Rarely an isolated incident: Acknowledging the interrelatedness of child maltreatment, victimisation and trauma
Child maltreatment, victimisation and trauma: broadening concepts
Although concern about child maltreatment dates back centuries, it is only in the last few decades that it has been widely acknowledged, systematically studied, and recognised as a public policy issue (Feerick & Snow, 2006; Miller-Perrin & Perrin, 2007). Indeed, academic interest in child abuse and neglect1 only gathered momentum relatively recently, catalysed by Kempe and colleagues seminal 1962 article on "battered child syndrome" in the Journal of the American Medical Association (Feerick & Snow, 2006; James, 2000).
Two of the defining features of the first few decades of child maltreatment research were a focus on individual forms of abuse and neglect, and the attempt to identify risk factors and outcomes specific to these forms (Anderson, 2010; Higgins, 2004a). In the 1960s and 1970s, much of the child maltreatment research focused on physical abuse and, to a lesser extent, neglect (Herrenkohl & Herrenkohl, 2009; James, 2000). The 1980s saw the focus of attention move to child sexual abuse and paedophilia (James, 2000), which grew out of the second wave of feminist literature focusing on rape and sexual assault. In the 1990s, more attention was directed towards understanding the nature, prevalence and consequences of psychological (or emotional) maltreatment (Higgins, 2004a), and many began to consider witnessing family violence an independent subtype of abuse (James, 1994; Miller-Perrin & Perrin, 2007). Although understanding of the different forms of abuse increased markedly in this period, attempts to identify risk factors and outcomes specific to individual forms of maltreatment were largely unsuccessful (Higgins, 2004a, 2004b).
Part of the reason for this lack of success is that most children who are maltreated are subjected to multiple forms of abuse and childhood adversity. Focusing on individual forms of abuse can create the misleading impression that there are strong lines of demarcation between the different types of childhood adversities, or that they occur in isolation (Miller-Perrin & Perrin, 2007; Child Family Community Australia [CFCA], 2012). However, there is a growing body of evidence to suggest that experiences of abuse or neglect seldom occur in isolation, and that the majority of individuals with a history of maltreatment report exposure to two or more subtypes (Arata, Langhinrichsen-Rohling, Bowers, & O'Farrill-Swails, 2005; Higgins & McCabe, 2000b; Ney, Fung, & Wickett, 1994). There is also evidence to suggest that broader experiences of victimisation tend to accumulate for certain individuals or in certain environments. For example, children who have been maltreated in a family context may be more susceptible than others to peer violence or exposure to crime, or those who were sexually abused may be more susceptible than others to revictimisation (Finkelhor, Ormrod, & Turner, 2007a; Tseloni & Pease, 2003).
A recent major shift in focus of child maltreatment research has been the recognition of the interrelatedness of childhood victimisation2 experiences (Anderson, 2010; Higgins, 2004a). In addition, a significant recent shift in the fields of traumatology and psychiatry has been the growing recognition that traditional mental health diagnoses, such as post-traumatic stress disorder (PTSD), do not adequately capture the effects of chronic and/or multiple types of victimisation (Briere & Spinazzola, 2005; Herman, 1992). The following section of this paper outlines a number of influential recent approaches to conceptualising, recognising and responding to the interrelatedness of child maltreatment, victimisation and trauma.
1 In order to enhance readability, the terms "child maltreatment", "child abuse and neglect", "childhood adversity" and "victimisation" are generally used interchangeably in this paper. However, on some occasions "child maltreatment" is used to denote a limited subcategory (i.e., the five forms of abuse and neglect measured in multi-type maltreatment) of broader "victimisation" experiences (i.e., the 34 forms of victimisation measured in polyvictimisation). It should be clear from the context which type of use is intended.
2 The British spelling of "victimisation" is generally used in this paper, unless the word is used as part of a title (e.g., Juvenile Victimization Questionnaire) or quote.