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Institutional Abuse: a Psychiatrist's Perspective

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Institutional Abuse: a Psychiatrist's Perspective Institutional Abuse: Untying the Gordian Knot Dr Julian Parmegiani MB BS FRANZCP September 2018 Out of Home Care – Current Statistics Heritability of Psychiatric Disorders The effects of trauma during childhood and adolescence Talk Snowballing Effects of Trauma Outline Protective Factors and Resilience False Memories Impact of legal proceedings Children subjected to investigation = 115,024 Substantiated = 45,714 Child Protection Children on care & Services – protection orders = 61,723 Children in out-of-home care = 2016 55,614 *AIHW Child Protection Report 2015-2016 Child Protection Services – Statistics Type of Abuse Primary + other abuse Emotional Abuse 43% 32.5% Neglect 27% 28.2% Physical Abuse 18% 15% Sexual Abuse 12% 1.7% *AIHW Child Protection Report 2015-2016 Out-of-home care • 46% under 5yrs old Child • 94% in home-based care – 49% in relative/kinship care Protection – 39% in foster care – 5% in third party parental care Services – – 1% other Statistics • 6% in institutions *AIHW Child Protection Report 2015-2016 No information about the parents – possible reasons: Child • Alcohol abuse Protection • Drug abuse • Mental illness Services – • Severe personality disorder Statistics • In custody • Cognitive impairment • Genetic vulnerability – Mental illness might have manifested itself anyway • Pre-existing behavioural problems – Parents couldn’t cope with uncontrollable child • Psychological trauma might have already caused irreparable damage before being Evaluation taken into institution • Targeting: Bullies and predators victimizing of Adult vulnerable targets – Odd – Socially inadequate Survivors – Shy – Anxious – Depressed • All of the above combined MJA • Volume 185 Number 9 • 6 November 2006 MJA • Volume 185 Number 9 • 6 November 2006 MJA • Volume 185 Number 9 • 6 November 2006 Alcohol Use Disorder - 50% heritable The heritability of alcohol use disorders: a Heritability meta-analysis of twin and adoption studies B. Verhulst, M. C. Neale, K. S. Kendler - Psychol Med. 2015 April ; 45(5): 1061– 1072. • 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempts • 2- to 4-fold increase in smoking, poor Effects of self-rated health, >50 sexual partners, Childhood and sexually transmitted disease • 1.4- to 1.6-fold increase in physical Trauma inactivity and severe obesity The Adverse Childhood Experiences (ACE) Study, Felitti et al, Am J Prev Med 1998;14(4) 3-fold odds of subsequently developing Effects of psychotic experiences The Adverse Childhood Experiences (ACE) Study, Felitti Trauma et al, Am J Prev Med 1998;14(4) Increased odds (x2.3) of later psychotic experiences (PE). Maladaptive family functioning- abuse, neglect, and parent maladjustment, exhibited the strongest associations Effects of with PE onset in all life-course stages. Sexual abuse exhibited a strong Trauma association with PE onset during childhood. The association between childhood adversities and subsequent first onset of psychotic experiences: a cross-national analysis of 23 998 respondents from 17 countries. Psychological Medicine, J. J. McGrath et al Volume 47, Issue 7 May 2017 , pp. 1230-1245 Epigenetics is the study of heritable Do life changes in gene function that events alter do not involve changes in physiology? the DNA sequence Radhakrishnan R. et al, Schizophrenia Bulletin vol. 43 no.4 pp693-697, May 17, 2017 Final Report Royal Commission into Institutional Responses to Child Sexual Abuse Effects of Abuse – p15 1. mental health 2. interpersonal relationships 3. physical health 4. sexual identity, gender identity and sexual behaviour 5. connection to culture 6. spirituality and religious involvement 7. interactions with society 8. education, employment and economic security 9. Some victims take their own lives Commonwealth of Australia 2017 • Substance abuse, depression, suicide • Poor interpersonal relationships – Tolerate abuse – Fear of commitment Effects of – Antisocial peers – Angry with others low self- • Poor physical health • Low educational goals esteem • Parenting problems • Unemployment • External locus of control Protective factors • Biological factors – MAO Gene – IQ – Temperament • Locus of control • Social support – Sibling Resilience – Grandparents – Significant role model – Peers – NB: Temperament , IQ , Special talent– Elicit support *Resilience – Chapter 25, Rutter ‘s Child and Adolescent Psychiatry ,5th Edition 2008 False A condition in which a person’s identity and interpersonal relationships are centered around a memory of traumatic Memory experience which is objectively false but in Syndrome which the person strongly believes.” *Kihlstrom JF 1998 >90% First sought therapy for depression then recovered “memories” during therapy 48% recovered memories of satanic ritual abuse 39% recovered memories of witnessing a murder False • Suggestive procedures • Pressure to recover memory Memory • Told self-doubt is common but not a sign of inaccuracy • Reading survivor literature • Completing “homework activities” focusing on abuse • Participating in survivor groups A psychiatrist’s experience Person becomes fully focussed on past trauma: Repeats story to commissions of inquiry, lawyers, doctors, courts, media, social support groups, online forums, spouse, children, parents, friends, employer. Psychological decline - Increase in anxiety and depression Impact of - Emergence of nightmares and flashbacks - Alcohol abuse escalates Legal - Embarrassment, guilt, anger Proceedings - Blames everything on past trauma Functional decline – Loss of employment, further alienation, Can causality be safely determined? • Limited information about family history of mental disorder • Cannot isolate impact of early developmental trauma • Cannot determine whether incidents occurred as described • Cannot isolate impact of situation-specific Psychiatrist’s abuse • Cannot determine impact of free will on Task - making wrong choices • Cannot isolate impact of independent life events – i.e. being in the wrong place at the wrong time with the wrong people • Cannot determine contribution of legal proceedings to current psychopathology Questions?.
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