened because of something we did. The instinct is to hide it, but to keep going, pretending it never happened. That’s dangerous and leads to a lot of damage. You can keep it all bottled up inside for only so long and when it explodes to the surface, it comes back in full force, as if it had happened yesterday.

EATING DISORDERS

Eating disorders often stem from sexual abuse because of dissociation and the discomfort we feel towards our own bodies.

Eating disorders are only the symptoms revealing that a girl or young woman has a twisted perception of what her body is. She doesn’t want to see herself the way she really is…the way she was designed to be.

Eating disorders are linked with self loathing, guilt, shame – it’s a very complex disease. (visit ‘Tell Me What You See as a resource and for more information)

SELF HARMING

Some victims feel so much guilt and shame that they have to take it out on themselves. Self harming is not only cutting it can also be scratching, burning.

Advice: the girl may not always cut on her arms, she might cut somewhere so it will not be noticed.

SUBSTANCE ABUSE AND ADDICTION

Substance abuse can also be a way to deal with the pain and often leads to a drug addiction.

POST TRAUMATIC STRESS

Post traumatic stress is hard to describe precisely for each person, but often nightmares, panic attacks, unwanted memories and flashbacks haunt us as victims. Post traumatic stress is not rational  – it’s basically how our emotions choose to express themselves.

I remember having panic attacks in a class managed by a man, he had done nothing wrong or inappropriate, but just the idea of sitting down in his class was unbearable. It’s not a rational thing; yet the emotions are so strong and just as hard to navigate.

lonely-girlTHE NEED TO FEEL SAFE

A victim of abuse will feel the need for protection, a need to protect herself. She will build up walls, physically and emotionally.

Physically:

1. She might change the way she dresses, to prevent boys or men to be attracted to her.

2. She might not want to sit close to a man or a boy. Being on a bus or a subway is still a nightmare for me.

Emotionally:

1. She will distance herself and not let anyone get close to her. I was always in control,  choosing what I would say, what I would do in front of people. I would lie through my teeth swearing up and down that I was okay when asked; please don’t take it personally when we lie…we lie to ourselves first and foremost.

2. If the girl has friends who are boys, she might have a difficult time being around them.

UNEASINESS TALKING ABOUT SEXUALITY

Obviously, they will be uncomfortable with the topic of sexuality and the topic of dating, relationship with men/women. Our minds associate sexuality with the abuse even if it couldn’t be farther from the truth and anything that isn’t safe is out of the question.

ATTACHMENT TO CHILD BEHAVIOUR

After abuse, I didn’t want to think of myself as a woman so I was semi-consciously reverting back to acting like a child, sleeping with a teddy bear…

DEPRESSION

This looks like having trouble getting out of bed in the mornings, not wanting to make plans with anyone, wanting to stay in all the time, an overall sadness, not smiling, not laughing, shutting yourself off.

MOOD SWINGS

MY ADVICE IF YOU THINK YOU KNOW SOMEONE WHO WAS OR IS BEING ABUSED:

  • Please be patient. Considering the amount of trauma she’s been through, she will not open up easily.
  • Tell her you love her and that it’s going to be okay. Assure her that you are going to be there for her no matter what!
  • If she says she was abused, believe her; you don’t need to know every single detail!
  • Help her find a safe place, a counselor she can talk to
  • Allow her to recover in her own time – don’t rush it and don’t force her to talk

paintingTHE RECOVERY PROCESS

Let those trained to deal with sexual trauma and abuse do their work. I understand it can be hard for families or friends to be kept out of the process, but it’s necessary.

Be happy and encouraged that she found someone safe to talk to, even if it’s not you.

ON THE TOPIC OF FORGIVENESS

Be really careful with the topic of forgiveness: don’t push it or rush it! Just hearing the word made my insides scream! I remember hearing about it at church, and at the time it took all I had in me not to explode and run out of there.

WHAT YOU CAN DO

  • encourage her
  • tell her you are praying for her
  • support her when she talks to you
  • you can also help her find an outlet for letting all the emotions out; if she’s a creative person: painting, drawing, writing, singing, or if she’s more active: find a sport

It is our hope, along with Magali’s, that by publishing this information we all will have a new awareness of those around us who might be suffering in silence, and be willing to offer help and hope.

♥ Thank you, Magali, for sharing so openly and honestly – and so courageously! ♥

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Adult Manifestations of Childhood Sexual Abuse

Adult Manifestations of Childhood Sexual Abuse
Full PDF article and figures can be found here:
http://publichealth.lacounty.gov/wwwfiles/ph/media/media/TPH-409.pdf

Background

While childhood sexual abuse (CSA) continues to be a major public health problem, an equally severe and silent epidemic are the estimated 39 million adult survivors of childhood sexual abuse in the United States who continue to exhibit aftereffects of CSA that predispose them to adverse psychosocial outcomes throughout their adolescent and adult life.

Early childhood traumas such as sexual abuse can have lifelong effects throughout adulthood, and the cost to society is high. Ninety percent of cases go unreported and untreated, as the symptoms of CSA are often misdiagnosed and unappreciated.

This article attempts to provide clinicians with awareness of the neurodevelopmental effects of CSA, the adult clinical symptoms, and the adverse psychosocial outcomes of CSA. It will also present tools to help identify the aftereffects of CSA in adulthood and provide mandated reporting protocols.

Definition

Sexual abuse is defined as any sexual activity that a child cannot comprehend or consent to. It includes acts such as fondling, oral-genital contact, and genital and anal intercourse, as well as exhibitionism, voyeurism, and exposure to pornography. A central characteristic of any abuse is the dominant position of an adult that allows him or her to force or coerce a child into sexual activity. Researchers have determined that child sexual abuse victims come from all cultural, racial, and economic groups. The lack of a universal definition of CSA contributes to the complexity of data collection and estimates.

Incidence and Prevalence

Currently, CSA prevalence in the U.S. is not known, but estimates vary from 12% to 40%. Incidence studies suggest that while on average 5.5 children per 10,000 enrolled in day care are sexually abused, a greater number of children (8.9 children per 10,000) are sexually abused in their home. Further CSA studies suggest that 53% of the abuse occurs in the home, 57% report the perpetrator was a family member, and 65% report repeated abuse. Overall, studies show that 1 in 3 females, and 1 in 6 males have experienced childhood sexual abuse by the age of 18.

While nearly 90,000 cases of child sexual abuse are reported each year in the U.S., between 88%-90% of CSA cases are estimated to be unreported and interestingly, between 21%-49% of CSA victims appear asymptomatic following victimization. The lack of disclosing a history of sexual abuse contributes to the lifelong effects of the abuse.

Neurodevelopmental Damage of CSA

Controlled studies have shown that adult survivors of child sexual abuse (ASCSA) are more likely to exhibit adverse psychopathologies in adulthood, and neuroimaging studies confirm that exposure to sexual abuse in childhood alters the neurobiology and neurostructures in the brain, leading to scarring, an abnormal neurohormonal response to future stressors, and predisposes the victim to a lifetime of negative consequences.

Neurological damage from sexual abuse alters early brain development, increasing the risk for psychopathology in adolescence and adulthood (Table 1). The hippocampus, responsible for new learning and memory, plays a critical role in recording emotions that are attached to a stressful event such as sexual abuse. The hippocampus is known to be very sensitive to stress. During stress, high levels of glucocorticoids are released, and over time (as observed among CSA victims, including those re-victimized) elevated levels of glucocorticoids damage neurons in the CA3 region of the hippocampus and lead to atrophy. While the hippocampus has been shown to regenerate neurons, stress inhibits neurogenesis.

Abnormalities of the hippocampus have been shown to be associated with pathological fear, mood imbalances, and anxiety reactions in trauma-related disorders (also hallmarks among ASCSA).

Magnetic resonance imaging (MRI) studies have demonstrated a 12% left hippocampal volume size reduction among adults who have been sexually abused in childhood as compared to healthy controls (Figure 1). Similar reductions are exhibited among subjects with trauma-spectrum disorders such as depression, dissociation, PTSD, and borderline personality disorder. In addition, the amygdala, responsible for emotional and fear regulation, is affected by early sexual trauma, resulting in similar psychopathologies.

Studies suggest sexually traumatized children are also less able to utilize both brain hemispheres to process experiences. The corpus callosum, a longitudinal fissure that connects the left and right cerebral hemispheres, is shown to be abnormal in sexually abused children. Generally, the left side of the brain processes positive emotions and logical thinking, and the right processes negative emotions such as fear. When the corpus callosum is not operating properly these processes are unable to function at the same time, thus supporting theories why many abused individuals divide people into “all good” or “all bad” and exhibit mood swings, as observed in borderline patients.

Adult Manifestations of CSA

There is no adopted definition to identify the symptoms exhibited among ASCSA; however, evidence-based research has confirmed long-term effects of CSA in adolescence and into adulthood. Later in their lives, many ASCSA, whether reported or not, exhibit psychopathology, acting-out behaviors (social dysfunction), relationship problems (interpersonally), somatic symptoms, and sexual disorders.

CSA survivor studies suggest that ASCSA use health care services more often than the general population, are shown to exhibit more somatic symptoms that do not respond to medical treatment, and present more severe and complex symptoms.The response to sexual abuse during childhood varies, and is largely dependent on 1) age at onset; 2) severity; 3) duration; 4) relationship to the perpetrator; 5) the child’s resiliency; and 6) stability of and support from the family.

Childhood survivors might initially seem unaffected by the trauma; however, by adolescence and adulthood, the consequences eventually become symptomatic, resulting in eating disorders, dissociation, phobias, obsessions, borderline personality disorder, depression, anxiety, bulimia, obesity, post traumatic stress disorder, hallucinations, conduct disorder, substance abuse disorder, panic disorder, antisocial personality disorder, affective disorder, and impaired sense of self.

Behavioral Effects of CSA 

Acting out

Children are limited in their physical, cognitive, and emotional development and, thus, dependent upon adult and often sibling caregivers to provide love, trust, and support. Once a child is violated however, shame and stigma often follow, as well as fear that disclosing the abuse will result in re-victimization, loneliness and isolation, physical violence, and death. Poor coping skills are common among this cohort, such as substance abuse, tobacco use, overeating, addiction, lying/stealing, poor academic performance, expectation of early death, poor adherence to medical treatment, suicide, anger, prostitution, and increased risk of sex crimes.

Relationship problems

Controlled studies identify an association between childhood sexual abuse and adult relationship problems. Adult manifestations of CSA increase the risk of intimate partner violence victimization and perpetration, rape after 18 years of age, low self-esteem, intimate relationship problems, divorce, interpersonal problems, victim-perpetrator cycle, superficial idealization of sexual relationships, and the inability to trust others.

Somatic symptoms

Evidence illustrates that CSA also results in biophysical changes. ASCSA show a decreased threshold for pain. Other effects include a heightened sensitivity in the pelvic or abdominal region, various bowel symptoms, musculoskeletal disorders, back pain, severe headaches, gastrointestinal problems, sleep disorders, asthma, and pseudocyesis.

Sexual disorders

Adult manifestations of CSA increase adolescent and adult risk of exposure to sexually transmitted diseases, compulsive sexual behaviors, early sexual activity, extreme masturbation, sexual promiscuity, poor sexual adjustment, poor contraceptive practices, and teen pregnancy.

Functional amnesia

Functional amnesia (dissociative amnesia–dissociative disorders) can develop after severe trauma, such as child sexual trauma. This is especially true among children experiencing severe sexual trauma or in those aged 5 years or younger. Functional amnesia among CSA cases varies widely, from 19% to 88%. While theories about amnesia and delayed recall of CSA vary and may be controversial due to false memories, it is important to recognize that later in adolescence or adulthood, the victim may not recall the experience. Additionally, if the abuse occurred in middle childhood, ages 6-12, the victim may 1) develop false memories that the abuse ever occurred; 2) be in denial; or 3) be unaware that the type of experience was determined to be sexual abuse. 

Role of the Clinician

The clinician plays an important role in caring for adult survivors of childhood sexual abuse. Because the presenting symptoms can be somatic in nature, the role of CSA in the patient’s illness or presenting symptoms can be overlooked.

Despite never reporting the abuse, 85% of adult survivors of child sexual abuse favor physician screening. Directly asking patients about the occurrence of abuse has been shown to elicit more positive responses compared to self-reporting, 29% versus 7% respectively. Further, especially among adolescent patients, it is important to remember that early disclosure of sexual abuse by the victim is critical to reducing the effects of CSA and to helping reduce psychological distress later in life. Symptoms of ASCSA can vary greatly and, in fact, the patient can be asymptomatic.

Evidence-based research suggests that many interventions can be useful in this population. For example, coping-skill interventions seem to help diminish or prevent post traumatic stress disorder and related adult aftereffects of CSA. Physicians can use the SAVE universal screening tool (Table-2) for childhood sexual abuse in adulthood, developed by the Florida Council Against Sexual Violence. This useful tool screens patients for sexual violence.

Physicians should also be familiar with their own hospital, clinic, or HMO policies and procedures regarding sexual violence reporting, as well as the use of specific reporting forms. The California Medical Training Center develops instructional materials and conducts training in clinical forensic medicine techniques for physician and other health care professionals, social workers, and related reporters.

 

James M. DeCarli, MPH, MPA, CHES
Injury and Violence Prevention Program
Los Angeles County Department of Public Health

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Effects of Childhood Sexual Abuse, Part 6

Effects of abuse on children, part 6
By Paul Irby Special to the Abilenian
Abilene Reporter-News
Posted June 10, 2009 at 3:25 p.m.

Over the last five months we have examined the possible effects of childhood sexual abuse on its victims. These effects were considered with regard to the impacts on cognitive, emotional and behavioral dimensions. In this article bringing a close to this series, I would like to address some common myths or misconceptions prevalent in our society.

The first misconception to be addressed is the narrow definition often assigned to sexual abuse. A complete conception of sexual abuse should also include exposure to graphic sexual material. Exposure can include Internet, magazines and video, as well as witnessing adults engaging in sexual acts. It should be clarified that a child who accidentally wanders in on parents having sex one time will not be forever psychologically damaged. Exposure becomes damaging and abusive when sex and sexual material is available frequently, without discrimination and/or purposely targeted to the child.

The second misconception to be addressed is the notion that victims of sexual abuse are somehow destined to perpetrate the abuse on other children. While it cannot be denied that the vast majority of abusers were abused themselves, it cannot and should not be assumed that the majority of abused children will become abusers. It is understandable how this misconception can be perpetuated given the increased likelihood that most abuses (physical, emotional and neglect) are handed down intergenerationally. Physical and emotional abuse are most likely to be handed down from generation to generation because they are usually impulsively expressed through anger and modeled frequently. Neglect is a more passive abuse, and is usually intergenerational because of lack of education and intervention. Sexual abuse is different in that it usually requires premeditation and incremental “grooming.” It is this premeditative nature of sexual abuse that decreases the likelihood of intergenerational transference compared to other abuses. It should also be noted that no victim of any form of abuse is destined to repeat it.

Lastly, I would like to offer some insight to parents who might be wondering how to best respond to their child who has been sexually abused. Typically there are two extreme responses parents can have, both of which are not best for the children. The first extreme is to “sweep” the abuse “under the carpet” after the initial disclosure, the family seeks to reduce the anxiety and awkwardness of talking about the abuse modeling an unwritten rule that this subject is now somehow taboo. The other extreme is when parents begin to define their child by the abuse, and consistently bring up the subject either in direct conversation or by initiating new rules for the child, such as not being alone with friends, going to friends’ houses and not being able to spend the night with friends. The best response parents can have is to resume normalcy in the routine at home and to let the child know that the parent is concerned about how the child might be dealing with being abused and is willing to listen if the child ever desires to talk about it.

I would like to personally thank executive director Kirk Hancock and the Mental Health Association of Abilene for allowing me to contribute these articles that I hope can be used as part of the healing dialogue in our community.

Paul Irby, M.A., is a licensed professional counselor with the Ministry of Counseling and Enrichment. Mental Health Matters is facilitated by the Mental Health Association in Abilene.

Original article found here:
http://www.reporternews.com/news/2009/jun/10/effects-abuse-children-part-6/

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Effects of Childhood Sexual Abuse, Part 4

April is Abuse Prevention Month
By Paul Irby Special to the Abilenian
Abilene Reporter-News
Posted April 1, 2009 at 5:26 p.m.

April is designated as abuse prevention month for the state of Texas. Therefore, the Mental Health Association of Abilene, felt it more than appropriate to run its latest installment of the “Effects of Abuse Series.” This installment is in two parts, because there is much to consider. In the previous two articles we considered the mental and emotional impacts of abuse, respectively. The third dimension to be examined is the behavioral dimension. What kinds of behaviors are “typical” of a person who has been sexually abused? The easy and disappointing answer is that there are no “typical” behaviors, and the behaviors that will be discussed are ambiguous enough that they should not be the sole determining factor in assessing if one has been abused. However, it is a fact that the behaviors are the first thing we notice in people that cause us alarm or concern. It is also important to clarify that behaviors are the end result of the “chain reaction” we have been discussing between thoughts/beliefs, feelings and behaviors.

The underlying belief that fuels those feelings of depression, anxiety, fear, anger, shame and doubt is the belief that he/she is “different” from others; that he/she is alone in this struggle and if anyone truly knew his/her plight, they would not value him/her. One of the most common manifestations of these beliefs and emotional responses is in the abused creating a persona of anger and aggression. This persona is in reality a wall meant to communicate to the world, “keep out!” and “if you don’t stay away, I’ll make sure you regret trying to get close.” Males will tend to be more physically aggressive while the females are more likely to be more verbally aggressive. Both are the result of a brooding anger which ultimately can be traced back to the fear of being betrayed, hurt, exploited and victimized again.

Depression and anxiety can lead to behavior manifestations like withdrawal, self-injury and suicidal ideations and attempts. Withdrawal is a common behavior in abuse victims. If the abuse begins at an early age and is chronic, this withdrawal may go unnoticed and explained away as a personality trait. Withdrawal is more noticeable in children between the ages of 8-18 because there is an already established pattern of social interaction. Self-injury is most common in adolescent females and takes the form of surface-level cuts on the forearms, abdomen, pelvis, or underneath the breast. The purpose of the self-injury is usually to achieve a sense of release reinforced by the initial shot of pain and subsequent presentation of blood. Many who engage in this behavior find it difficult or unacceptable to cry because crying leaves one with feelings of vulnerability, which is interpreted as weakness. Crying can also become uncontrollable, which again frightens the abuse victim, who often desires to have control in a life that seems so chaotic. The child who engages in self-injury believes they can control the cutting and therefore believe it to be a safe alternative. The self-injury then becomes another secret that has to be hidden and protected. In some ways this can relate back to the aspect of control, the cutter has control over the secret, but ultimately it becomes one more stressor which maintains the need to alleviate that stress. Self-injury can also be used as a form of self-punishment motivated by feelings of worthlessness. These feelings of worthlessness, when coupled with pent-up anxiety, depression, and fear, can lead to thoughts and attempts at suicide.

In the next installment we will look inside the possible sexual manifestations of a sexually abused child and how abuse can lead to substance and process addictions.

Paul Irby, M.A., is a licensed professional counselor with the Ministry of Counseling and Enrichment. Mental Health Matters is facilitated by the Mental Health Association in Abilene.

Original Article found here:
http://www.reporternews.com/news/2009/apr/01/april-abuse-prevention-month/