Adult Survivors Of Childhood Abuse Research Articles

Intraindividual variability and emotional change as predictors of sudden gains in imagery rescripting and EMDR for PTSD in adult survivors of childhood abuse.

Sudden gains, defined as large and stable improvements in symptom severity during psychological treatment, have consistently been found to be associated with better outcomes across treatments and diagnoses. Yet, insights on coherent predictors of sudden gains and on emotional changes around sudden gains in post-traumatic stress disorder (PTSD) are lacking. We aimed at replicating a measure of intraindividual variability as a predictor for sudden gains and testing its independence from change during treatment. Furthermore, we expected changes in emotions of guilt, shame and disgust prior to sudden gains to predict sudden gains. Data from a pre-registered randomized controlled trial (RCT) of eye-movement desensitization and reprocessing (emdr) and Imagery Rescripting (ImRs) for PTSD in 155 adult survivors of childhood abuse were used. Intraindividual variability of PTSD symptoms in both treatments did not predict sudden gains status and was not independent of change during treatment. In the EMDR condition, levels of shame during treatment predicted sudden gains and shame decreased shortly before a sudden gain in both treatments. Reductions in all emotions during sudden gains were significantly higher for participants with sudden gains than for comparable intervals in non-sudden gainers. Our findings do not support the predictive validity of intraindividual variability for sudden gains. The decrease of guilt, shame and disgust during sudden gains warrants further research on their role as a mechanism of treatment change for PTSD.

The top-100 cited articles on post-traumatic stress disorder: a historical bibliometric analysis

ABSTRACT This is a bibliometric analysis of the most-cited articles on post-traumatic stress disorder (PTSD) with the objective of identifying citation patterns for researchers, journals, centers, periods, topics, and nations. A search was conducted in Thomson Reuters’ WoS Core Collection employing the expression TI = (posttraumatic stress disorder OR post-traumatic stress disorder OR PTSD). The 100 most-cited articles were downloaded, and the relevant data were extracted and analyzed. These studies had a total of 69,649 citations, ranging from a minimum of 360 to a maximum of 6029 citations, with an average of 696.49, a standard deviation of 720.92, mode of 369, and a median of 512. Eighty-eight percent of the most-cited articles on PTSD originated from the USA, with just six cities accounting for 52% of the publications and the Boston area alone responsible for almost one-fifth of the total output. The universities of Yale and Harvard headed the ranking of institutions with larger numbers of highly-cited articles. Female researchers represented 42.3% of all authors, 51% of the first authors, and 48% of the corresponding authors. The proportion of M.D. authors decreased significantly between the 1980–1999 (42%) and the 2000–2019 (27.2%) periods while that of Ph.D. authors increased from 44% to 57.4%. The most studied population was military veterans (28%). Female victims of sexual or physical violence, traumatized children, and adult survivors of childhood abuse were assessed in only 6–7% of the most-cited publications. Ten clinical trials evaluated psychological interventions but only three investigated pharmacotherapy. We concluded that influential research on PTSD remains centralized in the USA. A balanced gender representation in publications was found. There was a heavy reliance on combat veterans as the study population. Few highly-cited studies on the pharmacotherapy for PTSD were identified. Focused efforts are needed to address these challenges.

Book Review: Group Therapy for Adult Survivors of Childhood Abuse: A Practical Guide for Mental Health Professionals

Book Review: Group Therapy for Adult Survivors of Childhood Abuse: A Practical Guide for Mental Health Professionals

A systematic review that evaluates the extent and quality of involving childhood abuse survivors in shaping, conducting and disseminating research in the UK

Despite a well-established understanding of the mental and physical health consequences associated with exposure to childhood abuse, the active voices of survivors are rarely present in shaping, conducting and disseminating research. To explore the extent and quality of involvement with adult survivors of childhood abuse in the UK, we performed a systematic review of research conducted ‘with’ or ‘by’ survivors, and analysed involvement against a new instrument, the Survivor Research Involvement Ladder, which was co-produced drawing from the principles of the Survivors Voices Charter. A search of relevant grey and peer-reviewed literature was conducted, which retrieved 662 sources after removing duplicates. Of these, 116 full-text articles on adult survivors of childhood abuse in the UK were subsequently assessed for involvement (beyond participation as ‘subjects’), of which only 15 (12.9 per cent) reported activities led, co-produced, advised or consulted on by survivors, and these were included in the review. From evaluations and analysis using the ladder, consumerist models were found to be the dominant form of involvement, with survivors filling advisory roles at isolated stages. Survivor-led research was scarce but emerged when survivor-researchers planned, conducted and disseminated their work. This review finds considerable opportunity for improvements in the level, quality and subsequent reporting of research activities involving survivors. The use of the instrument needs replication, validation and further field-testing.

Suicidality in childhood abuse survivors – the contribution of identification with the aggressor

ObjectiveChildhood abuse survivors are at risk for suicidal ideation and suicide attempts. Research has indicated that posttraumatic stress disorder (PTSD) symptoms and dissociation are related to elevated suicidal ideation and behavior (SIB) among this population. At the same time, although the theoretical and clinical literature in the trauma field have suggested that survivors’ pathological attachment to their perpetrators, known as identification with the aggressor, might explain SIB, this supposition has not been investigated to date. MethodFilling this gap, this study explored the associations between identification with the aggressor, PTSD symptoms, dissociation, and SIB among 589 adult survivors of childhood abuse. ResultsIdentification with the aggressor, PTSD symptoms, and dissociation were related to elevated levels in suicidal ideation and behavior. Furthermore, profile type (namely, having high versus medium or low levels of identification with the aggressor, PTSD symptoms, and dissociation) was implicated in participants’ SIB: Participants who adhered to a profile characterized by high levels of identification with the aggressor, PTSD symptoms, and dissociation had higher levels of suicide risk and suicidal ideation, as well as higher odds of reporting a history of suicide attempts, compared to participants who adhered to the other two profiles (i.e., characterized by medium or low levels of identification with the aggressor, PTSD symptoms, and dissociation). LimitationsThis study relied on convenience sampling and a cross-sectional design. ConclusionsIdentification with the aggressor might serve, alongside PTSD symptoms and dissociation, as a risk factor for suicidal ideation and behavior among childhood abuse survivors.

The impact of out-of-home placement characteristics with regard to suicidal risk among adult survivors of childhood abuse

Background: Childhood abuse is associated with increased lifetime suicidal risk (SR). Among victims of abuse, children in out-of-home care are also at risk. Out-of-home placement is aimed at stopping further exposure to maltreatment and at providing the necessary security for proper development. Research suggests that placement arrangements may impact children’s mental health outcomes. Objective: The study was aimed at examining (1) the direct effects of different placement characteristics (i.e. age at first placement, number of placements, placement disruptions, total time in care, contact with biological parents, contact with siblings, placement with siblings) on SR and (2) whether these characteristics moderate the link between maltreatment and SR. Participants: The sample consisted of 77 adults (52 women; 25 men; mean age: 26.6 years) who received out-of-home care during childhood. Method: Participants completed the Childhood Trauma Questionnaire and the Mini International Neuropsychiatric Interview (for SR). Participants’ records were used to determine placement characteristics and maltreatment. Results: PLS-PM analyses suggest a significant role of risk (age at first placement, number of placements, placement disruptions, contact with biological parents) and protective factors (contact with siblings, foster home placement) on SR. Risk factors also moderate the link between maltreatment and SR. Conclusions: Interventions aimed at limiting risk factors during placement seem important to reduce SR.

A Broad Overview of Solution Focused Severe Trauma & Stress Recovery Work, With the Introduction of Two Additional SF Instruments to Promote Thriverhood 🇨🇳 🇹🇼 🇫🇷 🇮🇱 🇮🇷 🇷🇺 🇪🇸

The purpose of this paper is to show how the author’s solution focused (SF) work with both adult survivors of child abuse and neglect; and, adult trauma survivors, has developed from Yvonne Dolan’s severe trauma recovery work (Dolan, 1998). Dolan’s major contribution to this way of working is acknowledged; and, her three-stage Victim – Survivor –Thriver continuum detailed, with an emphasis on the Thriver stage. Other contemporary practitioners’ work is described, in brief, also. From the author’s clinical work with survivors of trauma, over some 25 years, it has become clear that clients need to understand more fully what thriverhood is about, in order to move towards it more effectively. Psychoeducation in the form of in-session verbal information and typed sheets to take away, has proved to be helpful in most cases. Some recent neuroscientific research, with specific reference to neuroplasticity is referred to, to demonstrate how clients improve through this specialist SF application. The handouts ‘What Thriving is Like’ (Figure 1) and ‘The Thriver Progress Questionnaire’ (Figure 2) are more advanced materials to help clients have a better understanding of both what is possible and how to be thriving more fully. It is the author’s intention also, to encourage more practitioners, equipped with the additional tools referred to, to take up the challenge of those important and rewarding work. Russian full article (https://drive.google.com/file/d/1UTwEpWDEc0gTIotzHEO-g1pUQET_miME/view?usp=sharing) Chinese (Simplified) (https://drive.google.com/file/d/1PrecoGaMpry5FIx6ihDjEAJCHFN1aayG/view?usp=drive_link) Chinese (Traditional) (https://drive.google.com/file/d/1M1NrT9bj17FuJ0BFoyoTdaUOAhja09bS/view?usp=drive_link) French (https://drive.google.com/file/d/1Cmh3t0hpTrp5QxJ4IPD_kvKs2Vvdzc9l/view?usp=drive_link) Hebrew (https://drive.google.com/file/d/1Mz2SGfMbVJGPI04R_VDWNmenjOn7lH5Y/view?usp=drive_link) Persian (https://drive.google.com/file/d/1mn22oYIy9RH-YHaR88LlCNd6UsyZJITb/view?usp=drive_link) Russian (https://drive.google.com/file/d/1pKqZbNXJJtnZOK_SHXetAXps8bvRZCdv/view?usp=drive_link) Spanish (https://drive.google.com/file/d/11wlDQ1pRlv_dyuls6WQbufTovHFcOH9o/view?usp=drive_link)

Adult survivors of childhood trauma: Complex trauma, complex needs.

Childhood trauma is common and can have profound consequences throughout aperson's life. Adult survivors of childhood abuse pose a number of challenges for general practitioners (GPs). The diagnosis of their medical and psychiatric illnesses is complex; the therapeutic relationship can be both delicate and critical to recovery; and the treatments are varied, often expensive and frequently inaccessible. The aim of this article is to provide a conceptual framework for the assessment and management of an adult survivor of childhood adversity. GPs can be effective and facilitate recovery-orientated, trauma-focused care, even when local services are limited. This model considers the person's presenting symptoms and the consultation interaction, and it is applicable regardless of diagnosis. Key principles include listening and engaging to understand why the person is presenting in this way, and approaching care in a targeted and collaborative manner. This can alleviate emotional distress for the patient, GP and care team.

Emotion regulation strategies, self-esteem, and anger in adult survivors of childhood maltreatment in foster care settings

BackgroundAnger is a known factor that adds to the distress caused by mental health problems in traumatized samples. Limited strategies for emotion regulation play a key role in this relationship. People with a history of severe trauma frequently report less adaptive emotion regulation strategies, low self-esteem, and high levels of anger. To our knowledge, their interrelationship has not yet been sufficiently researched. MethodWe investigated the mediating role of self-esteem in the relation between emotion regulation strategies and different forms of anger (trait anger and anger rumination) in an Austrian sample of adult survivors of childhood abuse in foster care homes (n=220). ResultsThe relationship of emotion regulation strategies (DERS), trait anger (STAXI), anger rumination (DAQ), and self-esteem (MSWS) was assessed using two mediation models. Both models showed significant mediation effects. Self-esteem mediated 26% of the effect of emotion regulation on trait anger and 57.5% of the effect of emotion regulation on anger rumination. ConclusionSelf-esteem potentially supports adaptive emotion regulation through its beneficial effects on distressing emotional states. As a practical implication for treatment, it may be assumed that supporting adaptive emotion regulation strategies and self-esteem positively influences anger in traumatized patients.

Premature mortality in adult survivors of child abuse and neglect: a nationwide birth cohort study

BackgroundChild neglect and abuse are not uncommon. Both are associated with deleterious outcomes in adulthood, but there is sparse evidence on the association between such trauma and premature adult mortality. We aimed to establish whether different types of child maltreatments were associated with all-cause mortality in mid-adulthood and examined potential intermediaries of this association. MethodsUsing the 1958 British birth cohort (n=9310), we examined associations between child neglect (prospectively recorded at years 7 and 11 of age) and abuse (physical, psychological, witnessing and sexual; self-reported at years 44–45 of age) with all-cause mortality, using Cox proportional hazard models adjusted for early-life covariates and other maltreatment types. We tested interactions between each maltreatment type and sex; there was little evidence of effect modification (pinteraction>0·001), hence models also adjust for sex. Mortality follow-up was between 2002–03 and December 2016 (participants aged 44–45 to 58 years). Death was ascertained from the National Health Service Central Register (n=296) or from survey updates (n=16). Potential intermediaries included: adult social factors, health behaviours, adiposity, mental health, cardiometabolic markers, and growth (height) at years 7 to 45 of age. Missing data were imputed via multiple imputation. FindingsChild maltreatment prevalence varied from 1·6% (n=149; sexual abuse) to 11% (n=1000; physiological abuse); 77% (n=6536) reported no maltreatment. Neglect and abuse (physical and sexual) were associated with increased risk of premature death, independent of covariates and other maltreatment types; adjusted hazard ratios (HRs) were 1·47 (95% CI 1·05–2·05) for neglect, 1·73 (1·10–2 ·71) for physical abuse, and 2·60 (1·49–4·52) for sexual abuse. Associations for neglect and physical abuse disappeared after adjustment for adult health behaviours, and, for neglect only, social factors; other intermediaries had little effect on these associations. Sexual abuse associations were largely unexplained by examined intermediaries. Risk of all-cause mortality increased with the number of maltreatments (versus none): adjusted HRs were 1·44 (1·07–1·93) for one maltreatment and 2·04 (1·45–2·87) for at least two maltreatments. InterpretationChild neglect and physical and sexual abuse are associated with increased risk of premature mortality in mid-adulthood. Our findings highlight the importance of preventing specific child maltreatments and of supporting survivors to potentially mitigate differences in premature mortality. Child abuse was reported retrospectively and estimated associations for sexual abuse might be imprecise due to low prevalence. However, child neglect, potential confounders, and mediators were ascertained prospectively. FundingUS National Institute on Aging, the UK Economic and Social Research Council, the UK Biotechnology and Biological Sciences Research Council, and the UK National Institute for Health Research Biomedical Research Centre.

The association of posttraumatic stress disorder, complex posttraumatic stress disorder, and borderline personality disorder from a network analytical perspective

BackgroundPosttraumatic Stress Disorder (PTSD), Complex PTSD, and Borderline Personality Disorder (BPD) share etiological risk factors and an overlapping set of associated symptoms. Since the ICD-11 proposal for trauma-related disorders, the relationship of these disorders has to be clarified. A novel approach to psychopathology, network analysis, allows for a detailed analysis of comorbidity on symptom level. MethodsSymptoms were assessed in adult survivors of childhood abuse (N=219) using the newly developed ICD-11 Trauma-Questionnaire and the SCID-II. The psychopathological network was analyzed using the network approach. ResultsPTSD and Complex PTSD symptoms were strongly connected within disorders and to a lesser degree between disorders. Symptoms of BPD were weakly connected to others. Re-experiencing and dissociation were the most central symptoms. ConclusionsMental disorders are no discrete entities, clear boundaries are unlikely to be found. The psychopathological network revealed central symptoms that might be important targets for specific first interventions.

Gender and Race Variations in the Intersection of Religious Involvement, Early Trauma, and Adult Health.

This study aimed to determine gender and race variations in regards to the influence of religious involvement (RI) as a moderator of the effects of early traumatic stress (ETS) on health-related quality of life among adult survivors of child abuse. A cross-sectional predictive design was used to study Seventh-day Adventist adults in North America (N = 10,283). A secondary analysis of data collected via questionnaires was done using multiple regression. Data revealed that women had a significantly higher prevalence of any or all ETS subtypes, except for physical abuse prevalence, which was the same for both genders. Blacks reported a significantly higher prevalence of at least one ETS subtype than did Whites, except for neglect, where Whites had a higher prevalence. Exposure to at least one ETS subtype was associated with worse negative effect on mental health (B = -2.08, p < .0001 vs. B = -1.54, p < .0001) and physical health (B = -2.01, p < .0001 vs. B = -1.11, p < .0001) for women compared to men. Among those exposed to all ETS subtypes (n = 447), Whites had significant worse physical health, with White women having almost two times the negative effect on physical health (B = -4.50, p < .0001) than White men (B = -2.87, p < .05). As for RI moderation, based on tests of three-way interactions of race-RI-ETS, there were no associated differences. However, tests of three-way interactions of gender-RI-ETS showed a significant buffering effect. Among those with high levels of negative religious coping (RC), women exposed to ETS had significantly worse physical health (B = -1.28) than men. Results give evidence of gender and racial differences on the magnitude of the ETS-health effect, as well as gender differences in ETS-health buffering by RC. Findings suggest gender and racial differences must be considered when devising holistic nursing interventions for improving health outcomes of early trauma survivors.

Improving mental wellbeing for survivors of childhood abuse and neglect: psychological healing and education course in prisons

Since 1989, the National Association for People Abused in Childhood (NAPAC) has been working to help adult survivors of childhood abuse and neglect achieve recovery from the consequences of their trauma. NAPAC was set up to address this specific need In the absence of any existing national organisation and has developed ways of working which draw on a range of existing therapeutic and educational methods. Through experience gained by running a national free support phone line and listening to thousands of survivor accounts, NAPAC has Identified some common problems and practical ways to overcome them.COMMON PROBLEMSKey texts informing the development of NAPAC's approach were self-help books for survivors first published in the USA: The Courage to Heal1 for females and Victims No Longer2 for males. Both texts encouraged adult survivors to work through their problems at their own pace and explained many of the issues survivors face in adulthood. Some of the problems described include:*Not talking about the problems having been made to fear the consequences by the abuser(s) during childhood;*Self-blaming having been told by the abuser(s) that they were at fault in childhood;*Believing no one else shares the experience or could understand it; and*A belief in being damaged beyond any hope of recovery.Dr Judith Lewis Herman3 of Harvard Medical School brought rigorous academic analysis to the topic In Trauma and Recovery: The Aftermath of Violence by comparing the consequences of trauma on three social groups: domestic violence victims, military personnel injured in combat and adult survivors of sexual abuse during childhood. Herman Identified significant differences In the long term sequelae between these groups due to such factors as early age of onset, number of traumatic events and number of perpetrators and public recognition of the reality of the trauma. The consequences of sexual abuse during childhood were shown to be far more complex and difficult to address than combat trauma, for example, partly because the general public is less likely to believe a child's account than that of an adult member of the armed services engaged in action widely reported in the news media. For these and other reasons, Herman identified the concept of complexity In post-traumatic stress disorder (PTSD), which means that simple interventions such as cognitive behavioural therapy are less likely to be effective with survivors of childhood abuse than with personnel wounded in combat. Recovery from childhood trauma takes more time and harder work with more support than simple PTSD. Coping mechanisms learned In childhood may become deeply embedded through adulthood and therefore hard to replace; memories may have been repressed by the child and stored subconsciously causing a range of mental and physical problems.Such understanding has now become widely accepted by practitioners:The traumatic stress field has adopted the term complex trauma to describe the experience of multiple, chronic and prolonged, developmentally adverse traumatic events, most often of an interpersonal nature (e.g., sexual or physical abuse, war, community violence) and early-life onset.4More recently, the UK Government commissioned the Victims of Violence and Abuse Prevention Programme overseen by the late Dr Catherine Itzen, a very large scale assessment of the problem. Their report summarises the situation as follows in their Introduction:Domestic and sexual violence and abuse affects a very substantial minority of the population. It is largely women, and children of both sexes, who are affected, but men are also raped and experience domestic violence. Child physical, emotional or sexual abuse and neglect and domestic violence are causal factors in the mental and physical ill-health of children, adolescents and adults and affect a significant proportion throughout their lives. The high costs in prevalence and economic burden on health and social care services and the criminal justice system have pushed these issues up the policy agenda. …

Abuse Characteristics and Individual Differences Related to Disclosing Childhood Sexual, Physical, and Emotional Abuse and Witnessed Domestic Violence.

Many adult survivors of childhood abuse hide their victimization, avoiding disclosure that could identify perpetrators, end the abuse, and bring help to the victim. We surveyed 1,679 women undergraduates to understand disclosure of childhood sexual, physical, and emotional abuse, and, for the first time, witnessed domestic violence, which many consider to be emotionally abusive. A substantial minority of victims failed to ever disclose their sexual abuse (23%), physical abuse (34%), emotional abuse (20%), and witnessed domestic violence (29%). Overall, abuse-specific factors were better predictors of disclosure than individual-level characteristics. Disclosure of sexual abuse was related to experiencing more frequent abuse (by the same and by multiple perpetrators), being more worried about injury and more upset at the time of the abuse, and self-labeling as a victim of abuse. Disclosure of physical abuse was related to experiencing more frequent abuse (by the same and multiple perpetrators), being less emotionally close to the perpetrator, being older when the abuse ended, being more worried and upset, and self-labeling as a victim. Disclosure of emotional abuse was associated with being older when the abuse ended, and being more worried and upset. Disclosure was unrelated to victim demographic characteristics or defensive reactions (dissociative proneness, fantasy proneness, repressive coping style, and temporary forgetting), except that among physical and emotional abuse victims, repressors were less likely to disclose than non-repressors. Disclosure of witnessing domestic violence was not significantly related to any factors measured.

Pathways from childhood abuse to prospective revictimization: Depression, sex to reduce negative affect, and forecasted sexual behavior

Research suggests that adverse events in childhood, such as childhood physical, sexual, and emotional abuse, confer risk for later sexual assault. Psychological distress, coping strategies, and sexual behavior may help explain the path from childhood abuse to revictimization. The present study explored how the use of sex to regulate negative affect (SRNA) operates independently, and in combination with other psychosocial factors to increase college women's (N=541) risk of experiencing prospective adult sexual assault (ASA). Sequential multiple mediator models in Mplus were used to assess the effect of three different forms of childhood abuse on prospective ASA, both independently and while controlling for other forms of childhood abuse. The indirect effect of adolescent sexual assault (AdolSA), depressive symptoms, SRNA, and participants’ response to a sex-related vignette was tested using bias-corrected bootstrapping. In the full path model, childhood emotional abuse and AdolSA predicted ASA, while childhood physical and sexual abuse were directly associated with AdolSA, but not ASA. Additionally, depressive symptoms and participants’ estimate of their likely behavior in a sex-related vignette directly predicted prospective ASA. Results using bootstrapping revealed that a history of childhood abuse predicted prospective ASA via diverse direct and indirect paths, as well as through a similar multiple mediator path. Overall, findings suggest that a combination of affective, coping, and sexual expectancy factors contribute to risk for revictimization in adult survivors of childhood abuse. Future research directions and targets for risk-reduction programming are discussed.

Resilience and mental health in adult survivors of child abuse associated with the institution of the Austrian Catholic Church.

In recent years, reports of institutional abuse within the Catholic Church have emerged and research on the consequences on mental health is in its beginnings. In this study, we report findings on current mental health and resilience in a sample of adult survivors of institutional abuse (N = 185). We compared 3 groups of survivors that differed regarding their current mental health to investigate aspects of resilience, coping, and disclosure. The majority of the sample was male (76.2%), the mean age was 56.28 (SD = 9.46) years, and more than 50.0% of the sample was cohabiting/married. Most of the survivors reported severe mental health problems. Known protective factors (education, social support, age) were not associated with mental health in our sample. Our findings corroborate that institutional abuse has long-term effects on mental health. We found that fewer emotional reactions during disclosure, task-oriented coping, and optimism were associated with better mental health. The study was limited by a cross-sectional design, but we conclude that the kind of institutional abuse reported is especially adverse, and thus typical protective factors for mental health do not apply. Future research should focus on intrapersonal factors and institutional dynamics to improve treatment for persons affected by institutional abuse.

Barely Visible: The Child in Catholic Social Teaching

The experience of working with socially displaced children, who live and work on the streets, is one that engenders a kind of indignation at the thwarting of their capabilities and at the impact not only on their own lives but also on the human community who are denied the gifts of children who never reach their potential. This author thus began to examine what Catholic social teaching actually says about such children. This examination of the treatment of justice for children in Catholic social teaching was given further impetus on reading a devastating conclusion from the Report by the Commission of Investigation into clerical child abuse in the Catholic Archdiocese of Dublin, known as The Murphy Report. The report concluded: ‘the welfare of children which should have been the first priority, was not even a factor to be considered’. Lack of concern for the welfare of the child is a recurring bleak motif in the Murphy Report. Why was the welfare of children not even a factor to be considered? Aware of the danger of resorting to mono-causal explanations in the face of the complexity of the crimes and scandals of child abuse, it is nonetheless interesting to consider why the principles of justice enshrined in Catholic social teaching were not the principles guiding the response of church authorities to children and adult survivors of child abuse. Before examining the visibility of children in Catholic social teaching, the absence of serious consideration of children as subjects or as moral agents in modern philosophical discourse about justice must be noted. In John Rawls’ A Theory of Justice, the seminal text on justice in twentieth century liberal philosophy, there is no significant discussion of children in his conclusions about a just society. Rawls, influenced by the cognitive-development theories of Jean Piaget and Lawrence Kohlberg, considers children in terms of their moral development and their capacity to acquire a sense of justice, but not explicitly as subjects of justice. Amartya Sen, in Development as Freedom, discusses children more extensively in the context of his examination of the basic conditions of participatory freedom. In The Idea of Justice, Sen raises the question of the relationship between parental duties to their own children and a theory of justice that extends to the recognition that ‘other children may have similarly large and important interests at stake as one’s own children’. Children are barely visible in most contractarian accounts of justice, as are the poor, thus moving towards invisibility those who are both child and poor. Many key commentaries on Catholic social teaching contain no index reference to childhood or children. There are many fine Church statements on children, especially in relation to education, religious education and, most often, children are discussed in documents on marriage and family. The Compendium of the Social Doctrine of the Church asserts that ‘The Church’s social doctrine constantly points out the need to respect the dignity of children’. (244) In order to test the veracity of this assertion about the visibility of children in Catholic social teaching, bs_bs_banner

Nurturing connections in the aftermath of childhood trauma: A randomized controlled trial of emotionally focused couple therapy for female survivors of childhood abuse.

Emotionally focused therapy (EFT) for couples is an empirically supported treatment for relationship distress (Johnson and Greenberg Journal of Consulting and Clinical Psychology 1985a;53:175–184; Johnson, The practice of emotionally focused marital therapy: Creating connection. New York: Brunner-Routledge, 2004). Despite strong evidence of a link between experiences of childhood abuse and problems in intimate relationships during adulthood (Paradis and Boucher, Journal of Aggression, Maltreatment & Trauma 2010;19:138–158; Walker et al., Journal of Family Violence 2009; 24:397–406), there have not yet been any controlled trials of the efficacy of EFT for adult survivors of childhood abuse. In light of evidence of the effectiveness of individual EFT in the treatment of the sequelae of complex trauma (Paivio and Pascual-Leone, Emotion-focused therapy for complex trauma: An integrative approach. Washington, DC: American Psychological Association, 2010), we conducted the first randomized controlled trial of EFT for couples in which the female partner had a history of intrafamilial childhood abuse. Our primary hypothesis was that couples treated with EFT would experience a significant reduction in relationship distress. To test this hypothesis, 24 couples in Toronto, Ontario, Canada (mean relationship length 14 years), were randomly assigned to either a treatment group (24 sessions of EFT) or a control group (waiting list). Analyses of covariance with treatment condition as the fixed factor and baseline scores on the Dyadic Adjustment Scale (Spanier, Journal of Marriage and the Family 1976;38:15–28) as the covariate yielded a statistically significant effect of treatment group on relationship distress. Hierarchical regression analyses unveiled the particular circumstances under which EFT appeared to be effective. These results attest to the effectiveness of EFT for relational distress in trauma survivors and are discussed in light of the relevant clinical literature.

Prevalence and Demographic Distribution of Adult Survivors of Child Abuse in Japan

A cross-sectional study was conducted with a national epidemiological survey to investigate the prevalence and demographic distribution of adult survivors of child abuse in Japan. A self-administered questionnaire was used to measure the history of child abuse and the demographic characteristics. The participants reported the following 4 types of child abuse: physical abuse (3%), sexual abuse (0.6%), neglect (0.8%), and psychological abuse (4%). Significant unequal distribution of child abuse was found to be associated with sex, living region, marital status, job status, and educational status. We determined the prevalence of adult survivors of child abuse in Japan and found that their demographic characteristics were unequally distributed. Policy makers and public health providers should take these demographic disparities into account in considering effective public health interventions for survivors of child abuse.

Egocentric virtual maze learning in adult survivors of childhood abuse with dissociative disorders: Evidence from functional magnetic resonance imaging

Present neuroimaging findings suggest two subtypes of trauma response, one characterized predominantly by hyperarousal and intrusions, and the other primarily by dissociative symptoms. The neural underpinnings of these two subtypes need to be better defined. Fourteen women with childhood abuse and the current diagnosis of dissociative amnesia or dissociative identity disorder but without posttraumatic stress disorder (PTSD) and 14 matched healthy comparison subjects underwent functional magnetic resonance imaging (fMRI) while finding their way in a virtual maze. The virtual maze presented a first-person view (egocentric), lacked any topographical landmarks and could be learned only by using egocentric navigation strategies. Participants with dissociative disorders (DD) were not impaired in learning the virtual maze when compared with controls, and showed a similar, although weaker, pattern of activity changes during egocentric learning when compared with controls. Stronger dissociative disorder severity of participants with DD was related to better virtual maze performance, and to stronger activity increase within the cingulate gyrus and the precuneus. Our results add to the present knowledge of preserved attentional and visuospatial mnemonic functioning in individuals with DD.