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Book Forum: CHILD ABUSE AND PTSD   |    
Wednesday’s Child: Research Into Women’s Experience of Neglect and Abuse in Childhood and Adult Depression
Am J Psychiatry 2000;157:655-655. doi:10.1176/appi.ajp.157.4.655
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Chicago, Ill.

By Antonia Bifulco, and Patricia Moran. New York, Routledge, 1998, 207 pp., $80.00; $24.99 (paper).

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There is scarcely a psychiatric condition in women for which childhood abuse is not blamed. Nearly all of the research in this area, however, relies on unconfirmed retrospective reporting. Although people can remember important events from their childhoods, people who are ill may be more likely to remember negative events, and a woman will have had countless experiences between the time of the childhood abuse and her appearance in the research or treatment setting. So, when we try to understand the connections between abuse and psychiatric illness, we have two fundamental questions: How do we know it happened? How do we know it causes psychopathology?

This book is an attempt to answer these questions. The authors looked at links between childhood abuse and women’s depression in adulthood. They explain why they did not study children for whom there was direct evidence of abuse; there would be no outcome data until those children grew up, there would be ethical conflicts, and children would probably have considerable difficulty articulating accurate descriptions of the abuses they had suffered. So they used adult subjects and developed methodologies to address the problems with retrospective reports. They used a general, rather than a clinical, population. They conducted lengthy interviews in which women were helped to construct sequential accounts of their lives by "anchoring" the accounts with objective events (birthdays, starting school). They asked no leading questions about abuse, and they insisted on specifics rather than general statements about childhood mistreatment.

Most of the book consists of such descriptions. The authors reasoned that the incidence is underestimated rather than overestimated, because their subjects were more likely to minimize than dramatize abusive experiences. For a portion of the study, they attempted to corroborate data by interviewing pairs of sisters. The incidence of sexual, psychological, and physical abuse, they discovered, was very similar to that reported in previous studies.

The outcome variable was an episode of depression within the previous 12 months, as measured by the Present State Examination. The authors readily grant that there are biological factors beyond their purview. Having a great deal of demographic and historical information, they were able to perform statistical analyses so that correlations could be corrected for confounding variables, such as family poverty and parental psychopathology. They conclude that abuse does significantly increase vulnerability to depression, but not invariably:

It is the accumulation and escalation of risk over a number of years which make depressive episodes in adulthood a highly probable outcome, not some magical dormant link with childhood across a vacuum devoid of adversity. Thus, at each life stage, risk factors increase the risk of further risk factors which ultimately culminate in a disorder. (p. 154)

They hypothesize that the same holds true of protective factors and accounts for the resilience of abused children who do not become depressed adults.

This book does not offer paradigm-shifting information, but it is a worthy attempt to enumerate and analyze the nature and outcome of the abuse of girls, full of poignant quotes that bring its subject to life.




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