Why, when and how to ask about childhood abuse

Abstract

) and a member of the Executive Committee of the International Society for the Psychological Treatments of Schizophrenia (http://www.isps.org). Paul Hammersley is programme director for postgraduate studies in family and individual cognitive-behavioural therapy for psychosis at Manchester University, UK. He has written and lectured extensively on the relationship between childhood trauma and psychosis, and is a member of a multidisciplinary team offering training on how to ask about childhood abuse and researching the effectiveness of that training. Thom Rudegeair is clinical director of the psychiatric in-patient unit servicing central Auckland. He trained in the USA, earning a PhD in zoology (evolutionary theory) from the University of Florida, then an MD and psychiatry credentials from the University of Massachusetts. His current research interests include formulating an evolutionary model of 'madness' focusing on the role of childhood trauma and developmental derailment. AbstractSubscribers to the medical model of the causation of madness and distress emphasise the role of genes and can severely underestimate the impact of traumatic events on the development of the human mind. This bias persists despite the worldwide popular wisdom that mental illness arises when bad things happen to people. Childhood physical and sexual abuse and neglect are extremely common experiences among those who develop serious mental health problems. Unfortunately, victims are typically reluctant to disclose their histories of abuse and practitioners are often reluctant to seek it. We explore the nature and extent of the problem and the apparent reasons for the pervasive neglect of this important area of care. Then, on the basis of our experience in New Zealand, we provide guidelines on asking patients about childhood abuse and describe an ongoing initiative in the UK to further advance our understanding of the impact of abuse and our skills to detect it and treat survivors.1. We have not exhaustively referenced here every result discussed. Instead, we have cited only key studies or reviews. A full list of references is available from J.R.

Childhood adversity and psychosis: generalised or specific effects?

“…Despite guidelines emphasising the need to routinely assess adversity exposure in psychiatric serviceusers (National Health Service Confederation, 2008), research suggests such recommendations are often not implemented (Read et al 2007;Fisher et al 2011;Hepworth & McGowan, 2013).While staff should not pre-suppose a history of maltreatment unless confirmed by the client, the current findings support the contention that clinicians should receive support and training for making routine evaluations for possible experiences of maltreatment. This is particularly important given the significant under-detection of posttraumatic stress in patients diagnosed with psychosis (Salyers et al 2004;Lommen & Restifo, 2009;Mauritz et al 2013), and that such individuals are less likely to receive an appropriate clinical response (e.g., trauma-focused interventions) relative to those with non-psychotic diagnoses (Agar & Read, 2002;Salyers et al 2004;Grubaugh et al 2011) especially in instances where healthcare workers have strong convictions about biogenetic aetiology (Read & Fraser, 1998;Young et al 2001;Agar & Read, 2002).…”

The association between childhood trauma, parental bonding and depressive symptoms and interpersonal functioning in depression and bipolar disorder

“…Read et al (2007) found that amongst clinicians there is a reluctance to enquire about trauma due to fears of vicarious re-traumatisation, feelings of incompetence and anxiety regarding upsetting or distressing the client. Training for clinicians on the assessment of trauma and on evidence-based therapeutic interventions could help promote feelings of professional competency amongst clinicians (Read, 2006).…”

What do GPs actually know about their patients as persons?

“…What does seem to be documented by studies regarding topics identified as "sensitive" is that face-to-face, open-ended research interview settings provide a better frame and result in more disclosure and more detailed reports, than do standardized questionnaires. Also, considerably more disclosure occurs in clinical settings when patients are routinely asked to disclose as compared to when they are not asked [32]. Thus, the obstacles to disclosure of lifetime adversity seem to reside less on the side of the patients.…”