Green A H
Family Center, Presbyterian Hospital, New York, New York.
Psychiatr Clin North Am. 1988 Dec;11(4):591-610.
Although physical and sexual abuse are separate and distinct types of victimization, their impact on children is quite similar. Both of these forms of maltreatment involve the exploitation or misuse of a child by a parent or caretaker in the context of a pathologic family system. Physical and sexual abuse constitute an acute traumatic event for the child, generating phobic responses and anxiety-related symptoms including post-traumatic stress disorder. The long-term traumatic elements stemming from the chronic stigmatization and scapegoating contribute to problems of depression and low self-esteem and distortions in character formation. Betrayal by a primary caretaker leads to mistrust of others and difficulties with object relationships. Perhaps the most striking similarity between physical and sexual abuse of children is the tendency of the children to re-enact and recreate their victimization with others, leading to a transmission of violence in the next generation. Like their parents who were frequently victimized during childhood, they repeat and perpetuate an "aggressor-victim" interaction in their subsequent relationships. Both physical and sexual abuse are embedded in a deviant family structure, which adds to the psychopathology of the children. The contrast between physical and sexual abuse can be demonstrated by their specific impact on aggression and sexuality, respectively. The physically abused child has difficulty in experiencing and modulating aggressive impulses, whereas the victim of incest is often impaired in his ability to experience and integrate sexual feelings. The physically abused child is also at greater risk for cognitive and CNS impairment. Intervention with the abusing parents is the first step in protecting the children from further damage, but treatment of the child victims is necessary not only to diminish their psychopathology and emotional distress, but to prevent the cycle of violence in the next generation.
尽管身体虐待和性虐待是不同类型的受害形式，但它们对儿童的影响非常相似。这两种虐待形式都涉及在病态家庭系统中父母或照顾者对儿童的剥削或滥用。身体虐待和性虐待对儿童来说都是急性创伤事件，会引发恐惧反应和与焦虑相关的症状，包括创伤后应激障碍。长期以来，慢性污名化和替罪羊现象所带来的创伤因素会导致抑郁和自卑问题以及性格形成的扭曲。主要照顾者的背叛会导致儿童对他人的不信任以及客体关系方面的困难。儿童身体虐待和性虐待之间最显著的相似之处或许在于，儿童倾向于与他人重演和再现他们的受害经历，从而导致暴力在下一代中传播。就像他们在童年时期经常受害的父母一样，他们在随后的人际关系中重复并延续“攻击者 - 受害者”的互动模式。身体虐待和性虐待都存在于异常的家庭结构中，这加剧了儿童的精神病理学问题。身体虐待和性虐待的差异可以分别通过它们对攻击性和性方面的特定影响来体现。遭受身体虐待的儿童在体验和调节攻击冲动方面存在困难，而乱伦受害者在体验和整合性感受的能力方面往往受损。遭受身体虐待的儿童在认知和中枢神经系统受损方面的风险也更高。对虐待父母进行干预是保护儿童免受进一步伤害的第一步，但对儿童受害者进行治疗不仅是为了减轻他们的精神病理学问题和情绪困扰，也是为了防止暴力在下一代中循环。
