Psychological trauma refers to any event that threatens extreme psychological or physical damage, including severe bodily harm or death. Traumatic events evoke feelings of terror, horror, and helplessness. A traumatic event can involve direct threat to the self, but people can also feel traumatized after witnessing harm or threat of harm to someone else. Traumas can include natural disasters, such as an earthquake, tsunami, or hurricane, but traumas can also stem from human behavior, as with war, assault, or rape.
Ever since the first psychoanalytic case histories of the late nineteenth century, it has been recognized that severe trauma can have long-lasting impact on psychological functioning. An enormous body of research shows us that trauma can cause severe psychological distress and that a history of trauma is a risk factor for a very broad range of psychiatric and psychological disturbances.
It is important to distinguish between acute trauma in adulthood, such as a natural disaster or an assault, and chronic trauma that occurs in childhood, such as ongoing sexual or physical abuse. Trauma in general has been associated with anxiety, depression, increased drinking, anger outbursts, suicidal behavior, and a syndrome known as post-traumatic stress disorder (PTSD). While personality in adulthood is largely formed, personality is still developing in childhood. Thus, chronic trauma in childhood can have extremely pervasive and long-term effects on personality development.
People with histories of serious childhood abuse can develop severe personality disorders. They can also develop self-injurious behaviors, in which they may cut or burn themselves. Dissociative symptoms are also fairly common. These involve feelings of unreality and disconnection from mental and physical experience. There is a striking lack of awareness of certain feelings, thoughts, or actions. In extreme cases, people might develop dissociative identity disorder (previously known as multiple personality disorder), in which they literally believe that they have several different personalities within their own body.
Sigmund Freud’s early work on the seduction theory set the stage for many of the later developments in trauma psychology. Freud was initially interested in the problem of hysteria, which was a fairly common disorder in Victorian Europe. People would complain of various bodily problems that had no basis in actual physiology. We would now diagnose such complaints as conversion disorders. After interviewing numerous patients, Freud came up with the seduction theory, which stated that hysteria was caused by seduction in early life. In other words, hysteria stemmed from early experiences of childhood sexual abuse.
Within a few years, Freud abandoned this theory, believing that hysteria was too common to have been solely caused by sexual abuse. This would have meant that far more children were sexually abused than he believed was likely. He replaced his focus on actual experience with an emphasis on fantasy. The child may not have actually been seduced, but instead had repressed fantasies of seduction by the mother or father. With this turn from actual traumatic events to traumatic fantasies, the study of childhood trauma went underground for more than half a century, not to re-emerge until the 1970s and 1980s.
Although Freud’s abandonment of the seduction theory turned the budding mental health field away from the psychological effects of trauma, returning soldiers from World War I brought attention right back to the effects of trauma. The war was tremendously traumatic. Young men were sent away from home and exposed to the constant threat of their own death and to the violent and bloody death of their comrades. They were also forced to perform violent and murderous acts themselves, sometimes against civilians.
Many soldiers returning from WWI exhibited the emotional distress we now know as post-traumatic stress disorder. At the time it was known as “shell shock.” But there was little validation of these soldiers’ suffering at the time, and it was often seen as a sign of moral weakness. In World War II, the problem recurred (sometimes referred to as “battle fatigue”) and there was some progress in the study, treatment, and recognition of post-traumatic psychopathology.
It was not until the Vietnam War, however, that the mental health field truly mobilized to study and develop treatments for the emotional aftereffects of trauma. In 1980, five years after the end of the Vietnam War, the diagnosis of post-traumatic stress disorder was published in DSM-III. (The Diagnostic and Statistical Manual (DSM) is the official diagnostic manual for the mental health field. DSM-III was the third edition.)
Post-traumatic stress disorder (PTSD) is a particular condition that follows experience of a severe trauma. There are three clusters of symptoms: persistent avoidance of reminders of the event (numbing symptoms), persistent re-experiencing of the event (intrusive symptoms), and autonomic hyperarousal. With numbing symptoms, there is a blunting of emotional reactivity. There is flat affect, avoidance of various activities, loss of memory for traumatic events, and lack of motivation or interest in activities that used to engage the person. With intrusive symptoms, the opposite happens. Instead of a lack of memory for the traumatic events, there is a flood of memories that cannot be turned off. There may be nightmares or flashbacks, in which the trauma returns as if it is happening all over again. There may also be intrusive emotional storms, such as crying spells, rage outbursts, or panic attacks. With autonomic hyper-arousal, the autonomic nervous system is on overdrive. The body is continually on guard, ready to spring into action at any sign of danger. There can be an exaggerated startle response, difficulty concentrating and difficulty sleeping, as well as rapid heartbeat, sweating, and continued muscle tension.
Not everyone will get PTSD after a trauma. There are many different kinds of traumas, and different people respond to the same event in different ways. A number of factors within the trauma affect the risk of developing PTSD. Whether the trauma was natural or man-made, and whether the human-induced trauma was accidental (e.g., a car accident) or intentional (e.g., a mugging) all affect a person’s response. The more intentional, the more disturbing. Naturally the severity of the trauma is very important. How much danger was involved? How much physical pain was suffered? How much violence? Did anyone die? All these questions influence the impact of the trauma. The duration of the trauma is important as well—was it quick or did it last over time? Whether the trauma was a one-time event or ongoing (e.g., a mugging vs. a war) also factors in. Longer, more chronic, more severe, and intentionally malicious traumas cause greater psychological damage than shorter, milder, single-episode, and unintentional traumas.
While a natural disaster such as Hurricane Katrina or the tsunami of 2004 can have profound emotional impact on the survivors, there is a uniquely destructive effect from trauma that is caused by other people, specifically if there was intention to cause harm. We are profoundly social animals and a good deal of our psychology is devoted to the negotiation of interpersonal relationships. If we suffer significant harm at the hands of another person, that can throw our entire worldview into doubt. Are people still good? Can other people be trusted? While the loss of a sense of safety regarding our physical surroundings can be enormously frightening, we do not expect morality from the weather. A natural disaster does not in itself threaten our fundamental belief in the decency of humanity. When people lose trust in other people, they can suffer from deep depression and social alienation.
Although living through a natural disaster, such as a fire or earthquake, can result in emotional trauma, trauma that is inflicted by other people is much worse emotionally (iStock).
Not all people are equally traumatized by the same incident. What kinds of personal factors influence the risk of developing PTSD? Research suggests that people with a previous history of trauma, those with pre-existing psychiatric problems or personality disorders, those with less social support, and those with an external locus of control are more likely to develop PTSD in response to a traumatic event. People with an external locus of control believe that outside forces determine the events in their life. They do not believe they have much control over their life. In contrast, people with an internal locus of control believe they have significant control over their life. They tend to be more optimistic and more proactive about solving problems. Finally, people who react with dissociation at the time of event are shown to be likely to develop PTSD.
Trauma has considerable impact on our neurobiology, and there are actual physiological changes that can accompany trauma. To start with, trauma involves an intense activation of our stress response. The HPA axis (hypothalamus, pituitary gland, adrenal gland) mediates our brain’s stress response. In the face of stress, the HPA axis is activated. It sends out stress hormones, known as glucocorticoids. These serve to activate the autonomous nervous system, making our heart pump faster, our breath more rapid and shallow, and blood rush to our large muscle groups from our small muscle groups. This allows our body to respond rapidly to threat.
In normal circumstances, our parasympathetic nervous system acts to restore this system to a resting state, allowing our body to recover from the stress reaction. However, with trauma, the whole stress system can be thrown out of whack, causing abnormalities within the HPA axis, and keeping our autonomic nervous system (specifically the sympathetic nervous system) on overdrive. This has the effect of wearing down the body, compromising the immune system, and putting undue stress on many parts of the body’s regulating systems. In childhood when the brain is not fully developed, severe trauma can interfere with the brain’s actual development, causing long-term damage.
Dissociation involves an alteration in attention and awareness. People cut off awareness of feelings, thoughts, or even memories of actual events. Sometimes people remember all of the events but feel entirely emotionally detached from the memories. Alternatively, they may feel detached from personal experience, as if they are not a real person, but a robot. This is called depersonalization. Derealization occurs when people feel that the world around them is not real. Dissociation is similar to a trance state, which is an altered state of consciousness in which awareness of the surrounding world is changed.
Dissociation is fairly common among people who have undergone trauma and it serves to protect the person from becoming overwhelmed by intolerable emotions. During the trauma, some people remember slipping into dissociative states. “That wasn’t me down there on the bed. I was floating somewhere up on the ceiling.” Although dissociation may help people survive trauma, dissociative symptoms can cause problems after the trauma is over, interfering with the person’s ability to process the trauma and return to normal life.
There has been a good deal of controversy over the issue of repressed memories. Many researchers and clinicians have written about patients who lost access to their memories of abuse, only to recover them years later. Often the recovery of memories is associated with a surge of intrusive post-traumatic symptoms, such as nightmares, emotional outbursts, and even suicidality. In the 1980s and 1990s this concern with repressed memories of trauma exploded into a hysterical craze in which accusations flew and innocent people were charged with crimes that were suddenly “remembered” in psychotherapy. Partly in response to this excess, there are factions within the mental health field that discount the possibility of recovered memories at all. Professionals who work with adult survivors of childhood trauma, however, often encounter patients who recover childhood memories long after the traumatic events have occurred.
Elizabeth Loftus (1944–) is a researcher who has long studied the vagaries of memory. She became well known for challenging the idea of recovered memories. Her work showed that memory is extremely malleable, that people are highly suggestible, and that false memories can be implanted by suggestion. In other words, it doesn’t take that much to convince people that they remember things that never actually happened. Loftus’s work highlights the risk of eliciting recovered memories of childhood trauma in psychotherapy. Clinicians must tread very carefully with patients whom they suspect may have histories of abuse. Clinicians must take pains to avoid leading questions and always keep in mind that the absence of memory may simply mean the absence of abuse.
For the most part, the aftereffects of trauma are treated by psychotherapy, although the acute symptoms of PTSD may be treated by antianxiety or antidepressant medication. Immediately after an acute trauma, people need help in reducing their autonomic arousal. In other words, they need help calming down. They need to be assured that they are safe and that it is safe to let down their guard. Social support is also extremely important at all points of the recovery process, and groups who undergo traumas together often form very strong bonds.
After the immediate crisis has passed, it is helpful for people to discuss what happened, particularly to share their experiences with other people who have experienced the same trauma. This is where support groups or informal debriefings can be helpful. If symptoms of PTSD develop, individual therapy with cognitive-behavioral techniques can help reduce symptoms. Relaxation techniques can reduce the autonomic hyper-arousal, gradual desensitization can help people overcome tendencies to avoid any reminder of the trauma, and psychoeducation can help people make sense of their reactions to the trauma. Distorted cognitions about the trauma should also be addressed, particularly excessive self-blame.
Self-blame is a common reaction to trauma as it serves to combat the extreme sense of helplessness. “If it was my fault, I’m not helpless.” Likewise, people do need to feel empowered, and constructive actions that grant some sense of control should be encouraged. For example, letter writing to newspapers or government officials, public speaking about the event, and commemoration rituals can all help people feel empowered.
With more chronic, childhood trauma, the therapy takes more time and needs to move more slowly. The therapy should first address any severe problems with functioning, such as self-mutilation, suicidality, and severe personality pathology. Only when the patient can tolerate talking about the trauma without becoming overwhelmed by painful emotion or developing dangerous symptoms, should the therapy address the trauma directly. With some people this can happen fairly quickly, with others it might take years. Some people with very fragile emotional and behavioral control may never fully process the trauma. Instead, the therapy will focus on shoring up self-control capacities and the general ability to function.
While trauma is defined as any terrifying, life-threatening event, child abuse has a more specific meaning, referring to the maltreatment of a dependent child. Maltreatment can range from failure to attend to the child’s fundamental needs to intentionally inflicting harm. Such harm could include violent attacks or sexual molestation. Child maltreatment is generally divided into four categories: neglect, emotional or psychological abuse, physical abuse, and sexual abuse. Child maltreatment has received a good deal of attention within the field of psychology because of its extremely damaging and far-reaching effects—child abuse leaves its mark on almost all aspects of psychological functioning.
The U.S. Department of Health and Human Services compiles statistics on cases of child maltreatment that are reported to the authorities. According to these statistics, in 2007, there were almost 800,000 incidents of child maltreatment in the United States. Over half the reports involved neglect, 13 percent multiple forms of abuse, 10.8 percent physical abuse, and 7.6 percent sexual abuse. Of course this includes only the cases that were reported. We can assume that the real incidence of abuse is far higher.
As you can see from the table below, child neglect is the most common type of child mistreatment that comes to the attention of the authorities. These statistics come from the 2007 report on Child Mistreatment by the U.S. Department of Health and Human Services. While psychological abuse is listed as the second least common type of abuse reported to the authorities, this probably has little relationship to its frequency in the population. We can presume it is one of the most common forms of abuse, but because it does not put the child in immediate physical danger, it is likely underreported.
Types of Child Abuse Reported in the United States in 2007
| Type of Mistreatment | Percentage |
| Neglect | 59.0 |
| Multiple Types of Mistreatment | 13.1 |
| Physical Abuse | 10.8 |
| Sexual Abuse | 7.6 |
| Psychological Abuse | 4.2 |
| Medical Neglect | 0.9 |
| Other | 4.2 |
According to the U.S. Department of Health and Human Services 2007 statistics, parents were the most frequent perpetrators of child abuse in the cases reported to the authorities. The mother was the perpetrator in 38.7 percent of the cases, and the mother plus another person in 5.7 percent of the cases. The father was the perpetrator in 17.9 percent of the cases, the father plus another person in 0.9 percent of the cases, and the mother and father together in 16.8 percent of the cases. Day care staff accounted for 0.5 percent of the cases, friend/neighbors 0.4 percent, female relatives 1.7 percent, and male relatives 3.1 percent. Unrelated romantic partners of the parents also accounted for a small percent of the cases reported. Male partners accounted for 2.3 percent and female partners 1.7 percent.
As noted above, trauma in childhood differs from trauma in adulthood. While adults have largely formed personalities, children’s psychological capacities are not yet fully developed. Child abuse interferes with the child’s psychological development, stunting or distorting the child’s growing ability to regulate emotion, control impulses, plan and follow through with goals, negotiate interpersonal relationships, and maintain a stable and positive self-image. Abused children are also more likely to have difficulties with peer relationships and academic performance, and even suffer more medical problems than children who have not been abused. Consequently, child abuse raises the risk of anxiety, depression, impulse control disorders, and severe personality pathology throughout the lifespan. Most tragically, the abuse can teach the child that the world is cruel and uncaring, and that the child is unworthy of love, protection, or respect.
In the developing child’s brain, trauma can affect the very structure of the brain cells. Trauma can hinder mylenation, the growth of a fatty insulation around the neuron’s axon. Myelin improves the speed of electrical impulses travelling across the neuron. Trauma can also hinder synaptogenesis, the formation of connections between cells as well as the morphology or shape of the cell itself. Altogether, this reduces the density and connectivity of the brain. Moreover, brain cells are damaged in areas of the brain involved with emotion, memory, and behavioral control. Such areas include the amygdala, the hippocampus, and the frontal lobe.
Complex PTSD (post-traumatic stress disorder) pertains to the long-term effects of chronic and severe child abuse. This is quite different from normal PTSD, which describes the effects of acute trauma in adulthood. In complex PTSD, there are long-term changes in attention, memory, consciousness, regulation of emotion, and personality characteristics, including unstable, distorted and negative self-perceptions, and problematic interpersonal relationships. These problems can result in the dissociation, self-mutilation, self-destructive behaviors, and emotional storms that are often found with survivors of severe childhood abuse. While chronic PTSD is not an official diagnosis, it is currently being evaluated for inclusion in future editions of the Diagnostic and Statistical Manual (DSM).
Not everyone who has survived child abuse suffers the same results. Many factors affect the outcome. The first factor is the severity of the abuse. Violent, cruel, frequent and long-lasting abuse obviously has more of an effect than milder abuse. The relationship with the perpetrator is also critically important. The greater the emotional dependence on the perpetrator and the closer the relationship, the greater the damage. Consequently, abusive mothers do the most damage, followed by abusive fathers, other relatives, friends, acquaintances, and then strangers.
The table below shows the breakdown by age and sex of the total number of victimized children in the United States. As the table shows, most of the mistreatment cases occur with children under the age of four (60.2 percent of boys and 58.1 percent of girls). Most of these cases involve neglect. After age four the incidence of mistreatment goes down, only to rise again in adolescence for girls, but not boys. The increase in the mistreatment of teenage girls is probably due to an increase in sexual assaults starting at that time. These statistics come from the 2007 report on Child Mistreatment by the U.S. Department of Health and Human Services.
Percent of Child Abuse Victims (by Age and Sex) in 2007
| Age | % Boys | % Girls |
| < 1 yr. | 22.2 | 21.5 |
| 1 yr. | 13.2 | 12.7 |
| 2 yrs. | 12.8 | 12.2 |
| 3 yrs. | 12.0 | 11.7 |
| 4—7 yrs | 11.4 | 11.6 |
| 8—11 yrs. | 9.2 | 9.6 |
| 12—15 yrs. | 6.9 | 10.5 |
| 16—17 yrs. | 3.9 | 7.0 |
This table shows the frequency of different types of abuse across different age groups. For example, 21.8 percent of the total number of mistreatment cases involve neglect of children under the age of four. As you can see, neglect becomes less common as children get older, while sexual abuse becomes more common. All types of abuse decrease by the late teens. These statistics come from the 2007 report on Child Mistreatment by the U.S. Department of Health and Human Services.
Tragically, child abuse is often passed down from generation to generation. Frequently the parents of abused children have a history of child abuse in their own families. It is if they have learned automatically to treat children the way they have been treated. It is important to note, however, that the majority of abused children do not grow up to abuse their own children. Moreover, several factors buffer the effect of childhood abuse. For example, victims of child abuse with greater levels of education, social support, and financial security are less likely to abuse their own children.
Child abuse is often passed down generation to generation, but the cycle can be broken. The majority of child abuse victims do not grow up to be abusers themselves (iStock).
A warm, close relationship with an alternative caretaker, such as an aunt, grandparent, or even a caring neighbor, can soften the damaging effects of child abuse. Likewise, if the abuse is addressed promptly and the child protected from further harm, this can do a good deal to restore the child’s faith in the world. This is simplest if the abuser is not a close family member. However, if the child is strongly attached to the abuser—for example, if the abuser is a parent—separation from the abuser can also bring tremendous feelings of loss.
Psychotherapy can help the child victim understand what happened to him or her, correct any distorted views of the abuse (such as self-blame), and work through the complex and sometimes contradictory feelings about the abuse and the abuser. Hopefully, such help can protect against some of the negative psychological effects that often follow experiences of child abuse. Further, connections with institutions that foster relationships with the larger community (e.g., school, church), appropriate discipline in the home, and family stability protect against the negative psychological effects of child abuse.
As mentioned above, not all survivors of child abuse develop severe psychopathology. In fact, there are estimates that as much as one-third of children from abusive backgrounds grow up to be reasonably healthy and well-adjusted adults. Such children are considered resilient, which means they can bounce back and develop well even in the face of tremendous stress. Research has found several factors are associated with resilience in children: intelligence; the ability to make emotional connections with people outside the family; moderate self-control; positive self-image; and an internal locus of control all promote resilience. People with an internal locus of control believe they have reasonable control over their environment and that their actions make a difference. In addition, resilient survivors of child abuse are less likely than their less resilient counterparts to blame themselves for the abuse.
Sexual abuse of children involves inappropriate sexual contact between a child and an adult or a much older child. According to a definition used by Joan Liem, Jacqueline James, and colleagues in a 1997 study, sexual abuse involves any form of coercive sexual contact with an under-age child or any sexual contact between a child thirteen years or younger and someone five or more years older. Although the exact statutes vary state by state, any adult sexual contact with an under-age child is against the law. Sexual abuse ranges from exposure of genitals to fondling of body parts to direct genital contact and, ultimately, to anal or vaginal intercourse. Arguably, sexual abuse may be the most psychologically damaging form of child abuse.
The vast majority of incidents of child molestation are not violent. Most child molesters use manipulation or seduction to gain access to their child victims. A sizeable number of child molesters use just enough force to accomplish their goal. Only a small percentage is truly violent. These extreme cases attract the most media attention, however, which unfortunately gives the public a distorted sense of the problem of child sexual abuse.
According to government statistics, adolescent girls are the most common victims of child sexual abuse. Sexual abuse of pre-pubescent boys and girls is still widespread, however. In 2007, according to the U.S. Department of Health, there were approximately 56,460 cases of child sexual abuse reported to the authorities, 30,160 (53 percent) involved children under the age of twelve. Most children are abused by someone they know, 34.2 percent by family members, 58.7 percent by friends or acquaintances, and 7.0 percent by strangers, according to FBI statistics.
Although there is a wide range of psychological responses to childhood sexual abuse, problems with low self-esteem, depression, dissociation, lack of trust, and strong feelings of shame are very common. In fact, the diagnosis of complex PTSD was developed largely out of the study of sexual abuse survivors. Borderline personality disorder is also strongly linked to child sexual abuse. Not surprisingly, many sexual abuse survivors also have disturbances in their sexual functioning as adults. Some survivors become over-controlled sexually, with intense fear of and aversion to sexual contact. Others go to the opposite extreme and become sexually promiscuous, engaging in compulsive, driven, and often reckless sexual behavior. A 2008 study by Beth Brodsky and colleagues showed that the effects of child sexual abuse can reach across generations. Children of mothers who were sexually abused as children had an increased rate of suicidal tendencies compared to children of non-abused mothers.
Like many forms of child abuse, sexual abuse can be transmitted across generations. Adults who were abused as children can grow up to either abuse their own children or partner with someone who will abuse the children. Again, this is not to say that all childhood sexual abuse victims will grow up to abuse their own children. A large proportion of people who were sexually abused in childhood do not pass on their abuse experiences to their own children. Nonetheless, parents of abused children are more likely to have their own abuse histories than are parents of non-abused children.
According to FBI statistics, about 34 percent of child abuse cases involve incest. Incestuous abuse occurs when the child is related to the sexual abuser. Victims of incestuous abuse tend to experience more frequent, invasive, and long-term sexual abuse as the perpetrator has ongoing and convenient access to the victim. Research suggests that, on the whole, incest victims suffer greater psychological damage than do victims of other types of child sexual abuse. Not only is the child affected by the sexual abuse itself, the child’s entire view of interpersonal relationships is distorted by the incestuous relationship. Particularly when children are abused by a parent or a close caretaker, their ability to trust, to believe themselves worthy of care, and to value or even recognize their own needs and boundaries can be profoundly damaged. The abuser is not acting as a caretaker but as a user and exploiter of the child. In this context, it is often difficult for the child to understand that this is neither normal nor acceptable and that it is the adult who is at fault, not the child.
Pedophilia is a psychiatric disorder characterized by persistent sexual attraction to pre-pubescent children. Not all child molesters are pedophiles, however. For example, some child molesters sexually assault children not because they are sexually attracted to children, but because the child is a convenient target, because they are intoxicated, or for some other reason. Further, not all pedophiles are child molesters. Some people with strong and persistent sexual attraction to children may never act on their urges. Additionally, adults who molest adolescents are not necessarily pedophiles, as pedophilia refers only to the attraction to pre-pubescent children. The term hebephile is sometimes used to describe adults who are attracted to adolescents.
There have been several categorizations of pedophilia, but perhaps the most useful involves the distinction between true pedophiles and opportunistic pedophiles. Similar terms include fixated vs. regressed pedophiles and preferential vs. situational pedophiles. True pedophiles have persistent sexual attraction to pre-pubescent children. Opportunistic pedophiles have less of a focused sexual attraction to children. Their sexual engagement with children may depend on circumstances, such as the convenient availability of a child victim, loss of normal inhibitions due to substance abuse, or difficulty feeling comfortable with an adult sexual partner. In this way, opportunistic pedophiles may overlap with non-pedophilic child molesters.
At this point, there is no clear answer to this question, although quite a few possible causes have been proposed. Three possible causes include inadequate social skills, neurological impairment (or brain damage), and the pedophile’s own history of childhood sexual abuse.
Researchers and clinicians have suggested that pedophiles have poor self-esteem and inadequate social skills and turn to children out of fear of pursuing adult relationships. While this may be true for some pedophiles, it is clearly not true for many others, as there have been many high functioning, socially competent, and even married pedophiles.
There is also research suggesting that pedophiles suffer from some sort of neurological disturbance or brain damage. Again, there is some evidence of this. Several brain imaging studies have suggested abnormal brain function. There have also been cases of people developing pedophilia after suffering brain damage. However, this research is complicated by the samples used in pedophile studies. Most studies obtain their subjects from the criminal justice system. In other words, we study the ones who get caught. We rarely study the ones who have never been caught or have never acted on their urges. We know that, on the whole, convicted criminals tend to have lower intelligence, more problems with impulse control, and higher levels of psychopathic personality traits than the general population. Therefore, it is not clear if the biological findings are related to pedophilia per se, or to other problems common with a criminal population.
There does seem to be a clear relationship between sexual abuse in childhood and the development of pedophilia in adulthood. Many studies have shown a much higher rate of childhood sexual abuse in pedophilic samples than in the general population. Moreover, pedophiles have a higher rate of childhood sexual abuse than do non-sexual criminals and even sexual offenders against adults. As we are learning more and more about how early trauma affects the brain, it is possible that early sexual abuse disturbs the parts of the brain that regulate sexuality, contributing to the later development of pedophilia in some victims.
Children frequently do not tell anyone that they are being sexually abused. Even if the child has a close and trusting relationship with a parent and the abuse is by someone outside the family, the child may keep the abuse a secret out of shame, confusion, fear of retribution by the abuser or, if the child is young enough, lack of understanding about what is happening. In these cases, clues may be found in the behavior of the child. There may be a marked change in the child’s behavior, including a sudden onset of anxiety, depression, social withdrawal, reduced self-esteem, or sleep disturbances. A previously well-adjusted child may suddenly start acting truant, perform poorly in school or lose, or gain a good deal of weight. Unusual or predatory sexual behavior in the child can be another clue that the child has experienced sexual abuse. A sudden fear or aversion to a particular adult may also be a clue. Of course, behavioral changes like these can be due to many other causes besides sexual abuse. There is no need to assume a child who has developed some emotional problems has necessarily been sexually abused. Nonetheless, it is important to recognize that children cannot always verbalize that they have been abused and may express their suffering through marked changes in their behavior.
What is domestic violence?
Domestic violence refers to any kind of violence between intimate (or romantic) partners. Generally this refers to a husband and wife, but it can also apply to unmarried couples that do or do not live together. Domestic violence can also occur between homosexual couples, either gay men or lesbians. The severity of violence can range from mild aggression, such as a slap or a shove, to severe aggression (punching, kicking), to extreme aggression (long assaults, burning, or breaking bones), and even to murder.
Domestic violence is a very general term that does not specify the perpetrator, the severity of violence, or the duration of violence. Wife battering is a more specific term and refers to a systematic pattern of intimidation, control, terror, and physical violence inflicted upon a woman by her male partner. The intent of such behavior is to gain total control over the woman.
The problem of violence between people in intimate relationships has received shockingly little attention until quite recently. As part of the wave of civil rights movements starting in the 1960s, feminism brought attention to the profound problem of battered women, and the disturbing neglect that society has shown the victims. Several researchers and activists interviewed dozens, if not hundreds, of women who told dramatic stories about years of violence and abuse that were minimized, rationalized, and dismissed by the larger society. Police would brush off domestic violence as a private family matter, the clergy would emphasize the need to keep the family together over the women’s safety, and the courts would fail to prosecute the cases. Starting in the 1970s, a movement began to bring attention to the profoundly destructive effect of domestic violence and wife battering. Shelters for battered women were set up, new laws were written, and police, clergy and other authorities were educated about the seriousness of the problem.
The feminist movement played a central role in developing awareness of domestic violence. Feminist writers were the first to describe in detail the psychological, physical, economic, and cultural aspects of wife battering and to insist on bringing public attention to the problem. But as the feminist movement was essentially a political movement, the approach to domestic violence emphasized the political roots of the wife battering. More specifically, wife battering was seen as an outgrowth of the larger societal oppression of women. In a patriarchal (male dominated) society, women were seen as property and wife battering a quasi-legitimate means to keep women under control.
More recent work has taken a broader approach to the problem of domestic violence than was taken by the initial feminist writers. There is greater emphasis on empirical research instead of open-ended interviews and clinical histories. There is also interest in same-sex violence, the impact of domestic violence on children, the psychological features of anyone engaging in intimate partner violence, and the role of female-initiated violence. Importantly, empirical research has shown that not all of domestic violence can be explained by patriarchal oppression of women. Although classic instances of wife battering certainly do occur, women themselves are not always helpless victims of an abusive partner. Sometimes women are violent themselves and/or display some of the psychologically abusive tactics of a classic batterer. Additionally, violence between same-sex couples cannot easily be explained by societal oppression of women. Nonetheless, although later research shows a more complex picture than the earlier feminists described, the nature and frequency of domestic violence is undeniably influenced by the cultural, economic, and legal position of women in society.
Even though the study of domestic violence has broadened beyond the political vantage point of the 1970s, several key ideas introduced by feminist writers illuminate the psychological mechanics of battering relationships. Regardless of the gender of the people involved, a battering relationship has specific psychological characteristics that have long-lasting and very destructive effects on anyone caught in it. Three important concepts include the cycle of violence, coercive control, and traumatic bonding.
Both men and women can commit spousal abuse, but violence against women is more common whenever women have less economic or legal power in a society (iStock).
The psychologist Lenore Walker has written extensively about battered women. In an influential book entitled The Battered Woman, published in 1979, she introduced the concept of the cycle of violence to describe a consistent pattern in the violent behavior of batterers. Based on in-depth interviews with battered women, Walker described three phases of the cycle of violence: the tension-building phase, the acute battering incident, and the honeymoon phase. The tension-building phase precedes the acute battering incident. In this period, the batterer grows increasingly explosive and aggressive. There may be verbal abuse, temper explosions at minor frustrations, and an unpredictable building of tension. At this point, the battered woman knows that a serious explosion may occur at any moment, and she works overtime to appease her partner and avert what she ultimately knows is inevitable. She tiptoes around her partner, constantly walking on eggshells.
Over a period of time—the length of which can vary from a matter of days to several years—the tension escalates until it finally explodes into a violent assault, known as the acute battering incident. There can be punching, kicking, hitting with objects, and throwing down stairs. There can also be forced sexual activity. The abuse can go on for hours, sometimes ending only when the abuser is exhausted and has successfully released all his tension. In the honeymoon phase, the batterer expresses remorse, promises to change, and works hard to win back the woman’s love. Alternatively, he may threaten suicide if she wants to leave, or try to woo her back with heightened affection, gifts, and romantic attention. This continues until the tension-building phase begins anew. While Walker’s theory has been quite influential in the study and treatment of domestic violence, it has also been criticized as overly simplistic and not applicable to all cases of domestic violence. Nonetheless, most clinicians would agree that it is descriptive of some cases of domestic violence.
In 2007, Evan Stark published a book entitled Coercive Control: How Men Entrap Women in Personal Life. Stark’s ideas about coercive control were not new; in fact, they dated back to the 1970s. But after thirty years of working with battered women, Stark felt that the field of domestic violence had abandoned its feminist roots for an overly narrow focus on physical violence. In his view, it is the psychological aspects of the battering relationship that are the most damaging. Coercive control refers to the systematic attempts to psychologically dominate the battered women. Stark felt that this is at the core of all battering relationships.
Batterers use a broad range of tactics, which can include: micromanaging of the most intimate details of the victim’s life (e.g., dress, personal appearance, diet), paranoid levels of possessiveness, suspiciousness and sexual jealousy, verbal abuse and name calling, unpredictable outbursts over minor or even imaginary infractions, isolating the battered woman from all sources of social support, and continuous low levels of physical aggression (e.g., hair pulling, arm grabbing, shoving, pushing). These tactics create a climate of fear and self-doubt which, in turn, serves to break down the victim’s self-esteem, sense of autonomy, and capacity to resist the batterer’s domination. The serious assaults, when they come, only reinforce the victims’ helplessness. The violence does not stand on its own; it is part of a larger program to break down the victim and to effectively hold her hostage.
As several writers have noted, the tactics of coercive control used in battering relationships are remarkably similar to tactics used in other situations of captivity and terror. Political prisoners, cult members, and young girls “seasoned” into prostitution are frequently exposed to tactics of coercive control. The goal is always the same, to break down the self-confidence and autonomous sense of self of the victims, and leave them at the psychological mercy of their captors.
On February 4, 1974, 19-year-old Patty Hearst, granddaughter of the newspaper magnate William Randolph Hearst, was kidnapped off the campus of the University of California at Berkeley. A group calling themselves the Symbionese Liberation Army took responsibility for the crime. For months, Patty was locked in a closet, beaten, and raped. In April 1974, she was photographed taking part in a bank robbery. In September 1975, she was arrested for armed robbery. Prosecutors argued that she had willingly engaged in criminal behavior because she had failed to escape her abductors, even though she had ample opportunities to do so. Patty Hearst was found guilty and sentenced to 35 years in jail, which was later shortened to seven years. After only 21 months in prison, her sentence was commuted by President Jimmy Carter. Years later she would write of her ordeal and describe how the psychological effects of torture and captivity led her to identify with and then cooperate with her kidnappers’ demands, even when she was technically free to escape.
The dramatic case of Patty Hearst has become a textbook example of a kidnapping victim who comes to sympathize with her abductors. Hearst went so far as to commit armed robbery in 1974 at the behest of her kidnappers (Shutterstock).
In 1992 Judith Herman (1942–) published a book entitled Trauma and Recovery, which looked at the psychological effects of traumatic abuse from domestic abuse to political terror. Her chapter on the effects of captivity has particular relevance to the discussion of domestic violence. In effect, captivity can produce a form of brainwashing. In a severe battering situation, the batterer holds the victim captive. By controlling the victims’ entire world—their sleep-wake cycle, their diet, their physical safety and, most importantly, their access to other people—batterers can gradually take over their victims’ mind. Through constant verbal abuse and through the degradation of the physical abuse, the victim loses any sense of self-worth. Her confidence in her ability to control her environment is shattered. Her very sense of what is real is destroyed as the batterer controls the information that is available to her, and constantly denies her own sense of reality. Moreover, by keeping other people away, batterers remove any outside reality check on their distorted worldview.
A particularly powerful way to break down victims’ sense of self is to make them betray their own moral values. The victim may be forced to engage in emotionally disturbing sexual behavior or to participate in the abuse of another victim. Similar techniques are used in the brainwashing or “breaking down” of prisoners or cult members. A critical implication of this work is that, under the right circumstances, anyone can suffer the same psychological effects. Likewise, anyone can get into a battering relationship. Of course, certain people are more vulnerable to abusive relationships than others. People with a history of child abuse or domestic violence in childhood may be more vulnerable to entering into and staying in a battering relationship. Similarly, younger people and people with significant psychological problems may also be more vulnerable.
Traumatic bonding is another concept that helps us understand the power of the battering relationship. When people are under extreme stress, there is an intensified need to form powerful emotional bonds with other people. For example, soldiers in battle often form lifelong ties to other soldiers in their unit. Because of the acute trauma of the battering relationship, the victim also feels an intensified need for social bonds. But because of the victims’ social isolation, they have no one to turn to besides their batterers. In this way, victims develop great emotional dependency on the very person who is causing them such pain.
There are many reasons that battered women stay in a relationship, even though it can seem unfathomable to outside observers. First, there are often practical reasons, such as legal, economic, financial, and cultural considerations. Secondly, they have good reason to fear for their safety, and even their life, if they leave. Thirdly, the psychological effects of the battering relationship serve to break down self-confidence to the point that it can feel impossible to leave.
Although this is less true now than it was several decades ago, on a purely practical level it is often very difficult for a battered woman to leave her abuser. Inadequate financial means, inadequate legal protection, and lack of support by family and/or clergy can all hinder a battered woman’s escape. Although there is now much greater public awareness of domestic violence than there was in previous decades, battered women still may not have the resources or support they need to survive on their own, particularly if they have children. Additionally, battered women have good reason to fear for their safety or for the safety of their family. Batterers often threaten to kill the woman or to harm her family if she leaves. These are not idle threats. Murder by an intimate partner is the most common form of female homicide and the point of separation is a particularly dangerous time.
Hedda Nussbaum came to national attention after the 1987 beating death of her illegally adopted daughter, Lisa Steinberg. In 1989 her live-in companion, Joel Steinberg, was convicted of manslaughter in the child’s death. Initially, Nussbaum was also charged in her death, given her failure to take action to protect her daughter. However, Nussbaum was also a victim of Joel Steinberg’s abuse. Eventually, the court agreed that years of physical, sexual, and psychological torture rendered Nussbaum both psychologically and physically incapable of taking action against him, even to save her child’s life. Steinberg’s constant and brutal battery left Nussbaum permanently disfigured.
The whole aim of coercive control is to break down the independence of the victim. The verbal abuse, terror, unpredictability, and enforced social isolation all powerfully serve to crush a victim’s sense of self and even her sense of reality. A psychologically broken woman may not feel she is capable of living without her batterer. This is why so many women return to their batterer after they have left him.
There is no question that domestic violence has terrible effects on children. Children experience similar forms of psychological damage from witnessing domestic violence as they do from being a victim of it. Both child victims and child witnesses of physical abuse report higher levels of depression, aggression, problems in relationships, and problems in school. In sum, children who witness domestic violence are victims of it too. Moreover, children who are raised in violent homes can grow up thinking that violence in intimate relationships is normal. As adults, they are more likely to physically abuse their own partners, or to marry someone who will physically abuse them.
Early feminist scholars insisted that spousal battery was an overwhelmingly male phenomenon. However, a number of studies investigating couples in the community suggest that women were actually more likely than men to commit violence, especially mild forms of violence. In a 2007 study of 607 college students, Rosemarie Cogan and Tiffany Fennell found that 53 percent of women and 38 percent of men reported committing physical aggression toward an intimate partner. In a 2006 study by Susan O’Leary and Amy Slep, 453 cohabitating couples with young children reported similar results. Women admitted to a median of three acts of mild physical aggression and two acts of severe physical aggression in the past year, compared to men, who admitted to two mild acts and one severe act in the past year. Additionally, both males and females perceive female-initiated violence to be less dangerous and problematic than male-initiated violence.
Criminal statistics, however, tell a different story than the research quoted above. Men are far more likely to be involved in criminal assaults against a partner than are women and female homicide by an intimate partner is far more common than the reverse. In fact, murder by an intimate partner is the most frequent form of female homicide. Taken together, these findings suggest that American women are equally if not more likely than men to engage in mild to moderate aggression, but that men are still much more likely to engage in serious and life-threatening violence against their intimate partners.
The 1994 murder of Nicole Simpson and Ronald Goldman caused an enormous scandal. O.J. Simpson, a popular former football player and Nicole’s estranged husband, was arrested for the murders after a dramatic, televised car chase. There was a documented history of domestic violence in the Simpson family, with police records of multiple 911 calls made by Nicole during O.J.’s violent outbursts. There were also graphic photographs of Nicole’s bruised face taken years before the murder.
Despite what the defense described as an airtight case, O.J. was acquitted. His attorney, Johnny Cochran, skillfully turned the jury’s focus from the guilt or innocence of O.J. Simpson to the credibility of the Los Angeles Police Department. Simpson was later found guilty in a wrongful death civil suit. After the trial, considerable media attention was given to the ongoing racial divisions in the United States revealed by public response to this inter-racial scandal. Unfortunately, this highly publicized case brought little attention to the problem of domestic violence.
O.J. Simpson (right) with attorney Robert Shapiro during his August 1994 trial (AP Photo/Nick Ut, Pool).
What are the criminal statistics about intimate partner violence?
According to the U.S. Department of Justice, from 2001 to 2005, 0.4 percent of women and 0.09 percent of men reported an assault by an intimate partner to the police per year. This accounted for 21.5 percent of all nonfatal assaults for women and 3.6 percent for men. Further, in 2005, 1,181 women and 329 men were murdered by intimate partners. Between 1976 and 2005, 30.1 percent of female murders and 5.3 percent of male murders were committed by intimate partners. Thus women are 3.6 times more likely than men to be murdered by an intimate partner and 4.4 times more likely to suffer nonfatal intimate partner assaults. The good news, though, is that the incidence of all violent crimes by intimate partners has decreased dramatically over the last few decades.
Rates of domestic violence, particularly violence against women, appear to vary drastically across cultures. According to a 2009 report by the World Health Organization, the lifetime rate of spousal battery among ever-partnered women ranged from 15 to 72 percent. Rural areas had much higher rates of spousal abuse than urban areas. The lifetime rate of sexual or physical violence from an intimate partner was 72 percent in rural Ethiopia, 69 percent in rural Peru, and 62 percent in rural Bangladesh. The rate was 15 percent in urban Japan, 24 percent in urban Serbia and Montenegro, and 29 percent in urban Brazil. Although the annual rate of spousal abuse was much lower than the lifetime rate, abuse was rarely a one-time thing. If it happened once, it was likely to occur again.
Poverty, war, and political and economic instability lead to increased rates of violence against women. Additionally, alcohol abuse and exposure to domestic violence as a child both increase the likelihood of domestic violence. Arguably, however, the most important factor is the cultural attitude toward domestic violence and the rights of women. When women have no rights and men feel entitled to treat women as property, domestic violence can become endemic.
The widespread acceptance of the equal rights of women is a fairly new phenomenon, arising only in the last four decades. While women now make up almost half the work-force in the United States and account for about 50 percent of law, medical, and doctoral degrees, only thirty-five years ago women accounted for a small fraction of the professions. According to the U.S. State Department’s 2003 report on international human rights, the movement toward equal rights for women in the developing world is only just beginning.
In many Islamic countries, for example, the role of women is still extremely constricted, and religious conservatives believe that women should be entirely subordinate to men. Consequently, legal rights for women vary drastically across countries. In most developed Western countries women have essentially the same legal rights as men. In other countries, many things are forbidden to women: the legal right to work; to have access to credit; to own property; to initiate a divorce; to have custody of the children; and even to have one’s testimony in court carry as much weight as a man’s testimony. In some developing countries, such as South Africa, new, progressive laws support many rights for women. However the enforcement of such laws is often quite lax, and popular acceptance, particularly in rural areas, is very low. In other countries, such as Saudi Arabia, women are not allowed to drive or to travel without a man accompanying them.
The feminist movement brought the problem of domestic violence to public attention only within recent decades. Most industrialized countries now recognize the problem and have laws against it. For example, in Canada there were 524 shelters for battered women by 2002. In other developing countries, such as South Africa, there are laws prohibiting domestic violence but enforcement is a problem and there is little government support for public education against domestic violence or for shelters for battered women. Still other countries, such as Bulgaria or Zimbabwe, have no laws against domestic violence. In many cultures, popular attitudes promote a tolerance of domestic violence. The problem is minimized by the family and community as well as by judicial and medical systems, and both men and women believe a man has the right to physically “discipline” his wife.