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Monday, November 8, 2010

Childhood sexual abuse more than doubles the likelihood of developing psychosis

Posted by   on Pinterest reports that a study published in the November Archives of General Psychiatry suggests that children who are sexually abused may be at twice the risk for developing schizophrenia and other psychotic disorders.

In this study, Margaret C. Cutajar of Monash University, Victoria, Australia, and colleagues linked data from police and medical examinations of sexual abuse cases to a statewide register of psychiatric cases.  They compared the rates of psychiatric disorders among 2,759 individuals who had been sexually abused when younger than age 16 to 4,938 random individuals. Over a 30-year period, individuals who had experienced childhood sexual abuse had more the twice the incidence of psychosis (2.8 percent vs. 1.4 percent) and schizophrenia disorders (1.9 percent vs. 0.7 percent).

This is consistent with prior studies studies that have established that abused children are more likely to develop depression, anxiety, substance abuse, borderline personality disorder, post-traumatic stress disorder and suicidal behavior, according to background information in the article.  This study found that a history of sexual abuse with penetration especially increased the risk.

Participants experienced abuse at an average age of 10.2, and 1,732 (63 percent) of cases involved penetration of a bodily orifice by a penis, finger or other object. Those exposed to this type of abuse had higher rates of psychosis (3.4 percent) and schizophrenia (2.4 percent).

“The risks of subsequently developing a schizophrenic syndrome were greatest in victims subjected to penetrative abuse in the peripubertal and postpubertal years from 12 to 16 years and among those abused by more than one perpetrator,” the authors write.

“Children raped in early adolescence by more than one perpetrator had a risk of developing psychotic syndromes 15 times greater than for the general population.”

The results establish childhood sexual abuse as a risk factor for psychotic illness, but do not necessarily translate into abuse causing or increasing the risk of developing such a disease, the authors note.  “The possibility of a link between childhood sexual abuse and later psychotic disorders, however, remains unresolved despite the claims of some that a causal link has been established to schizophrenia,” the authors write.

Many cases of childhood sexual abuse never come to light, and the overall population of abused children may be significantly different from those whose abuse is detected by officials.

“Establishing that severe childhood sexual abuse is a risk factor for schizophrenia does have important clinical implications irrespective of questions of causality and irrespective of whether those whose abuse is revealed are typical,” the authors conclude.

“Children who come to attention following childhood sexual abuse involving penetration, particularly in the peripubertal and postpubertal period, should receive ongoing clinical and social support in the knowledge that they are at greater risk of developing a psychotic illness.”

“Such treatment in our opinion should focus on improving their current functioning and adaptation to the demands of the transition from adolescent to adult roles rather than primarily on the abuse experience itself.

“Such an approach should benefit all victims, irrespective of whether they have the potential to develop a psychotic illness.”

The study is found in the November issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Schizophrenia and Other Psychotic Disorders in a Cohort of Sexually Abused Children
Margaret C. Cutajar, DPsych, MAPS; Paul E. Mullen, DSc, FRANZCP, FRCPsych; James R. P. Ogloff, PhD; Stuart D. Thomas, PhD; David L. Wells, MA, FACLM; Josie Spataro, PhD, MAPS  Arch Gen Psychiatry. 2010;67(11):1114-1119.

Author: Skip provides support, education, tools, and perspective to individuals with a loved one affected by Borderline Personality Disorder. BPFamily is a non-profit, co-op of nearly 75,000 volunteer members and alumni formed in 1998. We welcome you to join our free 24 hour on-line support community with its nearly 3 million postings and grow with us as we learn to live better lives in the shadow of this disorder. For more information or to register, please click here.

Write comments
  1. "The evidence suggesting a complex etiology for BPD is also strenuously ignored by the clinicians who believe that sexual abuse per se is both a necessary and a sufficient precondition for the development of BPD. Although appealing in its simplicity, this view is simply not consonant with the relevant research findings. No study, including our own, which reports on the childhood experiences of an extremely impaired group of inpatients, has found that all borderline patients report having been sexually abused, and not all sexually abused patients in these studies are borderline" . We have repeatedly documented the complexity of this disorder, rather than looking for simple answers. I felt that the studies dealing with those patients who frequently mutilate or hurt themselves and those who repeatedly attempt suicide provided me with a richer perspective on the meaning of these behaviors than I previously had.

    Terry A. Travis, M.D.

  2. I suppose then that promiscuity in the early teen years is sexual abuse. This is a paradigm shift for me as a parent of a dwbpd.I understood that promiscuity was dangerous and emotionally difficult for my daughter, but I hadn't looked at it as sexual abuse because it was inflicted by peers and seemingly encouraged by her.I also was not aware of the severity of trauma likely from such experience. I also had no concept of the devastating consequences that were possible. What gruesome statistics about increased likelihood of mental illness! Oh how I wish I had been able to do something back then! Wish I could do something now, for that matter. Poor kid.Thanks for this article. It is extemely insightful for me.

  3. I was really taken back by these statistics involving the increased risk of developing psychosis based on the details surrounding the sexual abuse (i.e. penetration, age, number of perpetrators) ; especially the astounding number addressing “children raped in early adolescence by more than one perpetrator had a risk of developing psychotic syndromes 15 times greater than for the general population.” I think this study is a very valuable tool in helping with effective treatment of children who report their sexual abuse - by knowing what specifically can be putting them at such a higher risk and for what. I also believe that the survivors involved in the study would want nothing more than for their outcomes to help future survivors.