survivors can break the cycle of abusive parenting and be considered a preventive measure for suicidal behavior.

CHILDHOOD TRAUMA AS A RISK FACTOR FOR PSYCHOPATHOLOGY

Childhood trauma is a risk factor for the onset of psychopathology. Child sexual abuse and physical abuse have been the most intensively studied. They are associated with wide-ranging categories of mental disorders or symptomatology (for reviews, see Kendall-Tackett et al., 1993; Margolin and Gordis, 2000; NRC, 1993). About 40–50 percent of abuse victims develop at least two disorders by age 21 (Silverman et al., 1996). The most common outcomes of sexual or physical abuse are depression and post-traumatic stress disorder (PTSD). A meta-analysis of 37 studies of child sexual abuse, published between 1981–1995, found robust effect sizes for depression (d=0.44) and PTSD (d=0.40) (Paolucci et al., 2001). Most studies in this meta-analysis were conducted in clinical populations, but more recent studies feature population or community samples. After exposure to sexual abuse or physical abuse, about one-third to one-half of children prospectively develop PTSD (Silverman et al., 1996; Widom, 1999). Similar proportions of exposed children or adolescents prospectively develop depression (Brown et al., 1999; Fergusson et al., 1996; Silverman et al., 1996). PTSD or depression can persist from childhood into young adulthood (Brown et al., 1999; Fergusson et al., 1996; McCauley et al., 1997; Silverman et al., 1996; Widom, 1999).

Other outcomes of child sexual or physical abuse, from population or community studies, are substance use disorders (Dinwiddie et al., 2000; Fergusson et al., 1996; Kendler et al., 2000; Molnar et al., 2001b; Silverman et al., 1996; Widom et al., 1995; Wilsnack et al., 1997) and conduct disorder (Fergusson et al., 1996; Flisher et al., 1997; McLeer et al., 1998). Anti-social personality disorder and borderline personality disorder are also associated with childhood physical or sexual abuse (Brown and Anderson, 1991; Horwitz et al., 2001; Luntz and Widom, 1994; Silverman et al., 1996; van der Kolk et al., 1991).

Given the wide range of possible psychiatric outcomes, one study of child sexual abuse provides an indication of their relative likelihood. In a cohort of 1019 young adults (18 years old), the study found that adjusted odds ratios13 were greatest for conduct disorder, substance use disorders,

13  

In comparison to young people not exposed to childhood sexual abuse, after adjustment for social, family, and contextual factors that are associated with child sexual abuse and increased risk of disorder.



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