Transcript ABUSE IN CHILDHOOD AND PSYCHIATRIC DISORDER

SIX DEGREES OF
ALIENATION: PARENTING &
FAMILY CONFLICT
A/PROF CAROLYN QUADRIO
School of Psychiatry
University of NSW
SHARED PARENTING ORDERS
ADELAIDE, UNIVERSITY OF SA
APRIL 2008
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OVERVIEW
OF PRESENTATION
 Child trauma and abuse
 The spectrum of alienation
 Parenting patterns
 Case examples
 Breastfeeding
 Joint parenting considerations
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PERSONALITY DEVELOPMENT
& ATTACHMENT
 Personality develops from
infant interaction with carer
 Critical interaction: infant’s
needs/capacities and empathic
responsiveness of carer
(not time)
 Long term mental health outcomes
and early attachment/trauma
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CHILDHOOD TRAUMA & ABUSE
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Is common
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Mostly familial/carers
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CSA: 15-30%
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Severe CPA: 11%
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Witnessing DV: 14%
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Psychological trauma?
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Family conflict/violence
FLC cases: expect higher rates
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CSA IS COMMON
 Epidemiological data worldwide:
 1 in 3 female:1 in 4 male children
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36% Australian women
(Mazza and Dennerstein, 2001)
 Most CSA is unreported (80%)
 Probably higher rates in FLC
families: more dysfunctional group
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Child Abuse& Neglect (CAN):
Australian data 2004/5
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Reports doubled last 5 years
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700 new reports per day
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One new case/2 minutes
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Most abuse is intrafamilial
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Children in care  70% 10 yrs
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DV IS COMMON: UN DATA
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Most widespread and socially
tolerated form of HR violation
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Often prelude to coercive sex
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Kills + disables as many women
as cancer; > MVA’s + malaria
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Single biggest health risk to
Australian women of
reproductive age ($6.3B pa)
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20-30% of marriages
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NEW LEGISLATION:
PRESUMPTION EQUAL
PARENTING
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Burden of proof on victim?
Reality of CAN
Prevalence of DV
vs
False allegations as strategy
Breastfeeding as strategy
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ATTACHMENT & FAMILY
PATTERNS
children attach to primary care figures
 not related to time
 children in long day care
 children in kibbutzim
 ‘traditional’ families
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vs
children attach in spite of abuse
 may even cling (traumatic attachment)
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ALIENATION ‘SYNDROME’
SYNDROME
vs
REALITY
 90% allegations CSA
 CSA common/false
 PAS: ‘syndrome’
 no scientific validity
in FLC are false
explains this process
 deliberate alienation
(usually Mo)
allegations not
 non-diagnostic
 no probative value
 dangerous assumption
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ASSESSING CHILD
ABUSE/NEGLECT
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Only medical evidence conclusive – but rare
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Equally reflective of disturbance of divorce and/or
Most symptoms non-specific:
Anxiety, regression, sleep disturbance, nightmares,
acting out, depression, hyperactivity, school
problems
ongoing post separation conflict
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INDICES OF SUSPICION:

Stereotyped statements
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Same words as parent
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Language > development
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No contextual detail
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Minor issues in same vein
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Evoke sympathy – eg CSS
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Privy to details of legal process
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MENTAL STATUS of
ACCUSING PARENT
 Mental illness:
 Children more exposed to abuse
 Personality disorder:
 More prone to project BUT:
 More likely to be victim of abuse
 Less able to protect children from abuse
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MENTAL STATUS of
ACCUSED PARENT
 Limited if any assistance determining issue
 Normal or no psychological disturbance
 No perpetrator profile but some concerns:
 Previous violence
 D&A issues
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ALIENATION AS PROCESS
 Alienation: dynamic/process NOT syndrome
 Common in all divorcing families, esp FLC
 No specific association with CSA
 Can only be assessed in context of family
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SPECTRUM OF ALIENATION
 Motivation:
 altruism
 self-interest
 malice
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Psychology:
 normal
 anxious
 paranoid/deluded
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FIRST DEGREE
 Altruism/protection:
 CSA is actual and/or
sincerely believed
 Alienation = solely to
protect child
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SECOND DEGREE
 Hurt and/or depressed
parent:
 cannot conceal feelings
 children exquisitely sensitive
 alienation unintended
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THIRD DEGREE
 Immature/neurotic (> malicious):
 message to children:
 “take care of me” =
immature/dependent
or:
 “don’t blame me” = guilt prone
depressive or passive aggressive
adjustment
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FOURTH DEGREE
 Hurt, depressed, angry parent:
 personality disorder: more/less
malicious
 unable/unwilling adequately
to conceal feelings
 poor affect regulation (trauma,
often CSA)
 potential for projection
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FIVE DEGREES
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Hurt/angry parent:
declare feelings to children
recruit them as support
alienation is intentional to
break bond with other parent
 vengeful behaviour or $
 welfare of children disregarded
 deluded (ie genuine belief)
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SIX DEGREES
 Wilful and intended alienation
 every effort to block contact
 malicious false allegations
to gain advantage in FLC
 self-interest/manipulative
 sociopathic/malicious
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NEW LEGISLATION
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Joint parenting
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Property in common?
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Best interests of child
paramount?
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PARENTING PRACTICES
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Intact families: women do most of the
childcare even if employed
Rationale for altered pattern post
separation?
Most divorced families negotiate – those in
FLC the most acrimonious = my data
Joint parenting requires high degree of
cooperation
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CHANGING PATTERNS
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Old style ‘access’: Dad as Santa Claus
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CHANGING PATTERNS
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New style joint parenting: Mr Mom
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CHANGED PATTERN:
CASE EXAMPLE
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Fa: big business; no psychiatric Dx
Financial control & domination
Mo: 9 years exclusive childcare; anxious
3 children: 9, 5, 18 mos (breastfed)
Attachments: equally strong and secure
Fa now home based business
Joint parenting? One plan for 3?
Is change for the children or parent or $?
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Breastfeeding & Parenting Orders
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best form of infant nutrition
exclusive breastfeeding for first six months
and continue first two years:
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WHO & UNICEF
Australia: Dietary Guidelines; Federal Health;
AMA; Dieticians Association; Colleges:
Paediatrics & Midwives
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Breastfeeding Benefits
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maternal recovery from
pregnancy and childbirth
contraception
bonding and attachment
improved vision
psychomotor development
prevention of chronic disease
later in life: breast and
ovarian cancer, cardiovascular
disease, obesity
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Risks of not breastfeeding
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gastrointestinal disease
respiratory illnesses
including asthma
chronic otitis media
sudden infant death
syndrome.
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Shared Parenting Orders
& Breastfeeding
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separation affects breastfeeding
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contested cases unlikely to improve
relationships
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not common pattern pre separation
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paramountcy of best interests of child?
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court orders for mothers to wean
(Sweet & Power, 2008)
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CASE EXAMPLE: DELUSION?
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Mo: anxious – fears seem exaggerated
Overvalued idea? Deluded? Folie a deux?
Fa: no psychiatric Dx
Mo reports: child has range of symptoms
Child’s disclosures to Mo+GMo (no one else)
Court ordered supervision
Mo continues to report abuse
Supervisor alleged to be conspiring
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Examples: Domestic Violence
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NESB
Fa: no psychiatric Dx
Mo: isolated and abused – depression, PTSD
Finally leaves w children
Agreed contact; Fa refuses to return
Allegations to FLC: Mo depressed, suicidal
Orders: limited contact w Mo; 50/50; split
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QUALITY vs QUANTITY
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Quality of contact more important than time
Joint custody negated by parental conflict,
esp if children caught in ongoing conflict
There is no one size fits all arrangement
Risk of exposure to continuing conflict, DV,
or abuse: contact needs to be limited
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50/50 SHARED CARE
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Logistically complex, parents need to be:
organised, structured, plan ahead
cooperative amicable r’ship, keep children out of
child focused arrangements
commitment by all to make it work
family friendly work practices
degree of financial independence, especially Mo’s
a degree of paternal confidence
Geography
(B Smyth, 2005)
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