Key relationships, especially intimate adult partner relationships and parent/caregiver-child relationships, have a significant impact on the mental health of the individuals in the relationships. These relationships can be health-promoting and protective, neutral, or detrimental to mental health outcomes. Relationship problems that cannot be resolved by friends, family, or clergy require professional intervention by psychiatrists, clinical psychologists, social workers, and other mental health professionals.
Some of the main diagnostic categories for relationship problems involving children include:
Cognitive-behavioral therapy is the leading evidence-based treatment for children and adolescents who have experienced child abuse or neglect. Treatment should include education about trauma and its impact (e.g, PTSD); emotional management skills, such as relaxation and controlled breathing; gradual exposure to trauma memories; and cognitive processing to address unhelpful or inaccurate thoughts, such as guilt or self-blame.
For children who have severe or persistent symptoms despite psychotherapy, medications may be warranted, both to help with symptoms and to generate a more positive treatment response to psychotherapy.
The American Academy of Child and Adolescent Psychiatry (AACAP) suggests selective serotonin reuptake inhibitors (SSRIs) for the treatment of children and adolescents with PTSD but cautions that these medications should be considered only after an adequate trial of evidence-based psychotherapy alone is ineffective. For children with PTSD and coexisting disorders such as depression and anxiety, support for the use of medication in children is much stronger, and pharmacotherapy should be considered based on the degree of severity and impairment. In such cases, the AACAP recommends using medications as part of a more comprehensive treatment plan, as an adjunct to psychotherapy, and for simultaneous treatment of comorbid psychiatric diagnoses.
Resources to help parents deal with child abuse are available from the American Academy of Child & Adolescent Psychiatry.
To report child abuse or neglect in Florida, go to the Florida Department of Children and Families Florida Child Abuse Hotline.
Domestic violence (also known as spouse abuse) is defined as physical assault within the home in which one spouse is repeatedly assaulted by the other. It has been estimated that domestic violence occurs in one of every four families in the United States. The surgeon general has identified pregnancy as a high-risk period for battering; 15 to 25 percent of pregnant women are physically abused while pregnant, and the abuse often results in birth defects. Also, pregnant and recently pregnant women are more likely to die from homicide than any other cause. Some husbands also experience abuse from their wives. To report adult abuse in Florida, and to receive help, go to the Florida Department of Children and Families Adult Protective Services Hotline.
The perpetrators of domestic violence come from all races and socioeconomic levels and are most often male. Domestic violence most frequently occurs in families with problems of substance abuse, particularly alcohol and crack abuse. About 50 percent of battered wives grew up in violent homes and their most common trait is dependence. Abusive men are also likely to have come from violent homes where they witnessed wife-beating or were abused themselves as children. Abusive husbands tend to be immature, dependent, and non-assertive and to suffer from strong feelings of inadequacy. The husband’s aggression is bullying behavior designed to humiliate their wives and to build up their own low self-esteem. Some men feel remorse and guilt after an episode of violent behavior and become particularly loving. If this behavior gives the wife hope, she remains until the next inevitable cycle of violence.
Cognitive-behavioral therapy (CBT) offers the most researched and effective approaches for treating adult victims of abuse. Exposure therapy is a variant of CBT that has been shown to help patients emotionally process the abuse by decreasing their fear of memories or cues of the event. Eye movement desensitization and reprocessing is another alternative treatment for the processing of distressing memories. These individual therapies may be supported with group psychotherapy, art therapy, dance and movement therapy, music theory, and body-oriented approaches if they proved beneficial to the patient.
Medication may be beneficial in certain circumstances to treat symptoms of PTSD, depression, anxiety, obsessive-compulsive disorder, or psychosis. Although medication may be useful in symptom management, it should not be viewed as a replacement for psychotherapy focused on resolving symptoms of trauma.