Assessing abuse experiences

Practitioners vary in their confidence regarding the assessment of abusive experiences in childhood. In many ways, it is similar to the anxieties expressed when told to ask about suicidal ideas. Asking about suicide does not, as is feared, increase distress or induce a high risk state of mind in the individual; instead, it is experienced as a relief, allowing anxieties about a forbidden subject to be expressed. Practitioners should approach childhood abuse in the same way, anticipating that some individuals will not want to talk about it, but many will experience the interviewer’s interest as reassuring.

Although individual experiences are varied, abuse largely falls into three categories: sexual, physical and emotional. Definitions vary, but some guidelines are set out below to help the interviewer.

Sexual abuse is likely to comprise unwanted sexual experiences in childhood, perpetrated by someone at least five years older than the offender (usually an adult). However, some male children would not initially interpret sexual activity initiated by an older woman as abusive (although it is likely to be so), and it may be worth asking about early sexual experiences rather than abuse. Similarly, if physically aroused by the experience, it may not be labelled as abusive. Furthermore, although sexual play between peers as a child may not be inherently abusive or non-consensual, it may be very relevant to understanding disturbed sexual development. The importance of sexual victimisation often – but not always – lies in the cognitive and emotional aftermath; that is, the meaning of the abuse for the child.

Physical abuse can be more difficult to define, and there are cultural and social differences in approaches to physical discipline. However, usually, if physical contact is either unprovoked or excessive in relation to the misdemeanour on a number of occasions, it could be assumed to be abusive. One element would be the individual’s own perception of the degree of unfairness of the discipline.

Emotional abuse and neglect is the most subjective and difficult to define aspect of abuse. It could perhaps be thought of as persistent and marked failings on the part of the caregiver to provide adequate and consistent care.

Finally, although not a form of abuse, practitioners should never fail to ask about early behavioural problems, whether at home or at school. Pronounced emotional or behavioural difficulties – listed below – are the single most important indicator of later delinquent behaviour, and subsequently, antisocial behaviour in adulthood. This is particularly the case when the behaviour is noticeably more severe than in the peer group or siblings.

Check for:

  • Contact with parents by the primary school because of behaviour problems
  • Being suspended or expelled from secondary school, and the reasons
  • Persistent truanting, fighting, bullying (or indeed, being bullied) which is not easily resolved
  • Less common features, such as childhood self-harm, persistent misery, difficulties making friends, refusing to go to school, unusually late resolution of bed-wetting.