How the Effects of Child Abuse Have Become the Biggest Public Health Issue in America
Since the publication of DSM-IV in 1994, a massive body of neurobiological research has accumulated revealing how protracted childhood abuse and neglect can cause pervasive, devastating, and lasting biological and psychological harm, not unlike patients with a PTSD diagnosis.
Researchers in developmental psychopathology have shown that childhood maltreatment and neglect are associated with structural and functional abnormalities in different brain areas, including the:
- Pre-frontal cortex (logic and reasoning)
- Corpus callosum (integrating the right and left hemisphere)
- Amygdala (fear and facial recognition)
- Temporal lobe (hearing, verbal memory, language function)
- Hippocampus (memory)
These effects of child abuse may help explain why abused children are quicker to recognize and stare at angry faces than non-abused kids, and why they pick up anger even in faces with ambiguous expressions, while missing other emotions.
Abuse also disrupts the neuroendocrine system, altering the production of the stress-regulating hormone cortisol and neurotransmitters like epinephrine, dopamine, and serotonin—chemicals affecting mood and behavior.
Chronic trauma weakens the immune system and sets up children for illness far down the road. For example, the Centers for Disease Control reported that one of the effects of child abuse is that trauma’s disruption of cortisol levels leaves abused children vulnerable to chronic fatigue syndrome later in life.
Some of the most astonishing and far-reaching evidence for the lifelong and malign repercussions of childhood trauma has come not from the mental health field, but from the study of epidemiology. In 1995, internist Vincent Felitti, a preventative medicine specialist with California-based HMO Kaiser Permanente, and Robert Anda, and epidemiologist with the Centers for Disease Control, began the Adverse Childhood Experiences (ACE) Study to track the relationship between childhood maltreatment, neglect, and other family loss or dysfunction and adult mental and physical health.
This unprecedented study found that a majority of the participants surveyed had experienced some form of serious family dysfunction, neglect, and emotional, physical, and/or sexual abuse. Not only that, but the studies showed direct correlations with these “adverse experiences” and a remarkably large proportion of all the physical, mental, and social ills that beset society.
It’s by now glaringly obvious to mental health professionals that some of the effects of child abuse are the significantly increased risk for mental and emotional disorders—and associated risks for alcoholism, drug abuse, and smoking—though the ACE Studies nail the case beyond denial.
But who knew that childhood adversity was a major risk factor for many of society’s most prevalent biomedical illnesses and causes of death—for example, heart and lung disease, diabetes, liver and kidney disease, some cancers, sexually transmitted diseases, and autoimmune diseases? Or that being abused or neglected as a child increased the likelihood of being arrested as a juvenile by 59%, as an adult by 28%, and for committing violent crime by 30%?
In conservative estimates, the total direct and indirect costs of the effects of child abuse amounted to $103 billion in 2007. These costs include:
- Hospitalization and mental health care for children
- Increased health care costs for adults who were abused as children
- Child welfare services
- Law enforcement
- Special education
- Juvenile justice system
- Criminal justice system
- Lost productivity
In light of all this, it’s been asserted that child abuse is the largest single public health issue in America.
This article is reprinted with permission from the American Society for the Positive Care of Children (SPCC) and the author.