psychiatric impact of childhood sexual abuse: life on the borderline survivors of abuse – access...
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Psychiatric ImpactPsychiatric Impactofof
Childhood Sexual Childhood Sexual Abuse:Abuse:
Life on the BorderlineLife on the Borderline
Survivors of Abuse – Access to Survivors of Abuse – Access to JusticeJustice
Information Seminar, 14 May Information Seminar, 14 May 20042004
Ian Curtis MBBS FRANZCP Ian Curtis MBBS FRANZCP FAChAMFAChAM
BorderlandBorderland(author BV, with permission)(author BV, with permission)
The sand stingsThe Wind is HowlingOf pain past.
I know nothing The sand in my eyesOf pain present.
I just existI just existAsk me who “I” amAsk me who “I” amNo answer.No answer.
Gritting sand Gritting sand Prevents looking Prevents looking
wherewhereThe I is.The I is.
Can’t be heardCan’t be heardThe Wind is The Wind is
HowlingHowlingLonely and worse.Lonely and worse.
IsolateIsolateSo as not to feelSo as not to feelContact causes Contact causes hurt.hurt.
The Wind is The Wind is HowlingHowlingWhen will I be When will I be Whole?Whole?(BV)(BV)
Prevalence ofPrevalence ofBorderline FeaturesBorderline Features
• General populationGeneral population 1-2%1-2%• Outpatient mental health clinicsOutpatient mental health clinics
10%10%• Psychiatric inpatient clinicsPsychiatric inpatient clinics 20%20%• Special Clinic PopulationsSpecial Clinic Populations
involving personality disordersinvolving personality disorders 30-60%30-60%
The DamageThe Damage
AetiologyAetiology
Early life Physical and Sexual Early life Physical and Sexual Abuse, Neglect, Hostile Conflict, Abuse, Neglect, Hostile Conflict, and early Parental and early Parental Loss/Separation are more common Loss/Separation are more common in the Childhood histories.in the Childhood histories.
((Source: Diagnostic and Statistical Manual Mental Source: Diagnostic and Statistical Manual Mental Disorders, 4Disorders, 4thth Edition, p708) Edition, p708)
General BehavioursGeneral Behavioursof the Borderlineof the Borderline
• AmbivalenceAmbivalence• EmptinessEmptiness• AngerAnger• InstabilityInstability• Impulsivity and Impulsivity and
RecklessnessRecklessness• Deliberate Self-Deliberate Self-
HarmHarm• ImmaturityImmaturity
Frantic efforts to avoidFrantic efforts to avoidreal or imaginedreal or imaginedabandonment abandonment
Ambivalence:Ambivalence:
alternating betweenalternating betweenextremes of idealisationextremes of idealisation
and devaluationand devaluation
Pattern of unstable and Pattern of unstable and intense interpersonal intense interpersonal
relationshipsrelationshipsalternating between alternating between
extremesextremesof idealisation and of idealisation and
devaluationdevaluation
Identity disturbance:Identity disturbance:
unstable self-imageunstable self-imageor sense of selfor sense of self
Hopeless-Helpless:Hopeless-Helpless:
chronic feelings of chronic feelings of emptinessemptiness
Instability:Instability:
affective instability due affective instability due toto
a marked reactivity of a marked reactivity of moodmood
Anger Management Anger Management ProblemsProblems
inappropriate, intense inappropriate, intense angeranger
or difficulty controlling or difficulty controlling angeranger
Self-Harming:Self-Harming:
impulsivity in at least impulsivity in at least two areas that are two areas that are
potentially self-damagingpotentially self-damaging(eg spending, sex,(eg spending, sex,
substance abuse etc)substance abuse etc)
Suicidality:Suicidality:
recurrent suicidal recurrent suicidal behaviour, gestures, behaviour, gestures,
threats,threats,self-mutilating behaviourself-mutilating behaviour
Psychotic Border:Psychotic Border:
stress-related paranoid stress-related paranoid ideationideation
ororsevere dissociative severe dissociative
symptomssymptoms
And Drug AbuseAnd Drug Abuse
• Self-treatingSelf-treating• Fill emptinessFill emptiness• Isolate Isolate
interpersonallyinterpersonally• Pseudo-closenessPseudo-closeness• ““Control emotions”Control emotions”• Obscure angerObscure anger• Self-harmSelf-harm
Unique DifficultiesUnique Difficulties
BipolaritiesBipolarities
AmbivalenceAmbivalence
Embraced Embraced FailureFailure
(Abandoned Hope)(Abandoned Hope)
AbuseAbuse
ImpairedImpaired OverOverAchievementAchievementAchievementAchievement
VulnerabilityVulnerability
Transition to AdulthoodTransition to Adulthood
FailedFailed StalledStalled OverOver
CompensatedCompensated
Adult OutcomesAdult Outcomes
SeriousSerious AdultAdultImpairmentImpairment SuccessSuccess