The making of an abuser

This paper investigates how it is that a child has become an abuser, and by what means that process may be deconstructed. We know that abusers generally have a childhood history of abuse, though not necessarily sexual. Since not all children who have been traumatised repeat those patterns, and inflict abuse on others, then something must have happened for these particular children in response to their abuse. The author elaborates the view that there is no such thing, to paraphrase Winnicott, as ‘an abused child’ – no such child, that is, separate from the world of the relationships that formed him. He draws on the conceptualisation by Bentovim of an interlocking set of roles described as a ‘trauma organised system’; this notion reflects the fact that the child is a product not just of his specifically traumatic experiences but of a milieu in which power and control is exerted by someone who has typically succeeded in neutralising any caring function in a family in order to bring about the exploitation of a child. Clinical material is presented from the intensive psychotherapy of a nine-year-old boy, who happened also to be a refugee, for whom abusive family dynamics dominated his internal world. He was found to have identified with the abuser, his own father, in order to escape the pain of his victim self and was threatening to act this out in the treatment, making the therapist into a victim. Management of the treatment setting by the inclusion of a benign parental figure enabled the acting out to be contained. Symbolisation of the child’s inner conflicts became possible through play. As the abuser self was contained so the child’s victim experiences could be processed. The conclusion is drawn that engaging therapeutically with the residues of trauma from the beginning of treatment is essential in working with young people who have abused.     

A new diagnosis of complex Post-traumatic Stress Disorder,PTSD – a window of opportunity for the treatment of patients in the NHS?

The concept of complex trauma has been around for a long time and in 2018, it’s expected to become a new diagnosis in the International Classification of Diseases eleventh revision, ICD-11, the World Health Organisation, WHO, manual used formally in the NHS. Psychiatric diagnosis often does not sit well with psychoanalysis, which is at least as interested in unconscious phantasy as it is in symptoms. But as psychodynamically-trained practitioners in the NHS we need to engage with ICD-11 and apply our own understanding to service design so that patients have access to treatment which works for them. The service where I work (a secondary mental health team in the London borough of Lewisham) has already been receiving referrals for ‘complex trauma’ for some time, despite its not being formally classified. Patients so described are most often those with a history of childhood sexual abuse, and refugees with a history of brutality and torture. Differential diagnosis includes personality disorder since many have difficulties with interpersonal issues. In this paper I want to discuss how we might understand the new diagnosis of complex Post-traumatic Stress Disorder, PTSD, and its implications for treatment in the NHS.     

Coping style and memory specificity in adolescents and adults with histories of child sexual abuse

Individuals with histories of childhood trauma may adopt a nonspecific memory retrieval strategy to avoid unpleasant and intrusive memories. In a sample of 93 adolescents and adults with or without histories of child sexual abuse (CSA), we tested the hypothesis that nonspecific memory retrieval is related to an individual's general tendency to use avoidant (i.e., distancing) coping as a personal problem-solving or coping strategy, especially in victims of CSA. We also examined age differences and other individual differences (e.g., trauma-related psychopathology) as predictors of nonspecific memories. Distancing coping was significantly associated with less specific autobiographical memory. Younger age, lower vocabulary scores, and non-CSA childhood maltreatment (i.e., physical and emotional abuse) also uniquely predicted less autobiographical memory specificity, whereas trauma-related psychopathology was associated with more specific memory. Implications for the development of autobiographical memory retrieval in the context of coping with childhood maltreatment are discussed.     

Refusal Self‐Efficacy Among SMART Recovery Members by Affiliation Length and Meeting Frequency

Using the Brief Situational Confidence Questionnaire, the authors examined the refusal self‐efficacy of 105 Self‐Management and Recovery Training (SMART Recovery) members according to their affiliation length and meeting frequency. Results demonstrated that longer affiliation with SMART Recovery and higher meeting frequency significantly enhanced substance refusal self‐efficacy.     

The Relation Between Compulsive Sexual Behaviors and Aggression in a Substance-Dependent Population

Research supports a high comorbidity between compulsive sexual behaviors (CSBs) and substance use disorders (SUDs), which are both classified by increased impulsivity. Literature has also indicated that increased impulsivity and substance use are associated with aggression. However, no known research has examined the relationship between CSBs and aggression among a substance-dependent population. The purpose of this study was to examine this relationship. Participants included 349 male patients in treatment for SUDs. Results indicated that after controlling for alcohol and drug use and problems and age, CSBs were significantly associated with total aggression, aggressive attitudes, physical aggression, and verbal aggression. This is the first known study to examine this relationship; thus continued research is needed to extend and replicate these findings.     

The Relationship between Intimate Partner Violence and Suicidal Ideation among Young Chinese,Korean, and Vietnamese American Women

ABSTRACT

High depression and suicide rates are critical problems that have a significant impact on the lives of young Asian American women. Intimate partner violence (IPV) has been identified as a predictor of suicidality in general female samples, but no research study has examined the relationship between IPV and suicidality in a sample of 1.5 and second-generation Chinese, Korean, and Vietnamese American women. We used data collected from 173 women (aged 18-35 years) who were screened for eligibility to participate in the development and efficacy study of Asian American Women’s Action for Resilience and Empowerment (AWARE). We measured the prevalence of (a) IPV, (b) lifetime suicidal ideation/intent, and (c) childhood abuse and tested the association between IPV and lifetime suicidal ideation/intent among study participants who completed the clinical screening assessments. The results indicated that seven out of 10 women in our sample experienced lifetime suicidal ideation/intent, psychological aggression was the most commonly reported form of IPV during the last six months, followed by sexual coercion, and history of physical and/or sexual partner violence had the most robust association with lifetime suicidal ideation/intent after controlling for demographic factors and childhood abuse. Our study suggests that suicide prevention and intervention programs for young 1.5 and second-generation Asian American women should not only address experiences of childhood abuse, but also incorporate culturally adapted behavioral health approaches to identify and target physical and sexual partner violence. Furthermore, any such programs need to integrate a systemic approach in addressing IPV within the context of various marginalized experiences of Asian American women.     

Are emotion regulation difficulties a moderator in the relationship between dating abuse and body investment in eating disorders?

IntroductionIt is well known that eating disorders (EDs) are related to intimacy difficulties and to previous adverse experiences; however, little is known about dating abuse and how this kind of abuse is related to the different facets of body investment and emotion regulation difficulties in EDs. This study aimed to evaluate the presence of dating abuse in ED outpatients and to evaluate the moderating role of difficulties in emotion regulation in the relationship between dating abuse and the different facets of body investment.MethodSixty-four ED outpatients (95.3% females; aged from 15 to 30 years) completed self-report measures regarding dating abuse, body investment, difficulties in emotion regulation, and ED symptoms.ResultsApproximately 89% of ED outpatients identified a current or past dating relationship. Of those, 51 (89.5%) reported at least one episode of dating abuse perpetration, and 52 (91.2%) reported at least one episode of dating abuse victimization. Emotional abuse was the most reported type of dating abuse. High levels of dating abuse were related to elevated body care in participants with more difficulties in emotion regulation. The remaining models, incorporating the other facets of body investment, did not show significant moderating effects.DiscussionA substantial number of ED outpatients reported dating abuse. Pending longitudinal replication, body care may be used as a strategy to deal with dating abuse in the absence of more adaptive emotion regulation strategies.     

心理虐待与忽视对志愿投入的影响:链式中介效应分析

本研究根据道德认同模型与亲社会行为理论,以808名大学生志愿者为被试,通过问卷调查探索心理虐待与忽视对志愿投入的影响机制。结果发现:心理虐待与忽视对志愿投入的影响主要由公正世界信念与道德认同的中介作用来实现。本研究揭示了心理虐待与忽视与志愿投入的关系及内在机制,丰富了公正世界信念和道德认同的相关研究。