Why Awareness of Abuse and Neglect Matters
As a mental health clinician, I work with many clients who have experienced some form of abuse, whether it be verbal, emotional, physical, sexual abuse or childhood neglect. However, many of my clients often fail to recognize abuse as abuse or they might minimize the impact of abuse. I attribute some of this attitude towards survival mechanisms, such as denial, forgetting, and rationalizing, but a major reason many clients don't recognize abuse is because of social, cultural, or familial values that normalize and perpetuate abuse.
Abuse can be inflicted by parents, siblings, partners, peers, bosses, colleagues, strangers, and even friends. Intimate partner violence or domestic violence is a common form of abuse where a romantic relationship is based upon dynamics of power, control, and abuse as opposed to values of mutual respect, equality, and safety. Bullying is another form of abuse that is rampant in schools and experienced by many children and adolescents at epidemic levels. The increased and widespread use of social media, the internet, and technology has made it more difficult for some survivors to escape abuse.
Definitions, attitudes, and acceptability towards abuse and neglect vary from culture to culture and have changed throughout time. Historically, women and children have been regarded as property to be bought and sold, traded, or exploited. Many ancient societies regularly practiced infanticide and used abuse as a way to instill discipline or enforce rules. Up until the early 1900s in the U.S., children often long hours in factories or mines in dangerous conditions and women suffered social, economic, educational, and legal inequality. In the past century, there have been major strides forward in creating organizations, legal protections, resources, and support for survivors of abuse and neglect. However, there is still much more work that needs to be done to protect and provide justice for survivors.
Impact of Abuse on Pyschosocial Development
Abuse can create harmful and long-lasting impact on survivors, which also can lead to not only mental health, physical health, and economic problems, but it can also contribute to collective problems in society, such as poverty, increased criminal behavior and incarceration, domestic violence, child abuse and neglect, and lack of educational opportunities. In other words the negative impact of violence and abuse permeates beyond the limits of a family and impacts the community. Children may find it harder to learn or cope with difficult emotions or triggers at school and might fall behind in school, act out, or struggle to build friendships and social bonds. Furthermore, many of our organizations and institutions are unequiped and untrained to adequately identify abuse, stop the cycle of abuse, and help survivors heal.
The fallout of experiencing abuse or chronic trauma can result in a wide range of symptoms of psychological and emotional problems, health issues, attachment or relationship problems, low self-esteem or identity issues, and difficulty regulating emotions. Abuse can cause or contribute to symptoms of depression, anxiety, PTSD or other trauma-related disorders, bipolar, eating disorders, psychosis, dissociative disorders, personality disorders, and substance abuse disorders. In other words, the impact of abuse can manifest in a variety of different ways, but all symptoms are a result of trying to survive trauma and abuse.
Photo by Jackson Simmer
Survivors of abuse might develop maladaptive or self-destructive coping skills in order to survive abuse. It is very common for survivors to self-medicate with drugs or alcohol to numb emotional pain, cope with ongoing abuse, or forget traumatic memories. Research has shown that there is a strong correlation between childhood trauma, abuse, and neglect and substance abuse disorders. The National Institute of Drug Abuse notes that when a caregiver is unresponsive, absent, or inconsistent, "elevated levels of stress hormones can impede a child's healthy brain development" leading to problems in cognitive, motor, behavioral, social, or emotional problems. Furthermore, childhood abuse and neglect experienced within the first five years of life can be used as a predictor for likelihood of developing a substance abuse disorder.
Many survivors also internalize abuse they experience by forming negative core beliefs, such as I am bad, I deserved the abuse, I don’t deserve love or I am flawed. Survivors might also suffer from low self-esteem, engage in self-harm, or even attempt to end their lives as a result of experiencing abuse. For many survivors of abuse, feelings of isolation, the potential threat of continued violence, feelings of guilt or shame, as well as legal, economic, and social barriers might discourage the survivors from telling others about abuse, leaving, or seeking professional help. In addition, the fear of not being believed or being blamed for the abuse might cause survivors to remain silent and compound feelings of hopelessness.
Many survivors struggle with constant feelings of shame, guilt, or self-blame as a result of living through abuse. As the abuser repeatedly blames the survivor for his or her own abusive behavior, the survivor often begins to believe this message. Abusers often use gaslighting, a tactic repeatedly used to undermine one’s thoughts, emotions, and perception of reality and the past, as well as victim- blaming, to instill feelings of fear and self-doubt into survivors. Gaslighting statements include the following: "You made me do that," "You're too sensitive," "You don't feel
that way," "You're crazy," "You can't take a joke," or "You can't remember anything right."
Photo by Kat J.
Author Julie Hall notes “Victim blaming gains traction in families and society at large because it enables us to ignore disturbing evidence before us that the world can be a brutal, unsafe, and unjust place” (Hall, 2019, p.97). Victim blaming is not only psychlogically very harmful, but it also normalizes abuse, minimizes it, attempts to silence the survivor, and protects the abuser. Individuals with sociopathy, psychopathy, narcissist personality disorder, or antisocial personality disorder may continually blame survivors to deflect responsibility, maintain dominance, damage a surivior's credibility or reputation, and weaken the survivor's self-esteem.
When survivors experience abuse or neglect in childhood, they may struggle with low self-esteem, trust or attachment issues in relationships, or find themselves unconsciously attracted to abusive or controlling partners. The pattern they experienced in their childhood might repeat in their relationship with their romantic partner. Survivors might regard the abuse as normal unless they have had exposure to other relationships or environments or seek professional support. Breaking the cycle of abuse, leaving abusive relationships, and forming healthy relationships might feel like an almost impossible challenge. However, breaking the cycle, healing, and forming healthy attachments are all possible with time, support, healing, and education.
Domestic Violence or Intimate Partner Violence
For survivors who have been trapped in relationships with domestic violence of intimate partner violence, it can be very difficult to leave, especially if children are involved. Friends or family members may not understand why survivors stay silent about or try to cover up abuse and stay. Loved ones who are aware of the abuse may become angry, frustrated, or even sever ties with the survivors, because it is so painful to witness a loved one experience abuse. However, there are many reasons why survivors might not feel ready to leave. Abusers may use threats to kill survivors or their family or threats of continued abuse to keep them silent. Many abusers also use gaslighting, which aims to de-stabilize and undermine the survivors’ reality and lead them to question their own reality, can create feelings of low self-esteem, self-doubt, hopelessness, anxiety symptoms, depression symptoms, and even lead to Post-traumatic Stress Disorder.
Trauma bonding is another factor that might make it difficult to leave an abusive relationship. Trauma bonding involves a dysfunctional relationship or attachment that creates a stronger feeling of connection through shared traumatic experiences and often characterized by a feeling of danger, fear, excitement, and sexual feelings. After an intense period of abuse, dopamine, which is a feel good neurotransmitter and hormone, is released and creates feelings of calmness and pleasure thus reinforcing the bond. Relationships with trauma bonding will often include periods of love-bombing, intense periods of showering of love or excitement followed by periods of abuse, abandonment, or neglect. Some survivors might develop Stockholm syndrome, which is where the survivor learns to love and depend on their abuser for affection and validation. The survivor learns to becomes codependent and constantly emotionally attune to the abuser's needs, which can also lead to a loss of sense of self.
Photo by Davide Pietralunga
According to the Women Against Abuse, on average, it takes at least seven attempts to leave an abusive relationship before a survivor is able to successfully and permanently leave. Other factors that also might prevent the survivor from speaking up or leaving are that they fear judgement from loved ones, fear that they might not be believed, or they may fear being re-traumatized by being blamed for staying in the situation. In addition, patriarchal values reinforcing rigid gender roles and women’s subservient roles, exploitation, or objectification is often reinforced within many systems and instittutions present within our culture. This is still evident in much of our media, legal systems, economic systems, cultural, societal, or religious values. However, there are resources and professionals available to provide support, help survivors develop a safety plan, and work towards healing. It is important for us to listen to survivors with compassion without being judgement or critical.
Complex or Chronic PTSD and The Path to Healing
Whereas PTSD can arise from a single traumatic event, complex or chronic PTSD can arise from repeated traumatic experiences over a period of time, but involve similar symptoms. It is not uncommon for survivors of childhood abuse or neglect, human trafficking, domestic violence, intimate partner violence, bullying, or toxic work situations to develop symptoms consistent with Chronic or Complex Post-traumatic Stress Disorder. Some key features of CPTSD are flashbacks, nightmares, reliving events spontaneously, insomnia, hypervigilance, problems regulating emotions, insomnia, and other issues. Survivors of trauma may become hypervigilant and always expect danger, which elevates stress hormones, such as cortisol, adrenaline, and norepinephrine. When the nervous system and stress hormones are over-responsive, trauma survivors may feel stuck in the primitive fight/flight/freeze response, making it difficult to think clearly, reason, and regulate emotions.
For many clients, receiving a diagnosis of PTSD or CPTSD can be the first step in beginning to heal and acknowledging the impact of abuse or trauma. Recognizing the impact of trauma and how trauma continues to live out in the present, clients can begin to process and understand how trauma symptoms manifest in their life and re-prioritize the importance of physical and emotional safety. Counseling, holistic treatments, psychiatric medication, self-care routines, increased awareness of triggers and new coping skills, and a robust and healthy support system can support healing and recovery from abuse.
Impact of Abuse on Attachment Styles and Relationships
Abuse can have a long-lasting impact on relationships as survivors may develop trust issues, communication issues, and deep-seated fears of abandonment or engulfment. In cases of severe childhood abuse or neglect, the child begins to learn at a young age that the caregivers or parents are not safe, loving, trustworthy, dependable, or reliable. As a result, they begin to perceive the world beyond the family as a frightening, dangerous place where their needs cannot be met. The family unit is a microcosm, where the child learns how to bond, communicate, attune to others, work through conflict, and try to get their needs met. If caregiver or parent is absent, neglectful, or abuse, the child may not bond to the parent or any other substitute, which can have a lasting impact on the ability of the child to bond in future relationships. Some children who have experienced severe abuse might develop reactive attachment disorder, which leads to difficulty connecting emotionally with others, lack of trust, emotional problems, can develop if a child is repeatedly abandoned, neglected, or feels uncared for, powerless, or isolated.
Survivors of childhood abuse might develop a specific attachment style as a result of coping with abuse. Anxious-ambivalent attachment styles often involve intense feelings or fears about being rejected or abandoned. They may seek reassurance often from their partner, be overly preoccupied with the relationship, more sensitive to a partner’s needs rather than their own needs, and they may not feel completely secure in their relationships. Individuals with avoidant attachment styles may cope with relationships by attempting to emotionally distance themselves from relationships by rejecting a partner’s attempt to emotionally connect. These individuals might appear cold, detached, stoic, and may prefer autonomy and independence rather than closeness or connectedness They may fear engulfment in a relationships and need long periods of time alone. Disorganized attachment styles are characterized by a both the desire to form and avoid close attachments. They may recreate past traumas, switch between idealizing and devaluing a partner, and struggle to reconcile the desire to connect with the need to protect oneself emotionally. Individuals with this kind of attachment style might have fear and anxiety arise when forming relationships, suffer from low self-esteem, and feelings of loneliness.
Photo by Alex Iby
In most cases, survivors of abuse, neglect, and trauma may struggle with trust issues, have fear communicating directly, or have a difficult time getting needs met in relationships. At times, survivors may feel they are still trapped in an abusive relationship as they may feel they are reliving the abuse, project fears onto a current partner, or re-enact the abuse they experienced. If survivors feel safe enough, they might show or express emotions that they may have had to hide from their abuser, such as shame, self-blame, sadness, anger, frustration, and fear. Survivors might also unconsciously project these feelings onto their new partner in anticipation of the cycle of abuse repeating. Some survivors may recognize that they have been trapped in a pattern of abusive relationships or continue to attract abusive partners. It can be helpful for survivors may want to take time away from romantic relationships with the support of a counselor, friends, family, or a support group before entering into a new relationship. Entering into healthy relatioiships filled with trust, respect, and equality is possible, epecially if both partners can openly communicate their feelings in a healthy way, with awareness, responsibility, and self-accountability. Healing often occurs within relationships, when there are reparative experiences that reinforce different, healthier patterns of relating, communicating, and bonding.
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