A psychosocial model of the victim-to-patient process. Implications for treatment.

The psychosocial model of the victim-to-patient process explains how chronic abuse damages the self and sets into motion psychological processes that may evolve into various forms of mental illness. This model emphasizes the fragmented identity that derives from victims' attempts to accommodate to the judgments of others about the abuse, namely, it didn't happen; it happened, but it wasn't important and has no consequences; (s)he provoked it; and it wasn't abusive. Victims thus repress and deny the trauma and associated feelings in order to survive. The behavioral and psychological legacy of this adaptation forms the core of survivors' psychopathology and becomes an obstacle to treatment and recovery. The link between the damaged self and AIDS risk in adolescent runaway, homeless, and mentally ill survivor populations is underscored, along with recommendations for urgently needed clinical interventions.