Why, when and how to ask about childhood abuse

TLDR

The medical model overemphasizes genetics and underestimates trauma, yet childhood physical and sexual abuse and neglect are common among those with serious mental illness, and both victims and clinicians often avoid disclosure. The study investigates the extent of this problem and the reasons for its pervasive neglect in clinical care. Based on New Zealand experience, the authors offer guidelines for asking about childhood abuse and describe a UK initiative to improve detection and treatment of survivors.

Abstract

Subscribers to the medical model of the causation of madness and distress emphasise the role of genes and can severely underestimate the impact of traumatic events on the development of the human mind. This bias persists despite the worldwide popular wisdom that mental illness arises when bad things happen to people. Childhood physical and sexual abuse and neglect are extremely common experiences among those who develop serious mental health problems. Unfortunately, victims are typically reluctant to disclose their histories of abuse and practitioners are often reluctant to seek it. We explore the nature and extent of the problem and the apparent reasons for the pervasive neglect of this important area of care. Then, on the basis of our experience in New Zealand, we provide guidelines on asking patients about childhood abuse and describe an ongoing initiative in the UK to further advance our understanding of the impact of abuse and our skills to detect it and treat survivors.