Emotional Abuse & Social Anxiety -- Tortuous Recovery
Jul 30, 2012
Childhood maltreatment has been associated with the development of a variety of adult disorders, both physical and mental, with the severity of symptoms experienced, reduced quality of life, and impaired functioning across diverse domains. A recent study by Bruce et al (2012 -- [LINK]) has extended these findings to Social Anxiety Disorder (SAD). This study further examined the impact of different types of abuse, and the impact of abuse on the outcome of drug treatment for the disorder.
All types of maltreatment except for sexual abuse and physical abuse were related to greater symptom severity.
Emotional abuse and neglect were related to greater disability; and emotional abuse, emotional neglect, and physical abuse were related to decreased quality of life. Emotional abuse significantly predicted attrition -- dropping out of treatment. A time by emotional abuse statistical interaction suggests that for those who stayed the course, the impact of emotional abuse on severity of social anxiety weakened significantly over time. If you have been emotionally maltreatment during your childhood you are more likely to drop out of treatment, but if you can "survive" the challenges of treatment you are likely to benefit from treatment "almost" as much as those who suffered other types of abuse.
Emotional maltreatment was most strongly linked to dysfunction in SAD, despite a tendency in the anxiety literature to focus on the effects of sexual and physical abuse. Additionally, individuals reporting emotional abuse were more likely to dropout from pharmacotherapy, but those who stayed the course displayed similar outcomes to those without such a history.
To me, this creates an obligation on therapists to not only know the effect of various types of abuse on treatment process, but an obligation to monitor, through direct enquiry of the patient, how the patient is feeling about therapy, about how they feel they are being treated in therapy, and to devise a more effective working relationship with the patient -- see also the recommendations of Steidtmann et al (2012 -- [LINK] and Fluckiger -- [LINK].
In my next post, I shall explore the implications of these, and possibly related, findings for possible strategies for conducting more effective therapy with victims of childhood abuse and trauma.
Next post: The three R's of Trauma Therapy -- Relationship, Responsibility, Resilience -- The Core Elements of Treatment