1. Long term effects of Child Abuse
JHatlevig Ph.D., RNC

2. Post-traumatic Effects
Ann is a first year college student and comes into the college counselor saying that she is going crazy. Ann is anxious and shaky and she holds her arms in front of her. She reports having nightmares for the past three years along with panic attacks, difficulty concentrating and the sudden intrusion of sexual pictures into her thoughts. She sees erect penises, feels like she is suffocating and blood in the bathrrom sink. She reports being sexually and physically abused by her stepfather and was frequently locked in the garage when she misbehaved.

3. Symptoms
Reexperiencing the event via nightmares, intrusive thoughts or flashbacks (sensory memories)
Trauma event has transpired
Numbing of general responsiveness or avoidance of current events in the world
Persistent symptoms of increased arousal such as anxiety, sleep disturbances, concentration, and startle response

4. Cognitive Disturbances
Eric is a 30 year old man who has been in therapy intermittantly for 5 years. He constantly tells himself that he is “dumb, stupid, ugly, disgusting, filthy, gross” and other disparaging remarks. This internal monologue is constant and engenders feelings of unworthiness, inadequacy, fear of failure, and wanting to be dead. He denies having been abused and calls his parents perfect. They used psychological methods of control.

5. Cognitive symptoms Cognitive distortions Low self-esteem/self image
Self blame
Worthlessness
Vulnerability
Decreased self efficacy/powerlessness
Stigma/internalized judgement of self
Self messages-dichotomy

6. Self regulation/emotionality
Lisa is a 20 year old female who presents as a sad, slightly obese college student at the health center. Her parents divorced when she was 15 years of age due following discovery of the sexual abuse which had occurred since Lisa was 12. Her mother is lonesome and dating someone. Lisa has no siblings. She is becoming increasingly depressed and has started to return to cutting herself. Physical abuse occurred from both parents her whole life and she is glad to be at college.

7. Problems with emotions
Depression-#1 in the literature
Dysthymia
Alcoholism/CD
Cognitive distortions
Withdrawal
Anxiety
Rage
Psychosomatic disorders

8. Dissociation
Kari is a 16 year old who was referred for therapy following the discovery of sexual/physical/psychological abuse from a stepfather. Kari has a 15 year old sister, Jan, and a 9 year old half-sister, Becky. Jan was also abused and Becky was being groomed for abuse. Their stepfather would drink and hold a knife or gun while they performed oral sex. She says she spaces out, self-mutilates, is anxious or hypervigalent, gagging and self-disgust.

9. Dissociation Dissociative episodes-disengagement and detachment
Hypervigalence/anxiety
Sensory memories
Self-mutilation
Fragmented memories-amnesia
Overwhelming emotions, e.g. fear
Depersonalization

10. Impaired Sense of self
Emily is a 25 year old female who was sexually/physically abused by foster families most of her childhood. She works as a clerk and has lost several jobs. She is lesbian and has had many abusive relationships where she is the victim. She has been diagnosed with a dependent personality disorder and frequently stalks her former lovers.

11. Sense of self Identity problems Negative self definition
Confused boundaries
Feelings of emptiness
Difficulty maintaining any personal relationships
Hypervigalence/other directed

12. Disturbed relationships
Jan is a 44 year old supervisor at a retail store. She is in a group for incest survivors. She has been married 3 times and states that she has to have a man in her life. She acts like a child and flirts when men are around. With women she is angry, sarcastic and distrustful. She seeks out violent men who harm her before they leave. No one can get too close.

13. Disturbed relatedness
Intimacy disturbances
Altered sexuality
Aggression in relationships
Adversality
Manipulation
Sexual preoccupation

14. Avoidance
Amy is a 42 year old female sexually and physically abused by her stepmother as long as she remembers. Her stepmother had adopted her when her parents married and then her father left and would not take her. Her stepmother was brutal, frequently tying her up, burning her with cigarettes, and giving her to boyfriends. She suffered many broken bones, etc. but she said nothing to the authorities. She is chemically dependent and has treated several times.

15. Avoidance Chemical use and abuse Suicide Impulse control
Tension-reducing responses to numb, self soothe, interrupt dissociative state, restore control, fill emptiness, relief from guilt, alter sensory input, numb psychic pain, etc.
Self-mutilation
Sexually compulsive behavior
Binging and purging

16. Other DSMIV PTSD Borderline Personality Disorder
Dependant Personality Disorder
Acute Stress Responses.
Eating Disorders

17. Classify Depression
Major Depression ( Clinical term ) Depression in people who have no ability to cheer themselves up.
Postpartum Depression Depression that occurs in women soon after giving birth. ( Generally the same as Major Depression. )
Primary Depression Depression alone with no other medical illness / disorder.
Psychotic Depression ( Clinical term ) Depression accompanied by delusions and/or hallucinations.
Secondary Depression Depression that occurs after the onset of another medical illness / disorder.
Unipolar Depression Depression with no manic episode.

18. Continued
Atypical Depression ( Clinical term ) Depression in people who have an ability to cheer themselves up by doing certain things.
Bipolar Depression ( Clinical term ) Depression with manic episode(s).
Endogenous Depression Acute Depression with no obvious cause(s).
Involutional Depression Depression that occurs in the elderly. ( Generally the same as Major Depression. )
Reactive Depression Depression caused by an obvious traumatic life episode(s).

19. Anxiety Disorders Types
Acute Stress Disorder Agoraphobia Agoraphobia Without History of Panic Disorder Anxiety Disorder Due to a General Medical Condition Anxiety Disorder Not Otherwise Specified ( Anxiety Disorder NOS ) Generalized Anxiety Disorder ( GAD ) Obsessive-Compulsive Disorder ( OCD ) Panic Attack Panic Disorder With Agoraphobia. Panic Disorder Without Agoraphobia. Posttraumatic Stress Disorder Social Phobia Specific Phobia Substance-Induced Anxiety Disorder

20. Factitious Disorders Types
Factitious Disorders are characterized by feign symptoms or disorders. This is not for the purpose of any particular gain but because there is an inner need to maintain a role of being sick.
With Combined Psychological and Physical Signs and Symptoms. With Predominantly Physical Signs and Symptoms. With Predominantly Psychological Signs and Symptoms.

21. Impulse-Control Disorders
Impulse-Control Disorders are disorders in which a person act on a certain impulse, that is potentially harmful, but they cannot resist.
Impulse-Control Disorder Not Otherwise Specified.  ( NOS ) Intermittent Explosive Disorder. Kleptomania. Pathological Gambling. Pyromania. Trichotillomania.

22. Sleep disorders
Sleep disorders are divided into four categories, Primary Sleep Disorders, Sleep Disorder Due to a General Medical Condition, Sleep Disorder Related to Another Mental Disorder, and Substance-Induced Sleep Disorder. Primary Sleep Disorders consist of two subtypes, Dyssomnias and Parasomnias.  Dyssomnias is characterized by problems in getting the right amount of sleep, in the quality of sleep, and in the time sleep takes place. Parasomnias is characterized by problems in behavioral or the physiological aspect of sleep.

23. Dissociative Disorders Types
Dissociative Amnesia. Depersonalization Disorder. Dissociative Fugue. Dissociative Identity Disorder. Dissociative Disorder Not Otherwise Specified.  ( NOS )
Dissociative Amnesia: This disorder is characterized by a blocking out of critical personal information, usually of a traumatic or stressful nature. Dissociative amnesia, unlike other types of amnesia, does not result from other medical trauma ( e.g. a blow to the head ). Dissociative amnesia has several subtypes:
Localized amnesia is present in an individual who has no memory of specific events that took place, usually traumatic. The loss of memory is localized with a specific window of time. For example, a survivor of a car wreck who has no memory of the experience until two days later is experiencing localized amnesia.
Selective amnesia happens when a person can recall only small parts of events that took place in a defined period of time. For example, an abuse victim may recall only some parts of the series of events around the abuse.
Generalized amnesia is diagnosed when a person's amnesia encompasses his or her entire life.
Systematized amnesia is characterized by a loss of memory for a specific category of information. A person with this disorder might, for example, be missing all memories about one specific family member.
Dissociative Fugue is a rare disorder. An individual with dissociative fugue suddenly and unexpectedly takes physical leave of his or her surroundings and sets off on a journey of some kind. These journeys can last hours, or even several days or months. Individuals experiencing a dissociative fugue have traveled over thousands of miles. An individual in a fugue state is unaware of or confused about his identity, and in some cases will assume a new identity ( although this is the exception ).
Dissociative Identity Disorder ( DID ), which has been known as multiple personality disorder, is the most famous of the dissociative disorders. An individual suffering from DID has more than one distinct identity or personality state that surfaces in the individual on a recurring basis. This disorder is also marked by differences in memory which vary with the individual's alters, or other personalities.
Depersonalization Disorder is marked by a feeling of detachment or distance from one's own experience, body, or self. These feelings of depersonalization are recurrent. Of the dissociative disorders, depersonalization is the one most easily identified with by the general public; one can easily relate to feeling as they in a dream, or being spaced out. Feeling out of control of one's actions and movements is something that people describe when intoxicated. An individual with depersonalization disorder has this experience so frequently and so severely that it interrupts his or her functioning and experience. A person's experience with depersonalization can be so severe that he or she believes the external world is unreal or distorted.

24. Case Studies
The Landers Family (Child with unidentified anger issues) p Please answer the questions on p