psychiatric impact of childhood sexual abuse: life on the borderline survivors of abuse – access...
TRANSCRIPT
![Page 1: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/1.jpg)
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
![Page 2: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/2.jpg)
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.
![Page 3: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/3.jpg)
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.
![Page 4: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/4.jpg)
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)
![Page 5: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/5.jpg)
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%
![Page 6: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/6.jpg)
The DamageThe Damage
![Page 7: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/7.jpg)
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)
![Page 8: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/8.jpg)
![Page 9: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/9.jpg)
![Page 10: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/10.jpg)
General BehavioursGeneral Behavioursof the Borderlineof the Borderline
• AmbivalenceAmbivalence• EmptinessEmptiness• AngerAnger• InstabilityInstability• Impulsivity and Impulsivity and
RecklessnessRecklessness• Deliberate Self-Deliberate Self-
HarmHarm• ImmaturityImmaturity
![Page 11: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/11.jpg)
Frantic efforts to avoidFrantic efforts to avoidreal or imaginedreal or imaginedabandonment abandonment
![Page 12: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/12.jpg)
Ambivalence:Ambivalence:
alternating betweenalternating betweenextremes of idealisationextremes of idealisation
and devaluationand devaluation
![Page 13: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/13.jpg)
Pattern of unstable and Pattern of unstable and intense interpersonal intense interpersonal
relationshipsrelationshipsalternating between alternating between
extremesextremesof idealisation and of idealisation and
devaluationdevaluation
![Page 14: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/14.jpg)
Identity disturbance:Identity disturbance:
unstable self-imageunstable self-imageor sense of selfor sense of self
![Page 15: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/15.jpg)
Hopeless-Helpless:Hopeless-Helpless:
chronic feelings of chronic feelings of emptinessemptiness
![Page 16: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/16.jpg)
Instability:Instability:
affective instability due affective instability due toto
a marked reactivity of a marked reactivity of moodmood
![Page 17: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/17.jpg)
Anger Management Anger Management ProblemsProblems
inappropriate, intense inappropriate, intense angeranger
or difficulty controlling or difficulty controlling angeranger
![Page 18: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/18.jpg)
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)
![Page 19: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/19.jpg)
Suicidality:Suicidality:
recurrent suicidal recurrent suicidal behaviour, gestures, behaviour, gestures,
threats,threats,self-mutilating behaviourself-mutilating behaviour
![Page 20: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/20.jpg)
Psychotic Border:Psychotic Border:
stress-related paranoid stress-related paranoid ideationideation
ororsevere dissociative severe dissociative
symptomssymptoms
![Page 21: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/21.jpg)
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
![Page 22: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/22.jpg)
Unique DifficultiesUnique Difficulties
BipolaritiesBipolarities
AmbivalenceAmbivalence
Embraced Embraced FailureFailure
(Abandoned Hope)(Abandoned Hope)
![Page 23: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/23.jpg)
AbuseAbuse
ImpairedImpaired OverOverAchievementAchievementAchievementAchievement
![Page 24: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/24.jpg)
VulnerabilityVulnerability
![Page 25: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/25.jpg)
Transition to AdulthoodTransition to Adulthood
FailedFailed StalledStalled OverOver
CompensatedCompensated
![Page 26: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/26.jpg)
Adult OutcomesAdult Outcomes
SeriousSerious AdultAdultImpairmentImpairment SuccessSuccess
![Page 27: Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis](https://reader036.vdocument.in/reader036/viewer/2022062517/56649f1d5503460f94c340df/html5/thumbnails/27.jpg)