Transcript Survivors - Dr. Ian Curtis

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
The sand in my eyes
Of pain present.
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.
Isolate
So as not to feel
Contact causes hurt.
The Wind is Howling
When will I be Whole?
(BV)
Prevalence of
Borderline Features
•
•
•
•
General population
Outpatient mental health clinics
Psychiatric inpatient clinics
Special Clinic Populations
involving personality disorders
1-2%
10%
20%
30-60%
The Damage
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)
General Behaviours
of the Borderline
•
•
•
•
•
Ambivalence
Emptiness
Anger
Instability
Impulsivity and
Recklessness
• Deliberate Self-Harm
• Immaturity
Frantic efforts to avoid
real or imagined
abandonment
Ambivalence:
alternating between
extremes of idealisation
and devaluation
Pattern of unstable and intense
interpersonal relationships
alternating between extremes
of idealisation and devaluation
Identity disturbance:
unstable self-image
or sense of self
Hopeless-Helpless:
chronic feelings of emptiness
Instability:
affective instability due to
a marked reactivity of mood
Anger Management Problems
inappropriate, intense anger
or difficulty controlling anger
Self-Harming:
impulsivity in at least two areas
that are potentially self-damaging
(eg spending, sex,
substance abuse etc)
Suicidality:
recurrent suicidal behaviour,
gestures, threats,
self-mutilating behaviour
Psychotic Border:
stress-related paranoid ideation
or
severe dissociative symptoms
And Drug Abuse
•
•
•
•
•
•
•
Self-treating
Fill emptiness
Isolate interpersonally
Pseudo-closeness
“Control emotions”
Obscure anger
Self-harm
Unique Difficulties
Bipolarities
Ambivalence
Embraced Failure
(Abandoned Hope)
Abuse
Impaired
Achievement
Over
Achievement
Vulnerability
Transition to Adulthood
Failed
Stalled
Over
Compensated
Adult Outcomes
Serious
Impairment
Adult
Success