Abuse / Survivors of Abuse from GoodTherapy.org Abuse —physical, verbal, or emotional maltreatment—can leave psychological wounds that are harder to heal than bodily injuries. Intense, often negative feelings may plague the survivor, and he or she may struggle to cope and lead a happy, peaceful life. Distressing memories, anxiety, blocks to intimacy, and trust issues are common, although many people are able to overcome or minimize challenges like these. Types of Abuse All types of abuse are painful and can cause psychological distress, and it is not uncommon for a victim of abuse to experience more than one type of abuse. For example, someone who was sexually abused may have been emotionally abused concurrently. Abuse can occur within any relationship construct, whether familial, professional, or social, and it can also occur between strangers.

Any form of abuse in an intimate relationship, from physical to psychological, constitutes intimate partner violence. In fact, psychological abuse appears in almost every case of physical aggression between intimate partners, and it is often a precursor to physical violence.

The Psychological Repercussions of Abuse

While abuse in any form can have a negative impact on an individual's life, significant emotional or psychological problems do not necessarily result from every case of abuse. The severity of psychological repercussions can vary depending on many factors, such as how well the victim was associated with the abuser and whether the abuse was recognized or dismissed by the friends and family of the abused.

Children who have been sexually, psychologically, or physically abused often experience emotional problems that can affect their academic performance and social skills. As adults, survivors of abuse may experience difficulty maintaining healthy relationships and productivity at work. Survivors of abuse, who are at heightened risk for developing mental health issues like depression, are likely to encounter one or more of the following psychological issues:

•  Anxiety: People who have experienced abuse may be afraid of people or situations that remind them of their abuse experiences. They may be scared to be alone, frightened of strangers, or fearful of sexual intimacy, depending on the nature of the abuse they experienced. Disrupted sleep, compulsive behaviors, panic attacks, and other indications of anxiety are somewhat common in survivors of abuse.

•  Anger: Survivors of abuse may feel intense anger at their abusers, at those who knew of the abuse and failed to intervene, and even at themselves for being abused, particularly when they believe they could or should have stopped it. Anger is a natural and normal response to being abused, and survivors can learn to manage their anger in a constructive manner that will facilitate healing.

•  Dissociation: A lack of feeling, numbness, confusion, and out-of-body experiences may occur during or after abuse to help the victim avoid the pain and fear associated with abuse. In rare cases, memories of abuse may be repressed, so that the victim does not have any conscious memory of the abuse.

•  Mood Issues: Depression, irritability, and mood swings affect many survivors of abuse.

•  Posttraumatic Stress (PTSD): Nightmares, hypervigilance, flashbacks and other symptoms of PTSD may occur. Survivors are likely to avoid certain settings and situations that remind them of the abuse.

•  Shame: Guilt and shame are often experienced when a survivor believes that he or she deserved the abuse, was responsible for it, or failed to stop it. Challenging these beliefs in therapy can help a person transform these feelings.

•  Self-Destructive Behavior: Sometimes survivors will self-medicate, with drugs or alcohol for example, or engage in self-harm, such as burning or cutting themselves. Other times, people may seek out scenarios in which the abuse is repeated, neglect their personal health and hygiene, or sabotage any potential for success. These behaviors are often representative of low self-esteem, which is a common symptom of abuse.

•  Trust Issues: Learning to trust others after abuse has occurred can be challenging, particularly with regards to intimacy.

Psychotherapy for Abuse Survivors

Therapy can help a person express and process difficult emotions associated with the abuse, develop self-compassion and self-care strategies for managing moments when he or she feels emotionally overwhelmed, and learn to trust again.

Many therapeutic approaches are suitable for treating a person who has experienced abuse, from narrative therapy to eye movement desensitization and reprocessing (EMDR). In addition, therapy may employ mindfulness techniques, such as meditation, or experiential techniques that incorporate art, journaling, or equine-assisted activities.

Group therapy has demonstrated effectiveness in providing social support to help abuse survivors cope with and transform their feelings of shame, guilt, and alienation from others as they interact and bond with other people who have lived through similar experiences. For those who fear the vulnerability and exposure they may experience in a group setting, working one-on-one with a therapist can be a more intimate and personalized experience.

Case Examples of Abuse

•  Recovering from sexual abuse: Milika, 45, seeks therapy because she is in her first sexual relationship after more than two decades of avoiding intimacy. As a teenager, she was sexually abused by a male relative and feels great anxiety and anger whenever a man displays sexual desire for her. She has recently met a man who seems safe and compatible, but she does not trust her judgment. She is also triggered, almost to the point of having panic attacks, anytime he initiates physical intimacy. Learning relaxation skills, exploring ways to take care of herself to stay physically and emotionally safe, and acknowledging her grief and anxiety allows her to move forward in the relationship in the presence of such triggers. Eventually, Milika develops a deeper level of trust not just with her partner, but with human beings in general. Anxiety remains as an issue for her for many years, diminishing slowly in stops and starts.

•  Patterns of abusive romantic relationships: Julie, 32, has been in and out of several abusive romantic relationships with women over the last decade. She recognizes the pattern but continues to forgive abusive behaviors by her partners and blame herself for their actions. Therapy helps her see how her abusers are like her mother, and this insight alone improves her ability to set boundaries. The support of her therapist, over about a year, helps Julie to accept her own needs as legitimate and begin advocating for herself with her partners.

•  Physical abuse in childhood: Devon, 12, was severely beaten by caretakers and has little ability to form healthy attachment to adults. He picks on other children at school and has been shuffled around the foster-care system. His current caretakers want to adopt him, but only if they can find a way to manage his behaviors and win his trust. Family systems therapy with an experienced family therapist begins to alter the dynamics of the family's interactions, and after many years of intense and difficult sessions, Devon is able to feel that he is safe.