FAMILY VIOLENCE & MENTAL HEALTH IMPACTS

Prof. Jayashri KulkarniMonash Alfred Psychiatry research centrewww.maprc.org.au

Violence Against Women

• In Victoria, male intimate partner violence is found to be the leading contributor to death, disability and illness for women aged 15 to 44 years (VicHealth 2004).

• Ref “Preventing violence against women” http://www.vichealth.vic.gov.au

Violence Against Women

• The Personal Safety Survey is a survey of 16,400 Australians aged 18 years and over conducted by the ABS (2006).

Some Findings :• Well over one-third of women (40 percent) had experienced physical

and/or sexual violence.• Just under one in three women (29 per cent) had experienced

physical assault.• Nearly one in five (17 per cent) had experienced sexual assault.• Nearly one in seven (15 per cent) had experienced physical and/or

sexual violence by a previous partner.• Two per cent had experienced physical and/or sexual violence by

their current partner (ABS 2006).

Increasing rate of sexual abuse of girls in Australia

• As seen, there is a greater number of early – mid teenaged girls with incidences of maltreatment – sexual abuse, physical violence and/or neglect.

• The biological impact of this is long – lasting, with obesity, poor education attainment, health services engagement due to self harm and rage with resultant poor quality of life.

Early sexualisation of girls & Mental Illness• Premature sexualisation is linked with serious mental health

problems like eating disorders, low self-esteem and depression.• Sexualisation puts girls in danger. It contributes to exploitation and

violence against girls and women. It increases sexism, sex bias, and sexist attitudes.

• Strong evidence indicates the exposure to ideals of sexual attractiveness in the media is associated with greater body dissatisfaction among girls and young women.

• If girls and women are seen exclusively as sexual beings rather than as complicated people with many interests, talents, and identities, boys and men may have difficulty relating to them on any level other than the sexual.

• ( Ref Womensforum Australia 2013)

Monash Alfred Psychriatry Reseacrh Centre

Antenatal Domestic Violence• Antenatal violence associated with maternal depression in

pregnancy and postpartum.

• Behavioural problems seen in the child up to 4 years.

• Due to impact of cortisol and CRF on fetal neurons.

• Profound impact of maternal depression on baby/child development.

( Flasch et al 2011 – AVON longitudinal study of parents and children.14,451 pregnancies studies and followed)

What is TRAUMA?

• A direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about an unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (APA, 2000, p. 463).

What is Post –Traumatic Stress Disorder? (PTSD)

• PTSD was reserved as a term for the collection of symptoms experienced by war veterans – “shell shock” described in WW1.

• Definition broadened in the 1960s to include women and children who experienced psychological trauma, following abuse.

PTSD

• Re-experiencing symptoms: Flashbacks -reliving the trauma over and over, including physical symptoms like a racing heart or sweating. Bad dreams. Intrusive thoughts, dissociation, prolonged distress with any cues of the event.

• Avoidance symptoms: Staying away from places, events, or objects that are reminders of the experience. Feeling emotionally numb.

PTSD

• Hyperarousal symptoms: Being easily startled, irritable & angry, recklessness, poor concentration, self – destructive, poor sleep.

• Negative Alterations in Cognition : Unable to remember important aspects of the trauma (due to dissociation), persistent negative beliefs about self or the world “ I am bad”, self-blame for the event, guilt/shame, decreased interest in usual activities,feel detached, unable to feel positive emotions.

Biology of stress induced by trauma

Cortisol, Memory & Stress

• Glucocorticoids (cortisol and corticosterone)

released from the adrenal

cortex during stress have

adverse effects on cognitive

functions such as learning

and memory. Newcomer et al (1999)

The Brain Biology of Trauma

Many Effects of Trauma

• Depression• Anxiety• Brief reactive psychosis• Complex Trauma Disorder

A Case

• Emma, now 26 – was raised by her single mother.

• Her father left when Emma was 5.• She was sexually abused by her mother’s

boyfriend when she was aged 8 to age 14. • She told her mother who did not believe her.• Emma left home at age 16 and has a history of

amphetamine abuse, alcohol abuse.

A Case

• She cuts her arms and wrists and says this makes her feel “alive”.

• Emma could not complete school and said she was unable to concentrate and has a “bad memory”.

• She feels empty inside and often looks “dazed”.

• Emma has angry outbursts over minor things.

A Case

• Emma is very overweight.• She has made 11 suicide attempts.• Emma has had 4 admissions to psychiatry

wards.• She has a diagnosis of “BORDERLINE

PERSONALITY DISORDER”.

What is BORDERLINE PERSONALITY DISORDER?

• The DSM 5 term is “Borderline Personality Disorder”.

• What a useless term!!• A better term is COMPLEX OR CHRONIC

TRAUMA DISORDER.

Symptoms of BPD/ CTD

• Deep feelings of insecurity• Difficulty coping with fear of abandonment and loss;

continually seeking reassurance, even for small things; • Rage & anger towards others whom they consider

responsible for how they feel;• A fragile sense of self and one’s place in the world.• Dissociation with stress.• Self-harm Causing deliberate pain by cutting, burning or

hitting oneself; overdosing on prescription or illegal drugs; binge eating or starving; abusing alcohol and other drugs; repeatedly putting oneself in dangerous situations or attempting suicide.

Symptoms of BPD/ CTD

• Persistent impulsiveness - Abusing alcohol and other drugs; spending excessively; gambling; stealing; driving recklessly, or having unsafe sex.

• Confused, contradictory feelings. Frequent questioning and changing of emotions or attitudes towards others, and towards aspects of life such as goals, career, living arrangements or sexual orientation.

Symptoms of BPD/ CTD

• Some people with BPD may also have symptoms of other mental illnesses.

• May experience symptoms associated with anxiety or mood disorders.

• May experience psychotic symptoms such as delusions or false beliefs – believing, for example, they are being deceived, spied on or plotted against.

• Re-appearance of symptoms at menopause.

BPD/CTD• BPD is a complex disorder that is often

misunderstood.• People may self-harm due to low self esteem, to

momentarily express and release emotional pain or even to punish themselves.

• The anger and rejection that people with BPD display mean they are sometimes labelled as ‘bad,‘ ‘manipulative’ or ’attention-seeking’.

• “Push –pull” dynamic inrelationships• People with BPD can get better. While there is

no cure yet, BPD is a treatable disorder.

Relationship between Abuse/Stress and CTD

Trauma/Abuse ( sexual/physical/

emotional)

Ongoing stress – causing biological/

psychological changes

PTSD/Chronic Stress

DisordersSelf Harm,

rage, relationship & work issues

Management in General

• SAFETY- may need Police/legal interventions• Assess whether other conditions e.g: depression

present.• Psychotherapy – DBT, supportive at times of

crisis, insight directed when possible.• Medications – for acute crises, accompanying

depression, psychosis• Education/ support for family/ friends.• “Re-training” regarding relationship/ suicide

thoughts.