CALIFORNIA STATE UNIVERSITY, NORTHRIDGE

Religious : Impact on Mental Health and Development

A graduate project submitted in partial fulfillment of the requirements

For the degree of Master of Social Work

By

Breanna Barnes

May 2020

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The graduate project of Breanna Barnes is approved:

______Dr. Wendy Ashley Date

______Dr. Ioana Schmidt Date

______Dr. Alejandra Acuna (Chair) Date

California State University, Northridge

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Dedication

To all of those who showed me kindness, support, patience, and compassion over the last three years. Because of these gifts, I am closer to realizing the type of person and social worker I have always wanted to be.

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Table of Contents Signature Page ii Dedication iii List of Tables v Abstract vi Introduction 1 Methods 7 Results 11 Discussion 18 Conclusions 28 References 30

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List of Tables

Table A. Relevant research found in database searches 9

Table B. Review of relevant research 12

Table C. Themes 17

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Abstract

Religious Abuse: Impact on Mental Health and Development

By

Breanna Barnes

Master of Social Work

Purpose: To establish unique consequences of religious abuse experienced in childhood on mental health and development. Hypothesis: What is the impact of religious abuse on mental health and development? Methods: Systematic literature review utilizing research from five databases. Results: 599 potential articles were narrowed down to 17 that were deemed appropriate for the study. These articles were further explored for relevant information and reveal of themes. Discussion: Five themes were identified including: unique consequences present in abuse cases perpetuated by clergy, developmental and mental health consequences, diagnostic considerations and implications for treatment.

Keywords: religious abuse, spiritual abuse, mental health, development

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Introduction

The benefits of are a common topic of social work literature. It is well understood that religion can offer protective factors against drug abuse, a sense of community, and decreased likeliness of antisocial and rule-breaking behavior (Laird, Marks, & Marrero, 2011). Discussed much less frequently is the impact of religion when it is practiced in a negative, damaging way.

Religious abuse (RA), also known as spiritual abuse, is unique in that, as the name suggests, it is abuse perpetuated and often justified by one’s faith. Specifically, religious abuse is the use of religious ideas to intimidate and control (Simonic, Mandelj, & Novsak, 2013). It can also be described as any occasion in which religion or religious beliefs are present with various types of abuse (Simonic et al., 2013).

Background

Religion has been linked as a contributing factor to (Nason-Clark, 2004), child (Tishelman & Fontes, 2017), and other forms of interpersonal violence. The justification of the abuse using religion is what separates RA from other types of abusive behavior.

Some dynamics within religion that may enable it to become abuse include: unrealistic evaluation of spiritual acumen among clergy, unrealistic expectations by families and religious leaders alike, and misapplication of philosophy by twisting theology to suit personal motives, coercion through shame and fear, and premature transcendence, including ignoring physical, psychological, emotional, and social needs (Bhaktavatsala and Dhyanakunda-devi, 2001, as cited in Oluwole,

2010). RA may also appear within families when religious parents expect of emotions, perfectionism, and broken natural will based on distorted and sometimes literal interpretations of religious writings and the idea of the parent’s responsibility of appropriate child-rearing to teach their children to live according to God’s will (Simonic, Mandelj, & Novsak, 2013). Religiously

1 motivated medical , severe abuse, and even murder of children has occurred (Bottoms,

Nielson, Murray, & Filipas, 2003).

A study of religion-related found that 66% of cases involved ,

50% included sexual abuse, and 1/3 of cases reported (Bottoms et al., 2003). 43% of cases were perpetuated by fundamentalist Christians, 38% protestant, and 16% Catholic (Bottoms et al., 2003). While there is potential for RA to occur within the context of any religion, these will be the focus of this study. In 85% of cases, the parents were the perpetrators, though there were also religious authorities, teachers, and others (Bottoms et al., 2003). Most of the victims were between 5-11 years old (Bottoms et al., 2003). Abuse within the church differs slightly, with the majority of victims being between 11-14 years of age and 81% male (Denney, Kerley, & Gross,

2018). This paper aims to answer the question: According to research that is currently available, what is the impact of religious abuse on development and mental health? In addition to this guiding question, further focus will be placed on adults who have experienced some form of RA as children.

Types of Religious Abuse

There are two primary forms of emotional religious abuse. In the first, the abuser uses theological explanations to reason and justify the physical abuse of their partners or children

(Bottoms et al., 2003). The second form of RA occurs when religious beliefs are used to induce shame, fear, and guilt in victims, leading to them feeling alone, distressed, worthless, neglect, or cursed (Capps, 1995). Emotional RA may include inducing fear around religious matters (such as the consequences of , the afterlife, and supernatural entities), participation in burial ceremonies and religious rites, , , and (Nobakht & Dale, 2018). While the amount of research on RA and its impact are limited, RA has been described in research as

2 consisting of the following behaviors or components: leadership representing God, spiritual , acceptance via performance, and spiritual neglect (Ward, 2011). While RA can occur alongside virtually any other form of abuse, these specific concepts tend to be how RA appears as a lived experience, rather than an abstract concept. Some research claims that RA could be even more insidious than non-religious abuse, claiming that the impacts of RA could lead to poorer long-term emotional and psychological outcomes (Bottoms et al., 2003). Consequences of RA are varied and include in about 50% of cases and suicidal ideation in approximately 33%

(Bottoms et al., 2003). Victims of RA have also reported phobias, social withdrawal, inappropriate aggression, and dissociative disorders (Bottoms et al., 2003).

Religious abuse can also entail corporal and sexual abuse, also justified by religion in some way by the abuser. Within the Protestant Christian church, there were 7,095 claims of alleged sexual abuse by clergy, church staff, and other church members and volunteers from 1987 to 2007

(Denney, Kerley, & Gross, 2018). Several factors have been found to increase the likelihood of church members and officials engaging in abusive behaviors, including other churchgoers ignoring the warning signs, the niceness culture (which can lead to flirting or sexual advances being mistaken for friendliness), the ease of private communication, no oversight, church officials having multiple roles such as pastor and counselor, and inherent trust in the sanctuary (Denney et al.,

2018). Religious leaders specifically may be more likely to engage in sexual abuse due to having power in the church and accessibility to potential victims, the power of being above scrutiny by most churchgoers, and having personal knowledge of their congregants, such as family and marital issues (Denney et al., 2018). Approximately 35% of RA abuse by clergy is perpetuated on church grounds, and most abuse cases that occurred offsite occurred at the home of the perpetuating clergy

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(Denney et al., 2018). A majority of offenders within the religious setting are male, white, middle- aged, and employed in an official capacity within their church (Denney et al., 2018).

Aims and Objectives

The following formal review of the literature was decided upon after finding that while it is clear that RA is just as nefarious and damaging as many other forms of abuse, interestingly, the amount of published research on the subject is lacking. A simple internet search of the topics reveals many books written on the subject by those who have experienced it firsthand, indicating a need for these stories and experiences to be told. Despite this, the academic world has left the subject of RA relatively untouched when compared with other forms of abuse. It is likely that, due to the delicate nature of addressing religious practices, it is generally shied away from by researchers and institutions. Further, the importance of affording the right to freedom of religion is vital, so the topic must be addressed carefully and responsibly to protect and respect this right.

Due to these and other factors, it can be difficult to distinguish when it may be time to intervene.

Generally, it seems that the protections of freedom of religion has been used to cover a moral “grey” area, in which abuse flourishes (Pretorius, 2011). However, this lack of attention is precisely why this is a subject that is deserving of more. Those who are already speaking about their own experiences deserve to have this issue taken seriously, as well as the support of academic research to uphold the validity and severity of these experiences. Research such as that presented within this paper has the potential to be used to help church communities become safer, as awareness could be an important first step to developing some form of protocol within churches for preventing and controlling abuse while hopefully reducing abuse within the homes of churchgoers.

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Literature Review

In the currently available research, religious abuse tends to become grouped together with domestic violence (Bent-Goodley & Fowler, 2006; Nason-Clark, 2004), or is discussed in terms of religious officials perpetrating this abuse to members of their respective churches or belief systems (Segura-April, Prevette, & Greener, 2016; Hogan, 2011; Worsley, 2008). Research regarding RA specifically within the context of the family is more scarce, which was unexpected, due to the previously mentioned statistic that 85% of religious abuse occurs within the family.

Other research explores the types of RA that have occurred (Bottoms, Goodman, Tolou-Shams,

Diviak, & Shaver, 2015) and contributing factors that could increase the likelihood of the perpetuation of RA (Saradijan & Norbus, 2003; Rodriguez & Henderson, 2010, Denney et al.,

2018). Research that has been conducted on the impact of RA tend to focus on one specific consequence or symptom (Nonakht & Yngvar, 2018). One possible explanation for the gap in research is that disbelief by families and secrecy by the church may play a role in chronicity of abuse and late disclosure (McGraw et al., 2019). While this method of research is common and useful, this study seeks to create a generalist resource that can be used to understand many consequences of religious abuse, and to seek themes or patterns within these consequences.

While studies exploring the types of RA that occur and the reasons which they occur are valuable, it is also important to consider lasting impact that RA leaves on those who have experienced it. Subjective experiences have always held a special value in the fields of psychology and social work, and the researcher argues that subjective experiences are necessary when developing treatments, interventions, and standards of care for those who have experienced such a specific form of abuse. Survivors of RA are a neglected population in terms of both research and

5 treatment options. This literature review is being conducted to attempt to fill a small piece of this large gap in the research, or at least to present the existing research in a new and effective way.

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Methods

The author relied on digital databases to seek out academic, peer-reviewed articles relevant to the research question. Further criteria included that the articles should focus on Christianity,

Protestantism, or Catholicism, and should ideally be less than 15 years old to ensure that the conclusions and analyses made in this paper would be current and relevant to a modern demographic. Two search terms were used in each of the following databases: ATLA Religion,

PsycINFO, SAGE, EBSCO, GALE, and Google Scholar. These search terms included “religious abuse” and “spiritual abuse”. The author screened relevant articles during the initial search by reading abstracts and titles of potentially useful articles. If the article seemed appropriate to include, the author clicked on “Full Text” or downloaded the article and read the “Discussion” and

“Results” section to ensure it fit the mandatory requirements. At times, entire articles were skimmed by the author to ensure they were relevant to one of the research questions.

In each respective database, a limit was set on the publishing date (less than 10 years old), and the “Peer-Reviewed” filter was selected to ensure that any chosen articles would be reliable.

Further, search results were limited to articles whose full text was accessible. Specific databases and their respective search filters are listed on Table A, as the options differed slightly on each database. Finally, the author read each of the articles in their entirety, with a special attention on the direct impact of religious abuse on mental health or development. The results of these searches, as well as the articles chosen from them can be found on Table A. The author suspected that there would be repetitive information, however even repetitive information can be useful in revealing themes and commonalities.

In the database “ATLA Religion”, the search term “religious abuse” yielded 17 results, none of which were relevant. Searching “spiritual abuse” in ATLA Religion produced seven search

7 results, with one article appropriate for this study. When the database “PsycINFO” was searched,

“religious abuse” lead to 48 results, of which three were chosen. “Spiritual Abuse” was searched next, which provided two additional articles that fit the criteria. “SAGE Journals”, a much larger database than “PsycINFO” and “ATLA Religion”, produced a total of 16,633 search results for religious abuse and 14,523 results for spiritual abuse. While inspecting the results, it was evident that many results were repeated with each search term, which is likely why this number was so large. Despite the seemingly ample number of articles found, many articles were very loosely related to the search term, if they were even relevant at all, and only one article was found to be appropriate for the literature review. Due to the sheer number of articles, the researcher only reviewed the first 100 search results for each term, as by the point in the results, the articles were essentially unrelated to the research questions. Out of these initial 100 searches, two articles were found while searching “religious abuse” and no additional articles were found to be appropriate while searching “spiritual abuse”.

When the database EBSCO was searched, 65 results were found by searching “religious abuse”, but none of these met the criteria for the study. When spiritual abuse was searched, while it produced only 36 articles, the search provided two more that were appropriate for this research.

The last database that provided appropriate articles was Google Scholar, which was accessed through the California State University of Northridge library. The remaining 8 articles were found through this source. Two other databases were searched, but did not yield any useable articles.

These databases, JSTOR and Gale General OneFile, are not included in Table A. The results of these searches, as well as the articles chosen from them can be found on Table A.

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Table A. Relevant research found in database searches

Database Search Number of Selected Articles Additional Term Used Results Search Criteria ATLA Religious 17 None Relevant Linked Full Text Religion Abuse Scholarly (Peer Database Reviewed) Journals Year Published: 2005-2020 ATLA Spiritual 7 “The lived experience of distorted Linked Full Text Religion Abuse spirituality: A phenomenological study” Scholarly (Peer Database Reviewed) Journals Year Published: 2005-2020 PsycINFO Religious 48 “Consequences of abuse by religious Linked Full Text Abuse authorities: A review.” Academic “Relationship of abuse by religious Journals authorities to depression, religiosity, and Publication Date: child physical abuse history in a college 2005-2020 sample.” “Religious-related abuse in the family.” PsycINFO Spiritual 26 “The lived experience of spiritual abuse.” Linked Full Text Abuse Academic Journals Publication Date: 2005-2020 SAGE Religious 16,633* “The importance of religious/ abuse as a Only content Journals Abuse traumatic predictor of dissociation” which I have full “Religion and eating disorders: towards access to understanding a neglected perspective” Research Articles Publication Date: 2005-2020 SAGE Spiritual 14,523* None Relevant Only content Journals Abuse which I have full access to Research Articles Publication Date: 2005-2020 EBSCO Religious 65 None Relevant Full Text Abuse Scholarly (Peer Reviewed) Journals Published Date: 2005-2020 EBSCO Spiritual 36 “Spiritual Abuse and Masculinity Full Text Abuse Construction among African Adolescents” Scholarly (Peer “Exploring the impact of counsellors working Reviewed) with spiritually abused clients” Journals Published Date: 2005-2020

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Google Religious 653,000* “A Unique Betrayal: Clergy Sexual Abuse in Articles Scholar Abuse the Context of the Catholic Religious Custom date Tradition” range: 2005-2020 “Sexual abuse perpetrated by Roman Catholic priests and religious” “The Spiritual Trauma Experienced by Victims of Sexual Abuse by Catholic Clergy” “Effects of Sexual Abuse by Catholic Priests on Adults Victimized as Children” “Catholicism and Childhood Sexual Abuse: Women’s Coping and Psychotherapy” “Problem and Solution: The spiritual dimension of clergy sexual abuse and its impact on survivors.” “The spiritual trauma experienced by victims of sexual abuse by Catholic clergy” “Child abuse in religiously-affiliated institutions: Long-term impact on men’s mental health” Google Spiritual 230,000* None Relevant Articles Scholar Abuse Custom date range: 2005-2020 *Only the first 100 results were examined, as the relevance of the search results was negligible by that point

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Results

599 total potentially relevant articles were reviewed for eligibility. After these results were screened for compatibility with the inclusion criteria, 16 were chosen for the review. These articles and their important components and findings, may be reviewed in Table B. While the initial body of research seems great in scope, much of the published literature focused on causes for and contexts of religious abuse. Many more of the results were on how child abuse impacts religiosity as adults, or how religiosity can mitigate the impact of child abuse. Very little attention has been given specifically to survivors of religious abuse. Most of the articles that were found focused on abuse of children by Catholic clergy, usually about sexual abuse. This is likely due to this phenomenon receiving a great deal of attention by the media beginning in 2002, when it was recognized in a crisis (Terry, 2008). Many of the articles published in the late 2000’s chosen for this review were likely written in response to this crisis (Doyle, 2009; Ferrell, 2009; Flynn, 2008,

Guido, 2008; Pargament, Murray-Swank, & Mahoney, 2008; Shea, 2008; Wolfe, Francis, &

Straatman, 2006; Stevens, Aroumanian, Greenbaum, Schwab, & Dalenberg, 2019). The majority of the remaining studies chosen focused on the ways in which religious abuse impacts some specific area of functioning (Grenfell, 2006; Lang & Bochman 2016; Nobakht & Dale, 2017;

Oluwole, 2010). Shockingly, only one article was located that focused specifically on religious abuse within families (Simonic, Mandelj, & Novsak, 2013).

Most of the selected articles that were empirical in nature utilized interviews in order to extract the most data possible from small sample sizes (Ferrell, 2009; Flynn, 2008; Guido, 2008;

Lang & Bochman, 2016; Ward, 2011; Wolfe et al., 2006). However, for the purposes of this article, qualitative data is useful in determining specific impacts of RA. Other methods included a literature review (McGraw, Ebadi, Dalenberg, Wu, Naish, Nunez, 2019), a case study (Simonic et

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Table B. Review of relevant literature

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14

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16 al., 2013), several review articles (Doyle, 2009; Grenfell, 2006; Oluwole, 2010; Pargament et al.,

2008), and analysis of secondary data (Stevens et al., 2019). The apparent lack of large-scale, quantitative, and generalizable studies could be due in part to the difficulty of recruiting participants for studies regarding abuse, especially for longitudinal studies (Kinard, 2001).

All studies that had a specific population focused on adults or adolescents. A disproportionate number of studies focused specifically on men, with only two studies examining the impact of RA on women alone. All of the articles examined groups within the US or United

Kingdom, with only two exceptions, which explored RA in Nigeria (Oluwole, 2010) and Iran

(Nobakht & Dale, 2018). Most research found was centered on sexual abuse within a religious context, which again, is likely due to the Catholic child sexual abuse crisis. The current body of research prioritizing clergy sexual abuse does not indicate that other forms of RA are not occurring.

Several themes were identified, which are presented in Table C.

Table C

Themes

1. Abuse perpetuated by clergy or church officials unique impact on survivors 2. Spiritual trauma 3. PTSD, CPTSD, and religious abuse 4. Depression and other symptoms 5. Various developmental consequences 6. Diagnostic and treatment implications

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Discussion

Clergy-Perpetuated Abuse Specific Factors

While not included in the original research questions, one theme that revealed itself is the idea that RA is very frequently perpetuated by clergy or other church officials. While all forms of abuse can be damaging and sinister and usually involve some breach of trust, abuse perpetuated by clergy involves a unique betrayal: The added element of toxic spirituality. Following sexual abuse by clergy, survivors may feel alienated from God and society as a whole (Doyle, 2009).

Individuals possess a personal theory of reality which is developed over time in order to make sense of the world (Farrell, 2009). One’s personal theory of reality may be distorted, if not completely destroyed by these types of traumas, resulting in a unique form of psychological crisis

(Farrell, 2009). Abuse perpetuated by clergy or other religious figures steals from its victims their sense of protection, safety, and security of a life dedicated to God (Farrell, 2009). Abuse perpetuated by clergy within the Catholic faith specifically may be especially sinister due to the sacramental worldview of the Catholic church, which asserts a direct connection between priests and God (Guido, 2008).

It became apparent as articles were collected that most research on this subject focuses exclusively on men. While men and boys are frequent targets of this form of abuse, another contributing factor to this disparity may be that when women are abused sexually by clergy, social conditioning may lead others to mistake the abuse for a consensual matter of sexual ethics instead of the professional and damaging abuse it really is (Flynn, 2008). In one study, 88% of women interviewed were revealed to have misidentified their abuse, many turning to self-blame instead (Flynn, 2008). However, damaging results of clergy-related abuse was reported among women as well as men. Factors related specifically to the nature of the abuse included: struggling

18 with the antithetical nature of the experience, feeling trapped in the abuse situation, misidentification of the abuse, silence and denial, and issues with relational spirituality (Flynn,

2008). Some circumstances have been shown to help mitigate the damage caused by clergy-related abuse, such as the victim being believed and supported by the church, prompt removal of the offending clergy member, identifying the problem as the fault of the abuser, and creating support groups (Flynn, 2008).

In terms of how clergy-perpetuated abuse compares to abuse by other perpetrators, one study found that the seriousness appears to rival that of abuse where parents are the perpetrators

(McGraw et al., 2019; Stevens et al., 2019). Another study claimed to find no significant difference between a group who was abused by clergy and a group who was abused by laypersons, although it was noted by the authors that this could be due to confounding factors (Shea, 2008). Small sample size, a decision to only study the impact on male subjects (including victims and perpetrators), and a questionnaire, self-reporting style of research were some factors the authors admitted could skew the results (Shea, 2008). Following abuse by clergy, individuals may show greater variance in religiosity and may be more likely to break ties with their (Stevens et al., 2019). While it is important to note the differences in terms of presentation, symptoms, and consequences of various forms of abuse, comparing forms of abuse in terms of severity is likely extremely difficult due to pain being extremely subjective and personal.

Spiritual Trauma

Spiritual trauma is a unique consequence of RA. Spiritual trauma can be described as a severe jolt to the spiritual or religious belief system. This devastating consequence is due to the fact that churchgoers often place complete trust within the institutions of their faith, and this typically includes religious training to accept and believe what the church teaches without question

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(Doyle, 2009). Christians and Catholics alike are taught that God punishes and rewards good behavior, which can result in self-blame and immense confusion in survivors of RA (Doyle, 2009).

Most survivors of RA were born into devout religious families, resulting in a deeply religious foundation of their beliefs and worldview (Doyle, 2009). Abuse of this form can shake an individual’s understanding of the world and their faith, resulting in fear, guilt, and shame according to a review study that aimed to examine the symptoms and recovery of the spiritual dimension following traumatic abuse by clergy (Doyle, 2009). Additional repercussions of spiritual trauma include loss of trust towards religious officials, emptiness due to feeling unable to participate in familiar , despair from the loss of God, toxic guilt and immobilizing fear, and loss of spiritual security.

Mental Health Symptoms

PTSD, CPTSD, and Religious Abuse. Many of the reviewed studies found correlations between religious abuse and diagnoses of PTSD (Flynn, 2008; McGraw et al., 2019; Wolfe et al.,

2006) and complex post-traumatic stress disorder, CPTSD. CPTSD may appear as typical trauma responses, but it may also cause more subtle symptoms that may indicate permanent characterological changes (Flynn, 2008). Survivors of RA may experience several different types of internal struggles: Struggles with the divine (feeling angry, abandoned, and fear of God), interpersonal (religious tensions with family, church members, etc.), and intrapsychic struggles

(doubts around their religion, conflicts between thoughts, feelings, and behaviors, etc.)

(Pargament, Murray-Swank, Magyar, & Ano, 2005, as cited by Pargament et al., 2008). While many of the aforementioned psychological consequences may overlap with other diagnoses, the following trauma themes specific to survivors of clergy-related abuse include: theological conflict,

20 idiosyncratic silencing strategies, issues with spiritual identity, existentialism, political , and re-traumatization by the church (Farrell, 2009).

Those who experienced abuse strictly by clergy often report severe symptoms following their abuse. In one study, 90% of those victimized sexually by clergy met the criteria for PTSD and major depression (Leupker, 1999, as cited in McGraw et al., 2019). Another study reported mood disorders in 25% of participants who experienced abuse by clergy (Wolfe et al., 2006).

Survivors may see themselves as “damaged” and even “evil” (Flynn, 2008, as cited in McGraw et al., 2019). Possible contributors to the immense impact of this form of abuse could be that it induces shame, which can be a strong predictor of mental health problems in general, including depression (Talbot, Talbot, & Tu, as cited in McGraw et. al., 2019). Further, the additional element of feeling as if one is being sinful as a result of emotional, physical, or sexual RA assists in maintaining shame and may contribute to initiating depression (McGraw et al., 2019).

Depression and Other Symptoms and Diagnoses. Depression is frequently listed as a consequence of religious abuse. One study found that participants who experienced RA by clergy that 93% of the sample of abuse victims were diagnosed with major depressive disorder (Luepker,

1999, as cited in McGraw et al., 2019). Another study found a strong correlation with a history of

RA and dissociativity, including general dissociation, depersonalization/derealization, pathological dissociation, and absorption and imaginative involvement (Nobakht & Dale, 2018).

This study included a large sample size (100 men and 100 women), a large questionnaire, and a quantitative methodology (Nobakht & Dale, 2018). Dissociative Identity Disorder, or DID, is also closely linked to RA, and many of such patients experienced amnestic barriers and repressed memories around their experiences with RA (Nobakht & Dale, 2018). While an interesting contribution to the current body of research, this study may have lost some generalizability due to

21 its self-reporting structure. Longitudinal studies would also be an appropriate supplement to this article, as cross-sectional studies can sometimes lead to false-positive associations. Obsessive behaviors may also present following RA, such as excessive personal hygiene, hyper religiosity, body mutilation, refusal to take appropriate medications during illness, avoidance of technology, fixation on a unique and sole dress code, obsessive need for secrecy and privacy, need to treat those outside of the religious society as outcasts or contaminants, and excessive dependency on spiritual leaders (Oluwole, 2007, as cited in Oluwole, 2010).

Results of and responses to RA may also present in more covert ways. In devout

Christian families where parents have high expectations for their children, young women attempt to retake control by refusing to eat (Grenfell, 2006). Further, Christian families may define one’s community and religion as different from mainstream society. This may lead to anxiety about the appearance of the family, which may place a great deal of pressure on children. These and other social pressures and beliefs within religious families such as concerns of sexual morality, negative views of menstruation, disciplining of physical desires (fasting, etc.), avoidance of unchaperoned situations, and strict enforcement of dress codes places a great deal on children, particularly girls (Grenfell, 2006). While any of these behaviors or practices can be practiced harmlessly, it is debatable that many of them may qualify as emotional abuse if they are practiced in coercive, shaming, or otherwise punitive contexts. These and other factors may contribute to the development of disordered eating patterns and negative self-image among young Christian women (Grenfell, 2006). These claims are still subject to further research, as the research is written as a review article; further data collection and testing of these correlations is necessary. Other somatic symptoms have also been noted, as over time, psycho-spiritual

22 pressure can accumulate and manifest in other bodily and psychological complaints which may present as breakdowns, panic attacks, and other somatic complaints (Ward, 2011).

Developmental Impact

While it may seem straightforward, RA does impact the development or maintenance of one’s spiritual identity. Victims of RA may experience questions regarding: What religious figures stand for, what the church represents, what the church stands for, what God stands for, and if the

Bible can be believed (Farrell, 2009). Damage to one’s understanding of their spiritual self may result in many mental health difficulties, as well as the lack of a secure understanding of the world, which can impact other areas of functioning. Further, one’s worldview is closely associated or a part of one’s culture. To experience an extreme shift in one’s worldview also comes along with a loss of experiences, beliefs, symbols, ethics, rituals, and institutions that make up their religious culture (Guido, 2008). One study found that spiritual distortion caused by spiritual abuse can result in suppressed emotions, , resentment, judgmental attitudes, questions of self-value, depression, and a weakened relationship to their faith (Lang & Bochman, 2016).

In addition to one’s culture, other areas of personal identity understanding and formation may be altered by religious abuse. Those abused by clergy members of the same-sex may question their sexual identities (Isely et al., 2008, as cited in McGraw et al., 2019.) A review article focusing on Nigerian youth found that adolescents often turn to the church for psychological issues such as shyness and social competence, all of which may also present as normal challenges during maturation (Oluwole, 2010). In turn, they are shamed, made to feel as if there is something wrong with them, and told that spiritual exercises could remedy their psychological struggles.

Adolescents may be especially sensitive to RA due to their tendencies towards abstract thinking, impressionistic tendencies, hero worship, and experimentation (Oluwole, 2010). RA among this

23 population can result in poor social competence, and even difficulties in their developing masculinity among young males (Oluwole, 2010). Due to the non-empirical nature of this research, these claims could also benefit from further study and hypothesis testing. If spirituality is lost as a result of RA, some may turn to alcohol, drugs, promiscuity, or violence to fill their spiritual vacuum (Pargament et al., 2008). Some may become disengaged from their religions as adults, but this shift in spirituality may not be permanent. Other antisocial behaviors may also be associated with RA, as one study on the impact of RA on men who experienced clergy-related abuse, found that 21% of the sample reported alcohol abuse, and over 50% had a history of criminal behavior

(Wolfe et al., 2006).

RA that occurs within the context of the family may have a harmful impact on the victim’s intrapsychic level of experiencing themselves (their connection to the self, their identities, and personal qualities), interpersonal skills, and systemic issues (transactions, patterns, and boundaries found within the family system) (Simonic et al., 2013). Parents who are religiously abusive may be less interactive, playful, and relaxed around their children. They may also react negatively when their children express emotions and stress (Simonic et al., 2013). This may lead to the child experiencing difficulties with development of their emotional processing (Simonic et al., 2013).

Without a safe environment to grow, abused children may see the world as a confusing and extreme place, which could lead to trouble understanding, labeling, and regulating their own internal states

(Simonic et al., 2013). It is also possible that RA within the family may result in a transgenerational transfer of the abuse (Simonic et al., 2013).

Diagnosis and Treatment

Diagnostic Considerations. The DSM-IV offers a category for religious and spiritual problems called the “Religious & Spiritual Problem V-Code”, which includes examples of loss or

24 questioning of faith, problems associated with conversion of faith, and questioning of values that may not be related to a church or institution (Farrell, 2009). While this may be useful in some cases, it does not account for circumstances in which a religious figure or loved one uses trusted beliefs to justify harm against the victim. Current DSM diagnostic codes may be insufficient for describing the unique impact of RA.

One study found on the impact of clergy sexual abuse found that all participants met the criteria necessary for a clinical diagnosis of Post-Traumatic Stress Disorder, or PTSD, with an average symptom duration of 26 years and 5 months (Farrell, 2009). All but two participants had received psychological therapy at some point, yet their symptoms remained. This study revealed that although survivors of RA often meet the requirement for a PTSD diagnosis, there are many additional presenting symptoms not under the PTSD umbrella (Farrell, 2009). Just a few of the additional symptoms that survivors of RA may exhibit outside of those described by the DSM-IV criteria include: Depression, self-blame, guilt, shame, negative cognitions, schematic beliefs

(abandonment, unlovability, inadequacy, fear of making mistakes, etc.), and more (Farrell, 2009).

The current gap in clinical understanding could have some devastating ramifications. If survivors are inappropriately diagnosed, they may consequently receive mismatched treatment (Farrell,

2009). Further, if survivors are forced into diagnoses that do not fit, they may experience further traumatization (Farrell, 2009).

Treatment Implications. In regards to clergy-specific sexual abuse, treatment should begin with working on remedying any self-destructive belief systems. This may include de- mythologizing the concept of the priest which allows clients to re-imagine God as non-judgmental, non-vindictive, and not under control of the abusive church office-holder. This may allow them to construct a new vision of a God that is not predisposed to supporting toxic beliefs regarding guilt,

25 suffering sin, and punishment (Doyle, 2009). If a client shows difficulty accepting their former belief system, it may be useful to assist them in exploring the distinction between organized religion and spiritual security and strength (Doyle, 2009). This removes the confounding element of loyalty to a system which has caused them harm, allowing them to build a more secure and personal relationship with their Higher Power (Doyle, 2009). Other interventions clinicians can utilize include: creating a spiritual dialogue (by noting interest in spiritual aspects of the client’s life), accessing spiritual resources (assisting clients in identifying remaining spiritual assets and how they can still draw on them, or creating new ones), and addressing spiritual problems (aiding client’s in their spiritual transformation by helping them to create a new vision of their higher power, replace old rituals, let go of their intense anger, rage, and resentment, etc.) (Pargament et al., 2008).

Many individuals do not recognize that they have a spiritual component to their sense of self until it is lost. Healing should result in the victim discovering this part of themselves, and accepting life-giving, authentic spirituality, whatever that may look like to the individual (Doyle,

2009). Clients may experience anger towards the religious symptoms within which their abuse occurred. They may express anger or rage regarding outdated structures of their religious systems, homophobia, , sexism, cowardice, unbending power, misogyny, , danger, etc. (Farrell, 2009). As such anger is justified and useful in healing, clinicians should be prepared to validate and respect these feelings towards the church if clients express them (Farrell, 2009).

On the contrary, individuals may feel condemned or abandoned by their former faith-relevant community, which clinicians should be prepared for (McGraw et al., 2019).

When working with families struggling with religious abuse, clinicians can follow a few general stages of treatment. During the beginning stage, the clinician should work with the family

26 on building a therapeutic relationship by offering empathy to each client and describing how each is impacted and intertwined by the abuse (Simonic et al., 2013). The middle phase should focus on building and creating a space for clients to experience their emotions and helping clients to process their experiences by slowing down autonomic brain processes (Simonic et al., 2013). This should include expanding clients’ attention spans to focus on and explore experiences, and increasing and exploring their awareness of bodily sensations and emotions (Simonic et al., 2013).

Ideally, this process should replace old habits and neural pathways with new neural pathways and ways of thinking about experiences (Simonic et al., 2013). The final stage of treatment prioritizes integration and consolidation by reinforcing the clients’ faith and incorporating their relationship with God into a sense of connectedness (Simonic et al., 2013).

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Conclusions

While social work research as a whole usually tends to lean towards a more strengths-based approach, it is equally important that we understand the negative impact in order to devise ways in which we as clinicians and practitioners may counteract it. In order to be the best prepared to meet this challenge, it is vital to understand the nuance and unique needs that may arise from specific forms of abuse. Spiritual and religious abuse as a whole is drastically understudied, especially the impact of RA within the home. As mentioned above, a majority of research that exists currently was resultant of the clergy abuse crisis within the Catholic church. This does not mean that other exist in other religious contexts. While the body of research itself remains far from complete, several themes were identified that may be unique to religious abuse, including the impact of abuse perpetuated by clergy, spiritual trauma, the correlation between CPTSD,

PTSD, and religious abuse, depression and other psychological symptoms presenting following religious abuse, various developmental concerns, as well as some diagnostic and treatment implications. It is the researcher’s hope that this information presented together will provide a starting point for practitioners in the field, as well as a springboard for future research.

Applications and Limitations

The distinction of spiritual trauma in treatment of the aftermath of RA is crucial. While there is currently no prescribed treatment modality for working with this population, practitioners should examine the source of the trauma and respond to each aspect of it accordingly. Therapists who intend to work with survivors of RA should be aware of unique factors that may present with addressing spiritual trauma. It is the authors hope that future research will draw attention to the need present for distinct treatment methods and modalities to be developed for working with survivors of RA. A major limitation was simply that there is currently a very small body of research

28 regarding RA in general, and most of the existing research does not focus on the direct impact of

RA or it’s implications for survivors. While the causes of and contexts within which RA occurs are very important in terms of prevention, they do not offer insight on what survivors may experience or how to help them once it has already occurred. Should more research be completed in upcoming years, another literature review should be completed to fill currently existing gaps in this study.

Suggestions for Future Research

Based on the body of research found, the following gaps in research still exist and are needed to establish a fuller picture of the impact of religious abuse: RA within the context of families (physical, sexual, emotion), the impact of RA on women, LGBT, and other understudied populations, longitudinal studies that demonstrate the impact of childhood RA on adult functionality, and more research focused on the victims of RA in general, rather than the perpetrators.

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