Child abuse and neglect: causes, effects, and prevention

Dorrepaal, Thomaes, Smit, van Balkom, et al. (2010) address the topic of Complex Posttraumatic Stress Disorder (Complex PTSD) which often occurs following a history of child abuse. Complex PTSD has associated features in addition to the normal symptoms of PTSD that make it much more difficult to treat. As social workers will most likely encounter clients/patients suffering from PTSD symptoms and patients suffering from child abuse this topic is relevant to social work practice.

The researchers are primarily interested in knowing if stabilizing treatment normally used for PTSD and other psychiatric disorders is effective for patients with Complex PTSD, particularly women with PTSD and childhood sexual abuse. The research question is evaluative.

Literature Review

As this study is in the brief communications section does not contain an in depth literature review. The literature review in this study simply describes the features associated with Complex PTSD and presents the questions of the researchers and the reason for the study. It is not comprehensive.

Methodology

Sampling. This study uses a convenience sample of female outpatients with Complex PTSD and a history of child abuse. The participants were referred to mental health clinicians. Therefore the generalizability of the findings is very limited.

All participants were diagnosed with PTSD according to the Structured Diagnostic Interview for the DSM-IV and were also diagnosed with Complex PTSD according to the Structured Interview of Disorders of Extreme Stress. The history of child abuse before the age of 16 was also assessed through the Structured Trauma Interview.

Participants were excluded if they had antisocial personality disorder, a substance abuse disorder that would interfere with treatment, or if they had a current psychotic episode or dissociative identity disorder. Of the 55 patients 19 were excluded.

Design. The design is a repeated measures design with a pre-treatment evaluation and a post -- treatment evaluation on several measures including the Davison Trauma Scale, Borderline Personality Disorder Severity Index, Dissociative Experiences Scale, Beck Depression Inventory, and the Symptom Checklist. A brief diagram follows:

Pretest Score on MeasuresStabilization Therapy Intervention Posttest Scores on MeasuresSix Month Follow-up.

The repeated measures design has good statistical power and is useful in evaluating pre and post intervention effects, but there should be a formal control group of some type for this type of research (Runyon, Coleman, & Pittenger, 2000). The patients were not randomly selected to different treatments and the stabilization therapy was not the only treatment that patients received (e.g., many were on medications), so inferences regarding the effect of the therapy to cause changes in the severity of the symptoms in the sample is highly limited. High dropout rates also indicate that the treatment may not be appropriate for all patients of this type.

Measurement. The independent variable in this study is the stabilization treatment which is outlined in detail in the study and consists of 20 sessions. The treatment providers used manualized treatments in order for the treatment to be uniform across different therapists. The dependent variables in the study are the measures of the various symptoms of Complex PTSD as recorded on the aforementioned scales following the intervention and at a six-month follow-up period.

No data concerning the reliability and validity of the measures is presented in the article but there are references for them. The stabilization therapy is explained in detail.

Ethical Issues. No ethical issues were discussed; however, there were some ethical concerns noted. In particular, one third of the 36 patients who were in treatment dropped out before completion of the study. There is no mention of why these individuals dropped out, which may suggest that the treatment was somewhat harsh for this rather fragile group of patients. .

Statistics. Descriptive statistics for the sample are given in the results section. Other demographic data such as the type of abuse suffered, and pre- -- treatment and post -- treatment scores on the dependent measures are all also presented in the results section.

The inferential statistic used in the study consisted of a series of paired t-tests for each measure. The post -- treatment scores on the dependent measures was compared to the baseline (pre- -- treatment) measures and scores were collected after a six-month follow-up period were compared to the pre- -- treatment scores. Effect sizes were calculated for each of the t-test results. There is a major issue with the use of multiple t-tests for this data. A within subjects factorial MANOVA with appropriate post hoc tests would have been more appropriate and would have controlled for Type I error in this study. By performing multiple t-tests the researchers are more prone to making Type I errors in their findings (Tabachnick & Fidell, 2012).

Results and Discussion. The findings indicated that at post-treatment 22% of the patients no longer met the criteria for simple PTSD and that follow-up 35% of the patients no longer met the criteria for PTSD.