Childhood Abuse and Level of Manifested Anxiety in Adult Patients with Anxiety Disorder

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1 Macedonian Journal of Medical Sciences Mar 15; 5(1): Clinical Science OPEN ACCESS Childhood Abuse and Level of Manifested Anxiety in Adult Patients with Anxiety Disorder Dimitar Bonevski 1, Antoni Novotni 2, Marija Raleva 2, Andromahi Naumovska 1 1 Psychiatric Hospital Skopje, Center for Mental Health- Center, Skopje, Republic of Macedonia; 2 University Clinic of Psychiatry, Skopje, Republic of Macedonia Abstract Citation: Bonevski D, Novotni A, Raleva M, Naumovska A. Childhood Abuse and Level of Manifested Anxiety in Adult Patients with Anxiety Disorder. Maced J Med Sci Mar 15; 5(1): Key words: physical abuse; emotional abuse; child abuse; anxiety disorders; correlation. Correspondence: Dimitar Bonevski, MD. Psychiatric Hospital Skopje, Center for Mental Health- Center, Skopje, Republic of Macedonia. dbonevski@yahoo.com Received: 03-Nov-2011; Revised: 23-Dec-2011; Accepted: 24-Dec-2011; Online first: 09-Mar-2012 Copyright: 2012 Bonevski D. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Competing Interests: The authors have declared that no competing interests exist. Background: The relation of the childhood abuse with anxiety disorders is reported in numerous studies. Aim: Relation between the childhood abuse and level of manifested anxiety in adult patients with anxiety disorders. Material and Methods: The severity of the emotional and physical childhood abuse is measured with the CTQ, while the level of manifest anxiety of the patients is measured with the TMAS. Both questionnaires were administered to 96 patients with AD (32 with panic disorder, 32 with social phobia and 32 with generalized anxiety disorder) according ICD10. Results: In 35.42% of the examined patients was found abuse during the childhood. Childhood emotional abuse was higher among female patients. There is a statistically significant difference in the severity of the manifest anxiety between various groups of AD. Statistically significant relation between the physical and emotional abuse in childhood and the level of manifest anxiety of all three clinical groups that were examined was found. Conclusion: These findings confirm the correlation between childhood physical and emotional abuse and the level of manifest anxiety in adult patients with anxiety disorders. Introduction Child abuse as a serious problem with vast number of consequences on victims was always present in the history of civilization in a more forward or hidden form. After the first mentioning in the medicine of the battered-child sindrom by Kempe, 1962 [1], the understandings of the meaning of child abuse in regards of its frequency, the impact on the psychological development and the increase of the rate of total psychiatric mortality in the adult period have greatly evolved. Nowadays standpoints are that child abuse is 94 present in all societies and is markedly more frequent than Kempe have ever imagined. The impact of the emotional and physical abuse is considerably larger than the immediately visible effects. The abuse experiences can change the normal development of the child with the consequences being visible after many years even throughout the whole life. The longitudinal studies about child abuse denote that these traumatic experiences have negative development effects on the behavioral, emotional, social and cognitive level, leading to dysfunction in the period of adulthood

2 Bonevski et al. Childhood Abuse and Level of Manifested Anxiety in Adult Patients with Anxiety Disorder [2-4]. The relation between childhood abuse and the psychiatric disorder in adulthood is reported in a great number of epidemiological studies and researches based on the clinical population surveillance [5-7]. Numerous studies have significantly expressed the relation between childhood abuse and anxiety, i.e. the development of anxiety disorders. The physical and emotional childhood and adolescence abuse leads to an immediate feeling of insecurity, mood swings, sleeping problems and other anxiety symptoms. This early experience has an impact on the period of development and leads to maintenance of anxiety and creates anxiety disorders in adulthood [8-11]. Respecting the multi causality and the complexity of the anxiety disorders (AD) etiology, in this research we analyze the relation between the physical and emotional childhood abuse with the degree of manifested anxiety in the adult period of panic disorder (PD), generalized anxiety disorder (GAD) and social phobia (SP) patients by a hypothesis that we will confirm, on clinical sample, the existence of correlation between the intensity of physical and emotional child abuse and the intensity of manifest anxiety at anxiety disorders in the adult period. Material and Methods From all patients treated in the Mental Health Centre Skopje who met the diagnostic criteria (in accordance with ICD10) for the defined disorder (PD, GAD and SP) without any additional psychiatric diagnosis in 2010, 96 patients (tree groups by 32 patients) on the age 18 to 55, equally present in both sexes in each of the groups have been selected randomly and examined. For the evaluation of the physical and emotional abuse it was used Childhood Trauma Questionnaire (CTQ). It is a retrospective instrument designed to evaluate the expressiveness of physical, emotional and sexual abuse, as well as the physical and emotional neglect. This questionnaire has shown a high level of internal consistency and test- retest reliability, as well as a fair convergent validity with a structured interview for childhood trauma [12]. The patients are ansvering on a scale from 1 to 5 (never, once or twice, sometimes, often, very often). The questionnaire has 32 items (6 for physical, 6 for sexual and 5 for emotional abuse, 6 for physical neglect and 9 for emotional neglect). The higher scores from the questionnaire indicate a more severe level of abuse. Favor of the research requirements the received results on the subtests for physical and emotional abuse, have been analyzed. For the evaluation of the expressiveness of manifested anxiety was use Taylor Manifest Anxiety Scale (TMAS). It is used as a specific measurement for anxiety as a clinical entity. Reliability: the retest correlations of 0.89, 0.82 and 0.81 were found in the interval of three weeks, five months and nine to seventeen months. The item- total correlations are 0.01 to 0.70 in a study. The correlation can vary depending on the ethnicity and the level of education. The Kuder- Richardson evaluation of the internal consistency is 0.78 and 0.84 in two studies, and median alph of 0.82 in unspecified number of studies. The coefficient alpha 0.70 was determined on graduated students [13]. This psychological instrument with 50 items measures the expressiveness of the clinical anxiety manifestation, by answering yes (1) or no (0). The higher scores of this questionnaire indicate a more eminent level of anxiety. According ethical approval process all the patients agree to be involved in the research with guaranteed anonymity. The statistical analysis were conducted by SPSS 17.0 (SPSS Inc., Chicago, II., USA), and p<0.05 is taken as statistically significant. The results were analyzed by statistical methods (arithmetic mean, standard deviation, t-test example, one-way ANOVA and Pearson s coefficient of correlation). Results The average age of the respondents with PD is with SD 10.24, with GAD with SD 8.07 and with SP with SD There are no statistically significant differences between the groups regarding age. In 34 of the respondents was found emotional and/or physical abuse (35.42% of the total number of respondents). Physical abuse was found in 20.83%, and emotional in 33.33% of all respondents. Regarding the sex comparison there were no differences found concerning the physical abuse which is equally present with both sexes (male M=6.81, SD=3.85, female M=7.12, SD=3.46). However, the Maced J Med Sci Mar 15; 5(1):

3 Table 1: Physical and emotional childhood abuse in patients with SP, PD and GAD (M, N, and SD). Table 4: Differences in manifest anxiety in patients with SP, PD and GAD. evaluated clinical groups (PD, GAD and SP) with statistical significance p<0.01 (Table 5). A correlation emotional abuse of women respondents is more expressed by statistically significant differences on a 0.01 level (male M=7.23, SD=3.82, female M=8.44, SD=4.63). Table 5: Correlation between the level of manifest anxiety with physical and emotional abuse in childhood in patients with SP, PD and GAD. Table 2: Differences in physical and emotional childhood abuse in patients with SP, PD and GAD. between physical abuse and the level of manifest anxiety in adult patients with AD is 0.69, with statistical significance p<0.01. The correlation between emotional abuse and the level of manifest anxiety in adult patients with AD is 0.82, with statistical significance p<0.01 (Figure 1, Figure 2). Although the level of physical, as well as emotional abuse is highest in the PD group, then in the GAD and it is lowest in SP, there were no statistically significant differences among the evaluated groups (Table 1, Table 2). Table 3: Manifest anxiety in patients with SP, PD and GAD (M, N, and SD). There was statistically significant difference in the level of manifest anxiety with PD, GAD and SP patients (p<0.05). Mostly expressed difference was noted among the PD and SP patients (Table 3, Table 4). A correlation in the level of manifest anxiety with physical and emotional abuse was found among all 96 Figure 1: Correlation between the levels of manifest anxiety with physical abuse in childhood in patients with AD. Discussion The found frequency for emotional and physical abuse at the examined patients of anxiety disorders in this study is within the determined frequency in a range

4 Bonevski et al. Childhood Abuse and Level of Manifested Anxiety in Adult Patients with Anxiety Disorder Figure 2: Correlation between the levels of manifest anxiety with emotional abuse in childhood in patients with AD. of previous researches. In a 1995 study at the McMaster University, in a group of 205 patients with anxiety disorders Mancini found that 44.9% of them have experienced child abuse [9]. In another study in 1996, researching the presence of abuse in 122 patients of anxiety disorders Stein finds childhood abuse in 23% of them in comparison to 8.1% in the 124 subjects from the control group [14]. Examining a population of 665 children and adolescents in New York, on the age range from 9 to 17, Flisher and his co-workers have found a history of abuses with 25.9% of the respondents, which was significantly related with the appearance of high level of manifest anxiety [15]. Regarding sex differences in the level of abuse, higher emotional abuse was found in female respondents, which are in accordance with the world research findings and which many researchers relate it with the greater frequency of anxiety disorders with the female population in general. In the context of the above mentioned, the question of potential greater sensibility of women towards abuse is being initiated [6, 16-18]. The level of physical as well as emotional abuse is highest in the PD group, than in the GAD group, and lowest in the SP group. The same distribution among the tree evaluated groups is found regarding the level of manifest anxiety. There is correlation between physical and emotional abuse in childhood and the level of manifest anxiety in adulthood within all three evaluated clinical groups. The detected correlation of our study is in accordance with more findings in the literature [9, 10, 14]. The impact that the physical childhood abuse has in the development of adulthood anxiety disorders is unambiguous. As a consequence of this abuse, which most flagrantly threatens the feeling of security even for the physical integrity as well, the children s world becomes unsafe and frightening leading to loss of confidence in others and chronic feeling of insecurity which is a constituent of all anxiety disorders [15, 19]. The emotional abuse is especially underlined as a risk factor in the development period in all domains of functioning on emotional, behavioral and cognitive level. This type of abuse as isolated abuse, but also as a constituent of the physical abuse is a continuous traumatic factor with exceptionally negative effect during the complete psychological development [17-20]. The childhood abuse obstructs attachment to others and the creation of social relations, generating anxiety which continues to the adult period initiating the possibility to structure the anxiety disorders [21, 22]. The physical and emotional childhood abuse as a repetitive traumatic experience mainly during the complete psychological development leads to a continuous powerlessness and concern, which from a primary adaptive response have gradually transformed into continuous anxiety generator in adulthood. Individuals with anxiety disorders have more expressed responsiveness to traumatic conditions and the traumatic experience in the childhood of physical and emotional abuse, actually points out this existing constitutional factor. The long-timed repetitive trauma leads to anxiety from the childhood and though a continuum of manifestations to a manifested image of generalized anxiety, phobic fears from various social circumstances, i.e. panic disorder in the adult age. Conclusion: In the whole evaluated group of anxiety disorder, childhood emotional and/or physical abuse was detected in 35.42% of the respondents. The manifested anxiety of the evaluated groups is highest in the PD, lower in the GAD and lowest in the SP group. There is correlation between the physical and emotional abuse in childhood and the level of manifest anxiety in adult patients with AD in total and in all three evaluated clinical groups separately. References 1. Kempe CH, Silverman FN, Steele BF, Droegemueller W, Silver HK. The battered-child syndrome. JAMA. 1962;181: Maced J Med Sci Mar 15; 5(1):

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