Psychiatric diagnoses of self-reported child abusers

Parental personality disorder and child maltreatment: A systematic review and meta-analysis

BACKGROUND

Parental pathology may affect parenting capacity and is deemed a risk factor for child maltreatment. Especially parental personality disorder (PD) can significantly burden the relationship and interaction between parents and their children.

OBJECTIVE

This meta-analytic review aims to summarize and quantify the influence of parental PD on the occurrence / the risk of child maltreatment.

PARTICIPANTS AND SETTING

Studies had to meet the following inclusion criteria: They had to analyze a sample of parents with a diagnosed PD and the occurrence / risk of maltreating their children. To be included in the narrative synthesis and/or meta-analysis, they had to be case-control, cross-sectional, or longitudinal studies. Literature research was conducted in the databases Web of Science, Psychinfo, and Google Scholar up to January 2023.

METHODS

First, studies were analyzed on a narrative level, and eligible studies for the meta-analysis were identified. Studies were grouped according to the diagnosed PDs. Five different groups were included: borderline PD, antisocial PD, narcissistic PD, nondifferentiated PDs, and Cluster B PDs. Three different random-effects meta-analyses were computed (borderline PD, antisocial PD, Cluster B PDs). Meta-analyses were controlled for publication bias and different covariates (e.g., study quality, sample size).

RESULTS

After screening 41 full texts, 17 studies were included in the narrative synthesis, out of which 14 samples from 11 studies were included in the meta-analysis. Analysis of borderline PD showed an association with the occurrence / risk of child maltreatment (OR = 8.08; 95 % CI [2.51, 25.93]). However, after taking into account possible publication bias, this association was no longer significant. We found a significant and stable association between antisocial PD and the occurrence of / risk of child maltreatment (OR = 4.92; 95 % CI [3.26, 7.43]). Analysis of Cluster B PDs (antisocial, borderline, histrionic, narcissistic) revealed a significant overall association (OR = 4.23; 95 % CI [2.75, 6.5]), indicating that the presence of Cluster B PDs in parents significantly increases the occurrence of / the risk of child maltreatment.

CONCLUSIONS

Analyses indicated a significant association between of Cluster B PDs, and specifically between antisocial and borderline PD, with the occurrence of / the risk of child maltreatment. However, methodological limitations have to be taken into account, because results for borderline PD were no longer significant after controlling for possible publication bias. Moreover, the number of studies included was rather small, and results showed a substantial amount of heterogeneity.

OTHER

This work was not supported by any funding.

Polygenic risk for autism, attention-deficit hyperactivity disorder, schizophrenia, major depressive disorder, and neuroticism is associated with the experience of childhood abuse

People who experience childhood abuse are at increased risk of mental illness. Twin studies suggest that inherited genetic risk for mental illness may account for some of these associations. Yet, the hypothesis that individuals who have experienced childhood abuse may carry genetic loading for mental illness has never been tested with genetic data. Using polygenic risk scores for six psychiatric disorders-attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), bipolar disorder (BPD), major depressive disorder (MDD), neuroticism, and schizophrenia-we tested whether genetic risk for mental illness was associated with increased risk of experiencing three types of childhood abuse: physical/emotional abuse, physical assault, and sexual abuse, in a cohort of white non-Hispanic women (n = 11,315). ADHD and MDD genetic risk scores were associated with a higher risk of experiencing each type of childhood abuse, while neuroticism, schizophrenia, BPD, and ASD genetic scores were associated with a higher risk of experiencing physical/emotional abuse and physical assault, but not sexual abuse. Sensitivity analyses examining potential bias from the differential recall of childhood trauma, parental socioeconomic status, and population stratification were consistent with the main findings. A one-standard-deviation increase in genetic risk for mental illness was associated with a modestly elevated risk of experiencing childhood abuse (OR range: 1.05-1.19). Therefore, inherited genetic risk may partly account for the association of childhood abuse with mental illness. In addition, future treatments for mental illness will benefit from taking into consideration the co-occurrence of childhood trauma and genetic loading.

Parenting and personality disorder: clinical and child protection implications

I review some of the evidence that parental personality disorder represents a risk to child development, in terms of both transmission of genetic vulnerability and the environmental stress of living with a parent who has a personality disorder that negatively affects their parenting capacities. I argue that there are two compelling reasons to impose a duty on mental healthcare providers to offer services for adults with personality disorders that specifically focus on their parenting identity: first, because effective therapies for personality disorder are now available; and second, because there is a strong utilitarian and economic argument for improving parental mental health so as to reduce the economic and psychological burden of their offsprings' future psychiatric morbidity.

Fabrication and induction of illness in children: the psychopathology of abuse

Fabricating or inducing illness in children (previously called Munchhausen syndrome by proxy) is a form of child abuse in which a caregiver falsifies illness in a child by fabricating or producing symptoms and presenting the child for medical care disclaiming knowledge of the cause of the problem. The behaviour has attracted considerable interest and controversy, and some have questioned its existence. In this article, we assess the prevalence of the behaviour, describing behaviours that have been reported and identified, and discuss its psychopathology. We consider the role of psychiatric expertise in the investigation of such behaviour and in the assessment of those who carry it out, based on what is known to date about their psychopathology. We also outline an approach to management with special reference to the characteristics in the mother that may allow for reunification with the child after the abuse has been established.

Child Maltreatment Among Singletons and Multiple Births in Japan: A Population-Based Study

BACKGROUND

The occurrence of multiple births has been recognized as a risk factor for child maltreatment. However, few population-based studies have examined the relationship between multiple births and child maltreatment. This study aimed to evaluate the degree of risk of child maltreatment among singletons and multiple births in Japan and to identify factors associated with increased risk.

METHODS

Using population-based data, we analyzed the database of records on child maltreatment and medical checkups for infants aged 1.5 years filed at Nishinomiya City Public Health Center between April 2007 and March 2011. To protect personal information, the data were transferred to anonymized electronic files for analysis.

RESULTS

After adjusting by logistic regression for each associated factor and gestation number, multiples themselves were not associated with the risk of child maltreatment. However, compared with singletons, multiples had a significantly higher rate of risk factors for child maltreatment, including low birth weight and neural abnormality. Moreover, compared with mothers of singleton, mothers of twins had a significantly higher rate of poor health, which is a risk factor of child maltreatment.

CONCLUSION

Multiples were not associated with the risk of child maltreatment. However, compared with singletons, multiples and their mothers had a significantly higher rate of risk factors of child maltreatment.

Association of maternal developmental disorder traits with child mistreatment: a prospective study in Japan

Maternal mental disorders are known risk factors for child mistreatment. However, little is known about the involvement of maternal developmental disorder traits. The aim of this study was to examine maternal traits related to Pervasive Developmental Disorder (PDD) and Attention Deficit Hyperactivity Disorder (ADHD), and their possible association with child mistreatment. Maternal PDD and ADHD were assessed through a self-administered questionnaire (N=846) during mid-pregnancy using the Pervasive Developmental Disorders Autism Society Japan Rating Scale (PARS) and Adult ADHD Self-Report Scale (ASRS). The mothers completed another questionnaire on child mistreatment when the offspring was approximately 18 months of age. The associations between maternal PDD and ADHD traits and child mistreatment score were analyzed using linear regression models adjusted for covariates. Mothers who exhibited stronger PDD traits showed significantly higher child mistreatment score, even after adjustment for maternal characteristics at baseline and ADHD traits. At the same time, ADHD traits were significantly associated with child mistreatment after adjustment of covariates, although the association became non-significant after adjustment of PDD traits. Mothers who showed PDD and ADHD traits during pregnancy were more likely to mistreat their children. It is essential to educate mothers with such traits with appropriate, easy-to-follow childcare instructions, preferably in simple language combined with pictorial aids.

Exposure to the Lebanon War of 2006 and effects on alcohol use disorders: the moderating role of childhood maltreatment

BACKGROUND

Civilian populations now comprise the majority of casualties in modern warfare, but effects of war exposure on alcohol disorders in the general population are largely unexplored. Accumulating literature indicates that adverse experiences early in life sensitize individuals to increased alcohol problems after adult stressful experiences. However, child and adult stressful experiences can be correlated, limiting interpretation. We examine risk for alcohol disorders among Israelis after the 2006 Lebanon War, a fateful event outside the control of civilian individuals and uncorrelated with childhood experiences. Further, we test whether those with a history of maltreatment are at greater risk for an alcohol use disorder after war exposure compared to those without such a history.

METHODS

Adult household residents selected from the Israeli population register were assessed with a psychiatric structured interview; the analyzed sample included 1306 respondents. War measures included self-reported days in an exposed region.

RESULTS

Among those with a history of maltreatment, those in a war-exposed region for 30+ days had 5.3 times the odds of subsequent alcohol disorders compared to those exposed 0 days (95%C.I. 1.01-27.76), controlled for relevant confounders; the odds ratio for those without this history was 0.5 (95%C.I. 0.25-1.01); test for interaction: X(2)=5.28, df=1, P=0.02.

CONCLUSIONS

Experiencing a fateful stressor outside the control of study participants, civilian exposure to the 2006 Lebanon War, is associated with a heightened the risk of alcohol disorders among those with early adverse childhood experiences. Results suggest that early life experiences may sensitize individuals to adverse health responses later in life.

Child maltreatment increases sensitivity to adverse social contexts: neighborhood physical disorder and incident binge drinking in Detroit

INTRODUCTION

Exposure to child maltreatment is associated with elevated risk for behavioral disorders in adulthood. One explanation for this life-course association is that child maltreatment increases vulnerability to the effects of subsequent stressors; however, the extent to which maltreatment increases sensitivity to social context has never been examined. We evaluated whether the association between neighborhood physical disorder and binge drinking was modified by child maltreatment exposure.

METHODS

Data were drawn from the Detroit Neighborhood Health Study, a prospective representative sample of predominately African Americans in the Detroit population. Neighborhood physical disorder was measured via systematic neighborhood assessment. Child maltreatment indicators included self-reported physical, sexual, and emotional abuse. Incident binge drinking was defined as at least one episode of ≥5 drinks (men) or ≥4 drinks (women) in the past 30-day period among those with no binge drinking at baseline (N=1013).

RESULTS

Child maltreatment and neighborhood physical disorder interacted to predict incident binge drinking (B=0.16, p=0.02) and maximum number of past 30-day drinks (B=0.15, p=0.04), such that neighborhood physical disorder predicted problematic alcohol use only among individuals with high exposure to child maltreatment.

CONCLUSION

The results add to the growing literature that African Americans in the US are exposed to an array of stressors that have pernicious consequences for problematic alcohol use. Our results document the need for increased attention to the potential for at-risk alcohol use among populations with a high degree of stress exposure.

From correlates to causes: can quasi-experimental studies and statistical innovations bring us closer to identifying the causes of antisocial behavior?

Longitudinal, epidemiological studies have identified robust risk factors for youth antisocial behavior, including harsh and coercive discipline, maltreatment, smoking during pregnancy, divorce, teen parenthood, peer deviance, parental psychopathology, and social disadvantage. Nevertheless, because this literature is largely based on observational studies, it remains unclear whether these risk factors have truly causal effects. Identifying causal risk factors for antisocial behavior would be informative for intervention efforts and for studies that test whether individuals are differentially susceptible to risk exposures. In this article, we identify the challenges to causal inference posed by observational studies and describe quasi-experimental methods and statistical innovations that may move researchers beyond discussions of risk factors to allow for stronger causal inference. We then review studies that used these methods, and we evaluate whether robust risk factors identified from observational studies are likely to play a causal role in the emergence and development of youth antisocial behavior. There is evidence of causal effects for most of the risk factors we review. However, these effects are typically smaller than those reported in observational studies, suggesting that familial confounding, social selection, and misidentification might also explain some of the association between risk exposures and antisocial behavior. For some risk factors (e.g., smoking during pregnancy, parent alcohol problems), the evidence is weak that they have environmentally mediated effects on youth antisocial behavior. We discuss the implications of these findings for intervention efforts to reduce antisocial behavior and for basic research on the etiology and course of antisocial behavior.

Childhood maltreatment and the structure of common psychiatric disorders

BACKGROUND

Previous research suggests that various types of childhood maltreatment frequently co-occur and confer risk for multiple psychiatric diagnoses. This non-specific pattern of risk may mean that childhood maltreatment increases vulnerability to numerous specific psychiatric disorders through diverse, specific mechanisms or that childhood maltreatment engenders a generalised liability to dimensions of psychopathology. Although these competing explanations have different implications for intervention, they have never been evaluated empirically.

AIMS

We used a latent variable approach to estimate the associations of childhood maltreatment with underlying dimensions of internalising and externalising psychopathology and with specific disorders after accounting for the latent dimensions. We also examined gender differences in these associations.

METHOD

Data were drawn from a nationally representative survey of 34 653 US adults. Lifetime DSM-IV psychiatric disorders were assessed using the AUDADIS-IV. Physical, sexual and emotional abuse and neglect were assessed using validated measures. Analyses controlled for other childhood adversities and sociodemographics.

RESULTS

The effects were fully mediated through the latent liability dimensions, with an impact on underlying liability levels to internalising and externalising psychopathology rather than specific psychiatric disorders. Important gender differences emerged with physical abuse associated only with externalising liability in men, and only with internalising liability in women. Neglect was not significantly associated with latent liability levels.

CONCLUSIONS

The association between childhood maltreatment and common psychiatric disorders operates through latent liabilities to experience internalising and externalising psychopathology, indicating that the prevention of maltreatment may have a wide range of benefits in reducing the prevalence of many common mental disorders. Different forms of abuse have gender-specific consequences for the expression of internalising and externalising psychopathology, suggesting gender-specific aetiological pathways between maltreatment and psychopathology.

The relationship between distress tolerance and antisocial personality disorder among male inner-city treatment seeking substance users

There is currently limited research on the potential mechanisms underlying the development of antisocial personality disorder (ASPD). One such mechanism, distress tolerance (defined as an individual's behavioral persistence in the face of emotional distress) may underlie the development of ASPD and its associated behavioral difficulties. It was hypothesized that substance users with ASPD would evidence significantly lower levels of distress tolerance than substance users without ASPD. To test this relationship, we assessed 127 inner-city males receiving residential substance abuse treatment with two computerized laboratory measures of distress tolerance. The mean age of the sample was 40.1 years (SD = 9.8) and 88.2% were African American. As expected, multiple logistic regression analyses indicated that distress intolerance significantly predicted the presence of an ASPD diagnosis, above and beyond key covariates including substance use frequency and associated Axis I and II psychopathology. Findings suggest that distress tolerance may be a key factor in understanding the development of ASPD, setting the stage for future studies expanding on the nature of this relationship, as well as the development of appropriate interventions for this at-risk group.

Perinatal Factors Associated with Infant Maltreatment

Background

The association between birth outcomes and child maltreatment remains controversial. The purpose of this study is to test whether infants without congenital or chronic disease who are low birth weight (LBW), preterm, or small for gestational age (SGA) are at an increased risk of being maltreated.

Methods

A hospital-based case-control study of infants without congenital or chronic diseases who visited the National Center for Child Health and Development, Tokyo, between April 1, 2002 and March 31, 2005 was conducted. Cases (N = 35) and controls (N = 29) were compared on mean birth weight, gestational age, and z-score of birth weight.

Results

SGA was significantly associated with infant maltreatment after adjusting for other risk factors (adjusted odds ratio: 4.45, 95% CI: 1.29–15.3). LBW and preterm births were not associated with infant maltreatment.

Conclusion

Infants born as SGA are 4.5 times more at risk of maltreatment, even if they do not have a congenital or chronic disease. This may be because SGA infants tend to have poorer neurological development which leads them to be hard-to-soothe and places them at risk for maltreatment.

Abbreviations

SCAN, Suspected Child Abuse and Neglect; LBW, low birth weight; ZBW, z-score of birth weight adjusted for gestational age, sex, and parity; SGA, small for gestational age; SD, standard deviation; OR, odds ratio; aOR, adjusted odds ratio; CI, confidence interval; IPV, intimate partner violence.

Attachment representations in mothers with abnormal illness behaviour by proxy

BACKGROUND

Abnormal illness behaviour by proxy (also known as factitious illness by proxy or Munchhausen syndrome by proxy) is a type of child maltreatment, the origins of which are poorly understood.

AIMS

To describe attachment representations in a cohort of mothers demonstrating abnormal illness behaviour by proxy.

METHOD

Sixty-seven mothers who had shown this behaviour took part in a semistructured interview assessing their attachment representations.

RESULTS

Only 12 mothers (18%) were rated secure in terms of their own childhood attachments. There was evidence of unresolved trauma or loss reactions in 40 mothers (60%). Eighteen mothers (27%) gave unusually disorganised and incoherent accounts of attachment relationships in their own childhoods. The frequency of these attachment categories is higher than in normal non-clinical samples.

CONCLUSIONS

Insecure attachment is a risk factor for this type of child maltreatment. Therapeutic interventions could be offered in relation to unresolved traumatic stress or bereavement responses. Further study of similar groups, such as mothers with sick children or mothers with histories of traumatic experience, would be a useful next step.

The relationships of dissociation and affective family environment with the intergenerational cycle of child abuse

OBJECTIVE

The purpose was to test a model that may explain how physically abused children become physically abusive parents. It was predicted that when the family's affective environment is uncohesive, unexpressive, and conflictual, a history of abuse experiences would be associated with elevated dissociation. It was hypothesized that dissociation would mediate between a childhood history of abuse and the current potential to be physically abusive.

METHOD

Abuse history, affective environment in the family-of-origin, dissociation, and abuse potential were assessed in a sample of 76 mothers with elementary school-age children.

RESULTS

Predictions were supported. Affective Family Environment moderated the relation between abuse history and dissociation, with abuse history relating to greater dissociation primarily when the family environment was conflictual, uncohesive and unexpressive. Further, dissociation significantly mediated the relation between abuse history and abuse potential (Z = 2.19, p < .05).

CONCLUSIONS

Dissociation's strong association with abuse potential may partially explain why only some abused children later perpetuate the cycle of abuse, as those who are not dissociative into adulthood are likely to have lower abuse potential, in contrast to those displaying elevated dissociation. The extent of the dissociation may depend on the affective family environment in which the abuse took place.

The role of fathers in risk for physical child abuse and neglect: possible pathways and unanswered questions

Despite overrepresentation of fathers as perpetrators in cases of severe physical child abuse and neglect, the role they play in shaping risk for physical child abuse and neglect is not yet well understood. This article reviews the possible father pathways that may contribute to physical child abuse and neglect risk and their existing empirical support. The present empirical base implicates a set of sociodemographic factors in physical maltreatment risk, including fathers' absence, age, employment status, and income they provide to the family. As well, paternal psychosocial factors implicated in physical child maltreatment risk include fathers' abuse of substances, their own childhood experiences of maltreatment, the nature of fathers' relationships with mothers, and the direct care they provide to the child. However, the empirical base presently suffers from significant methodological limitations, preventing more definitive identification of risk factors or causal processes. Given this, the present article offers questions and recommendations for future research and prevention.

Risk of mother-reported child abuse in the first 3 years of life

OBJECTIVE

The purpose of this research was to investigate, within an at-risk population, parent and child characteristics associated with a mother's self-reports of severe physical assault and assault on the self-esteem of the child in the first 3 years of life.

DESIGN

The study population consisted of a community-based sample of mothers of newborns identified as at-risk for child maltreatment (n=595). Families were assessed annually from the child's birth through age 3 using instruments with established psychometric properties. Independent variables investigated included: family socio-demographics, parity, mother's social support, maternal depression, maternal problem drug or alcohol use, partner violence, child's age, child's sex, low birth weight/small for gestational age (SGA), and mother's perception of child's demand level. Associations with maltreatment were examined using multivariable methods for longitudinal data.

RESULTS

Child severe physical assault was significantly associated with parent characteristics (maternal depression and partner violence); and child characteristics (SGA). Assault to the child's self-esteem was significantly associated with maternal depression, maternal illicit drug use, partner violence and mother's perception of child's demand level. Controlling for family sociodemographic characteristics did not change the associations. Likewise, while mother's perception of child demand level had an independent association with self-esteem assault, the associations described above persisted while demand level was held constant. In this high-risk sample, abuse was not associated with mother's age, education, race, parity, or household income level.

CONCLUSIONS

While characteristics such as SGA can serve as markers for increased abuse risk, they are not amenable to intervention after the child is born. However, certain other risk factors, such as maternal depression and domestic violence are malleable and should be targeted for intervention with the goal of preventing child maltreatment.

Predicting borderline and antisocial personality disorder features in nonclinical subjects using measures of impulsivity and aggressiveness

This study examines impulsivity and aggressiveness dimensions as predictors of borderline (BPD) and antisocial (ASPD) personality disorder symptoms in nonclinical subjects. A total of 747 undergraduate university students were administered the Personality Diagnostic Questionnaire-4+, the Barratt Impulsiveness Scale-11, and the Buss-Durkee Hostility Inventory. Hierarchical regression analysis showed that motor impulsiveness, irritability, resentment, and guilt predicted BPD symptoms among university students after controlling for the effect of ASPD and depressive symptoms. ASPD symptoms were predicted by motor impulsiveness, physical aggression, indirect aggression, and negativism. These results indicate that in nonclinical subjects BPD and ASPD symptoms share a common impulsivity dimension but are linked to different aggressiveness facets.

Physical Maltreatment Victim to Antisocial Child: Evidence of an Environmentally Mediated Process

The well-documented finding that child physical maltreatment predicts later antisocial behavior has at least 2 explanations: (a). Physical maltreatment causes antisocial behavior, and (b). genetic factors transmitted from parents to children influence the likelihood that parents will be abusive and that children will engage in antisocial behavior. The authors tested these hypotheses in the representative Environmental-Risk cohort of 1116 twin pairs and their families, who were assessed when the twins were 5 and 7 years old. Mothers reported on children's experience of physical maltreatment, and mothers and teachers reported on children's antisocial behavior. The findings support the hypothesis that physical maltreatment plays a causal role in the development of children's antisocial behavior and that preventing maltreatment can prevent its violent sequelae.

The relationship between parental substance abuse and child maltreatment: findings from the Ontario Health Supplement

OBJECTIVE

This study examined the relationship between reported exposure to child abuse and a history of parental substance abuse (alcohol and drugs) in a community sample in Ontario, Canada.

METHOD

The sample consisted of 8472 respondents to the Ontario Mental Health Supplement (OHSUP), a comprehensive population survey of mental health. The association of self-reported retrospective childhood physical and sexual abuse and parental histories of drug or alcohol abuse was examined.

RESULTS

Rates of physical and sexual abuse were significantly higher, with a more than twofold increased risk among those reporting parental substance abuse histories. The rates were not significantly different between type or severity of abuse. Successively increasing rates of abuse were found for those respondents who reported that their fathers, mothers or both parents had substance abuse problems; this risk was significantly elevated for both parents compared to father only with substance abuse problem.

CONCLUSIONS

Parental substance abuse is associated with a more than twofold increase in the risk of exposure to both childhood physical and sexual abuse. While the mechanism for this association remains unclear, agencies involved in child protection or in treatment of parents with substance abuse problems must be cognizant of this relationship and focus on the development of interventions to serve these families.

The impact of maternal depression on familial relationships

Depression is one of the most prevalent psychiatric illnesses. It is particularly common in women of childbearing age. It is recurrent and tends to have a chronic course and is often comorbid in nature. It is important to view depression within its social context, as it is a disease, which impacts not only the individual but also the wider community. Evidence abounds as to the negative impact of maternal depression on children, husbands/partners, and family. Children of depressed women show deficits in social, psychological, and cognitive domains and are at increased risk for depression themselves and other psychiatric illness such as conduct disorder. They are also at an increased risk for child abuse. The mechanisms by which maternal depression may lead to child psychopathology including genetics, poor parenting, modelling, and environment are explored. Many children with depressed mothers cope well and escape negative effects; consequently the concept of resilience is elucidated. Research shows that a significant percentage of men become depressed when their wives/partners are depressed particularly if they have postnatal depression. There is an increase in marital discord and conflict within families of depressed women, all of which can have a deleterious effect on children. Children with two depressed parents are at an elevated risk of a negative outcome as compared to those with only one depressed parent. Finally the various interventions, management, and recommendations are examined.

Child-related cognitions and affective functioning of physically abusive and comparison parents

OBJECTIVE

The goal of this research was to utilize the cognitive behavioral model of abusive parenting to select and examine risk factors to illuminate the unique and combined influences of social cognitive and affective variables in predicting abuse group membership.

METHODOLOGY

Participants included physically abusive parents (n=56) and a closely-matched group of comparison parents (n=62). Social cognitive risk variables measured were (a) parent's expectations for children's abilities and maturity, (b) parental attributions of intentionality of child misbehavior, and (c) parents' perceptions of their children's adjustment. Affective risk variables included (a) psychopathology and (b) parenting stress. A series of logistic regression models were constructed to test the individual, combined, and interactive effects of risk variables on abuse group membership.

RESULTS

The full set of five risk variables was predictive of abuse status; however, not all variables were predictive when considered individually and interactions did not contribute significantly to prediction. A risk composite score computed for each parent based on the five risk variables significantly predicted abuse status. Wide individual differences in risk across the five variables were apparent within the sample of abusive parents.

CONCLUSIONS

Findings were generally consistent with a cognitive behavioral model of abuse, with cognitive variables being more salient in predicting abuse status than affective factors. Results point to the importance of considering diversity in characteristics of abusive parents.

Mother-child separations among homeless and housed families receiving public assistance in New York City

We examined the incidence, characteristics, and predictors of separations of children from mothers in 543 poor families receiving public assistance, 251 of whom had experienced homelessness during the previous 5 years. Forty-four percent of the homeless mothers and 8% of housed mothers were separated from one or more children. A total of 249 children were separated from 110 homeless families and 34 children from 23 housed families. Children were placed with relatives and in foster care but were rarely returned to their mothers. Maternal drug dependence, domestic violence, and institutionalization predicted separations, but homelessness was the most important predictor, equivalent in size to 1.9 other risk factors. We infer that policies regarding child welfare and substance abuse treatment should be changed to reduce unnecessary placements. Studies of homeless children who remain with families may be biased if separated children are excluded.

Origins and consequences of child neglect in substance abuse families

The empirical literature pertaining to the prevalence, origins, and consequences of neglectful parenting as it relates to substance abuse is critically reviewed. Available evidence indicates that children who experience parental neglect, with or without parental alcohol or drug abuse, are at high risk for substance use disorder (SUD). The effects of parental substance abuse on substance abuse outcome of their children appear to be partly mediated by their neglectful parenting. The discussion concludes with presentation of a developmental multifactorial model in which neglect, in conjunction with other individual and environmental factors, can be integratively investigated to quantify the child's overall liability across successive stages of development as well as to map the trajectory toward good and poor outcomes.

The relationship between parental psychiatric disorder and child physical and sexual abuse: findings from the Ontario Health Supplement

OBJECTIVE

The study's goal was to examine the relationship between a history of parental psychiatric disorder and a history of child abuse in a general population sample of Ontario residents.

METHOD

A representative community sample of 8548 respondents who participated in the Ontario Mental Health Supplement (OHSUP) were interviewed about parental psychiatric history and completed a self-report measure of childhood physical and sexual abuse.

RESULTS

The lifetime prevalence of either parent with a psychiatric disorder was as follows: 14.1% for depression, 3.7% for manic depression, 2.4% for schizophrenia, 2.4% for antisocial behavior, and 17.3% for any parental psychiatric disorder. Respondents reporting a parental history of depression, mania, or schizophrenia had a two to threefold increase in the rates of physical, sexual, or any abuse. Parental history of antisocial disorder increased the risk of exposure to physical abuse (adjusted odds ratios [OR 6.1] and any abuse [OR 7.5]). There was no statistically significant difference between parental psychiatric disorder and childhood physical or sexual abuse by gender of the respondent. There was a trend for increasing risk associated with father only, mother only, and both parents having any psychiatric disorder.

CONCLUSIONS

The elevated risk for physical and sexual abuse among respondents reporting a parental history of psychiatric illness highlights the need to examine the mechanism for this association. Such information is important in developing approaches to assist families where the risk of child maltreatment is increased.

Impact of parental substance use disorder and child neglect severity on substance use involvement in male offspring

Two child self-report scales were developed to measure parental neglect (emotional distance and parental involvement) in a sample of 344 boys between 10 and 12 years of age. Psychometric analyses of the parental emotional distance and involvement scales demonstrated their unidimensionality; construct, concurrent, and predictive validity; and reliability. Cross-sectional analyses indicated that neglect was more severe among boys who had a parent with a DSM-III-R lifetime substance use disorder (SUD) compared to youth whose parents had no Axis I psychiatric disorder. In addition, children reported more severe neglect by the mother than the father. Longitudinal analyses of a subsample (n = 99) revealed that child neglect at ages 10-12 predicted significant variance on a composite measure of substance use involvement and severity of substance use as well as increased the risk for SUD at age 19.

Psychiatric co-morbidity in caregivers and children involved in maltreatment: a pilot research study with policy implications

OBJECTIVE

The purpose of this study was to determine the lifetime incidence of mental disorders in caregivers involved in maltreatment and in their maltreated child.

METHODS

Lifetime DSM-III-R and IV psychiatric diagnoses were obtained for 53 maltreating families, including at least one primary caregiver and one proband maltreated child or adolescent subject (28 males, 25 females), and for a comparison group of 46 sociodemographically, similar nonmaltreating families, including one proband healthy child and adolescent subject (22 males, 22 females).

RESULTS

Mothers of maltreated children exhibited a significantly greater lifetime incidence of anxiety disorders (especially post-traumatic stress disorder), mood disorders, alcohol and/or substance abuse or dependence disorder, suicide attempts, and comorbidity of two or more psychiatric disorders, compared to control mothers. Natural fathers or mothers' live-in mates involved in maltreatment exhibited a significantly greater lifetime incidence of an alcohol and/or substance abuse or dependence disorder compared to controls. The majority of maltreated children and adolescents reported anxiety disorders, especially post-traumatic stress disorder (from witnessing domestic violence and/or sexual abuse), mood disorders, suicidal ideation and attempts, and disruptive disorders. Most maltreated children (72%) suffered from comorbidity involving both emotional and behavioral regulation disorders.

CONCLUSIONS

Families involved in maltreatment manifest significant histories of psychiatric comorbidity. Policies which target identification and treatment of comorbidity may contribute to breaking the intergenerational transmission of maltreatment.

Dissociation as a mediator between child abuse history and adult abuse potential

OBJECTIVE

It has commonly been found that abused children are at risk for later becoming abusive parents (Kaufman & Zigler. 1987; Oliver, 1993) and observational learning has been discussed as a mechanism that perpetuates this intergenerational cycle of abuse. However, two thirds of abused children do not become abusive (Kaufman & Zigler, 1987). Thus, the goal of the current study was to examine whether dissociation functions as an additional mechanism mediating the relation between a history of child abuse and abusiveness as an adult.

METHOD

A cross-sectional design was used to examine physical abuse history, dissociation, and physical abuse potential in a sample of 190 college students. Questionnaires were utilized to assess the three constructs.

RESULTS

Findings indicated that the three constructs were intercorrelated. In particular, a newly established association was found between dissociation and physical abuse potential (r = .54, p < .0001). The primary finding was that the relation between physical abuse history and physical abuse potential was significantly mediated (z = 2.19, p < .05) by level of dissociation, with dissociation accounting for approximately half of the observed relation between history of abuse and abuse potential.

CONCLUSION

Results suggested that dissociation may be one mechanism that helps to perpetuate the intergenerational cycle of abuse. Although dissociation promotes psychological survival during children's abuse experiences, it may result in the development of abusive tendencies in later life. Reducing parental dissociation may assist clinicians in preventing or terminating physical child abuse.

Stressed parents with infants: reassessing physical abuse risk factors

OBJECTIVE

This study aimed to examine the relationship between a range of potentially adverse psychosocial and demographic characteristics identified in the immediate postpartum period and child physical abuse potential at 7 months.

METHOD

Data collected as part of a randomized controlled trial of a nurse home visiting programme for vulnerable families with newborns was used. Women (181) were recruited in the immediate postpartum period. At 7 months, 151 participants were available for evaluation. Potential for child physical abuse was assessed using the Child Abuse Potential (CAP) Inventory.

RESULTS

Significant risk indicators identified by univariate analysis were financial stress, elevated Edinburgh Postnatal Depression Scale (EPDS) scores, education level less than 10 years, concern regarding the provision of housing, and domestic violence characterized by verbal and social abuse. There was no association between child abuse potential and sole parenthood, poverty, young maternal age, history of childhood abuse, or psychiatric history. Two variables were found to be of independent significance using a logistic regression model; elevated EPDS and perceived difficulty "making ends meet."

CONCLUSIONS

The findings indicate that perceived stress relating to finances, accommodation and relationships in the immediate postpartum period are associated with heightened child physical abuse potential at 7 months. Elevated EPDS in the early postpartum period is also a risk indicator. The outcome of this study suggests that perinatal assessment of child abuse risk is possible and simple and is related to perceived stressors at the time surrounding delivery. This is independent of a range of demographic variables traditionally thought to predict high risk.

Psychopathology in the relatives of depressed-abused children

OBJECTIVE

To determine if the type of symptomatology abused children manifest is related to family history of psychopathology.

METHOD

Lifetime history of psychopathology was assessed in the relatives of 26 preadolescents--13 depressed abused (MDD-AB) and 13 depressed nonabused (MDD-NA) children. Rates of disorder in the relatives of these children were compared to published rates of psychopathology in relatives of 27 normal control (NC) children. Data were obtained on 104 first-degree relatives (MDD-AB = 25, MDD-NA = 29, NC = 50) and 503 second-degree relatives (MDD-AB = 127, MDD-NA = 117, NC = 259). The Schedule for Affective Disorders and Schizophrenia was used to assess psychopathology in parents, and Family History method was used to obtain lifetime psychiatric data for all other relatives.

RESULTS

When compared to first-degree relatives of NC children, first-degree relatives of MDD-AB children had approximately a nine-fold increased risk for major depression, and a three- to nine-fold increased risk for other disorders associated with the familial subtype of affective illness known as Depression Spectrum Disease (e.g., antisocial personality, alcohol and substance dependence). Similar findings were reported in second-degree relatives, and comparisons between the relatives of MDD-NA and NC children.

CONCLUSION

The findings extend results of prior research and (1) suggest familial vulnerability factors influence the symptom profile of abused children; and (2) highlight the value of incorporating psychiatric formulations into multidisciplinary models of child abuse research and treatment programs.

Eating disorders, nursing and the Allitt report

Images

Onset of physical abuse and neglect: psychiatric, substance abuse, and social risk factors from prospective community data

Studies of psychiatric and social risk factors for child maltreatment have been limited by retrospective methodologies and reliance on officially reported or identified samples. Using data from both Waves I and II of the National Institute for Mental Health's Epidemiologic Catchment Area survey, 7,103 parents from a probabilistic community sample who did not self-report physical abuse or neglect of their children at Wave I were followed to determine the risk factors associated with the onset of self-reported physical abuse or neglect identified at Wave II. Social factors considered included age, socioeconomic status, social support, education, household size, and gender. In addition, several psychiatric disorders, including substance abuse disorders and depression were examined. Risk models were developed using hierarchical logistic regression. Physical abuse and neglect were found to have distinct sets of risk factors, with minimal overlap between the groups. Social and demographic variables were found to be limited predictors of maltreatment, while substance abuse disorders were strongly associated with the onset of both abuse and neglect (relative risks = 2.90 and 3.24 respectively). Depression was found to be a strong risk factor for physical abuse (relative risk = 3.45). Implications of the findings are discussed in terms of major causal models of maltreatment.