Experiences of abuse during the life course : disclosure and the care provided among women in a general psychiatric context

Malmö University health and society, doctoral dissertations, 2014:6. Experiences of abuse are common among women in Sweden and being abused during childhood as well as adulthood has consequences for the lives of girls and women. One consequence of abuse is the impact on their mental health, which entails them seeking psychiatric care as a consequence of this. Being abused as a child has consequences during childhood as well as during adolescence and adulthood and there is a link between childhood abuse and mental ill health as an adult. Adults who have experienced abuse during their childhood have poorer mental health as adults and are overrepresented within the health care systems. Women who experience abuse as adults often describe consequences such as depression, posttraumatic stress disorder and anxiety. The psychiatric context is often described as being unhelpful when you have experience of abuse and women could be reluctant to disclose their experiences to staff for a variety of reasons. This thesis aims to identify experiences of abuse during childhood and adulthood among women who have experienced abuse and have mental ill health. The thesis also aims to explore women’s disclosure of abuse and experiences of the care provided in a general psychiatric context. The first study aimed to explore women’s disclosure of experiencing physical, emotional and/or sexual abuse to staff during their latest contact at a general psychiatric clinic. The study also aimed to explore whether the women had ever disclosed abuse to anyone at all. Seventy-seven women completed a questionnaire at the clinic and the results showed that the women often disclosed their experiences of abuse to others, but they had often chosen not to disclose their experiences during their latest contact with staff at the general psychiatric clinic. In the second study 10 women were interviewed regarding their experiences of physical, emotional and/or sexual abuse and its influence on their self-reported mental ill health. The overall theme evolving from the interviews were, “Being vulnerable and without protection in a frightful reality that limits one’s possibilities of living and being the person one wishes to be”. The categories that emerged were: ”Living in fear that persistently influences the substance of life”, “Living with the sense of being worthless”, “Living with a constant question about who you are” and “Living between hope and despair”. The third study aimed to elucidate how women subjected to physical, emotional and/or sexual abuse experience the care provided at a general psychiatric clinic after the disclosure of abuse. The overall theme capturing the essence of the nine interviews was visualized as ”Dependency as a reality containing a duality of suffering and trust”. The categories that emerged in the text were: “Being belittled”, “Being misinterpreted” and “Being cared for”. The fourth study aimed to investigate the life course of women within psychiatric care who had experienced abuse. The study also aimed to focus on the women’s resources, stressful events, experience of abuse, perpetrators, mental ill health and care and support throughout the life course. The subcategories that shaped the categories were presented within the life spans; childhood 0-12 years, adolescence 13-19 years and adulthood 20 years and above. The life charts revealed that adulthood was the period of life that had most frequent events of abuse. The women who had few experiences of abuse during childhood had also only a few noted events of mental ill health during that period of life. Emotional abuse was most frequent throughout the life course. Sexual abuse was the lesser noted abuse during childhood, but increased during adolescence and adulthood. The life charts also visualize that the women had seldom revealed the abuse during their childhood to others growing up and as adults the women often went to formal networks for support and care. The results of the thesis show that the general psychiatric care must improve their efforts to identify and support women who have experienced abuse. The women’s own stories regarding experiences of abuse during the life course must be recognized and integrated with traditional biomedical care.