Childhood Physical Abuse and long-term health implications – scientific evidence & call to action

What is Childhood Physical Abuse? 

Physical abuse of a child is defined as the intentional use of physical force against a child that results in—or has a high likelihood of resulting in—harm to the child’s health, survival, development, or dignity[i]. Physical abuse includes hitting, beating, kicking, shaking, biting, strangling, scalding, burning, poisoning, and suffocating. Much physical violence against children in the home is inflicted with the object of punishment[ii]. Physical abuse leaves a more profound impact on an individual, and evidence suggests that it transforms into severe mental and physical health disorders.

Prevalence of Childhood Physical Abuse

In a study conducted in 2016,  thirty-eight reports provided quality data for 96 countries on past-year prevalences of violence against children. Base case estimates showed a minimum of 50% or more of children in Asia, Africa, and Northern America experienced past-year violence and that globally, over half of all children—1 billion children, ages 2–17 years—experienced such violence[iii]. Unfortunately,  there has been significant growth in these numbers as per WHO’s recent data. The WHO data indicates that nearly 3 in 4 children, about 0.3 Billion children between the ages of 2 and 4 years, regularly suffer from physical and/or psychological violence from their parents or caregivers[iv].  Another review of 52 inpatient studies found that over 50% of the men and over 60% of the women had been sexually or physically abused as children[v].  The following section provides an overview of the health implications of physical abuse.

Long term implications for adults who have experienced childhood physical abuse

Childhood Physical abuse is associated with short- and long-term psychological and physiological difficulties.

  • The short term challenges include behaviour like running away, vandalism or hurting others, low self-esteem, nightmares and trouble sleeping, poor social function and social withdrawal/isolation, poor grades and skipping school[vi].
  • The long-term correlates of childhood physical abuse include many adult mental health problems, including depression, anxiety disorders, eating disorders, sexual dysfunction, personality disorders, dissociative disorder, substance abuse, PTSD (Post Traumatic Stress Disorder), bipolar disorder and psychosis[vii].

Exposure to family violence, including marital aggression and physical child abuse, is increasingly recognized as a possible precursor to PTSD in children and adolescents[viii].

Overview and insights from the work we do at the Society for Energy & Emotions

At the Society for Energy & Emotions, as part of our analysis, we analyze the data to increase the effectiveness of our work.  Anuja Bhandari did a recent study for her internship with us during the summer of 2022 and worked with Heer Vaghela, Counseling Psychologist and Gunjan Y Trivedi, Life Coach and Riri G Trivedi, Trainer and Regression Therapist, who does most of the interviews with the clients.

Anuja found that nearly 1 out of 3 individuals who fill the self-assessment of the Adverse Childhood Experiences questions do not put “Yes” to the question on the physical abuse despite having experienced it as a child.  Unfortunately, this is still better than the evidence from a recent systematic review that reported that only 33.1% of the physical abuse (weighted average of several studies) is found in the files by the mental health services provider![ix].

 Why is it essential to assess the history of childhood physical abuse? 

This data is serious since, among those who we assess for PTSD, physical abuse is present in 1 out of 4 people. Those with physical abuse have a much higher ACE score (~6 on core ACE 10 questions) than those who have not experienced physical abuse but still have PTSD (ACE score ~3.8).  Hence, we must get insights into the physical abuse (we also have a qualitative questionnaire that further assesses the details).

Many people tell us it happened decades ago, or it doesn’t happen now. Unfortunately, physical abuse continues to happen even in the 21st century.  Considering our Gen Z[1] age group data (Figure 1), compared to those who haven’t experienced physical abuse, the clients (Gen Z) who have experienced physical abuse come to us with severe anxiety, depression and clinical insomnia.

Adverse Childhood Experiences

Figure 1 – Genz with and without Physical Abuse – and implications on mental health parameters

Source: Society for Energy & Emotions, Wellness Space data (2022)

The good news is that people who seek help see improvement in their well-being, sleep quality and reduction in their anxiety and depression levels.

So what? 

  1. Awareness: Please become aware and increase awareness about the implications of physical abuse.
  2. Prevention from happening: Once you become aware, please join hands to find a way to educate parents, caregivers, healthcare specialists and everyone else.
  3. Prevention from further impact: It is essential to realize that if you have experienced physical abuse as a child, you need help.  The implications are often beyond just the physical abuse (of course, if the frequency and intensity were higher, it leaves a more profound impact).  Children who are abused often have experienced emotional abuse or fear or irrational phobia, or other experiences that create a much more significant impact.
  4. Review additional insights from the scientific evidence (see below) – if you need further details.

 

Additional insights are below:

Exhibit – Evidence on the long term mind-body impact of childhood physical abuse.

Association between Childhood Physical Abuse and Mental Health Disorders

Robust evidence suggests that adverse childhood effects from physical abuse cause many mental health problems[x]. There is a direct link between childhood physical abuse and the development of mental health challenges. People abused as children are high users of adult mental health services; are more likely to be admitted to a psychiatric hospital and have earlier,  more prolonged and more frequent admissions; have higher global symptom severity, and are more likely to self-harm kill themselves[xi]. Adults scoring high on the Adverse Childhood Experiences scale are 10 times more likely to be prescribed antipsychotics and 17 times more likely to be prescribed antidepressants.

Association between Childhood Physical Abuse and Somatic Disorders

Scientific evidence suggests that childhood adversities and early-onset mental disorders have independent, broad-spectrum effects that increase the risk of diverse chronic physical conditions in later life. In a Cross-sectional community survey of adults in 10 countries, which comprised of 18,303 Adults aged 18 and above, with diagnostic assessment and determination of age at onset of DSM-IV mental disorders, assessment of childhood familial adversities, and age of diagnosis or start of chronic physical conditions, it was established that Physical abuse was associated with the onset of chronic disease outcomes like  Heart Disease, Asthma, Diabetes, Mellitus Osteoarthritis Chronic Spinal Pain (Back or Neck) & Frequent or Severe Headache. A retrospective cohort study of 15,357 subjects found that Childhood traumatic stress increased the likelihood of hospitalization with a diagnosed autoimmune disease decades into adulthood. The prevalence of physical abuse for the same is 28%. This means that physical abuse and such traumatic childhood experiences can be linked with Autoimmune diseases in adulthood.

Additional evidence linking childhood physical abuse to mental health challenges faced by the adults:

  1. Physical Abuse and its Mental and Physical Health Outcomes included Anxiety, Depression, Eating Disorders, Suicide attempts, Increased propensity for drug use and risky sexual behaviour.
  2. Physical abuse also causes  Childhood behavioural/conduct disorders like ADHD (Attention Deficit Hyperactivity Disorder, ODD Oppositional Defiant Disorder and other Emotional Disorders with symptoms like Inappropriate actions or emotions under normal circumstances,
  3. Learning difficulties that are not caused by another health factor, Difficulty with interpersonal relationships, including relationships with teachers and peers, A general feeling of unhappiness or depression and feelings of fear and anxiety related to personal or school matters[xii].

Foonote: [1] Gen Z is the generation born between the late 1990s and 2010.

 

References:

[i] Center for Disease Control Website: https://www.cdc.gov/violenceprevention/childabuseandneglect/fastfact.html (Last Accessed Mar 20, 2022)

[ii] Norman, Rosana E.; Byambaa, Munkhtsetseg; De, Rumna; Butchart, Alexander; Scott, James; Vos, Theo; Tomlinson, Mark (2012). The Long-Term Health Consequences of Child Physical Abuse, Emotional Abuse, and Neglect: A Systematic Review and Meta-Analysis. PLoS Medicine, 9(11), e1001349–. doi:10.1371/journal.pmed.1001349

[iii] Hillis, S., Mercy, J., Amobi, A., & Kress, H. (2016). Global prevalence of past-year violence against children: a systematic review and minimum estimates. Pediatrics, 137(3).

[iv] World Health Organization Website: https://www.who.int/news-room/fact-sheets/detail/child-maltreatment (Last Accessed, May 4, 2022)

[v] Read, John; Harper, David; Tucker, Ian; Kennedy, Angela (2017). Do adult mental health services identify child abuse and neglect? A systematic review. International Journal of Mental Health Nursing, (), –. doi:10.1111/inm.12369

[vi] Short and long-term effects of abuse on children and teens – Indiana Child Advocacy Centers and Chapter of NCA. Indiana Child Advocacy Centers and Chapter of NCA. Retrieved 16 December 2021, from https://incacs.org/prevention/short-and-long-term-effects-of-abuse-on-children-and-teens/.

[vii] Read, John; Harper, David; Tucker, Ian; Kennedy, Angela (2017). Do adult mental health services identify child abuse and neglect? A systematic review. International Journal of Mental Health Nursing, (), –. doi:10.1111/inm.12369

[viii] Margolin, G., & Vickerman, K. A. (2007). Post-traumatic Stress in Children and Adolescents Exposed to Family Violence: I. Overview and Issues. Professional psychology, research and practice, 38(6), 613–619. https://doi.org/10.1037/0735-7028.38.6.613

[ix] Read, John; Harper, David; Tucker, Ian; Kennedy, Angela (2017). Do adult mental health services identify child abuse and neglect? A systematic review. International Journal of Mental Health Nursing, (), –. doi:10.1111/inm.12369

[x] Trivedi, G. Y., Pillai, N., & Trivedi, R. G. (2021). Adverse Childhood Experiences & mental health – the urgent need for public health intervention in India. Journal of preventive medicine and hygiene62(3), E728–E735. https://doi.org/10.15167/2421-4248/jpmh2021.62.3.1785

[xi] Read, John; Harper, David; Tucker, Ian; Kennedy, Angela (2017). Do adult mental health services identify child abuse and neglect? A systematic review. International Journal of Mental Health Nursing, (), –. doi:10.1111/inm.12369

[xii] Behavioral Disorder Symptoms, Causes and Effects – PsychGuides.com. PsychGuides.com. Retrieved 3 January 2022, from https://www.psychguides.com/behavioral-disorders/.