Abstract
Child and adolescent mental health services (CAMHS) routinely overlook assessing for, and providing treatment to, infants and children living with family violence, despite family violence being declared endemic across the globe. As contemporary neuro-developmental research recognises the harm of being exposed to early relational trauma, key international diagnostic texts such as the DSM-5 and ICD-10 struggle to acknowledge or appreciate the relational complexities inherent in addressing family violence and its impacts during childhood. These key texts directly influence thinking, funding and research imperatives in adult services as well as CAMHS, however, they rarely reference family violence. Their emphasis is to pathologise conditions over exploring causality which may be attributable to relational violence. Consequently, CAMHS can miss important indicators of family violence, misdiagnose disorders and unwittingly, not address unacceptable risks in the child’s caregiving environment. Notwithstanding urgent safety concerns, ongoing exposure to family violence significantly heightens the development of mental illness amongst children. CAMHS providers cannot and should not rely on current diagnostic manuals alone. They need to act now to see family violence as a significant and important risk factor to mental health and to treat its impacts on children before these develop into enduring neurological difficulties.
Highlights
The prevalence of violence within families is considered to be at endemic levels across the world [1,2,3]
This review found that there was a dearth of references to violence occurring within familial relationships across the DSM-5, the ICD-10 and the DC:0-5
The DSM-5 and ICD-10’s failure to recognise the links between early childhood exposure to family violence and mental health disorders, and assessing for current exposure to family violence essentially disappears and disavows the experience of infants, children, adolescents and adults impacted by that violence
Summary
The prevalence of violence within families is considered to be at endemic levels across the world [1,2,3]. Relational trauma and exposure to toxic stress—in utero and perinatally—has been shown to have enduring and detrimental impacts across development within the early years, childhood, and beyond, significantly increasing the development of mental health disorders [4] This invited paper provides a commentary on the misalignment between current knowledge regarding early brain development and the application of this knowledge in key mental health diagnostic texts in determining, or failing to determine, responses to children impacted by familial violence. Brain Sci. 2017, 7, 133 two significant classification and diagnostic manuals in their assessment and treatment plans for children and young people These two texts are the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) produced by the American Psychiatric Association [5], and the ICD-10 Substance-Related and Addictive “Nightmares occurring after traumatic experiences may replicate the threatening situation (“replicative nightmares”), but most do not” p. 404
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