Table of Contents
- Literature Review
Child abuse is the most common social problem plaguing the modern world today. While what is now considered physical abuse was once a means of disciplinary action, different types of abuse began to take a darker route and become more prominent throughout the world. With the types abuse came different effects on both physical and mental health. Physical health effects include cardiopulmonary problems, obesity, and chronic pain, whereas some mental health affects include alcohol dependence and eating disorders. The purpose of this study is to gain a better understanding of how suffering from physical, mental, or sexual abuse as a child can having a lasting psychological or physical affect in adulthood.
Exploring the Effects of Child Abuse on Adult Health
Child abuse is a social problem that has effected the youth of America for years. Child abuse is defined as “when a parent or caregiver, whether through action or failing to act, causes injury, death, emotional harm or risk of serious harm to the child”. There are several different types of child abuse. These types include; physical abuse, sexual abuse, emotional abuse, neglect, and exploitation, according to ChildHelp.org. While no form of abuse is more severe than the other, they are all equally wrong and can cause a slew of problems that can last into adulthood.
ChildHelp.org has also defined the three main types of abuse, which are physical, sexual, and emotional. Physical abuse is “is when a parent or caregiver causes any non-accidental physical injury to a child.” This could include hitting or punching, or kicking or shoving a child. This could also include burning a child or even pulling their hair. Signs of physical child abuse include injuries that are at different stages of healing, as well as injuries that are unexplained or are explained to a point where they don’t make any sense. Behavioral signs of physical abuse include aggression towards peers or animals, being afraid of parents or other adults, and self-destructive behavior.
In addition to physical abuse, there is also emotional abuse. Emotional abuse is “when a parent or caregiver harms a child’s mental and social development, or causes severe emotional harm, it is considered emotional abuse”. Emotional abuse can include showing little or no interest in a child, or telling a child that he/she is unwanted or unloved. Emotional abuse can also include “threatening the child where physical injury potential is high”. Parents who have extremely high expectations and expect their children to be perfect (i.e. perfectionistic parents) can also be considered emotionally abusive. According to ChildHelp.org, signs of emotional abuse include anxieties, inappropriate behavior based on age – such as being too adult or too infantile – suicidal thoughts, and being overly compliant or defensive.
Also, sexual abuse is a type of abuse that is common as well. Sexual abuse is “when an adult uses a child for sexual purposes or involves a child in sexual acts” and can also refer to “when a child who is older or more powerful uses another child for sexual gratification or excitement”. This can include inappropriate sexual talk, exploitation, fondling a child, or forcing a child to perform a sexual act. According to ChildHelp.org, physical signs of this form of abuse in children include difficulty sitting or walking, stained or bloody undergarments, and bleeding or pain in the genital area. Behavioral signs include depression or anxiety, unusual or advanced sexual knowledge, aggression, and poor self-image or self-care.
In addition to abuse, neglect and exploitation are to be looked at as well. Neglect is “when a parent or caregiver does not give the care, supervision, affection and support needed for a child’s health, safety and well-being”. A few examples of child neglect include deserting a child, repeatedly leaving a child in the care of someone else, failing to provide appropriate clothing, ignoring a child’s need for attention or affection, or can even include refusing to get a child the needed medical treatment. Signs that a child may be experiencing ‘neglect’ include hearing the child speak about having to care for their siblings due to lack of a caregiver at home, frequent truancy or incomplete homework, hygiene problems, or frequent signs of fatigue.
According to Legal Dictionary, the definition of exploitations in reference to child abuse is “using a minor child for profit, power, status, sexual gratification, or some other purpose”. The most common form of exploitation involving children is sexual exploitation, which includes involvement of a child in pornography, indecent touching of a child, or sexual slavery, according to LegalDictionary.net. This form of exploitation often involves an adult abusing his position of authority over the child.
There are many statistics to look at when exploring these different forms of child abuse. According to the National Children’s Alliance, in 2013, “an estimated 1,520 children died from abuse and neglect in the United States.” About 18% of children suffered from physical abuse, while another 9% suffered from sexual abuse. According to ChildHelp.org, roughly 28.3% of adults have reported about suffering physical abuse during their childhood. A further 20.7% of adults have reported to have suffered sexual abuse as a child, while only 10.6% of adults reportedly suffered from emotional abuse as a child. While there were no statistics of how many adults reportedly suffered from neglect as a child, according to the National Children’s Alliance, 80% of children in 2013 experienced neglect.
There have been several studies done by researchers over the years to determine any links between abuse during childhood and health problems during adulthood. Studies have found that some physical health effects include hypertension and diabetes, as well as muscle pain problems and cardiopulmonary problems as well. Some mental health effects included anxiety and depression, as well as a dependence on drugs and alcohol. Other mental health effects of abuse can include post-traumatic stress disorder and eating disorders.
In 2005, researcher Sachs-Ericsson along with his colleagues conducted a study involving adults 15-54; a survey called National Comorbidity Survey (NCS). This survey investigated the association between childhood physical and sexual abuse and medical problems among the adults. Sachs-Ericsson concluded that “both physical and sexual abuse before age 15 were independently associated with higher past-year prevalence of serious health problems including hypertension and diabetes” (Herrenkohl, Hong, Klika, Herrenkohl, & Russo, 2012). In 2004, Batten – whom was another researcher – along with some colleagues, used his own survey that focused and found that “child maltreatment increased risk of cardiovascular disease for women” (Herrenkohl, Hong, Klika, Herrenkohl, & Russo, 2012).
Other articles have highlighted that sexual abuse has an impact on physical health as well, impacting areas of health that some folks never even think about. One of the areas of health that have been impacted is gastrointestinal health. Researchers discovered that “53% of patients with GI disorders have a history of childhood sexual abuse” (Irish, Kobayashi, & Delahanty, 2009). In a 1995 study, researchers Talley, Fett, and Zinsmeiser also “found that patients with a history of CSA were 1.7 times more likely to suffer from IBS symptoms than those without abuse history” (Irish, Kobayashi, & Delahanty, 2009). There has also been research done to conclude that childhood sexual abuse – or CSA – has resulted in pain disorders during the adult years. The article states that, “CSA experiences predicted greater risk for later musculoskeletal pain symptoms, including headaches, backaches, muscle aches, joint pain, and general pain symptoms” (Irish, Kobayashi, & Delahanty, 2009).
A link has also been discovered between childhood sexual abuse and other physical limitations such as cardiopulmonary symptoms and obesity. In fact, individuals who experienced sexual abuse as a child had overall poor heart health. According to Irish, Kobayashi, and Delahanty (2009), chest pain, shortness of breath, irregular heartbeat, and ischemic heart disease are among those cardiopulmonary symptoms that are linked to this form of abuse. Obesity however, is perhaps one of the more common physical health problems that has been linked to childhood sexual abuse. Researchers did conclude, however, that those who suffer from other physical and psychological problems and who also have a history of CSA “are at increased risk for obesity” (Irish, Kobayashi, & Delahanty, 2009). In a 2007 study, researcher Mamun and his colleagues, found that “penetrative CSA was associate with increased BMI in women but not in men” (Irish, Kobayashi, & Delahanty, 2009).
Other studies over the years that have been conducted have also found the link between the forms of child abuse and mental illnesses in adulthood as well. In in the article, “Developmental Impacts of Child Abuse and Neglect Related to Adult Mental Health, Substance Use, and Physical Health”, researcher Bonomi, along with some colleagues concluded that there was a link between childhood sexual abuse and adult depression and anxiety. In another 2008 study, Bonomi and colleagues also sampled women ages 18 to 64, eventually finding that there was a “higher prevalence of more severe forms of depression among those who were physically and sexually abused” (Herrenkohl, Hong, Klika, Herrenkohl, & Russo, 2012). In a 2010 study, researcher Thornberry concluded that “childhood-limited maltreatment predicted the use of drugs and problems from drug use” and also that “maltreatment during adolescence resulted in drug use, criminal offending, and arrest” (Herrenkohl, Hong, Klika, Herrenkohl, & Russo, 2012, p.192).
Another article highlighted a link between psychological stress in adult women and childhood sexual abuse as well. The article states that, “posttraumatic stress disorder (PTSD), depression, anxiety, somatization, substance abuse, eating disorders and suicidal behavior are diagnoses and behaviors that have been found to be associated with CSA” . The article also highlighted that feelings of shame and guilt are often associated with childhood sexual abuse. Another article highlighted that a 1998 study conducted by researcher Felitti and colleagues found that “witnessing intimate partner violence (IPV) in childhood—a stressful, adverse experience is associated with poor health well into adulthood”.
There are other articles that have also supported the claims that emotional abuse and neglect can have impacts on adult mental health that can ultimately lead to physical health problems as well. In their journal article, Yates and Wekerle (2009), explained that a caregiver who has emotionally terrorized their child “likely provokes an anxiety response and heightened arousal”, such as “impaired self-soothing and exaggerated startle.” On the contrast to that, a caregiver ignored their child “may elicit a depressive response and decreased arousal” such as “withdrawal and disengagement”.
An article via PLOS Medicine highlighted that abuse – especially physical abuse – can have a severe impact on mental health as well. According to an article via PLOS Medicine, researchers found a link between physical abuse and mental disorders, especially eating disorders. The article stated that physical abuse was “associated with an almost 3-fold increased risk of eating disorders” as well as “a 5-fold increased risk of developing bulimia nervosa meeting Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria”. The article also explained that researchers discovered that “bulimia nervosa is more likely with more severe and repeated physical abuse”.
Norman and colleagues went on to explain that physical abuse has an impact on addiction, especially to alcohol. According to the article, physical abuse resulted in an “increased risk of alcohol problem drinking (risky drinking, alcohol abuse/dependence, binge drinking)”. Physical abuse was also “associated with alcohol abuse/dependence meeting DSM criteria”. However, there were differences between the genders. In females, problem drinking was down to neglect. However, there was a different result when it came to males. According to Norman’s 2012 report, the “physical abuse association with alcohol dependence was higher in males”, indicating that males who were physically abused were more likely to abuse or be highly dependent on alcohol. Also according to the article, abused individuals also “had a significantly increased risk of suicidal behavior compared with non-abused individuals”.
Another research article touched on the socioeconomic wellbeing of an adult who was mistreated as a child. The study mentioned in Zielinski’s 2009 article, “Child Maltreatment and Adult Socioeconomic Well Being”, stated that results “indicate that adults who had experienced maltreatment were twice as likely as non-maltreated adults to be unemployed”. The article also stated that “Adults who had experienced more than one type of maltreatment were at increased risk for employment difficulties in comparison to adults who had not experienced multiple types of maltreatment” (Zielinski, 2009).
Hypothesis: Abuse during childhood; whether physical, emotional, or sexual; will have an effect on the victim’s physical and mental health during adulthood.
The purpose of this study is to examine how incidents of child abuse and neglect can affect physical and mental health during adulthood. After researching the different types of abuse and gaining statistics of how many incidents occur per year, my purpose is to gain an understanding of how these incidents can influence physical and mental health as an adult. Some of the adult effects of childhood abuse include eating disorders, alcohol and drug dependence, anxiety, and depression – to name a few.
Targeted & Sampling Population
For my research, the targeted populations are adults from ages 18 to 50 who are still experiencing the effects of childhood abuse and neglect. My proposal is to study those individuals who have sought counseling or confirmed to be suffering adult health effects that have stemmed from abuse and/or neglect as a child. The sampling frame will consist of a population of about 60 individuals which I will perhaps split up depending on which form of abuse they suffered as a child. To choose those who are participating in my research, I will look into support groups for adults who suffered any form of abuse as a child and whom are suffering from the above effects as a result of these experiences. My sample frame will be the adults from age 18 to 50 who have reported to have suffered abuse as a child and have any of the physical or mental health problems listed above. To gather this information, I will use random sampling which is an unbiased, precise scientific procedure for selecting research population elements for a sample. Random sampling guarantees an equal probability of selection of each element when substantial samples are selected from large populations. Another sampling method I plan on using is disproportionate stratified sampling seeing as the groups of individuals may be small based on the types of abuse endured.
I have chosen a non-experimental design for this research proposal. In order to gain information about who suffered what type of abuse, I will use a survey that asks their age, the age range in which they endured the abuse, as well as what type of abuse and whether it was from a family member or family friend. I will then separate individuals into groups based on the type of abuse endured, which would be considered stratification. I will also consider using a pre-test and post-test study design as well. I will study the effects that child abuse has had on adult health before counseling, and I will once again study the effects after counseling.
In order to collect my information, I plan on using surveys. The surveys will relate to the different types of abuse suffered, and I will use the answers to separate my subjects into groups. In order to discover any effects of abuse that are being experienced, I will administer a questionnaires to find out what effects are being experienced by people. I will administer the surveys and questionnaires online, which could be easier in case there is someone who is more tech savvy than someone else. The benefit of having surveys and questionnaires online would be the fact that we were able eliminate the costs of mailing and stamps. The disadvantage would be having a participant who either does not have access to technology or is not tech savvy at all. While the main means of administering the survey would be through email, I would also have the option to have the survey mailed to a participant if the mailing costs are not a problem to them.
For my survey, I might choose to have close ended questions. The close ended questions would ask whether or not the person experienced any type of abuse, what types of abuse they did experience, and any effects they may have had. The benefit to having close ended questions is that the answers will be straight to the point – a choice of ‘yes’ or ‘no’, or an ‘all of the above’ type question. If I were to not have close-ended questions, I think that maybe I would have a contingency question. I would ask whether or not the person has been abused, and then maybe follow up with, ‘if yes, indicate the type of abuse suffered’ etc. This would be more beneficial in a way as I would still be able to see who has suffered what type of abuse as well.
Once the data is collected, I would send emails to those who participated, explaining that their information has been submitted and thanking them for their cooperation. Using an email would increase the chance of having a response since emailing is free and is commonly used by most individuals. Stamps are usually needed for mailing purposes and can be expensive, so mail may not generate a lot of responses from participants. Emailing would be much more convenient. Again, the only disadvantage of this is having a participant that is not tech savvy or does not have access to a computer. For reasons such as this, I would have the option to have any answers mailed into me and I would mail any information to my participants.
I will group the similar responses to those questions. Each type of abuse will have their own group, and if there are individuals who have suffered all three types of abuse, they will have their own group as well. Any effects of abuse that are being experienced in adulthood will be then grouped as well once I have that information. For the types of abuse suffered and correlating effects, , I will provide a statistic indicating how many people out of all my participants have experienced a certain effects relating to adult health. These scales and graphs will show how many people experienced particular effects, which will help me to understand which effect may be considered the most severe.
When doing my research, I also had to consider if the proposal consisted of any limitations that may be an issue towards conducting my research. I personally do not feel as though there are too many limitations with my research proposal. My sampling method is one that consists of focusing on the small subgroups of a population. For example, my overall population consists of those who have been abused, and with disproportionate stratified sampling, the focus will fall on the subgroups which are the types of abuse endured. The study design consists of pretest and posttest designs to study the effects of abuse before and after counseling has taken place. The study design could fit with my hypothesis, as it does study what effects that child abuse has on adult health.
The only limitation that I feel could be associated with my instrumentation is the manner in which I plan on administering my questionnaires. I plan to administer questionnaires through email, and this could be a problem for someone who either does not have email or is just not technology savvy anyway. I plan on asking either close ended questions or contingency questions; most likely contingency questions actually. With contingency questions, I can ask whether or not a participant has suffered abuse and have a section that state; ‘if yes, indicate the type of abuse suffered’ which will allow the participant to indicate any types of abuse they may have suffered. The close ended questions would be limited because they would simply have a one answer and not give room for explanation or room to indicate any other details, unlike a contingency question.
For my data collection, I explained that I would notify my participants by mail or email that their information has been received. There are limitations to these as well. With emails, I may have a participant that is not tech savvy or does not have an email. Any participants that may have this problem, I planned on mailing their information to them but this chose pose a problem when I need them to respond by mail. Email would generate more responses, but if a person does not have email and needs to mail their responses to me, this could be a problem due to the costs of mailing. The length of time could also be a problem with mailing a response, as mail sometimes takes a day or two to arrive in certain places.
In my opinion, the main bias could be what is actually considered child abuse. Some people may feel as though they were never victims of child abuse; they may feel as though they were just receiving normal discipline. Not only this, but there may be a person who wants to participate but may not have ever told anyone about the abuse they suffered. This research is geared more so towards those who have spoken out about their abuse experiences and are willing to participate, whereas there could be someone who is shy about sharing their abuse experiences. The study design may also be biased as it focuses on those who have received counseling, and there may be a participant that has not received counseling yet or who does not want to receive counseling.
There is also a bias in both the instrumentation and the data collection. As I stated above, there is always the possibility of having a participant that may not be good with computers. With the main means of communication for this survey being done by email, there is a chance that there are participants that do not have email. While I did give the option to have mailed responses and while there may be participants where the costs of mailing does not pose as a problem, there may be other participants that do not want to deal with the costs of buying stamps for mail. Another bias that may be overlooked is having a participant that may not fully understand the questions that are being asked. This could result in having false information or refusal to participate in the research study altogether.
Abuse is one of the most common social problems throughout the world. While the practice has been around for years, this social problem was once considered disciplinary until the actions began to take on a darker route. Thousands of children around the world are abused on a daily basis, and it is a strong possibility that those who have suffered from any type of abuse in the past continue to suffer either mentally or physically in adulthood.
With this research proposal, I hope to gain a better understanding of the mental or physical effects of suffering from abuse as a child. With a better understanding of the affects that can be present in adulthood, hopefully there will be more steps taken to protect the next generation to come if they are stuck in abusive situations.