Abuse and trauma are not easily categorised; what may be seen as abuse to one person may be poverty of caring to another. Similarly, there may be some disagreement between different peoples views of what actually took place. The same argument can be applied to trauma; what definition can be applied to trauma? What scale of measurement can be used for abuse and trauma?
Abuse largely falls into the broad categories of sexual, emotional or physical, and the consequences to the victim’s psychological well being, while varying from person to person, could benefit from counselling or similar professional support. If the survivor feels intense anger or guilt, they would need help to work through those feelings, not because they are mental health conditions but to stop them becoming health conditions, either psychosomatic such as cancer or asthma, or psychological such as periods of psychosis or depression. It is, perhaps, better to err on the cautious as surviving abuse, and the coping strategies and behaviour patterns adopted during times of extreme stress, negatively impact a person’s well-being.
What needs to be carefully avoided is relaying health conditions back to previous trauma. It may well be the case, but assigning symptoms to causes is full of pitfalls, not least of which is the area of misdiagnosis. Freud is known for having assigned mental health conditions primarily to past causes, and his work continues to be controversial. Although it is certainly true that abuse and trauma can cause mental health conditions in later life (for reference I could suggest looking back at the research carried out on twins in older studies of schizophrenia or more recent research on depression or alcoholism), for the reasons outlined above there needs to be careful consideration before assigning the etiology of a condition to past trauma or abuse. Ideally, all possibilities should be considered, rather than focus on abuse as an immediate cause-effect relationship.
When someone has been abused, it is difficult for them to go on to form an intimate relationship. A healthy relationship is based on a number of areas; one of them being trust, another is self-esteem, or an idea of self-worth. When these areas are damaged or their growth has been stunted as a result of abuse then forming a natural loving relationship becomes difficult. Normality is skewed. Perception of one’s self comes from feedback from others, particularly when a person is vulnerable. If this feedback is based on the abuser’s need for compliance or sexual gratification then the victim won’t necessarily have the built up core values about themselves. The victim may disassociate in order to cope. That would damage the client’s growth of self-esteem. It may be that they were repeatedly told, and come to believe, that they deserved abuse or that it was somehow their fault that the abuse occurred.
There may be, or have been, a degree of co-dependancy in the abusive relationship that needs to be explored. When a man or a woman is freed from their abuser they are, paradoxically, also cut adrift from their main source of support. Friendships and bonds with relatives have frequently been devalued by the abuser, as an abuser frequently isolates his victim to weaken their stance.
Learning what normal, loving ‘relationships’ are can be learned anew, but it needs to be handled with great delicacy. Effectively, what the abused has to learn is that everything they knew before is ‘wrong’, and there is a very real danger here that low self esteem might be reinforced. A good way forward would b for the abused to join support groups where he or she can explore their feelings with other survivors of abuse.