Relational Problems and Abuse

How do relationships affect mental health?

Key relationships, especially intimate adult partner relationships and parent/caregiver-child relationships, have a significant impact on the mental health of the individuals in the relationships. These relationships can be health-promoting and protective, neutral, or detrimental to mental health outcomes. Relationship problems that cannot be resolved by friends, family, or clergy require professional intervention by psychiatrists, clinical psychologists, social workers, and other mental health professionals.

What are relational problems that involve children? 

Some of the main diagnostic categories for relationship problems involving children include:

  • Parent-Child Relational Problem
    Typically, the parent-child relationship problem is associated with impaired functioning in behavioral, cognitive, or other affected areas. Examples of behavioral problems include inadequate parental control, supervision, and involvement with the child; parental overprotection; excessive parental pressure; arguments that escalate to threats of physical violence; and avoidance without resolution of problems. Cognitive problems may include negative attitudes toward the other’s intentions, hostility toward or scapegoating of the other, and unwarranted feelings of estrangement. The problem may result in feelings of sadness, apathy, or anger about the other individual in the relationship.

  • Sibling Relational Problem
    This diagnosis is used when a pattern of interaction between siblings is associated with significant impairment in individual or family functioning. The relationship problem may also affect the course, prognosis, or treatment of a sibling’s mental or other medical disorder. Siblings in this context include full, half-, step-, foster, and adopted siblings.

  • Upbringing Away from Parents
    This diagnosis is used when a child struggles with issues caused by being raised away from parents. The separate upbringing may also affect the course, prognosis, or treatment of a mental or other medical disorder. The child could be under state custody and placed in kin care or foster care. The child could also be living in a nonparental relative’s home or with friends. Problems related to a child living in a group home or orphanage are also included in this category.

  • Child Affected by Parental Relationship Distress
    This category is used when parental relationship conflict or distress negatively affects a child in the family. The discord may also negatively affect the child’s mental health or other medical disorders.
What relational problems involve couples or families?
  • Relationship Distress with Spouse or Intimate Partner
    This diagnosis is used when there is distress within an intimate (spouse or partner) relationship or when the quality of that relationship is affecting the course, prognosis, or treatment of a mental or other medical disorder. Partners can be of the same or different genders. Typically, relationship distress is associated with impaired functioning in behavioral, cognitive, or other areas of life. Examples of behavioral problems include conflict resolution difficulty, withdrawal, and overinvolvement. Cognitive problems can include chronic negative attitudes toward the other’s intentions or dismissals of the partner’s positive behaviors. Problems may result in chronic sadness, apathy, and/or anger about the other partner.

  • Disruption of Family by Separation or Divorce
    This diagnosis is used when partners in an intimate adult couple are living apart due to relationship problems or are in the process of a divorce.

  • High Expressed Emotion Level Within Family
    This diagnosis refers to hostility, emotional overinvolvement, and criticism directed toward a family member. This category is used when a family’s high level of expressed emotion is the focus of clinical attention or is affecting the course, prognosis, or treatment of a family member’s mental health or other medical disorder.

  • Uncomplicated Bereavement
    This diagnosis is used when a person is undergoing a normal reaction to the death of a loved one. Some grieving individuals go through bereavement with symptoms characteristic of a major depressive episode, such as feelings of sadness, insomnia, poor appetite, and weight loss. The duration of “normal bereavement” varies considerably among different cultural groups.
What diagnoses relate to child abuse and neglect?
  • Child Physical Abuse
    A diagnosis of child physical abuse may be applied when a person causes physical injury to a child, ranging from minor bruises to severe fractures.  Injuries are considered abuse regardless of whether the caregiver intended to hurt the child. Physical discipline, such as spanking or paddling, is not considered abuse as long as it is reasonable and causes no bodily injury to the child.

    Physically abused children may be affected by depression, conduct disorder, ADHD, oppositional defiant disorder, dissociation, and PTSD. The psychological consequences of physical abuse and neglect include insecure and atypical attachment patterns, impaired peer relationships involving increased aggression or social withdrawal, academic underachievement, and impaired ability to regulate negative emotional states. Abused children may be unusually fearful, docile, distrustful, and guarded. They may be wary of physical contact and show no expectation of being comforted by adults. They may be on the alert for danger and may be afraid to go home.

  • Child Sexual Abuse
    Child sexual abuse includes any sexual act involving a child that is intended to provide sexual gratification to a parent, caregiver, or another individual who has responsibility for the child. Sexual abuse includes activities such as fondling a child’s genitals, penetration, incest, rape, sodomy, and indecent exposure. Sexual abuse also includes noncontact exploitation of a child by a parent or caregiver, such as forcing, tricking, enticing, threatening, or pressuring a child to participate in acts for the sexual gratification of others, without direct physical contact between the child and abuser.

    Sexually abused children may experience anxiety symptoms, depression, dissociative reactions, hysterical symptoms, disturbances in sexual behaviors, and somatic complaints. Anxiety symptoms may include fearfulness, phobias, insomnia, nightmares that portray the abuse, somatic complaints, and PTSD. Depression may be demonstrated by low self-esteem and suicidal and self-mutilative behaviors. Dissociative reactions may include amnesia, daydreaming, translate states, hysterical seizures, and symptoms of dissociative identity disorder. Approximately one-third of sexually abused children have no apparent symptoms.

  • Child Neglect
    Child neglect is defined as any confirmed or suspected egregious act or omission by a child’s parent or another caregiver that deprives the child of having basic age-appropriate needs mentor has reasonable potential to result in physical or psychological harm to the child. Child neglect includes abandonment; lack of appropriate supervision; failure to attend to necessary emotional or psychological needs; and failure to provide necessary education, medical care, nourishment, shelter, and/or clothing.

  • Child Psychological Abuse
    Child psychological abuse is nonaccidental verbal or symbolic acts by a child’s parent or caregiver that result, or have reasonable potential to result, in significant psychological harm to the child. Examples include berating, disparaging, or humiliating the child; threatening the child with harm or abandonment; physically confining the child; scapegoating of the child; coercing the child to inflict pain on himself or herself, and disciplining the child excessively through physical or nonphysical means.
What are treatments for child abuse or neglect?

Cognitive-behavioral therapy is the leading evidence-based treatment for children and adolescents who have experienced child abuse or neglect. Treatment should include education about trauma and its impact (e.g, PTSD); emotional management skills, such as relaxation and controlled breathing; gradual exposure to trauma memories; and cognitive processing to address unhelpful or inaccurate thoughts, such as guilt or self-blame.

For children who have severe or persistent symptoms despite psychotherapy, medications may be warranted, both to help with symptoms and to generate a more positive treatment response to psychotherapy.

The American Academy of Child and Adolescent Psychiatry (AACAP) suggests selective serotonin reuptake inhibitors (SSRIs) for the treatment of children and adolescents with PTSD but cautions that these medications should be considered only after an adequate trial of evidence-based psychotherapy alone is ineffective. For children with PTSD and coexisting disorders such as depression and anxiety, support for the use of medication in children is much stronger, and pharmacotherapy should be considered based on the degree of severity and impairment. In such cases, the AACAP recommends using medications as part of a more comprehensive treatment plan, as an adjunct to psychotherapy, and for simultaneous treatment of comorbid psychiatric diagnoses.

Resources to help parents deal with child abuse are available from the American Academy of Child & Adolescent Psychiatry

To report child abuse or neglect in Florida, go to the Florida Department of Children and Families Florida Child Abuse Hotline.

What diagnoses relate to adult abuse and neglect?
  • Spouse or Partner Violence – Physical
    This diagnosis is used when nonaccidental acts of physical force result in or have reasonable potential to result in, physical harm to an intimate partner in the past year. In place of physical harm, the behavior could cause significant fear in the partner.

  • Spouse or Partner Violence – Sexual
    This diagnosis is used when forced or coerced sexual acts with an intimate partner have occurred during the past year. Sexual violence may involve the use of physical force or psychological coercion to make the partner engage in a sexual act against his or her will. Also included in this category are sexual acts with an intimate partner who is unable to consent.

  • Spouse or Partner Neglect
    Partner neglect is any egregious act or omission in the past year by one partner that deprives a dependent partner of basic needs, resulting in, or having the potential to result in, physical or psychological harm to the dependent partner. This category is used in the context of relationships in which one partner is extremely dependent on the other partner for care or for assistance in navigating ordinary daily activities. This would typically involve a partner who is incapable of self-care due to substantial physical, psychological/intellectual, or cultural limitations (e.g., inability to communicate with others and manage everyday activities due to living in a foreign culture).

  • Spouse or Partner Abuse – Psychological
    Partner psychological abuse includes non-accidental verbal or symbolic acts by one partner that result in or have the potential to result in, significant harm to the other partner. This category is used when psychological abuse has occurred during the past year. Acts of psychological abuse include berating or humiliating the victim; interrogating the victim; restricting the victim’s ability to come and go freely; obstructing the victim’s access to assistance (e.g., law enforcement; legal, protective, or medical resources); threatening the victim with physical harm or sexual assault; harming or threatening to harm people or things that the victim cares about; unwarranted restriction of the victim’s access to or use of economic resources; isolating the victim from family, friends, or social support resources; stalking the victim; or trying to make the victim think that he or she is crazy.

  • Adult Abuse by Nonspouse or Nonpartner
    This diagnosis is used when an adult has been abused by another adult who is not an intimate partner. Such maltreatment may involve acts of physical, sexual, or emotional abuse. Examples of adult abuse include nonaccidental acts of physical force that have resulted – or have the potential to cause – physical harm or have caused significant fear; forced or coerced sexual acts; and verbal or symbolic acts with the potential to cause psychological harm. Examples of the latter include berating or humiliating the person; interrogating the person; restricting the person’s ability to come and go freely; obstructing the person’s access to assistance, threatening the person; harming or threatening to harm people or things that the person cares about; restricting the person’s access to or use of economic resources; isolating the person from family, friends, or social support resources; stalking the person; or trying to make the person think that he or she is crazy.

How prevalent is domestic violence?

Domestic violence (also known as spouse abuse) is defined as physical assault within the home in which one spouse is repeatedly assaulted by the other. It has been estimated that domestic violence occurs in one of every four families in the United States. The surgeon general has identified pregnancy as a high-risk period for battering; 15 to 25 percent of pregnant women are physically abused while pregnant, and the abuse often results in birth defects. Also, pregnant and recently pregnant women are more likely to die from homicide than any other cause. Some husbands also experience abuse from their wives.  To report adult abuse in Florida, and to receive help, go to the Florida Department of Children and Families Adult Protective Services Hotline.

What are the reasons for domestic violence and abuse?

The perpetrators of domestic violence come from all races and socioeconomic levels and are most often male. Domestic violence most frequently occurs in families with problems of substance abuse, particularly alcohol and crack abuse. About 50 percent of battered wives grew up in violent homes and their most common trait is dependence. Abusive men are also likely to have come from violent homes where they witnessed wife-beating or were abused themselves as children.  Abusive husbands tend to be immature, dependent, and non-assertive and to suffer from strong feelings of inadequacy. The husband’s aggression is bullying behavior designed to humiliate their wives and to build up their own low self-esteem. Some men feel remorse and guilt after an episode of violent behavior and become particularly loving. If this behavior gives the wife hope, she remains until the next inevitable cycle of violence.

What are treatments for adult abuse?

Cognitive-behavioral therapy (CBT) offers the most researched and effective approaches for treating adult victims of abuse. Exposure therapy is a variant of CBT that has been shown to help patients emotionally process the abuse by decreasing their fear of memories or cues of the event. Eye movement desensitization and reprocessing is another alternative treatment for the processing of distressing memories. These individual therapies may be supported with group psychotherapy, art therapy, dance and movement therapy, music theory, and body-oriented approaches if they proved beneficial to the patient.

Medication may be beneficial in certain circumstances to treat symptoms of PTSD, depression, anxiety, obsessive-compulsive disorder, or psychosis. Although medication may be useful in symptom management, it should not be viewed as a replacement for psychotherapy focused on resolving symptoms of trauma.

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Mental Health Library Sources:
Information included in all topics of the Mental Health Library comes from the Desk Reference to the Diagnostic Criteria From DSM-5 and Kaplan & Sadock’s Concise Textbook of Clinical Psychiatry. Complete diagnostic and treatment information may be found within these publications.
Information within the Mental Health Library is not intended to be used for self-diagnosis purposes. Rather, it is provided as a public educational service to make people aware of mental health conditions. Please consult a qualified mental health professional for a diagnosis of any suspected mental health illness.
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