Child abuse and psychiatric disorders: A review | [Abuso infantile e disturbi psichiatrici: rassegna]

Background: Child abuse is a worldwide and often unrecognized social problem. In recent years, there has been an increasing interest in the impact of child abuse on mental health and in the relation between psychiatric disorders and early traumatic experiences. Objectives: To summarize the research literature that documents the link between child abuse and subsequent development of psychopathology. Materials and methods: Using the Pub Med data base, the search terms child abuse (with a specific DSMIV-TR psychiatric disorder) identified 65 studies published during the period 19882005 in North-American, European and Australian journals. Publications included in the review are prospective studies, retrospective studies, meta-analysis and other reviews. Results: Many psychiatric disorders, particularly those characterized by problems with self-esteem (depression, BN, substance abuse) estrangement from self (dissociative disorders, PD, PTSD), self-destructive behavior (BPD, BN), disturbances in sense of self (schizophrenia, BPD) and in modulation of mood (depression) are related to a history of abuse in early life. In other disorders (schizophrenia, BD), a positive link between child abuse and a worse course of the illness has been demonstrated. Conclusions: The main problem of these studies is that the identification of child abuse has been made retrospectively, when the psychiatric disorder had already developed. Moreover the studies considered were methodologically limited and definitions of sexual abuse varied widely. The possible link to a history of abuse at an infantile age was not investigated in equal measure regarding different psychiatric disorders. There are still only a small number of well-designed studies, controlling for possible confounding variables, with large and representative samples (more community-based and not only clinical studies). We suggest clearer and unequivocal definition of abuse, improved sampling, more rigorous data collection and more sophisticated data analyses. The study of the existing relation between child abuse and psychiatric disorders is still at the early stages and requires more research to evaluate and integrate the theories that have recently been proposed.