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Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline

Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline. Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis MBBS FRANZCP FAChAM. Borderland (author BV, with permission). The sand stings The Wind is Howling Of pain past. I know nothing

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Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline

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  1. Psychiatric ImpactofChildhood Sexual Abuse:Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis MBBS FRANZCP FAChAM

  2. Borderland(author BV, with permission) The sand stings The Wind is Howling Of pain past. I know nothing The sand in my eyes Of pain present.

  3. I just exist Ask me who “I” am No answer. Gritting sand Prevents looking where The I is. Can’t be heard The Wind is Howling Lonely and worse.

  4. Isolate So as not to feel Contact causes hurt. The Wind is Howling When will I be Whole? (BV)

  5. Prevalence ofBorderline Features • General population 1-2% • Outpatient mental health clinics 10% • Psychiatric inpatient clinics 20% • Special Clinic Populations involving personality disorders 30-60%

  6. The Damage

  7. Aetiology Early life Physical and Sexual Abuse, Neglect, Hostile Conflict, and early Parental Loss/Separation are more common in the Childhood histories. (Source: Diagnostic and Statistical Manual Mental Disorders, 4th Edition, p708)

  8. General Behavioursof the Borderline • Ambivalence • Emptiness • Anger • Instability • Impulsivity and Recklessness • Deliberate Self-Harm • Immaturity

  9. Frantic efforts to avoidreal or imaginedabandonment

  10. Ambivalence:alternating betweenextremes of idealisationand devaluation

  11. Pattern of unstable and intense interpersonal relationshipsalternating between extremesof idealisation and devaluation

  12. Identity disturbance:unstable self-imageor sense of self

  13. Hopeless-Helpless:chronic feelings of emptiness

  14. Instability:affective instability due toa marked reactivity of mood

  15. Anger Management Problemsinappropriate, intense angeror difficulty controlling anger

  16. Self-Harming:impulsivity in at least two areas that are potentially self-damaging(eg spending, sex,substance abuse etc)

  17. Suicidality:recurrent suicidal behaviour, gestures, threats,self-mutilating behaviour

  18. Psychotic Border:stress-related paranoid ideationorsevere dissociative symptoms

  19. And Drug Abuse • Self-treating • Fill emptiness • Isolate interpersonally • Pseudo-closeness • “Control emotions” • Obscure anger • Self-harm

  20. Unique Difficulties Bipolarities Ambivalence Embraced Failure (Abandoned Hope)

  21. AbuseImpaired OverAchievement Achievement

  22. Vulnerability

  23. Transition to AdulthoodFailed Stalled Over Compensated

  24. Adult OutcomesSerious AdultImpairment Success

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