psychiatric impact of childhood sexual abuse: life on the borderline survivors of abuse – access...

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